scholarly journals The final stages of the global eradication of poliomyelitis

2013 ◽  
Vol 368 (1623) ◽  
pp. 20120140 ◽  
Author(s):  
Nicholas C. Grassly
Keyword(s):  
Virus Transmission ◽  
Polio Eradication ◽  
Oral Poliovirus Vaccine ◽  
Intestinal Immunity ◽  
Oral Vaccination ◽  
Wild Poliovirus ◽  
Global Polio Eradication Initiative ◽  
Global Eradication ◽  
Lower Income Countries

The global incidence of poliomyelitis has dropped by more than 99 per cent since the governments of the world committed to eradication in 1988. One of the three serotypes of wild poliovirus has been eradicated and the remaining two serotypes are limited to just a small number of endemic regions. However, the Global Polio Eradication Initiative (GPEI) has faced a number of challenges in eradicating the last 1 per cent of wild-virus transmission. The polio endgame has also been complicated by the recognition that vaccination with the oral poliovirus vaccine (OPV) must eventually cease because of the risk of outbreaks of vaccine-derived polioviruses. I describe the major challenges to wild poliovirus eradication, focusing on the poor immunogenicity of OPV in lower-income countries, the inherent limitations to the sensitivity and specificity of surveillance, the international spread of poliovirus and resulting outbreaks, and the potential significance of waning intestinal immunity induced by OPV. I then focus on the challenges to eradicating all polioviruses, the problem of vaccine-derived polioviruses and the risk of wild-type or vaccine-derived poliovirus re-emergence after the cessation of oral vaccination. I document the role of research in the GPEI's response to these challenges and ultimately the feasibility of achieving a world without poliomyelitis.

scholarly journals Polio Today: State of the Global Eradication Program and Modern Strategy of WHO on Immunization

2015 ◽  
Vol 14 (2) ◽  
pp. 73-78 ◽  
Author(s):  
O. E. Ivanova
Keyword(s):  
Strategic Plan ◽  
Polio Eradication ◽  
Oral Poliovirus Vaccine ◽  
Paralytic Poliomyelitis ◽  
Immunization Strategy ◽  
Eradication Program ◽  
Polio Immunization ◽  
Global Polio Eradication Initiative ◽  
Global Eradication

The review presents data on the current stature of the Global Polio Eradication Initiative of the WHO. The success of its implementation mainly depends on the solutions of the problems associated with continuing use of trivalent oral poliovirus vaccine (OPV): vaccine- associated paralytic poliomyelitis (VAPP) and vaccine-derived polioviruses (VDPV). The information about the polio immunization strategy proposed by WHO in «Polio Eradication and Endgame Strategic Plan 2013 - 2018» is presented.

Breaking the Last Chains of Poliovirus Transmission: Progress and Challenges in Global Polio Eradication

2018 ◽  
Vol 5 (1) ◽  
pp. 427-451 ◽  
Author(s):  
Olen Kew ◽  
Mark Pallansch
Keyword(s):  
High Risk ◽  
Genetic Instability ◽  
Polio Eradication ◽  
Oral Poliovirus Vaccine ◽  
Wild Poliovirus ◽  
Vaccine Preventable Diseases ◽  
Social Innovations ◽  
Global Polio Eradication Initiative ◽  
Widespread Dissemination

Since the launch of the Global Polio Eradication Initiative (GPEI), paralytic cases associated with wild poliovirus (WPV) have fallen from ∼350,000 in 1988 to 22 in 2017. WPV type 2 (WPV2) was last detected in 1999, WPV3 in 2012, and WPV1 appeared to be localized to Pakistan and Afghanistan in 2017. Through continuous refinement, the GPEI has overcome operational and biological challenges far more complex and daunting than originally envisioned. Operational challenges had led to sustained WPV endemicity in core reservoirs and widespread dissemination to polio-free countries. The biological challenges derive from intrinsic limitations to the oral poliovirus vaccine: ( a) reduced immunogenicity in high-risk settings and ( b) genetic instability, leading to repeated outbreaks of circulating vaccine-derived polioviruses and prolonged infections in individuals with primary immunodeficiencies. As polio eradication enters its multifaceted endgame, the GPEI, with its technical, operational, and social innovations, stands as the preeminent model for control of vaccine-preventable diseases worldwide.

