Update on Vaccine-Derived Poliovirus Outbreaks - Worldwide, January 2018-June 2019

Abstract

Certification of global eradication of indigenous wild poliovirus type 2 occurred in 2015 and of type 3 in 2019. Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988 and broad use of live, attenuated oral poliovirus vaccine (OPV), the number of wild poliovirus cases has declined >99.99% (1). Genetically divergent vaccine-derived poliovirus* (VDPV) strains can emerge during vaccine use and spread in underimmunized populations, becoming circulating VDPV (cVDPV) strains, and resulting in outbreaks of paralytic poliomyelitis.^† In April 2016, all oral polio vaccination switched from trivalent OPV (tOPV; containing vaccine virus types 1, 2, and 3) to bivalent OPV (bOPV; containing types 1 and 3) (2). Monovalent type 2 OPV (mOPV2) is used in response campaigns to control type 2 cVDPV (cVDPV2) outbreaks. This report presents data on cVDPV outbreaks detected during January 2018-June 2019 (as of September 30, 2019). Compared with January 2017-June 2018 (3), the number of reported cVDPV outbreaks more than tripled, from nine to 29; 25 (86%) of the outbreaks were caused by cVDPV2. The increase in the number of outbreaks in 2019 resulted from VDPV2 both inside and outside of mOPV2 response areas. GPEI is planning future use of a novel type 2 OPV, stabilized to decrease the likelihood of reversion to neurovirulence. However, all countries must maintain high population immunity to decrease the risk for cVDPV emergence. Cessation of all OPV use after certification of polio eradication will eliminate the risk for VDPV emergence.

FIGURE 1

Circulating vaccine-derived poliovirus (cVDPV) outbreaks — worldwide, January 2018–June 2019 Abbreviation: cVDPV2 = circulating type 2 VDPV. * All cVDPV outbreaks were confirmed by genetic sequence data and evolutionary analyses.

FIGURE 2

Number of circulating vaccine-derived poliovirus (cVDPV) cases detected, by serotype — worldwide, 2000–2019 Abbreviations: cVDPV1 = circulating type 1 VDPV; cVDPV2 = circulating type 2 VDPV; cVDPV3 = circulating type 3 VDPV. * Number of cases detected and reported as of September 10, 2019.