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    Polio Eradication

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    Nishith Dholakia
    1) The Global Polio Eradication Initiative has faced challenges in reaching its goal of eradicating polio, including missing its original target of 2000 and consuming $1 billion annually since. 2) Two fundamental errors have undermined eradication efforts. First, the assumption that poliovirus transmission is primarily fecal-oral despite evidence it spreads more like measles via respiratory routes. Second, continuing to use vaccine viruses beyond when they were no longer needed epidemiologically. 3) To succeed, GPEI must prioritize interrupting circulating vaccine-derived poliovirus type 2 transmission in over 20 countries, promote inactivated polio vaccine use through routine immunization programs, and withdraw oral pol

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    Polio Eradication

    Uploaded by

    Nishith Dholakia
    11 views1 page
    1) The Global Polio Eradication Initiative has faced challenges in reaching its goal of eradicating polio, including missing its original target of 2000 and consuming $1 billion annually since. 2) Two fundamental errors have undermined eradication efforts. First, the assumption that poliovirus transmission is primarily fecal-oral despite evidence it spreads more like measles via respiratory routes. Second, continuing to use vaccine viruses beyond when they were no longer needed epidemiologically. 3) To succeed, GPEI must prioritize interrupting circulating vaccine-derived poliovirus type 2 transmission in over 20 countries, promote inactivated polio vaccine use through routine immunization programs, and withdraw oral pol

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    Challenges en route to polio eradication

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    Polio eradication

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    1) The Global Polio Eradication Initiative has faced challenges in reaching its goal of eradicating polio, including missing its original target of 2000 and consuming $1 billion annually since. 2) Two fundamental errors have undermined eradication efforts. First, the assumption that poliovirus transmission is primarily fecal-oral despite evidence it spreads more like measles via respiratory routes. Second, continuing to use vaccine viruses beyond when they were no longer needed epidemiologically. 3) To succeed, GPEI must prioritize interrupting circulating vaccine-derived poliovirus type 2 transmission in over 20 countries, promote inactivated polio vaccine use through routine immunization programs, and withdraw oral pol

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    11 views1 page

    Polio Eradication

    Uploaded by

    Nishith Dholakia
    1) The Global Polio Eradication Initiative has faced challenges in reaching its goal of eradicating polio, including missing its original target of 2000 and consuming $1 billion annually since. 2) Two fundamental errors have undermined eradication efforts. First, the assumption that poliovirus transmission is primarily fecal-oral despite evidence it spreads more like measles via respiratory routes. Second, continuing to use vaccine viruses beyond when they were no longer needed epidemiologically. 3) To succeed, GPEI must prioritize interrupting circulating vaccine-derived poliovirus type 2 transmission in over 20 countries, promote inactivated polio vaccine use through routine immunization programs, and withdraw oral pol

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    Correspondence

    Challenges en route to type 3 virus, and the most common 5 Singh J, Datta KK. Epidemiological
    considerations of the age distribution of
    cause in unvaccinated contacts of
    polio eradication vaccinated children is the type 2
    measles in India: a review. J Trop Pediatr 1997;
    43: 111–15. Published Online
    July 11, 2022
    The Global Polio Eradication Initiative virus.6 WPV type 2 was eradicated in 6 WHO. The relation between acute persisting
    spinal paralysis and poliomyelitis vaccine https://doi.org/10.1016/
    (GPEI) has set a new target of 2026.1 October, 1999,7 so use of the type (oral): results of a WHO enquiry. S0140-6736(22)01274-0
    Since the original target of 2000 2 vaccine should have ended in Bull World Health Organ 1976; 53: 319–31.
    was missed, GPEI has consumed November, 2002.7 Continuation of 7 John TJ. Two good reasons to drop type 2 virus
    from oral polio vaccine. Lancet 2004;
    US$1 billion each year.2 the type 2 vaccine until April, 2016, 364: 1666.
    Two fundamental errors have resulted in unknown numbers of VAPP 8 Jorba J, Diop OM, Iber J, et al. Update on vaccine-
    debased the GPEI. First, the GPEI cases and many outbreaks caused by derived polioviruses—worldwide, January
    2016–June 2017. MMWR Morb Mortal Wkly Rep
    assumed, without evidence, that in circulating vaccine-derived poliovirus 2017; 66: 1185–91.
    low-income countries, the predom­ (cVDPV) type 2, beginning in 2006.8 9  WHO. Circulating vaccine-derived poliovirus
    type 3—Israel. April 15, 2022. https://www.
    inant route of transmission of wild Today, very high priority must be given who.int/emergencies/disease-outbreak-news/
    polioviruses (WPVs) was faecal–oral, to interrupting the transmission of item/circulating-vaccine-derived-poliovirus-
    despite every epidemiological clue cVDPV type 2 in over 20 countries. type-3---israel (accessed June 3, 2022).