Polio Eradication—Within Our Reach?

2017 ◽  
pp. 1-32
Author(s):  
David Besanko ◽  
Sarah Gillis ◽  
Sisi Shen
Keyword(s):  
Infectious Disease ◽  
Public Good ◽  
Polio Eradication ◽  
Global Strategy ◽  
Global Public Good ◽  
List Type ◽  
Global Public Health ◽  
Wild Poliovirus ◽  
Global Polio Eradication Initiative ◽  
Epidemiological Characteristics

The years 2011, 2012, and 2013 witnessed both significant developments and setbacks in global polio eradication efforts. On the positive side, January 13, 2012, marked a full year since India had detected a case of wild poliovirus. On the negative side, polio continued to be endemic in three countries-Pakistan, Afghanistan, and Nigeria-and in those countries the goal of eliminating polio seemed more challenging than ever. Between December 2012 and January 2013, sixteen polio workers were killed in Pakistan, and in February 2013, nine women vaccinating children against polio in Kano, Nigeria, were shot dead by gunmen suspected of belonging to a radical Islamist sect. In addition, after a 95 percent decline in polio cases in 2010, the number of cases in Nigeria rebounded in 2011. Recognizing that polio was unlikely to be eliminated in these countries in the near term, the Global Polio Eradication Initiative moved its target date for eradication from 2013 to 2018.These setbacks sparked a debate about the appropriate strategy for global eradication of polio. Indeed, some experts believed that recent setbacks were not caused by poor management but were instead the result of epidemiological characteristics and preconditions that might render polio eradication unachievable. These experts argued that global health efforts should focus on the control or elimination of polio rather than on the eradication of the disease.This case presents an overview of polio and the Global Polio Eradication Initiative and recounts the successful effort to eradicate smallpox. The case enables a rich discussion of the current global strategy to eradicate polio, as well as the issue of whether eradication is the appropriate global public health objective. More generally, the case provides a concrete example of a particular type of global public good, namely infectious disease eradication.After analyzing and discussing the case, students will be able to: Understand the nature of a global public good Perform a back-of-the-envelope benefit-cost analysis of polio eradication Discuss the appropriate strategy for eradicating an infectious disease Apply game theory to analyzing which countries would be likely to contribute funds toward global polio eradication Discuss the role of private organizations in the provision of global public goods

Polio Eradication Initiative in India: Deconstructing the GPEI

2005 ◽  
Vol 35 (2) ◽  
pp. 361-383 ◽  
Author(s):  
C. Sathyamala ◽  
Onkar Mittal ◽  
Rajib Dasgupta ◽  
Ritu Priya
Keyword(s):  
Developing Countries ◽  
Disease Control ◽  
Polio Eradication ◽  
Health Priorities ◽  
Political Will ◽  
Global Polio Eradication Initiative ◽  
Global Eradication ◽  
Year 2000 ◽  
The U.S

The Global Polio Eradication Initiative (GPEI) promised eradication of polio by the year 2000 and certification of eradication by 2005. The first deadline is already a matter of history. With the reporting of polio cases in 2004, the new deadline for polio eradication by 2004 is postponed further. This article seeks to argue that the scientific and technical bodies spearheading the GPEI, including the WHO, UNICEF, and the U.S. Centers for Disease Control, have formulated a conceptually flawed strategy and that it is not weak political will that is the central obstacle in this final push for global eradication. The validity of the claims of “near success” by the proponents of the GPEI is also examined in detail. By taking India as a case study, the authors examine the achievements of the GPEI in nine years of intense effort since 1995. They conclude that the GPEI is yet another exercise in mismanaging the health priorities and programs in developing countries in the era of globalization.

scholarly journals The role of genetic sequencing and analysis in the polio eradication programme

2020 ◽  
Vol 6 (2) ◽  
Author(s):  
David Jorgensen ◽  
Margarita Pons-Salort ◽  
Alexander G Shaw ◽  
Nicholas C Grassly
Keyword(s):  
New Technologies ◽  
Polio Eradication ◽  
Wild Type ◽  
Eradication Programme ◽  
Genetic Sequencing ◽  
Serotype 1 ◽  
Speed Up ◽  
Eradication Campaign ◽  
Global Polio Eradication Initiative

