Global poliomyelitis eradication
- John F Modlin, MD
John F Modlin, MD
- Deputy Director, Polio Research
- Global Development
- Bill and Melinda Gates Foundation
Given the availability of an inexpensive oral polio vaccine (OPV) and the success of the Pan American Health Organization polio eradication program in the Americas, the World Health Assembly resolved in 1988 to eradicate polio globally by the year 2000 . This goal proved more challenging than originally foreseen, and important obstacles remain; these obstacles include poor access to children in remaining endemic areas due to insecurity and co-circulation of oral poliovirus vaccine-derived polioviruses (cVDPV). Nonetheless, great progress has been made: the incidence of paralytic polio worldwide has been reduced by more than 1000-fold, two of the three naturally occurring (wild-type) poliovirus serotypes no longer circulate, and type 1 poliovirus disease is now confined to only two countries, Pakistan and Afghanistan .
The Global Poliomyelitis Eradication Initiative (GPEI) expects to interrupt transmission of all wild-type and cVDPV viruses by 2017, introduce inactivated poliovirus vaccine (IPV) into the routine infant immunization schedule in all countries, and phase out of OPV use in a staged manner to reduce the risk of new cVDPV outbreaks following complete interruption [3,4].
Issues related to polio eradication are reviewed here. Issues related to polio infection and routine polio vaccination are discussed separately. (See "Polio and infectious diseases of the anterior horn" and "Poliovirus vaccination".)
GLOBAL ERADICATION PARTNERSHIP
The Global Polio Eradication Initiative partnership was launched in 1988 and is led by five organizations: the World Health Organization, the United States Centers for Disease Control and Prevention, the United Nations Children's Fund, Rotary International, and the Bill and Melinda Gates Foundation. The partnership includes many governmental and nongovernmental donors as well as the ministries of health of all affected nations who plan and carry out the program's initiatives, at an overall cost that exceeds $1 billion per year.
The global eradication program is based on four strategies: routine infant immunization, supplementary immunization activities (SIAs) in at-risk middle- and low-income countries, surveillance for acute flaccid paralysis (AFP), and mop-up campaigns .
- World Health Organization. Global eradication of poliomyelitis by the year 2000. Wkly Epidemiol Rec 1988; 63:161.
- World Health Organization GPEP. Wild Poliovirus Weekly Update. http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx. (Accessed on March 21, 2016).
- World Health Organization. Polio Eradication and Endgame Strategic Plan 2013–2018. WHO, Geneva 2013.
- Garon J, Seib K, Orenstein WA, et al. Polio endgame: the global switch from tOPV to bOPV. Expert Rev Vaccines 2016; 15:693.
- Wright PF, Kim-Farley RJ, de Quadros CA, et al. Strategies for the global eradication of poliomyelitis by the year 2000. N Engl J Med 1991; 325:1774.
- Polio vaccines: WHO position paper, January 2014. Wkly Epidemiol Rec 2014; 89:73.
- John TJ, Jayabal P. Oral polio vaccination of children in the tropics. I. The poor seroconversion rates and the absence of viral interference. Am J Epidemiol 1972; 96:263.
- Sutter RW, Suleiman AJ, Malankar P, et al. Trial of a supplemental dose of four poliovirus vaccines. N Engl J Med 2000; 343:767.
- Krishnan R, Jadhav M, John TJ. Efficacy of inactivated poliovirus vaccine in India. Bull World Health Organ 1983; 61:689.
- Kopel E, Kaliner E, Grotto I. Lessons from a public health emergency--importation of wild poliovirus to Israel. N Engl J Med 2014; 371:981.
- Roberts L. Polio endgame. Polio: The final assault? Science 2004; 303:1960.
- Patriarca PA, Wright PF, John TJ. Factors affecting the immunogenicity of oral poliovirus vaccine in developing countries: review. Rev Infect Dis 1991; 13:926.
- Grassly NC, Fraser C, Wenger J, et al. New strategies for the elimination of polio from India. Science 2006; 314:1150.
- Sutter RW, John TJ, Jain H, et al. Immunogenicity of bivalent types 1 and 3 oral poliovirus vaccine: a randomised, double-blind, controlled trial. Lancet 2010; 376:1682.
- Kew O, Morris-Glasgow V, Landaverde M, et al. Outbreak of poliomyelitis in Hispaniola associated with circulating type 1 vaccine-derived poliovirus. Science 2002; 296:356.
- Kew OM, Wright PF, Agol VI, et al. Circulating vaccine-derived polioviruses: current state of knowledge. Bull World Health Organ 2004; 82:16.
- Sutter RW, Bahl S, Deshpande JM, et al. Immunogenicity of a new routine vaccination schedule for global poliomyelitis prevention: an open-label, randomised controlled trial. Lancet 2015; 386:2413.
- Asturias EJ, Bandyopadhyay AS, Self S, et al. Humoral and intestinal immunity induced by new schedules of bivalent oral poliovirus vaccine and one or two doses of inactivated poliovirus vaccine in Latin American infants: an open-label randomised controlled trial. Lancet 2016; 388:158.
- Jafari H, Deshpande JM, Sutter RW, et al. Polio eradication. Efficacy of inactivated poliovirus vaccine in India. Science 2014; 345:922.
- John J, Giri S, Karthikeyan AS, et al. Effect of a single inactivated poliovirus vaccine dose on intestinal immunity against poliovirus in children previously given oral vaccine: an open-label, randomised controlled trial. Lancet 2014; 384:1505.