The ten-years experience of acute flaccid paralysis (AFP) surveillance in Belarus has been summarized. Among 456 AFP cases reported from 1996 to 2005, 11 were classified as vaccine-associated paralytic poliomyelitis (VAPP), 445--as non-polio AFP. The risk of VAPP for the period 1996-2001 was 1 case per 745,000 used doses of oral poliovaccine (OPV). For the recipients of OPV the risk was 1 case per 911,700 doses and for the first-dose recipients--1 case per 96,000 doses. The high incidence of VAPP was a reason for implementation of sequential polio vaccination schedule in 2000. Guillain-Barre syndrome dominated among non-polio AFP (39.3% of cases); more rare were traumatic neuritis (27.9% of cases), transient monoparalysis (12.1%), myelitis (7.6%). Non-polio AFP differed from VAPP by following epidemiological and virological characteristics: predominance of previously repeatedly vaccinated against poliomyelitis; development of paralysis in long-term period after vaccination; isolation of non-polio viruses belonged to three serotypes of Coxsackie B viruses (B1, B4, B6) and six serotypes of Echo viruses (6, 7, 11, 14, 24, 25) in 8.1% of cases; absence of typical for polio residual paralyses in patients who excreted vaccine polioviruses.

A total of 135 polioviruses (PV), including 25 wild and 110 vaccine-related, isolated in Belarus in 1957-1999 were studied by the analysis of the polymorphism of the restriction fragments lengths of two distal regions of the genome: the region (480 oligonucleotide pairs) coding the N-terminal fragment of capsid protein VP1 (RLFP-1) and the region (291 oligonucleotide pairs) coding the N-terminal fragment of nonstructural protein of 3D-polymerase (RLFP-3D1). The genetic analysis of the viruses made it possible to determine 3 epidemiologically different periods of PV circulation:(1) the prevaccination period (1957-1959) when wild PV of all 3 serotypes circulated on the territory of Belarus;(2) the early period of the use of Oral Poliomielytis Vaccine (1960-1966), characterized by simultaneous circulation of wild and vaccine PV, as well as vaccine/wild recombinant PV;(3) the period of the elimination of wild PV of indigenous origin and the circulation of vaccine-related viruses (1967-1999). The characteristic feature of wild PV was their pronounced genetic variability. 8 genetic variants of PV1, including 4 genetic groups, 2 genetic variants of PV2 and 1 genetic variant of PV3 were detected; 2 vaccine/wild recombinant PV were detected in 1960 and 1966. More than 40% of the vaccine-related PV under study had altered genetic characteristics (mutations and/or recombinations. Reverse variability, linked with the loss of a number of signs of attenuation, was shown to be characteristic of vaccine PV1. Recombinants occurred most frequently among PV3 (44.9%) and PV2 (40.0%), their recombinations being formed mainly with PV1. Recombinants PV2/PV1 and PV3/PV1 were found to have high frequency of reversion in the "PV1" fragment of the genome; this frequency exceeded that in PV1 with the homotypical genome (66.7 and 44.4% in contrast to 12.5%).

The frequency of vaccine poliovirus isolation from children aged under 3 years was studied in Belarus, a country with a high level of immunization against poliomyelitis. Antigenic and genetic characteristics of the isolated strains were studied. Vaccine poliovirus detection rate was high (11.8%). Polioviruses were isolated from children immunized recently (27.2%), immunized more than 2 months before (7.5%), and from non-immunized children (9.8%). An appreciable number (36.1%) of the isolated strains were antigenically and/or genetically modified derivatives of Sabin virus. Epidemiological data and genetic characteristics of the isolated polioviruses indicate that some of them can be sufficiently transmissive for maintaining their "silent" circulation even in a population with a high level of immunization.

