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J Infect Dis. 2014 Nov 1;210 Suppl 1:S424-33. doi: 10.1093/infdis/jit843.

Individual-based modeling of potential poliovirus transmission in connected religious communities in North America with low uptake of vaccination.

Author information

Kid Risk, Inc. Delft University of Technology, Delft, The Netherlands.
Kid Risk, Inc.
Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention.
Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
Kid Risk, Inc. College of Medicine, University of Central Florida, Orlando, Florida.



Pockets of undervaccinated individuals continue to raise concerns about their potential to sustain epidemic transmission of vaccine-preventable diseases. Prior importations of live polioviruses (LPVs) into Amish communities in North America led to their recognition as a potential and identifiable linked network of undervaccinated individuals.


We developed an individual-based model to explore the potential transmission of a LPV throughout the North American Amish population.


Our model demonstrates the expected limited impact associated with the historical importations, which occurred in isolated communities during the low season for poliovirus transmission. We show that some conditions could potentially lead to wider circulation of LPVs and cases of paralytic polio in Amish communities if an importation occurred during or after 2013. The impact will depend on the uncertain historical immunity to poliovirus infection among members of the community.


Heterogeneity in immunization coverage represents a risk factor for potential outbreaks of polio if introduction of a LPV occurs, although overall high population immunity in North America suggests that transmission would remain relatively limited. Efforts to prevent spread between Amish church districts with any feasible measures may offer the best opportunity to contain an outbreak and limit its size.


disease outbreaks; heterogeneity; immunization; individual-based model; polio

[Indexed for MEDLINE]

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