Figure 1 - uploaded by Azmi Mahafzah
Content may be subject to copyright.
Map of Jordan showing all 8 Jordan governorates and seroepidemiologic study sites in Jordan Valley and Gore Valley.
Source publication
Between November 1991 and March 1992, 37 cases of paralytic poliomyelitis occurred in Jordan, where none had been reported
since 1988. Of these, 17 (50%) of 34 patients had received at least three doses of oral poliovirus vaccine (OPV3). The first
and 2 subsequent case-patients were children of Pakistani migrant workers, and the first 8 and a total...
Similar publications
Historical records of patients with vaccine-associated paralytic poliomyelitis (VAPP) in Hungary during 1961-1981 were reviewed to assess the risk of VAPP after oral polio vaccine (OPV) administration. A confirmed VAPP case was defined as a diagnosis of paralytic poliomyelitis and residual paralysis at 60 days in a patient with an epidemiologic lin...
OBJECTIVE: To characterize the circumstances in which poliomyelitis occurred among three children in Bulgaria during 2001 and to describe the public health response. METHODS: Bulgarian authorities investigated the three cases of polio and their contacts, conducted faecal and serological screening of children from high-risk groups, implemented enhan...
Background
We performed a cross-sectional survey in April–May 2018 among Rohingya in Cox’s Bazar, Bangladesh, to assess polio immunity and inform vaccination strategies.
Methods and findings
Rohingya children aged 1–6 years (younger group) and 7–14 years (older group) were selected using multi-stage cluster sampling in makeshift settlements and si...
The Global Polio Eradication Initiative was launched in 1988 with the aim to eliminate paralytic poliomyelitis. Two effective vaccines are available: inactivated polio vaccine (IPV) and oral polio vaccine (OPV). Since 1964, OPV has been used instead of IPV in most countries due to several economic and biological advantages. However, in rare cases,...
Afghanistan, Pakistan, and Nigeria remain the only countries where transmission of endemic wild poliovirus type 1 (WPV1) continues (1). This report describes polio eradication activities, progress, and challenges to eradication in Afghanistan during January 2017-May 2018 and updates previous reports (2, 3). Fourteen WPV1 cases were confirmed in Afg...
Citations
... Achieving a high percentage of vaccination coverage, while common and necessary, may not be sufficient to eliminate or eradicate polio. Outbreaks of diseases occur in under-immunized inaccessible populations living within otherwise highly immunized populations [8][9][10][11][12][13]. In Angola, one of the major contributing factors for this is the quality of vaccination volunteers. ...
Background:
Growing conflict and insecurity played a major role in precipitating polio outbreaks in the Horn of Africa and the Middle East. In Angola, the early post-conflict situation was characterized by the presence of many inaccessible zones and districts due to insecurity and poor infrastructure. Partnership with the Angolan Army health service (AAHS) was one of the innovative strategies that the Polio Eradication Initiative (PEI) introduced into the country to support the polio vaccination campaigns in insecure and hard to reach zones.
Methods:
Before embarking on creating a partnership with Angolan military it was essential to make high-level advocacy with top military decision makers to engage the leadership in the process for better and sustainable support to the strategy. The principal supports provided by the AAHS were the administration of oral polio vaccine, vitamin A, deworming agents, social mobilization, monitoring campaign quality, and surveillance. Distribution of logistics using military vehicles and helicopters to hard to reach and insecure zones was also part of the support.
Results:
Using this partnership it was possible to reach a significant number of children in insecure and hard to reach areas with polio vaccine and other child survival interventions. The military partnership also contributed in increasing the demand and addressing rejection for the polio vaccine.
Conclusion:
Military is a potentially productive force that can be used for any development activities in any country. The Angolan experience has demonstrated that it is possible to form a partnership with the military for basic health intervention activities with little training and investment.
... With a clear need for the vast majority of financial and human resources to be devoted to vaccine purchase and administration, cold chain management, surveillance, training and logistics, early research efforts to support the PEI would necessarily be limited, and would focus mainly on practical ways to enhance the effectiveness of the 4 core strategies. These included enhancements in surveillance, case investigation and response [19]; further studies of the basis for the lessthan-optimal immunogenicity of OPV in the tropics and subtropics [20]; and field investigations of the genesis and kinetics of large-scale epidemics that continued to emerge despite very high rates of immunization [21][22][23][24]. These investigations would ultimately provide only limited insights and practical solutions, but did serve to reinforce and extend the previous and unsatisfying conclusion that suboptimal responses to OPV were common and could be ascribed to a complex array of factors related to the vaccine, host and environment [25]. ...
... Because Israel and the Palestinian Authority are both located in the same geographical region of endemicity (1,2,27,37), the possibility of a new introduction of wild-type poliovirus always exists. The virus can circulate in a well-vaccinated population (7,16,19,26,27,32,33) with or without clinical cases. ...
