Search

Despite a half-century-long global eradication effort, polio continues to have a devastating impact on individuals and communities worldwide, especially in low-income countries affected by conflict or geographic barriers to immunization programs. In response, the World Health Organization (WHO) Global Polio Eradication Initiative (GPEI) employs disease surveillance and vaccination campaigns coordinated through the WHO Regional Office for Africa (AFRO) Geographic Information System (GIS) Centre. Established in 2017, the AFRO GIS Centre played a key role in the eradication of wild-type polioviruses (WPVs) in 2020, but the COVID-19 pandemic, emergence of circulating vaccine-derived polioviruses, and transmission of WPV1 from Central Asia have led to a resurgence of polio in Sub-Saharan Africa. The AFRO GIS comprises a set of mobile device or cloud-based tools for geospatial data collection, analysis, and visualization. Using tools such as Auto-Visual Acute Flaccid Paralysis Detection and Reporting, electronic surveillance, and Integrated Supportive Supervision, GIS personnel collect polio case numbers and locations, track field worker activities, follow the movements of nomadic populations vulnerable to polio and other diseases, and determine needs for further healthcare deployments. The system is location specific and operates in real time, enabling the AFRO GIS to promptly target its responses to polio, COVID-19, Ebola virus disease, and other public health crises and natural disasters. The present review describes the components of the AFRO GIS and how the AFRO GIS Centre coordinated on-the-ground polio eradication efforts to help secure Africa's certification as WPV free. It also examines current and prospective challenges regarding other disease outbreaks in the COVID-19 era and how the AFRO GIS Centre is addressing these ongoing public health needs., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2024 Kipterer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Geospatial data reporting from surveillance and immunization efforts is a key aspect of the World Health Organization (WHO) Global Polio Eradication Initiative in Africa. These activities are coordinated through the WHO Regional Office for Africa Geographic Information Systems Centre. To ensure the accuracy of field-collected data, the WHO Regional Office for Africa Geographic Information Systems Centre has developed mobile phone apps such as electronic surveillance (eSURV) and integrated supportive supervision (ISS) geospatial data collection programs. While eSURV and ISS have played a vital role in efforts to eradicate polio and control other communicable diseases in Africa, disease surveillance efforts have been hampered by incomplete and inaccurate listings of health care sites throughout the continent. To address this shortcoming, data compiled from eSURV and ISS are being used to develop, update, and validate a Health Facility master list for the WHO African region that contains comprehensive listings of the names, locations, and types of health facilities in each member state. The WHO and Ministry of Health field officers are responsible for documenting and transmitting the relevant geospatial location information regarding health facilities and traditional medicine sites using the eSURV and ISS form; this information is then used to update the Health Facility master list and is also made available to national ministries of health to update their respective health facility lists. This consolidation of health facility information into a single registry is expected to improve disease surveillance and facilitate epidemiologic research for the Global Polio Eradication Initiative, as well as aid public health efforts directed at other diseases across the African continent. This review examines active surveillance using eSURV at the district, country, and regional levels, highlighting its role in supporting polio surveillance and immunization efforts, as well as its potential to serve as a fundamental basis for broader public health initiatives and research throughout Africa., (©Marie Aimee Babona Nshuti, Kebba Touray, Ticha Johnson Muluh, Godwin Akpan Ubong, Reuben Opara Ngofa, Bello Isa Mohammed, Ishimwe Roselyne, David Oviaesu, Evans Mawa Oliver Bakata, Fiona Lau, John Kipterer, Hugh Henry W Green, Vincent Seaman, Jamal A Ahmed, Modjirom Ndoutabe. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 21.06.2024.)

