Skip to main content
SpringerLink
Log in

Perspectives on rapid elimination and ultimate global eradication of paralytic poliomyelitis caused by polioviruses

  • Published:
European Journal of Epidemiology Aims and scope Submit manuscript

Abstract

Poliomyelitis caused by polioviruses has already been eradicated from industrialized countries of North America, Europe, Asia and Oceania, but the procedures by which this eradication was achieved are not adequate for the poor tropical and subtropical countries. The major challenge now is first to eliminate it rapidly from Asia and Africa where an estimated 250,000 cases and 25,000 deaths currently occur annually. The great progress toward eradication of “wild” polioviruses from poor tropical and subtropical countries in Latin America was achieved not by the procedures still recommended by the WHO Expanded Program on Immunization (EPI) but by the independently organized annual, national days of antipolio vaccination — all based on the use of large armies of well-trained non-professional, community volunteers — first used in Cuba (1962), Brazil (1980), Nicaragua (1981), Dominican Republic (1983), Paraguay (1985), and Mexico (1986). This novel approach, described in some detail in this communication, is recommended for the rapid elimination of wild polioviruses from Asia and Africa, and for ultimate global eradication with the help of a special cadre within the EPI of WHO. The extensive use by the Pan American Health Organization (PAHO) of highly sophisticated regional virus laboratories has led to the recognition that, in areas from which poliomyelitis caused by polioviruses has been largely eliminated, there are thousands of cases of acute flaccid paralysis, previously clinically diagnosed as “probable poliomyelitis”, that have no viral etiology, a phenomenon previously reported by Dr. Manuel Ramos Alvarez in Mexico City in 1967.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bertran M. and Reid R.S. (1985): The national immunization campaign of Turkey. - Assignment Children, 69/72: 1–36.

    Google Scholar 

  2. Cassio de Moraes J., Pannuti C., Camargo M.C.C. et al. (1988): Pesquisa sobre avaliação de cobertura vacinal contra o sarampo e a poliomielite... Grande São Paulo, Janeiro de 1985 a Agosto de 1987. Document of preliminary data prepared for the Secretaria de Estado da Saúde de São Paulo.

  3. Centers for Disease Control (1977): Neurotropic diseases surveillance: poliomyelitis summary 1974–1976.- Atlanta, GA.

  4. Centers for Disease Control (1986): Update: Poliomyelitis outbreak — Finland, 1984–1985. -Morbidity and Mortality Weekly Report, 35: 82–86.

    Google Scholar 

  5. Centers for Disease Control (1989): Progress toward eradicating poliomyelitis from the Americas. -Morbidity and Mortality Weekly Report, 38:532–535.

    Google Scholar 

  6. Centers for Disease Control (1990): International task force for disease eradication. - Morbidity and Mortality Weekly Report, 39: 209–217.

    Google Scholar 

  7. Chumakov M.P., Voroshilova M.K., Drozdov S.G. et al. (1960): On the course of mass immunization of the population in the Soviet Union with the live poliovirus vaccine from Albert B. Sabin's strains. In: Second International Conference on Live Poliovirus Vaccines (Washington, D.C., 6–10 June, 1960). -Scientific publication No. 50, Pan American Health Organization, Washington, D.C., pp. 413–432.

    Google Scholar 

  8. EPI Newsletter-PAHO (1982): EPI in Cuba-program evaluation. 4 (No. 3): 1–2.

    Google Scholar 

  9. EPI Newsletter-PAHO (1982): Polio surveillance, Dominican Republic, 4 (No.4): 1–3. EPS evaluation in the Dominican Republic, 4 (No. 5): 1–5.

    Google Scholar 

  10. EPI Newsletter-PAHO (1982): Identification of the origin of poliovirus isolates. 4 (No.5): 6 and 8.

    Google Scholar 

  11. EPI Newsletter-PAHO (1985): Goal for 1990: Polio eradication in the Americas.

  12. EPI Newsletter-PAHO (1985): Number of poliomyelitis cases by country, 1975–1984. 7 (No. 3): (Table 2).

  13. EPI Newsletter-PAHO (1988): Lameness survey among shool-aged children in Costa Rica, 10 (No.2): 4–5.

    Google Scholar 

  14. EPI Newsletter-PAHO (1988): The regional laboratory network reviews diagnostic methodology. 10 (No.6): 5–6.

    Google Scholar 

  15. EPI Newsletter-PAHO (1989): Polio in Europe. 11 (no. 3). p. 2.

  16. EPI Newsletter-PAHO (1988 and 1989): Reported cases of EPI diseases: for 1986 and 1987, 10 (No.2): 7; for 1988 and 1989, 12 (No. 2): 7.