... Because Israel and the Palestinian Authority are both located in the same geographical region of endemicity (1,2,27,37), the possibility of a new introduction of wild-type poliovirus always exists. The virus can circulate in a well-vaccinated population (7,16,19,26,27,32,33) with or without clinical cases. Therefore, eradication of the virus can only be proven if, in addition to a lack of poliomyelitis cases, the results of continuous surveillance for wild-type virus are negative. ...
The global eradication of poliomyelitis, believed to be achievable around the year 2000, relies on strategies which include high routine immunization coverage and mass vaccination campaigns, along with continuous monitoring of wild-type virus circulation by using the laboratory-based acute flaccid paralysis (AFP) surveillance. Israel and the Palestinian Authority are located in a geographical region in which poliovirus is still endemic but have been free of poliomyelitis since 1988 as a result of intensive immunization programs and mass vaccination campaigns. To monitor the wild-type virus circulation, environmental surveillance of sewage samples collected monthly from 25 to 30 sites across the country was implemented in 1989 and AFP surveillance began in 1994. The sewage samples were processed in the laboratory with a double-selective tissue culture system, which enabled economical processing of large number of samples. Between 1989 and 1997, 2,294 samples were processed, and wild-type poliovirus was isolated from 17 of them in four clusters, termed "silent outbreaks," in September 1990 (type 3), between May and September 1991 (type 1), between October 1994 and June 1995 (type 1), and in December 1996 (type 1). Fifteen of the 17 positive samples were collected in the Gaza Strip, 1 was collected in the West Bank, and 1 was collected in the Israeli city of Ashdod, located close to the Gaza Strip. The AFP surveillance system failed to detect the circulating wild-type viruses. These findings further emphasize the important role that environmental surveillance can play in monitoring the eradication of polioviruses.
... Despite this, relatively high coverage was achieved during the NID among children < 1 year of age, which undoubtedly contributed to the success of this activity in Pakistan. Although maternal antibody may provide some protection, many young infants remain susceptible to poliovirus infection, as evidenced by the not infrequent occurrence of paralytic poliomyelitis in infants <6 months of age [14] . Although infants are probably less likely to transmit wild poliovirus to other children since they are not ambulatory, transmission can occur, particularly in settings with poor sanitation and crowding . ...
Pakistan conducted national immunization days (NIDs) for the first time in 1994. To estimate coverage, to evaluate risk factors
for failure to be immunized, and to determine the effectiveness of mass media, parents of 1288 children in 714 households
in four districts were surveyed after the first NID round. In each district, a high proportion of children (93%–96%) received
oral poliovirus vaccine (OPV) during the NID. In three districts, unimmunized or partially immunized children were less likely
to receive NID OPV than were fully immunized children (Kohistan, P < .001; Quetta, P < .001; and Sibi, P = .05). Although a high proportion of children in each age cohort received NID OPV, in three districts children 0–11 months
of age were less likely to receive NID OPV than were older children. Television and radio reached a high proportion of survey
households, but other mass media were less effectively utilized. Risk factor and media effectiveness surveys provide important
information that is useful for planning future NIDs.
... It is possible that improved maintenance of the cold chain during the short (3 weeks) mass campaigns compared with the year-round routine program could have contributed to the increased immunogenicity of OPV doses administered during mass vaccination campaigns observed in our study. This is unlikely, however, since visits to 10 vaccine storage facilities in the Jordan Valley in 1991 (during a polio outbreak investigation) did not identify any problems with cold-chain maintenance [15]. Nevertheless, we were unable to assess potential differences in cold-chain maintenance directly, since a formal cold-chain evaluation for vaccines administered in Jordan for the 2-year period before and including the 1994 mass campaigns was beyond the scope of the current study. ...
... The potential for transmission of wild poliovirus in populations with relatively high coverage with three doses of OPV if exposure to an imported wild poliovirus strain occurs has been highlighted by recent outbreaks in well-immunized populations in Taiwan (1982), Gambia (1986), Oman (1989 and 1991), Jordan (1991)(1992), and Namibia (1993) [15,[18][19][20][21][22]. Since the risk of outbreaks of paralytic poliomyelitis caused by imported strains of wild poliovirus will continue until global eradication of wild poliovirus infection is achieved, it is important to devise strategies to prevent the spread of such strains if reintroduction occurs. ...
To compare the immunogenicity of routine versus mass campaign doses of oral poliovirus vaccine COPY), serum neutralizing antibodies
were measured in 254 children before and after two mass vaccination campaigns in Jordan. Precampaign seroprevalences to poliovirus
types 1, 2, and 3 in children who had received three, four, or five routine doses of OPV were compared with postcampaign seroprevalences
in children who had received one, two, or three routine doses plus two mass campaign doses. Seroprevalences were consistently
higher in subgroups that received two doses through mass campaigns than in subgroups that received all doses through the routine
program, especially for poliovirus type 3. Geometric mean titers were also consistently higher for mass campaign subgroups,
particularly for poliovirus type 3. The findings suggest that adding further doses of OPV to the routine schedule is unlikely
to have as great an impact on the immune state of children as administering the same number of doses during mass campaigns.