Serotype 2 oral poliovirus vaccine (OPV2) can revert to regain wild-type neurovirulence and spread to cause emergences of vaccine-derived poliovirus (VDPV2). After its global withdrawal from routine immunization in 2016, outbreak response use has created a cycle of VDPV2 emergences that threaten eradication. We implemented a hierarchical model based on VP1 region genetic divergence, time, and location to attribute emergences to campaigns and identify risk factors. We found that a 10 percentage point increase in population immunity in children younger than 5 years at the campaign time and location corresponds to a 18.0% decrease (95% credible interval [CrI], 6.3%-28%) in per-campaign relative risk, and that campaign size is associated with emergence risk (relative risk scaling with population size to a power of 0.80; 95% CrI, .50-1.10). Our results imply how Sabin OPV2 can be used alongside the genetically stable but supply-limited novel OPV2 (listed for emergency use in November 2020) to minimize emergence risk., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

In August 2020, Africa was declared free of poliomyelitis (polio), bringing to fruition a goal that took more than 30 years to achieve. This Perspective chronicles global, continental, national and community actions taken by diverse stakeholders that finally led to the elimination of transmission of wild poliovirus in Africa. The cascade of events started with the development of polio vaccines and the realization that polio, much like smallpox, could be eradicated. After a 1988 pledge by the World Health Assembly to eradicate polio globally, concerted and deliberate efforts were made in Africa to achieve this goal. This included the use of evidence-based approaches for the harmonization and standardization of public health strategies, using a network of polio laboratories and emergency operation centres and actively pursuing underserved populations. Innovative solutions to counter challenges such as conflict and vaccine hesitancy may be of use in future public health interventions., (© 2021. Springer Nature Limited.)

In April 2016, the Global Polio Eradication Initiative (GPEI) adjusted its polio vaccination strategy, converting trivalent oral polio vaccine (tOPV) into bivalent oral polio vaccine (bOPV), and withdrawing type 2 oral polio vaccine (OPV2) globally. However, after the withdrawal of OPV2, there were many outbreaks of type-2 circulating vaccine-derived poliovirus (cVDPV2) in Asia and Africa. In order to eradicate poliovirus completely, GPEI launched the research and development of the novel serotype 2 oral polio vaccine (nOPV2) in 2010 and considering whether it is necessary to reuse OPV. This paper summarizes the epidemiological situation of cVDPV2 before and after OPV2's withdrawal, the related factors affecting the reuse of OPV and the related research progress of nOPV2.

Background: As we move toward a polio-free world, the challenge for the polio program is to create an unrelenting focus on smaller areas where the virus is still present, where children are being repeatedly missed, where immunity levels are low, and where surveillance is weak., Objective: This article aimed to describe a possible solution to address weak surveillance systems and document the outcomes of the deployment of the Auto-Visual Acute Flaccid Paralysis Detection and Reporting (AVADAR) project., Methods: This intervention was implemented in 99 targeted high-risk districts with concerns for silent polio circulation from eight countries in Africa between August 1, 2017, and July 31, 2018. A total of 6954 persons (5390 community informants and 1564 health workers) were trained and equipped with a smartphone on which the AVADAR app was configured to allow community informants to send alerts on suspected acute flaccid paralysis (AFP) and allow health worker to use electronic checklists for investigation of such alerts. The AVADAR and Open Data Kit ONA servers were at the center of the entire process. A dashboard system and coordination teams for monitoring and supervision were put in place at all levels., Results: Overall, 96.44% (24,142/25,032) of potential AFP case alerts were investigated by surveillance personnel, yielding 1414 true AFP cases. This number (n=1414) reported through AVADAR was higher than the 238 AFP cases expected during the study period in the AVADAR districts and the 491 true AFP cases reported by the traditional surveillance system. A total of 203 out of the 1414 true AFP cases reported were from special population settings, such as refugee camps and insecure areas. There was an improvement in reporting in silent health areas in all the countries using the AVADAR system. Finally, there were 23,473 reports for other diseases, such as measles, diarrhea, and cerebrospinal meningitis, using the AVADAR platform., Conclusions: This article demonstrates the added value of AVADAR to rapidly improve surveillance sensitivity. AVADAR is capable of supporting countries to improve surveillance sensitivity within a short interval before and beyond polio-free certification., (©Johnson Muluh Ticha, Godwin Ubong Akpan, Lara MF Paige, Kamel Senouci, Andrew Stein, Patrick Briand, Jude Tuma, Daniel Rasheed Oyaole, Reuben Ngofa, Sylvester Maleghemi, Kebba Touray, Abdullahi Ahmed Salihu, Mamadou Diallo, Sisay Gashu Tegegne, Isah Mohammed Bello, Umar Kabo Idris, Omosivie Maduka, Casimir Manengu, Faisal Shuaib, Michael Galway, Pascal Mkanda. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 02.12.2020.)