    Google Scholar 

  17. PI Newsletter-PAHO (1990): Reference laboratories meet to reviev progress. 12 (No. 2): 7. See also EPI vaccine coverage in Americas, p. 8.

    Google Scholar 

  18. EPI Newsletter-PAHO (1990): New polio case classification in effect. 12 (No.2): 1.

    Google Scholar 

  19. Epidemiology Subcommittee (1967): Evaluation of Sabin live poliovirus vaccine in Japan. VI. Large scale use of vaccine during type 1 poliomyelitis epidemic, 1961. - Jpn. J. Med. Sci. Biol. 20: 303–314.

    Google Scholar 

  20. Fernández de Castro J. (1984): Mass vaccination against poliomyelitis in Mexico. - Rev. Infect. Dis. 6 (Suppl.): 5397–5389.

    Google Scholar 

  21. Gefand H.M., Potash L., LeBlanc D.R. and Fox J.P. (1959): Revised preliminary report on the Louisiana observations of the natural spread within families of living vaccine strains of poliovirus. In: Live Poliovirus Vaccines, Scientific publication No. 44, Pan American Sanitary Bureau, Washington, D.C., pp. 203–217.

    Google Scholar 

  22. Goldblum N. and Swartz T. (1984): The Israeli experience in the control of poliomyelitis during a quarter of a century, 1957–1982. - Rev. Infect. Dis. 6 (Suppl.): 5313–5317.

    Google Scholar 

  23. Gracia H.F. and Mas Lago P. (1967): Estado actual de la campana de erradicacion de la poliomielitis en Cuba. - Bol. Hig. Epid. 5: 145–155.

    Google Scholar 

  24. Guerra de Macedo C. and de Quadros C.A. (1989): The Americas take the lead. - World Health (WHO), December, pp. 3–5.

  25. Hashimoto I., Hagiwara A. and Kodama H. (1978): Neurovilence in cynomolgus monkeys of enterovirus 71 isolated from a patient with hand, food and mouth disease. - Arch. Virol., 56: 257–261.

    Google Scholar 

  26. Henderson D.A. (1989): How smallpox showed the way. - World Health (WHO), December, pp. 19–21.

  27. Henderson R.H. (1984): Vaccine preventable diseases of children: the problem. In: Protecting the world's children: vaccines and immunization—report of Bellagio Conference, March 13–15, 1984. - New York: Rockefeller Foundation.

    Google Scholar 

  28. Henderson R.H. (1989): Polio eradication: part and parcel of EPI. - World Health (WHO), December, pp. 6–9.

  29. Hinman A.R., Foege W.H., de Quadros C.A., Patriarca P.A., Orenstein W.A. and Brink E.W. (1987): The case for global eradication of poliomyelitis. - Bull. WHO 65: 835–840.

    Google Scholar 

  30. Horstmann D.M., Niederman J.C. and Paul J.R. (1959): Attenuated type 1 poliovirus vaccine: Its capacity to infect and spread from “vaccinees” within institutional population. - J.A.M.A., 170: 1–8.

    Google Scholar 

  31. Horstmann D.M. (1967): Discussion in “Vaccines Against Viral and Rickettsial Diseases of Man”, Scientific publication No. 147, Pan American Health Organization, Washington, D.C., pp. 234–235.

    Google Scholar 

  32. Hung T.P. and Kono R. (1979): Neurological complications of acute hemorrhagic conjunctivitis (a polio-like syndrome in adults). In: Klavans H.L., Vinken P.J. and Bruyn G.W. [ed.] Handbook of Clinical Neurology, 38: Part 1, Neurological Manifestations of Systemic Diseases. - North Holland, Amsterdam, pp. 595–623.

    Google Scholar 

  33. Johns R.B., Farnsworth S., Thompson H. and Brady F. (1963): Two voluntary mass immunization programs using Sabin oral vaccine. - J.A.M.A. 183: 171–175.

    Google Scholar 

  34. Kim-Farley R.J., Schonberger L.B., Nkowane B.M. Kew O.M., Bart K.J., Orenstein W.A., Hinman A.R., Hatch M.H. and Kaplan J.E. (1984): Poliomyelitis in the USA: Virtual elimination of disease caused by wild virus. - The Lancet (December 8) 2: 1315–1316.

