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Poliomyelitis outbreak in Israel in 1988: a report with two commentaries
P E Slater1, W A Orenstein, A Morag
1Department of Epidemiology, Ministry of Health, Jerusalem, Israel.
Lancet (London, England)
|May 19, 1990
Summary
A 1988 polio outbreak in Israel led to mass vaccinations. Experts debated whether enhanced inactivated poliovaccine (eIPV) or a combined eIPV and oral poliovaccine (OPV) strategy was best for future polio prevention.
Area of Science:
- Epidemiology
- Vaccinology
- Public Health
Background:
- A 1988 paralytic poliomyelitis outbreak occurred in Israel, primarily in the Hadera subdistrict.
- This region had exclusively used enhanced inactivated poliovaccine (eIPV) for infants since 1982.
- Nine of the 15 cases were adults aged 15+, with many previously vaccinated with oral poliovaccine (OPV).
Purpose of the Study:
- To investigate the causes of the type 1 poliovirus outbreak in Israel.
- To evaluate the effectiveness of different poliovaccine strategies in controlling the outbreak.
- To inform future polio vaccination policies in Israel.
Main Methods:
- Analysis of outbreak cases, vaccination histories, and geographic distribution.
- Comparison of seropositivity and antibody titers between vaccine strains and the epidemic strain.
- Epidemiological investigation into potential transmission routes, including sewage and social contact.
Main Results:
- The outbreak involved 15 cases of paralytic poliomyelitis due to type 1 poliovirus.
- A significant number of cases occurred in individuals previously vaccinated with OPV or in young adults.
- Disagreement among researchers regarding the primary causative factors and optimal vaccination approach.
Conclusions:
- One group suggested a combined eIPV and OPV vaccination program for Israel, citing susceptibility in OPV-vaccinated adults and potential low gut immunity in eIPV-vaccinated children.
- Another group favored eIPV alone, attributing the outbreak to environmental exposure, a distinct epidemic strain, and lower antibody responses to this strain compared to vaccine strains.
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