3. Polio Symptoms
fever, 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 route
Vehicle
Mainly children
Invade CNS
paralysis
4. Epidemiology of Polio
Irreversible paralysis
In those infected
1 / 200 5 - 10%
Died among
those paralyzed
350 000
cases
in 1988
74
cases
in 2015
200 000
Cases per year
If failed to eradicate
Global collaboration Fail to eradicate
6. “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
7. 1580-1350 BC 1789 AC
Had existed
First-Known
Clinical
Description
1840 AC
Theory developed
That polio is
Contagious
1894 AC
First Documented
Polio outbreak
Leading to paralysis
8. 1908
Hypothesis that
polio might be
caused by virus
1916
Outbreak in NY, USA.
Research accelerated.
1931
Different types of
polio virus are
identified.
1938
Campaign on
polio research.
(President F. D.
Roosevelt)
1948
Successfully grow
polio virus in live
cell.
1955
Salk develops
the first killed
polio vaccine.
1961
Sabin develops
live oral vaccine
against polio.
9. 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.html
20th 上旬
58,000人罹病
21,000人不良於行
死亡3,000+
1952 大流行
21,269人終身殘廢
3,145人死亡
10. The battle song of OPV and IPV
administer MouthInjection
TypeInactivated
Live
attenuated
GI immune
Requirements
Revert
O
O
X
X
StrictNot Strict
IPV
Salk
OPV
Sabin
11. 1954 Sabin began testing his OPV in humans.
1955 IPV developed by Salk was licensed for use. (60-90% effective)
1955 IPV Cutter incident (40,000 polio, 200 paralyzed, 10 died)
1959 15,000,000 people had been given OPV in Soviet Union with
no apparent side effects.
1960 Cases dropped from 20,000 per year (1955) to 2,500.
1961 OPV successfully developed by Sabin.
1962 IPV abandoned by American doctors in favor of OPV for
largescale national immunization.
12. Total number of reported paralytic poliomyelitis and
Vaccine-associated PP in United States
75萬名疫苗接受者中，
平均約有1人產生疫苗相關麻痺型脊髓灰質炎（VAPP）
台灣衛生署統計則為240萬人中出現1個。
13. 1980s Breakthrough in understanding of vaccine-associated paralysis
(VAPP)
1988 WHO began its poliovirus eradication initiative
1996 Advisory Committee on Immunization Practices decided that
the US would transition to IPV
WHO has recommended a global transition to IPV
1997 the Advisory Committee on Immunization Practices (ACIP)
recommended adoption of a sequential IPV-OPV vaccination
schedule.
17. WHA41.28 Global eradication of
poliomyelitis by the year 2000 (1988)
1. Strengthening routine immunization
programs
2. “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 of polio
18. Global Wild Poliovirus cases
Credit: EPI from WHO, GPEI
⬇1988 Global Polio Eradication Initiatives
⬇1991 Last Case of polio in Americas
⬇1994 “Kick Polio out of Africa"
⬇1999 “House to House”
⬆2000 West Pacific Polio-free
⬆2002 Europe Polio-free
States still with Polio cases:
Afghanistan, India, Nigeria, and Pakistan
19. 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 Pakistan’s
Northwest Frontier Province ⬇
2009 Taliban refused to let health
officials administer polio
vaccinations ⬇
20. WHA66/18 Polio Eradication and Endgame
Strategic Plan 2013-2018 (2013)
Eradication
• refers to wild virus
Endgame
• refers to
management of
VDPVs and VAPP
22. Types of polioviruses
• 99% reduction in cases of wild poliovirus since 1988
• Type 1 (369 cases as of 31 December 2013†)
• Type 2 (eliminated worldwide in 1999)
• Type 3 (none detected since November 2012)
Wild
• Vaccine 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 cVDPVs
VDPVs
*
• Vaccine-associated paralytic poliomyelitis (VAPP)**
• Estimated ~250-500 globally per year
• Type 2 accounts for about 40% of VAPP
VAPP**
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.
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-2
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)
SIAs, the most visible aspect of the program, are typically conducted every 4–8 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 surveillance—the testing of sewage for polioviruses—is 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
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.”
