National Poliomyelitis Immunization Days -- People's Republic of
China, 1993
In 1988, the World Health Organization (WHO) established the
goal of global eradication of poliomyelitis by the year 2000 (1).
Based on cases officially reported to WHO, progress toward
eradication has been substantial: in 1992, a total of 15,445
paralytic poliomyelitis cases were reported worldwide, compared
with 32,419 cases in 1988. Beginning in December 1993, the People's
Republic of China will conduct a series of two National
Immunization Days that target approximately 100 million children
(all children aged less than 4 years) to receive oral poliovirus
vaccine (OPV) in each of two separate rounds of vaccination,
possibly representing the largest public health event of its kind
in history. This report summarizes the plans for National
Immunization Days and efforts in China to eradicate poliomyelitis
by 1995.
Because of the large population in China (approximately 21% of
the world's population) and the proportion of worldwide
poliomyelitis cases occurring in China, this vaccination initiative
is crucial to the global eradication effort. In 1990, of the 21,627
total poliomyelitis cases reported to WHO, 5065 (23.4%) occurred in
China; in 1992, however, the number reported by China decreased to
1191 (7.7%) of 15,445 total cases. The absolute and relative
decreases in poliomyelitis in China have been associated with
initiation of supplementary vaccination activities by an increasing
number of provincial health departments. These activities have been
conducted in addition to routine vaccination of children with three
doses of OPV at ages 2, 3, and 4 months.
Supplemental vaccination activities in China have included
administering one or two extra doses of OPV to young children
(generally those aged less than 4 years) at 1-2-month intervals
during the low-incidence season for poliomyelitis (i.e., December-
April). The number of provinces conducting the WHO-recommended two
rounds of supplemental vaccination activities during low-incidence
season increased from six of 30 during 1991-92 to 25 provinces
during 1992-93. As a consequence, the number of supplemental doses
of OPV administered during the low-incidence season increased from
71 million during 1990-91 to 186 million during 1992-93
(Figure_1).
During January-August 1993, 348 poliomyelitis cases were reported
through the notifiable diseases reporting system, compared with 877
cases during January-August 1992; in addition, there was no
characteristic summertime seasonal increase in reported cases
during 1993 (Figure_2).
Although reported cases of poliomyelitis in 1993 have occurred
throughout China, a high proportion have been reported from
southern provinces. Of the 348 cases reported through August 1993,
107 (31%) were from one southern province (Guangdong); in addition,
231 (66%) have been reported from six southern provinces (Fujian,
Guangdong, Guangxi, Guizhou, Hainan, and Jiangxi), which comprise
19% of the population of China.
Reported by: B Yang, MD, Div of Expanded Program on Immunization,
Z Dai, MD, Z Wang, MD, Dept of Health and Epidemic Prevention,
Ministry of Public Health; K Wang, MD, R Zhang, MD, J Zhang, MD, T
Jiang, MD, Chinese Academy of Preventive Medicine, Beijing,
People's Republic of China. Expanded Program on Immunization Unit,
Western Pacific Regional Office, World Health Organization, Manila,
Philippines. Div of Viral and Rickettsial Diseases, National Center
for Infectious Diseases; Polio Eradication Activity, National
Immunization Program, CDC.
Editorial Note
Editorial Note: The plan for implementing National Immunization
Days in China has been based on three factors: 1) the success of
the provincial supplemental vaccination activities, 2) concerns
about the potential accumulation of susceptible children since the
nationwide poliomyelitis outbreak during 1989-1990 (Figure_1)
in
parts of China still not adequately covered by previous provincial
supplemental vaccination activities, and 3) the goal of eradicating
poliomyelitis from the Western Pacific Region (WPR) of WHO by 1995.
China and other member countries in the WPR have committed to
eradicate poliomyelitis by 1995. Only five of the 29 countries in
the region (Cambodia, China, the Lao People's Democratic Republic,
Philippines, and Vietnam) continue to report endemic poliomyelitis-
-of the 1908 cases that occurred in this region during 1992, 1191
(62%) were reported from China.
The apparent elimination of wild poliovirus infections in the
Americas and the substantial progress already achieved in the WPR
underscore the feasibility of achieving this goal in WPR and other
regions of the world (2-4). The successful implementation of
National Immunization Days will assist WHO and member countries in
global application of the strategies for eradication as recommended
by WHO. Additional National Immunization Days in China are planned
for 1994-95 and 1995-96. The success of such public health efforts
is dependent on the support and collaboration of organizations from
the public and private sectors including, for example, the Ministry
of Public Health, health departments in each of the Chinese
provinces, Rotary International, the Japanese International
Cooperation Agency, WHO, and the United Nations Children's Fund
(UNICEF).
References
World Health Assembly. Global eradication of poliomyelitis by
the year 2000. Geneva: World Health Organization, 1988. (Resolution
WHA41.28).
CDC. Update: eradication of paralytic poliomyelitis in the
Americas. MMWR 1992;41:681-3.
CDC. Update: polio eradication -- the Americas, 1993. MMWR
1993;42:685-6.
Foege WH. A world without polio. JAMA 1993;270:1859-60.
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