Re-emergence and Control of Circulating Vaccine-Derived Poliovirus Type 2 in Post-Elimination Indonesia, 2014-2025: A Public Health Case Report
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Abstract
Indonesia was certified free of wild poliovirus transmission in 2014, yet persistent immunity gaps and disruption of routine childhood vaccination created conditions for poliovirus re-emergence. This public health case report describes the epidemiological course and control of circulating vaccine-derived poliovirus type 2 in Indonesia from 2014 to 2025. The source report identified an index event in Pidie District, Aceh, in October 2022 involving a 7-year-old boy with fever followed by acute left-leg paralysis; reverse-transcription polymerase chain reaction subsequently confirmed poliovirus type 2. By June 2024, the report recorded 33 confirmed cases across seven provinces. Acute flaccid paralysis surveillance, environmental surveillance, and outbreak response assessments were used to evaluate transmission. The national response combined large-scale supplementary immunization with novel oral poliovirus vaccine type 2, integration of a second inactivated poliovirus vaccine dose, strengthened surveillance, and community mobilization. Approximately 60 million supplementary vaccine doses were delivered, no new case was reported after 27 June 2024, and the outbreak was declared closed on 19 November 2025. This experience shows that polio-free certification is not self-sustaining. Durable protection requires uniformly high vaccination coverage, rapid detection, reliable vaccine logistics, improved sanitation, equitable access to health services, and sustained public trust in immunization.
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