title: Certification of poliomyelitis eradication in Singapore and the challenges ahead.
abstract: BACKGROUND
  This study reviewed the epidemiological trends of poliomyelitis from 1946 to 2010, and the impact of the national immunisation programme in raising the population herd immunity against poliovirus. We also traced the efforts Singapore has made to achieve certification of poliomyelitis eradication by the World Health Organisation.
  
  
  METHODS
  Epidemiological data on all reported cases of poliomyelitis were obtained from the Communicable Diseases Division of the Ministry of Health as well as historical records. Coverage of the childhood immunisation programme against poliomyelitis was based on the immunisation data maintained by the National Immunisation Registry, Health Promotion Board. To assess the herd immunity of the population against poliovirus, 6 serological surveys were conducted in 1962, 1978, 1982 to 1984, 1989, 1993 and from 2008 to 2010.
  
  
  RESULTS
  Singapore was among the fi rst countries in the world to introduce live oral poliovirus vaccine (OPV) on a mass scale in 1958. With the comprehensive coverage of the national childhood immunisation programme, the incidence of paralytic poliomyelitis declined from 74 cases in 1963 to 5 cases from 1971 to 1973. The immunisation coverage for infants, preschool and primary school children has been maintained at 92% to 97% over the past decade. No indigenous poliomyelitis case had been reported since 1978 and all cases reported subsequently were imported.
  
  
  CONCLUSIONS
  Singapore was certified poliomyelitis free along with the rest of the Western Pacific Region in 2000 after fulfilling all criteria for poliomyelitis eradication, including the establishment of a robust acute flaccid paralysis surveillance system. However, post-certification challenges remain, with the risk of wild poliovirus importation. Furthermore, it is timely to consider the replacement of OPV with the inactivated poliovirus vaccine in Singapore's national immunisation programme given the risk of vaccine-associated paralytic poliomyelitis and circulating vaccine-derived polioviruses.
authors.affiliation: Health Regulation Group, Ministry of Health, Singapore. lee_hwee_ching@moh.gov.sg
authors.forename: Hwee Ching
authors.initials: HC
authors.lastname: Lee
authors.forename: Joanne
authors.initials: J
authors.lastname: Tay
authors.forename: Cynthia Y H
authors.initials: CY
authors.lastname: Kwok
authors.forename: Moi Kim
authors.initials: MK
authors.lastname: Wee
authors.forename: Li Wei
authors.initials: LW
authors.lastname: Ang
authors.forename: Yuske
authors.initials: Y
authors.lastname: Kita
authors.forename: Jeffery L
authors.initials: JL
authors.lastname: Cutter
authors.forename: Kwai Peng
authors.initials: KP
authors.lastname: Chan
authors.forename: Suok Kai
authors.initials: SK
authors.lastname: Chew
authors.forename: Kee Tai
authors.initials: KT
authors.lastname: Goh
mesh_terms: D000293:Adolescent; D002568:Certification; D002648:Child; D002675:Child, Preschool; D060740:Disease Eradication / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011051:Poliomyelitis / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology; D017955:Poliovirus / Q000276:immunology; D012846:Singapore / Q000453:epidemiology