Milestones in European polio eradication
- Europe certified polio-free on June 21
- All Member States provide updated documentation to
the Regional Certification Commission in January and
commit to ongoing immunization and surveillance activities
after regional certification.
- The Regional Certification Commission meets in March
and reviews national documents from all 51 Member States
of the European Region. The Commission identifies three
pre-conditions for certification: strong evidence that
importations into the Region were effectively controlled,
country plans of action to sustain poliomyelitis eradication
efforts until global certification, and country progress
reports on laboratory containment of wild polioviruses.
- Wild poliovirus related to virus in the Indian subcontinent
is imported twice into the Region: three Roma children
in Bulgaria are paralysed during an outbreak from March
to May, and poliovirus infects a 5-year-old incompletely
immunized boy in Georgia in September.
- At the MECACAR Coordination Meeting in Cairo, MECACAR
countries propose to continue their cooperation for
another 3 years and to expand their mandate to include
broader immunization issues.
- All laboratories in the regional laboratory network
are accredited by WHO.
- 26 November marks the third anniversary of the last
reported case of indigenous wild poliovirus identified
in the European Region.
- The fiftieth session of the Regional Committee endorses
the certification plan and laboratory containment processes
for the European Region.
- Laboratory containment process is initiated in European
Region to assess which laboratories hold wild poliovirus
and potentially infectious material.
- 26 November marks the second anniversary of the last
reported case of indigenous wild poliovirus identified
in the European Region.
Transmission of wild poliovirus appears to have been
interrupted in the European Region in 1998 while just
eight years earlier, in 1990, 354 cases had been reported
in 14 countries.
- 26 November marks the first anniversary of the last
reported case of indigenous wild poliovirus in the countries
of the European Region.
- Assessments of the quality of surveillance for acute
flaccid paralysis (AFP) are conducted in all MECACAR
(Mediterranean countries, Caucasian republics and central
Asian republics) countries: Armenia, Azerbaijan, Georgia,
Kazakhstan, Kyrgystan, Russia, Tajikistan, Turkey, Turkmenistan
and Uzbekistan. Quality indicators for surveillance
are met in most recently endemic countries.
- All stool specimens from all AFP cases and contacts
are investigated at accredited laboratories.
- The Regional Certification Commission begins reviewing
documentation submitted by non-endemic countries of
- An outbreak caused by type 1 and 3 poliovirus occurs
in Turkey, causing 26 cases of poliomyelitis. Intensive
mop-up immunization activities undertaken in October
and November are able to reach populations not effectively
reached in the past, apparently stopping transmission
of wild poliovirus.
- Melik Minas, a 33-month-old unvaccinated child, is
found paralysed by poliomyelitis on 26 November in Turkey-the
last reported case of poliomyelitis in the Region due
to indigenous wild poliovirus.
- Joint meetings of the European and Eastern Mediterranean
regions of WHO related to the prevention of cross-border
transmission of poliomyelitis are convened, with the
first meeting held in May in Alexandria, Egypt.
- The third year of Operation MECACAR is completed.
The initiative has coordinated poliomyelitis eradication
efforts across 18 countries and areas in the European
and Eastern Mediterranean Regions of WHO since 1995
and has greatly reduced transmission of wild poliovirus
throughout the European Region.
- A meeting of the MECACAR countries is held in October
in Rome. All agree to Operation MECACAR Plus - the addition
of synchronized sub-national immunization days and continued
collaboration for three more years.
- The regional laboratory network is fully operational.
- Only seven cases of poliomyelitis are reported for
the European Region: one from Tajikistan and six from
- The first meeting of the Regional Certification Commission
is held in Paris in March. The Commission endorses the
global criteria for certification established in 1995
and develops a regional strategy for certification.
- The Russian Federation joins Operation MECACAR in
the spring of 1996. The last case of indigenous poliomyelitis
is reported from the Russian Federation.
- Albania, free of wild poliovirus for 18 years, suffers
an outbreak of 138 cases of poliomyelitis, of which
16 prove fatal. The virus spreads to neighbouring countries,
causing five cases of poliomyelitis in Greece and 25
in Kosovo, Yugoslavia. Control efforts successfully
stop the outbreak and the last reported indigenous poliomyelitis
cases are detected in Albania, Greece and Yugoslavia.
- Wild poliovirus is found in one sample taken from
the Paris sewage system. The virus is determined to
originate from Morocco. This highlights the constant
risk of importation, even into countries with strong
immunization programs and healthcare systems.
- Operation MECACAR is initiated: an unprecedented coordinated
polio eradication effort across 18 countries and areas
in the Mediterranean, Caucasus and Central Asia - including
10 countries of the European Region of WHO. The first
coordination meeting is held in Ankara in January to
synchronize plans for the campaigns to be conducted
in April and May.