The author analyzes the aftermath of Edward Hooper's suggestion that the trial of an oral polio vaccine (OPV) in the Belgian colonies of Africa engendered the pandemic form of the AIDS virus, HIV-1. In response to Hooper's book, The River (1999), the Royal Society in London held a conference to debate the origins of HIV. Examination of the quick dismissal of the OPV theory opens a space for legitimately challenging the widely held belief that the vaccine contamination question was convincingly resolved. This article interrogates the relationship between historiography and the making of scientific facts and history, suggesting that historians have been too credulous of scientists' testimony. The further result of the lack of a thorough analysis of the evidence backing the OPV hypothesis has resulted in a missed opportunity to read The River as one of the few detailed accounts of the immense social, political, technological, and interspecies infrastructure constituted by Cold War vaccine production. This biomedical infrastructure dramatically changed the geographic and interspecies mobility of viruses in ways that may be impossible to reconstruct. Yet these potential transmission routes remain crucial to acknowledge. The COVID-19 pandemic draws attention to the critical importance of studying The WetNet, a concept coined by the author to name the conceptual and material infrastructures of inter- and intraspecies fluid bonding., (© 2020 The Authors. Medical Anthropology Quarterly published by Wiley Periodicals, Inc. on behalf of American Anthropological Association.)

Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Introduction: The effect of the Global polio eradication initiative (PEI) on public health programs beyond polio is widely debated. PEI contribution to other health programs has been assessed from the perspective of polio-funded personnel, which may introduce bias as PEI staff are probably more likely to show that they have benefited of other programs. We set out to identify and document how public health programs have benefited from the public health capacity that was provided at the country level as part of the PEI program in a systematic and standardized manner., Methods: Between July and November 2017, we conducted a mixed-methods cross-sectional study, which combined two methods: a multi-country quantitative survey and a qualitative study. We created a self-administered electronic multi-lingual questionnaire in English, French and Portuguese. The qualitative study, which followed an interim analysis of the quantitative survey, comprised interviews with national and subnational level staff in a few countries., Results: A total of 127 public health workers from 43 of the 47 countries in the African WHO Region responded online. Most of the respondents 56/127 (42.7%) belonged to the immunization sector and 51/127 (38.9%) belonged to the emergencies and outbreaks sector. Respondents who identified themselves with the immunization (50/64 (78%)) and maternal health program (64/82 (78%)) reported the highest level of greatly benefiting from PEI resources. A total of 78/103 (76%) respondents rated PEI's contribution data management system to their program very high and high. Of the 127 respondents, the majority 91 (71.6%) reported that the withdrawal of PEI resources would result in a weakening of surveillance for other diseases; 88 (62.9%) reported that there would be inadequate resources to carry out planned activities and 80 (62.9%) reported that there would be poor logistics and transport for implementation of activities. Cameroon, DRC, Nigeria and Uganda participated in the qualitative study. Each country had between 7-8 key informants from the national and sub-national level for a total of 31 key informants. Polio funds and other PEI resources have supported various activities in the ministries of health of the four countries especially IDSR, data management, laboratories and development of the public health workforce. Respondents believed that the infrastructure and processes that PEI has created need to be maintained, along with the workforce and they believed that this was an essential role of their governments with support from the partners., Conclusion: There is a high awareness of the PEI program in all the countries and at all levels which should be leveraged into improving other child survival activities for example routine immunizations. Future large-scale programs of this nature should be designed to benefit other public health programs beyond the specific program. The public health workforce, surveillance development, data management and laboratory strengthening that have been developed by PEI need to be maintained., Competing Interests: The authors declare no competing interests.

