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Public Health Dispatch: Certification of Poliomyelitis Eradication --- European Region, June 2002

On June 21, 2002, the Regional Commission for the Certification of Poliomyelitis Eradication (the Commission) certified that the European Region (EUR)* of the World Health Organization (WHO) is free of indigenous wild poliovirus transmission. The last known case in EUR of polio caused by indigenous wild poliovirus transmission occurred in southeast Turkey in November 1998. EUR comprises 51 countries with an estimated population of 873 million and is the third of the six WHO regions to be certified as polio-free, following the Americas Region in 1994 (1) and the Western Pacific Region in 2000 (2) (Figure). An estimated 3.4 billion persons (55% of the world's population) live in countries and territories certified free of endemic polio.

The Commission completed a 4-year review of programmatic data compiled by national certification committees to ensure that the absence of reported wild poliovirus isolation reflected interruption of indigenous wild transmission. The prerequisite for regional certification is the absence of indigenous wild poliovirus isolation for at least 3 years (3). Other criteria used to certify that regions are polio-free include 1) high vaccination coverage rates in all countries and within all areas of a country, 2) sensitive surveillance for acute flaccid paralysis (AFP) meeting standard performance indicators and/or other means of sensitive virologic surveillance, 3) a plan of action to respond to imported cases of wild poliovirus, and 4) political commitment by national governments to maintain high levels of vaccination coverage and surveillance through global certification of polio eradication. In addition, the Commission sought evidence of substantial progress in the process of laboratory containment of wild poliovirus in each country.

In 1988, the Global Polio Eradication Initiative was launched by the World Health Assembly; the initiative is coordinated by WHO in primary partnership with Rotary International, the United Nations Children's Fund (UNICEF), and CDC. National governments, private foundations, nongovernment organizations, corporations, and volunteers are collaborating to achieve eradication. During 2001, a total of 10 countries in three WHO regions (African, Eastern Mediterranean, and Southeast Asia) reported transmission of wild poliovirus (4).

Until polio is eradicated globally, all polio-free countries are at risk for wild poliovirus importation. In EUR, this risk was underscored by the discovery of poliovirus in Bulgaria (5) and Georgia in 2001§. During 2000--2001, two outbreaks of polio caused by circulating vaccine-derived poliovirus were documented among populations with low vaccination coverage on the island of Hispaniola (the Dominican Republic and Haiti) and the Philippines (6). Polio-free countries should maintain high levels of polio vaccination coverage and sensitive surveillance for the prompt detection of any circulating poliovirus. To minimize the risk for poliovirus spread, supplementary vaccination campaigns will continue in high-risk areas of some EUR countries. Many of these campaigns are synchronized with those of countries of the Eastern Mediterranean Region (EMR). During 1995--2002, Operation MECACAR (Eastern Mediterranean, Caucasus, and Central Asian Republics) coordinated polio eradication activities among 18 EUR and EMR countries; this effort represented a major advance toward eliminating virus circulation (7,8).

Reported by: Vaccine-preventable Diseases and Immunization Programme, World Health Organization Regional Office for Europe, Copenhagen, Denmark. Dept of Vaccines and Biologicals, World Health Organization, Geneva, Switzerland. Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases; Global Immunization Div, National Immunization Program, CDC.

References

  1. CDC. Certification of poliomyelitis eradication---the Americas, 1994. MMWR 1994;43:720--2.
  2. CDC. Certification of poliomyelitis eradication---Western Pacific Region, October 2000. MMWR 2001;50:1--3.
  3. Expanded Programme on Immunization. Report of the first meeting of the Global Commission for the Certification of the Eradication of Poliomyelitis. Geneva, Switzerland: World Health Organization, 1995 (Document no. WHO/EPI/GEN/95.6).
  4. CDC. Progress toward global eradication of poliomyelitis, 2001. MMWR 2002;51:253--7.
  5. CDC. Imported wild poliovirus causing poliomyelitis---Bulgaria, 2001. MMWR 2001;50:1033--5.
  6. CDC. Outbreak of poliomyelitis---Dominican Republic and Haiti, 2000--2001. MMWR 2001;50:855--6.
  7. CDC. Progress toward poliomyelitis eradication---European region, 1998--June 2000. MMWR 2000;49:656--60.
  8. World Health Organization Regional Offices for Europe and the Eastern Mediterranean. Operation MECACAR: eradicating polio, final report 1995--2000. Copenhagen, Denmark: World Health Organization Regional Office for Europe, 2001.

*Albania, Andorra, Armenia, Austria, Azerbaijan, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Luxembourg, Malta, Monaco, Netherlands, Norway, Poland, Portugal, Republic of Moldova, Romania, Russian Federation, San Marino, Slovakia, Slovenia, Spain, Sweden, Switzerland, Tajikistan, The Former Yugoslav Republic of Macedonia, Turkey, Turkmenistan, Ukraine, United Kingdom, Uzbekistan, and the Federal Republic of Yugoslavia.

The quality of AFP surveillance is evaluated by two key indicators: sensitivity of reporting (target: nonpolio AFP rate of >1 cases per 100,000 children aged <15 years) and completeness of specimen collection (target: two adequate stool specimens from >80% of all persons with AFP). All stool samples should be analyzed in WHO-accredited laboratories.

§During March--May 2001, three cases of polio were reported in Bulgaria. In October 2001, wild poliovirus was isolated from a stool specimen of a child in Georgia with aseptic meningoencephalitis. In both instances, the wild poliovirus type 1 isolated had 98% homology with virus isolated in the Indian subcontinent. Both countries and their neighbors initiated supplementary immunization and enhanced surveillance in response.


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