- Operation MECACAR achieves 92 % coverage by reaching
approximately 60 million children for vaccination. The
last reported indigenous poliomyelitis cases are detected
in Armenia, Azerbaijan, Kazakhstan and Uzbekistan. The
operation ultimately influences the global approach
to poliomyelitis eradication with the African and Southeast
Asia regions of WHO employing the concept of synchronized
national immunization days (NIDs) in later years.
- Immunization delivery in the Republic of Chechnya,
within the Russian Federation, is interrupted in the
early 1990's allowing for an outbreak of poliomyelitis
that paralyses approximately 150 children. The outbreak
is linked to virus originally imported into Tajikistan
from Pakistan causing an outbreak in 1991 and spread
to Ukraine, Uzbekistan and lastly to the Republic of
- The poliomyelitis eradication partnership for the
European Region commits to coordinated support for childhood
immunization in the Newly Independent States by signing
the Kyoto Declaration in July. The declaration serves
as the platform for the establishment of the Immunization
Interagency Coordination Committees (IICC).
- The European and Eastern Mediterranean Regions of
WHO develop the first draft of the project proposal
for Operation MECACAR in August.
- As vaccine supply to fully respond to the outbreak
in Uzbekistan in the previous year was limited, the
outbreak causes an additional 120 cases in 1994. Sufficient
vaccine supply is arranged and NIDs are conducted.
- The first meeting of the IICC for the European Region
is held in Amsterdam in December. At this meeting the
IICC endorses the plan for Operation MECACAR.
- Due to a lack of vaccine supply over a nine-month
period, an outbreak of poliomyelitis caused by type
1 and 3 poliovirus occurs in Uzbekistan. The outbreak
starts in March and continues through April 1994 causing
68 cases of paralysis in 1993. Some vaccine becomes
available in late 1993 and is administered to infants
less than 2-years-old, limiting the outbreak.
- Rotary International expands its partnership with
the eradication programme in the European Region. The
Central and Eastern European Countries Polio Plus Project
Committee, later called the European Regional Polio
Plus Committee, is formed to support eradication activities
in the European Region.
- An outbreak of poliomyelitis in Azerbaijan causes
69 cases due to inadequate supply of vaccine required
for routine immunization. With international support
the first round of the NID was effectively conducted
- Fourteen years after the last case of poliomyelitis
was detected in the Netherlands an outbreak begins among
populations refusing immunization for religious reasons.
The outbreak results in 71 cases and 2 deaths from September
1992 to February 1993. Laboratory analysis indicates
the probable origin of the virus is the Indian subcontinent.
Control efforts stop the outbreak; however, not before
the virus spreads to groups of similar religious denominations
- An outbreak of poliomyelitis in Yugoslavia results
in 10 cases
- An outbreak of poliomyelitis starting in Ukraine
in 1992 results in 27 cases.
- Immunization efforts successfully control the Romanian
outbreak that started in 1991. Romania reports the last
indigenous case of poliomyelitis.
- An outbreak of poliomyelitis in Tajikistan results
in 111 cases, including four deaths. The outbreak is
linked to poliovirus circulating in the Indian subcontinent.
- Low immunization coverage in the Roma community in
Bulgaria allows an outbreak of poliomyelitis to occur.
The virus is closely linked to viruses from Azerbaijan,
Georgia and Turkmenistan originating from a middle-eastern
reservoir. Mass immunization campaigns are organized
with international support, and appear to interrupt
transmission resulting in the last reported indigenous
case of poliomyelitis from Bulgaria.
- After 6 years with no cases of poliomyelitis, an
outbreak of 13 cases occurs in Romania. The outbreak,
which began in late 1990 and would run through early
1992, involves Roma children who were either unvaccinated
or inadequately vaccinated and can be attributed to
poliovirus with probable origin from Turkey.
- An outbreak of poliomyelitis in the Soviet Republic
of Azerbaijan causes 182 cases.
- An outbreak of poliomyelitis in the Soviet Republic
of Georgia from 1990 to 1991 causes 36 cases.
Transmission of wild poliovirus is dramatically reduced.
An estimated 209 cases are reported for the European Region
in 1980, an 81% decrease from the number reported in 1975.
The geographic extent of wild poliovirus transmission
is reduced significantly as 12 additional countries appear
to have interrupted transmission.
- The thirty-ninth session of the Regional Committee
meets in September and endorses the target of regional
poliomyelitis elimination by 2000 and approves the first
plan of action aimed at its achievement.
- On 13 May the World Health Assembly adopts a resolution
to eradicate poliomyelitis by the year 2000.