    Google Scholar 

  35. Kim-Farley R.J., Lichfield P., Orenstein W.A., Bart K.J., Rutherford G., Shu-Tao Hsu, Schonberger L.B., King-Jong Lui and Chau-Ching Ling (1984): Outbreak of paralytic poliomyelitis in Taiwan. - The Lancet 2: 1322–1324.

    Google Scholar 

  36. LaForce F.M., Lichnevski M.S., Keja J. and Henderson R.H. (1980): Clinical survey techniques to estimate prevalence and annual incidence of poliomyelitis in developing countries. - Bull. WHO, 58: 609–620.

    Google Scholar 

  37. Leon de Coto E.M. (1984): Evolution of the poliomyelitis vaccination program in Costa Rica. -Rev. Infect. Dis. 6 (Suppl.): S442-S443.

    Google Scholar 

  38. Mas Lago P. et al. (1984): Aspectos de laboratorio en el control de la poliomyelitis en Cuba. Report of Instituto Nacional de Higiene, Epidemiologia y Microbiologia, Habana, Cuba, 80 pages and many tables.

    Google Scholar 

  39. Melnick J.L., Schmidt N.J., Mirkovic R.R., Chumakov M.P., Lavrova I.K. and Voroshilova M.K. (1979): Identification of Bulgarian strain 258. Intervirology 12: 297–302.

    Google Scholar 

  40. Melnick J.L. (1989): The poliovirus and the vaccines. World Health (WHO), December, pp. 13–15.

  41. Mesa JL., Castillo 0., Echeverria D. and Johnston T. (1986): House to house immunization: the Dominican Republic Experience, UNICEF (Regional Office for Latin America and the Caribbean) - Rapid Assessment March 1986, pp. 16.

  42. Ministry of Health (Republic of Colombia) (1985): National vaccination crusade, 1984. Bogota D.E., Colombia, pp. 55.

  43. Minor P.D. (1980): Comparative biochemical studies of type 3 poliovirus. - J. Virol. 34: 73–84.

    Google Scholar 

  44. Nicholas D.D., Kratzer J.H., Ofosu-Amaah S. and Belcher D.W. (1977): Is poliomyelitis a serious problem in developing countries? — the Danfa experience. - Brit. Med. J. 1: 1009–1012.

    Google Scholar 

  45. Ofosu-Amaah S., Kratzer J. and Nicholas D.D. (1977): Is poliomyelitis a serious problem in developing countries? — lameness in Ghanian schools. - Brit. Med. J. 1: 1012–1014.

    Google Scholar 

  46. Pan American Health Organization, EPI in the Americas (1990): Status of analysis of stool samples, by laboratory and country, weeks 89/25-90/24. Weekly Bulletin for the week ending 16 June, Table No. 1.

  47. Ramos Alvarez M. (1967): Discussion in “Vaccines Against Viral and Rickettsial Diseases of Man”, Scientific publication No. 147, Pan American Health Organization, Washington, D.C., pp. 235–239.

    Google Scholar 

  48. Ramos Alvarez M., Gomez Santos F., Rangel Rivera L. and Mayes O. (1959): Viral and serological studies in children immunized with live poliovirus vaccine —preliminary report of a large trial conducted in Mexico. In: Live Poliovirus Vaccines. Scientific publication No. 44, Pan American Sanitary Bureau, Washington, D.C., pp. 483–496.

    Google Scholar 

  49. Ramos Alvarez M., Bustamante M.E. and Alvarez Alba R. (1960): Use of Sabin's live poliovirus vaccine in Mexico. Results of a large-scale trial. In: “Live Poliovirus Vaccines”. Scientific publication No. 50. Pan American Health Organization, Washington, D.C., pp. 386–412.

    Google Scholar 

  50. Ramos Alvarez M., Bessudo L. and Sabin A.B. (1969): Paralytic syndromes associated with noninflammatory cytoplasmic or nuclear neuronopathy: acute paralytic disease in Mexican children, neuropathologically distinguishable from Landry-Guillain-Barré syndrome. - J.A.M.A., 207:1481–1492.

    Google Scholar 

  51. Risi J.B. Jr. (1984): The control of poliomyelitis in Brazil. - Rev. Infect. Dis. 6 (Suppl): S400-S403.

    Google Scholar 

  52. Risi J.B. Jr. and Menezes da Costa M. Neto (1988): Bases tecnicas para a erradicação da transmissão autoctone da poliomietite, 2a edicão. Brasilia: Centro de Documentação do Ministerio da Saúde.

