The baseline seroprevalence among infants aged months in was better than that in Eliminating the risk of polio from vaccine-derived polioviruses is essential for creating a polio -free world, and eliminating that risk will require stopping use of all oral polio vaccines OPVs once all types of wild polioviruses have been eradicated. Significant preparation will be needed for a thorough, synchronized, and full withdrawal of OPV, and such preparation would be aided by setting a reasonably firm date for OPV withdrawal as far in advance as possible, ideally at least 24 months.

A shorter lead time would provide valuable flexibility for decisions about when to stop use of OPV in the context of uncertainty about whether or not all types of wild polioviruses had been eradicated , but it might increase the cost of OPV withdrawal. Poliomyelitis surveillance in India previously involved the passive reporting of clinically suspected cases.

The capacity for detecting the disease was limited because there was no surveillance of acute flaccid paralysis AFP. In October , 59 specially trained Surveillance Medical Officers were deployed throughout the country to establish active AFP surveillance; 11, units were created to report weekly on the occurrence of AFP cases at the district, state and national levels; timely case investigation and the collection of stool specimens from AFP cases was undertaken; linkages were made to support the polio laboratory network; and extensive training of government counterparts of the Surveillance Medical Officers was conducted.

Data reported at the national level are analysed and distributed weekly. Annualized rates of non- polio AFP increased from 0. The number of polio cases associated with the isolation of wild poliovirus decreased from in the first quarter of to 77 in the first quarter of Widespread transmission of wild poliovirus types 1 and 3 persists throughout the country; type 2 occurs only in Bihar and Uttar Pradesh. In order to achieve polio eradication in India during , extra national immunization days and house-to-house mopping-up rounds should be organized.

Understanding vaccine hesitancy in polio eradication in northern Nigeria. Understanding hesitancy, leading in some cases to refusal, is vital to the success of GPEI. Re-emergence of circulating wild poliovirus in northern Nigeria in mid, after 24months polio -free, gives urgency to this.


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But it is equally important to protect and sustain the global gains available through routine immunisation in a time of rising scepticism and potential rejection of specific vaccines or immunisation more generally. This study is based on a purposive sampling survey of households in high- and low-performing rural, semiurban and urban areas of three high-risk states of northern Nigeria in Sokoto, Kano and Bauchi. The survey sought to understand factors at household and community level associated with propensity to refuse polio vaccine.

Wealth, female education and knowledge of vaccines were associated with lower propensity to refuse oral polio vaccine OPV among rural households. But higher risk of refusal among wealthier, more literate urban household rendered these findings ambiguous. Ethnic and religious identity did not appear to be associated with risk of OPV refusal. Risk of vaccine refusal was highly clustered among households within a small sub-group of sampled settlements.

Contrary to expectations, households in these settlements reported higher levels of expectation of government as service provider, but at the same time lesser confidence in the efficacy of their relations with government. The availability and use of high quality immunization and surveillance data are crucial for monitoring all components of the Global Polio Eradication Program GPEI. The Stop Transmission of Polio STOP program was initiated in to train and mobilize human resources to provide technical support to polio endemic and at-risk countries and in the STOP data management STOP DM deployment was created to provide capacity development in the area of data management for immunization and surveillance data for these countries.

In this report we provide an overview of the history, current status, and future of the STOP DM program , with a specific focus on the African continent. Polio eradication initiative in Afghanistan, This article reviews the epidemiology of polio , acute flaccid paralysis AFP surveillance, and the implementation of supplemental immunization activities SIAs in Afghanistan from thru Recommendations from independent advisory groups and Afghan government informed the conclusions.

From thru , the annual number of confirmed polio cases fluctuated from a low of 4 in to a high of 80 in Wild poliovirus types 2 and 3 were last reported in and , respectively. Circulating vaccine-derived poliovirus type 2 emerged in AFP surveillance quality in children aged 8 per , population. Since , at least 6 SIAs have been conducted annually.

Afghanistan has made progress moving closer to eliminating polio. The program struggles to reach all children because of management and accountability problems in the field, inaccessible populations, and inadequate social mobilization. Consequently, too many children are missed during SIAs. Afghanistan adopted a national emergency action plan in to address these issues, but national elimination will require consistent and complete implementation of proven strategies.

Lessons Learned, Transition Planning, and Legacy. Abstract Hundreds of thousands of Rotary volunteers have provided support for polio eradication activities and continue to this day by making financial contributions to the Rotary Polio Plus program , participating in national immunization days, assisting with surveillance, working on local, national, and international advocacy programs for polio eradication , assisting at immunization posts and clinics, and mobilizing their communities for immunization activities including poliovirus and other vaccines and other health benefits.

Its unwavering commitment to eradicate polio has been vital to the success of the program. Rotary is providing additional support for routine immunization and healthcare. When polio is finally gone, we will have the knowledge from the lessons learned with Polio Plus, such as the value of direct involvement by local Rotarians, the program for emergency funding, innovative tactics, and additional approaches for tackling other global issues, even those beyond public health.

Rotary has already transitioned its grants program to include 6 areas of focus: The legacy of the polio program will be the complete eradication of poliovirus and the elimination of polio for all time. Interactive games that highlight global health challenges and solutions are a potential tool for increasing interest in global health.

To test this hypothesis, we developed an interactive " Polio Eradication " PE game and evaluated whether playing or watching was associated with increased public interest in global health. The PE game is a life-size, human board game that simulates PE efforts. Four players-a researcher, a transportation expert, a local community coordinator, and a healthcare worker-collaborate as an interdisciplinary team to help limit ongoing and future polio outbreaks in Pakistan, represented on the game board.

Participants who played or observed the game and those who did not participate in the game, but visited noninteractive global health exhibits, completed a survey on participation outcomes. We used relative risk regression to examine associations between cofactors and change in global health interest. Three variables predicted increased global health interest among the game participants: Our results suggest that a hands-on, interactive game may increase the public's interest in global health, particularly among those with minimal previous knowledge of or involvement in global health activities.

