Global Impact of Mass Vaccination Campaigns on Circulating Type 2 Vaccine-Derived Poliovirus Outbreaks: An Interrupted Time-Series Analysis.

Abstract

Background: Between 2016 and 2023, 3248 cases of circulating vaccine-derived type 2 poliomyelitis (cVDPV2) were reported globally and supplementary immunization activities (SIAs) with monovalent type 2 oral poliovirus vaccine (mOPV2) and novel type 2 oral poliovirus vaccine (nOPV2) targeted an estimated 356 and 525 million children, respectively. This analysis estimates the community-level impact of nOPV2 relative to mOPV2 SIAs.

Methods: We fitted interrupted time-series regressions to surveillance data between January 2016 and November 2023 to estimate the impact of nOPV2 and mOPV2 SIAs on cVDPV2 poliomyelitis incidence and prevalence in environmental surveillance across 37 countries, directly comparing the impact of SIAs in 13 countries where both vaccines were used.

Results: We did not find any statistically significant differences between nOPV2 and mOPV2 SIA impact except for in the Democratic Republic of Congo (DRC), where nOPV2 SIAs had lower impact (adjusted relative risk [aRR] for cVDPV2 poliomyelitis incidence per nOPV2 SIA, 0.505; 95% confidence interval [CI], .409-.623) compared to mOPV2 (aRR, 0.193; 95% CI, .137-.272); P value for difference in RRs = 3e-6.

Conclusions: We find variation in OPV2 SIA impacts globally, with greater certainty about Nigeria and DRC, where large outbreaks provided an opportunity to assess impact at scale. In most countries, we find no significant difference between nOPV2 and mOPV2 SIA impact. We are unable to identify the reason for the significant difference in DRC, which could include differential SIA coverage, timing, vaccine effectiveness, or outbreak dynamics.