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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.


  1. Pan American Health Organization. Director announces campaign to eradicate poliomyelitis from the Americas by 1990. Bull Pan Am Health Organ 1985;19:213-5.

  2. 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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