Outbreak preparedness and significant improvements in surveillance and immunization coverage remain essential to ensure that poliovirus (polio) cannot make a comeback in the European Region. This was expressed by the European Regional Commission for the Certification of Poliomyelitis Eradication (RCC) at its 30th meeting on 31 May–2 June 2016, held in Copenhagen, Denmark. The RCC's conclusions echoed the global assessment of the Emergency Committee under the International Health Regulations (2005) (IHR) on 12 May 2016, which declared that the spread of poliovirus continues to constitute a Public Health Emergency of International Concern.
RCC conclusions
The RCC is an independent panel of 5 international polio experts, who together monitor the status of polio eradication efforts in the WHO European Region. This year, it reviewed the annual reports for 2015 from 51 of 53 Member States, including their polio surveillance, monitoring and immunization results, as well as the steps taken to interrupt transmission of circulating vaccine-derived poliovirus (cVDPV) type 1 that had been detected in Ukraine in 2015.
Stressing the need for continued vigilance, Professor David Salisbury, Chair of the RCC, said, "All countries remain at risk to varying degrees and must take appropriate action." Among other recommendations, the five-member Commission called for urgent measures to reverse declines in vaccination coverage and surveillance quality in some countries to prevent re-establishment of transmission in the event of an importation or emergence of vaccine-derived strains. The RCC further recommended that all Member States undertake polio outbreak simulation exercises. In general, the RCC was pleased with the improved quality of reports, but expressed concern regarding the timeliness of reporting.
It was encouraged by the successful completion of the switch to bivalent oral polio vaccine in April 2016 by the 19 affected countries in the Region.
The RCC furthermore recognized the ongoing challenges posed by the recent influx of refugees and migrants to the Region and commended measures taken so far to provide immunization services appropriate to their needs. It also commended the high-quality work of the regional Polio Laboratory Network. With a large number of polio and enterovirus laboratories and polio vaccine manufacturers located in the Region, the Network faces a considerable workload in the coming year to fully implement all requirements for laboratory containment of poliovirus (as described in the "WHO Global Action Plan to minimize poliovirus facility-associated risk after type-specific eradication of wild polioviruses and sequential cessation of oral polio vaccine use – GAP III").
IHR global assessment
The Emergency Committee under the IHR met for the 9th time regarding the international spread of poliovirus on 12 May 2016. After reviewing the status of all countries that had been affected by wild poliovirus or cVDPVs, it concluded that all possible measures are still needed to support the final phases of polio eradication. It therefore recommended that the temporary recommendations issued by the WHO Director-General, Dr Margaret Chan, in May 2014 be extended for a further three-month period. Based on a final report on environmental circulation of wild poliovirus in Israel (detected in 2013), the Emergency Committee agreed that this country is no longer subject to the temporary recommendations.
Review of Ukraine outbreak response measures
In April 2016, a team of technical experts made a six-month assessment of Ukraine's response to the cVDPV outbreak, concluding that transmission had likely been interrupted, but that the country remains at high risk for new outbreaks.
The RCC met with representatives from Ukraine to review the assessment report and a status update from its National Certification Committee. The RCC will deliberate again after receiving a twelve-month outbreak report, due in late 2016, to determine whether the Region has retained its polio-free status.