As of May 1, 2016, use of oral poliovirus vaccine (OPV) type 2 for routine and supplementary
immunization activities ceased after a synchronized global switch from trivalent OPV
(tOPV; containing Sabin strain types 1, 2, and 3) to bivalent OPV (bOPV; containing
Sabin strain types 1 and 3) subsequent to the certified eradication of wild type poliovirus
(WPV) type 2 in 2015 (
1
–
3
). Circulating vaccine-derived poliovirus (cVDPV) outbreaks* occur when transmission
of Sabin strain poliovirus is prolonged in underimmunized populations, allowing viral
genetic reversion to neurovirulence, resulting in cases of paralytic polio (
1
–
3
). Since the switch, monovalent OPV type 2 (mOPV2, containing Sabin strain type 2)
has been used for response to cVDPV type 2 (cVDPV2) outbreaks; tOPV is used if cVDPV2
co-circulates with WPV type 1, and bOPV is used for cVDPV type 1 (cVDPV1) or type
3 (cVDPV3) outbreaks (
1
–
4
). In November 2020, the World Health Organization (WHO) Emergency Use Listing procedure
authorized limited use of type 2 novel OPV (nOPV2), a vaccine modified to be more
genetically stable than the Sabin strain, for cVDPV2 outbreak response (
3
,
5
). In October 2021, the Strategic Advisory Group of Experts on Immunization (WHO’s
principal advisory group) permitted wider use of nOPV2; however, current nOPV2 supply
is limited (
6
). This report updates that of July 2019–February 2020 to describe global cVDPV outbreaks
during January 2020–June 2021 (as of November 9, 2021)
†
(
3
). During this period, there were 44 cVDPV outbreaks of the three serotypes affecting
37 countries. The number of cVDPV2 cases increased from 366 in 2019 to 1,078 in 2020
(
7
). A goal of the Global Polio Eradication Initiative’s (GPEI) 2022–2026 Strategic
Plan is to better address the challenges to early CVDPV2 outbreak detection and initiate
prompt and high coverage outbreak responses with available type 2 OPV to interrupt
transmission by the end of 2023 (
8
).
Detection of cVDPV1
The most recently detected poliovirus genetically linked to the cVDPV1 emergence (PHL-NCR-2)
§
circulating during the previous reporting period was found in environmental surveillance
samples (sewage) in Malaysia during March 2020 (
3
) (Table) (Figure 1). During this reporting period, three new cVDPV1 emergences were
detected in Madagascar (MAD-ANO-1, MAD-SUE-1, and MAD-SUO-1). The YEM-SAD-1 emergence
was first isolated from specimens collected during July 2019 from contacts of an acute
flaccid paralysis (AFP) patient in Yemen; circulation was confirmed after the previous
global update (
3
