World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland.
Vaccine. 2011 Dec 30;29 Suppl 4:D80-5. doi: 10.1016/j.vaccine.2011.10.005.
Following the rapid progress towards interrupting indigenous wild poliovirus transmission in the Americas in the early 1980s, the Global Polio Eradication Initiative (GPEI) was launched with a resolution of the World Health Assembly (WHA) in 1988. The GPEI built on many lessons learned from smallpox eradication, including the large-scale deployment of technical assistance, implementing agendas of innovation and research and the use of professionally planned and guided advocacy. By the year 2000, the incidence of polio globally had decreased by 99% compared with the estimated >350,000 cases reported from 125 endemic countries in 1988. By 2002, three WHO Regions (the Americas, Western Pacific and European Regions) had been certified polio-free. By 2005, transmission of indigenous wild poliovirus (WPV) had been interrupted in all but 4 'endemic' countries: India, Nigeria, Pakistan and Afghanistan, where eradication efforts effectively stalled. WPV exported from northern Nigeria and northern India subsequently caused >50 outbreaks and paralysed >1500 children in previously polio-free countries across Asia and Africa. In each of the four remaining polio-endemic countries different challenges, or a combination of factors, prevented to build up sufficient levels of population immunity to stop transmission. Consequently, specific strategies were increasingly tailored to each setting. A new 2010-2012 GPEI Strategic Plan was developed which brought together several approaches to overcome the remaining hurdles to eradication, including the large-scale use of bivalent oral poliovaccine (bOPV) in supplementary immunization activities (SIAs). By the end of 2010, the impact of the new GPEI Strategic Plan 2010-2012 was apparent. Compared to 2009, the number of new polio cases in 2010 fell by 95% in both northern Nigeria and northern India, the world's largest remaining reservoirs of indigenous WPVs. By mid-2011, India had not reported a polio case for more than 5 months, and in Nigeria, endemic transmission appeared to be restricted to the north-east and north-west corners of the country. While polio cases due to WPV type 3 were still being detected in west and central Africa, the overall level of WPV3 transmission globally was at an all-time low. Uncontrolled WPV transmission appeared to be restricted to Chad and Pakistan, which increasingly represented the greatest risks to the GPEI. Although insufficient financing continued to be a major concern, political support for completing polio eradication in polio-infected countries was stronger than ever by mid-2011. While continued transmission in some areas, particularly in Pakistan and Chad, still had to be controlled as a matter of urgency, there were real opportunities to achieve new landmarks in polio eradication, especially in the key WPV reservoirs of India and Nigeria, setting the stage for polio to soon follow smallpox into the history books.
自 20 世纪 80 年代初在美洲迅速阻断本土野生脊髓灰质炎病毒传播以来，全球根除脊髓灰质炎行动（GPEI）于 1988 年世界卫生大会（WHA）决议中启动。GPEI 借鉴了根除天花的许多经验教训，包括大规模部署技术援助、实施创新议程和研究以及利用专业规划和指导的宣传。到 2000 年，与 1988 年报告的 125 个流行国家估计的>350,000 例相比，全球脊髓灰质炎发病率下降了 99%。到 2002 年，世界卫生组织三个区域（美洲、西太平洋和欧洲区域）已被认证为无脊髓灰质炎区。到 2005 年，除了 4 个“流行”国家：印度、尼日利亚、巴基斯坦和阿富汗外，本土野生脊髓灰质炎病毒（WPV）的传播已被阻断，在根除工作实际上停滞不前的地方。随后，来自尼日利亚北部和印度北部的 WPV 出口导致亚洲和非洲以前无脊髓灰质炎的国家发生了>50 次暴发，并使 1500 多名儿童瘫痪。在其余四个脊髓灰质炎流行国家中，不同的挑战或多种因素的结合阻止了建立足以阻断传播的人群免疫力。因此，专门针对每个环境制定了更具体的策略。制定了新的 2010-2012 年全球根除脊髓灰质炎行动战略计划，汇集了克服根除剩余障碍的几种方法，包括在补充免疫活动（SIAs）中大规模使用二价口服脊髓灰质炎疫苗（bOPV）。到 2010 年底，新的全球根除脊髓灰质炎行动 2010-2012 年战略计划的影响显而易见。与 2009 年相比，2010 年尼日利亚北部和印度北部的新脊髓灰质炎病例数分别下降了 95%，这是世界上剩余的最大本土 WPV 储存库。到 2011 年年中，印度已经有 5 个多月没有报告脊髓灰质炎病例，而在尼日利亚，流行传播似乎仅限于该国的东北部和西北部。虽然西非和中非仍在检测到 WPV 3 型病例，但全球 WPV3 传播的总体水平处于历史最低点。未得到控制的 WPV 传播似乎仅限于乍得和巴基斯坦，这对全球根除脊髓灰质炎行动构成了越来越大的威胁。尽管资金不足仍然是一个主要问题，但到 2011 年年中，各国对完成脊髓灰质炎感染国家的根除工作的政治支持比以往任何时候都更加强烈。虽然在某些地区，特别是在巴基斯坦和乍得，仍需紧急控制持续传播，但在根除脊髓灰质炎方面确实有机会取得新的里程碑，特别是在印度和尼日利亚这两个关键的 WPV 储存库，为脊髓灰质炎尽快跟随天花进入历史书籍铺平了道路。
