J Infect Dis

On 29 October 2000, the World Health Organization (WHO) Regional Commission for the Certification of Poliomyelitis Eradication in the Western Pacific certified the WHO Western Pacific Region as free of indigenous wild poliovirus. This status has been maintained to date: wild poliovirus importations into Singapore (in 2006) and Australia (in 2007) did not lead to secondary cases, and an outbreak in China (in 2011) was rapidly controlled. Circulation of vaccine derived polioviruses in Cambodia, China and the Philippines was quickly interrupted. A robust acute flaccid paralysis surveillance system, including a multitiered polio laboratory network, has been maintained, forming the platform for integrating measles, neonatal tetanus, and other vaccine-preventable disease surveillance and their respective control goals. While polio elimination remains one of the most important achievements in public health in the Western Pacific Region, extended delays in global eradication have, however, led to shifting and competing public health priorities among member states and partners and have made the region increasingly vulnerable.001/WHO_/World Health OrganizationInternational/CC999999/ImCDC/Intramural CDC HHSUnited States

Epidemiological Characteristics of Poliomyelitis During the 21st Century (2000-2013)

Poliovirus is the pathogenic agent of paralytic poliomyelitis that belongs to the picornaviridae family. Poliomyelitis has an extended history dating over to the Egyptian eighteenth dynasty. It was recognized as distinct disease in the late nineteenth century when the world was ravaged by large number of outbreaks and epidemics in many countries. Paralytic Polio, the rarest but the most severe form of the disease, is characterized by acute flaccid paralysis of any or rarely both of the limbs. Increasing epidemics during the late 19th and 20th centuries lead to the initiation of a worldwide global effort for polio eradication in 1988, super headed by WHO and various other organizations. The launch of Global Polio Eradication Initiative together with the introduction of two polio vaccines resulted in 99% reduction of wild poliovirus cases worldwide while the total number of polio-endemic countries dropped from 24 countries in the year 2000 to only three countries in 2012; Afghanistan, Nigeria and Pakistan. This review will focus on the general biology of poliovirus, some historic and geographic epidemiological aspects of poliomyelitis eradication during the year 2000-2012 and also on the major failing factors associated with the efficiency of the vaccines to eradicate polio in Pakistan

Epidemiological Characteristics of Poliomyelitis during the 21st century (2000-2013)

Poliovirus is the pathogenic agent of paralytic poliomyelitis that belongs to the picornaviridae family. Poliomyelitis has an extended history dating over to the Egyptian eighteenth dynasty. It was recognized as distinct disease in the late nineteenth century when the world was ravaged by large number of outbreaks and epidemics in many countries. Paralytic Polio, the rarest but the most severe form of the disease, is characterized by acute flaccid paralysis of any or rarely both of the limbs. Increasing epidemics during the late 19th and 20th centuries lead to the initiation of a worldwide global effort for polio eradication in 1988, super headed by WHO and various other organizations. The launch of Global Polio Eradication Initiative together with the introduction of two polio vaccines resulted in 99% reduction of wild poliovirus cases worldwide while the total number of polio-endemic countries dropped from 24 countries in the year 2000 to only three countries in 2012; Afghanistan, Nigeria and Pakistan. This review will focus on the general biology of poliovirus, some historic and geographic epidemiological aspects of poliomyelitis eradication during the year 2000-2012 and also on the major failing factors associated with the efficiency of the vaccines to eradicate polio in Pakistan

WHO criteria for measles elimination: A critique with reference to criteria for polio elimination

Smallpox was formally declared as eradicated in 1979. Smallpox is the only infectious disease of humans that has ever been eradicated. Poliomyelitis has been eliminated from three of the six World Health Organization (WHO) regions although not all countries within those regions always meet the elimination criteria. Elimination criteria for measles are being discussed. We use poliomyelitis and measles as examples to illustrate our assertion that the current approach to documenting measles elimination relies too heavily on criteria for surveillance quality, disadvantaging countries with long established and relatively inflexible surveillance systems. We propose an alternative approach to documenting measles elimination, with the two key criteria being molecular evidence to confirm the lack of a circulating endemic genotype for at least one year and maintenance of 95% coverage of one dose of measles-containing vaccine, with an opportunity for a second dose. Elimination status should be reviewed annually. We suggest four principles that should guide development of final criteria to document measles elimination: countries that have eliminated measles should be able to meet the elimination criteria; quality surveillance criteria are necessary but not sufficient to define elimination; quality surveillance criteria should be guided by elimination criteria, not the other way around; and elimination criteria should not differ between the WHO regions without good reason

