Update: Eradication of Paralytic Poliomyelitis in the Americas
On August 23, 1991, a 2-year-old boy in the district of Junin,
Peru, had onset of symptoms of culture-confirmed paralytic
poliomyelitis. This is the last case of paralytic poliomyelitis
with a wild poliovirus isolate reported to the Pan American Health
Organization (PAHO) and the first time since reporting of
poliomyelitis began in the Western Hemisphere that no such
paralytic disease has been detected for an entire year. This report
updates the poliomyelitis eradication effort in the Americas.
The initiative to eradicate the indigenous transmission of
wild poliovirus from the Western Hemisphere was initiated by the
Director of PAHO in May 1985 (1). Using national vaccination days
with live, oral poliovirus vaccine (OPV) and intensive surveillance
activities, the number of cases of poliomyelitis caused by wild
poliovirus decreased from approximately 1000 reported cases in 1986
to nine laboratory-confirmed cases in 1991. Eight of the nine cases
detected in 1991 occurred in Colombia during January through April.
An extensive active surveillance system for acute flaccid
paralysis (AFP), used as a proxy indicator of paralytic
poliomyelitis, has been established in all countries in Latin
America. More than 20,000 health units participate in the network
and report each week on the occurrence or absence of AFP. A
parallel laboratory-based surveillance network was also established
to isolate and characterize polioviruses. Of the more than 6000
stool specimens collected from case-patients with AFP tested during
1990-1992, wild poliovirus was isolated from 18 persons with
confirmed poliomyelitis * in 1990, nine in 1991, and none thus far
in 1992.
In July 1990, PAHO established an International Certification
Commission to independently verify whether transmission of wild
poliovirus infection has been truly interrupted in the Americas.
The work of the Commission is expected to last at least until 1995.
If surveillance for AFP is maintained at very high levels and if no
confirmed cases of paralytic poliomyelitis are detected over a
3-year period, the Americas will be certified as polio-free.
However, vaccination coverage must be maintained at high levels
until global eradication has been accomplished.
Reported by: C de Quadros, MD, J-M Olive MD, P Carrasco, MPA, C
Silveira, MD, J Fitzsimmons, MURP, F Pinheiro, MD, Pan American
Health Organization, Washington, DC.
Editorial Note
Editorial Note: Based on the successful implementation of the
eradication initiative in the American Region and the progress of
the Expanded Program on Immunization in achieving high levels of
vaccination coverage worldwide, the 41st World Health Assembly
adopted a resolution in May 1988 that called for the global
eradication of poliomyelitis by the year 2000 (2). Countries in the
Western Pacific Region of the World Health Organization (WHO),
including the Peoples Republic of China, have established the goal
of poliomyelitis eradication by 1995. Although many of the
countries of the African, Eastern Mediterranean, European, and
Southeast Asia regions still report endemic poliomyelitis, regional
and national elimination plans have been developed and are being
implemented. Although WHO estimates that the current worldwide
reporting efficiency for poliomyelitis is only approximately 10%,
the number of reported cases declined to 12,992 in 1991,
representing a 41% decrease from 1990 and a 60% decrease from 1988.
The apparent elimination of wild poliovirus infection in the
Americas underscores the feasibility of achieving a similar goal in
other regions. The current WHO-recommended strategy for the global
eradication effort is based on the experience gained by PAHO and
includes maintaining high OPV coverage levels in all districts;
improving surveillance of AFP; conducting supplemental vaccination
activities, such as national vaccination campaigns (in addition to
the routine program); and establishing a global laboratory network.
The WHO strategy offers the best means available to eliminate
poliomyelitis from other areas of the world, and all areas with
endemic polio should plan to implement this approach. Major
challenges facing the global initiative are to 1) generate the
necessary political and social will in all countries; 2) identify
sufficient funds to purchase vaccine and conduct eradication
activities; 3) seek means of reducing the cost of OPV; and 4)
refine strategies to achieve eradication in the most timely and
cost effective manner.
Reference
Pan American Health Organization. Director announces campaign to
eradicate poliomyelitis from the Americas by 1990. Bull Pan Am
Health Organ 1985;19:213-5.
World Health Assembly. Global eradication of poliomyelitis by
the year 2000. Geneva: World Health Organization, 1988. (Resolution
WHA41.28).
Either from case-patient or from children in contact with
case-patient.
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