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 using mass vaccination with Sabin 2 OPV, which carries a small, but serious risk of seeding future cVDPV2 outbreaks in settings of low population immunity. Accurate forecasting models are essential to quantify transmission and reversion risk to optimize effectiveness of mass OPV2 campaigns and minimize cVDPV2 emergence risk. Here, we developed an agent-based model of Sabin 2 vaccine transmission to simulate and to assess the role of household community structure on transmission during a clinical trial designed to monitor community transmission following a mass OPV campaign in Matlab, Bangladesh. Our results emphasize the role of household and community membership and shows that vaccine virus transmission occurs primarily between local community members. When constructing disease forecasting models, ignoring community structure and asserting mass action systematically overestimates emergence probability, duration, and epidemic size due to mechanistic differences in how transmissions are distributed. Model forecasting of vaccine transmission and cVDPV2 emergence risk must incorporate existing knowledge regarding community and social contact structure to provide accurate assessments of transmission risk and ensure the efficacy of future cVDPV2 containment and prevention strategies.

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