J Infect Dis

The Global Polio Laboratory Network (GPLN) began building in the late 1980s on a 3-tiered structure of 146 laboratories with different and complementary technical and support capacities (poliovirus isolation, molecular strain characterization including sequencing, quality assurance, and research). The purpose of this network is to provide timely and accurate laboratory results to the Global Polio Eradication Initiative. Deeply integrated with field case-based surveillance, it ultimately provides molecular epidemiological data from polioviruses used to inform programmatic and immunization activities. This network of global coverage requires substantial investments in laboratory infrastructure, equipment, supplies, reagents, quality assurance, staffing and training, often in resource-limited settings. The GPLN has not only developed country capacities, but it also serves as a model to other global laboratory networks for vaccine-preventable diseases that will endure after the polio eradication goal is achieved. Leveraging lessons learned during past 27 years, the authors discuss options for transitioning GPLN assets to support control of other viral vaccine-preventable, emerging, and reemerging diseases.2017001/World Health Organization/InternationalCC999999/Intramural CDC HHS/United States28838192PMC5853949770

Global health strategies versus local primary health care priorities- a case study of national immunisation days in southern Africa

Building on the successful eraclication of smallpox, the World Health Organisation, together with other agencies, is now moving quickly to the eradication of poliomyelitis, originally aimed for the year 2000. Plans for the subsequent global eradication of measles are in an advanced stage. Eradication of both polio and measles incorporate as a fundamental strategy high routine coverage, surveillance and special national immunisation days (NIDs), which are supplementary to routine vaccination services.There has been a lively debate on whether poor countries, with many health problems that could be controlled, should divert their limited resouxces for a global goal of eradication that may have low priority for their children. From a costeffectiveness perspective, NIDs are fully justifiable. However, field observations in sub-saharan Africa show that NIDs divert resources and, to a certain extent, attention from the development of comprehensive primary health care (PHC). The routine immunisation coverage rates dropped on average since the introduction of NIDs in 1996, which is contrary to what was observed in the western Pacific and other regions.The additional investment to be made when moving from disease control to eraclication may exceed the financial capacity of an individual country. Since the industrialised countries benefit most from eradication, they should take responsibility for covering the needs of those countries that cannot afford the investment. The WHO's frequent argument that NIDs are promotive to PHC: is not confirmed in the southern African region. The authors think that the WHO should, therefore, focus its attention on diminishing the   negative side-effects of NIDs and on getting the positive side effects incorporated in the integrated health services in a sustainable way

Challenges Facing Healthcare Administration , Public Health, Nurses And Microbiology Team Towards Prevention Of Transmission Of Wild Poliovirus

The Global Commission for the Certification of the Eradication of Poliomyelitis will declare the world free of wild poliovirus transmission when no wild virus has been detected for a minimum of 3 consecutive years, and all laboratories that possess wild poliovirus materials have implemented effective containment measures. These achievements can be attained through the collaborative efforts of healthcare administration, public health, nursing, and microbiology teams in addressing the challenges associated with transmission. The primary obstacles to achieving polio eradication are the lack of robust political backing at the national level, insufficient financial support that hampers the implementation of WHO recommendations, potential issues with the availability of polio vaccine due to inadequate support, and the unsatisfactory rate of progress in polio surveillance

J Infect Dis

Background.The European region, certified as polio free in 2002, had recent wild poliovirus (WPV) introductions, resulting in a major outbreak in Central Asian countries and Russia in 2010 and in current widespread WPV type 1 circulation in Israel, which endangered the polio-free status of the region.Methods.We assessed the data on the major determinants of poliovirus transmission risk (population immunity, surveillance, and outbreak preparedness) and reviewed current threats and measures implemented in response to recent WPV introductions.Results.Despite high regional vaccination coverage and functioning surveillance, several countries in the region are at high or intermediate risk of poliovirus transmission. Coverage remains suboptimal in some countries, subnational geographic areas, and population groups, and surveillance (acute flaccid paralysis, enterovirus, and environmental) needs further strengthening. Supplementary immunization activities, which were instrumental in the rapid interruption of WPV1 circulation in 2010, should be implemented in high-risk countries to close population immunity gaps. National polio outbreak preparedness plans need strengthening. Immunization efforts to interrupt WPV transmission in Israel should continue.Conclusions.The European region has successfully maintained its polio-free status since 2002, but numerous challenges remain. Staying polio free will require continued coordinated efforts, political commitment and financial support from all countries.001/WHO_/World Health OrganizationInternational/CC999999/ImCDC/Intramural CDC HHSUnited States

Barriers and Potential in the Final Stage of Global Polio Eradication Initiative, NDHS 2008

