Polio eradication is possible only through ensuring the highest possible vaccination coverage worldwide and maintaining it indefinitely
The recent public health emergency declarations in New York and London due to polio infection and the detection of the virus in the sewage of these two cities strongly suggest that polio is nowhere near eradicated.
Now, four members of Global Virus Network (GVN) Proposed changes to the Global Polio Eradication Strategy to get the world back on track to one day eliminate the polio threat. Among the authors of the recommendations is the University of Maryland School of Medicine director of the Human Virology Institute and co-founder Robert C. Gallo, MD, Homer & Martha Gudelsky Distinguished Professor of Medicine, Co-Founder and Chair of the Scientific Leadership Council for GVN; two of the world’s foremost poliovirus experts, Konstantin Chumakov, MD, MD, assistant professor at George Washington University and the University of Maryland, and Stanley Plotkin, MD, scientific advisor for the Coalition for Epidemic Preparedness Innovations (CEPI); and GVN President Christian Prichot, MD, PhD, professor at the University of South Florida.
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They suggested that eradication is only possible by ensuring the highest possible vaccination coverage worldwide and maintaining it indefinitely. Vaccination policies should be individually tailored for different regions of the world and use polio vaccine made from inactivated virus (in combination with other vaccines), as well as newer, improved oral polio vaccines that use live, attenuated virus. He also urged the experts to reconvene a scientific group advising the WHO on poliovirus eradication that could respond as needed and adapt policies in the face of newer data or public health emergencies.
Infectious disease experts published their perspectives in perspective New England Journal of Medicine On February 16, 2023.
The Global Polio Eradication Initiative (GPEI), which was formed 34 years ago, aims to achieve the goal of polio eradication by the year 2000. This group developed the original polio eradication plan and formed a scientific advisory group that was later disbanded before the expected goals were achieved. According to the authors, this led to some decisions that were not based on strong science, including not immunizing against one of the three types of poliovirus while a weaker version of the poliovirus was still present in the communities. The resulting resurgence of poliovirus continues to this day, and the virus has re-emerged in the UK, US and other countries decades after it was thought to have been eradicated.
“The initiative based its guidelines on the strategy that was used to eradicate smallpox. However, the poliovirus is trickier in that for every person infected with paralysis, hundreds have no symptoms at all, meaning the virus can circulate in communities silently.” Without anyone knowing.” It was too early to assume that the plans would run smoothly. These recent outbreaks underscore the need for an active scientific advisory team that can council, mobilize and adjust the polio eradication plan in real time as needed.”
Over the past few decades, there has been an increase in global travel, which could allow infections to migrate from developing countries where they are more common in communities in industrialized nations where they can spread undetected becoming the greatest risk to unvaccinated and weakened people. immune systems.
With most people in the UK and US vaccinated against polio, how did this latest outbreak happen in two major international cities? As with other viruses once thought to be rare in more developed countries, such as measles or mumps, some communities have chosen not to vaccinate. Also, the nature of polio vaccines in industrialized nations may have allowed asymptomatic infections to circulate undetected for a while now.
There are two main types of polio vaccines: the injectable version that uses non-infectious virus particles to generate immunity (IPV) or the oral polio vaccine (OPV) that uses a live, weakened version of the virus.
“The ‘killed’ injectable polio vaccine protects against paralysis, but unlike the live version it does not generate the robust immunity in the gut needed to prevent viral circulation. This means that asymptomatic cases can spread in vaccinated individuals. So, why not Do we use the direct version instead?” said Dr. Chumakov. “The live, attenuated version can revert to virulence (a more contagious version) and spread to people who are not immunized or have compromised immune systems and sometimes cause paralysis. In fact, modified versions of the OPV are what are currently circulating in London and New York.” It’s Catch-22, but there may be a way out: A new version of the vaccine has recently been developed that does not transform into virulent vaccine-derived poliovirus.In combination with the injectable polio vaccine, the new oral polio vaccine could become an effective tool for creating A comprehensive immunity can safely stop the spread of disease.”
Current polio eradication is planned to phase out live oral polio vaccines three years after the last documented wild or natural poliovirus case, and replace them with injectable polio vaccine.
“As history has recently shown us with COVID vaccines, just because we would like these vaccines to be available, does not mean that they will be. There may be a scramble and rich countries will secure vaccines before other countries,” said Dr. Plotkin. “So, we at GVN We suggest that the group make a policy change based not only on milestones, but rather whether there is adequate supply to compensate for the increased demand. Better yet, incorporate a strategy to ensure that injectable polio vaccines are available to support global supply when the time comes.”
Once the entire world switched to injectable vaccines, GEPI’s plan was to remove all polio vaccines ten years after that switch.
The biggest challenge on the path to polio eradication is doing so safely through the combined use of inactivated and live oral vaccines. The former would prevent paralysis caused by wild and vaccine-derived poliovirus, while the latter would ultimately prevent circulation of both forms of poliovirus and polio. “The vaccine industry is capable of doing both if given the command to do so.”
