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. 2014 Nov 1;210 Suppl 1(Suppl 1):S194-207.
doi: 10.1093/infdis/jiu096.

Challenges of maintaining polio-free status of the European Region

Nino Khetsuriani  1 , Dina Pfeifer  2 , Sergei Deshevoi  2 , Eugene Gavrilin  2 , Abigail Shefer  2 , Robb Butler  2 , Dragan Jankovic  2 , Roman Spataru  2 , Nedret Emiroglu  2 , Rebecca Martin  3
Affiliations

Challenges of maintaining polio-free status of the European Region

Nino Khetsuriani et al. J Infect Dis. .

Abstract

Background: The European region, certified as polio free in 2002, had recent wild poliovirus (WPV) introductions, resulting in a major outbreak in Central Asian countries and Russia in 2010 and in current widespread WPV type 1 circulation in Israel, which endangered the polio-free status of the region.

Methods: We assessed the data on the major determinants of poliovirus transmission risk (population immunity, surveillance, and outbreak preparedness) and reviewed current threats and measures implemented in response to recent WPV introductions.

Results: Despite high regional vaccination coverage and functioning surveillance, several countries in the region are at high or intermediate risk of poliovirus transmission. Coverage remains suboptimal in some countries, subnational geographic areas, and population groups, and surveillance (acute flaccid paralysis, enterovirus, and environmental) needs further strengthening. Supplementary immunization activities, which were instrumental in the rapid interruption of WPV1 circulation in 2010, should be implemented in high-risk countries to close population immunity gaps. National polio outbreak preparedness plans need strengthening. Immunization efforts to interrupt WPV transmission in Israel should continue.

Conclusions: The European region has successfully maintained its polio-free status since 2002, but numerous challenges remain. Staying polio free will require continued coordinated efforts, political commitment and financial support from all countries.

Keywords: European region; polio eradication; polio-free status; poliomyelitis.

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Conflict of interest statement

Potential conflict of interest. All authors: No reported conflicts.

All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Risk of wild poliovirus spread following importation in countries of the European region, 2010–2013. Countries ranked at high risk in a given year are individually listed.
Figure 2.
Figure 2.
Routine immunization coverage with 3 doses of polio vaccine (Pol3) in countries of the European region, 2003–2012.
Figure 3.
Figure 3.
Coverage with three doses of polio vaccine (Pol3) at subnational level, European region, 2010–2012.
Figure 4.
Figure 4.
(A) Annual acute flaccid paralysis (AFP) surveillance index at national level and (B) average nonpolio AFP rate per 100 000 population at subnational level, European region, 2010–2012. *2013 index is annualized based on the data reported to WHO as of week 47 of 2013. AFP surveillance index is calculated by multiplying the nonpolio AFP rate per 100 000 population by the proportion of cases with stool specimens.
See this image and copyright information in PMC

References

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