Abstract Background: Poliomyelitis is a viral disease that causes temporary or permanent paralysis among children less than five years of age; however, the virus can infect adults, too. There is no cure for poliomyelitis. The only possible way to save the children under the age of five from the disease is to get them vaccinated against the poliovirus. The Global Polio Eradication Initiative (GPEI) aimed to eradicate the poliovirus by the year 2000. Unexpectedly, even today there are still three polio-endemic countries in the world: Afghanistan, Pakistan, and Nigeria. The main hypothesis of the current paper was that mothers with higher levels of education and wealth index are more likely to get their children vaccinated against poliovirus, as compared to the ones with less education and lower wealth index. Also, it is hypothesized that Muslim communities are more reluctant to polio vaccines as compared to non-Muslim communities. Methods: First, the 2008 Nigeria Demographic and Health Surveys (NDHS) data for Nigeria was analyzed to explore a binary outcome (whether or not the child had polio vaccination). The outcome was explained by categorical variables related to the mother\u27s SES and religion. Next, Seven reasons given by mothers who did not vaccinate their children and who lived in either rural or urban settings was analyzed. The reasons included: Lack of information, fear of side effects, fear that child will get disease, vaccines do not work, post too far and child was absent Results: Results of the study indicated a statistically significant and direct association between the Nigerian mothers’ level of education and the odds of getting their child vaccinated. It was also suggested that the odds of getting the polio vaccines were higher between the Nigerian Catholic and other Christian communities as compared to the Muslim communities. Lack of information was the number one reason for not getting the child vaccinated between mothers in rural settings (24%) while fear of side effects and span of vaccination posts stood second and third. Among mothers in urban settings fear of side effects was the main reason (16%) while lack of information and religious reasons were the number two and number three reasons. Conclusion: The study findings suggested that mothers’ SES could affect the likelihood of getting their children vaccinated, suggesting that the governments of polio endemic countries should consider women’s education and empowerment as part of their health promotion policies and strategies. In addition, study findings were consistent with other related literature in pointing out the need for raising awareness regarding the goals of GPEI and adopting community-based strategies to combat the existing sensitivity against the polio eradication campaigns. Further research needs to be conducted to assess the vaccination related behaviors and attitudes related to mothers’ SES with a special focus on Muslim communities where higher reluctance were experienced against polio vaccines as compared to the non-Muslim communities. Nevertheless, the odds of getting their children vaccinated were lesser among the Traditionalists as compared to Muslims. Less has been written about the vaccination disparities among this religious minority in Nigeria. Future research is recommended to explore the factors that influence polio immunization refusals among the mentioned group

Poliomyelitis prevention in the United States: updated recommendations of the Advisory Committee on Immunization Practices (ACIP)

These recommendations of the Advisory Committee on Immunization Practices (ACIP) for poliomyelitis prevention replace those issued in 1997. As of January 1, 2000, ACIP recommends exclusive use of inactivated poliovirus vaccine (IPV) for routine childhood polio vaccination in the United States. All children should receive four doses of IPV at ages 2, 4, and 6-18 months and 4-6 years. Oral poliovirus vaccine (OPV) should be used only in certain circumstances, which are detailed in these recommendations. Since 1979, the only indigenous cases of polio reported in the United States have been associated with the use of the live OPV. Until recently, the benefits of OPV use (i.e., intestinal immunity, secondary spread) outweighed the risk for vaccine-associated paralytic poliomyelitis (VAPP) (i.e., one case among 2.4 million vaccine doses distributed). In 1997, to decrease the risk for VAPP but maintain the benefits of OPV, ACIP recommended replacing the all-OPV schedule with a sequential schedule of IPV followed by OPV. Since 1997, the global polio eradication initiative has progressed rapidly, and the likelihood of poliovirus importation into the United States has decreased substantially. In addition, the sequential schedule has been well accepted. No declines in childhood immunization coverage were observed, despite the need for additional injections. On the basis of these data, ACIP recommended on June 17, 1999, an all-IPV schedule for routine childhood polio vaccination in the United States to eliminate the risk for VAPP. ACIP reaffirms its support for the global polio eradication initiative and the use of OPV as the only vaccine recommended to eradicate polio from the remaining countries where polio is endemic.The following CDC staff members prepared this report: D. Rebecca Prevots, Roger K. Burr, Epidemiology and Surveillance Division; Roland W. Sutter, Vaccine-Preventable Disease Eradication Division; Trudy V. Murphy, Epidemiology and Surveillance Division, National Immunization Program.Includes bibliographical references (p. 19-22).15580728Infectious DiseasePrevention and ControlCurrentACI