Milestones in European polio eradication
- Europe certified polio-free on 21 June.
- 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
- 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
- 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 western Europe.
- 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 Turkey.
- 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
- The Russian Federation joins Operation MECACAR in the spring of
1996. The last case of indigenous poliomyelitis is reported from the
- 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 Chechnya.
- 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
- 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
- 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 in December.
- 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 in Canada.
- 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
- 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
- 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 in Spain.
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 cases.
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 11 cases.
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 1950's.
· 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 Region.
- 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
- 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 1951-1955.
- 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
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 of years.