The perspective of global eradication of poliomyelitis

In recent years, Germany and Switzerland have changed national policies to recommend vaccination with IPV (inactivated polio vaccine) instead of OPV (oral polio vaccine) for protection against poliomyelitis. An all IPV-schedule in routine childhood polio vaccination eliminates the - albeit minimal - risk of OPV-associated paralytic poliomyelitis. However, the impact of such a vaccination scheme on the goal to eventually eradicate poliomyelitis on a global level remains debatable. Published studies indicate that vaccine-derived poliovirus may persist in the environment for prolonged periods of time even after completion of a global eradication programme that relies on the near-exclusive use of OPV in the developing countries. Travellers vaccinated with IPV only might become silently infected with vaccine-derived virus, shedding it in large quantities. We therefore plead for a vaccination schedule that includes at least one last dose of OPV to induce strong mucosal immunity.     

The case for global eradication of poliomyelitis

Global eradication of poliomyelitis can be achieved by a programme strategy that includes achievement and maintenance of high immunization levels, effective surveillance to detect all new cases, and a rapid vigorous response to the occurrence of new cases. Regional eradication targets have already been set in Europe and the Americas. Possible impediments to eradication include the necessity to generate political and social will; managerial constraints; issues of vaccine efficacy, stability, and cost; and adequacy of surveillance. We believe that the impediments can be overcome and that with intensified effort and increased international collaboration, global eradication could be achieved as early as 1995.     

韶关市实现无脊髓灰质炎目标的评价

目的 评价韶关市消灭脊髓灰质炎(脊灰)的措施及效果,提出今后应注意的问题。方法 对1956～2002年的脊灰疫情报告、计划免疫、AFP监测等资料进行统计和分析。结果 自1966年大规模应用脊灰减毒活疫苗以来,常规免疫接种率不断提高,1990年起年接种率保持在95％以上;1989年起实施强化免疫,脊灰发病率自上世纪50年代的3．65／10万降至80年代的0.34／10万,死亡率由0．16／10万降至0．02/10万,脊灰野病毒传播范围明显缩小。从1991年5月起,连续11年无脊灰病例。结论 实施消灭脊灰措施效果显著,阻断了脊灰野病毒的循环,实现无脊灰目标。但今后仍需继续落实预防接种措施,防止输入病例,巩固无脊灰成果。     

Progress toward global poliomyelitis eradication, 2000

In 1988, the World Health Assembly resolved to eradicate poliomyelitis globally by 2000 (1). Substantial progress toward this goal has been reported from all six World Health Organization (WHO) regions; 20 countries reported poliovirus transmission in December 2000 compared with 30 in 1999. WHO has prepared a global action plan that anticipates certification of polio eradication in 2005 (2). This report summarizes the status of the eradication effort and describes the remaining tasks to be completed to reach global polio eradication     

Progress toward global poliomyelitis eradication, 1999

In 1988, the World Health Assembly resolved to eradicate poliomyelitis globally by the end of 2000. Since then, substantial progress has been made in implementing polio eradication strategies, and during 1999 these activities were accelerated to reach the global target. The number of countries where polio is endemic decreased, and the number and quality of vaccination rounds increased. Acute flaccid paralysis (AFP) surveillance improved, and political commitment and the global partnership for polio eradication strengthened. This report updates progress toward achieving the polio eradication goal during 1999.     

Perspectives from the global poliomyelitis eradication initiative

Ten years after the year 2000 target was set by the World Health Assembly, the global poliomyelitis eradication effort has made significant progress towards that goal. The success of the initiative is built on political commitment within the endemic countries. A partnership of international organizations and donor countries works to support the work of the countries. Interagency coordinating committees are used to ensure that all country needs are met and to avoid duplication of donor effort. Private sector support has greatly expanded the resources available at both the national and international level. At the programmatic level, rapid implementation of surveillance is the key to success, but the difficulty of building effective surveillance programmes is often underestimated. Mass immunization campaigns must be carefully planned with resources mobilized well in advance. Programme strategies should be simple, clear and concise. While improvements in strategy and technology should be continuously sought, changes should be introduced only after careful consideration. Careful consideration should be given in the planning phases of a disease control initiative on how the initiative can be used to support other health initiatives.     

Progress toward global eradication of poliomyelitis, 2002

Since the 1988 World Health Assembly resolution to eradicate poliomyelitis globally through 2002, the number of countries where polio is endemic declined from 125 to seven, and the estimated incidence of polio decreased >99%. In 2002, the European Region became the third World Health Organization (WHO) region certified as polio-free, joining the Region of the Americas and the Western Pacific Region, certified polio-free in 1994 and 2000, respectively. Despite these achievements, a provisional total of 1,920 polio cases were reported during 2002, a substantial increase from 483 in 2001, reflecting primarily the large polio epidemic in India. This report summarizes global progress achieved in polio eradication during 2002 and describes remaining challenges.     

