Methods for poliomyelitis eradication: is there a consensus?

Abstract

I have been a strong advocate, for many years, for the merits of IPV for the control of poliomyelitis, and the ultimate eradication of the disease and of poliovirus from the environment (Beale AJ. Poliovaccines: time for a change in immunization policy? Lancet 1990; 335:839-842). I have also recognized how fortunate we are in the Public Health field to have such an excellent vaccine as Sabin's OPV. Dr. Foege has argued aloquently and cogently for an approach that uses both vaccines: OPV and IPV. The EPI programme has used 3 or 4 doses of OPV, but in a number of developing countries this has proved inadequate to provide satisfactory control. In South America the use of 10 or more doses has been required to bring the disease under control. A combined approach of using killed poliovaccine combined in DTP and three doses of OPV seems to be the preferred consensus solution. It would cause the minimum and, hopefully, no disruption of the existing programmes of the EPI. It would almost certainly bring forward the day when poliomyelitis will be controlled and the disease at least will be eradicated. It is clear that the sooner this is done the better. It is cheaper to do it now, although it requires more funds in the short term; and it is better for the children of the world--present and future. The extra cost of putting IPV into DTP is probably about one US$ per course, which is probably no more expensive than giving six more doses of OPV, when the total costs of administration are considered.(ABSTRACT TRUNCATED AT 250 WORDS)