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Status Brief

Developmental Milestones/Developments to Date:

Current Assessment/State of the Field:




Baker, Michael & David Fidler, “Global Public Health Surveillance Under New International Health Regulations,” Emerging Infectious Diseases, Vol. 12, No. 7, pgs. 1058-1065, July 2006.

  1. “IHR (International Health Regulations) 2005 identifies health-related events that each country that agrees to be bound by the regulations must report to WHO.”
  2. “These events include any unexpected or unusual public health events regardless of its origin or source.”
  3. “IHR 2005 also requires state parties …to inform WHO of public health risks identified outside their territories that may cause international disease spread, as manifested by exported or imported human cases, vectors that may carry infection or contamination, or contaminated goods.”
  4. “IHR 2005 defines a ‘public health emergency of international concern’ (PHEIC) as ‘an extraordinary event’ which is determined by the WHO.”
  5. “IHR 2005 contains a ‘decision instrument’ that helps state parties identify whether a health-related event may constitute a PHEIC and therefore requires formal notification to WHO.”
  6. “IHR 2005 includes a list of diseases for which a single case may constitute a PHEIC and must be reported to WHO immediately.  This list consists of smallpox, poliomyelitis, human influenza (flu) caused by new subtypes, and severe acute respiratory syndrome (SARS).”
  7. “IHR 2005 also encourages state parties to consult with WHO over events that do not meet the criteria for formal notification but may still be of public health relevance.”
  8. “IHR 2005’s surveillance strategy, especially the decision instrument, has been specifically designed to make IHR 2005 directly applicable to emerging infectious disease events, which are usually unexpected and often threaten to spread internationally.”
  9. “IHR 2005’s purpose is to prevent, protect against, control, and facilitate public health responses to the international spread of disease.”
  10. “IHR 2005 makes surveillance central to guiding effective public health action against cross-border disease threats.”
  11. “Surveillance needs to be sufficiently sensitive to detect infectious agents that have not yet resulted in large numbers of diagnosed cases.”
  12. “One approach to this challenge is [[Syndromic Surveillance]], but such surveillance has not been effective in detecting emerging infectious diseases early.”

Biosurveillance, Flu, Anthrax, Polio, SARS, Smallpox, Public Health


McNeil Jr., Donald, G., “Polio in Nigeria Traced to Mutating Vaccine.” NYT, A15, October 11, 2007,

Vaccination, Egypt, Africa, Polio


Collett, Marc S., et al., “A case for developing antiviral drugs against polio, Antiviral Research,” Volume 79, Issue 3, September 2008, Pages 179-187.

  1. ”Polio eradication is within sight. … Here, we argue that antiviral drugs against poliovirus be added to the arsenal. Anti-poliovirus drugs could be used to treat the infected and protect the exposed, acting rapidly on their own to contain an outbreak and used as a complement to IPV. …Stakeholders must come to understand the potential Public Health benefits of polio drugs, the feasibility of their development, and the relatively modest costs involved. Given the timelines for eradication and those for drug development, the time for action is now.”

Polio, Public Health


Associated Press, “Polio vaccine blamed for outbreaks in Nigeria
Mutation of live virus in oral doses linked to 124 cases this year, experts say,” MSN, Aug. 14, 2009, http://www.msnbc.msn.com/id/32418446/ns/health-infectious_diseases

Vaccination, Polio


Kate Kelland, “Angola polio outbreak threatens neighbors: WHOReuters, Last accessed October 18 2010 http://www.reuters.com/article/idUSTRE69037I20101001

  1. “The WHO’s spokeswoman on polio eradication, Sona Bari, said an outbreak of the crippling virus, which started in 2007 after Angola had been polio-free for six years, now has “international consequences” if it is not stopped.”
  2. “It is the only expanding outbreak in all of Africa, spreading both within Angola and into the Democratic Republic of Congo,” Bari said in a telephone interview. “It’s a high threat to neighboring countries.”

