Modelling the Time-varying Transmission of Wild Poliovirus in Pakistan

Aims/Objectives: The efforts to eradicate the wild poliovirus since 1988 have successfully reduced its global prevalence by 99%. However, as of 2024, Pakistan and Afghanistan remain the only two endemic countries facing the virus transmission. This study employs a transmission dynamic model to understand the persistence of wild poliovirus type 1 (WPV1) in Pakistan.

Study Design: An ordinary differential equations-based deterministic type of mathematical model was developed.

Place and Duration of Study: Department of Epidemiology and Public Health and Institute of Microbiology, University of Agriculture Faisalabad, March 2023 to August 2023.

Methodology: We included the number of reported polio cases and the proportion of missed children by supplementary immunization activities (SIAs) across the country from 2017-2022. The model considered both human-human and environment-human virus transmission through sewage contamination and these are represented by time-dependent transmission rate parameters. The parameter estimation was done by model fitting to the reported data of WPV1 cases. The model simulations then predicted the future polio infections in Pakistan.

Results: Our analysis identified that the asymptomatic infectious population missed by the SIAs is the major contributor to disease persistence in the country. Moreover, the environment can contribute to virus transmission in areas with poor WASH infrastructure and under-immunized populations. The estimated basic reproduction number through the next-generation matrix method was 1.61 while the estimated effective reproduction number was 0.12. The model showed a better predictive ability than constant transmission rate models. The numerical simulations considering the reduction in the virus-shedding rate by the asymptomatic population resulted in an 85% reduction in future polio cases in Pakistan.

Conclusion: The results suggest that endemic virus transmission will continue subject to the current higher vaccination coverage across the country. The model can be further utilized to guide eradication efforts for targeted allocation of preemptive measures.