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PROBABILITY OF OCCURRENCE OF VACCINE-ASSOCIATED PARALYTIC POLIOMYELITIS IN THE TERRITORY OF THE REPUBLIC OF ARMENIA DURING 2003-2015
Hovhannisyan H.
Yerevan State Medical University after M. Heratsi, Department of Epidemiology, Yerevan, Republic of Armenia
Badalyan A.
Yerevan State Medical University after M. Heratsi, Department of Epidemiology, Yerevan, Republic of Armenia
Abstract
Eradication of poliomyelitis in the world is considered to be one of the current health issues. The most effective method to achieve this goal is through vaccination by oral poliovirus vaccine (OPV). In rare cases, OPV can cause vaccine-associated paralytic poliomyelitis (VAPP). The purpose of this study to review the probability of occurrence of VAPP throughout the territory of Armenia, 2003-2015 based on retrospective and prospective analysis of the data. Bringing the argument of the VAPP absence during the investigated period to the fore there is a need to understand what are the reasons of the VAPP absence in Armenia.
Keywords: poliomyelitis, indigenous, vaccine-associated paralytic poliomyelitis (VAPP), oral poliovirus vaccine (OPV), inactivated
Background: In 1988 WHO adopted the program of eradication of poliomyelitis worldwide (1). The disease rate was dramatically declined up to 99% in recent years. Afghanistan, Pakistan and Nigeria still remained the endemic countries where wild poliovirus (WPV) is circulated (2). Second type of wild poliovirus was isolated last time in October 1999 in India and in 2015 Global Commission for the Certification of Poliomyelitis Eradication (GCC) declared that indigenous WPV-2 had been eradicated worldwide (3, 4). WPV-3 has not been detected since November 2012 so WPV-1 - is likely the only WPV that remains in circulation. It goes without saying that is one of the corn stones of polio eradication is immunization with oral poliovirus vaccine (OPV) which consist of three types 1, 2 and 3 live attenuated polioviruses. OPV has some advantages as low cost, ease of use, and high efficacy rate with herd immunity. The only serious adverse events associated with OPV are rare cases of vaccine associated paralytic poliomyelitis that consider being one of the current obstacles in progress of polio eradication. It may occur within 4-30 day among the vaccinated recipients (9). According to WHO standards the likelihood of VAPP following vaccination against polio with OPV is 2-4 cases/1 million birth cohort (8). Furthermore, VAPP case is almost impossible to differentiate with wide-type poliomyelitis. The annual incidence of VAPP in European countries, according to the WHO is 0.4-3.0 per million vaccinated children. In US the estimated risk for VAPP is fluctuated from 1 case per 2.5 million doses of OPV to 1 case per 3.2 million doses (5).
In 2012 World health Organization (WHO) developed the Polio Eradication and Endgame Plan 20132018 (10), and according to the pan all 126 countries
starting from 2013 were only using OPV and were required to introduce at least 1 dose of the inactivated polio vaccine (IPV) into national immunization schedule (6,7).
The Republic of Armenia was certified by the WHO as a polio-free zone in 2002. Armenia has introduced 1 dose of IPV in national immunization schedule at the age 24 weeks.
Purpose. To investigate probability of occurrence VAPP in the Republic of Armenia for the period of 2003-2015 based on retrospective and prospective analysis of the data for the mentioned period of time.
Material and methods: The materials of investigation were weekly, monthly and yearly official report forms on poliomyelitis and acute flaccid paralysis (AFP) approved by the Ministry of Health of RA as well as monthly and yearly report form on infectious and parasitic diseases (N85) and adverse events following immunization, implemented vaccinations and rejection from vaccinations (P1), report forms of separate epidemiological investigations on AFP's, report forms on coverage of immunizations (P3 and P4) and official statistical data of National Statistical Services of Armenia referring to children up to 15 years old during 2003 -2015.
Several scenarios were elaborated: 1. Initial data -the rate of VAPP is 2-4 cases per 1 million birth cohort are, 2. According to the WHO probability 1 case of VAPP per 750 000 vaccinations is related to the first shot against polio, 3-4. As 1 case per 2.4 million doses is related to following vaccinations with OPV and 1 case per 5.4 million doses is related to the subsequent
vaccinations (5). Also, the fact that 200 000 vaccinations with OPV are being yearly implemented in Armenia was pointed out.