As the global eradication of poliomyelitis approaches the final stages, prompt detection of new outbreaks is critical to enable a fast and effective outbreak response. Surveillance relies on reporting of acute flaccid paralysis AFP cases and laboratory confirmation through isolation of poliovirus from stool. However, delayed sample collection and testing can delay outbreak detection. We investigated whether weekly testing for clusters of AFP by location and time, using the Kulldorff scan statistic, could provide an early warning for outbreaks in 20 countries.

A mixed-effects regression model was used to predict background rates of nonpolio AFP at the district level. In Tajikistan and Congo, testing for AFP clusters would have resulted in an outbreak warning 39 and 11 days, respectively, before official confirmation of large outbreaks. This method has relatively high specificity and could be integrated into the current polio information system to support rapid outbreak response activities. Since , the world has come very close to eradicating polio through the Global Polio Eradication Initiative, in which communication interventions have played a consistently central role.

Mass media and information dissemination approaches used in immunization efforts worldwide have contributed to this success. However, reaching the hardest-to-reach, the poorest, the most marginalized and those without access to health services has been challenging. In the last push to eradicate polio , Polio Eradication Initiative communication strategies have become increasingly research-driven and innovative, particularly through the introduction of sustained interpersonal communication and social mobilization approaches to reach unreached populations.

This review examines polio communication efforts in India and Pakistan between the years and It shows how epidemiological, social and behavioural data guide communication strategies that have contributed to increased levels of polio immunity, particularly among underserved and hard-to-reach populations. It illustrates how evidence-based and planned communication strategies - such as sustained media campaigns, intensive community and social mobilization, interpersonal communication and political and national advocacy combined - have contributed to reducing polio incidence in these countries.

Findings show that communication strategies have contributed on several levels by: The review concludes with observations about the added value of communication strategies in polio eradication efforts and implications for global and local public health communication interventions. Polio Eradication Initiative PEI contribution in strengthening public health laboratories systems in the African region.

The laboratory has always played a very critical role in diagnosis of the diseases. The success of any disease programme is based on a functional laboratory network. Health laboratory services are an integral component of the health system. Efficiency and effectiveness of both clinical and public health functions including surveillance, diagnosis, prevention, treatment, research and health promotion are influenced by reliable laboratory services.

The establishment of the African Regional polio laboratory for the Polio Eradication Initiative PEI has contributed in supporting countries in their efforts to strengthen laboratory capacity. On the eve of the closing of the program , we have shown through this article, examples of this contribution in two countries of the African region: Questionnaires and self-administered and in-depth interviews and group discussions as well as records and observation were used to collect information during laboratory visits and assessments.

Through laboratory technical staff training supported by the PEI, skills and knowledge were gained to reinforce laboratories capacity and performance in quality laboratory functioning, processes and techniques such as cell culture. In the same way, infrastructure was improved and equipment provided. General laboratory quality standards, including the entire laboratory key elements was improved through the PEI accreditation process. The Polio Eradication Initiative PEI is a good example of contribution in strengthening public health laboratories systems in the African region.

It has established strong Polio Laboratory network that contributed to the. Where are we in Europe and what next? The world was never so close to reach the polio eradication: The risk of polio outbreaks in the EU is smaller than it has ever been in the past, but it is not so small that we can ignore it. The EU MS must remain alert and plan and prepare for managing polio events or outbreaks because of the possible dire consequences. The IPV only vaccination schedule universally applied in EU has achieved satisfactory coverage, but constantly leaving small accumulating pockets of susceptible individuals.

Moreover the IPV only schedule is not an absolute barrier against poliovirus silent transmission as demonstrated in the recent Israel outbreak. The availability of annually revised S. Poliovirus eradication will continue to be challenged as long as there is the worldwide presence of polioviruses in laboratories and vaccine production plants.

Most of the world's OPV vaccines are produced in the EU and many laboratories and research centers store and handle polio viruses. EU Member States are engaged actively in implementing the poliovirus biocontainment plans that are part of the polio eradication strategy and to certify the destruction of poliovirus strains and potentially contaminated biological materials. Global polio eradication has entered its final phase, but still faces enormous challenges.

The Polio Eradication and Endgame Strategic Plan set the target for making the world polio -free by The Sabin IPV has a high production safety and low production cost, compared with the wild-virus IPV and, therefore, can play an important role in the final stage of global polio eradication. Use of m-Health in polio eradication and other immunization activities in developing countries.

Reaching the children that are chronically missed by routine immunization services has been a key pillar of success in achieving progress toward polio eradication. The rapid advancement and accessibility of mobile technology "mHealth" in low and lower middle income countries provides an important opportunity to apply novel, innovative approaches to provide vaccine services. We sought to document the use and effectiveness of mHealth in immunization programs in low and lower middle income countries.

We particularly focused on mHealth approaches used in polio eradication efforts by the Global Polio Eradication Initiative GPEI to leverage the knowledge and lessons learned that may be relevant for enhancing ongoing immunization services. In June , the electronic database PubMed was searched for peer reviewed studies that focused on efforts to improve immunization programs both ongoing immunization services and supplemental immunization activities or campaigns through mobile technology in low and lower middle income countries. The search yielded papers of which 25 met the inclusion criteria.

One additional article was included from the hand searching process. Mobile phones were the most common mobile device used. Of the 26 studies, 21 of 26 studies With the growing capacity and access to mobile technology, mHealth can be a powerful and sustainable tool for enhancing the reach and impact of vaccine programs.

Quantifying the impact of expanded age group campaigns for polio eradication. A priority of the Global Polio Eradication Initiative GPEI strategic plan is to evaluate the potential impact on polio eradication resulting from expanding one or more Supplementary Immunization Activities SIAs to children beyond age five-years in polio endemic countries.

