The eradication of polio: a novel bivalent poliovirus vaccine

Stephanie Mita
Introduction Results Antibody titre is a measure of the amount of antibody present in
At 30 days mOPV1 (n=168) mOPV2 (n=170) mOPV3 (n=165) tOPV (n=168) bOPV (n=159) serum. The reverse cumulative distribution curves shown in Figure
Poliomyelitis has been almost eradicated To poliovirus 1 20% 5% 4% 15% 20% 2 are a summary measure of antibody distribution. For example,
due to widespread usage of the trivalent To poliovirus 2 4% 21% 2% 25% 4% for poliovirus type 1, mOPV1 showed a similar curve to that of
oral poliovirus vaccine (tOPV)—designed To poliovirus 3 3% 0% 12% 4% 7% bOPV, and both were superior to tOPV. For poliovirus type 2,
to vaccinate against all three types of At 60 days mOPV1 (n=168) mOPV2 (n=170) mOPV3 (n=165) tOPV (n=168) bOPV (n=159) mOPV2 was only slightly superior to tOPV; mOPV1, mOPV3, and
poliovirus—developed by Albert Sabin in To poliovirus 1 87% 12% 8% 54% 80%
bOPV were far inferior in triggering the development of antibodies
1962. The number of poliomyelitis- To poliovirus 2 9% 84% 11% 85% 8% specific to poliovirus type 2. For poliovirus type 3, mOPV3 showed
endemic countries has dropped from To poliovirus 3 5% 5% 81% 49% 71% a similar curve to that of bOPV, and both were superior to tOPV.
125 in 1988 to 4 in 2005. The Figure 1. Seroconversion to poliovirus types 1, 2, and 3 measured at 30 days and 60 days after vaccination
introduction of monovalent types 1 and with monovalent type 1 OPV (mOPV1), monovalent type 2 OPV (mOPV2), monovalent type 3 OPV As shown in Figure 3, for poliovirus type 1, mOPV1 and bOPV led
3 OPV (mOPV1 and mOPV3) in 2005 (mOPV3), trivalent OPV (tOPV), and bivalent types 1 and 3 OPV (bOPV). Seroconversion was compared to significantly higher seroconversion than tOPV. This is shown by
across the five treatment groups after the first dose (30 days) and second dose (60 days).
decreased polio cases further, but it the overlapping 95% CIs for mOPV1 and bOPV but non-overlap
caused confusion about which vaccine to Seroconversion is the with tOPV. Similarly, for poliovirus type 3, mOPV3 and bOPV led to
Poliovirus type 1 development of antibodies
administer: tOPV, mOPV1, mOPV3, or 100 mOPV1
significantly higher seroconversion than tOPV.
something else? 90
bOPV specific to microbes in the
tOPV serum in response to
80 Vaccines containing poliovirus type 1 Figure 3. Non-inferiority
mOPV2 immunization. Here it was
To address this question, in this 2008 70
mOPV3 mOPV1 and superiority
defined as a titre four times
Infants (%)

60 assessments for treating

study, Sutter et. al performed a trial to higher than the expected fall bOPV
assess the effectiveness of a new
50 poliovirus types 1 and 3
40 in maternal antibody after a two-dose schedule
bivalent types 1 and 3 polio vaccine tOPV
30
concentrations. of vaccines. For poliovirus
(bOPV) that specifically targets types 1 1 0.8 0.6 0.4 0.2 type 1, bOPV was as
20 As shown in Figure 1, for Proportion of infants with seroconversion
and 3 without the interference of effective as mOPV1 at
10 poliovirus type 1, at 30 days, Vaccines containing poliovirus type 3
treating type 2. Is monovalent type 2 0 seroconversion was 20% for triggering seroconversion,
(mOPV2), mOPV3, or bOPV more 1 10 100 1000 10000 mOPV1 and bOPV but 15%
mOPV3 and both were more
effective than tOPV, and is bOPV just as Antibody titre (day 60) effective than tOPV. For
Poliovirus type 2
for tOPV. At 60 days, bOPV
effective as mPOV1 and mPOV3? Can poliovirus type 3, bOPV was
100
mOPV1 seroconversion was 80% for tOPV as effective as mOPV3, and
polio finally be eradicated by a novel 90 bOPV mOPV1 and bOPV but 50%
bivalent polio vaccine? 80 tOPV for tOPV. For poliovirus type 1 0.8 0.6 0.4 0.2 both were more effective
Proportion of infants with seroconversion than tOPV.
70 mOPV2 2, at 30 days and 60 days,
60 mOPV3 there was no significant
Infants (%)

50
difference between mOPV2
40 and tOPV. For poliovirus
Conclusions
30 type 3, at 30 days, there was
Methods  The bivalent poliovirus types 1 and 3 vaccine is superior
20 no significant difference
10
between tOPV and bOPV,
to the trivalent vaccine in treating poliovirus types 1 and 3.
Sutter et. al randomly assigned 900 0
but seroconversion was 12%  The monovalent poliovirus type 2 vaccine and trivalent vaccine
1 10 100 1000 10000 are equally effective in treating poliovirus type 2.
newborn babies born at three Indian Antibody titre (day 60) for mOPV3 and 4% for tOPV.
medical centers to five treatment At 60 days, seroconversion In the trivalent vaccine, there is interference of poliovirus
100 Poliovirus type 3 mOPV1
groups: mOPV1, mOPV2, mOPV3, tOPV, was 70% for mOPV3 and type 2 with treating poliovirus types 1 and 3.
90
bOPV bOPV, whereas it was 50%
and bOPV. At birth, cord blood was 80 tOPV  Transitioning to the bivalent vaccine could lead, at last, to the
sampled, and one dose of vaccine was for tOPV.
70 mOPV2 complete eradication of polio.
given. At 30 days, blood samples were 60 mOPV3 Figure 2. Reverse poliovirus
Infants (%)

antibody distribution curves for

taken, and the infants received a 50
second dose of the same vaccine. At 60 40
days, a third blood sample was taken. 30
Across the five treatment groups, 20
10
seroconversion was compared after the
0
first dose and after the second dose. 1 10
Antibody titre (day 60)
poliovirus types 1, 2, and 3. For
type 1, mOPV1 yields the highest
antibody titre, followed by bOPV
References
and then tOPV. For type 2,
mOPV2 and tOPV are similarly Sutter, Ronald et. al. “Immunogenicity of bivalent types 1 and 3
effective. For type 3, mOPV3 is oral poliovirus vaccine: a randomised, double-blind, controlled
100 1000 10000 most effective, followed by bOPV trial.” Thelancet.com. 26 Oct 2010. 1 Nov 2010.
and then tOPV.