Community structure mediates Sabin 2 polio vaccine virus transmission

Since the global withdrawal of Sabin 2 oral poliovirus vaccine (OPV) from routine immunization, the Global Polio Eradication Initiative (GPEI) has reported multiple circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreaks. cVDPV2 outbreaks are controlled with mass Sabin 2 OPV vaccination campaigns, which carry a small but serious risk of seeding future cVDPV2 outbreaks. Accurate forecasting models are essential for quantifying current and future cVDPV2 outbreak risk following Sabin 2 OPV campaigns, but it is unclear whether household community structure influences vaccine virus transmission or is relevant for assessing cVDPV2 outbreak risk. Here, we developed an agent-based model of Sabin 2 vaccine transmission to assess the role of household community structure on vaccine virus transmission following a mass OPV campaign performed in Matlab, Bangladesh. Household community structure strongly limits vaccine virus transmission to local community members and ignoring it overestimates outbreak risk in terms of emergence probability, duration, and epidemic size.