It has been hypothesized that such expanded age group EAG campaigns could accelerate polio eradication by eliminating immunity gaps in older children that may have resulted from past periods of low vaccination coverage. Using an individual-based mathematical model, we quantified the impact of EAG campaigns in terms of probability of elimination, reduction in polio transmission and age stratified immunity levels. The model was specifically calibrated to seroprevalence data from a polio -endemic region: We compared the impact of EAG campaigns, which depend only on age, to more targeted interventions which focus on reaching missed populations.

Implementation of EAG campaigns in polio endemic regions would not improve prospects for eradication. In endemic areas, vaccination campaigns which do not target missed populations will not benefit polio eradication efforts. A Framework for Verifying Measles Elimination.

These highly visible bodies provide a framework to be replicated to independently verify measles and rubella elimination in the regions and globally. A key strategy for polio eradication has been the development of a skilled and deployable workforce to implement eradication activities across the globe.

STOP has also informed the development of other public health workforce capacity to support polio eradication efforts, including national STOP programs. In addition, the program has diversified to address measles and rubella elimination, data management and quality, and strengthening routine immunization programs. This article describes the STOP program and how it has contributed to polio eradication by building global public health workforce capacity.

Abstract Since , the world has come very close to eradicating polio through the Global Polio Eradication Initiative, in which communication interventions have played a consistently central role. It illustrates how evidence-based and planned communication strategies — such as sustained media campaigns, intensive community and social mobilization, interpersonal communication and political and national advocacy combined — have contributed to reducing polio incidence in these countries.

Impact of inactivated poliovirus vaccine on mucosal immunity: The polio eradication endgame aims to bring transmission of all polioviruses to a halt. To achieve this aim, it is essential to block viral replication in individuals via induction of a robust mucosal immune response. Although it has long been recognized that inactivated poliovirus vaccine IPV is incapable of inducing a strong mucosal response on its own, it has recently become clear that IPV may boost immunity in the intestinal mucosa among individuals previously immunized with oral poliovirus vaccine.

Indeed, mucosal protection appears to be stronger following a booster dose of IPV than oral poliovirus vaccine, especially in older children. Here, we review the available evidence regarding the impact of IPV on mucosal immunity, and consider the implications of this evidence for the polio eradication endgame. We conclude that the implementation of IPV in both routine and supplementary immunization activities has the potential to play a key role in halting poliovirus transmission, and thereby hasten the eradication of polio.

Can We Capitalize on the Virtues of Vaccines? Insights from the Polio Eradication Initiative. Twenty-five years after the eradication of smallpox, the ongoing effort to eradicate poliomyelitis has grown into the largest international health initiative ever undertaken. By , however, the polio eradication effort was threatened by a challenge regularly faced by public health policymakers everywhere—misperception about the benefits and risks of vaccines.

The propagation of false rumors about oral poliovirus vaccine safety led to the reinfection of 13 previously polio -free countries and the largest polio epidemic in Africa in recent years. With deft management of such challenges by local, national, and international health authorities, poliomyelitis, a disease that threatened children everywhere just 2 generations ago, could soon be relegated to history like smallpox before it. The critical role of acute flaccid paralysis surveillance in the Global Polio Eradication Initiative. Active surveillance visits to priority health facilities are used to assure all children polio laboratories.

The quality of AFP surveillance is regularly monitored with standardized surveillance quality indicators. In highest risk countries and areas, the sensitivity of AFP surveillance is enhanced by environmental surveillance testing of sewage samples. Genetic sequencing of detected poliovirus isolates yields programmatically important information on polio transmission pathways. AFP surveillance is one of the most valuable assets of the GPEI, with the potential to serve as a platform to build integrated disease surveillance systems.

Continued support to maintain AFP surveillance systems will be essential, to reliably monitor the completion of global polio eradication , and to assure that a key resource for building surveillance capacity is transitioned post- eradication to support other health priorities. For permissions, please e-mail: Wild and vaccine-derived poliovirus circulation, and implications for polio eradication. Polio cases due to wild virus are reported by only three countries in the world.

Poliovirus type 2 has been globally eradicated and the last detection of poliovirus type 3 dates to November Poliovirus type 1 remains the only circulating wild strain; between January and September it caused 26 cases nine in Afghanistan, 14 in Pakistan, three in Nigeria. The use of oral polio vaccine OPV has been the key to success in the eradication effort. However, paradoxically, moving towards global polio eradication , the burden caused by vaccine-derived polioviruses VDPVs becomes increasingly important.

In this paper circulation of both wild virus and VDPVs is reviewed and implications for the polio eradication endgame are discussed. In order to decrease the risk for cVDPV2 re-emergence inactivated polio vaccine IPV has been introduced in the routine vaccine schedule of all countries. The likelihood of re-emergence of cVDPVs should markedly decrease with time after OPV cessation, but silent circulation of polioviruses cannot be ruled out even a long time after cessation.

For this reason, immunity levels against polioviruses should be kept as high as possible in the population by the use of IPV, and both clinical and environmental surveillance should be maintained at a high level. Rotary's Polio Plus Program: Hundreds of thousands of Rotary volunteers have provided support for polio eradication activities and continue to this day by making financial contributions to the Rotary Polio Plus program , participating in national immunization days, assisting with surveillance, working on local, national, and international advocacy programs for polio eradication , assisting at immunization posts and clinics, and mobilizing their communities for immunization activities including poliovirus and other vaccines and other health benefits.

Polio eradication is just over the horizon: As the GPEI launched its eradication effort in , it underestimated both the difficulty and the costs of the campaign. Advocacy for resource mobilization came as an afterthought in the late s, when achieving eradication by the target date of began to look doubtful. The reality of funding shortfalls undercutting eradication leads to the conclusion that advocacy for resource mobilization is as central to operations as are scientific and technical factors.

After 2 decades of focused efforts to eradicate polio , the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization RI and primary healthcare PHC. Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review.

Our quantitative analysis did not find compelling evidence of widespread and significant effects of polio eradication campaigns, either positive or negative, on measures of RI and maternal healthcare. Our qualitative analysis revealed context-specific positive impacts of polio eradication activities in many of our case studies, particularly disease surveillance and cold chain strengthening. These impacts were dependent on the initiative of policy makers. Negative impacts, including service interruption and public dissatisfaction, were observed primarily in districts with many campaigns per year.