).
TABLE
Circulating vaccine-derived polioviruses detected, by serotype, source, and other
selected characteristics — worldwide, January 2020–June 2021
Country
Outbreak/
Emergence designation*
Years detected†
Serotype
No. of detections§ January 2020–June 2021
Capsid protein VP1 divergence from Sabin OPV strain**(%)
Date of latest outbreak case, healthy child specimen, or environmental sample††
From AFP cases
From other human sources (non-AFP)¶
From environmental surveillance
Afghanistan
PAK-GB-1
2020–2021
2
225
36
271
0.7–3.4
Jun 9, 2021
AFG-NGR-1
2020–2021
2
127
18
154
0.7–2.2
Jun 23, 2021
AFG-HLD-1
2020–2021
2
4
0
5
0.9–1.7
Jan 28, 2021
Angola
ANG-HUI-1
2019–2020
2
2
0
0
1.3–1.5
Feb 9, 2020
ANG-LUA-1
2019–2020
2
1
0
0
1.5
Feb 9, 2020
Benin
NIE-JIS-1
2019–2021
2
6
2
10
2.4–5.1
May 25, 2021
Burkina Faso
NIE-JIS-1
2019–2021
2
61
13
0
3.1–5.5
Jun 9, 2021
TOG-SAV-1
2020
2
6
0
0
1.8–2.6
Oct 13, 2020
Cameroon
CHA-NDJ-1
2019–2020
2
3
0
0
1.4–1.9
Sep 20, 2020
CAR-BER-1
2020
2
1
0
7
1.4–2.3
Sep 29, 2020
CAR-BNG-1
2020
2
3
4
3
1.7–2.8
Jun 2, 2020
Central African Republic
CHA-NDJ-1
2020
2
3
1
0
1.4–1.7
Nov 4, 2020
CAR-BER-1
2019–2020
2
1
0
0
1.3
Feb 5, 2020
CAR-BNG-1
2019–2020
2
0
0
3
1.5–1.8
Feb 5, 2020
Chad
NIE-JIS-1
2019–2020
2
8
3
1
3.1–4.5
Aug 10, 2020
CHA-NDJ-1
2019–2020
2
91
16
2
0.8–2.6
Dec 15, 2020
CAR-BIM-3
2020
2
1
0
0
1.4
Oct 18, 2020
China
CHN-SHA-1
2020–2021
3
0
1
1
1.8–2.0
Jan 25, 2021
Côte d’Ivoire
NIE-JIS-1
2019–2020
2
63
27
175
2.9–5.1
Dec 23, 2020
TOG-SAV-1
2020
2
1
0
0
2.0
Feb 10, 2020
Democratic Republic of the Congo
DRC-KAS-3
2019–2021
2
82
82
2
1.7–3.1
Apr 30, 2021
DRC-MAN-2
2021
2
1
0
0
0.8
Jun 27, 2021
DRC-TPA-2
2020
2
0
6
0
0.7–0.8
May 14, 2020
DRC-EQT-1
2020
2
1
8
0
0.7–1.5
Sep 11, 2020
CAR-BNG-1
2020
2
0
2
0
2.3
Oct 27, 2020
ANG-LNO-2
2020
2
1
0
0
2.1
Feb 19, 2020
ANG-LUA-1
2019–2020
2
2
0
0
1.0–1.3
Jan 29, 2020
Egypt
CHA-NDJ-1
2020–2021
2
0
0
11
2.1–2.5
Jun 8, 2021
Ethiopia
ETH-ORO-1
2019–2021
2
22
6
4
1.4–4.3
Mar 27, 2021
ETH-ORO-2
2019–2020
2
2
0
0
1.3–1.5
Feb 18, 2020
ETH-ORO-3
2019–2020
2
1
2
0
2.0–2.8
Oct 11, 2020
ETH-ORO-4
2019–2020
2
1
0
0
2.9
Feb 23, 2020
ETH-SOU-1
2020–2021
2
9
0
0
1.1–2.4
Apr 13, 2021
ETH-SOU-2
2019–2021
2
5
0
0
2.1–3.0
Jun 24, 2021
SOM-AWL-1
2020
2
2
0
0
1.5–2.3
Dec 14, 2020
CHA-NDJ-1
2020
2
0
0
1
1.4
Dec 28, 2020
Ghana
NIE-JIS-1
2019–2020
2
11
10
34
2.9–4.1
Jun 16, 2020
Guinea
NIE-JIS-1
2020–2021
2
48
1
1
3.0–4.8
Apr 1, 2021
Guinea-Bissau
NIE-JIS-1
2021
2
2
0
0
4.1–4.5
Jun 27, 2021
Iran
PAK-GB-1
2020–2021
2
0
0
11
1.5–3.6
Feb 20, 2021
Kenya
SOM-BAN-1
2018, 2020–2021
2
0
3
2
7.2–7.6
Jan 25, 2021
