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- W2080771908 abstract "The excellent study by Q Sue Huang and colleagues (July 30, p 394)1Huang QS Greening G Baker MG et al.Persistence of oral polio vaccine virus after its removal from the immunization schedule in New Zealand.Lancet. 2005; 366: 394-396Summary Full Text Full Text PDF PubMed Scopus (53) Google Scholar addresses crucial questions about global polio eradication. Several lessons are to be learned from it. If two cases of vaccine-associated paralytic polio (VAPP) in a population of 3·7 million prompted the switch from live attenuated oral polio vaccine (OPV) to inactivated vaccine (IPV), what should countries with much larger numbers of cases do? India had 181 cases of VAPP in 1999.2Kohler K Banrjee K Hlady WG Andrus JK Sutter RW Vaccine-associated paralytic poliomyelitis in India during 1999: decreased risk in spite of massive use of oral poliovaccine.Bull World Health Organ. 2002; 80: 210-216PubMed Google Scholar OPV must be stopped as early as possible after interrupting wild virus transmission, but will it be safe to discontinue OPV without vaccination coverage with IPV? Huang and colleagues recommend doing studies on vaccine virus persistence in tropical developing countries where transmission is likely to be more intense. Whatever the outcome of such a study, stopping OPV without IPV coverage will be unsafe. Canada, USA, most European countries, and New Zealand have already switched from OPV to IPV and if the success of curtailing vaccine virus circulation was at least in part due to IPV, the same approach will be necessary in developing countries. Indeed, no alternative model is available for them to adopt. The sewage isolates in New Zealand showed the persistence of vaccine viruses for 4 months after discontinuation of OPV, despite vaccination with IPV. In countries with high birth rates and population density, even such a relatively short duration of persistence might be sufficient for vaccine virus transmission to continue, especially in unvaccinated infants born after stopping OPV. If even one strain continues transmission, it could develop into a circulating vaccine-derived poliovirus (cVDPV),3Kew OM Wright PF Agol VI Delpeyroux F Shimizu H Nathanson N Circulating vaccine-derived polioviruses: current state of knowledge.Bull World Health Organ. 2004; 92: 16-23Google Scholar which can undo much of the hard work put in for eradication. The probability of this risk is unknown and may be low, but it is not zero. Without sewage surveillance, it will be detected only after it causes acute flaccid paralysis, which may be a year or more later.3Kew OM Wright PF Agol VI Delpeyroux F Shimizu H Nathanson N Circulating vaccine-derived polioviruses: current state of knowledge.Bull World Health Organ. 2004; 92: 16-23Google Scholar By then it would have spread widely and would require widespread vaccination to contain its circulation.3Kew OM Wright PF Agol VI Delpeyroux F Shimizu H Nathanson N Circulating vaccine-derived polioviruses: current state of knowledge.Bull World Health Organ. 2004; 92: 16-23Google Scholar What could be done if this happens? Reintroduction of OPV will expose all new, immunologically naive birth cohorts to vaccine viruses. The consequence could be the seeding of more strains leading to cVDPV. A better solution could be to use IPV to interrupt transmission of cVDPV, should the need arise. But we do not know how exactly to do it, especially since campaigns will be necessary. A better approach is to prevent, as much as possible, the transmission of vaccine viruses, for which high IPV coverage will be necessary before withdrawing OPV. In other words, it would be wiser to introduce IPV while OPV is still in use, and to withdraw OPV only after achieving high IPV coverage.4John TJ Polio eradication in India: what is the future?.Ind Pediatr. 2003; 40: 455-462PubMed Google Scholar The source of the type 2 infection with 99·9% homology with Sabin virus, detected in a 10-month girl 19 months after discontinuing OPV, must have been importation. Therefore, no country should stop vaccination against polio while another country continues to use OPV. Although simultaneous stopping of OPV worldwide is ideal, its practicalities need to be worked out. As a deterrent against importation of vaccine viruses, high IPV coverage before stopping OPV would be ideal in developing countries. I am a member of global, regional, and national committees concerned with immunisation and polio eradication, but opinions presented here are my own." @default.
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- W2080771908 date "2005-10-01" @default.
- W2080771908 modified "2023-09-27" @default.
- W2080771908 title "Eradication of poliomyelitis" @default.
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- W2080771908 doi "https://doi.org/10.1016/s0140-6736(05)67476-4" @default.
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