AAP Abroad, Vaccine/Immunization
AAP Abroad: Polio vaccine switch is world's largest coordinated public
health effort
by Trisha Korioth, Staff Writer
A major public health effort next month involving thousands of health care providers, government leaders,
nongovernment organizations and industry is taking the world one step closer to polio eradication.
From April 17 to May 1, trivalent oral polio vaccine (tOPV) will be replaced with bivalent oral polio vaccine (types
1 and 3) (bOPV) in 155 countries. About 126 countries also have recently introduced or will be introducing
trivalent inactivated polio vaccine (IPV, also known as the Salk vaccine).
Dr. Orenstein Continued use of the tOPV, which contains type 2 poliovirus, is
contributing to circulating vaccine-derived poliovirus 2 (cVDPV2) outbreaks, explained Walter A. Orenstein,
M.D., FAAP, in a Perspective in the Feb. 11 New England Journal of Medicine ( http://bit.ly/1L6yPi6).
cVDPV2 viruses can proliferate when they are transmitted among susceptible people, resulting in mutations
conferring both the neurovirulence and transmissibility characteristics of wild polioviruses.
The choreographed switch involves replacing stockpiles of tOPV with bOPV and IPV during a low season for
polio over a short time period. The plan is part of the Global Polio Eradication Initiative Polio Eradication and
Endgame Strategic Plan 2013-2018 (http://bit.ly/1RsfNiN).
"This is a very special effort to try and make sure we don't generate any new circulating vaccine-derived
poliovirus 2," said Dr. Orenstein, co-author of the 2015 AAP clinical report on polio eradication
(http://bit.ly/polioCR).
Routine use of oral polio vaccine containing the type 2 strain no longer is necessary in part because the last
case of naturally occurring type 2 wild poliovirus occurred in 1999.
"The declaration that type 2 polio has been eradicated, it's the first time since smallpox and only the second time
in history that at least one form of virus has been eradicated in the human population," said Dr. Orenstein, who
headed the U.S. National Immunization Program from 1988-2004. Polio has been a particularly challenging
disease to eradicate because there are three strains. " We should be calling it the polios," he added.
Upon switching to bivalent oral polio vaccine, the Global Polio Eradication Initiative will deploy independent
monitors to check on program performance and ensure complete removal of tOPV.
The major focus of the eradication effort is type 1, which still circulates as wild poliovirus in Afghanistan and
Pakistan. Although type 3 has not been declared eradicated by the Global Commission for Certification of the
Eradication of Poliomyelitis, the strain has been undetected for more than three years and may have been
eradicated.
Copyright © 2016, The American Academy of Pediatrics
AAP Abroad, Vaccine/Immunization
Dr. Maldonado "Eventually, the plan is to phase out live poliovirus vaccines altogether. That
has to be done in a stepwise approach," said Yvonne A. Maldonado, M.D., FAAP, vice chair of the AAP
Committee on Infectious Diseases. She has represented the Academy during polio containment policy planning
and at World Health Organization global partners meetings on ongoing eradication efforts, and has dedicated
most of her career to studying the disease and polio vaccines.
To be able to certify complete eradication, criteria must be met that involves a minimum of three years without
detection of the virus in the presence of certification standard surveillance and laboratory bio-containment
measures for wild poliovirus.
"The Academy supports efforts around global vaccine advocacy and especially using polio as an example of
how vaccines can help eliminate diseases that impact children," Dr. Maldonado said.
The infrastructure built to achieve polio eradication and the lessons learned will help world health leaders tackle
future health burdens on a global scale, not unlike how measles elimination was a major driving force for
building the National Immunization Program in the U.S., Dr. Orenstein said.
"The wonderfulness of eradication," he said, "is that it protects people forever in the future so that in essence it
is a gift from our generation and all the generations involved to all future generations."
How U.S. pediatricians can help end polio
●
Make sure patients are immunized against polio. Ask patients about travel plans and give boosters to
patients traveling to polio endemic countries (Pakistan and Afghanistan), http://wwwnc.cdc.gov/travel/.
●
Advocate with the Academy and local Rotary International chapter for government support of polio
eradication.
●
Consider volunteering for the Centers for Disease Control and Prevention Stop Transmission of Polio
teams,
which
complete
short-term
assignments
www.cdc.gov/globalhealth/immunization/stop/index.htm.
Recent AAP Abroad articles
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"Pediatric leaders develop plans to tackle non-communicable diseases"
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"10 tips for residents considering a global health rotation"
Copyright © 2016, The American Academy of Pediatrics
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