Liberia
NIE-JIS-1
2020–2021
2
3
6
47
3.0–6.1
May 28, 2021
Madagascar
MAD-SUE-1
2020–2021
1
6
9
18
3.0–3.6
Jun 29, 2021
MAD-SUO-1
2021
1
1
3
0
1.6–2.0
Feb 24, 2021
MAD-ANO-1
2021
1
0
0
5
1.3–1.6
May 17, 2021
Malaysia
PHL-NCR-1
2019–2020
2
0
0
3
7.5
Feb 4, 2020
PHL-NCR-2
2019–2020
1
3
0
10
3.4–4.0
Mar 13, 2020
Mali
NIE-SOS-7
2020
2
3
1
0
1.5–2.2
Jul 5, 2020
NIE-JIS-1
2020
2
47
2
10
3.1–4.6
Dec 23, 2020
Mauritania
NIE-JIS-1
2021
2
0
0
2
3.9–4.0
Jun 30, 2021
Niger
NIE-JIS-1
2018–2020
2
11
2
11
2.8–5.1
Dec 8, 2020
NIE-ZAS-1
2021
2
1
0
0
2.2
Jun 20, 2021
Nigeria
NIE-JIS-1
2018–2021
2
15
3
19
2.8–4.6
Jun 29, 2021
NIE-SOS-8
2020
2
2
7
0
1.1–1.8
Sep 17, 2020
NIE-ZAS-1
2020–2021
2
69
13
83
1.8–3.5
Jun 30, 2021
NIE-SOS-7
2019, 2021
2
10
4
3
2.4–3.1
Jun 30, 2021
NIE-KGS-1
2019–2020
2
1
0
1
1.4–1.5
Jan 26, 2020
Pakistan
PAK-GB-1
2019–2021
2
114
6
257
0.7–3.1
Apr 28, 2021
PAK-TOR-1
2019–2020
2
0
1
1
1.1–1.5
Mar 4, 2020
PAK-KHI-2
2020
2
0
0
4
0.7–1.0
Oct 14, 2020
PAK-FSD-1
2020
2
10
1
8
0.7–1.2
Oct 13, 2020
PAK-FSD-2
2020
2
2
0
0
0.8–1.4
Sep 29, 2020
PAK-ZHB-1
2020
2
0
0
5
0.7–1.1
Oct 16, 2020
AFG-NGR-1
2020–2021
2
12
2
59
0.7–2.3
May 18, 2021
AFG-HLD-1
2020
2
2
0
0
1.3–1.4
Aug 24, 2020
PAK-LKW-1
2020–2021
2
3
0
1
0.7–1.0
Jan 11, 2021
PAK-KAM-1
2020–2021
2
0
0
4
0.7–0.9
Feb 9, 2021
PAK-PWR-1
2021
2
0
0
2
0.8
Jun 14, 2021
Philippines
PHL-NCR-1
2019–2020
2
1
0
4
7.1–7.6
Jan 24, 2020
Republic of the Congo
ANG-HUI-1
2020
2
2
1
0
2.0–2.5
Nov 14, 2020
DRC-KAS-1
2021
2
1
0
0
2.2
Jan 31, 2021
CAR-BNG-1
2020–2021
2
0
0
4
2.3–2.6
Apr 14, 2021
CAR-BER-1
2021
2
0
0
1
3.3
Jun 1, 2021
ANG-LUA-1
2020
2
0
1
0
2.1
Oct 12, 2020
Senegal
NIE-JIS-1
2020–2021
2
14
30
13
3.8–5.7
Jun 14, 2021
Sierra Leone
NIE-JIS-1
2020–2021
2
15
16
10
3.4–4.6
Jun 29, 2021
Somalia
SOM-BAN-1
2017–2021
2
14
9
37
5.5–8.3
May 23, 2021
SOM-AWL-1
2020
2
1
0
0
2.3
Aug 1, 2020
ETH-ORO-3
2020
2
0
5
0
2.8
Sep 22, 2020
South Sudan
CHA-NDJ-1
2020–2021
2
56
24
11
1.3–3.0
Apr 8, 2021
ETH-SOU-1
2021
2
1
0
0
2.2
Jan 8, 2021
Sudan
CHA-NDJ-1
2020
2
51
16
15
1.1–2.8
Dec 18, 2020
Tajikistan
PAK-GB-1
2020–2021
2
26
11
51
2.2–3.8
Jun 26, 2021
The Gambia
NIE-JIS-1
2021
2
0
0
14
4.0–4.6
Jun 24, 2021
Togo
NIE-JIS-1
2019–2020
2
6
8
0
2.8–4.1
July 9, 2020
TOG-SAV-1
2019–2020
2
3
1
0
1.5–2.1
May 3, 2020
Uganda
CHA-NDJ-1
2021
2
0
0
1
4.0
Jun 1, 2021
Yemen
YEM-SAD-1
2019–2021
1
32
0
0
1.9–3.3
Jan 13, 2021
Total cVDPV
—§§
—§§
—§§
1,335
423
1,412
—§§
—§§
Abbreviations: AFP = acute flaccid paralysis; cVDPV = circulating vaccine-derived
poliovirus; OPV = oral poliovirus; VDPV = vaccine-derived poliovirus; VP1 = viral
protein 1.
