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Countries using oral poliovirus vaccine (OPV) in May 2016 following the global switch from trivalent OPV to bivalent OPV. Data are unpublished and from the World Health Organization Immunization Repository.
Source publication
Eliminating the risk of polio from vaccine-derived polioviruses is essential for creating a polio-free world, and eliminating that risk will require stopping use of all oral polio vaccines (OPVs) once all types of wild polioviruses have been eradicated. In many ways, the experience with the global switch from trivalent OPV (tOPV) to bivalent OPV (b...
Contexts in source publication
Context 1
... of August 2016, 6 companies were producing World Health Organization (WHO)-prequalified bOPV for the international market [14], with 7 additional companies producing bOPV for their domestic markets [15]. Among the 150 countries and terri- tories currently using OPV (Figure 2), approximately 75 procure bOPV through the United Nations Children's Fund (UNICEF), while the rest self-produce or self-procure bOPV. Among coun- tries and territories procuring bOPV through UNICEF, SIAs are the key demand driver, with routine immunization accounting for approximately 20% of UNICEF's procurement of 1.2 billion doses in 2016. ...
Context 2
... the other components of OPV withdrawal, the moni- toring and confirmation process could potentially involve more than just the countries that are still using bOPV at the date of OPV withdrawal or the countries that continued to use OPV after the switch (Figure 2). To fully minimize the possibility of OPV being used after its withdrawal, all countries that have ever used OPV, including those that ceased using it years before the switch, should ideally confirm that all of their OPV has either been (1) withdrawn and destroyed or (2) safely contained in an approved poliovirus-essential facility. ...
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Background
The Oral Polio Vaccine (OPV or Sabin) is genetically unstable and may mutate to form vaccine-derived polioviruses (VDPVs). Methods
In 2014, two VDPVs type 2 were identified during routine surveillance of acute flaccid paralysis (AFP) cases. Consequently, a retrospective VDPV survey was conducted to ensure that there was no circulating VD...
Patients with severe primary immunodeficiency are at risk for complications from live attenuated vaccines. Here, we report a case of a vaccine associated paralytic polio (VAPP) and Bacille Calmette-Guérin (BCG) disease in a 6-month-old girl with severe-combined immunodeficiency (SCID) due to homozygous recombinant activating gene 1 (RAG-1) deficien...
In the context of the near-global eradication of wild poliovirus, the significance of non-polio enteroviruses (NPEVs) in causing acute flaccid paralysis (AFP) and their impact on public health has gained increased attention. This research, conducted from 2001 to 2021, examined stool samples from 1597 children under 15 years in São Paulo, Brazil, th...
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Citations
... This challenge was described in studies from several geographical regions, including the Eastern Mediterranean Region, 30 the West Pacific Region, 35 Region of Americas, 45,57 Sri Lanka, 31 India, 40,41 Pakistan, 46 and on a global scale. 33,34,37,42 To this end, countries had to delay the IPV introduction into their immunization programs. 2,33,37 Countries already introduced IPV faced shortages and had to use intradermal fractional IPV instead. ...
... 33,34,37,42 To this end, countries had to delay the IPV introduction into their immunization programs. 2,33,37 Countries already introduced IPV faced shortages and had to use intradermal fractional IPV instead. 31,46,57 Impact of this challenge in vaccine supply included insufficient access to vaccines, which resulted in children missing scheduled vaccinations. ...
... Training and supervision of health-care professionals was a challenge in almost all types of vaccine switches mentioned in the included studies. These were switch of the route of administration (poliovirus vaccines: OPV to IPV, 30,49,51,57 and from intramuscular full-dose to intradermal fractional dose of IPV), 31,46 switch of serotype coverage (poliovirus vaccines: tOPV to bOPV), 30,37,49 switch of the number of doses per vial (PCV: single-dose vial to multi-dose vial), 50 and switch of vaccination schedule of PCV (3 primary doses without a booster (3+0) to 2 primary doses with a booster dose (2 +1), 52 and 3, 5, and 12 months to 2, 4, and 12 months). 53 During the global shortage of IPV, countries that had already introduced IPV to their NIPs were disrupted by unexpected vaccine supply constraints. ...
