Editorial: Certification of Polio-free Status in the WHO European Region
Published: 07.05.04 Updated: 20.08.2004 09:19:22
On 21 June 2002 the WHO Regional Commission for the Certification of Poliomyelitis Eradication in the European Region (RCC/EUR) certified the WHO European Region as free of indigenous wild poliovirus transmission. The last known case of paralytic poliomyelitis caused by indigenous wild poliovirus in European Region occurred in South-East Turkey on 26 November 1998. European Region is the third of the WHO six regions to be certified as polio-free, following certification of the Region of the Americas in 1994 and of the Western Pacific Region in 2000. An estimated 3,4 billion people globally (56% of the world's population) now live in countries and territories certified free of endemic wild poliovirus transmission.
The RCC/EUR completed a four-year review of surveillance and programme data from all countries in the region, as compiled and submitted by national certification committees, to ensure that the absence of reported wild poliovirus isolation reflected interruption of indigenous wild poliovirus transmission. The prerequisite for regional certification in the absence of indigenous wild poliovirus isolation for at least three years, under conditions of high-quality acute flaccid paralysis surveillance. Other criteria used by RCC/EUR to certify the region as polio-free include (1) high immunization coverage rates in all countries and within all areas of a country; (2) sensitive surveillance for acute flaccid paralysis meeting standard performance indicators and/or other means of sensitive virological surveillance; (3) a plan of action to respond to importation of wild poliovirus and (4) political commitment by national governments to maintain high levels of immunization coverage and surveillance until global certification of polio eradication. Additionally, the RCC/EUR required to see evidence for substantial progress in the process of laboratory containment of wild poliovirus in each country with aim to minimize the risk of an accidental or intentional reintroduction of wild poliovirus.
The Global Polio Eradication Initiative was launched by the World Health Assembly in 1988, and is being coordinated by WHO in primary partnership with the Centers for Disease Control and Prevention (United States), Rotary International and UNICEF. During 2001, endemic transmission of wild poliovirus was reported from only ten countries in the WHO Regions (African, Eastern Mediterranean and South-East Asian Regions).
All polio-free countries and areas remain at risk of wild poliovirus importation until polio is eradicated globally. In European Region this was underscored by the detection of wild poliovirus importations into Bulgaria and Georgia from Indian subcontinent during 2001. During 2000-2001, outbreaks of polio were documented among populations with low immunization coverage in Dominican Republic, Haiti and Philippines. Polio-free countries should maintain high levels of routine polio immunization coverage and sensitive surveillance from the prompt detection of any circulating polioviruses. To minimize the risk for poliovirus spread, supplementary oral poliovirus vaccine immunization campaigns will continue in high-risk areas of some European Region countries.