Certification and maintenance of polio-free status in the European Region
In June 2002, all 53 Member States in the WHO European Region were certified polio free by the Regional Commission for the Certification of Poliomyelitis Eradication (RCC). Since that time vaccination against polio has continued to be a cornerstone of routine immunization services in every Member State, and national and regional surveillance systems and laboratories have ensured that no polio case could have been left undetected.
In addition to helping Member States retain their polio-free status by providing support in surveillance and immunization activities and advocating for political commitment to immunization goals, WHO/Europe provides immediate technical support in the event of an outbreak. Since being certified polio free, the Region has experienced at least two episodes of wild poliovirus importation. In both cases, transmission was interrupted and the Region's elimination status was not affected. The Region also experienced an outbreak of circulating vaccine-derived poliovirus type 1 (cVDPV1) in Ukraine in 2015, which was assessed as interrupted in April 2016.
The first importation of wild poliovirus was reported in Tajikistan in 2010. This outbreak spread rapidly and affected 35 of the country's 65 administrative territories, and also spread to 3 nearby countries.
The Government of Tajikistan responded effectively when the cases were detected through close cooperation with WHO and other partners. In responding to the outbreak, 6 nationwide immunization rounds and 1 subnational mop-up campaign were implemented in the country; as a result of which, the outbreak was stopped in Tajikistan. However, the outbreak caused more than 700 cases of polio, mostly in children. Many of these have developed impairments and need long-term physical rehabilitation care.
Wild poliovirus type 1 (WPV1) was isolated in sewage samples from various sampling sites in Israel in early 2013. With WHO support, the Government of Israel conducted mass supplementary immunization activities (SIA) with oral polio vaccine (OPV) as well as a catch-up campaign targeting any un- or under- immunized children using inactivated polio vaccine (IPV). No positive environmental samples have been detected since March 2014 and no cases of paralytic polio were reported.
On 28 August 2015, the WHO Regional Office for Europe was notified of two confirmed cases of circulating vaccine-derived poliovirus type 1 (cVDPV1) in Ukraine. The two cases had a genetic similarity, indicating that active transmission of cVDPV1 was ongoing. Circulation of cVDPV occurred because of the low immunization coverage in Ukraine since 2008. In 2014, only 49% of children were fully vaccinated against polio, and at the time of the outbreak, the rate of vaccination against polio among children under 1 year old was only 14.1%, because of a shortage of vaccine. WHO and UNICEF provided the Ministry of Health with both technical and on-site support in planning and implementing large-scale supplementary immunization activities and communication campaigns to rapidly stop circulation of the virus.
In April 2016, an expert team from different United Nations agencies and partners assessed the polio-outbreak response in five Ukrainian regions. After analysing the disease surveillance systems, supplementary immunization activities, and communications, the team concluded that transmission of poliovirus was interrupted.