* In the column “Outbreaks/Emergences,” outbreaks list total cases clearly associated
with cVDPVs, emergences indicate independent cVDPV outbreaks, and names of emergences
designate the country and geographic subnational region of the emergence and the number
of emergences in each subnational region.
† Total years detected for previously reported cVDPV outbreaks.
§ During January 2020–June 2021 with data as of November 9, 2021. For AFP cases, the
number of AFP cases with a VDPV-positive specimen or in which a direct contact of
the case had a VDPV-positive specimen when the case did not; for other human sources,
the number of contacts or healthy children with a VDPV-positive specimen; for detections
from environmental surveillance, the total VDPVs detected from environmental (sewage)
collections.
¶ Contacts and healthy child specimen sampling during January 2020–June 2021 with
data as of November 9, 2021 for all emergences.
** Percentage of divergence is estimated from the number of nucleotide differences
in the VP1 region from the corresponding parental OPV strain.
†† For AFP cases, dates refer to date of paralysis onset; for contacts, healthy children,
and environmental (sewage) samples, dates refer to date of collection during January
2020–June 2021 with data as of November 9, 2021.
§§ Dashes indicate data were not cumulative.
FIGURE 1
Ongoing circulating vaccine-derived poliovirus outbreaks — worldwide, January 2020–June
2021*
Abbreviations: cVDPV = circulating vaccine-derived poliovirus; cVDPV1 = cVDPV type
1; cVDPV2 = cVDPV type 2; cVDPV3 = cVDPV type 3.
* Data as of November 9, 2021.
Figure is a map showing the global distribution of the ongoing circulating vaccine-derived
poliovirus outbreaks during January 2020 through June 2021.
Detection of cVDPV2
During January 2020–June 2021, there were 38 cVDPV2 emergences in active transmission
in 34 countries; 28 (82%) of these countries are in Africa (Table) (Figure 1). Nineteen
(50%) of the 38 emergences were previously detected during 2017–2019, three (8%) (ETH-ORO-4,
ETH-SOU-2, and NIE-SOS-7) were newly detected in 2019 but were confirmed after the
last global report, and 16 (42%) were newly detected during 2020–2021 (
1
,
3
). During the reporting period, fifteen (58%) of the 26 emergences in active transmission
in African countries were detected, either in AFP patients or through environmental
surveillance, outside of the country of first isolation of genetically linked virus
(Figure 2). No polioviruses genetically linked to two previously described emergences
(CHN-XIN-1 and ZAM-LUA-1) have been detected since 2019 (
1
,
3
).
FIGURE 2
Acute flaccid paralysis cases and environmental samples positive for circulating vaccine-derived
poliovirus type 2 associated with outbreaks ongoing during January 2020–June 2021
that involved international spread since emergence, by outbreak and country — Africa,
October 2017–June 2021 (A)*
,†and January 2019–June 2021 (B)*
,†
Abbreviations: AFP = acute flaccid paralysis; ENV = environmental samples.
* Dates (quarter and year) refer to the date of paralysis onset of AFP cases; ENV
(sewage) dates refer to date of collection. When dates are the same, symbols will
overlap; thus, not all isolates are visible. Outbreaks are illustrated for the country
where the emergence was first detected and for countries where outbreaks with genetically
linked virus were ongoing during January 2020–June 2021.
† Data as of November 9, 2021.
Figure is a diagram that shows outbreak-associated cases of acute flaccid paralysis
and environmental samples positive for circulating vaccine-derived poliovirus type
2 during October 2017-June 2021 and January 2019-June 2021 by outbreak and country.