Switching a vaccine for another on a pediatric national immunization program is often done for the betterment of society. However, if poorly implemented, switching vaccines could result in suboptimal transitions with negative effects. A systematic review was conducted to evaluate the existing knowledge from identifiable documents on implementation challenges of pediatric vaccine switches and the real-world impact of those challenges. Thirty-three studies met the inclusion criteria. We synthesized three themes: vaccine availability, vaccination program deployment, and vaccine acceptability. Switching pediatric vaccines can pose unforeseen challenges to health-care systems worldwide and additional resources are often required to overcome those challenges. Yet, the magnitude of the impact, especially economic and societal, was frequently under-researched with variability in reporting. Therefore, an efficient vaccine switch requires a thorough consideration of the added benefits of replacing the existing vaccine, preparation, planning, additional resource allocation, implementation timing, public–private partnerships, outreach campaigns, and surveillance for program evaluation.
... Because global polio eradication is predicated on the achievement of the eradication of paralytic polio due to all live polioviruses, including vaccinerelated viruses [7], eliminating the risk of VAPP and cVDPVs will require stopping all use of OPV in routine immunization services and supplementary immunization activities [8,9]. The Global Commission for the Certification of the Eradication of Poliomyelitis certified the eradication of type 2 poliovirus in 2015 [10] following the last case in 1999 and type 3 poliovirus in 2019 following the last case in 2012 [11], making type 2 and type 3 polioviruses the first human pathogens to be eradicated since smallpox. ...
... The first phase of OPV withdrawal took place in 2016 with the global switch from trivalent OPV (tOPV) to bivalent OPV (bOPV) in the 155 OPV-using countries of the world, through cessation of all manufacturing and distribution of tOPV and its rapid withdrawal from clinics and storage facilities [8,9]. The type 2 vaccine virus was prioritized for removal because type 2 cVDPV (cVDPV2) cases comprised approximately 95% of all cVDPV cases during 2006 to May 2016 and approximately 30% of all VAPP cases. ...
... The type 2 vaccine virus was prioritized for removal because type 2 cVDPV (cVDPV2) cases comprised approximately 95% of all cVDPV cases during 2006 to May 2016 and approximately 30% of all VAPP cases. Additionally, the type 2 OPV vaccine virus is the most infectious and immunogenic of the 3 vaccine virus strains and interferes with the replication of other vaccine strains in the intestinal tract and, hence, the type 1 and 3 vaccine effectiveness using tOPV was lower [2,8,9]. A stockpile of monovalent type 2 (mOPV2) vaccine was established to respond to potential outbreaks of cVDPV2. ...
... The new 2019-2023 GPEI strategic plan includes continued OPV pSIAs in many GPEIsupported countries, but at a decreasing rate between now and the planned timing of globally-coordinated cessation of bivalent OPV (bOPV) (Global Polio Eradication Initiative, 2019). The GPEI led the effort to globally-coordinate cessation of serotype 2 OPV (OPV2) in 2016, and also supported global introduction of one dose of inactivated poliovirus vaccine (IPV) into all national immunization programs (not already using IPV as of 2016) (Hampton et al., 2017). The GPEI motivated IPV introduction by noting that it would offer protection from paralysis due to serotype 2 poliovirus infection for otherwise unprotected IPV recipients. ...
Many countries use supplemental immunization activities (SIAs) with oral poliovirus vaccine (OPV) to keep their population immunity to transmission high using preventive, planned SIAs (pSIAs) and outbreaks response SIAs (oSIAs). Prior studies suggested that investment in pSIAs saved substantial health and financial costs due to avoided outbreaks. However, questions remain about the benefits of SIAs, particularly with the recent introduction of inactivated poliovirus vaccine (IPV) into routine immunization in all OPV‐using countries. The mounting costs of polio eradication activities and the need to respond to oSIAs threatens the use of limited financial resources for pSIAs, including in the remaining countries with endemic transmission of serotype 1 wild poliovirus (WPV1) (i.e., Pakistan and Afghanistan). A recent updated global poliovirus transmission model suggested that the Global Polio Eradication Initiative (GPEI) is not on track to stop transmission of WPV1 in Pakistan and Afghanistan. We use the updated global model to explore the role of pSIAs to achieve WPV1 eradication. We find that unless Pakistan and Afghanistan manage to increase the quality of bivalent OPV (bOPV) pSIAs, which we model as intensity (i.e., sufficiently high‐coverage bOPV pSIAs that reach missed children), the model does not lead to successful eradication of WPV1. Achieving WPV1 eradication, the global objectives of the GPEI, and a successful polio endgame depend on effective and sufficient use of OPV. IPV use plays a negligible role in stopping transmission in Pakistan and Afghanistan and most other countries supported by the GPEI, and more IPV use will not help to stop transmission.
