Key result
In children aged 6-11 months from high-risk areas of Pakistan, receiving inactivated poliovirus vaccine was associated with significantly higher odds of anti-polio seropositivity (AOR 4.43).
Cross-Sectional (n=1,301)
2-stage cluster sampling
Yes
Odds Ratio: 4.43 (95% CI 1.76–11.13)
p-value: p=0.002
While overall serologic protection against poliovirus is high in Pakistan, significant immunity gaps remain in young children in high-risk areas, which are strongly associated with malnutrition and lack of IPV vaccination.
May support supplemental IPV strategies in endemic settings; leaves open causality and practice change pending randomized trials.
BACKGROUND: Pakistan is one of the 3 remaining wild poliovirus endemic countries. We collected sera from children to assess the prevalence of poliovirus antibodies in selected high-risk areas for poliovirus transmission. METHODS: Children in 2 age groups (6-11 and 36-48 months) were randomly selected between November 2015 and March 2016 in 6 areas of Pakistan (Sindh Province: Karachi and Kashmore; Khyber Pakhtunkhwa Province: Peshawar, Bannu and Nowshera; Punjab Province: Faisalabad). After obtaining informed consent, basic demographic and vaccination history data were collected, 1 peripheral venipuncture was obtained, and assays to detect poliovirus (PV)-neutralizing antibodies were performed. RESULTS: A total of 1301 children were enrolled and had peripheral blood drawn that analyzed. Study subjects were evenly distributed among survey sites and age groups. Anti-polio seroprevalence differed significantly among geographic areas (P < 0.001); in the 6-11 months group, it ranged between 89% and 98%, 58% and 95%, and 74% and 96% for PV serotypes 1, 2 and 3, respectively; in 36-48 months group, it ranged between 99% and 100%, 95% and 100%, and 92% and 100% for PV 1, 2, and 3, respectively. Having received inactivate poliovirus vaccine, malnourishment (stunting) and educational level of parents were found to be associated with presence of anti-polio antibodies. CONCLUSION: The polio eradication program achieved overall high serologic protection; however, immunity gaps in young children in the high polio risk areas remain. These gaps enable sustained circulation of wild poliovirus type 1, and pose risk for emergence of vaccine-derived polioviruses. Focusing on the lowest socioeconomic strata of society, where malnutrition is most prevalent, could accelerate poliovirus eradication.
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Hussain et al. (2017) conducted a cross-sectional in Poliovirus (n=1,301). Inactivated poliovirus vaccine (IPV) receipt vs. No IPV receipt was evaluated on Anti-polio seropositivity (AOR 4.43, 95% CI 1.76-11.13, p=0.002). In children aged 6-11 months from high-risk areas of Pakistan, receiving inactivated poliovirus vaccine was associated with significantly higher odds of anti-polio seropositivity (AOR 4.43).
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