Oral poliovirus vaccine in tropical Africa: greater impact on incidence of paralytic disease than expected from coverage surveys and seroconversion rates

During the first 5 years of a poliomyelitis control programme in Yaounde, Cameroon, a maximum of 35% of children aged 12-23 months were estimated to have received three doses of trivalent oral vaccine. Despite this low immunization coverage and low seroconversion rates, which were determined concurrently, the estimated incidence of paralytic poliomyelitis decreased by 85%.A detailed study of immunized children and of children living in the same households suggests that community spread of the vaccine virus and cross-immunity may have partly been responsible for the dramatic decrease in the incidence of paralytic disease, and that competing non-polio enterovirus infection was not a cause for the low seroconversion rates. These results suggest that immunization coverage and seroconversion rates alone are not sufficient criteria for determining the effectiveness of control programmes that use oral poliovirus vaccine in tropical Africa; surveillance of the incidence of paralytic disease must also be carried out.