Ismoedijanto M P
Staf UPF AnakDosen, Lek Kep, SMF IKA FKUNAIRRSUD Dr Soetomo
Poliomyelitis was ubiquitous and distributed globally, before the OPV and IPV licensing. Introduction of vaccine and mass vaccination had rapidly reduced the child paralytic cases. Mass vaccination in several countries had demonstrated the vaccine is able to interrupt the transmission of wild polio virus. Global Polio Eradication Initiative (GPEI) was organized to four main eradication activities, strengthening routine immunization with OPV, Supplementary Immunizatioin activities (SIA), Acute Flaccid Paralysis surveillance (sAFP) and mop up vaccination campaign. Reduction of polio cases had rapidly achieved and some WHO region was declared as polio free. Some programmatic innovation had improved the speed and lift the coverage of immunization and India (SEARO) became polio free in 2014.
However, in three endemic countries, Nigeria, Afganistan and Pakistan, the transmission had never been interrupted and caused outbreaks in adjacent countries, force to complete the eradication as a global health emergency. Other problem arises as the trivalent OPV had the ability to back-mutate to the cVDPV in areas under coverage and forced the immunization from oral to injection.
A transition was needed to keep the countries remain polio free from wild polio virus and cVDPV and continue the eradication in the three endemic areas. Heightened AFP surveillance and additional environtmental surveillance had detected the existance of wild and also cVDPV in areas which had been declared as polio free before. Three main pillars of activities were needed: containment of any poliovirus from any potential sources (laboratories, vaccine producers, research centers), protect population immunity by switching the trivalent to bivalent OPV and withdraw the OPV from use and immunize the populations by using IPV to guard against any re-emergence poliovirus, promptly detect any poliovirus in human or environment and rapidly respond to stop and prevent transmissions.
In 2018, a VDPV3 was detected in environtmental sample in West district Delhi and later an outbreak of cVDPV1 arise in Papua New Guinea. These evidences strongly support the recommendation to countries in Regions to commit to the three pillars of activities to eradicate the polio globally.
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