Poliomyelitis control in Israel, the West Bank and Gaza Strip: changing strategies with the goal of eradication in an endemic area.

Israel has faced the challenge presented by epidemic poliomyelitis by using different immunization strategies. In the 1950s, inactivated poliovirus vaccine (IPV) helped to reduce the total burden of the disease, but cases continued to occur. Introduction of oral poliovirus vaccine (OPV) in mid-1961 had a dramatic effect in controlling an extensive epidemic of poliomyelitis; however, poliovirus activity and cases continued during the 1970s, and at a low level in the 1980s. A localized outbreak of 15 cases of poliomyelitis in 1988 occurred in an area using enhanced potency IPV (eIPV) only. This led to a revision of poliomyelitis immunization policy. The successful poliomyelitis control in the West Bank and the Gaza Strip using both OPV and IPV since 1978 shows the advantages of a combined approach. This programme was therefore adopted in modified form in the whole of Israel, the West Bank and Gaza. Since late 1988, no cases of poliomyelitis have occurred in any of these three areas, indicating the success of the combined poliomyelitis immunization programme. These experiences may be helpful to other countries, especially those where there is a danger of importation of wild poliovirus, and to prevent vaccine-associated disease. The combined approach provides an additional immunization model in the international effort to eradicate poliomyelitis.