[11].Soon,however,thisviruswillnolongerhurtourchildren.Sinceitscreationin1988,the
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ControllingtheEradicationofPolioRyanHernandezMay1,2003
1IntroductionPoliomyelitisischaracterizedbyfever,motorparalysis,andatrophyofskeletalmuscles(acuteflaccidparalysis,AFP).Thecripplingvirushasdisablednearly20millionpeoplelivingtoday[11].Soon,however,thisviruswillnolongerhurtourchildren.Sinceitscreationin1988,theGlobalPolioEradicationInitiativehashelpedcuttheglobaltollofpolioparalysisfromanestimated350,000tofewerthan500in2001[11].Afterbeingdeemederadicated,poliowillbecomethesecondvirustohavebeeneradicatedfromtheworld(thefirstbeingsmallpoxin1980[10]).Thegoalofpolioeradicationhasbeenmetinmostpartsoftheworld(WHOdeemedtheAmericasPolio-freein1994[11]andthe51countriesrepresentingtheEUROregionwerecertifiedpolio-freeinJune2002[1]),andeachcountrythathascitizenssufferingfromthediseasehasbeengivenaplanofactionforeradication[1].Therearetwomainvaccinesthatareusedtobuildthehumanimmunesystem:oralpoliovirusvaccineandinactivatedpoliovirusvaccine.OPV,asitsnamesuggestscanbeadministeredorally,eitherasadropintothemouth,oronasugarpill.Thebenefitsofthisvaccinearethatitdoesnotrequireatrainedmedicalstafffortheimmunizationofpeople,nordoesitrequiresterileinjectionequipment.Themaincostofusingthisvaccinationisthatitisastrainof“live”virus,hencethosegiventhisvaccineenteraninfectiousstage,andthereisariskofsufferingtheconsequencesofcontractingpoliowhenusingit.IPVisa“dead”formofthevirus,hencethereisnoriskofcontractingpoliofromthevaccine,however,itisnotcompletelyeective.Onlyafractionofthosewhoreceivethisvaccinebecomecompletelyimmune,whereasothersenterastageofreducedsusceptibility(hencecanstillcontractthewild-strainofpoliovirus).Thisvaccinecanonlybeadministeredthroughaninjection.Thiscreatestheneedfortrainedmedicalstaffandtheuseoflargeamountsofsterileinjectionequipment(whichisbynomeansinexpensive)[11].Themainmethodbywhichdevelopingcountriesvaccinatethepopulationisbyorganizingnationalimmunizationdays(NIDs).Thesedaysareorganizedbymanygroupsinternational
1organizations(onecouldseethescheduleofnationalimmunizationdaysforeachcountrybyvisiting).Generally,theseprogramstargetaspecificagegroup(mostlychildren),andonecouldbevaccinatedmultipletimes.Thegoalofmathematicallymodelingpolioistopredictthetransmissionofpolio.Modelsincludingvaccinationdynamicsgenerallyseektofindsomeminimumvaccinationlevelsuchthattheviruswillbeeradicated.Thegoalhereistodetermineanoptimalpolioeradicationstrategyforagivencountrybysubjectingasystemofdierentialequationtothetheoryofoptimalcontrol.
2MathematicalModelsofPoliomyelitisOneofthemorerecentdeterministicmodelsofpoliotransmissionandvaccinationprovidesasystemofdierentialequationsforeachvaccineseparately[4].Variousothermodelshaveaddressedvariousaspectsofthetransmissionofpoliovirus.Forexample,Cvjetanovic,et.al.consideredanagestructuredmodel[2].Thiswouldbekeyforlookingattheeectsofanationalimmunizationdaywhereonlythosefromacertainagebracketarebeingvaccinated.
2.1TheOPVModelTheOPVmodelofEichnerandHadeler[4]considers4sub-populations:thefractionofthepopulationcurrentlysusceptible(s);thefractionofthepopulationthathasbeenvaccinated,butarestillintheinfectivestage(v);thefractionofthepopulationthathasbeeninfectedbywildpoliovirus(w);andthefractionofthepopulationthathasbecomeimmune(r).Inthismodel,theauthorsassumeaconstantpopulation,andhencethebirthrate=deathrate=µ.Themodelisasfollows:
˙s=(1−p)µ−wsw−vsv−µs(1)˙v=pµ+vsv−vv−µv(2)
˙w=wsw−ww−µw(3)
˙r=ww+vv−µr(4)
wherepistheconstantfractionofnewbirthsthatarevaccinated(theauthorsassumevaccinationatbirth),µisboththebirthanddeathrateofthepopulation,βvandwaretheinfectionratesthatsomeoneinpopulationvandw(resp.)contactsandinfectsasusceptibleindividual,andvandwaretherecoveryratesofpopulationvandw(resp.).Itisofinteresttonotethatsincewehaveaconstantpopulationwehavethefollowingrelationship:s+v+w+r=1,henceweneedonlyconsiderthe3dimensionalsystemof(s,v,w).
2FollowingtheanalysisofEichnerandHadeleronthismodel,wecanfindthebasicreproductivenumbers,RvandRw,ofthevandwpopulations(resp.).Thebasicreproductivenumberdeterminesthenumberofpeoplethatwillbeinfectedbyanaverageinfectedperson.IfRw≥1,thevirusisendemic.Inthiscasewehave
Rv=vv+µ(5)
Rw=ww+µ.(6)
Ingeneral,RwandRvaregreaterthanone,thusthediseaseisendemicandhenceitisrequiredthatweusevaccinationstoforcethesystemintoavirus-freeequilibrium(orunin-fected).Theuninfectedequilibriumcanbyfoundbysettingw=0andsolvingfor¯sand¯vbysetting˙s=0and˙v=0.Fromthiswefind
¯s=Rv+12Rv−12Rv{(Rv−1)2+4pRv}1/2(7)¯v=µ(1−¯s)µ+v.(8)However,sinceweassumethatwearenotyetonanuninfectedequilibriumtrajectory,wesolvethe(s,v,w)systemforequilibriumandfind