The global eradication of poliomyelitis will require substantial changes in immunization practices. One of the proposed scenarios includes cessation of vaccination with live oral poliovirus vaccine (OPV) and the creation of an OPV stockpile for emergency response in case of the reintroduction of poliovirus into circulation. We describe here a retrospective analysis of the cessation of OPV usage in a region of the Byelorussian Republic of the former Soviet Union in 1963 to 1966. During this period, a widespread circulation and evolution of independent lineages of vaccine-derived polioviruses took place in the region. Some of these lineages appeared to originate from OPV given to 40 children in the community during this period of essentially no vaccinations. The data demonstrate very high risks associated with both the local cessation of OPV vaccination and the proposed use of OPV to control a possible reemergence of poliovirus in the postvaccination period. The high transmissibility of OPV-derived viruses in nonimmune population, documented here, and the known existence of long-term OPV excretors should be also considered in assessing risks of the synchronized global cessation of OPV usage.The remarkable success of the Program for Global Eradication of Poliomyelitis, which has resulted in a Ͼ99% reduction of the incidence of paralytic poliomyelitis and an immense decrease in the circulation of wild polioviruses, mandates the formulation of an optimal strategy for the "endgame" (8,19,27,30) that must include both vaccination policy and emergency response measures. Among the options under consideration is the complete and coordinated cessation of vaccination with the live oral poliovirus vaccine from Sabin strains (OPV [currently the most widely used type of polio vaccine]) soon after the world is certified free from circulating wild polioviruses (32). Major advantages of this strategy are obvious: it would prevent cases of vaccine-associated paralytic poliomyelitis, which occur at a rate of one case per ϳ10 6 of the first doses of the vaccine distributed (32), and would save substantial financial and other resources that could be redirected toward solving other important public health problems. On the other hand, stopping vaccination will inevitably result in a dramatic growth in the nonimmune population and create an opportunity for a rapid spread of poliovirus should it ever be unintentionally or purposefully reintroduced into the population. This risk can only be assessed in large-scale experiments that are ethically unacceptable. However, important lessons can be learned from certain past epidemiological situations, which may be regarded as possible scenarios for the future. We describe here a retrospective analysis of such a situation.
MATERIALS AND METHODSVirus isolation and preliminary characterization. For virus isolation, HeLa cells or primary cultures of human embryonic cells were used. Restriction fragment length polymorphism analysis was performed as described previously (15).DNA oligonucleotide microa...