Polio eradication activities can provide support for RI and PHC, but many opportunities to do so remain missed. Increased commitment to scaling up best practices could lead to significant positive impacts. Per Diems in Polio Eradication: Nearly all global health initiatives give per diems to community health workers CHWs in poor countries for short-term work on disease-specific programs. International officials defended per diems for CHWs with an array of arguments, primarily that they were necessary to defray the expenses that workers incurred during campaigns.

But high-level ministry of health officials in many countries were concerned that even small per diems were unsustainable. By contrast, CHWs saw per diems as a wage; the very small size of this wage led many to describe per diems as unjust. Per diem polio work existed in the larger context of limited and mostly exploitative options for female labor. Taking the perspectives of CHWs seriously would shift the international conversation about per diems toward questions of labor rights and justice in global health pay structures. Performance and determinants of routine immunization coverage within the context of intensive polio eradication activities in Uttar Pradesh, India: Background Studies that have looked at the effect of polio eradication efforts in India on routine immunization programs have provided mixed findings.

This paper explores the performance of routine immunization services in the CGPP intervention areas concurrent with intensive polio eradication activities. The paper also explores determinants of routine immunization performance such as caretaker characteristics and CGPP activities to strengthen routine immunization services.

This is done to judge if there is any evidence that routine immunization services are being disrupted. This increase occurred concurrent with polio eradication efforts intensive enough to result in interruption of transmission. Conclusions A limitation of the analysis is. With recent outbreaks in Syria and Horn of Africa, silent circulation of wild poliovirus type 1 WPV1 in Israel, West Bank, and Gaza, and fresh spate of violence against vaccinators and their security personnel in Pakistan, the world is facing a turbulent final ascent to the summit of polio eradication.

On the positive side, we may also be witnessing the end of wild poliovirus type 3 WPV3 and defused programmatic crisis caused by funding gaps, while India registers third consecutive polio -free year. Having a cogent endgame plan , informed by some cardinal lessons learned from an eventful decade in India, is also a very significant development. Endgame would also involve integration of at least one dose of affordable inactivated polio vaccine IPV to up-scaled routine immunization RI , switch from trivalent oral polio vaccine tOPV to bivalent oral polio vaccine bOPV in countries before , stockpiling of mOPV, and simultaneous global cessation of bOPV before Role of antivirals in post- eradication era is still unclear.

Some specific threats emerging at this stage are as follows: Global buildup of new birth cohorts in non-endemic countries with weak RI and downscaled supplementary immunization activities SIAs , tremendous pressure on peripheral health workers, and fatigued systems. Cultural resistance to transnational programs is taking a violent shape in some areas. Differential interpretations of 'right to say no', on both sides of the divide, are damaging a global cause. Amidst all these concerns, let us not forget to underline the sacrifice made by frontline vaccinators working in some of the most challenging circumstances.

The global polio eradication initiative: The GPEI built on many lessons learned from smallpox eradication , including the large-scale deployment of technical assistance, implementing agendas of innovation and research and the use of professionally planned and guided advocacy. By , transmission of indigenous wild poliovirus WPV had been interrupted in all but 4 'endemic' countries: India, Nigeria, Pakistan and Afghanistan, where eradication efforts effectively stalled.

In each of the four remaining polio -endemic countries different challenges, or a combination of factors, prevented to build up sufficient levels of population immunity to stop transmission. Consequently, specific strategies were increasingly tailored to each setting. A new GPEI Strategic Plan was developed which brought together several approaches to overcome the remaining hurdles to eradication , including the large-scale use of bivalent oral poliovaccine bOPV in supplementary immunization activities SIAs.

By mid, India had not reported a polio case for more than 5 months, and in. Surveillance systems to track progress toward global polio eradication - worldwide, AFP surveillance is supplemented by environmental surveillance, testing sewage samples from selected sites for PVs. Virologic surveillance, including genomic sequencing to identify isolates by genotype and measure divergence between isolates, guides Global Polio Eradication Initiative GPEI activities by confirming the presence of PV, tracking chains of PV transmission, and highlighting gaps in AFP surveillance quality.

It also summarizes the results of environmental surveillance and reviews indicators assessing the timeliness of reporting of PV isolation and of virus strain characterization globally. Regional-level performance indicators for timely reporting of PV isolation were met in five of six WHO regions in and To achieve polio eradication and certify interruption of PV transmission, intensive efforts to strengthen and maintain AFP surveillance are. Introducing an accountability framework for polio eradication in Ethiopia: Introduction the World Health Organization WHO , Ethiopia country office, introduced an accountability framework into its Polio Eradication Program in with the aim of improving the program 's performance.

Our study aims to evaluate staff performance and key program indicators following the introduction of the accountability framework.

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Methods the impact of the WHO accountability framework was reviewed after its first year of implementation from June to June We analyzed selected program and staff performance indicators associated with acute flaccid paralysis AFP surveillance from a database available at WHO. Data on managerial actions taken were also reviewed.

Performance of a total of 38 staff was evaluated during our review. Results our review of results for the first four quarters of implementation of the polio eradication accountability framework showed improvement both at the program and individual level when compared with the previous year. Managerial actions taken during the study period based on the results from the monitoring tool included eleven written acknowledgments, six discussions regarding performance improvement, six rotations of staff, four written first-warning letters and nine non-renewal of contracts.

Conclusion the introduction of the accountability framework resulted in improvement in staff performance and overall program indicators for AFP surveillance. Polio eradication in the African Region on course despite public health emergencies. The World Health Organization, African Region is heading toward eradication of the three types of wild polio virus, from the Region. This scenario in Nigeria, the only endemic country, marks a remarkable progress. This significant progress is as a result of commitment of key partners in providing the much needed resources, better implementation of strategies, accountability, and innovative approaches.