Progress toward global eradication of poliomyelitis, 2001

From the initiation of the global poliomyelitis eradication initiative in 1988 through 2001, the number of countries where polio is endemic decreased from 125 to 10, and the number of reported polio cases decreased by >99% from an estimated 350,000 to <1,000. Wild type 2 poliovirus has not been detected worldwide since October 1999. The American and Western Pacific Regions of the World Health Organization (WHO) have been certified free of indigenous wild poliovirus. Current challenges to global polio eradication efforts include ongoing intense transmission in northern India, continued importations of wild poliovirus into polio-free areas, and the detection of circulating vaccine-derived poliovirus (cVDPV). This report summarizes global progress in polio eradication during 2001 and the current status of the initiative.     

Progress towards the global eradication of poliomyelitis.

Poliomyelitis has been virtually eliminated from the industrialized countries by mass campaigns conducted with oral polio vaccine (OPV). In 1988, the World Health Assembly set the goal of global eradication of poliomyelitis by the year 2000. The current WHO strategy for eradication uses three primary activities beyond routine immunization with OPV. They are: (i) improved disease surveillance, (ii) building a global network of laboratories, and (iii) supplemental immunization strategies which include mass immunization campaigns with OPV at the national level, and targeted campaigns at the local level. Eradication of polio from the Region of the Americas is close and may have already been achieved. In other regions, the number of reported polio cases has declined, largely as a result of high immunization coverage. As more countries implement polio eradication strategies, the number of polio cases will continue to fall until eradication is achieved.     

National programme for the control of poliomyelitis

Oral polio vaccine was introduced into India's national immunization program in 1979-80. Coverage with this vaccine has increased rapidly from 0.67 million in 1979-80 to 9.63 million in 1984-85. 3 doses of the vaccine are recommended at age 3-12 months, followed by a booster dose 12-18 months later. The vaccine is administered along with the DPT vaccine. The vaccines are provided as a package of services under the expanded program on immunization (EPI). India's government initiated the EPI in 1978 with the goal of reducing the morbidity and mortality due to diphtheria, pertussis, tetanus, poliomyelitis, tuberculosis, and typhoid fever by making vaccination services available to all eligible children and pregnant women by 1990. In 1985-86, measles vaccination was included in the program. Another objective was to achieve self-sufficiency in the production of vaccines required for the program. Immunization services are provided through the existing health care delivery system: hospitals, dispensaries, and maternal and child health (MCH) clinics in the urban areas primary health centers in rural areas. The aim of universal immunization for all India has been set for 1989-90; some areas may achieve this goal earlier. 30 districts and catchment areas of 50 medical colleges have been taken up in the universal immunization program for 1985-86. The objectives of the universal immunization program include: to provide universal immunization coverage to pregnant women and to infants; to document a reduction in the vaccine preventable diseases; to develop effective implementation and to streamline logistics; and to encourage the active participation of the medical faculty, interns, and students from the planning to the evaluation stages. The government of India provides the vaccines required under the national immunization program to the state health authorities. Over 50 million doses of oral polio vaccine are expected to be utilized during 1985-86. The annual requirements are likely to exceed 80 million doses by 1989-90. The planned targets of vaccination coverage are linked closely to the development of the cold chain system. Since 1984 field samples of oral polio vaccine have been collected for potency tests in order to monitor the quality of the cold chain for vaccines. The effectiveness of the control measures will be evaluated by determining the vaccination coverage of the eligible population and by recording the reduction in incidence of poliomyelitis in the area.     

Global eradication of poliomyelitis: benefit-cost analysis.

A benefit-cost analysis of the Poliomyelitis Eradication Initiative was undertaken to facilitate national and international decision-making with regard to financial support. The base case examined the net costs and benefits during the period 1986-2040; the model assumed differential costs for oral poliovirus vaccine (OPV) and vaccine delivery in industrialized and developing countries, and ignored all benefits aside from reductions in direct costs for treatment and rehabilitation. The model showed that the "break-even" point at which benefits exceeded costs was the year 2007, with a saving of US$ 13 600 million by the year 2040. Sensitivity analyses revealed only small differences in the break-even point and in the dollars saved, when compared with the base case, even with large variations in the target age group for vaccination, the proportion of case-patients seeking medical attention, and the cost of vaccine delivery. The technical feasibility of global eradication is supported by the availability of an easily administered, inexpensive vaccine (OPV), the epidemiological characteristics of poliomyelitis, and the successful experience in the Americas with elimination of wild poliovirus infection. This model demonstrates that the Poliomyelitis Eradication Initiative is economically justified.     

