Update on Vaccine-Derived Poliovirus Outbreaks - Worldwide, July 2019-February 2020

Abstract

Circulating vaccine-derived polioviruses (cVDPVs) can emerge in areas with low poliovirus immunity and cause outbreaks* of paralytic polio (1-5). Among the three types of wild poliovirus, type 2 was declared eradicated in 2015 (1,2). The use of trivalent oral poliovirus vaccine (tOPV; types 1, 2, and 3 Sabin strains) ceased in April 2016 via a 1-month-long, global synchronized switch to bivalent OPV (bOPV; types 1 and 3 Sabin strains) in immunization activities (1-4). Monovalent type 2 OPV (mOPV2; type 2 Sabin strain) is available for cVDPV type 2 (cVDPV2) outbreak response immunization (1-5). The number and geographic breadth of post-switch cVDPV2 outbreaks have exceeded forecasts that trended toward zero outbreaks 4 years after the switch and assumed rapid and effective control of any that occurred (4). New cVDPV2 outbreaks have been seeded by mOPV2 use, by both suboptimal mOPV2 coverage within response zones and recently mOPV2-vaccinated children or contacts traveling outside of response zones, where children born after the global switch are fully susceptible to poliovirus type 2 transmission (2-4). In addition, new emergences can develop by inadvertent exposure to Sabin OPV2-containing vaccine (i.e., residual response mOPV2 or tOPV) (4). This report updates the January 2018-June 2019 report with information on global cVDPV outbreaks during July 2019-February 2020 (as of March 25, 2020)^† (2). Among 33 cVDPV outbreaks reported during July 2019-February 2020, 31 (94%) were cVDPV2; 18 (58%) of these followed new emergences. In mid-2020, the Global Polio Eradication Initiative (GPEI) plans to introduce a genetically stabilized, novel OPV type 2 (nOPV2) that has a lower risk for generating VDPV2 than does Sabin mOPV2; if nOPV2 is successful in limiting new VDPV2 emergences, GPEI foresees the replacement of Sabin mOPV2 with nOPV2 for cVDPV2 outbreak responses during 2021 (2,4,6).

FIGURE 1

Ongoing circulating vaccine-derived poliovirus (cVDPV) outbreaks — worldwide, July 2019–February 2020 Abbreviations: cVDPV1 = cVDPV type 1; cVDPV2 = cVDPV type 2. * Data as of March 24–27, 2020.

FIGURE 2

Acute flaccid paralysis (AFP) cases and environmental samples positive for circulating vaccine-derived poliovirus type 2 associated with outbreaks ongoing during July 2019–February 2020 that involved international spread since emergence, by outbreak and country — Africa, October 2017–February 2020^,† Abbreviation: CAR = Central African Republic; DRC = Democratic Republic of the Congo; ENV = environmental surveillance. * Dates (month/year) refer to the date of specimen collection. For samples collected on the same dates, symbols will overlap; thus, not all isolates are visible. ^† Data as of March 25, 2020, for all emergences except the following: 1) SOM-BAN-1 (as of March 24, 2020) and 2) CHA-NDJ-1, NIE-JIS-1, and TOG-SAV-1 (as of March 27, 2020).