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CDC Telebriefing Transcript
Progress Toward Global Polio Eradication
March 28, 2002
MR. ALLEN: Thank you for joining us today. Today, Dr. Patrick Zuber--that
is spelled Z-u-b-e-r--a medical epidemiologist with the National
Immunization Program at CDC, will discuss progress toward global eradication
of polio.
With that, I will turn it over to Dr. Zuber, and after his initial remarks,
we will open it up for questions. Thank you very much.
Dr. Zuber?
DR. ZUBER: Good afternoon. During 2001, there have been 473
laboratory-confirmed poliomyelitis cases reported throughout the world.
There were only 10 countries, three in Asia and seven in Africa, that
experienced indigenous transmission. Of these 10 countries, only
three--India, Pakistan, and Nigeria--are still considered to be major polio
virus reservoirs.
Improved access to all children, continued political commitment, and
assurance of uninterrupted funding will be will be necessary to interrupt
wide polio transmission globally.
As the eradication of poliomyelitis is in sight, preparation for
post-eradication activities is underway. This includes the development of
laboratory containment plans in all countries, certification that the world
is free of polio after six regional certification commissions will have
reviewed all available evidence, and planning for post-certification
vaccination policy.
MR. ALLEN: Okay. Bill, we will open it up for questions now. Thank you.
CDC MODERATOR: Thank you.
Ladies and gentlemen, if you wish to ask a question, please press "1" on
your touchtone phone. You will hear a tone indicating you have been placed
in queue, and you may remove yourself from queue at any time by pressing the
pound key. If you are using a speaker phone, please pick up your handset
before pressing the number. Once again, if you do have a question or
comment, please press the "1" at this time.
The first line will open. It is Ted Vigodsky [ph] at Public Broadcasting.
Please go ahead. Mr. Vigodsky, your line is open.
QUESTION: I have no question. I am just listening. Thank you.
CDC MODERATOR: All right. Thank you. We will move on.
The next line that will open is Maryn McKenna [ph], the Atlanta Journal
Constitution. Please go ahead.
QUESTION: Hi. Thanks for conducting this.
Dr. Zuber, could you comment on the expectation that eradication will be
achieved by the date set by WHO in light of the work reported a few weeks
ago by Drs. Mark Pallansch [ph] and Olen Kew [ph] at the CDC's Polio Lab
that low levels of vaccination in Hispaniola had allowed the vaccine virus
to revert back to something resembling a wild virus type and cause an
outbreak?
DR. ZUBER: Yes, certainly. Thank you for asking this question.
There are really two different challenges. One challenge is getting rid of
the current wild polio for which we are reporting that there are only 10
countries left with endemic disease. The next challenge is to discuss
strategies to discontinue oral poliovirus vaccination, and the latest events
in Hispaniola that you are mentioning, but also a similar situation in the
Philippines has demonstrated to us that when a country keeps a low level of
routine vaccination with oral poliovirus vaccine, there is a risk that the
vaccine virus can revert to a virulent form.
However, the good news is that there is a strategy that works for control of
the wild polio. This strategy also appears to work for the vaccine-derived
polio. In Hispaniola, it was possible to control this outbreak with exactly
the same strategy of mass vaccinations campaigns that are used in countries
with wild polioviruses.
QUESTION: Can I ask a follow-up question?
MR. ALLEN: Sure.
DR. ZUBER: Sure.
QUESTION: When they announced their reports, Drs. Kew and Pallansch made the
point that, as a result of their findings, post-eradication activities might
have to be a two-step process; that the first goal would be eradication of
wild-type polio. The second goal would be the cessation of OPV use, and
since OPV is particularly well adapted to the demands of polio eradication
in the developing world and since vaccination has to go on for a certain
number of years in order to achieve eradication, can you just unpack a
little more the degree of challenge that the finding poses?
DR. ZUBER: Yes. I think that what our colleagues implied is that once
countries have not observed wild polio cases for several years, the job may
not be over because there is still a risk that the disease would either come
back as a result of importation, but also come back as a result of mutation,
like they demonstrated in their article. So countries that have weak
infrastructure for delivering routine vaccination will probably need to keep
conducting mass vaccination campaigns for a certain time until it is
possible to discontinue oral polio vaccine use throughout the world.
And there is a working group from the World Health Organization and its
partners that is currently trying to explore the various scenarios to
identify the best strategy to discontinue oral polio vaccination.
QUESTION: Okay. Thank you.
MR. ALLEN: Thank you.
CDC MODERATOR: Our next question will come from Martha Curr [ph] at Reuters
Health. Please go ahead.
QUESTION: Dr. Zuber, what plans do you have or does the world have to
improve vaccination rates in India, Pakistan, and Nigeria?
DR. ZUBER: Each of these three countries benefit now from a technical
advisory group. These groups review progress on a very regular basis, and
they propose, in addition to the annual mass vaccination campaigns, some
focal activities where the highest risk of polio transmission is found. In
certain areas of these countries, as many as four to six rounds of mass
vaccination campaign can be conducted during a year, and we are hopeful that
this approach should allow us to finish the job over the next 12 to 34
months.
QUESTION: Okay. Thank you.
MR. ALLEN: Next question.
CDC MODERATOR: Once again, ladies and gentlemen, if you do have a question
or comment, please press the "1" at this time, and our next question will
come from the line of Paul Simione [ph] with Reuters. Please go ahead.
QUESTION: Thank you. I notice you have listed two cases in Europe in 2001. I
was wondering what they referred to and what the background was on them.
DR. ZUBER: Yes. There were two cases that were diagnosed in Bulgaria. These
cases were found among children from minority groups of Roma people, and
when the virus was isolated, it was found that this virus strain was a virus
strain that had never been found in Europe before, but resembled very much a
strain that was circulating in the Northern India 6 to 12 months earlier. So
the most likely explanation is that this was an importation of wild polio
into Bulgaria from India, and the exact mechanism for interdiction of this
strain remains unknown, but we have seen importations of polio in various
parts of the world, and we tend to identify these importation more
frequently now that polio has become a rare event.
QUESTION: Thank you.
MR. ALLEN: Next question.
CDC MODERATOR: Well, there are no additional questions at this time, sir.
Please continue with your presentation.
MR. ALLEN: If there are no further questions, we will conclude the
presentation.
The presentation will be on the website around 4:00 this afternoon, and you
are welcome to call, to visit the website, or if you have additional
questions, you might want to try calling the press office at (404)(
639-3286).
Thank you very much.
CDC MODERATOR: Ladies and gentlemen, that does conclude your teleconference
for today. Thank you for your participation and for using the AT&T Executive
Teleconference Service. You may now disconnect.
