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Science 2016 Jan 22;351(6271):348

Eradicating polio: a balancing act.

Agol V, Cello J, Chumakov K, Ehrenfeld E, Wimmer E

Abstract

The editorial by Adams and Salisbury [1] presented great news about the progress of World Health Organization led efforts to eradicate polio: there were only 66 cases of paralytic poliomyelitis caused by wild polioviruses (WPV) of serotype 1 in 2015, whereas disease caused by WPV2 and WPV3 has not been registered for at least 3 years. These statistics, however, omit another significant source of infection and disease. Highly pathogenic vaccine-derived polioviruses (VDPVs) continue to cause numerous outbreaks across the globe [2] and are chronically excreted by a small number of immune-compromised individuals, sometimes for years or even decades [3]. The overwhelming majority of poliovirus infections are asymptomatic, leading to silent circulation detectable only by environmental surveillance, which is not performed globally. Thus, it is not possible to ensure that virus is truly absent, requiring continued global immunization, confirming David Baltimore's assertion made in 1971 that polio is not dead [4]. It is recognized that eradication of polio will never be possible as long as the current live vaccine strains are in use [5], leading WHO to plan a phased, globally synchronized withdrawal of the live vaccine replacing it with safer inactivated vaccine. This transition will not be possible or sustainable without development and introduction of a new generation of safer, more effective and affordable vaccines and treatment options for chronic excretors. The major message of the editorial is that “all polioviruses (wild and vaccine strains) in laboratory, research and manufacturing facilities will have to be destroyed or securely contained” in order to prevent inadvertent release. Excessively strict and premature containment will dramatically hinder the availability of new vaccines and therapeutics [6] currently under development with support from WHO and the Bill & Melinda Gates Foundation. These new products may be critical for ensuring the lasting success of the eradication program.


Category: Journal Article, Letter
PubMed ID: #26798005 DOI: 10.1126/science.351.6271.348-b
Includes FDA Authors from Scientific Area(s): Biologics
Entry Created: 2016-02-19 Entry Last Modified: 2016-02-27
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