Polio

Polio @ Poliovirus in MedicinePolio in Human HistoryVaccines and PreventionsCombating Polio around the World

Photo credit: http://polioeradication.org/polio-today/history-of-polio/

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(poliomyelitis)(infantile paralysis)

http://www.rotarian-publication.org/%E6%9C%88%E5%88%8A/2009/2009-2/%E5%B0%8F%E5%85%92%E7%97%B2%E7%97%B9%E7%9A%84%E9%A9%9A%E4%BA%BA%E6%95%85%E4%BA%8B.pdf2

Polio Symptomsfever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs.

In a small proportion of cases, the disease causes paralysis, which is often permanent.

Fecal-oral routeVehicleMainly childrenInvade CNS paralysis

Photo from: http://www.natural-health-news.com/wp-content/uploads/2015/06/Polio.jpg

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Epidemiology of PolioIrreversible paralysisIn those infected1 / 200 5 - 10%Died among those paralyzed 350 000 cases in 198874cases in 2015

200 000Cases per yearIf failed to eradicate

Global collaborationFail to eradicate

http://www.who.int/mediacentre/factsheets/fs114/en/4

Map of Polio infections

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There is no cure for polio, it can only be prevented. Polio vaccine, given multiple times, can protect a child for life.

World Health Organization

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1580-1350 BC

1789 ACHad existedFirst-KnownClinical Description

1840 ACTheory developedThat polio isContagious

1894 ACFirst DocumentedPolio outbreak Leading to paralysis

http://polioeradication.org/polio-today/history-of-polio/7

1908Hypothesis that polio might be caused by virus

1916Outbreak in NY, USA.Research accelerated.

1931Different types of polio virus are identified.

1938Campaign on polio research.(President F. D. Roosevelt)

1948Successfully grow polio virus in live cell.

1955Salk develops the first killed polio vaccine.

1961Sabin develops live oral vaccine against polio.

http://polioeradication.org/polio-today/history-of-polio/8

Case rate and death rate of polio (US)Anne Carrington Gawne and Lauro S. Halstead, Post-Polio Syndrome: Pathophysiology and Clinical Management, 2010.http://www.poliosurvivorsnetwork.org.uk/archive/lincolnshire/library/gawne/ppspandcm-s03.html20th 58,00021,0003,000+1952 21,2693,145

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The battle song of OPV and IPV

administerMouthInjectionTypeInactivatedLive attenuatedGI immuneRequirementsRevertOOXXStrictNot StrictIPVSalkOPVSabin

https://www.moskvaer.com/moscows-game-of-thrones-food-festival-dine-on-the-food-of-westeros-sit-upon-the-iron-throne-and-more/

According to the World Health Organization, routine immunization with OPV must cease after the eradication of poliovirus because of the danger of outbreaks of circulating vaccine-derived poliovirus and the risk of VAPP.

http://cid.oxfordjournals.org/content/49/8/1287.full#ref-210

1954Sabin began testing his OPV in humans.1955IPV developed by Salk was licensed for use. (60-90% effective)1955IPV Cutter incident (40,000 polio, 200 paralyzed, 10 died)195915,000,000 people had been given OPV in Soviet Union with no apparent side effects.1960Cases dropped from 20,000 per year (1955) to 2,500.1961OPV successfully developed by Sabin.1962IPV abandoned by American doctors in favor of OPV for largescale national immunization.

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Context: http://www.virology.ws/2015/09/10/why-do-we-still-use-sabin-poliovirus-vaccine/

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Total number of reported paralytic poliomyelitis and Vaccine-associated PP in United States751VAPP2401

Outbreaks of vaccine-associated paralytic poliomyelitis (VAPP) have been reported in many countries of the world.

http://liuchienyi.pixnet.net/blog/post/34647319-%E7%AC%AC%E4%BA%8C%E5%80%8B%E8%A2%AB%E6%BB%85%E7%B5%95%E7%9A%84%E7%97%85%E6%AF%92%EF%BC%9F(%E6%B7%BA%E8%AB%87%E7%96%AB%E8%8B%97%E4%B9%8B%E4%BA%8C)12

1980sBreakthrough in understanding of vaccine-associated paralysis (VAPP)1988WHO began its poliovirus eradication initiative1996Advisory Committee on Immunization Practices decided that the US would transition to IPVWHO has recommended a global transition to IPV1997the Advisory Committee on Immunization Practices (ACIP) recommended adoption of a sequential IPV-OPV vaccination schedule.