... The degree to which serotypes 1 and 3 OPV viruses behave like serotype 2 OPV viruses, especially regarding their ability to spread and evolve into VDPVs, is a key consideration for the planning and implementation of bOPV cessation. Similar behavior between serotype 2 and serotypes 1 and 3 would suggest a need for similar synchronization and monitoring while a serotype with substantially lower ability to spread and cause VDPVs could be withdrawn with much looser synchronization and monitoring without substantially increasing the risks associated with the withdrawal [21]. We previously used existing models [4,22] to explore the risks associated with a failure to globally synchronize the tOPV-bOPV switch or to fully withdraw tOPV, leading to its inadver- tent use [15,16]. ...
... Thus, one should not assume that bOPV cessation comes with lower risks than the tOPV- bOPV switch. Synchronization of bOPV cessation within and across countries, minimizing unauthorized OPV use after cessation, and maintaining high population immun- ity to transmission until bOPV cessation are important strategies for minimizing the risks associated with bOPV cessation [21]. ...
... In addition to the epidemiological risks involved with a failure to globally synchronize bOPV cessation, a lack of synchronization would significantly complicate bOPV supply management [21,23,28] and could complicate efforts to secure cooperation from national governments in bOPV cessation [41,42]. A lack of synchronization would cause countries that stop earlier to incur higher risks associated with importations of partially-or fully- reverted polioviruses from OPV compared to countries that stop later, mainly due to lower population immunity to transmission at the time of global cessation for the countries that stop earlier. ...
Background:
Oral polio vaccine (OPV) containing attenuated serotype 2 polioviruses was globally withdrawn in 2016, and bivalent OPV (bOPV) containing attenuated serotype 1 and 3 polioviruses needs to be withdrawn after the certification of eradication of all wild polioviruses to eliminate future risks from vaccine-derived polioviruses (VDPVs). To minimize risks from VDPVs, the planning and implementation of bOPV withdrawal should build on the experience with withdrawing OPV containing serotype 2 polioviruses while taking into account similarities and differences between the three poliovirus serotypes.
Methods:
We explored the risks from (i) a failure to synchronize OPV cessation and (ii) unauthorized post-cessation OPV use for serotypes 1 and 3 in the context of globally-coordinated future bOPV cessation and compared the results to similar analyses for serotype 2 OPV cessation.
Results:
While the risks associated with a failure to synchronize cessation and unauthorized post-cessation OPV use appear to be substantially lower for serotype 3 polioviruses than for serotype 2 polioviruses, the risks for serotype 1 appear similar to those for serotype 2. Increasing population immunity to serotype 1 and 3 poliovirus transmission using pre-cessation bOPV supplemental immunization activities and inactivated poliovirus vaccine in routine immunization reduces the risks of circulating VDPVs associated with non-synchronized cessation or unauthorized OPV use.
Conclusions:
The Global Polio Eradication Initiative should synchronize global bOPV cessation during a similar window of time as occurred for the global cessation of OPV containing serotype 2 polioviruses and should rigorously verify the absence of bOPV in immunization systems after its cessation.
... However, in the first year after the switch, no outbreaks of cVDPV2 have been attributed to ongoing use of tOPV, supporting the contention that the vast majority of tOPV has been withdrawn globally. Hampton et al discuss implications of the switch experience for all OPV withdrawal after polio eradication [100]. They note that the higher stakes after polio eradication may justify a more aggressive approach for all OPV withdrawal, involving advanced planning, funding, monitoring, and attention to withdrawal from the private sector. ...