    Google Scholar 

  53. Rodriguez Cruz R. (1984): Cuba: Mass polio vaccination program, 1962–1982. - Rev. Infect. Dis. 6 (Suppl): S408-S412.

    Google Scholar 

  54. Sabin A.B. (1955): Behavior of chimpanzee-avirulent poliomyelitis viruses in experimentally infected human volunteers. - Am. J. Med. Sci., 230: 1–8.

    Google Scholar 

  55. Sabin A.B. (1957): Properties and behaviour of orally administered attenuated poliovirus vaccine. - J.A.M.A. 164: 1216–1223.

    Google Scholar 

  56. Sabin A.B. (1959): Present position of immunization against poliomyelitis with live virus vaccines. - Brit. Med. J. 1: 663–680.

    Google Scholar 

  57. Sabin A.B. (1959): Recent studies and field tests with live attenuated poliovirus vaccine. In: Live Poliovirus Vaccines, Scientific publication No. 44, Pan American Sanitary Bureau, Washington, D.C., pp. 14–38.

    Google Scholar 

  58. Sabin A.B. (1961): Poliomyelitis incidence in the Soviet Union in 1960. - J.A.M.A. 176: 231–232.

    Google Scholar 

  59. Sabin A.B. (1962): Oral poliovirus vaccine — recent results and recommendations for optimum use. -Royal Society of Health Journal 82: 51–58.

    Google Scholar 

  60. Sabin A.B. (1962): Eradication of poliomyelitis —present status and future prospects. - Rhode Island Med. J. 45: 453–462.

    Google Scholar 

  61. Sabin A.B. (1963): Is there an exceedingly small risk associated with oral poliovirus vaccine? - J.A.M.A. 183: 268–271.

    Google Scholar 

  62. Sabin A.B. (1967): Poliomyelitis: accomplishments of live virus vaccine. In: First International Conference on Vaccines Against Viral and Rickettsial Diseases of Man. Scientific publication 147. Washington, D.C.: Pan American Health Organization, pp. 171–178.

    Google Scholar 

  63. Sabin A.B. (1969): Vaccine-associated poliomyelitis cases. - Bull. WHO 40: 947–949.

    Google Scholar 

  64. Sabin A.B. (1977): Oral poliomyelitis vaccine: achievements and problems in worldwide use. -Bulletin of International Pediatric Association 2: 6–22.

    Google Scholar 

  65. Sabin A.B. (1980): Vaccination against poliomyelitis in economically underdeveloped countries. - Bull. WHO, 58: 141–157.

    Google Scholar 

  66. Sabin A.B. (1981): Paralytic poliomyelitis: old dogmas and new perspectives. - Rev. Infect. Dis., 3: 543–564.

    Google Scholar 

  67. Sabin A.B. (1981): Eradication of smallpox and elimination of poliomyelits: contrasts in strategy. -Japanese J. Mod. Sci. Biol. 34: 109–112.

    Google Scholar 

  68. Sabin A.B. (1981): Poliomyelitis. In: Medical Microbiology and Infectious Diseases, edit by A.I. Braude, W.B. Saunders Company, Philadelphia, pp. 1348–1365.

    Google Scholar 

  69. Sabin A.B. (1982): Vaccine control of poliomyelitis in the 1980s. - Yale J. Biol. Med. 55: 383–389.

    Google Scholar 

  70. Sabin A.B. (1983): Inadequate serological surveys for immunity to poliomyelitis — inadequate indicators of immune status of communities using oral poliovirus vaccine and inadequate guides to vaccination policy.- Med. J. Australia 1: 100–102.

    Google Scholar 

  71. Sabin A.B. (1984): Strategies for elimination of poliomyelitis in different parts of the world with use of oral poliovirus vaccine. - Rev. Infect. Dis. 6 (Suppl.): S381-S396.

    Google Scholar 

  72. Sabin A.B. (1985): Oral poliovirus vaccine: History of its development and use and current challenge to eliminate poliomyelitis from the world. - J. Infect. Dis. 1510: 420–436.

    Google Scholar 

  73. Sabin A.B. (1986): Strategy for rapid elimination and continuing control of poliomyelitis and other vaccine preventable diseases of children in developing countries. - Brit. Med. J. 292: 531–533.

    Google Scholar 

  74. Sabin A.B. (1987): Commentary: Is there a need for a change in poliomyelitis immunization policy? Pediatr. Infect. Dis. J. 6: 887–889.

    Google Scholar 

  75. Sabin A.B. (1987): Role of my cooperation with Soviet scientists in the elimination of polio: Possible lessons for relations between the U.S.A. and the USSR. - Perspectives in Biol. Med. 31: 57–64.

