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Original Research

Modeling undetected poliovirus circulation following the 2022 outbreak in the United States

, , , , , , , & show all
Pages 186-195 | Received 17 Nov 2023, Accepted 21 Dec 2023, Published online: 04 Jan 2024

Figures & data

Figure 1. The geographic distribution of wastewater sampling sites for polio with respect to outbreak counties, non-outbreak counties and the NY state in general. Note that sampling sites are primarily in outbreak counties as well as the adjacent non-outbreak counties with high population density.

Figure 1. The geographic distribution of wastewater sampling sites for polio with respect to outbreak counties, non-outbreak counties and the NY state in general. Note that sampling sites are primarily in outbreak counties as well as the adjacent non-outbreak counties with high population density.

Table 1. New York State Wastewater characteristics for polio by outbreak and non-outbreak counties.

Table 2. Assignment of the percentage of New York State poliovirus WS observations for each mixing scenario for the.

Figure 2. Confidence about no circulation in NYS as a function of the detected-event free period assuming perfect acute flaccid myelitis (AFM) surveillance only (no WS). Dashed horizontal lines indicate 99% and 95% confidence levels for ease of reference. Note that with AFM alone, reaching high confidence of no circulation (95%) it will take approximately 4 years for the no isolation and partial isolation mixing scenarios, and never occurs for the subpopulation isolation mixing scenario for the model time horizon.

Figure 2. Confidence about no circulation in NYS as a function of the detected-event free period assuming perfect acute flaccid myelitis (AFM) surveillance only (no WS). Dashed horizontal lines indicate 99% and 95% confidence levels for ease of reference. Note that with AFM alone, reaching high confidence of no circulation (95%) it will take approximately 4 years for the no isolation and partial isolation mixing scenarios, and never occurs for the subpopulation isolation mixing scenario for the model time horizon.

Figure 3. Detected-event-free period in years at which the confidence about no circulation exceeds 95% (CNC95%, z-axis) as a function of the wastewater surveillance (WS) sensitivity coefficient (C) assuming no AFM surveillance and perfect AFM surveillance. Results for different mixing assumptions are presented in panels a to c. For each set of results, SWS assumes distribution of WS sites equally over the general and under-vaccinated subpopulations, UVS assumes all WS sites represent only the under-vaccinated subpopulations, and GPS assumes all WS sites represent only the general subpopulations.

Figure 3. Detected-event-free period in years at which the confidence about no circulation exceeds 95% (CNC95%, z-axis) as a function of the wastewater surveillance (WS) sensitivity coefficient (C) assuming no AFM surveillance and perfect AFM surveillance. Results for different mixing assumptions are presented in panels a to c. For each set of results, SWS assumes distribution of WS sites equally over the general and under-vaccinated subpopulations, UVS assumes all WS sites represent only the under-vaccinated subpopulations, and GPS assumes all WS sites represent only the general subpopulations.

Figure 4. Surface plots of the detected-event-free period in years at which the confidence about no circulation exceeds 95% (CNC95%, z-axis) as a function of the fraction population (F) covered by wastewater surveillance (WS) and WS sensitivity coefficient level (C) assuming no AFM surveillance (same as figure 3 but zoomed in on the high quality WS range, i.e. high F and low C). Results for different mixing assumptions are presented in panels a to c. DEFP results are color-coded to highlight different scales of the z-axis. For each set of results, SWS assumes distribution of WS sites equally over the general and under-vaccinated subpopulations, UVS assumes all WS sites represent only the under-vaccinated subpopulations, and GPS assumes all WS sites represent only the general subpopulations.

Figure 4. Surface plots of the detected-event-free period in years at which the confidence about no circulation exceeds 95% (CNC95%, z-axis) as a function of the fraction population (F) covered by wastewater surveillance (WS) and WS sensitivity coefficient level (C) assuming no AFM surveillance (same as figure 3 but zoomed in on the high quality WS range, i.e. high F and low C). Results for different mixing assumptions are presented in panels a to c. DEFP results are color-coded to highlight different scales of the z-axis. For each set of results, SWS assumes distribution of WS sites equally over the general and under-vaccinated subpopulations, UVS assumes all WS sites represent only the under-vaccinated subpopulations, and GPS assumes all WS sites represent only the general subpopulations.