On Wednesday, December 14, CDC Director Thomas R. Frieden, M.D., M.P.H., charged the entire CDC community to become active participants in an intensified strategy to eradicate polio, worldwide. The briefing followed Dr. Frieden’s December 2nd announcement activating CDC’s Emergency Operations Center for the agency’s partnership engagement through the Global Polio Eradication Initiative (GPEI). GPEI is committed to eradicating polio by the end of 2012. For more about CDC’s Emergency Operations Center, see http://www.cdc.gov/phpr/eoc.htm.
Isn’t Polio Gone?
Polio, or poliomyelitis, is an infectious viral disease that can strike at any age and affects a person's nervous system. In the late 1940s to the early 1950s, in the U. S. alone, polio crippled around 35,000 people each year -- making it one of the most feared diseases of the 20th century. Yet, thanks to a massive vaccination effort, by 1979 the country became polio free. For more about polio and how it was eradicated in the U.S., see “A Polio-Free U.S. Thanks to Vaccine Efforts,” http://www.cdc.gov/Features/PolioFacts/. The eradication of polio from the western hemisphere of the world is one of the most significant public health achievements of all time. But victory over polio cannot be claimed until the entire world is made safe from the disease and this commitment has been made by the global public health community.
The Early Years of CDC’s Fight against Polio
The fight against polio has been part of CDC’s mission since the 1950s, and the global push to eradicate polio is just the latest chapter in CDC’s polio efforts. Shortly after CDC was created, it established a national polio surveillance unit (PSU) headed by CDC’s Epidemic Intelligence Service (EIS) founder Alex Langmuir. CDC worked collaboratively with the two giants in polio eradication, 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 and also gather and analyze surveillance data.
CDC’s Chief EIS Officer at the time, Ira L. Myers, M.D., M.P.H., remembers the collaboration of CDC’s PSU and EIS with Salk and Sabin as something monumental, “As I think back on it, to sit in a conference room where Jonas Salk and Albert Sabin were sitting across from each other trying to decide whose vaccine was going to be first, is something that stays with your memory forever.” For more about CDC’s role in the early days of polio vaccine administration and surveillance, see “ ‘Bright, Aggressive, and Abrasive:’ A History of the Chief Epidemic Intelligence Service Officer of the U.S. Centers for Disease Control and Prevention,1951 – 2006”.
Keeping the U.S. Polio-Free
Landmark vaccination and surveillance efforts along with subsequent national mass Salk and Sabin vaccination programs – with CDC epidemiologists continuing to administer vaccine and conduct disease surveillance -- eradicated polio in the U.S. by 1979. Now, we are on the verge of worldwide eradication of this dreaded disease. In the U.S. meanwhile, continued protection from polio depends on continuing the impressive and historically high rate of polio vaccination. People at greatest risk include those who never had polio vaccine, or didn’t receive all the recommended doses, as well as those traveling to areas with polio cases. Vaccination will be necessary for full protection as long as polio remains in the world.
"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 that 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,” http://www.cdc.gov/vaccines/vpd-vac/polio/unprotected-story.htm.
Polio control remains an important priority for CDC today, as it was in the 1950s. Today, with global eradication within reach, efforts are focused on those few remaining areas where polio remains widespread and where polio transmission has been re-established.
The Global Push toward Worldwide Eradication
Launched in 1988, GPEI has been the largest public health initiative in history. At that time, more than 125 countries had widespread polio, with an estimated 350,000 children paralyzed by the disease annually – nearly 1,000 each day. The World Health Organization (WHO), Rotary International, CDC, UNICEF, and the Bill & Melinda Gates Foundation are all major partners in the initiative, with CDC serving as a lead technical partner.
GPEI’s four key strategies outlined by the World Health Organization for stopping polio transmission are:
- High infant immunization coverage with four doses of oral polio vaccine (OPV) in the first year of life in developing and countries where polio is still pervasive and routine immunization with OPV and/or IPV elsewhere.
- Organization of “national immunization days” to provide supplementary doses of oral polio vaccine to all children less than five years of age.
- Active surveillance for wild poliovirus through reporting and laboratory testing of all cases of acute flaccid paralysis among children less than fifteen years of age.
- Targeted "mop-up" campaigns once wild poliovirus transmission is limited to a specific focal area. For more about GPEI’s strategy to eliminate polio worldwide, see Global Polio Eradication Initiative Strategic Plan: 2004–2008.
Polio rates have dropped more than 99 percent since the launch of global polio eradication efforts in 1988, and no polio cases have been reported since January 2011 in India – one of the four remaining countries where it has continued. Nevertheless, poliovirus transmission is ongoing in other three countries – Afghanistan, Nigeria, and Pakistan, and travelers have carried the infection back to 39 previously polio-free countries over the last several years. Three of these countries – Angola, Chad, and Democratic Republic of the Congo – have continued to have transmission of poliovirus for more than one year, raising concerns that a window of opportunity to eradicate this crippling and sometimes deadly disease may be closing. It is therefore critical that we give this final push toward eradication our best effort. 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, every year, polio could disable or kill more than 100,000 children.”
CDC’s Role in the Race to the Finish
In the final push toward global polio eradication, CDC will continue its close teamwork with our partners at WHO, UNICEF, Rotary, and the Gates Foundation to ensure a coordinated global and country-level response.
CDC’s scale-up of polio eradication activities will include:
- Providing technical assistance for outbreak response, surveillance reviews, and vaccination campaign planning and monitoring;
- Advancing efforts to strengthen immunization infrastructure in key areas related to polio eradication;
- Supporting efforts to strengthen management capacity;
- Actively seeking out, evaluating, and scaling up effective innovations to identify and vaccinate children;
- Reinforcing CDC country offices resources, and increasing in-country planning and coordination; and
- Facilitating partner engagement and enhanced support for countries most threatened by pervasive or recurrent polio outbreaks.
CDC’s partnership in this important eradication effort is part of working 24/7 to keep America safe and secure from health threats, foreign or domestic. CDC is the U.S. health protection agency saving lives, protecting people, and saving money through prevention. This effort continues the fight begun in CDC’s early years to rid the world of polio and sustains the ideal of a world forever free from this deadly and crippling disease.