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National Poliomyelitis Immunization Days -- People's Republic of China, 1993

In 1988, the World Health Organization (WHO) established the goal of global eradication of poliomyelitis by the year 2000 (1). Based on cases officially reported to WHO, progress toward eradication has been substantial: in 1992, a total of 15,445 paralytic poliomyelitis cases were reported worldwide, compared with 32,419 cases in 1988. Beginning in December 1993, the People's Republic of China will conduct a series of two National Immunization Days that target approximately 100 million children (all children aged less than 4 years) to receive oral poliovirus vaccine (OPV) in each of two separate rounds of vaccination, possibly representing the largest public health event of its kind in history. This report summarizes the plans for National Immunization Days and efforts in China to eradicate poliomyelitis by 1995.

Because of the large population in China (approximately 21% of the world's population) and the proportion of worldwide poliomyelitis cases occurring in China, this vaccination initiative is crucial to the global eradication effort. In 1990, of the 21,627 total poliomyelitis cases reported to WHO, 5065 (23.4%) occurred in China; in 1992, however, the number reported by China decreased to 1191 (7.7%) of 15,445 total cases. The absolute and relative decreases in poliomyelitis in China have been associated with initiation of supplementary vaccination activities by an increasing number of provincial health departments. These activities have been conducted in addition to routine vaccination of children with three doses of OPV at ages 2, 3, and 4 months.

Supplemental vaccination activities in China have included administering one or two extra doses of OPV to young children (generally those aged less than 4 years) at 1-2-month intervals during the low-incidence season for poliomyelitis (i.e., December- April). The number of provinces conducting the WHO-recommended two rounds of supplemental vaccination activities during low-incidence season increased from six of 30 during 1991-92 to 25 provinces during 1992-93. As a consequence, the number of supplemental doses of OPV administered during the low-incidence season increased from 71 million during 1990-91 to 186 million during 1992-93 (Figure_1). During January-August 1993, 348 poliomyelitis cases were reported through the notifiable diseases reporting system, compared with 877 cases during January-August 1992; in addition, there was no characteristic summertime seasonal increase in reported cases during 1993 (Figure_2).

Although reported cases of poliomyelitis in 1993 have occurred throughout China, a high proportion have been reported from southern provinces. Of the 348 cases reported through August 1993, 107 (31%) were from one southern province (Guangdong); in addition, 231 (66%) have been reported from six southern provinces (Fujian, Guangdong, Guangxi, Guizhou, Hainan, and Jiangxi), which comprise 19% of the population of China. Reported by: B Yang, MD, Div of Expanded Program on Immunization, Z Dai, MD, Z Wang, MD, Dept of Health and Epidemic Prevention, Ministry of Public Health; K Wang, MD, R Zhang, MD, J Zhang, MD, T Jiang, MD, Chinese Academy of Preventive Medicine, Beijing, People's Republic of China. Expanded Program on Immunization Unit, Western Pacific Regional Office, World Health Organization, Manila, Philippines. Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases; Polio Eradication Activity, National Immunization Program, CDC.

Editorial Note

Editorial Note: The plan for implementing National Immunization Days in China has been based on three factors: 1) the success of the provincial supplemental vaccination activities, 2) concerns about the potential accumulation of susceptible children since the nationwide poliomyelitis outbreak during 1989-1990 (Figure_1) in parts of China still not adequately covered by previous provincial supplemental vaccination activities, and 3) the goal of eradicating poliomyelitis from the Western Pacific Region (WPR) of WHO by 1995. China and other member countries in the WPR have committed to eradicate poliomyelitis by 1995. Only five of the 29 countries in the region (Cambodia, China, the Lao People's Democratic Republic, Philippines, and Vietnam) continue to report endemic poliomyelitis- -of the 1908 cases that occurred in this region during 1992, 1191 (62%) were reported from China.

The apparent elimination of wild poliovirus infections in the Americas and the substantial progress already achieved in the WPR underscore the feasibility of achieving this goal in WPR and other regions of the world (2-4). The successful implementation of National Immunization Days will assist WHO and member countries in global application of the strategies for eradication as recommended by WHO. Additional National Immunization Days in China are planned for 1994-95 and 1995-96. The success of such public health efforts is dependent on the support and collaboration of organizations from the public and private sectors including, for example, the Ministry of Public Health, health departments in each of the Chinese provinces, Rotary International, the Japanese International Cooperation Agency, WHO, and the United Nations Children's Fund (UNICEF).

References

  1. World Health Assembly. Global eradication of poliomyelitis by the year 2000. Geneva: World Health Organization, 1988. (Resolution WHA41.28).

  2. CDC. Update: eradication of paralytic poliomyelitis in the Americas. MMWR 1992;41:681-3.

  3. CDC. Update: polio eradication -- the Americas, 1993. MMWR 1993;42:685-6.

  4. Foege WH. A world without polio. JAMA 1993;270:1859-60.


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