Western Africa. The previously described cVDPV2 emergence (NIE-JIS-1) (
1
,
3
), first detected in Nigeria in 2018, continued to circulate during the reporting
period. Since first detected, genetically linked virus has circulated in 17 west and
central African countries, from Mauritania to Cameroon; during the reporting period;
circulation was documented in 16 of the 17 countries (excluding Cameroon) resulting
in 310 cases of cVDPV2 in 14 countries and detection through environmental surveillance
in 13 countries (
1
,
3
). The most recent detection of the previously described NIE-KGS-1 emergence was through
environmental surveillance in January 2020 (
1
,
3
).
During July–September 2019, the NIE-SOS-7 emergence was detected through environmental
surveillance in Nigeria; circulation was confirmed after the previous global update
(
3
). Virus genetically linked to the NIE-SOS-7 emergence was detected in specimens from
AFP patients and from one healthy child in Mali during 2020. NIE-SOS-7 was not detected
in Nigeria during 2020; however, genetically linked virus was isolated in 2021 from
specimens obtained from AFP patients and healthy children, and through environmental
surveillance. Two new cVDPV2 emergences (NIE-SOS-8 and NIE-ZAS-1) were detected and
circulated in Nigeria during the reporting period, with the most recent detections
in September 2020 and June 2021, respectively. During June 2021, NIE-ZAS-1 emergence
was detected in Niger. There was no evidence of continued circulation of any other
previously described emergences first detected in Nigeria (
1
,
3
). The previously reported TOG-SAV-1 cVDPV2 emergence circulated in Burkina Faso,
Côte d’Ivoire, and Togo during the reporting period (
3
).
Central Africa. The most recent detection of the ANG-HUI-1 emergence in Angola was
in February 2020; however, genetically linked virus was isolated from specimens collected
from AFP patients and one healthy child during late 2020 in the Republic of the Congo
(1,3). The ANG-LUA-1 emergence was most recently detected in the Democratic Republic
of the Congo and Angola in specimens from AFP patients with paralysis onset in January
and February 2020, respectively and in a healthy child in the Republic of the Congo
in October 2020 (3). The ANG-LNO-2 emergence was last detected in Angola in December
2019; the most recent isolation of genetically linked virus was in the Democratic
Republic of the Congo from specimens from an AFP patient with paralysis onset in February
2020 (
1
,
3
). No polioviruses genetically linked to two previously described emergences (ANG-LNO-1
and ANG-MOX-1) were detected during the reporting period (
1
,
3
).
The CHA-NDJ-1 emergence was first detected in Chad and then Cameroon during 2019;
genetically linked virus was detected during the reporting period in Cameroon, the
Central African Republic, Chad, Egypt, Ethiopia, South Sudan, Sudan, and Uganda (
3
). Genetically linked virus was most recently detected in Egypt and Uganda through
environmental surveillance during June 2021. This emergence resulted in 204 paralytic
cases in five of these eight countries during the reporting period.
Of the seven emergences first detected in the Central African Republic during 2019
(CAR-BAM-1, CAR-BAM-2, CAR-BER-1, CAR-BIM-1, CAR-BIM-2, CAR-BIM-3, and CAR-BNG-1),
three (CAR-BER-1, CAR-BIM-3, and CAR-BNG-1) continued to circulate and spread internationally
during the reporting period (
1
,
3
). Virus genetically linked to CAR-BER-1 was detected in Cameroon, the Central African
Republic, and the Republic of the Congo; to CAR-BIM-3 was detected in Chad; and to
CAR-BNG-1 was detected in Cameroon, the Central African Republic, the Republic of
the Congo, and the Democratic Republic of the Congo.
Two previously described emergences (DRC-KAS-1 and DRC-KAS-3) detected in the Democratic
Republic of the Congo in 2019 continued to circulate (
1
,
3
). After being first detected in 2019 in specimens from an AFP patient and healthy
children (1), the DRC-KAS-1 emergence was not detected again until early 2021 in the
Republic of the Congo in the specimens from an AFP patient. During the current reporting
period, the DRC-KAS-3 emergence resulted in 82 paralytic cases in the Democratic Republic
of the Congo, with the most recent paralysis onset in April 2021. Three new emergences
(DRC-EQT-1, DRC-MAN-2, and DRC-TPA-2) were detected during the reporting period. There
was no evidence of continued circulation of any other previously described emergences
first detected in the Democratic Republic of the Congo (
1
,
3
).
