Modeling Options to Manage Type 1 Wild Poliovirus Imported Into Israel in 2013

Background. After 25 years without poliomyelitis cases caused by circulating wild poliovirus (WPV) in Israel, sewage sampling detected WPV type 1 (WPV1) in April 2013, despite high vaccination coverage with only inacti-vated poliovirus vaccine (IPV) since 2005. Methods. We used a differential equation–based model to simulate the dynamics of poliovirus transmission and population immunity in Israel due to past exposure to WPV and use of oral poliovirus vaccine (OPV) in addition to IPV. We explored the influences of various immunization options to stop imported WPV1 circulation in Israel. Results. We successfully modeled the potential for WPVs to circulate without detected cases in Israel. Maintain-ing a sequential IPV/OPV schedule instead of switching to an IPV-only schedule in 2005 would have kept population immunity high enough in Israel to prevent WPV1 circulation. The Israeli response to WPV1 detection prevented paralytic cases; a more rapid response might have interrupted transmission more quickly. Conclusions. IPV-based protection alone might not provide sufficient population immunity to prevent polio-virus transmission after an importation. As countries transition to IPV in immunization schedules, they may need to actively manage population immunity and consider continued use of OPV, to avoid the potential circulation of im-ported live polioviruses before globally coordinated cessation of OPV use