Mass Vaccination with Oral Poliovirus Vaccine -- Asia and Europe, 1995

The theme of World Health Day, April 7, 1995, is "Target 2000- -A World Without Polio" (1). In conjunction with World Health Day activities, 18 geographically contiguous countries in Europe, Central and South Asia, and the Middle East are conducting coordinated National Immunization Days (NIDs) * with oral poliovirus vaccine (OPV) Figure_1. The World Health Organization (WHO) has designated this effort "Operation MECACAR" (MEditerranean, CAucasus, and Central Asian Republics). This report describes the efforts of this campaign and summarizes polio surveillance data for 1994.

To maximize the geographic area covered and the number of children targeted simultaneously for mass vaccination with OPV, Operation MECACAR has been committed to by adjoining countries in Europe (Armenia, Azerbaijan, Bulgaria, Georgia, and Turkey), Central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan), South Asia (Pakistan), and the Middle East (Afghanistan, Iran, Iraq, Jordan, Lebanon, Syria, and one national identity {Palestine ** }). Approximately 56 million children aged less than 5 years have been targeted to receive two doses each of OPV Table_1. Efforts have been planned and will be coordinated under the direction of both the European Regional Office (EURO) and the Eastern Mediterranean Regional Office (EMRO) of WHO.

Participating countries in each region have provisionally reported a high proportion of the total polio cases in their respective regions in 1994. In EURO, participating countries reported 200 (95%) of the 211 cases reported in the region, including Uzbekistan with 117 cases; Tajikistan, 28; Turkey, 23; Azerbaijan, 17; Turkmenistan, six; Armenia, five; and Kazakhstan, four. Participating countries in EMRO reported 669 (69%) of the 973 cases reported in the region, including Pakistan with 520; Iran, 80; Iraq, 63; Jordan, four; and Lebanon, two.

Some of the countries in these regions previously have conducted NIDs, including Azerbaijan (1993 and 1994), Lebanon (1994), Iran (1994), Syria (1993 and 1994), Pakistan (1994), and Uzbekistan (1994), while others conducted subnational immunization days. Based on the desirability of scheduling mass vaccination campaigns simultaneously and during the low polio incidence season, either the first round (EURO) or the second round (EMRO) of NIDs has been scheduled during March 24-April 29. Countries participating in Operation MECACAR are planning to repeat NIDs in 1996 and 1997. Reported by: Regional Office for Europe, Copenhagen; Regional Office for Eastern Mediterranean Region, Alexandria, Egypt; Global Program for Vaccines and Immunization, World Health Organization, Geneva. Respiratory and Enterovirus Br, National Center for Infectious Diseases; International Health Program Office; Polio Eradication Activity, National Immunization Program, CDC.

Editorial Note

Editorial Note: Since 1988, when the World Health Assembly (the governing body of WHO) adopted the goal of global polio eradication by the year 2000 (2), substantial progress has been made toward this goal. In particular, during 1994 the Western Hemisphere was certified free of wild poliovirus by an international certification commission (3). From 1988 through 1994, reported polio declined 82%, with particular progress in the Western Pacific Region of WHO, including China (4), Philippines (5), and Vietnam (6); polio-free zones are emerging in Western Europe, Southern and Northern Africa, and the Arabian Peninsula (7).

The coordinated effort to vaccinate approximately 56 million children aged less than 5 years in 18 countries represents one of the largest public health events in history (4,8). Operation MECACAR will entail cooperation between countries with dramatically different political systems, economic organization, cultures, and religions. In particular, efforts include negotiations to curtail hostilities and, in countries with internal conflict or civil wars, to secure cease-fires during the vaccination campaigns. To ensure the success of previous NIDs, similar arrangements had been mediated in countries of the Americas (9) and in Philippines (5). Reported polio incidence in the European Region stabilized during the 1990s with approximately 200 cases reported each year. Consequently, further reductions in polio incidence and the elimination of poliovirus from the remaining polio-endemic countries will require supplementary vaccination activities, including NIDs. In the Eastern Mediterranean Region, substantial decreases in polio incidence have been achieved since 1988; however, approximately 2500 cases of polio were reported in 1993, and approximately 1000 cases were provisionally reported in 1994. Synchronized NIDs, if effectively implemented (i.e., vaccination of greater than 90% of the target population) and repeated as planned in 1996 and 1997, should decrease the incidence of polio substantially in these countries.

The technical basis for achieving worldwide polio eradication already exists; persistent impediments to the eradication objective for the year 2000 include insufficient political will and inadequate resources. Operation MECACAR is supported by a coalition of organizations that includes WHO, United Nations Children's Fund (UNICEF), other bilateral and multilateral organizations, and Rotary International, which provided the funds for the OPV vaccine needed by member countries of the European Region to conduct NIDs in 1995.

References

1. CDC. World Health Day -- April 7, 1995. MMWR 1995;44:233.

2. World Health Assembly. Global eradication of poliomyelitis by the year 2000. Geneva: World Health Organization, 1988. (Resolution WHA41.28).

3. CDC. Certification of poliomyelitis eradication -- the Americas, 1994. MMWR 1994;43:720-2.

4. CDC. Progress toward poliomyelitis eradication -- People's Republic of China, 1990-1994. MMWR 1994;43:857-9.

5. CDC. National immunization days and status of poliomyelitis eradication -- Philippines, 1993. MMWR 1994;43:6-7,13.

6. CDC. Progress toward poliomyelitis eradication -- Socialist Republic of Vietnam, 1991-1993. MMWR 1994;43:387-91.

7. CDC. Progress toward global eradication of poliomyelitis, 1988- 1991. MMWR 1993;42: 486-7,493-5.

8. Pan American Health Organization. Measles elimination by the year 2000. EPI Newsletter 1994;6:1-2.

9. deQuadros CA, Andrus JK, Olive JM, de Macedo CG. Polio eradication from the Western hemisphere. Ann Rev Public Health 1992;13:239-52.

* Mass campaigns over a short period (days to weeks) in which two doses of oral poliovirus vaccine are administered to all children in the target group, regardless of prior vaccination history, with an interval of 4-6 weeks between doses. 

** Includes the territories of Gaza, Jericho, and the West Bank.

TABLE 1. Features of the coordinated National Immunization Days
(NIDs) -- Operation MECACAR, 1995
========================================================================
                                    World Health Organization regions
                                    ------------------------------------
Feature                              EURO *       EMRO +      Total
------------------------------------------------------------------------
No. participating countries           10            8          18
Target population aged <5 years
  (millions)                          18           38          56
Doses of oral poliovirus vaccine
  required (millions)                 45           95         140
Months of NIDs (no. countries@)
  March                                1            5           6
  April                               10            7          17
  May                                  9            4          13
------------------------------------------------------------------------
* European Region (includes Armenia, Azerbaijan, Bulgaria,
  Georgia, Kazakhstan,
  Kyrgyzstan, Tajikistan, Turkey, Turkmenistan, and Uzbekistan).
+ Eastern Mediterranean Region (includes Afghanistan, Iran, Iraq,
  Jordan,
  Lebanon, Pakistan, Syria, and one national identity {Palestine,
  which
  includes the territories of Gaza, Jericho, and the West Bank}).
@ Each country has two scheduled rounds of NIDs.
========================================================================

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