Background: Persons with primary immune deficiency disorders (PID), especially those disorders affecting the B-cell system, are at substantially increased risk of paralytic poliomyelitis and can excrete poliovirus chronically. However, the risk of prolonged or chronic excretion is not well characterized in developing countries. We present a summary of a country study series on poliovirus excretion among PID cases., Methods: Cases with PID from participating institutions were enrolled during the first year and after obtaining informed consent were tested for polioviruses in stool samples. Those cases excreting poliovirus were followed on a monthly basis during the second year until 2 negative stool samples were obtained., Results: A total of 562 cases were enrolled in Bangladesh, China, Iran, Philippines, Russia, Sri Lanka, and Tunisia during 2008-2013. Of these, 17 (3%) shed poliovirus, including 2 cases with immunodeficient vaccine-derived poliovirus. Poliovirus was detected in a single sample from 5/17 (29%) cases. One case excreted for more than 6 months. None of the cases developed paralysis during the study period., Conclusions: Chronic polioviruses excretion remains a rare event even among individuals with PID. Nevertheless, because these individuals were not paralyzed they would have been missed by current surveillance; therefore, surveillance for polioviruses among PID should be established., (© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Despite substantial progress, global polio eradication has remained elusive. Indigenous wild poliovirus (WPV) transmission in 4 endemic countries (Afghanistan, India, Nigeria, and Pakistan) persisted into 2010 and outbreaks from imported WPV continued. By 2013, most outbreaks in the interim were promptly controlled. The number of polio-affected districts globally has declined by 74% (from 481 in 2009 to 126 in 2013), including a 79% decrease in the number of affected districts in endemic countries (from 304 to 63). India is now polio-free. The challenges to success in the remaining polio-endemic countries include (1) threats to the security of vaccinators in each country and a ban on polio vaccination in areas of Afghanistan and Pakistan; (2) a risk of decreased government commitment; and (3) remaining surveillance gaps. Coordinated efforts under the International Health Regulations and efforts to mitigate the challenges provide a clear opportunity to soon secure global eradication., (Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2014. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Since 1988, when the Global Polio Eradication Initiative (GPEI) began, the annual number of polio cases has decreased by >99%. Only three countries remain that have never interrupted wild poliovirus (WPV) transmission: Afghanistan, Nigeria, and Pakistan. Since 2001, outbreaks have occurred in 31 formerly polio-free counties in Africa, with outbreaks in 25 countries caused by WPV originating in Nigeria (2-4). After the declaration of the World Health Assembly of polio eradication as a programmatic emergency in 2012, efforts to identify areas at high risk for importation-associated outbreaks and to reduce that risk have been intensified. This report updates the 2013 assessment of the risk for outbreaks attributable to importation of poliovirus in 33 countries in Africa, using indicators of childhood susceptibility to poliovirus and proximity to countries currently affected by polio . From January 2013 to August 12, 2014, outbreaks occurred in five African countries. Four of the five (Cameroon, Equatorial Guinea, Ethiopia, and Somalia) have had recent transmission (cases within the previous 12 months). Based on the current risk assessment, 15 countries are considered to be at high risk for WPV outbreaks, five at moderate-to-high risk, seven at moderate risk, and six at low risk. In 15 of the 33 countries, less than half of the population resides in areas where surveillance performance indicators have met minimum targets. Enhanced, coordinated activities to raise childhood immunity are underway in 2014 to prevent additional WPV spread. Although substantial progress toward polio eradication has occurred in Nigeria, all African countries remain at risk for outbreaks as long as WPV continues to circulate anywhere on the continent.

In 2012, the World Health Assembly of the World Health Organization (WHO) declared the completion of polio eradication a programmatic emergency. Indigenous wild poliovirus (WPV) transmission remains uninterrupted in Nigeria (in the WHO African Region [AFR]) and in Afghanistan and Pakistan (in the WHO Eastern Mediterranean Region [EMR]). In the WHO AFR, multiple WPV outbreaks have occurred since 2003 after importation of indigenous West African WPV into 21 previously polio-free countries in a "WPV importation belt"* that extends across the continent. The Global Polio Eradication Initiative (GPEI) and WHO regional offices have used indicators of population immunity, surveillance quality, and other factors (e.g., high-risk subpopulations and proximity to WPV-affected countries) to assess the risk for outbreaks in polio-free countries and guide the implementation of risk mitigation measures to limit poliovirus transmission after WPV importation and prevent the emergence of circulating vaccine-derived poliovirus (cVDPV). Despite risk mitigation efforts, a polio outbreak, first confirmed in May 2013, is ongoing; as of September 10, a total of 178 WPV type 1 (WPV1) cases have been reported in Somalia† (163 cases), Kenya (14 cases) and Ethiopia (1 case), after importation of WPV1 of West African origin. This report summarizes steps taken by the GPEI to assess and mitigate the risks for outbreaks after WPV importation or the emergence of cVDPV in polio-free countries within the WHO AFR's "WPV importation belt." All countries will continue to have some level of risk for WPV outbreaks as long as endemic circulation continues in Afghanistan, Nigeria, and Pakistan.

