In Reply: Mr Steinglass correctly points out that we could not explore the full complexity of global polio eradication in our article. Regular, detailed updates are available on the Internet1 and from weekly publications.2,3 The cause of all remaining poliovirus circulation worldwide is insufficient population immunity, usually the consequence of low rates of OPV coverage. In northern Nigeria, failure to vaccinate is the reason for continuing poliovirus circulation. Up to 60% of children in certain high-risk states (eg, Kano) have received 3 or fewer doses of OPV despite numerous opportunities either through routine immunization or the many rounds of supplemental immunization activities (SIAs).2 This large-scale failure to vaccinate is unique among the remaining endemic areas of the world.
Cochi SL, Kew O. Global Eradication of Polio—Reply. JAMA. 2009;301(2):161-162. doi:10.1001/jama.2008.914