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INIZIO_TESTO_DA_INDICIZZARE

RESEARCH PROGRAM

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Research Units
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Keywords
POLIOMYELITIS; ERADICATION; SURVEILLANCE; VACCINATION; WILD POLIOVIRUS; SABIN LIKE; VDPV; SEWAGES; CARRIER

NEED OF VIROLOGICAL AND SEROLOGTICAL SURVEILLANCE OF THE ITALIAN POPULATION DURING THE FINAL STEPS OF WORLDWIDE ERADICATION OF POLIOMYELITIS

Università degli Studi di Roma "La Sapienza"
Abstract
The WHO Polio Eradication Strategic Plan 2004-2008 revises timeframe for certification of eradication and outlines the key polio eradication activities: 1) Interruption of Poliovirus Transmission Phase (2005-2006?); 2) Global Certification and Mainstreaming Phase (2006-2008); OPV Cessation Phase (from 2009). The major issue is the rapid interruption of polio transmission in Nigeria, India, Pakistan, Niger, Afghanistan and Egypt. While in endemic areas the priority is to ensure NIDs and sNIDs, in polio free areas the emergency could be represented by wild poliovirus importation and/or circulating VDPVs. Today, the emergency regards the countries bordering Nigeria: in Africa the emergency is due to the fact that the imported strain begins to circulate in countries where the routine coverage of vaccination is low. The recent cases in Saudi Arabia and Ethiopia show that nobody can feel safe, even after years of wild polio strain absence The globalization of tourism and migrations can represent a risk of reintroducing wild poliovirus or OPV or cVDPV into polio free countries, Italy included, where, starting 2002, children are vaccinated with IPV to eliminate the OPV paradox. The only concern is the absence of mucosal immunity that could permit again poliovirus circulation. Actually, the Italian situation can be considered optimal: no polio cases, no VAPP, good vaccination coverage, but in the same time Italy is a high risk country for the reason just illustrated. If the risk of >>>

Principal Investigator
Gaetano Mario Luigi FARA Università degli Studi di ROMA "La Sapienza"
Research Objectives
The present study is a public health surveillance, and as such it deserves standardized methods, so that results can be compared at national and international level. Some modiications have been introduced but always in comparison with the standard methods, and an international comparison is compuolsory before adoption. The study is to be performed in two steps: phase 1 (18 months): organization of the survey, enrollment of the children, environmental sampling and analysis performance. Phase 2 includes statistical analysis of the results, interpretation and preparation of the report.
The enclosed scheme reports the distrribution of the work to the different units and the level of integration among them.
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The goals of the present project are:
1. the surveillance of italian children aged 0-14 y;
2. the virological surveillance of Sabin-like virus or VDPV in healthy children (0-14 y old): stool survey
3. the virological survey in the environment (sewage and/or surface waters), 3 years after OPV vaccination interruption.
4. The virological and serological surveillance of foreign children of recent adoption by Italian families
Goal 1: the last national serological survey performed in 2000-2001 has involved 10054 subjects aged 0-40 (2571 children 0-15; 7483 people 17-40) enrollede through all the italian regions. Results have shown a protection of 93.1% >>>

Timescale
24 months
National and international background
By bike or just walking, an army of 28,000 volunteers rushes through cities and villages of Ivory Coast with the goal of vaccinating ALL the children. The same scene takes place in at least 17 more countries of Africa, 3 of which are endemic and 14 more are suffering again from paralytic poliomyelitis due to the reintroduction of wild polioviruses. In Africa is "red" emergency: after 18 years of hard work, the expected final phase of polio eradication is apparently ranning away. But says David Heyman - in charge for WHO of polio eradication project - we are not allowed to be pessimistic, we must be convinced that al last the poliovirus will be wiped off by 2005, or we are condemned to a definite failure.
Poliomyelitis is an infectious disease caused by any one of three related enteroviruses: poliovirus types 1, 2, or 3. It can strike at any age, but, in more than 50% of all cases, affects children under 3. The disease causes paralysis, which is almost always permanent as the virus destroys motor neurons. The leg muscles are affected more often than the arm's. The limb becomes floppy and lifeless - a condition known as Acute Flaccid Paralysis (AFP). More extensive paralysis can result in quadriplegia. In the most severe cases (bulbar polio), poliovirus attacks the motor neurons of the brain stem - reducing breathing capacity and causing difficulty in swallowing and speaking. Without respiratory support, bulbar polio can result in death. Polio has probably caused >>>