... Deuterium oxide has been proposed as a stabilizer to improve thermostability of OPV, permitting storage at 37°C for 7 days [29]. However, estimates of vaccine efficacy in recent outbreaks have been in the expected range [30][31][32]. Thus, field experience demonstrates that thermal inactivation is not a major problem with the current vaccine. ...
Significant progress is being made towards the global eradication of poliomyelitis by the year 2000. The strategies recommended
by the World Health Organization for polio eradication are as follows: maintaining high routine immunization coverage; conducting
nationwide mass immunization campaigns; building effective, laboratory-based surveillance for acute flaccid paralysis; and
conducting localized immunization campaigris directed at the final reservoirs of virus transmission. Sixty-three countries
have conducted nationwide anti-polio immunization campaigns. Three hundred million children were immunized in these campaigns
worldwide in 1995. The reported incidence of poliomyelitis has fallen by ∼80% since the global target was set in 1988, and
the geographic range of polio is being restricted. The major challenges for achieving eradication are establishing effective
surveillance systems in all countries and mobilizing the resources needed to fully implement the recommended strategies in
the 67 countries in which polio remains endemic.
... It is possible that improved maintenance of the cold chain during the short (3 weeks) mass campaigns compared with the year-round routine program could have contributed to the increased immunogenicity of OPV doses administered during mass vaccination campaigns observed in our study. This is unlikely, however, since visits to 10 vaccine storage facilities in the Jordan Valley in 1991 (during a polio outbreak investigation) did not identify any problems with cold-chain maintenance [15]. Nevertheless, we were unable to assess potential differences in cold-chain maintenance directly, since a formal cold-chain evaluation for vaccines administered in Jordan for the 2-year period before and including the 1994 mass campaigns was beyond the scope of the current study. ...
... The potential for transmission of wild poliovirus in populations with relatively high coverage with three doses of OPV if exposure to an imported wild poliovirus strain occurs has been highlighted by recent outbreaks in well-immunized populations in Taiwan (1982), Gambia (1986), Oman (1989 and 1991), Jordan (1991)(1992), and Namibia (1993) [15,[18][19][20][21][22]. Since the risk of outbreaks of paralytic poliomyelitis caused by imported strains of wild poliovirus will continue until global eradication of wild poliovirus infection is achieved, it is important to devise strategies to prevent the spread of such strains if reintroduction occurs. ...
To compare the immunogenicity of routine versus mass campaign doses of oral poliovirus vaccine COPY), serum neutralizing antibodies were measured in 254 children before and after two mass vaccination campaigns in Jordan. Precampaign seroprevalences to poliovirus types 1, 2, and 3 in children who had received three, four, or five routine doses of OPV were compared with postcam-paign seroprevalences in children who had received one, two, or three routine doses plus two mass campaign doses. Seroprevalences were consistently higher in subgroups that received two doses through mass campaigns than in subgroups that received all doses through the routine program, especially for poliovirus type 3. Geometric mean titers were also consistently higher for mass campaign subgroups, particularly for poliovirus type 3. The findings suggest that adding further doses of OPV to the routine schedule is unlikely to have as great an impact on the immune state of children as administering the same number of doses during mass campaigns. Current immunization strategies for the global eradication of paralytic poliomyelitis consist of achieving high levels of routine immunization with oral poliovirus vaccine (OPV) and implementing supplemental immunization activities, including biannual mass vaccination campaigns [1, 2]. These strategies have been associated with a marked decrease in the incidence of poliomyelitis worldwide and the elimination of paralytic poliomyelitis from two continents, North and South America [3, 4]. The precise mechanisms by which mass vaccination campaigns interrupt wild poliovirus transmission are not well defined. Since children in countries that implement this strategy may receive as many as 14 doses of OPV (through biannual mass campaigns and routine vaccination), it has been postulated that increases in individual humoral and secretory immunity through an increase in the total number of OPV doses could explain the effectiveness of mass vaccination campaigns and that the same results could be achieved by administering an equal number of doses through the routine program [5]. Despite their effectiveness, mass vaccination campaigns require substantial financial, logistic, managerial, and vaccine resources, which are not yet available in many countries; conse-Informed consent was obtained from the parents of children enrolled in these studies. quently, a number of polio-endemic countries have not yet implemented this strategy. Thus, determining whether mass campaigns offer an advantage over an equal number of OPV doses administered through the routine program (at lower cost) is important to guide OPV vaccination strategies in the remaining polio-endemic countries. To determine whether the effectiveness of mass campaigns is due strictly to the total number of OPV doses received or to a unique advantage derived from the strategy of pulsed, mass vaccination, we compared the immunogenicity of OPV doses delivered in mass vaccination campaigns with that of those delivered by the routine program among children in Jor-dan. Our findings are relevant to the need for mass vaccination campaigns as one of the major strategies of the global polio eradication initiative. Background