- An outbreak of poliomyelitis occurs in Israel resulting
in 16 cases. Until this point only inactivated polio
vaccine (IPV) was in use in the area. A combined IPV/OPV
(oral polio vaccine) immunization policy is introduced,
controlling the outbreak and apparently interrupting
transmission. The last indigenous case of poliomyelitis
is reported from Israel.
- An outbreak that began in 1987 in Spain results in
11 cases of poliomyelitis. Immunization activities are
conducted apparently stopping the outbreak with the
last reported indigenous case of poliomyelitis detected
The Regional Committee establishes the reduction of
communicable diseases as its fifth regional target, specifically
noting that by 2000 there should be no indigenous cases
of poliomyelitis in the Region.
- After two decades of being free from poliomyelitis,
Finland suffers an outbreak that causes 9 cases. The
outbreak, linked to strains of poliovirus type 3 circulating
in the Mediterranean countries, appears to be stopped
by mass immunization and Finland reports its last indigenous
case of poliomyelitis.
- An outbreak of poliomyelitis in Spain results in 25
An estimated 1119 children are paralysed by poliomyelitis
in the countries of the region in 1975, an 85% decrease
from the numbers of cases reported a decade earlier. Five
more countries appear to have interrupted transmission
- An outbreak of poliomyelitis in the Netherlands,
among a group that refused to be immunized for religious
reasons, results in 80 cases. Virus from this outbreak,
with probable origin from Turkey, is imported into the
United States causing 10 cases and into Canada causing
An estimated 7 671 children are paralysed annually by
poliomyelitis in the countries of the European Region
from 1961-1965. This is a dramatic decrease, approximately
74%, from the numbers of cases seen in the early 1950's
and clearly shows the impact of introduction of vaccination
against poliomyelitis. Twelve countries appear to interrupt
transmission of poliovirus after introduction of polio
vaccine. OPV is introduced in many of the European countries
based on the successes observed with its use in the late
· Based on the successes of the OPV campaigns
conducted in 1959 in the Soviet Republics of Estonia,
Lithuania and a number of others, the USSR starts its
regular vaccination programme.
During this decade historic progress is made toward
the control of poliomyelitis as vaccine against the virus
becomes available and is introduced throughout the European
- The first mass immunization with OPV is conducted
in the Soviet Republic of Estonia, which has extremely
high incidence of poliomyelitis. The campaign demonstrates
the safety of OPV, and its ability to eliminate transmission
of wild poliovirus in large geographic areas within
an extremely short time period. The knowledge gained
through this immunization campaign provides the scientific
basis for eradication.
- Having gained experience with the use of OPV in the
Soviet Republic of Estonia, other republics of the USSR:
Belarus, Estonia, Georgia, Kyrgystan, Latvia, Lithuania,
Moldova, Ukraine and Uzbekistan, as well as Hungary
and Poland begin vaccination against poliomyelitis with
- Dr Albert Sabin shares strains of poliovirus with
Dr Mikhail Chumakov, enabling extensive study of the
Sabin attenuated poliovirus at the Institute for Poliomyelitis
Research in Moscow. Based on the research conducted,
and his expectation that successful implementation could
rapidly change the epidemic situation in the Baltic
states. Dr Chumakov proposes a program of trial vaccination
with OPV in the Estonian Republic. The USSR Academy
of Medical Sciences and the Estonian Minister of Public
Health approve the proposal.
- Almost all countries of the European Region begin
vaccination against poliomyelitis with IPV.
- The first vaccination against poliomyelitis in Europe
starts in Denmark using Salk vaccine.
- The Institute for Poliomyelitis Research is established
in the Academy of Medical Sciences, Moscow by Dr Chumakov.
The Institute carries out extensive work related to
vaccination against poliomyelitis.
Poliomyelitis paralyses an estimated 28 500 children
annually in the countries of the European Region from
- Austrian physicians Karl Landsteiner and Erwin Popper
make the first hypothesis that poliomyelitis may be
caused by a virus.
- Dr Ivar Wickman, a Swedish paediatrician, categorizes
the different clinical types of poliomyelitis.
- Dr Jacob van Heine conducts the first systematic
investigation of poliomyelitis developing the theory
that the disease may be contagious. Von Heine`s treatments
are used well into the 20th century.
- Dr Michael Underwood, a British physician, attempts
the first known clinical description of poliomyelitis,
entitled Debility of the lower extremities.
1403 - 1365 BC
- An Egyptian limestone stele exhibited in the Glyptotek
Museum in Copenhagen portrays a man and his family giving
offerings to the Goddess Astarte. The man has a thin,
withered leg widely believed have been caused by poliomyelitis,
suggesting that the disease has been endemic for thousands