9/28/2014

Updates on CDC’s Polio Eradication Efforts


September 12, 2014

CDC Continues to Support the Global Polio Eradication Effort
The eradication of polio is an important priority for the Centers for Disease Control and Prevention (CDC). We are closer than we have ever been to eradicating polio and it is critical that we take advantage of this opportunity.
On December 2, 2011, CDC Director Thomas R. Frieden, MD, MPH, activated CDC’s Emergency Operations Center (EOC) to strengthen the agency’s partnership engagement through the Global Polio Eradication Initiative (GPEI)External Web Site Icon, which is committed to completing the eradication of polio. On December 14, 2011, Dr. Frieden enlisted the support of the entire CDC community to become active participants in an intensified effort to eradicate polio worldwide.
CDC’s Involvement
In the final push toward global polio eradication, CDC continues its close collaboration with partners, including the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), Rotary International, and the Bill and Melinda Gates Foundation to ensure a coordinated global and country-level response.
CDC polio eradication activities and staff have moved into the EOC operational structure to ensure maximum use of CDC resources to support polio eradication, and to scale up timely technical expertise and support for polio-infected countries (Afghanistan, Cameroon, Equatorial Guinea, Ethiopia, Iraq, Nigeria, Pakistan, and Syrian Arab Republic) and for countries at risk of polio outbreaks, in coordination with GPEI partners.
Since December 2, 2011, approximately 530 workers have supported CDC’s polio eradication efforts in the EOC and in the field. Of these, 161 workers have completed 721 field deployments to Angola, Chad, Cote d’Ivoire, and other areas. Each day an average of 45 people are working on polio eradication in CDC’s EOC.
Activation of the EOC has provided enhanced capacity for CDC’s STOP Transmission of Polio (STOP)program, which trains public health volunteers in the United States and globally to improve polio surveillance and help plan, implement, and evaluate vaccination campaigns. Since December 2, 2011, 793 individuals have been deployed to work with the STOP program in dozens of countries, including Chad, Haiti, and Kenya.
In addition, the EOC has provided enhanced capacity to scale up in-country technical expertise and support for – polio surveillance, planning, implementation, and monitoring of polio vaccination campaigns – strengthening routine immunization, strengthening management and accountability.
A few additional examples of CDC polio eradication activities include:
  • An in-depth review of priority countries’ polio eradication plans to assess program gaps and training needs, and elaboration of plans for CDC’s engagement in those countries.
  • Publication of several joint World Health Organization Weekly Epidemiologic Record/CDC Morbidity and Mortality Weekly Reports (MMWR) highlighting polio eradication progress related to Nigeriathe STOP Programrisk assessment for polio outbreaksglobal progress 2011-2013, and surveillance indicators.
  • Collaboration with GPEI partners on detailed country-plans for expanded technical and management support, including assistance with outbreak responses, surveillance reviews, vaccination campaign planning and monitoring, and data management.
  • The development of indicators for monitoring polio vaccination campaign performance in the areas of planning, implementation, and evaluation.
Review of WHO proposed outbreak response protocols for all polio-affected and at risk countries.
The Global Push toward the Finish Line
Polio incidence has dropped more than 99 percent since the launch of global polio eradication efforts in 1988. According to global polio surveillance data from September 10, 2014, 171 polio cases have been reported to date in 2014 from Afghanistan, Cameroon, Equatorial Guinea, Ethiopia, Iraq, Nigeria, Pakistan, and Syria. In 2013, a total of 416 polio cases were reported from the following countries: Afghanistan, Cameroon, Ethiopia, Kenya, Nigeria, Pakistan, Somalia, and Syrian Arab Republic.
On March 27, 2014, Dr. Frieden and senior CDC immunization staff were present when India, along with the other 10 countries of the South East Asia Region, was certified polio-free.  The country was once considered the most complex challenge to achieving global polio eradication. Four of the six regions of the World Health Organization have been certified polio-free: the Americas (1994), Western Pacific (2000), Europe (2002) and South East Asia (2014). 80% of the world’s people now live in polio-free areas.
While no polio cases have been detected in India for more than three years, poliovirus transmission is ongoing in the three endemic countries – Afghanistan, Nigeria, and Pakistan. GPEI’s Independent Monitoring Board considers Nigeria and Pakistan to be the greatest challenges for eradicating polio. On May 5, 2014, after receiving advice from an Emergency Committee of independent experts and in order to protect progress toward eradication, WHO Director-General Margaret Chan declaredExternal Web Site Icon the recent international spread of wild poliovirus a “public health emergency of international concern,” and issued Temporary Recommendations under the International Health Regulations (2005) to prevent further spread of the disease.
It is therefore imperative that we make this final push toward eradication one of our highest priorities. As Dr. Frieden has stated, “If we fail to get over the finish line, we will need to continue expensive control measures for the indefinite future…,More importantly, without eradication,  a resurgence of polio could paralyze more than 200,000 children worldwide every year within a decade.” Now is the time, we must not fail.

Why CDC Is Involved

The Early Years of CDC’s Fight against Polio

While the global push to eradicate polio is the latest chapter in CDC’s polio efforts, the fight against polio has been part of CDC’s mission since the 1950s. Shortly after the agency’s creation, CDC established a national polio surveillance unit (PSU) headed by CDC’s Epidemic Intelligence Service (EIS) founder Alex Langmuir. CDC worked collaboratively with Dr. Jonas Salk, of the University of Pittsburgh, who developed the inactivated polio vaccine (IPV) in the early 1950s, and Dr. Albert Sabin, who developed the oral polio vaccine (OPV) in the early 1960s. CDC’s PSU staff and EIS officers worked to administer both the Salk and Sabin polio vaccines in the field, and also gather and analyze surveillance data.
quotes Failure is not an option. There is no escalation beyond the declaration of an emergency. quotesIt is now or never.
— Dr. Margaret Chan, WHO Director- General.

Sustaining Eradication of Polio in the U.S.

These landmark vaccination and surveillance efforts along with subsequent national mass Salk and Sabin vaccination programs—in which CDC epidemiologists continued to administer vaccine and conduct disease surveillance—led to the eradication of polio in the U.S. by 1979. We are now on the verge of eradicating the disease worldwide. Meanwhile, continued protection from polio in the U.S. depends on maintaining the impressive and historically high rate of polio vaccination. People at greatest risk include those who never had polio vaccine, or received all recommended doses, as well as those traveling to areas with polio cases. As long as polio remains in the world, vaccination will be necessary for full protection.
"Scenarios for polio being introduced into the United States are easy to imagine, and the disease could get a foothold if we don’t maintain high vaccination rates," explains CDC’s Dr. Greg Wallace, Team Lead, Measles, Mumps, Rubella, and Polio, Epidemiology Branch, Division of Viral Diseases, National Center for Immunization and Respiratory Diseases. "For example, an unvaccinated U.S. resident could travel abroad and become infected before returning home. Or, a visitor to the United States could travel here while infected. The point is, one person infected with polio is all it takes to start the spread of polio to others if they are not protected by vaccination." For more about the importance of continued polio vaccination in the U.S., see Polio: Unprotected Story.
Polio control remains an important priority for CDC today, as it was in the 1950s. Today, global eradication is within reach, as efforts are focused on those few remaining areas where polio remains endemic and where polio transmission has been re-established.

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