In 1988, the World Health Assembly resolved to eradicate poliomyelitis worldwide. One of the main tools used in polio eradication efforts has been the live, attenuated oral poliovirus vaccine (OPV). This inexpensive vaccine is administered easily by mouth, makes recent recipients resistant to infection by wild polioviruses (WPVs), and provides long-term protection against paralytic disease through durable humoral immunity. Nonetheless, rare cases of vaccine-associated paralytic poliomyelitis can occur both among immunologically normal OPV recipients and their contacts and among persons who are immunodeficient. In addition, vaccine-derived polioviruses (VDPVs) can emerge to cause polio outbreaks in areas with low OPV coverage and can replicate for years in persons who are immunodeficient. This report updates previous surveillance summaries and describes VDPVs detected worldwide during April 2011-June 2012. In 2011, a new outbreak of circulating VDPVs (cVDPVs) was identified in Yemen; a second VDPV isolate, related to a previously reported VDPV isolate, signaled an outbreak in Mozambique; and VDPV circulation reemerged in Madagascar. An outbreak that began in Somalia in 2008 continued until December 2011. Outbreaks in Nigeria and the Democratic Republic of the Congo (DRC) identified in 2005 and 2008, respectively, continued in 2012. Niger experienced a new cVDPV importation from Nigeria in 2011. Twelve newly identified persons in six middle-income countries were found to excrete immunodeficiency-associated VDPVs (iVDPVs), and VDPVs were found among healthy persons and environmental samples in 13 countries. To prevent VDPV emergence and spread, all countries should maintain high vaccination coverage against all three poliovirus serotypes; OPV use will be discontinued worldwide once all WPV transmission is interrupted.

Problem of poliomyelitis eradication is examined in the review. After the eradication of wild poliovirus, vaccine poliomyelitis virus continues to circulate in the human population. In rare cases it can cause the development of the disease. The authors describe disadvantages of the use of oral and inactivated poliomyelitis vaccines and note that by using oral poliomyelitis vaccine and eradication only of wild poliovirus, eradication of poliomyelitis as an infection will not succeed. As one of the approaches to reach this goal the authors propose the use of various enterovirus interference. Use of live enterovirus vaccine is described and its advantages and disadvantages are examined.

In January 2012, polio eradication was declared a "programmatic emergency for global public health" by the Executive Board of the World Health Organization (WHO). Since the Global Polio Eradication Initiative (GPEI) began in 1988, progress has been tracked by surveillance of acute flaccid paralysis (AFP) cases and testing of linked stool specimens for polioviruses (PVs) in WHO-accredited Global Polio Laboratory Network (GPLN) laboratories, complemented by sewage testing (environmental surveillance) in selected areas. Monitoring AFP surveillance quality at national and subnational administrative levels using standard performance indicators identifies potential gaps where PV circulation might go undetected; monitoring specimen transport and laboratory reporting timeliness identifies areas where reporting delays could lead to late response, permitting ongoing transmission. This report provides an assessment of 2010-2011 performance indicators for AFP surveillance at national and subnational levels in polio-affected countries and laboratory reporting at the regional level, updated from 2009-2010. Overall, 16 (62%) of 26 countries with circulating wild PV (WPV) met national AFP surveillance indicator targets during both 2010 and 2011. All three countries with reestablished WPV transmission and 16 of 19 countries with WPV outbreaks had substantial proportions (>20%) of their respective populations living in areas with underperforming surveillance during 2010 or 2011. Targets for timely reporting of PV isolation and type characterization results were met in three of six WHO regions in 2010 and five regions in 2011. To achieve polio eradication, efforts are needed to improve AFP surveillance and laboratory performance.

