Document Type

Journal Article

Date of this Version



Suggested Citation:
Nathanson, N. and Kew, O.M. (2010). FromEmergence to Eradication: The Epidemiology of Poliomyelitis Deconstructed. American Journal of Epidemiology. Voo. 172(11). p. 1213-1229

Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health.
DOI: 10.1093/aje/kwq320


Poliomyelitis has appeared in epidemic form, become endemic on a global scale, and been reduced to nearelimination, all within the span of documented medical history. Epidemics of the disease appeared in the late 19th century in many European countries and North America, following which polio became a global disease with annual epidemics. During the period of its epidemicity, 1900–1950, the age distribution of poliomyelitis cases increased gradually. Beginning in 1955, the creation of poliovirus vaccines led to a stepwise reduction in poliomyelitis, culminating in the unpredicted elimination of wild polioviruses in the United States by 1972. Global expansion of polio immunization resulted in a reduction of paralytic disease from an estimated annual prevaccine level of at least 600,000 cases to fewer than 1,000 cases in 2000. Indigenous wild type 2 poliovirus was eradicated in 1999, but unbroken localized circulation of poliovirus types 1 and 3 continues in 4 countries in Asia and Africa. Current challenges to the final eradication of paralytic poliomyelitis include the continued transmission of wild polioviruses in endemic reservoirs, reinfection of polio-free areas, outbreaks due to circulating vaccine-derived polioviruses, and persistent excretion of vaccine-derived poliovirus by a few vaccinees with B-cell immunodeficiencies. Beyond the current efforts to eradicate the last remaining wild polioviruses, global eradication efforts must safely navigate through an unprecedented series of endgame challenges to assure the permanent cessation of all human poliovirus infections.


epidemiology, history of medicine, poliomyelitis, poliovirus, vaccines



Date Posted: 28 September 2011

This document has been peer reviewed.