Poliomyelitis in the USA: virtual elimination of disease caused by wild virus.

The average number of paralytic poliomyelitis cases per year in the United States has fallen from 16 000 just before vaccine was introduced in the 1950s to only 12 in 1978-83. 18 of the 69 cases (26%) reported in this 6-year period were not vaccine associated according to the epidemiological classification of paralytic poliomyelitis cases, established in 1975. The van Wezel antigenic differentiation test and oligonucleotide fingerprinting provide a laboratory basis for definitive characterisation of wild and vaccine-like poliovirus strains. Of the 69 cases, isolates from 42 have been analysed; 31 were vaccine-like poliovirus and 11 wild poliovirus. 7 of the wild poliovirus isolates are from cases in a 1979 outbreak caused by poliovirus imported from the Netherlands through Canada; 1 is from a single importation; and 3 are from isolated cases with no identified source. No indigenous wild strain has been isolated from any reported poliomyelitis case since 1981, when a wild strain was isolated from an immunodeficient individual.