By January 2012, 23 years after the Global Polio Eradication Initiative (GPEI) was begun, indigenous wild poliovirus (WPV) transmission had been interrupted in all countries except Afghanistan, Pakistan, and Nigeria. However, importation of WPV into 29 previously polio-free African countries during 2003-2011 led to reestablished WPV transmission (i.e., lasting >12 months) in Angola, Chad, Democratic Republic of the Congo (DRC), and Sudan (although the last confirmed case in Sudan occurred in 2009). This report summarizes progress toward polio eradication in Africa. In 2011, 350 WPV cases were reported by 12 African countries, a 47% decrease from the 657 cases reported in 2010. From 2010 to 2011, the number of cases decreased in Angola (from 33 to five) and DRC (from 100 to 93) and increased in Nigeria (from 21 to 62) and Chad (from 26 to 132). New WPV outbreaks were reported in 2011 in eight African countries, and transmission subsequently was interrupted in six of those countries. Ongoing endemic transmission in Nigeria poses a major threat to the success of GPEI. Vigilant surveillance and high population immunity levels must be maintained in all African countries to prevent and limit new outbreaks.

Background: Outbreaks of poliomyelitis in African countries that were previously free of wild-type poliovirus cost the Global Polio Eradication Initiative US$850 million during 2003-2009, and have limited the ability of the program to focus on endemic countries. A quantitative understanding of the factors that predict the distribution and timing of outbreaks will enable their prevention and facilitate the completion of global eradication., Methods and Findings: Children with poliomyelitis in Africa from 1 January 2003 to 31 December 2010 were identified through routine surveillance of cases of acute flaccid paralysis, and separate outbreaks associated with importation of wild-type poliovirus were defined using the genetic relatedness of these viruses in the VP1/2A region. Potential explanatory variables were examined for their association with the number, size, and duration of poliomyelitis outbreaks in 6-mo periods using multivariable regression analysis. The predictive ability of 6-mo-ahead forecasts of poliomyelitis outbreaks in each country based on the regression model was assessed. A total of 142 genetically distinct outbreaks of poliomyelitis were recorded in 25 African countries, resulting in 1-228 cases (median of two cases). The estimated number of people arriving from infected countries and <5-y childhood mortality were independently associated with the number of outbreaks. Immunisation coverage based on the reported vaccination history of children with non-polio acute flaccid paralysis was associated with the duration and size of each outbreak, as well as the number of outbreaks. Six-month-ahead forecasts of the number of outbreaks in a country or region changed over time and had a predictive ability of 82%., Conclusions: Outbreaks of poliomyelitis resulted primarily from continued transmission in Nigeria and the poor immunisation status of populations in neighbouring countries. From 1 January 2010 to 30 June 2011, reduced transmission in Nigeria and increased incidence in reinfected countries in west and central Africa have changed the geographical risk of polio outbreaks, and will require careful immunisation planning to limit onward spread. Please see later in the article for the Editors' Summary.

In 1988, the World Health Assembly resolved to eradicate poliomyelitis worldwide. The live, attenuated oral poliovirus vaccine (OPV) has many advantages favoring its use in polio eradication: it is administered easily by mouth; confers intestinal immunity, making recent OPV recipients resistant to infection by wild polioviruses (WPVs); provides long-term protection against paralytic disease through durable humoral immunity; and is inexpensive. Despite its many advantages, OPV use carries the risk for occurrence of rare cases of vaccine-associated paralytic poliomyelitis among immunologically normal OPV recipients and their contacts and the additional risk for emergence of vaccine-derived polioviruses (VDPVs). Because of these risks, OPV use will be discontinued worldwide once the goal of eradicating all WPV transmission is achieved. VDPVs can cause polio outbreaks in areas with low OPV coverage and can replicate for years in immunodeficient persons; therefore, strategies to strengthen global polio immunization and surveillance are needed to limit emergence of VDPVs. This report updates previous surveillance summaries and describes VDPVs detected worldwide during July 2009--March 2011 and reported as of June 20, 2011. Three new outbreaks of circulating VDPVs (cVDPVs), ranging in size from six to 16 cases, were identified in Afghanistan, Ethiopia, and India; three previously identified outbreaks in Nigeria, Democratic Republic of Congo (DRC), and Somalia continued through late 2010 or into 2011 and resulted in 355, 37, and 13 total cases, respectively; two countries experienced importations of cVDPVs from Nigeria; nine newly identified paralyzed immunodeficient persons in seven middle-income and developing countries were found to excrete VDPVs; and VDPVs were found among persons and environmental samples in 15 countries. With the use of alternate OPV formulations since 2005 and with enhanced poliovirus surveillance sensitivity and laboratory screening, the number of identified cVDPV outbreaks per year has increased over time . To prevent VDPV emergence and spread, all countries should maintain high poliovirus vaccination coverage against all three poliovirus serotypes. Sensitive poliovirus surveillance to detect VDPVs will continue to increase in importance.