Horn of Africa. The previously described SOM-BAN-1 emergence continued to circulate
during the reporting period; genetically linked virus was detected each year during
2017–2021 in Somalia, and during 2018 and 2020–2021 in neighboring Kenya (
1
,
3
). During 2020, a new emergence (SOM-AWL-1) resulted in one case in Somalia and two
cases in Ethiopia. Three previously described cVDPV2 emergences (ETH-ORO-1, ETH-ORO-2,
and ETH-ORO-3) detected in Ethiopia in 2019 were detected during the reporting period
in Ethiopia and Somalia (
3
). Two new emergences (ETH-ORO-4 and ETH-SOU-2) were confirmed after the previous
global update (
3
) and subsequently resulted in six paralytic cases in Ethiopia. During 2020–2021,
an additional new emergence (ETH-SOU-1) that circulated in Ethiopia and South Sudan
resulted in ten paralytic cases. There have been no detections of the previously described
ETH-SOM-1 emergence since 2019 (
3
).
Afghanistan, Iran, Pakistan, and Tajikistan. Among the five previously described cVDPV2
emergences detected in 2019 in Pakistan (PAK-GB-1, PAK-GB-2, PAK-GB-3, PAK-KOH-1,
and PAK-TOR-1) only PAK-GB-1 and PAK-TOR-1 continued to be detected during the reporting
period (
3
). The latest detection of PAK-TOR-1 was in a healthy child in Pakistan in early 2020.
During the reporting period, PAK-GB-1 spread internationally resulting in a total
of 251 cases in Afghanistan and Tajikistan, and 114 cases in Pakistan. There have
been 11 environmental surveillance isolations of PAK-GB-1 in Iran, but no paralytic
cases. During the reporting period, seven cVDPV2 emergences (PAK-FSD-1, PAK-FSD-2,
PAK-KAM-1, PAK-KHI-2, PAK-LKW-1, PAK-PWR-1, and PAK-ZHB-1) were newly detected in
Pakistan resulting in 15 paralytic cases; two cVDPV2 emergences (AFG-HLD-1 and AFG-NGR-1)
were newly detected in Afghanistan during 2020 and spread to Pakistan. An additional
cVDPV2 emergence (PAK-PB-1) was first and most recently detected through environmental
surveillance in Pakistan in December 2019; confirmation of circulation occurred after
the last global report (
3
).
Malaysia and the Philippines. The most recent detection of the PHL-NCR-1 cVDPV2 emergence
in the Philippines was in January 2020 (3). The most recent detection of this emergence
globally was through environmental surveillance during February 2020 in Malaysia (
3
).
Detection of cVDPV3
The most recent isolation of the CHN-SHA-1 cVDPV3 emergence, the only cVDPV3 in transmission
during the reporting period, was through environmental surveillance in January 2021
in China (Table) (Figure 1). No paralytic cases were reported as of November 9, 2021.
Outbreak Control
As of October 31, 2021, no transmission was detected for >12 months for outbreaks
in certain countries related to three cVDPV1 and 46 cVDPV2 emergences that circulated
during 2018–2020, indicating probable interruption of transmission in those countries
(>12 months since the most recent date of paralysis onset in an AFP patient, or of
collection of environmental surveillance sample or other sample [e.g., healthy child],
positive for genetically linked virus as of October 31, 2021) (
1
,
3
,
9
) (Table) (Supplementary Table; https://stacks.cdc.gov/view/cdc/112105). In addition,
as of October 31, 2021, there have been no genetically linked isolations for 7 to
12 months, indicating possible outbreak cessation of AFG-HLD-1 in Afghanistan; TOG-SAV-1
in Burkina Faso; CHA-NDJ-1 in the Central African Republic, Chad, Ethiopia, and Sudan;
CAR-BIM-3 in Chad; CHN-SHA-1 in China; NIE-JIS-1 in Côte d’Ivoire, Mali, and Niger;
CAR-BNG-1 in the Democratic Republic of the Congo; ETH-ORO-1, ETH-ORO-3, and SOM-AWL-1
in Ethiopia; MAD-SUO-1 in Madagascar; PAK-FSD-1, PAK-KAM-1, PAK-KHI-2, PAK-LKW-1 and
PAK-ZHB-1 in Pakistan; ANG-HUI-1, ANG-LUA-1, and DRC-KAS-1 in the Republic of the
Congo; ETH-SOU-1 in South Sudan; PAK-GB-1 in Iran; SOM-BAN-1 in Kenya; and YEM-SAD-1
in Yemen (
1
,
3
).
