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    Mass polio vaccination. Eradication by 2000 is a realistic goal [editorial]

    Chander J; Subrahmanyan S

    BMJ. British Medical Journal. 1996 May 11; 312(7040):1178-9.

    Mass administration of the oral polio vaccine (OPV) will effect eradicate poliomyelitis in developing countries. Since 1974 the World Health Organization (WHO) has operated the expanded program on immunization (EPI). Progress has been so successful that in 1988 WHO/EPI announced its commitment to global eradication of poliomyelitis by 2000. Strategies to achieve global eradication are increasing and sustaining coverage with PVO, conducting national immunization days, developing surveillance for acute flaccid paralysis, and mopping up vaccination campaigns. EPI helps countries change their national disease prevention programs into disease eradication programs. During 1988-94 the number of reported cases of poliomyelitis decreased by 84%. In 1994 India made up 93% of the regional total and 62% of the global total. Polio has almost disappeared from many developed countries. Since South East Asia is still a major global reservoir of polio viruses, WHO is implementing polio eradication strategies fully there. The mass polio vaccination campaign in most developing countries distributes two doses of PVO to all children aged 5 or less. In areas where wild poliovirus still circulates at low levels during the final stages of eradication, door to door administration of the two doses to all young children is undertaken in order to further reduce its circulation in these areas. This door to door campaign operates alongside routine polio vaccination. Pulse or cluster immunization is being successfully implemented in India. The effect of OPV is that it mimics natural infection and produces both humoral and intestinal immunity much faster than the inactivated polio vaccine. It blocks infection with the wild polio virus by establishing itself in the alimentary tract. Further, the vaccine virus spreads to children who have not been vaccinated, extending immunity to the wider population without additional expenditure. Improving vaccine delivery systems (improved maintenance of the cold chain) rather than changing immunization schedules is needed to achieve eradication. Wild poliovirus transmission has been interrupted in the Americas.
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