The Challenge of Global Poliomyelitis Eradication

• Type of Material: Article
• Authors: Julie R Garon, Emory University; Stephen L Cochi, Center for Global Health Centers for Disease Control and Prevention; Walter A Orenstein, Emory University
• Language: English
• Date: 2015-12-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): https://doi.org/10.1016/j.idc.2015.07.003
• Title of Journal or Parent Work: Infectious Disease Clinics of North America
• Volume: 29
• Issue: 4
• Start Page: 651
• End Page: 665
• Keywords: paralytic polio; Global Polio Eradication Initiative; Inactivated poliovirus vaccine (IPV); poliomyelitis; Oral poliovirus vaccine (OPV)
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Today, few Americans may remember the devastating implications and fear caused by poliomyelitis outbreaks given that there has not been an outbreak of paralytic polio in the United States since 1979. Before the development of effective vaccines, poliomyelitis was a seasonal epidemic disease in the United States. The number of cases peaked in 1952 when more than 20,000 cases of paralytic polio were reported.1 Although some people recovered from paralytic polio, many suffered permanent paralysis and even death. Hospital wards filled with iron lungs and permanently disabled children served as painful visible reminders to society of the toll this debilitating disease took on young lives. With an estimated 350,000 polio cases worldwide and endemic disease in 125 countries the World Health Assembly launched the Global Polio Eradication Initiative (GPEI) in 1988, targeting the disease for eradication. POLIO AS A CANDIDATE FOR ERADICATION Global eradication is currently defined as, “the worldwide absence of a specific disease agent in nature as a result of deliberate control efforts that may be discontinued where the agent is judged no longer to present a significant risk from extrinsic sources.”2 Determining if a disease is a good candidate for eradication depends on whether or not it meets 4 key criteria. These criteria include the following: Humans are required to maintain the pathogen. Sensitive and specific diagnostic tools are available. There is an effective intervention to terminate human-to-human transmission. There is proof of principle (ie, elimination of transmission in a large geographic area). Poliovirus requires a specific cell receptor (PVR or CD155) for infection that is expressed only on human and simian cells.3 Therefore, humans are the only host for sustained poliovirus transmission as primate population sizes are too small to maintain sustained transmission. Breaking the chains of human-to-human transmission can eradicate the virus. Although asymptomatic cases present a challenge to surveillance, AFP reporting and virologic testing of stool are reliable ways to detect polio cases in populations. Although not without certain limitations, oral poliovirus vaccine (OPV) and inactivated poliovirus vaccine (IPV) are effective tools in preventing infection in individuals and reducing circulation of poliovirus within communities. With its low cost, ease of administration, and ability to induce mucosal immunity, OPV has been a particularly useful tool in interruption of transmission in populations. Lastly, early elimination of polio in the Western hemisphere served as proof of principle that eradication was possible throughout the world.