    supporting respiratory transmission. Type 3 vaccine virus should have


    In the pre-eradication era, polio been removed by the end of 2015,
    infections began in infancy during 3 years after WPV type 3 was last
    exclusive breastfeeding, with a median detected in November, 2012. 8 The
    age of infection of 15 months.3 WPVs’ consequences of continuing the type
    basic reproduction number (R0) was 40– 3 vaccine include unknown numbers
    45,4 making faecal–oral transmission of VAPP cases and the recent cVDPV
    implausible, whereas the R0 of measles type 3 polio outbreak in Israel.9
    was 30 (with a median age of infection The best course of action for
    of 24 months).4,5 Polio was therefore GPEI is to work with the Expanded
    more contagious than measles, and it Programme on Immunisation (EPI) to
    was confined to children younger than promote IPV (three doses per child),
    6 years, whereas measles often spilled and to withdraw OPV from countries
    over to children aged 6–10 years.5 that reach 85% coverage in children
    Water-borne polio outbreaks have younger than 5 years. Providing IPV
    never been reported. through the EPI in Afghanistan and
    During the past two decades there Pakistan will prevent WPV type 1 and
    have been innumerable importations cVDPV type 2 polio. The same tactic
    of WPV type 1 from endemic countries will prevent polio anywhere, caused by
    to polio-free locations. Adults, cVDPV types 1, 2, or 3.
    themselves immune but prone to We declare no competing interests.
    reinfections, were the travelling
    T Jacob John, *Dhanya Dharmapalan
    transmission vectors. In endemic drdhanyaroshan@gmail.com
    communities, presumably adults and
    Christian Medical College, Vellore, India (TJJ);
    children acted as transmission vectors. Paediatric Infectious Diseases, Apollo Hospitals,
    The role of oral poliovirus vaccines Navi Mumbai 400614, India (DD)
    (OPVs) was to rapidly reduce WPV 1 WHO. Polio eradication strategy 2022–2026:
    transmission, preparing for a final delivering on a promise. Geneva: World Health
    Organization, 2021.
    assault with inactivated poliovirus 2 Thompson KM, Kalkowska DA. An updated
    vaccine (IPV), which induces better economic analysis of the global polio
    pharyngeal immunity to interrupt eradication initiative. Risk Anal 2021;
    41: 393–406.
    respiratory transmission than OPVs. 3 Soudarssanane MB, Rotti SB, Srinivasa DK,
    GPEI’s second error was to continue Ramalingam G. Paralytic poliomyelitis in
    children under 6 years in Pondicherry:
    using vaccine viruses (which occa­ a community survey.
    sionally caused polio) beyond their J Epidemiol Community Health 1993;
    epidemiological need. According to 47: 210–14. Submissions should be
    4 Anderson RM. Directly transmitted viral and made via our electronic
    WHO, the most common cause of bacterial infections of man. In: Anderson RM, submission system at
    vaccine-associated paralytic polio ed. Population dynamics of infectious diseases. http://ees.elsevier.com/
    London: Chapman and Hall, 1982: 137.
    (VAPP) in vaccinated children is the thelancet/

    www.thelancet.com Published online July 11, 2022 https://doi.org/10.1016/S0140-6736(22)01274-0 1

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