Statistical processing of retrospective and prospective probability of VAPP in Armenia was based on binominal distribution (Bernoulli distribution) that is distribution of the quantify of occurrence of a probable event in case of repeated independent experiments, provided that the probability of occurrence of the event is equal to (0<p<1) in each experiment.
Results: Considering the fact that the frequency of VAPP per 1 million birth cohorts are 2-4 cases the probability of VAPP in Armenia for the period 2003 -2015 is fluctuated between 65-88% among 520 000 births for the mentioned period. Based on the data of the second scenario, the probability of VAPP is equal to 50% which means that the rate of VAPP is 1 per 750,000 first vaccinations, and then there is a 44% chance of having at least 1 VAPP among 520,000 children born. Having the third scenario of further developments the VAPP's probability is 66% when if the rate of VAPP is 1 per 2,600,000 doses and there are 200,000 doses per year, then there is a 66% chance of having at least 1 VAPP in a 13-year period and finally according to the last scenario If the rate of VAPP is 1 per 2,600,000 doses and there are 200,000 doses per year, then there is a 40% chance of having at least 1 VAPP in a 13-year period.
Conclusion: In spite of the absence of statistical data regarding of the VAPP in Armenia the likelihood of VAPP is high according to all scenarios. It means that based on all four scenarios the absence of VAPP in upcoming years brings to the point of additional investigations in order to understand what are the reasons of the absence of VAPP in Armenia.
REFERENCES:
1. CDC, Cessation of Trivalent Oral Poliovirus Vaccine and Introduction of Inactivated Poliovirus Vaccine - Worldwide, 2016. - Morb.Mortal.Wkly Rep. September 9. 2016;65(35):934-938
2. CDC, Introduction of Inactivated Poliovirus Vaccine and Switch from Trivalent to Bivalent Oral Poliovirus Vaccine - Worldwide, 2003-2016. -Morb.Mortal.Wkly Rep. July 3. 2015;64(25):699-702
3. CDC, Update on Vaccine-Derived Po-lioviruses - Worldwide, January 2015-May 2016. -Morb.Mortal.Wkly Rep. August 5, 2016;65(30):763-769
4. Classification and reporting of vaccine-derived polioviruses (VDPV), GPEI guidelines, August 2016, p.2-8
5. Kim S. J., Kim S. H. et al. Vaccine-associated Paralytic Poliomyelitis: A Case Report of Flaccid Monoparesis after Oral Polio Vaccine. //J Korean Med Sci 2007:22:362-4
6. McKenna M., Polio Eradication: Is 2016 The year? 01 April 2016, http://phenomena.nationalgeo-graphic.com/2016/01/04/2016-predict/
7. The introduction of IPV, the OPV switch, and risk mitigation, polio global eradication initiative, 7 April 2016, p.1-8
8. Polio vaccines: WHO position paper - March, 2016. // Weekly Epidemiological Record, 2016;12(91): 145-168.
9. WHO, Observed rate of vaccine reactions, polio vaccines, Information sheet, May 2014, p.1-5
10. WHO, Polio Eradication & Endgame Strategic Plan 2013-2018, 2013, p.1-4
BIOCIDE WITH PROLONGED ACTION
Kuznetsov O.
Candidate of Biological Sciences, Associate Professor of the Department of Clinical Laboratory
Diagnostics and Immunology, Grodno State Medical University
Pavlyukovets A.
Candidate of Biological Sciences, Associate Professor of the Department of Microbiology, Virology and
Immunology. I.S. Gelberg of the Grodno State Medical University
Bolotov D
Student of the Grodno State Medical University БИОЦИД С ПРОЛОНГИРОВАННЫМ ДЕЙСТВИЕМ
Кузнецов О.Е.
Кандидат биологических наук, доцент кафедры клинической лабораторной диагностики и иммунологии
Гродненского государственного медицинского университета
Павлюковец А. Ю.
Кандидат биологических наук, доцент кафедры микробиологии, вирусологии и иммунологии им. И.С.
Гельберга Гродненского государственного медицинского университета
Болотов Д.Ю.
Студент Гродненского государственного медицинского университета
Abstract
Search and creation of new disinfectants with better characteristics. Development of a disinfectant with a wide spectrum of antimicrobial activity and long-term disinfecting action (prolonged) in low concentrations of active ingredient, environmental and operational safety.
