Polio eradication: end-stage challenges.

Abstract

Editor – I wish to suggest an alterna-tive to those strategies discussed by Sutter et al. for poliomyelitis “end-stage and post-eradication” (1). The suggestion is based on the successful eradication of poliomyelitis in Israel and the West Bank and Gaza Strip during the 1980s.The “Gaza System” for polio eradi-cation used a combined programme of live attenuated oral poliovirus vaccine (OPV) and inactivated poliovirus vac-cine (IPV), recommended by Joseph Melnick and Natan Goldblum (2). The system was implemented with the full support of Palestinian public health officials, who participated in discussions on immunization policy.The system was adopted to control the epidemics of poliomyelitis in the West Bank and Gaza Strip between 1976 and 1977, which occurred despite widespread and intensive use of OPV. Cases included children who had re-ceived up to four doses of OPV (3). The combined OPV/IPV programme almost immediately eliminated poliomyelitis from the West Bank and Gaza Strip.Israel adopted the “Gaza System” after an outbreak of poliomyelitis in 1988 among 15 young adults (4). This outbreak revealed major shortcomings in the use of OPV and IPV indepen-dently: IPV-only populations were sus-ceptible to and could transmit imported wild poliovirus (3), while OPV-only populations experienced declining im-mune levels (5).