Journal
JOURNAL OF INFECTIOUS DISEASES
Volume 224, Issue -, Pages S398-S404Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/infdis/jiaa622
Keywords
poliomyelitis; inactivated poliovirus vaccine; oral poliovirus vaccine; polio eradication
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Funding
- Bill and Melinda Gates Foundation
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Both inactivated poliovirus vaccine (IPV) and oral poliovirus vaccine (OPV) have played a role in the eradication of paralytic poliomyelitis. The Global Polio Eradication Initiative has made significant progress, but challenges such as poor vaccine uptake and new outbreaks have slowed down the efforts. Introduction of a more stable OPV vaccine may help prevent future vaccine-derived poliovirus outbreaks.
Both inactivated poliovirus vaccine (IPV) and oral poliovirus vaccine (OPV) have contributed to the rapid disappearance of paralytic poliomyelitis from developed countries despite possessing different vaccine properties. Due to cost, ease of use, and other properties, the Expanded Programme on Immunization added OPV to the routine infant immunization schedule for low-income countries in 1974, but variable vaccine uptake and impaired immune responses due to poor sanitation limited the impact. Following launch of the Global Polio Eradication Initiative in 1988, poliomyelitis incidence has been reduced by >99% and types 2 and 3 wild polioviruses are now eradicated, but progress against type 1 polioviruses which are now confined to Afghanistan and Pakistan has slowed due to insecurity, poor access, and other problems. A strategic, globally coordinated replacement of trivalent OPV with bivalent 1, 3 OPV in 2016 reduced the incidence of vaccine-associated paralytic poliomyelitis (VAPP) but allowed the escape of type 2 vaccine-derived polioviruses (VDPV2) in areas with low immunization rates and use of monovalent OPV2 in response seeded new VDPV2 outbreaks and reestablishment of type 2 endemicity. A novel, more genetically stable type 2 OPV vaccine is undergoing clinical evaluation and may soon be deployed prevent or reduce VDPV2 emergences.
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