Strengthening the partnership between routine immunization and the global polio eradication initiative to achieve eradication and assure sustainability.

Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988, the number of polio endemic countries has declined from 125 to 3 in 2013. Despite this remarkable achievement, ongoing circulation of wild poliovirus in polio-endemic countries and the increase in the number of circulating vaccine-derived poliovirus cases, especially those caused by type 2, is a cause for concern. The Polio Eradication and Endgame Strategic Plan 2013-2018 (PEESP) was developed and includes 4 objectives: detection and interruption of poliovirus transmission, containment and certification, legacy planning, and a renewed emphasis on strengthening routine immunization (RI) programs. This is critical for the phased withdrawal of oral poliovirus vaccine, beginning with the type 2 component, and the introduction of a single dose of inactivated polio vaccine into RI programs. This objective has inspired renewed consideration of how the GPEI and RI programs can mutually benefit one another, how the infrastructure from the GPEI can be used to strengthen RI, and how a strengthened RI can facilitate polio eradication. The PEESP is the first GPEI strategic plan that places strong and clear emphasis on the necessity of improving RI to achieve and sustain global polio eradication.

Abdelwahab J ，Dietz V ，Eggers R ，Maher C ，Olaniran M ，Sandhu H ，Vandelaer J ... -  《-》

Contribution of Global Polio Eradication Initiative-Funded Personnel to the Strengthening of Routine Immunization Programs in the 10 Focus Countries of the Polio Eradication and Endgame Strategic Plan.

The Polio Eradication and Endgame Strategic Plan (PEESP) established a target that at least 50% of the time of personnel receiving funding from the Global Polio Eradication Initiative (GPEI) for polio eradication activities (hereafter, "GPEI-funded personnel") should be dedicated to the strengthening of immunization systems. This article describes the self-reported profile of how GPEI-funded personnel allocate their time toward immunization goals and activities beyond those associated with polio, the training they have received to conduct tasks to strengthen routine immunization systems, and the type of tasks they have conducted. A survey of approximately 1000 field managers of frontline GPEI-funded personnel was conducted by Boston Consulting Group in the 10 focus countries of the PEESP during 2 phases, in 2013 and 2014, to determine time allocation among frontline staff. Country-specific reports on the training of GPEI-funded personnel were reviewed, and an analysis of the types of tasks that were reported was conducted. A total of 467 managers responded to the survey. Forty-seven percent of the time (range, 23%-61%) of GPEI-funded personnel was dedicated to tasks related to strengthening immunization programs, other than polio eradication. Less time was spent on polio-associated activities in countries that had already interrupted wild poliovirus (WPV) transmission, compared with findings for WPV-endemic countries. All countries conducted periodic trainings of the GPEI-funded personnel. The types of non-polio-related tasks performed by GPEI-funded personnel varied among countries and included surveillance, microplanning, newborn registration and defaulter tracing, monitoring of routine immunization activities, and support of district immunization task teams, as well as promotion of health behaviors, such as clean-water use and good hygiene and sanitation practices. In all countries, GPEI-funded personnel perform critical tasks in the strengthening of routine immunization programs and the control of measles and rubella. In certain countries with very weak immunization systems, GPEI-funded personnel provide critical support for the immunization programs, and sudden discontinuation of their employment would potentially disrupt the immunization programs in their countries and create a setback in capacity and effectiveness that would put children at higher risk for vaccine-preventable diseases.

van den Ent MMVX ，Swift RD ，Anaokar S ，Hegg LA ，Eggers R ，Cochi SL ... -  《-》

Polio Eradication and Endgame Plan - Victory within Grasp.

Patel M ，Menning L ，Bhatnagar P 《-》

The new polio eradication end game: rationale and supporting evidence.

Polio eradication requires the removal of all polioviruses from human populations, whether wild poliovirus or those emanating from the oral poliovirus vaccine (OPV). The Polio Eradication & Endgame Strategic Plan 2013-2018 provides a framework for interruption of wild poliovirus transmission in remaining endemic foci and lays out a plan for the new polio end game, which includes the withdrawal of Sabin strains, starting with type 2, and the introduction of inactivated poliovirus vaccine, for risk mitigation purposes. This report summarizes the rationale and evidence that supports the policy decision to switch from trivalent OPV to bivalent OPV and to introduce 1 dose of inactivated poliovirus vaccine into routine immunization schedules, and it describes the proposed implementation of this policy in countries using trivalent OPV.

Sutter RW ，Platt L ，Mach O ，Jafari H ，Aylward RB ... -  《-》

Eradicating polio: how the world's pediatricians can help stop this crippling illness forever.

The American Academy of Pediatrics strongly supports the Polio Eradication and Endgame Strategic Plan of the Global Polio Eradication Initiative. This plan was endorsed in November 2012 by the Strategic Advisory Group of Experts on Immunization of the World Health Organization and published by the World Health Organization in April 2013. As a key component of the plan, it will be necessary to stop oral polio vaccine (OPV) use globally to achieve eradication, because the attenuated viruses in the vaccine rarely can cause polio. The plan includes procedures for elimination of vaccine-associated paralytic polio and circulating vaccine-derived polioviruses (cVDPVs). cVDPVs can proliferate when vaccine viruses are transmitted among susceptible people, resulting in mutations conferring both the neurovirulence and transmissibility characteristics of wild polioviruses. Although there are 3 different types of wild poliovirus strains, the polio eradication effort has already resulted in the global elimination of type 2 poliovirus for more than a decade. Type 3 poliovirus may be eliminated because the wild type 3 poliovirus was last detected in 2012. Thus, of the 3 wild types, only wild type 1 poliovirus is still known to be circulating and causing disease. OPV remains the key vaccine for eradicating wild polioviruses in polio-infected countries because it induces high levels of systemic immunity to prevent paralysis and intestinal immunity to reduce transmission. However, OPV is a rare cause of paralysis and the substantial decrease in wild-type disease has resulted in estimates that the vaccine is causing more polio-related paralysis annually in recent years than the wild virus. The new endgame strategic plan calls for stepwise removal of the type 2 poliovirus component from trivalent oral vaccines, because type 2 wild poliovirus appears to have been eradicated (since 1999) and yet is the main cause of cVDPV outbreaks and approximately 40% of vaccine-associated paralytic polio cases. The Endgame and Strategic Plan will be accomplished by shifting from trivalent OPV to bivalent OPV (containing types 1 and 3 poliovirus only). It will be necessary to introduce trivalent inactivated poliovirus vaccine (IPV) into routine immunization programs in all countries using OPV to provide population immunity to type 2 before the switch from trivalent OPV to bivalent OPV. The Global Polio Eradication Initiative hopes to achieve global eradication of polio by 2018 with this strategy, after which all OPV use will be stopped. Challenges expected for adding IPV into routine immunization schedules include higher cost of IPV compared with OPV, cold-chain capacity limits, more complex administration of vaccine because IPV requires injections as opposed to oral administration, and inferior intestinal immunity conferred by IPV. The goal of this report is to help pediatricians understand the change in strategy and outline ways that pediatricians can help global polio eradication efforts, including advocating for the resources needed to accomplish polio eradication and for incorporation of IPV into routine immunization programs in all countries.

Orenstein WA ，Committee on Infectious Diseases 《-》