Abstract Genetic sequencing of polioviruses detected through clinical and environmental surveillance is used to confirm detection, identify their likely origin, track geographic patterns of spread, and determine the appropriate vaccination response. The critical importance of genetic sequencing and analysis to the Global Polio Eradication Initiative has grown with the increasing incidence of vaccine-derived poliovirus (VDPV) infections in Africa specifically (470 reported cases in 2019), and globally, alongside persistent transmission of serotype 1 wild-type poliovirus in Pakistan and Afghanistan (197 reported cases in 2019). Adapting what has been learned about the virus genetics and evolution to address these threats has been a major focus of recent work. Here, we review how phylogenetic and phylogeographic methods have been used to trace the spread of wild-type polioviruses and identify the likely origins of VDPVs. We highlight the analysis methods and sequencing technology currently used and the potential for new technologies to speed up poliovirus detection and the interpretation of genetic data. At a pivotal point in the eradication campaign with the threat of anti-vaccine sentiment and donor and public fatigue, innovation is critical to maintain drive and overcome the last remaining circulating virus.

scholarly journals Multiscale model for forecasting Sabin 2 vaccine virus household and community transmission

2021 ◽  
Vol 17 (12) ◽  
pp. e1009690
Author(s):  
Michael Famulare ◽  
Wesley Wong ◽  
Rashidul Haque ◽  
James A. Platts-Mills ◽  
Parimalendu Saha ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Mechanistic Model ◽  
Virus Transmission ◽  
Multiscale Model ◽  
Polio Eradication ◽  
Oral Poliovirus Vaccine ◽  
Vaccine Virus ◽  
Mass Action ◽  
Transmission Risk ◽  
Contact Rates

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. Here, we generated an agent-based, mechanistic model designed to assess OPV-related vaccine virus transmission risk in populations with heterogeneous immunity, demography, and social mixing patterns. To showcase the utility of our model, we present a simulation of mOPV2-related Sabin 2 transmission in rural Matlab, Bangladesh based on stool samples collected from infants and their household contacts during an mOPV2 clinical trial. Sabin 2 transmission following the mOPV2 clinical trial was replicated by specifying multiple, heterogeneous contact rates based on household and community membership. Once calibrated, the model generated Matlab-specific insights regarding poliovirus transmission following an accidental point importation or mass vaccination event. We also show that assuming homogeneous contact rates (mass action), as is common of poliovirus forecast models, does not accurately represent the clinical trial and risks overestimating forecasted poliovirus outbreak probability. Our study identifies household and community structure as an important source of transmission heterogeneity when assessing OPV-related transmission risk and provides a calibratable framework for expanding these analyses to other populations. Trial Registration: ClinicalTrials.gov This trial is registered with clinicaltrials.gov, NCT02477046.

Moving from oral poliovirus vaccine to inactivated poliovirus vaccine: The rationale and challenges

2019 ◽  
Vol 31 (1) ◽  
pp. 22-28 ◽  
Author(s):  
Kazi Zulfiquer Mamun ◽  
Nabeela Mahboob ◽  
Kazi Taib Mamun ◽  
Hasina Iqbal
Keyword(s):  
Oral Polio Vaccine ◽  
Sole Source ◽  
Polio Eradication ◽  
Oral Poliovirus Vaccine ◽  
Routine Immunization ◽  
Inactivated Polio Vaccine ◽  
Polio Vaccine ◽  
The Past ◽  
Global Polio Eradication Initiative

Oral polio vaccine (OPV) has served as the cornerstone of polio eradication efforts over the past 30 years, trivalent inactivated polio vaccine (IPV) has re-ascended to prominence in the past year, now acting as the sole source of protective immunity against type 2 poliovirus in routine immunization programmes. The Polio Eradication and Endgame Strategic plan 2013–2018, developed by the Global Polio Eradication Initiative (GPEI) outlines the phased removal of OPVs, starting with type 2 poliovirus–containing vaccines and introduction of inactivated polio vaccine in routine immunization to mitigate against risk of vaccine-associated paralytic polio and circulating vaccine-derived poliovirus. Bangladesh J Medicine Jan 2020; 31(1) : 22-28

scholarly journals Seroprevalence of Antipolio Antibodies among Children <15 Years of Age in Border Provinces in China

