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Brief Report: Global Polio Eradication Initiative Strategic Plan, 2004

Since the 1988 World Health Assembly resolution to eradicate poliomyelitis (1), the number of polio-endemic countries has decreased from 125 in 1988 to six in 2003 (i.e., Afghanistan, Egypt, India, Niger, Nigeria, and Pakistan), and the number of cases reported worldwide has decreased from approximately 350,000 to 682. In 2003, approximately 90% of cases were reported from Nigeria (305), India (220), and Pakistan (99); epidemiologic and virologic data demonstrated focal endemic transmission in Afghanistan and Niger, with repeated importations from Pakistan and Nigeria, respectively, and localized transmission in Egypt. On January 15, 2004, the World Health Organization (WHO) released an updated Global Polio Eradication Initiative Strategic Plan outlining activities required to 1) interrupt poliovirus transmission globally, 2) achieve global certification of polio eradication, and 3) prepare for global cessation of childhood vaccination with oral poliovirus vaccine (OPV) (2). The discontinuation of mass vaccination campaigns in the majority of polio-free countries has left these areas vulnerable to importations of wild poliovirus (WPV) from the remaining countries in which polio is endemic. For polio to be eradicated, all remaining poliovirus reservoirs must be eliminated.

Objective 1 details the immunization and surveillance activities required to interrupt transmission in the remaining countries where polio is endemic. During 2004, supplementary immunization activities (SIAs) in India, Nigeria, and Pakistan will be intensified. The suspension in 2003 of OPV campaigns in the highly polio-endemic areas of northern Nigeria led to a marked increase in the number of reported cases from that country, resulting in WPV transmission in previously polio-free areas within Nigeria and importation of WPV into at least six neighboring countries. For polio to be eradicated, all children aged <5 years in Nigeria, the other five countries in which polio also is endemic, and those countries with imported cases must be vaccinated during intensified SIAs in 2004.

Objectives 2 and 3 outline activities for certifying the world polio-free and preparing for the cessation of use of OPV. Objective 2 focuses on improving surveillance quality (especially in the 19 countries that have not achieved certification-standard surveillance), reversing declines in surveillance sensitivity in the WHO regions that have been certified polio-free, and working to complete WPV laboratory containment. Objective 3 outlines the development of policies for the postcertification era, including detection and notification of circulating polioviruses as public health emergencies, long-term containment of all poliovirus strains, polio vaccine stockpiles and outbreak response mechanisms, and routine vaccination.

Objective 4 outlines how to incorporate the human resources, physical infrastructure, and institutional arrangements that have been established for polio eradication into other disease-control programs and recommends that those polio-eradication activities that must be continued indefinitely (i.e., surveillance, vaccine stockpiles, and laboratory containment) be undertaken by existing national, WHO, and United Nations Children's Fund (UNICEF) programs.

More information about the Global Polio Eradication Initiative is available from CDC at http://www.cdc.gov/nip/global/stopteam/backgrd.htm. Copies of the Global Polio Eradication Initiative Strategic Plan are available from WHO, e-mail, polioepi@who.int or at http://www.polioeradication/all/news/document.asp.

Reported by: Polio Eradication Initiative/Office of the Director-General and Dept of Immunization, Vaccines and Biologicals/Family and Community Health, World Health Organization, Geneva, Switzerland. United Nations Children's Fund, New York, New York. Rotary International, Evanston, Illinois. Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases; Global Immunization Div, National Immunization Program, CDC.

References

  1. World Health Assembly. Global eradication of poliomyelitis by the year 2000: resolution of the 41st World Health Assembly. Geneva, Switzerland: World Health Organization, 1988 (WHA resolution no. 41.28).
  2. Polio Eradication Initiative, Office of the Director-General and Department of Immunization, Vaccines and Biologicals, Family and Community Health. The Global Polio Eradication Initiative Strategic Plan 2004--2008. Geneva, Switzerland: World Health Organization, 2004.

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