Discussion
During January 2020–June 2021, GPEI continued to be challenged by cVDPV outbreaks,
86% of which were type 2 outbreaks affecting 28 African countries. The SOM-BAN-1,
NIE-JIS-1, and CHA-NDJ-1 cVDPV2 emergences first detected in 2017, 2018, and 2019,
respectively have continued to circulate well beyond the countries of first detection;
these and numerous other old and new emergences have cumulatively resulted in 1,293
paralytic cVDPV2 cases during the reporting period (
1
,
3
).
Disruptions in AFP and environmental surveillance, partly because of the COVID-19
pandemic, might have resulted in case undercounts and delayed cVDPV2 outbreak detection
during the reporting period (
3
,
8
,
10
). Outbreak response supplementary immunization activities were suspended during March–June
2020 (initial months of the COVID-19 pandemic) (
8
). Many outbreak response supplementary immunization activities conducted before and
after the suspension have been of poor quality, and, in many countries, there have
been delays of weeks to months in supplementary immunization activities implementation
after outbreak confirmation, all leading to lingering and geographically expanding
cVDPV2 transmission and seeding of new emergences (
1
,
3
,
8
).
A goal of the GPEI 2022–2026 Strategic Plan is to interrupt all cVDPV2 transmission
by the end of 2023 by better addressing the challenges to early outbreak detection
and effective outbreak responses (
8
). Initial nOPV2 outbreak response supplementary immunization activities, anticipated
for late 2020 after the Emergency Use Listing was announced, were delayed until March
2021 (
3
,
6
,
8
); to date approximately 100 million nOPV2 doses have been administered in seven countries
(Benin, Liberia, Niger, Nigeria, the Republic of the Congo, Sierra Leone, and Tajikistan)
(
6
). The improved genetic stability of nOPV2 over that of the Sabin vaccine strain and
its effectiveness in interrupting cVDPV2 transmission are being monitored because
this vaccine is now authorized for wider use (6). In the interim, the initiative is
confronted with multiple cVDPV2 outbreaks and limited nOPV2 supply because of manufacturing
delays resulting from the COVID-19 pandemic and larger than anticipated nOPV2 consumption
(6). Therefore, the recommendation from the Strategic Advisory Group of Experts on
Immunization,
¶
WHO Director-General’s Emergency Committee for the International Health Regulations
regarding the spread of poliovirus as a Public Health Emergency of International Concern
(9), and the GPEI Independent Monitoring Board** is that countries should initiate
rapid outbreak response with available type 2 OPV, whether that is Sabin or the novel
vaccine (6).
Summary
What is already known about this topic?
Circulating vaccine-derived polioviruses (cVDPVs) can emerge in settings with low
poliovirus population immunity and cause paralysis.
What is added by this report?
During January 2020–June 2021, 44 cVDPV outbreaks were ongoing, resulting in 1,335
paralytic cases; 38 (86%) were cVDPV type 2 (cVDPV2). Initial use of novel type 2
oral poliovirus vaccine (OPV), modified to be more genetically stable than Sabin strain
poliovirus, began in March 2021 for cVDPV2 outbreak responses; current supplies are
limited.
What are the implications for public health practice?
A goal of the Global Polio Eradication Initiative’s 2022–2026 Strategic Plan is to
better address the challenges to early cVDPV2 outbreak detection and initiate prompt
and high coverage outbreak responses with available type 2 OPV to interrupt transmission
by the end of 2023.