Perspectives from the dracunculiasis eradication programme

After a slow beginning in association with the International Drinking Water Supply and Sanitation Decade (1981-1990), the global Dracunculiasis Eradication Programme has reduced the incidence of dracunculiasis by nearly 97%, from an estimated 3.2 million cases in 1986 to less than 100,000 cases in 1997. Over half of the remaining cases are in Sudan. In addition, the programme has already produced many indirect benefits such as improved agricultural production and school attendance, extensive provision of clean drinking-water, mobilization of endemic communities, and improved care of infants. Most workers in the campaign have other responsibilities in their communities or ministries of health besides dracunculiasis eradication.     

Disease eradication as a public health strategy: a case study of poliomyelitis eradication

Disease eradication as a public health strategy was discussed at international meetings in 1997 and 1998. In this article, the ongoing poliomyelitis eradication initiative is examined using the criteria for evaluating candidate diseases for eradication proposed at these meetings, which covered costs and benefits, biological determinants of eradicability (technical feasibility) and societal and political considerations (operational feasibility). The benefits of poliomyelitis eradication are shown to include a substantial investment in health services delivery, the elimination of a major cause of disability, and far-reaching intangible effects, such as establishment of a "culture of prevention". The costs are found to be financial and finite, despite some disturbances to the delivery of other health services. The "technical" feasibility of poliomyelitis eradication is seen in the absence of a non-human reservoir and the presence of both an effective intervention and delivery strategy (oral poliovirus vaccine and national immunization days) and a sensitive and specific diagnostic tool (viral culture of specimens from acute flaccid paralysis cases). The certification of poliomyelitis eradication in the Americas in 1994 and interruption of endemic transmission in the Western Pacific since March 1997 confirm the operational feasibility of this goal. When the humanitarian, economic and consequent benefits of this initiative are measured against the costs, a strong argument is made for eradication as a valuable disease control strategy.     

湛江市2004年维持无脊髓灰质炎工作评价

目的了解湛江市2004年急性弛缓性麻痹(AFP)病例监测系统的运转情况与口服脊髓灰质炎(脊灰)疫苗(OPV)免疫接种情况,为维持无脊灰状态和消灭脊灰工作制定有效措施提供科学依据。方法对湛江市2004年AFP病例进行流行病学分析,对AFP病例监测系统及OPV免疫接种率进行评价。结果2004年全市报告AFP病例26例,零剂次免疫儿童2例;病例分布于25个镇,无明显季节高峰,<5岁病例占总病例数的61.5%,男女性别比为1.89∶1。26例AFP病例中脊灰病毒分离率为3.8%,为脊灰疫苗株;非脊灰肠道病毒分离率为15.4%。<15岁儿童非脊灰AFP病例报告发病率为1.30/10万。AFP病例48 h调查率、合格粪便标本采集率、标本及时送检率和随访表及时上报率均为100%。本地和流动儿童OPV基础免疫报告接种率分别为97.3%和99.1%。2004/2005年度两轮OPV强化免疫接种率分别为96.9%和97.2%,两轮强化免疫现场快速评估调查接种率均>95%。结论AFP病例监测系统各项监测指标均达到世界卫生组织和卫生部无脊灰证实标准,但AFP病例首诊报告率低,OPV免疫空白仍然存在。今后应继续提高AFP监测系统工作质量,提高OPV免疫接种率,消除免疫空白人群。     

The national leprosy eradication programme in India

India has the largest leprosy problem in the world, with an estimated 4 million patients. The number of registered cases in the country was 2.4 million by June 1990, and the number of new cases detected during 1989-1990, 0.47 million. The disease prevalence varies widely from state to state and even among districts within states--8 of the 26 states contribute to 90% of all the registered cases. The country has a high priority for leprosy and the National Leprosy Eradication Programme (NLEP) aims to arrest the disease among all known cases in the country by the turn of the century through a strategy which includes multidrug therapy (MDT), early case detection, health education and rehabilitation. The specialized leprosy infrastructure in the country has a total of about 8,500 establishments including 719 leprosy control units, 244 district leprosy units and 49 training centres. By June 1990, 130 districts with 2.15 million patients had come under MDT. It is planned to cover 196 districts by 1992, ensuring coverage for 90% of the patients in the country. The country spends approximately 600 million rupees (US$ 33.3 million) per year on NLEP. In addition, a number of bilateral and international agencies including nongovernmental organizations participate in the programme. WHO supports the NLEP through technical inputs, monitoring and evaluation, and training. Plans to integrate leprosy control within primary health care, particularly after completion of the intensive phase of MDT, are being developed. Operational and technical constraints are constantly reviewed in order to find optimal solutions.