Specific humoral immunity, total immune status and typing of HLA antigens, class 1, in loci A and B were studied in children with vaccine-associated paralytic poliomyelitis (VAPP). The immune status investigation revealed that changes in the content of serum immunoglobulins were most frequent. Out of 8 examined children, 5 children had IgA deficiency and 1 child had total variable immunodeficiency. In one case disturbances in cell-mediated immunity prevailed. Tissue typing revealed the presence of HLA A2 and B44 in 5 out of 6 examined children, which considerably exceeded their average occurrence among the Belorussian population. In spite of frequent detection of immunological disturbances in VAPP patients, out of 38 serologically examined children 36 (95%) were found to have virus-neutralizing serum antibodies to poliovirus, which was indicative of the capacity of their immune system for response to the administration of vaccine virus. To minimize the risk of VAPP in children and to achieve the goal of poliomyelitis eradication the combined immunization scheme consisting of 1-3 vaccinations with inactivated poliovaccine with subsequent administration of oral vaccine prepared from attenuated Sabin viruses is regarded as most promising.

One hundred and eight vaccine-derived strains of types 1, 2, and 3 poliovirus (25 PV1, 34 PV2, and 48 PV3) isolated in Belarus in 1960-1999 were analyzed by double restriction fragment length polymorphism assay (RFLP-1,-3D1). Forty-four (40.7%) of strains were genetically modified. Eight (7.4%) PV were modified by mutation, 16 (14.8%) by recombination, and 20 (18.5%) by both mutation and recombination. The genomes of 16 PV were analyzed by multiple RFLP technique covering VP1-, VP1/VP2A-, P2-, 3AC-, and 3D1-coding regions. The majority of recombinants were "simple"(with one crossing over site). One strain was "double" recombinant (two crossings over sites) and one more "multiple" recombinant (three crossing over sites). Partial nucleotide sequencing of some recombinant strains showed that the degree of these strains' divergence was less than 1% in comparison with the original vaccine viruses.

The outbreak of diphtheria in the Republic of Belarus developed in the presence of a sharp deficiency of immunity among the population aged 35 years and over. In connection with a higher initial immunity level resulting from vaccination made in one injection the minimum antibody level (> or = 0.01 I.U./ml) was found in 79.7% of the examinees among the population under 35 years. For the age group of 35-60 years vaccination in one and two injections proved to be insufficiently effective (the minimum protective antibody titer was found, respectively, in 64.3% and 63.3% of the vaccinees). To achieve the full protection of this group of the population, vaccination in three injections was necessary; after that the minimum protective antibody titer was found in 90.7%, the protective antibody titer (0.1 I.U./ml) was found in 53.5% and the highly protective antibody titer (1.0 I.U./ml) was found in 11.6% of the examinees. The low level of highly protected persons among vaccinees receiving three injections was due to a low dose of diphtheria toxoid (2 Lf) in adsorbed DT-m vaccine with reduced antigen content.

In 1996 the immunization of children against measles, mumps and rubella with combined vaccine Trimovax ("Pasteur Mérieux Connaught", France) was carried out in the Republic of Belarus. The reactogenicity of the vaccine was studied in 372 children. To evaluate immunological effectiveness, the sera of 324 children were used. Postvaccinal reactions of different intensity were registered in 5.6% of the children; of these, 1.3% exhibited severe reactions. Among the vaccinees, protective titers of antibodies to measles were found in 97.6% to mumps, in 93.8% and to rubella, in 96.0% of the children. Antibodies to all three components of the vaccine were present mainly in high and moderate titers. The results thus obtained indicate that, Trimovax was well tolerated and proved to be immunologically active.

The results of the study of epidemic poliomyelitis in Byelorussia in 1981-1978 are presented. Two consecutive phases of the epidemic process were established: the suppression of the infection and its elimination. In the suppression phase sporadic cases of poliomyelitis still persisted, due to reduced circulation of wild polioviruses. In the elimination phase no wild polioviruses were isolated and no cases of the disease occurred.

The revaccination of 70% of schoolchildren, previously immunized with measles vaccines of 26 different batches with insufficient immunogenic potency, has led to the pronounced and stable increase of immunity in the corresponding groups of children and has decreased measles morbidity among them 20 times.

Oligonucleotide mapping of the RNA genome was applied for analysis of poliovirus clinical isolates in Byelorussia in 1967-1985. All the maps have been clearly shown to resemble the reference maps of the corresponding vaccine strains. Examination of the oligonucleotide maps of poliovirus isolates provides a measure of distribution of some of the mutations over the viral genome.