This is taking place in the face of public emergencies and challenges, which overburden health systems of countries and threaten sustainability of health programmes. Outbreak of Ebola and other diseases, insecurity, civil strife and political instability led to displacement of populations and severely affected health service delivery.

The goal of eradication is now within reach more than ever before and countries of the region should not relent in their efforts on polio eradication. WHO and partners will redouble their efforts and introduce better approaches to sustain the current momentum and to complete the job.

The carefully planned withdrawal of oral polio vaccine type II OPV2 with an earlier introduction of one dose of inactivated poliovirus vaccine IPV , in routine immunization, will boost immunity of populations and stop cVDPVs. English Choose a language for shopping. Amazon Music Stream millions of songs. Amazon Advertising Find, attract, and engage customers.

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As of August 12, , confirmed polio cases reported in Nigeria totaled including WPV1 cases , compared with cases 53 WPV1 reported during the same period in This report updates overall progress toward polio eradication in Nigeria during Contribution to improved communicable diseases surveillance in WHO African region. Since the launch of the Global Polio Eradication Initiative GPEI in , there has been a tremendous progress in the reduction of cases of poliomyelitis.

The plan provides a timeline for the completion of the GPEI by eliminating all paralytic polio due to both wild and vaccine-related polioviruses. We reviewed how GPEI supported communicable disease surveillance in seven of the eight countries that were documented as part of World Health Organization African Region best practices documentation.

Data from WHO African region was also reviewed to analyze the performance of measles cases based surveillance. The difference is on the number of diseases included based on epidemiology of diseases in a particular country. The results showed that the polio eradication infrastructure has supported and improved the implementation of surveillance of other priority communicable diseases under integrated diseases surveillance and response strategy. As we approach polio eradication , polio- eradication initiative staff, financial resources, and infrastructure can be used as one strategy to build IDSR in Africa.

As we are now focusing on measles and rubella elimination by the year , other disease-specific programs having similar goals of eradicating and eliminating diseases like malaria, might consider investing in general infectious disease surveillance following the polio example. Published by Elsevier Ltd.. From regional pulse vaccination to global disease eradication: Mass-vaccination campaigns are an important strategy in the global fight against poliomyelitis and measles.

The large-scale logistics required for these mass immunisation campaigns magnifies the need for research into the effectiveness and optimal deployment of pulse vaccination. In order to better understand this control strategy, we propose a mathematical model accounting for the disease dynamics in connected regions, incorporating seasonality, environmental reservoirs and independent periodic pulse vaccination schedules in each region. The effective reproduction number, Re, is defined and proved to be a global threshold for persistence of the disease.

Analytical and numerical calculations show the importance of synchronising the pulse vaccinations in connected regions and the timing of the pulses with respect to the pathogen circulation seasonality. Our results indicate that it may be crucial for mass-vaccination programs, such as national immunisation days, to be synchronised across different regions. In addition, simulations show that a migration imbalance can increase Re and alter how pulse vaccination should be optimally distributed among the patches, similar to results found with constant-rate vaccination.

Furthermore, contrary to the case of constant-rate vaccination, the fraction of environmental transmission affects the value of Re when pulse vaccination is present. Progress toward poliomyelitis eradication --Afghanistan and Pakistan, January August In , the World Health Assembly declared the completion of polio eradication a programmatic emergency for global public health and called for a comprehensive polio endgame strategy.

Afghanistan and Pakistan are two of the three remaining countries the other is Nigeria where circulation of indigenous wild poliovirus WPV has never been interrupted. This report updates previous reports and describes polio eradication activities and progress in Afghanistan and Pakistan during January August In Afghanistan, 14 WPV cases were reported in , compared with 37 cases in ; nine cases were reported during January-August , compared with six cases during the same period in In Pakistan, 93 WPV cases were reported in , compared with 58 cases in ; cases were reported during January-August , compared with 33 cases during the same period in Vaccination campaigns have been banned since June in specific areas in Pakistan, where an estimated , children aged Eradication and Endgame Strategic Plan for both countries should continue to negotiate access of vaccinators to insecure and temporarily inaccessible areas, improve immunization program performance to reach more children in accessible areas, and ensure that political and health leaders at all levels are fully committed to the program, including being committed to providing financial resources needed to fully implement all the recommendations of external technical advisory groups.

Both countries should also continue to strengthen cross-border collaboration to improve surveillance and case detection, coordinate outbreak response, and maximize vaccination coverage of children moving between the two countries. India's journey from hyperendemic to polio-free status. India's success in eliminating wild polioviruses WPVs has been acclaimed globally. Since the last case on January 13, success has been sustained for two years. By early India could be certified free of WPV transmission, if no indigenous transmission occurs, the chances of which is considered zero.

Until early s India was hyperendemic for polio, with an average of to children getting paralysed daily. The VE against types 1 and 3 was the lowest in Uttar Pradesh and Bihar, where the force of transmission of WPVs was maximum on account of the highest infant-population density. Transmission was finally interrupted with sustained and extraordinary efforts. During the years since annual pulse polio vaccination campaigns were conducted 10 times each year, virtually every child was tracked and vaccinated - including in all transit points and transport vehicles, monovalent OPV types 1 and 3 were licensed and applied in titrated campaigns according to WPV epidemiology and bivalent OPV bOPV, with both types 1 and 3 was developed and judiciously deployed.

India is poised to progress to phase 2, with introduction of inactivated poliovirus vaccine IPV , switch from tOPV to bOPV and final elimination of all vaccine-related and vaccine-derived polioviruses. True polio eradication demands zero incidence of poliovirus infection, wild and vaccine. Global polio eradication initiative: The world is on the verge of achieving global polio eradication. It is important to document the lessons learned from polio eradication , especially because it is one of the largest ever global health initiatives.

The health community has an obligation to ensure that these lessons and the knowledge generated are shared and contribute to real, sustained changes in our approach to global health. We have summarized what we believe are 10 leading lessons learned from the polio eradication initiative. We have the opportunity and obligation to build a better future by applying the lessons learned from GPEI and its infrastructure and unique functions to other global health priorities and initiatives.