The Global Commission for the Certification of the Eradication of Poliomyelitis certified the eradication of type 2 poliovirus in September 2015, making type 2 poliovirus the first human pathogen to be eradicated since smallpox. The eradication of type 2 poliovirus, the absence of detection of type 3 poliovirus worldwide since November 2012, and cornering type 1 poliovirus to only a few geographic areas of 3 countries has enabled implementation of the endgame of polio eradication which calls for a phased withdrawal of oral polio vaccine beginning with the type 2 component, introduction of inactivated poliovirus vaccine, strengthening of routine immunization in countries with extensive polio resources, and initiating activities to transition polio resources, program experience, and lessons learned to other global health initiatives. This supplement focuses on efforts by global partners to successfully launch polio endgame activities to permanently secure and sustain the enormous gains of polio eradication forever. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.
The Australian Paediatric Surveillance Unit (APSU), established in 1993 to address the paucity of national data on rare childhood disorders, has become an invaluable research resource. It facilitates prospective, active surveillance for a variety of rare disorders, with monthly reporting by ~1500 paediatricians, who are invited to notify incident cases and provide demographic and clinical data. APSU is highly collaborative (used by >400 individuals/organisations), patient-informed and productive (>300 publications). In 30 years, 72 studies have been initiated on rare infections, and genetic, psychological and neurological disorders, and injuries. Return rates of monthly report cards were >90% for 30 years and paediatricians have provided data for >90% of notified cases. Although there are limitations, including case underascertainment in remote regions, APSU often provides the only available national data. APSU has assisted the government in reporting to the WHO, developing national strategies, informing inquiries and investigating disease outbreaks. APSU data have informed paediatrician education, practice, policy, and service development and delivery. APSU was integral in establishing the International Network of Paediatric Surveillance Units (INoPSU) and supporting development of other units. APSU’s expanded remit includes one-off surveys, hospital audits, systematic reviews, studies on the impacts of rare disorders on families, surveillance evaluations, and joint studies with INoPSU members. Paediatricians value the APSU, reporting that APSU data inform their practice. They must be congratulated for an outstanding collective commitment to the APSU, in providing unique data that contribute to our understanding of rare disorders and support optimal, evidence-based care and improved child health outcomes.
Introduction
in August 2020, the World Health Organization African Region was certified free of wild poliovirus (WPV) when Nigeria became the last African country to interrupt wild poliovirus transmission. The National Polio Emergency Operations Center instituted in 2012 to coordinate and manage Nigerian polio eradication efforts reviewed the epidemiology of WPV cases during 2000-2020 to document lessons learned.
Methods
we analyzed reported WPV cases by serotype based on age, oral poliovirus vaccine immunization history, month and year of reported cases, and annual geographic distribution based on incidence rates at the Local Government Area level. The observed trends of cases were related to major events and the poliovirus vaccines used during mass vaccination campaigns within the analysis period.
Results
a total of 3,579 WPV type 1 and 1,548 WPV type 3 laboratory-confirmed cases were reported with onset during 2000-2020. The highest WPV incidence rates per 100,000 population in Local Government Areas were 19.4, 12.0, and 11.3, all in 2006. Wild poliovirus cases were reported each year during 2000-2014; the endemic transmission went undetected throughout 2015 until the last cases in 2016. Ten events/milestones were highlighted, including insurgency in the northeast which led to a setback in 2016 with four cases from children previously trapped in security-compromised areas.
Conclusion
Nigeria interrupted WPV transmission despite the challenges faced because of the emergency management approach, implementation of mass vaccination campaigns, the commitment of the government agencies, support from global polio partners, and special strategies deployed to conduct vaccination and surveillance in the security-compromised areas.
Introduction
The introduction of effective human papillomavirus (HPV) vaccination, screening, and treatment programs has led the World Health Organization to call for the global elimination of cervical cancer. Assessing progress toward this goal is supported through monitoring vaccination coverage and its impact.
Areas covered
We performed a targeted review to assess the characteristics of HPV-related data systems from seven high-income countries (HICs) that represented varied approaches, including Australia, Canada, France, Italy, Scotland, Sweden, and the United States (US). Included data systems focused on preventive and early detection measures: HPV vaccination and cervical screening programs, as well as HPV-related disease outcomes. Differences were observed in approach to development of data systems, along with variation in geographical scope and methods of data collection.
Expert opinion
A challenge exists in how to best follow-up the ongoing global-scale elimination efforts in a comprehensive manner. These sources provide a wealth of information regarding the strengths and limitations of, and notable variation among, current data systems used in HICs. This review can inform improvements to existing prevention programs and the implementation of new programs in other countries, and thus support optimization of cervical cancer prevention policy.
