POLIO VACCINE

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 Since its inception in 1988, the Global Polio Eradication Initiative (GPEI) has made significant progress in reducing the global burden of wild poliovirus (WPV) transmission by more than 99%. Currently, only two countries, Afghanistan and Pakistan, remain endemic for type 1 WPV (WPV1) [1].  In 2020, the African continent achieved the milestone of being certified WPV-free, with Nigeria reporting its last case of WPV1 in 2016 [2].  However, recent WPV1 cases in Mo
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zambique and Malawi, genetically linked to strains detected in Pakistan, highlight the ongoing challenges in maintaining a polio-free status [3,4].

 Polio eradication efforts are further complicated due to the spread of circulating vaccine-derived poliovirus (cVDPV).  Sabin oral poliovirus vaccine (OPV) strains can, in rare circumstances, lose their attenuating mutations and generate VDPVs that are transmissible and neurovirulent.  As such, poliovirus transmission, both of WPV and cVDPVs, officially recognized as a Public Health Emergency of International Concern (PHEIC), continues to stay.

 To minimize the risk of serotype 2 vaccine associated paralytic poliomyelitis (VAPP) and cVDPV2, more importantly after the certification of global WPV2 eradication [5], trivalent OPV (tOPV, containing all 3 poliovirus strains) was withdrawn from routine immunization (RI) schedules in 2016 with a global switch from tOPV to bivalent OPV (containing types 1 and 3) [6].  In order to close the type 2 immunity gap, it was recommended that at least one dose of the inactivated poliovirus vaccine (IPV) be administered in Rhode Island. Nigeria introduced one dose of IPV (IPV1) into RI in 2015 at 6 weeks of age, and a second dose of IPV (IPV2) was added in 2021 at 14 weeks of age.  WHO and UNICEF estimates of national immunization coverage report persistently sub-optimal IPV1 coverage at a sustained 62 % from 2020 to 2022 [8]; IPV2 coverage data is estimated to be 17 % and 37 % in the years 2021–2022 [7].

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