In so doing, we can extend the global public good gained by ending for all time one of the world's most devastating diseases by also ensuring that these investments provide public health dividends and benefits for years to come. Poliomyelitis surveillance in Shandong Province, China, In Shandong Province, China, programmes were initiated in for mass immunization against poliomyelitis and for the immediate reporting of acute flaccid paralysis AFP. The incidence of non- poliomyelitis AFP was found to be 0.

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The incidence of such illness peaked among children aged years. Although laboratory investigations have improved, in they were still inadequate in nearly a third of confirmed poliomyelitis cases. As the prevalence of wild poliovirus declines in China, reliable laboratory support needs to be established and adequately sensitive and specific AFP surveillance be developed if poliomyelitis is to be eradicated. Polio eradication initiative in India: The first deadline is already a matter of history. With the reporting of polio cases in , the new deadline for polio eradication by is postponed further.

Centers for Disease Control, have formulated a conceptually flawed strategy and that it is not weak political will that is the central obstacle in this final push for global eradication. The validity of the claims of "near success" by the proponents of the GPEI is also examined in detail.

By taking India as a case study, the authors examine the achievements of the GPEI in nine years of intense effort since They conclude that the GPEI is yet another exercise in mismanaging the health priorities and programs in developing countries in the era of globalization. The declaration in that smallpox had been eradicated reawakened interest in disease eradication as a public health strategy. The smallpox programme's success derived, in part, from lessons learned from the preceding costly failure of the malaria eradication campaign.

In turn, the smallpox programme offered important lessons with respect to other prospective disease control programmes, and these have been effectively applied in the two current global eradication initiatives , those against poliomyelitis and dracunculiasis. Taking this theme a step further, there are those who would now focus on the development of an inventory of diseases which might, one by one, be targeted either for eradication or elimination. This approach, while interesting, fails to recognize many of the important lessons learned and their broad implications for contemporary disease control programmes worldwide.

Environmental surveillance for polioviruses in the Global Polio Eradication Initiative. This article summarizes the status of environmental surveillance ES used by the Global Polio Eradication Initiative , provides the rationale for ES, gives examples of ES methods and findings, and summarizes how these data are used to achieve poliovirus eradication.

ES complements clinical acute flaccid paralysis AFP surveillance for possible polio cases. ES detects poliovirus circulation in environmental sewage and is used to monitor transmission in communities. If detected, the genetic sequences of polioviruses isolated from ES are compared with those of isolates from clinical cases to evaluate the relationships among viruses.

To evaluate poliovirus transmission, ES programs must be developed in a manner that is sensitive, with sufficiently frequent sampling, appropriate isolation methods, and specifically targeted sampling sites in locations at highest risk for poliovirus transmission. ES provides valuable information, particularly in high-density populations where AFP surveillance is of poor quality, persistent virus circulation is suspected, or frequent virus reintroduction is perceived. Acute flaccid paralysis surveillance: In surveillance of acute flaccid paralysis AFP cases was introduced in Malaysia along with the establishment of a national referral laboratory at the Institute for Medical Research.

The objective of this study was to determine the incidence, viral etiology and clinical picture of AFP cases below 15 years of age, reported from to Six hundred seventy-eight of reported cases were confirmed as AFP by expert review. The clinical presentation of acute flaccid paralysis in these cases was diverse, the most commonly reported being Guillian-Barre syndrome Sixty-nine viruses were isolated in this study. Malaysia has been confirmed as free from wild polio since the surveillance was established.

Poliomyelitis in the United States: Examines poliomyelitis in the United States by reviewing clinical manifestations and outcomes, history, recent epidemiologic characteristics, characteristics of currently available vaccines, controversies surrounding vaccination policy, current poliovirus vaccination recommendations, and prospects for worldwide eradication.

One of the innovations successfully implemented since mid is the WHO's engagement of surge capacity personnel. The WHO reorganized its functional structure, adopted a transparent recruitment and deployment process, provided focused technical and management training, and applied systematic accountability framework to successfully manage the surge capacity project in close collaboration with the national counterparts and partners. The deployment of the surge capacity personnel was guided by operational and technical requirement analysis.

These additional personnel were directly engaged in efforts aimed at improving the performance of polio surveillance, vaccination campaigns, increased routine immunization outreach sessions, and strengthening partnership with key stakeholders at the operational level, including community-based organizations.

Programmatic interventions were sustained in states in which security was compromised and the risk of polio was high, partly owing to the presence of the surge capacity personnel, who are engaged from the local community. Since mid, significant programmatic progress was registered in the areas of polio supplementary immunization activities, acute flaccid paralysis surveillance, and routine immunization with the support of the surge capacity personnel.

The surge infrastructure has also been instrumental in building local capacity. The surge infrastructure has. Strengthening the partnership between routine immunization and the global polio eradication initiative to achieve eradication and assure sustainability. Despite this remarkable achievement, ongoing circulation of wild poliovirus in polio-endemic countries and the increase in the number of circulating vaccine-derived poliovirus cases, especially those caused by type 2, is a cause for concern.

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This is critical for the phased withdrawal of oral poliovirus vaccine, beginning with the type 2 component, and the introduction of a single dose of inactivated polio vaccine into RI programs. Impact of Targeted Programs on Health Systems: The results of 2 large field studies on the impact of the polio eradication initiative on health systems and 3 supplementary reports were presented at a December meeting convened by the World Health Organization. All of these studies concluded that positive synergies exist between polio eradication and health systems but that these synergies have not been vigorously exploited.

The eradication of polio has probably improved health systems worldwide by broadening distribution of vitamin A supplements, improving cooperation among enterovirus laboratories, and facilitating linkages between health workers and their communities. The results of these studies also show that eliminating polio did not cause a diminution of funding for immunization against other illnesses.

Relatively little is known about the opportunity costs of polio eradication.