Polio, WHO


Lichtarowicz Ania, “New polio vaccine more effective in reducing disease” Last accessed October 27, 2010 http://www.bbc.co.uk/news/health-11621842

  1. “Research published online in the journal The Lancet, shows that the new vaccine is significantly better at protecting children against polio than the current popular vaccine.”
  2. “The new vaccine has already been used in immunisation campaigns in Afghanistan, India and Nigeria.”
  3. “In India the number of cases this time last year was 464. Over the same period this year there have only been only 39 cases.
    Nigeria has seen an even greater difference, with cases falling by 95%.”



Branswell, Helen, “Finland Looks for a Mystery Person Spreading Poliovirus,” Aug 15, 2011, The Atlantic, available at http://www.theatlantic.com/international/archive/2011/08/finland-looks-for-one-mystery-man-spreading-polio/243604/ last checked 8/17/2011.

  1. “Somewhere in Tampere, Finland, someone is excreting polioviruses. He or she has been doing it there since at least 2008, passing stools laced with polioviruses then flushing them into the sewers of Finland’s third largest city..”
  2. “Known in polio science circles as a long-term excreter, the unidentified individual is likely completely unaware of this quirk of his or her bowel. .”
  3. “Roivainen is the director of the intestinal virus unit at Finland’s National Institute for Health and Welfare. There she oversees a program of environmental surveillance for polioviruses — the routine testing of sewage samples from nine cities around the country.”
  4. “Finland’s environmental surveillance program started in 1960 and for decades the country’s sewage systems seemed to be poliovirus free. Bimonthly sampling turned up no wild polioviruses. (Scientists use the term “wild” polioviruses to distinguish between the viruses found in nature and the weakened viruses used in oral polio vaccine.) Because Finland uses injectable polio vaccine made with killed viruses, there were rarely any sightings of the altered live vaccine viruses that are hallmarks of oral polio vaccine use. Those viruses are called Sabin strains after the man who developed the oral polio vaccine, Albert Sabin.”
  5. “Tests were also consistently negative for vaccine-derived polioviruses, a troubling byproduct of Sabin strains. These viruses, known by the nickname VDPVs, don’t look exactly like wild polioviruses if you study their genetic codes. They have evolved from the Sabin strains, picking up mutations as they spread from human gut to human gut. But while they don’t look exactly like wild polioviruses, they act like them. Just like wild polioviruses, vaccine-derived polioviruses paralyze a percentage of the people who become infected with them.”
  6. “Science can estimate how long vaccine-derived viruses have been circulating–in other words, how long ago the vaccine dose that started the problem was given. They look at the genetic distance of the VDPVs from Sabin strains, then calculate the time based on the rate at which polioviruses are known to mutate. The person shedding the Tampere VDPVs has probably been generating polioviruses for 12 or 13 years, scientists believe.”
  7. “Genetic analysis of the Tampere viruses suggests they have all passed through the gut of one person, likely someone whose immune system doesn’t work properly. When healthy people get oral polio vaccine, their immune systems respond to stop the virus from replicating in their gastrointestinal systems. The antibodies generated in that process protect them against future infection. But in a small number of people the immune system doesn’t shut down virus replication after vaccination, so they keep generating and excreting polioviruses.”
  8. “Attempts to find Tampere’s long-term excreter have been time consuming and frustrating. By studying the sewage system, Roivainen’s team has homed in on the part of the city where the excreter lives. The problem is 30,000 other people live there too. The sewers, she says, have taken this investigation as far as they can.”
  9. “Now efforts are focused on finding people known to have immunodeficiencies and asking them to submit stool samples for analysis. ‘But we have got only very few stool specimens till now and they all have been negative,’ Roivainen admits. ‘I don’t know if we will ever be able to identify him or her.'”
  10. “there is nothing medically that can be done to stop his or her virus-shedding problem. In some people shedding continues for decades. In others, it stops on its own. And in some cases, the viruses turn on the shedder, who develops polio. Still, polio scientists are eager to get a better picture of who these long-term shedders are. That’s because these people, some scientists fear, could potentially re-establish spread of polio if the global polio eradication campaign succeeds in stamping out wild polioviruses.”
  11. “Once wild polioviruses are gone, the World Health Organization will tell countries to stop using oral polio vaccine. Those that can’t afford to replace it with the more expensive injectable vaccine will start to develop ever larger numbers of polio-susceptible children.”
  12. “While only about 40 long-term poliovirus excreters have been identified worldwide, no one knows how widespread the problem is. Hovi, for one, thinks there may be more of these people than scientists currently estimate.”
  13. “VDPVs had been found in sewage coming from Skalica, a town of 15,000 people located about 30 miles from Slovakia’s capital, Bratislava. Working with sanitation engineers, researchers tracked the viruses to a branch of the sewage system that served five or six apartment blocks where about 500 people resided. Stool samples were collected from most of those residents. Analyzing that many stool samples is a lot of work, but the researchers thought they were on the verge of finding their man or woman. ‘And we couldn’t find any polio virus in any of those (samples),’ Hovi says. It was later discovered two other buildings were illegally dumping into that sewage branch. But before further testing could be done, VDPVs stopped showing up in Skalica sewage samples. The trail went cold. ‘It might have been possible to detect the person, but we didn’t,’ Hovi says. ‘Perhaps he or she moved away. You never know. And also it is possible of course that he or she stopped shedding the virus.'”