2013 ◽  
Vol 20 (7) ◽  
pp. 1070-1075 ◽  
Author(s):  
HaiBo Wang ◽  
Hui Cui ◽  
ZhengRong Ding ◽  
Pian Ba ◽  
ShuangLi Zhu ◽  
...  
Keyword(s):  
Neutralizing Antibody ◽  
Polio Eradication ◽  
Oral Poliovirus Vaccine ◽  
World Health ◽  
Cross Sectional ◽  
Autonomous Region ◽  
Wild Poliovirus ◽  
Xinjiang Uygur Autonomous Region ◽  
Tibet Autonomous Region ◽  
Antibody Titers

ABSTRACTDespite remarkable progression toward polio eradication worldwide, wild poliovirus (WPV) importation has been a great challenge for China, as it shares borders with countries where WPV is endemic. The objective of this study was to estimate poliovirus antibody seroprevalence among children <15 years of age in 3 border provinces (Yunnan Province, Tibet Autonomous Region, and Xinjiang Uygur Autonomous Region) in China. A cross-sectional, hospital-based study was undertaken in 3 border provinces in 2010. Individuals <15 years old who visited hospitals at the prefecture level or above to have their blood drawn for any reason were invited to participate in our study. Neutralizing antibody titers to polio serotypes 1 (P1), P2, and P3 were assayed according to the World Health Organization manual for the virological investigation of polio. Antibody titers of ≥8 were considered positive. Among the 1,360 subjects enrolled, 1,220 (89.7%), 1,259 (92.6%), and 1,112 (81.8%) were seropositive to P1, P2, and P3, respectively, and 1,051 (77.3%) subjects were seropositive to all three serotypes. The highest seropositive rates were observed in Xinjiang Uygur Autonomous Region. By age, 3- to 5-year-old subjects had the highest rate of seropositivity, and seropositivity decreased significantly with increasing age. The risk of WPV importation will continue until WPV transmission has been interrupted worldwide. Consistent with the Global Polio Eradication Initiative's polio endgame strategy, China must maintain its polio-free status by ensuring adequate population immunity against polio. Because immunity wanes with increasing age, a booster dose with bivalent type 1 and 2 oral poliovirus vaccine could be considered for teenagers in China.

PARALLEL DILEMMAS: POLIO TRANSMISSION AND POLITICAL VIOLENCE IN NORTHERN NIGERIA

Africa ◽  
2014 ◽  
Vol 84 (3) ◽  
pp. 466-486 ◽  
Author(s):  
Elisha P. Renne
Keyword(s):  
Federal Government ◽  
Political Violence ◽  
Polio Eradication ◽  
Northern Nigeria ◽  
Wild Poliovirus ◽  
Polio Immunization ◽  
Eradication Campaign ◽  
Global Polio Eradication Initiative ◽  
Low Levels ◽  
Parental Opposition

ABSTRACTNigeria is one of three countries where polio continues to be endemic. In northern Nigeria, areas with low levels of polio immunization due to persistent parental opposition as well as implementation and infrastructural problems have contributed to wild poliovirus transmission. Furthermore, political violence associated with Islamic groups opposed to the federal government has also hampered the conclusion of the Global Polio Eradication Initiative (GPEI) efforts. This violence, which began in Borno State and has spread to other parts of northern Nigeria, occurs precisely where poliovirus transmission continues. These two related aspects – parallel dilemmas of low immunization and political violence – confound the conclusion of GPEI efforts in Nigeria. This situation also raises ethical questions both about the final stages of eradication efforts and about military actions to contain ongoing violence. The Nigerian government's attempts to suppress opposition to the polio eradication campaign by threatening non-compliant parents with arrest and by closing down media outlets may frighten some parents into compliance but can also breed resentment and resistance, just as military and police activities, such as house-to-house sweeps and widespread arrests, may encourage sympathy for Islamic insurgents. This situation suggests that the possible solution of one problem – the ending of wild poliovirus transmission – depends upon a solution of the other, i.e. the cessation of violent anti-government activities.

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