Virologic Monitoring of Poliovirus Type 2 after Oral Poliovirus Vaccine Type 2 Withdrawal in April 2016 - Worldwide, 2016-2017

Abstract

The Global Polio Eradication Initiative (GPEI) has made substantial progress since its launch in 1988; only 37 wild poliovirus type 1 (WPV1) cases were detected in 2016, the lowest annual count ever. Wild poliovirus type 3 has not been detected since November 2012, and wild poliovirus type 2 was officially declared eradicated in September 2015. This success is attributable to the wide use of live oral poliovirus vaccines (OPVs). Since 2001, numerous outbreaks were caused by the emergence of genetically divergent vaccine-derived polioviruses (VDPVs) whose genetic drift from the parental OPV strains indicates prolonged replication or circulation (1). In 2015, circulating VDPV type 2 (cVDPV2) outbreaks were detected in five countries worldwide (Nigeria, Pakistan, Guinea, Burma, and South Sudan), and VDPV2 single events were reported in 22 countries. These events prompted the GPEI to withdraw the type 2 component (Sabin2) of trivalent OPV (tOPV) in a globally coordinated, synchronized manner in April 2016 (2,3), at which time all OPV-using countries switched to using bivalent OPV (bOPV), containing Sabin types 1 and 3. This report details for the first time the virologic tracking of elimination of a live vaccine that has been withdrawn from routine and mass immunization systems worldwide (3). To secure elimination, further monitoring is warranted to detect any use of tOPV or monovalent OPV type 2 (mOPV2).

FIGURE 1

Number of poliovirus type 2 isolates from persons with acute flaccid paralysis or their contacts and from sewage samples in countries where mOPV2 was not used after the global synchronized switch from tOPV to bOPV — January 2016–March 2017 Abbreviations: bOPV = bivalent oral poliovirus vaccine; mOPV2 = monovalent oral poliovirus vaccine type 2; tOPV = trivalent oral poliovirus vaccine.

FIGURE 2

Number of poliovirus type 2 isolates from persons with acute flaccid paralysis or their contacts and from sewage samples in countries where mOPV2 SIAs were conducted* after the global synchronized switch from tOPV to bOPV — January 2016 to March 2017 Abbreviations: bOPV = bivalent oral poliovirus vaccine; mOPVs = monovalent oral poliovirus vaccine type 2; SIA = supplementary immunization activity; tOPV = trivalent oral poliovirus vaccine. * Number of vaccination rounds shown for SIAs.