Photo: http://gameofthrones.wikia.com/wiki/File:Petyr_and_Varys_1x05.pnghttp://www.virology.ws/2015/09/10/why-do-we-still-use-sabin-poliovirus-vaccine/

Context: http://www.virology.ws/2015/09/10/why-do-we-still-use-sabin-poliovirus-vaccine/

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1/3

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198265%8%33()

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95% WHOOPV

http://61.57.41.133/uploads/files/201405/bb5ebb4f-3ee3-43a3-9553-816c03a6aa3f.pdf16

WHA41.28 Global eradication of poliomyelitis by the year 2000 (1988)

1. Strengthening routine immunization programs2. Supplementary immunization activities (SIAs) in the form of mass vaccination campaigns 3. Surveillance for acute flaccid paralysis 4. Targeted mop-up campaigns around any confirmed cases ofpolio

SIAs, the most visible aspect of the program, are typically conducted every 48 weeks until transmission has been stopped.AFP surveillance is a critical component in countries both with and without polio, where the surveillance system is expected to detect nonpolio cases of AFP at a rate of at least 1 per 100,000 per year in industrialized countries and 2 per 100,000 per year in developing countries.Environmental surveillancethe testing of sewage for poliovirusesis also a sensitive tool for poliovirus detection and plays an increasing role in surveillance for poliovirus.

https://wwwnc.cdc.gov/travel/yellowbook/2016/infectious-diseases-related-to-travel/for-the-record-a-history-of-polio-eradication-efforts

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Global Wild Poliovirus cases

Credit: EPI from WHO, GPEI1988 Global Polio Eradication Initiatives1991 Last Case of polio in Americas1994 Kick Polio out of Africa"1999 House to House

2000 West Pacific Polio-free2002 Europe Polio-freeStates still with Polio cases:Afghanistan, India, Nigeria, and Pakistan

http://www.earth-policy.org/data_highlights/2011/highlights1918

Domestic situation and polio eradication

Mullah claiming the purpose of vaccine is to spread AIDS 2009 Governors ensure enough children would receive the polio vaccine

2007 violent opposition to vaccinations arose in Pakistans Northwest Frontier Province

2009 Taliban refused to let health officials administer polio vaccinations

http://www.earth-policy.org/data_highlights/2011/highlights19

mullahs in northern Nigeria began to oppose the polio vaccination program there, claiming that it was a plot to spread AIDS and sterility. As a result, the local vaccination effort broke down, and polio cases in Nigeria tripled over the next three years.

Meanwhile, Nigerian Muslims making their annual pilgrimage to Mecca may have spread the disease, reintroducing the virus in some Muslim countries, such as Indonesia, Chad, and Somalia, that were already polio-free. In response, Saudi officials imposed a polio vaccination requirement on all younger visitors from countries with reported cases of polio.

The Independent Monitoring Board of the Global Polio Eradication Initiative notes that on its current course, Pakistan risks being the country that prevents global polio eradication.

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WHA66/18 Polio Eradication and Endgame Strategic Plan 2013-2018 (2013)Eradicationrefers to wild virusEndgamerefers to management of VDPVs and VAPP

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Thank youfor your attention

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Types of polioviruses99% reduction in cases of wild poliovirus since 1988Type 1 (369 cases as of 31 December 2013)Type 2 (eliminated worldwide in 1999)Type 3 (none detected since November 2012)WildVaccine derived polioviruses (VDPV)Most are circulating VDPVs (cVDPVs)*~58-184 per year since 2008 (through 31 Dec 2013)Type 2 cVDPVs account for 97% of cVDPVsVDPVs*Vaccine-associated paralytic poliomyelitis (VAPP)**Estimated ~250-500 globally per yearType 2 accounts for about 40% of VAPPVAPP**OPV related More up-to-date numbers can be found at http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx*Other extremely rare VDPVs include primary immunodeficiency VDPVs (iVDPVs) and ambiguous VDPVs (aVDPVs)**Refers to spontaneous reversion to neurovirulence of one of the attenuated viruses in OPV. VAPP occurs in OPV recipients or their close contacts in contrast to cVDPVs which are widely transmitted in a community and are not likely to be related to contact with a recent vaccine recipient.

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http://polioeradication.org/wp-content/uploads/2016/07/PEESP_EN_US.pdf23