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      The final stages of the global eradication of poliomyelitis

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          Abstract

          The global incidence of poliomyelitis has dropped by more than 99 per cent since the governments of the world committed to eradication in 1988. One of the three serotypes of wild poliovirus has been eradicated and the remaining two serotypes are limited to just a small number of endemic regions. However, the Global Polio Eradication Initiative (GPEI) has faced a number of challenges in eradicating the last 1 per cent of wild-virus transmission. The polio endgame has also been complicated by the recognition that vaccination with the oral poliovirus vaccine (OPV) must eventually cease because of the risk of outbreaks of vaccine-derived polioviruses. I describe the major challenges to wild poliovirus eradication, focusing on the poor immunogenicity of OPV in lower-income countries, the inherent limitations to the sensitivity and specificity of surveillance, the international spread of poliovirus and resulting outbreaks, and the potential significance of waning intestinal immunity induced by OPV. I then focus on the challenges to eradicating all polioviruses, the problem of vaccine-derived polioviruses and the risk of wild-type or vaccine-derived poliovirus re-emergence after the cessation of oral vaccination. I document the role of research in the GPEI's response to these challenges and ultimately the feasibility of achieving a world without poliomyelitis.

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          Most cited references106

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          Chemical synthesis of poliovirus cDNA: generation of infectious virus in the absence of natural template.

          Full-length poliovirus complementary DNA (cDNA) was synthesized by assembling oligonucleotides of plus and minus strand polarity. The synthetic poliovirus cDNA was transcribed by RNA polymerase into viral RNA, which translated and replicated in a cell-free extract, resulting in the de novo synthesis of infectious poliovirus. Experiments in tissue culture using neutralizing antibodies and CD155 receptor-specific antibodies and neurovirulence tests in CD155 transgenic mice confirmed that the synthetic virus had biochemical and pathogenic characteristics of poliovirus. Our results show that it is possible to synthesize an infectious agent by in vitro chemical-biochemical means solely by following instructions from a written sequence.
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            Outbreak of poliomyelitis in Hispaniola associated with circulating type 1 vaccine-derived poliovirus.

            An outbreak of paralytic poliomyelitis occurred in the Dominican Republic (13 confirmed cases) and Haiti (8 confirmed cases, including 2 fatal cases) during 2000-2001. All but one of the patients were either unvaccinated or incompletely vaccinated children, and cases occurred in communities with very low (7 to 40%) rates of coverage with oral poliovirus vaccine (OPV). The outbreak was associated with the circulation of a derivative of the type 1 OPV strain, probably originating from a single OPV dose given in 1998-1999. The vaccine-derived poliovirus associated with the outbreak had biological properties indistinguishable from those of wild poliovirus.
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              What Led to the Nigerian Boycott of the Polio Vaccination Campaign?

              Jegede discusses the recent controversy surrounding polio immunization in Nigeria, in which three northern states boycotted the immunization campaign.
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                Author and article information

                Journal
                Philos Trans R Soc Lond B Biol Sci
                Philos. Trans. R. Soc. Lond., B, Biol. Sci
                RSTB
                royptb
                Philosophical Transactions of the Royal Society B: Biological Sciences
                The Royal Society
                0962-8436
                1471-2970
                5 August 2013
                5 August 2013
                : 368
                : 1623 , Theme Issue 'Towards the endgame and beyond: complexities and challenges for the elimination of infectious diseases' compiled and edited by Petra Klepac, C. Jessica E. Metcalf and Katie Hampson
                : 20120140
                Affiliations
                Department of Infectious Disease Epidemiology, Imperial College London , Norfolk Place, London W2 1PG, UK
                Author notes
                Article
                rstb20120140
                10.1098/rstb.2012.0140
                3720038
                23798688
                b0d83734-503b-4f92-b994-feece1ec3b6c

                © 2013 The Authors. Published by the Royal Society under the terms of the Creative Commons Attribution License http://creativecommons.org/licenses/by/3.0/, which permits unrestricted use, provided the original author and source are credited.

                History
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                87
                Articles
                Review Article
                Custom metadata
                August 5, 2013

                Philosophy of science
                poliovirus,poliomyelitis,polio,eradication,vaccine,public health
                Philosophy of science
                poliovirus, poliomyelitis, polio, eradication, vaccine, public health

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