    Google Scholar 

  76. Sabin A.B. (1991): Measles, killer of millions in developing countries: strategy for rapid elimination and continuing control. - Eur. J. Epidemiol. 7: 1–22.

    Google Scholar 

  77. Sabin A.B., Michaels R.H., Spigland J., Pelon W., Rhim J.S. and Wehr R.E. (1961): Community-wide use of oral poliovirus vaccine. Effectiveness of the Cincinnati program. - Am. J. Dis. Child. 101: 546–567.

    Google Scholar 

  78. Sabin A.B., Ramos-Alvarez M., Alvarez-Amezquita J., Pelon W., Michael R.H., Spigland I., Koch M.A., Barnes J.M. and Rhim J.S. (1960): Live, orally given poliovirus vaccine — effect of rapid mass immunization on population under conditions of massive enteric infections with other viruses. -JAMA 173: 1521–1526.

    Google Scholar 

  79. Sabin A.B. and Silva E. (1983): Residual paralytic poliomyelitis in a tropical region of Brazil, 1969–1977: prevalence surveys in different age groups as indicators of changing incidence. - Am. J. Epidemiol. 117: 193–200.

    Google Scholar 

  80. Shindarov L., Chumakov M., Voroshilova M.K. et al. (1979): Epidemiological, clinical and pathomorphological characteristics of epidemic poliomyelitis-like disease associated with enterovirus type 71. - J. Hyg. Epidemiol. Microbiol. Immunol. 23:284–295.

    Google Scholar 

  81. Skovranek V (1960): Further observations in conjunction with first field trial with live poliovirus vaccine in Czechoslovakia. Epidemiological study (1960). In Second International Conference on Live Poliovirus Vaccines (Washington, D.C., 6–10 June 1960). Scientific publication No. 50, Pan American Health Organization, Washington D.C., pp. 507–521.

    Google Scholar 

  82. Skovranek V., Zacek K., Vonka V., Adam E., Adamova V., Burian V. and Vojtova H. (1959): Field trial with Sabin's live poliovirus vaccine in Czechoslovakia 1958–1959. In: Live Poliovirus Vaccine, Scientific publication No. 44, Pan American Sanitary Bureau, Washington, D.C., pp. 530–571.

    Google Scholar 

  83. Smorodintsev A.A. et al. (1960): Material on the immunological and epidemiological effectiveness of live poliomyelitis vaccine. In: Second International Conference on Live Poliovirus Vaccines (Washington, D.C., 6–10 June, 1960), Scientific publication No. 50, Pan American Health Organization, Washington, D.C., pp. 482–506.

    Google Scholar 

  84. Takatsu T., Tagaya I. and Hirayama M. (1973): Poliomyelitis in Japan during the period 1962–68 after the introduction of mass vaccination with Sabin vaccine. - Bull. WHO, 49: 129–137.

    Google Scholar 

  85. Valdez M., Gonzalez A. and Werthein L.J. (1984): Impacto de las JPS [Jornadas Populares de Salud] en el perfil epidemiologico de las enfermedades prevenibles por vacunas y Malaria. - Boletin Nicaraguense de Higiene y Epidemiologia, 1: 77–86.

    Google Scholar 

  86. Weissfeiler J, Editor (1961): The control of poliomyelitis by live poliovirus vaccine: studies on mass vaccinations in Hungary, in the USSR, in Czechoslovakia and in the German Democratic Republic. - Akademiai Kiado, Budapest, p. 156.

    Google Scholar 

  87. World Health Assembly (1988): Global eradication of poliomyelitis by the year 2,000. Geneva: World Health Organization (Resolution WHA 41.28).

    Google Scholar 

  88. World Health Organization (1976): Data on poliomyelitis reported to WHO by countries in the American Region, 1951–1974. Weekly Epidemiological Record (13 February), 51: 55.

    Google Scholar 

  89. World Health Organization (1979): Virus diseases surveillance (Hungary). Weekly Epidemiological Record 54: 57.

    Google Scholar 

  90. World Health Organization (1988): Expanded programme on immunization-global advisory group. Weekly Epidemiological Record 63: 10.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. 3101 New Mexico Ave., N. W. - Apartment 1001, 20016-5902, Washington, D.C., U.S.A.

    A. B. Sabin

Authors
  1. A. B. Sabin
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sabin, A.B. Perspectives on rapid elimination and ultimate global eradication of paralytic poliomyelitis caused by polioviruses. Eur J Epidemiol 7, 95–120 (1991). https://doi.org/10.1007/BF00237353

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00237353

Key words

Search

Navigation