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Improved planning in disease eradication initiatives can minimize disruptions in the delivery of other services. Future initiatives should include indicators and baseline data for monitoring effects on health systems development. A Matched Cohort Study. Poliomyelitis is a viral infectious disease caused by 1 of the 3 strains of poliovirus. The World Health Organization launched an eradication campaign in Although the number of cases of poliomyelitis has drastically declined, eradication has not yet been achieved, and there are a substantial number of survivors of the disease.

Survivors of poliomyelitis present a unique set of challenges to the anesthesiologist. The scientific literature regarding the anesthetic management of survivors of poliomyelitis , however, is limited and primarily experiential in nature. Using a retrospective, matched cohort study, we sought to more precisely characterize the anesthetic implications of poliomyelitis and to determine what risks, if any, may be present for patients with a history of the disease.

Using the Mayo Clinic Life Sciences System Data Discovery and Query Builder, study subjects were identified as those with a history of paralytic poliomyelitis who had undergone major surgery at Mayo Clinic Rochester between and For each case, 2 sex- and age-matched controls that underwent the same surgical procedure during the study period were randomly selected from a pool of possible controls. Medical records were manually interrogated with respect to demographic variables, comorbid conditions, operative and anesthetic course, and postoperative course.

We analyzed cases with 2: Pain scores, postanesthesia care unit admission, length of postanesthesia care unit stay, intensive care unit admission, length of intensive care unit stay, and initial extubation location were not significantly different between the 2 groups.


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  5. Passive Immunization Against Poliomyelitis. Poliomyelitis has gone from being one of the worst scourges of the 20th century to nearing eradication in the 21st. This success is well known to be attributable to the Salk inactivated and Sabin attenuated poliovirus vaccines. However, before introduction of these vaccines, William McDowall Hammon of the University of Pittsburgh Graduate School of Public Health led the first major breakthrough in prevention of the disease by using passive immunization in one of the earliest double-blind, placebo-controlled clinical trials.

    This study provided the first evidence that antibodies to poliovirus could prevent the disease in humans. The global initiative for poliomyelitis eradication can only remain relevant if survey systems are regularly assessed. In order to identify shortcomings and to propose improvement, the data collection and transmission during case investigation were assessed in the Banfora health district in Burkina Faso.

    The survey targeted six 6 primary health centres, the district laboratory and the national laboratory, all involved in the poliomyelitis surveillance system. Data from registers, forms documenting suspected cases, stool sample forms and weekly reports were collected by means of a data grid. Data from actors involved in the poliomyelitis case investigation system were collected by means of an individual questionnaire.

    The reactivity of investigating suspected cases was satisfactory with a median alert questionnaire notification time of 18 hours. The completeness of the reporting system was satisfactory. Nevertheless, the promptness of data management by primary heath centres and the national laboratory remained unsatisfactory. Evaluation of data management revealed logistic and organization shortcomings. The overall efficacy of the poliomyelitis surveillance could be improved by using management tools for laboratory supplies, collecting data related to the homes of suspected cases and implementing a cold chain maintenance plan.

    Dracunculiasis, also known as guinea worm disease, is caused by the large female of the nematode Dracunculus medinensis, which emerges painfully and slowly from the skin, usually on the lower limbs. The disease can infect animals, and sustainable animal cycles occur in North America and Central Asia but do not act as reservoirs of human infection. The disease is endemic across the Sahel belt of Africa from Mauritania to Ethiopia, having been eliminated from Asia and some African countries.

    It has a significant socioeconomic impact because of the temporary disability that it causes. Dracunculiasis is exclusively caught from drinking water, usually from ponds. A campaign to eradicate the disease was launched in the s and has made significant progress. The strategy of the campaign is discussed, including water supply, health education, case management, and vector control.

    Current issues including the integration of the campaign into primary health care and the mapping of cases by using geographic information systems are also considered. Finally, some lessons for other disease control and eradication programs are outlined. Since the beginning of Global Polio Eradication Initiative in , poliomyelitis cases caused by wild poliovirus PV have been drastically reduced, with only 74 cases reported in 2 endemic countries in The current limited PV transmission suggests that we are in the endgame of the polio eradication program.

    However, specific challenges have emerged in the endgame, including tight budget, switching of the vaccines, and changes in biorisk management of PV. To overcome these challenges, several PV studies have been implemented in the eradication program. Some of the responses to the emerging challenges in the polio endgame might be valuable in other infectious diseases eradication programs. Here, I will review challenges that confront the polio eradication program and current research to address these challenges. Global Polio Eradication - Way Ahead. In , the World Health Assembly resolved to eradicate poliomyelitis by the year Although substantial progress was achieved by , global polio eradication proved elusive.

    In India, the goal was accomplished in , and the entire South-East Asia Region was certified as polio-free in The year marks the lowest wild poliovirus type 1 case count ever, the lowest number of polio-endemic countries Afghanistan, Nigeria and Pakistan , the maintenance of wild poliovirus type 2 eradication , and the continued absence of wild poliovirus type 3 detection since The year also marks the Global Polio Eradication Initiative GPEI moving into the post-cessation of Sabin type 2, after the effort of globally synchronized withdrawal of Sabin type 2 poliovirus in April Sustained efforts will be needed to ensure polio eradication is accomplished, to overcome the access and security issues, and continue to improve the quality and reach of field operations.

    After that, surveillance the "eyes and ears" will move further to the center stage. Sensitive surveillance will monitor the withdrawal of all Sabin polioviruses, and with facility containment, constitute the cornerstones for eventual global certification of wild poliovirus eradication. An emergency response capacity is essential to institute timely control measures should polio still re-emerge. Simultaneously, the public health community needs to determine whether and how to apply the polio-funded infrastructure to other priorities after the GPEI funding has stopped. Eradication is the primary goal, but securing eradication will require continued efforts, dedicated resources, and a firm commitment by the global public health community.