The Global Polio Eradication Initiative (GPEI) was launched in 1988. By 2006, transmission of indigenous wild poliovirus (WPV) was interrupted in all but four countries (Afghanistan, Pakistan, India, and Nigeria). Subsequently, 39 previously polio-free countries experienced outbreaks following importation of WPV, and transmission became reestablished in Angola, Chad, Democratic Republic of the Congo (DRC), and Sudan. This update summarizes progress toward polio eradication during 2010 and the first quarter of 2011. Worldwide, 1,291 WPV cases were reported in 2010, a 19% decrease from 2009; WPV type 3 (WPV3) cases decreased 92%, but WPV type 1 (WPV1) cases increased 145%. During 2010, 232 (18%) WPV cases were reported from the four polio-endemic countries; 159 (12%) cases were reported in Angola, Chad, and DRC; and 900 (70%) cases were reported in 13 countries, including two countries with outbreaks continuing from 2009 and 11 with new importations. During 2010, WPV cases in India and Nigeria decreased ≥94% compared with 2009. Outbreaks in Tajikistan and the Republic of the Congo (Congo) accounted for two thirds of cases (842) in 2010. All new outbreaks in 11 polio-free countries in 2010 were stopped or were on track to being stopped within 6 months of outbreak confirmation. During January--March 2011, substantially more WPV cases occurred in Chad, DRC, and Pakistan than during the same period of 2010. To further progress toward polio eradication and achieve the 2012 target of ending all WPV transmission, significant increases in resources and political commitment are needed.

By examining the role research has played in eradication or regional elimination initiatives for three viral diseases--smallpox, poliomyelitis, and measles--we derive nine cross-cutting lessons applicable to malaria eradication. In these initiatives, some types of research commenced as the programs began and proceeded in parallel. Basic laboratory, clinical, and field research all contributed notably to progress made in the viral programs. For each program, vaccine was the lynchpin intervention, but as the programs progressed, research was required to improve vaccine formulations, delivery methods, and immunization schedules. Surveillance was fundamental to all three programs, whilst polio eradication also required improved diagnostic methods to identify asymptomatic infections. Molecular characterization of pathogen isolates strengthened surveillance and allowed insights into the geographic source of infections and their spread. Anthropologic, sociologic, and behavioural research were needed to address cultural and religious beliefs to expand community acceptance. The last phases of elimination and eradication became increasingly difficult, as a nil incidence was approached. Any eradication initiative for malaria must incorporate flexible research agendas that can adapt to changing epidemiologic contingencies and allow planning for posteradication scenarios.