Biosurveillance, Polio, Vaccination


Jeremy Laurance, “One doctor’s dream: to keep India’s last polio ward empty.” March 1, 2013, The Independent, http://www.independent.co.uk/life-style/health-and-families/health-news/one-doctors-dream-to-keep-indias-last-polio-ward-empty-8517409.html Last Checked, March 4, 2013.

  1. “In the early 1990s there were 3,000 cases of paralytic polio each year in India. Now there are none.”
  2. “In a country of 1.2 billion people, the monumental scale of that achievement – successfully vaccinating 95 per cent of children aged five and under – is a tribute to Indian diligence. India’s passion for bureaucracy may burden businesses with paper work (and drive visa applicants to despair) but here has proved it can also save lives.”
  3. “The centrepiece of the campaign is the national immunisation days (NIDs), begun in 1995, around which all other activities are organised. The aim is to vaccinate 172 million children under five on a single day, employing 2.5 million vaccinators who are moved in 155,000 vehicles (including boats, elephants and camels) carrying over six million ice packs (to keep the vaccine cool) and supplying over 700,000 vaccination booths – set up in hospitals, on street corners and out of the back of cars. The NID is followed by a five day mop up phase in which vaccinators move from house to house, following a meticulously planned route, seeking out those missed.”
  4. “The task is a logistical nightmare. The local distribution centre for Mukundpur, north west Delhi, is in a dingy office in the Jagiwan Ram Government hospital where the boxes of vaccine are kept in a freezer. At 6.30am last Sunday the vaccine was loaded into insulated containers with a packet of ice – it must be kept between four and eight degrees centigrade – and dispatched in one of 15 vehicles to supply 160 booths.”
  5. “Until the 1950s polio outbreaks occurred regularly across the world, terrifying parents and causing death and disability to thousands of children.”
  6. “The polio virus infects nerve cells, destroying muscle function and eliminating tendon reflexes, especially in the legs, leaving the victim severely paralysed. In the worst cases it spreads into the brain stem, destroying the nerve cells that control breathing and swallowing. Survival then depends on artificial ventilation – thousands were treated in iron lungs – and tube feeding until the acute phase of the illness is past.”
  7. “Albert Sabin argued that his oral polio vaccine, launched in 1960, could be used to eliminate the disease. Coming five years after Jonas Salk’s vaccine (made from killed virus and injected), it had two advantages: it was easy to administer and, as a live virus, produced a mild contagious illness that spread immunity.”
  8. “A trial in the 1950s in Toluca, Mexico, a town with a 100,000 population in which polio had broken out, proved its potential. In four days Sabin’s team vaccinated 26,000 children and in weeks polio disappeared from Toluca. In 1995 India used a trivalent vaccine against three types of the virus. Type 2 was eradicated in 1999, but not Type 3 and Type 1. Single vaccines were introduced in 2005 for each type and alternated each year, but Type 3 spiked in 2007-8. In 2010 a bivalent vaccine was introduced –and within a year, India had recorded its last polio case.”

Vaccination, Polio, India