The polio eradication effort has been a great success--let's finish it and replace it with something even better.

The polio eradication campaign has greatly reduced the effects of this disease, but many new challenges have emerged. These challenges include the occurrence of polio outbreaks caused by wild-type polioviruses or circulating vaccine-derived polioviruses (cVDPVs) in areas where vaccination coverage is low, the existence of people who excrete poliovirus persistently, and the inability to know definitely that poliovirus has gone. As a result, there is uncertainty about if, when, and how we can end polio immunisation. In this article, we discuss several scenarios for the future of polio control. Because the emergence of cVDPVs necessitates discontinuing the use of live oral polio vaccine, we propose to strive towards a global coverage of near 100% vaccination against all major childhood infections using combination vaccines that contain inactivated poliovirus vaccine. Such a policy will present multiple challenges.

[1]  T. Kimman,et al.  Excretion of Wild-Type and Vaccine-Derived Poliovirus in the Feces of Poliovirus Receptor-Transgenic Mice , 2003, Journal of Virology.

[2]  D. Heymann,et al.  OPV Cessation--the Final Step To a "Polio-Free" World , 2005, Science.

[3]  S. Cochi,et al.  Cost analysis of post-polio certification immunization policies. , 2004, Bulletin of the World Health Organization.

[4]  L. Roberts.  The Exit Strategy , 2004, Science.

[5]  H. Hull,et al.  Ending polio immunization. , 1997, Science.

[6]  D. Malvy,et al.  Elimination of poliomyelitis in France: epidemiology and vaccine status. , 1993, Public health reviews.

[7]  M. Pallansch,et al.  Outbreak of Poliomyelitis in Hispaniola Associated with Circulating Type 1 Vaccine-Derived Poliovirus , 2002, Science.

[8]  L. Roberts.  Polio: The Final Assault? , 2004, Science.

[9]  Francis Delpeyroux,et al.  Circulating vaccine-derived polioviruses: current state of knowledge. , 2004, Bulletin of the World Health Organization.

[10]  M. Mulders,et al.  Poliomyelitis outbreak in an unvaccinated community in the Netherlands, 1992-93 , 1994, The Lancet.

[11]  M. Rennels,et al.  Effect of different vaccination schedules on excretion of oral poliovirus vaccine strains. , 2005, The Journal of infectious diseases.

[12]  C. Winsor,et al.  Age incidence and seasonal development of neutralizing antibodies to lansing poliomyelitis virus. , 1950, American journal of hygiene.

[13]  N. Ledinko,et al.  Development of neutralizing antibodies against the three types of poliomyelitis virus during an epidemic period; the ratio of inapparent infection to clinical poliomyelitis. , 1953, American journal of hygiene.