The Global Polio Eradication Initiative (GPEI) began in 1988. By 2006, indigenous transmission of wild poliovirus (WPV) had been interrupted in all but four countries (Afghanistan, India, Nigeria, and Pakistan). However, outbreaks following WPV importations into previously polio-free countries remain an ongoing risk until polio is eradicated. The GPEI Strategic Plan for 2010-2012 set the following two goals for outbreak control: 1) end outbreaks occurring in 2009 by mid-2010 and 2) end outbreaks occurring during 2010 to mid-2012 within 6 months of confirmation. This report describes new outbreaks that have occurred in the World Health Organization (WHO) European Region and updates previous reports on the status of outbreaks in Africa and Asia. In 2010, the first WPV importation into the European Region since the region was declared polio-free in 2002 resulted in 476 confirmed cases: 458 in Tajikistan, 14 in Russia, three in Turkmenistan, and one in Kazakhstan. In Africa and Asia, 11 new importations into six countries were observed in 2010; 30 WPV importations that occurred during 2008-2009 resulted in 215 cases in 15 African countries during 2009-2010. An outbreak is considered interrupted if 6 months have elapsed since the latest confirmed case and surveillance performance indicators meet WHO standards. All 2009 outbreaks in Africa appear to have been interrupted, and 2010 outbreaks in three countries appear to have been interrupted. Maintaining high routine vaccination coverage and sensitive surveillance at all times and rapidly instituting additional immunization programs to control outbreaks are key to limiting and stopping the spread of WPV.

The aim of this study was to evaluate the level of poliomyelitis immunization in refugees residing in the Asylum Seeker Center in Bari. The study was carried out during 2008 and involved 573 refugees. An antibody titer >or=1:8 was found in 99.6% for poliovirus 1, in 99.8% for poliovirus 2, and in 99.5% for poliovirus 3.

In 1988, the World Health Assembly resolved to eradicate poliomyelitis worldwide. Subsequently, the Global Polio Eradication Initiative of the World Health Organization (WHO) reduced the global incidence of polio associated with wild polioviruses (WPVs) from an estimated 350,000 cases in 125 countries in 1988 to 1,651 reported cases in 2008 and reduced the number of countries that have never interrupted WPV transmission to four (Afghanistan, India, Nigeria, and Pakistan). Under current WHO plans, when the goal of eradicating all WPV transmission is attained, oral poliovirus vaccine (OPV) use worldwide eventually will be discontinued. However, because vaccine-derived polioviruses (VDPVs) can produce polio outbreaks in areas with low rates of Sabin OPV coverage and can replicate for years in immunodeficient persons, enhanced strategies are needed to limit emergence of VDPVs. This report updates previous summaries and describes VDPVs detected worldwide during January 2008-June 2009. During this period, 1) two new outbreaks of circulating VDPVs (cVDPVs) (accounting for 4-20 cases) were identified in the Democratic Republic of Congo and Ethiopia; 2) a previously identified outbreak in Nigeria ultimately resulted in a cumulative total of 292 cases; 3) two newly identified paralyzed immunodeficient persons in Argentina and the United States were found to excrete VDPVs; and 4) isolated VDPVs were found among persons and environmental samples in 11 countries. All countries need to maintain 1) high rates of poliovirus vaccination coverage to prevent VDPV spread and 2) sensitive poliovirus surveillance to detect VDPVs.

The Global Polio Eradication Initiative began in 1988; by 2006, indigenous transmission of wild poliovirus (WPV) type 2 infection had been interrupted globally, and indigenous transmission of type 1 and 3 (WPV1 and WPV3) infection had been interrupted in all but four countries worldwide (Afghanistan, India, Nigeria, and Pakistan). Despite this success in controlling indigenous transmission, during 2002-2006, 20 previously polio-free countries in Africa and Asia had importations of WPV1 originating from Nigeria, and three polio-free countries in Africa had WPV1 importations originating from India. By the end of 2007, control efforts in all countries except Angola, Chad, Democratic Republic of the Congo (DRC), Niger, and Sudan had stopped transmission of WPV1 caused by these importations. However, during 2008-2009, multiple importations of WPV from countries with ongoing transmission resumed in Africa. This report describes 32 WPV importations into 15 African countries, resulting in 96 polio cases during January 2008-March 2009 and persistent WPV transmission in five previously polio-free African countries. As with the 2002-2006 resurgence, all of the importations originated from Nigeria or India, but more rapid WPV identification and response resulted in substantially fewer polio cases than reported during 2002-2006. Sensitive surveillance and continued rapid response supplemental immunization activities (SIAs) are key to limiting further WPV spread, interrupting the outbreaks, and allowing the polio prevention focus in Africa to return to eradicating polio in countries with persistent WPV transmission.