    The Global Polio Eradication Initiative: The world is closer than ever to achieving global polio eradication , with record-low polio cases in and the impending prospect of a polio-free Africa. Tens of millions of volunteers, social mobilizers, and health workers have participated in the Global Polio Eradication Initiative. The program contributes to efforts to deliver other health benefits, including health systems strengthening. As the initiative nears completion after more than twenty-five years, it becomes critical to document and transition the knowledge, lessons learned, assets, and infrastructure accumulated by the initiative to address other health goals and priorities.

    The primary goals of this process, known as polio legacy transition planning, are both to protect a polio-free world and to ensure that investments in polio eradication will contribute to other health goals after polio is completely eradicated. The initiative is engaged in an extensive transition process of consultations and planning at the global, regional, and country levels. A successful completion of this process will result in a well-planned and -managed conclusion of the initiative that will secure the global public good gained by ending one of the world's most devastating diseases and ensure that these investments provide public health benefits for years to come.

    Impact on the Global Polio Eradication Initiative. There are currently huge efforts by the World Health Organization and partners to complete global polio eradication. With the significant decline in poliomyelitis cases due to wild poliovirus in recent years, rare cases related to the use of live-attenuated oral polio vaccine assume greater importance. Poliovirus strains in the oral vaccine are known to quickly revert to neurovirulent phenotype following replication in humans after immunisation.

    These strains can transmit from person to person leading to poliomyelitis outbreaks and can replicate for long periods of time in immunodeficient individuals leading to paralysis or chronic infection, with currently no effective treatment to stop excretion from these patients.

    Here, we describe an individual who has been excreting type 2 vaccine-derived poliovirus for twenty eight years as estimated by the molecular clock established with VP1 capsid gene nucleotide sequences of serial isolates. This represents by far the longest period of excretion described from such a patient who is the only identified individual known to be excreting highly evolved vaccine-derived poliovirus at present. Using a range of in vivo and in vitro assays we show that the viruses are very virulent, antigenically drifted and excreted at high titre suggesting that such chronic excreters pose an obvious risk to the eradication programme.

    Our results in virus neutralization assays with human sera and immunisation-challenge experiments using transgenic mice expressing the human poliovirus receptor indicate that while maintaining high immunisation coverage will likely confer protection against paralytic disease caused by these viruses, significant changes in immunisation strategies might be required to effectively stop their occurrence and potential widespread transmission.

    Eventually, new stable live-attenuated polio vaccines with no risk of reversion might be required to respond to any poliovirus isolation in the post- eradication era. The critical role of acute flaccid paralysis surveillance in the Global Polio Eradication Initiative. Active surveillance visits to priority health facilities are used to assure all children eradication , and to assure that a key resource for building surveillance capacity is transitioned post- eradication to support other health priorities.

    For permissions, please e-mail: To evaluate the efficacy and safety of Saccharomyces boulardii Sachets combined with bismuth quadruple therapy for initial Helicobacter pylori H. From March to March , participants from the third hospital of Hebei medical university with H. Short-term group and long-term group received the same quadruple therapy for 10 days as above, as well as Saccharomyces boulardii Sachets mg bid for 14 days and 28 days, respectively. And side effects were investigated during the therapy. Both short and long-term Saccharomyces boulardii Sachets reduced the overall side effect rate and occurrence of diarrhea or abdominal distension when combined with bismuth quadruple therapy for initial H.

    Contribution of polio eradication initiative to strengthening routine immunization: Lessons learnt in the WHO African region. Important investments were made in countries for the polio eradication initiative. On 25 September , a major milestone was achieved when Nigeria was removed from the list of polio-endemic countries. Routine Immunization, being a key pillar of polio eradication initiative needs to be strengthened to sustain the gains made in countries. For this, there is a huge potential on building on the use of polio infrastructure to contribute to RI strengthening. We conducted a systematic review of best practices documents from eight countries which had significant polio eradication activities.

    Immunization programmes have improved significantly in the African Region. A decrease was noted in the Ebola-affected countries i. PEI has been associated with increased spending on immunization and the related improvements, especially in the areas of micro planning, service delivery, program management and capacity building. Continued efforts are needed to mobilize international and domestic support to strengthen and sustain high-quality immunization services in African countries. Strengthening RI will in turn sustain the gains made to eradicate poliovirus in the region. The IMB meets with senior program officials every months.

    Its reports provide analysis and recommendations about individual polio-affected countries. The IMB also examines issues affecting the global program as a whole. Its areas of focus have included escalating the level of priority afforded to polio eradication particularly by recommending a World Health Assembly resolution to declare polio eradication a programmatic emergency, which was enacted in May , placing greater emphasis on people factors in the delivery of the program, encouraging innovation, strengthening focus on the small number of so-called sanctuaries where polio persists, and continuous quality improvement to reach every missed child with vaccination.

    The IMB's true independence from the agencies and countries delivering the program has enabled it to raise difficult issues that others cannot. Other global health programs might benefit from establishing similar independent monitoring mechanisms. Which is More Feasible?

    As we approach the third decade since the WHO started addressing the eradication of poliomyelitis and leprosy, a reflection of the previous campaigns efficacy and an evaluation of further elimination feasibility is important to adapt and intensify the next steps.

    We performed a critical review of the poliomyelitis and leprosy eradication campaigns to evaluate their technical and operational feasibilities. Vaccination and active case search are highly effective tools against poliomyelitis.

    If political stability and good vaccination coverage is achieved, poliomyelitis will be an easy target for eradication. Leprosy, on the other hand, faces many barriers towards elimination. The lack of a high efficacy vaccine, the long asymptomatic but infective period, the lack of screening tests and a poorly established elimination target, prevents this disease from being eliminated. In a world where resources and funding are limited, it is apparent that poliomyelitis is a more feasible target for elimination than leprosy.

    Lessons for Malaria Eradication. Jacob; Levine, Myron M. 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.

    However, because of the persistence of endemic WPV transmission and recurring outbreaks in polio-free countries after the original polio eradication target date of , the World Health Assembly in declared the completion of polio eradication a programmatic emergency. During , 1, volunteers were identified, trained, and deployed for 2, assignments in 69 countries.