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Milestones in European polio eradication

21st Century



  • 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 by WHO.
  • 26 November marks the third anniversary of the last reported case of indigenous wild poliovirus identified in the European Region.

20th Century


  • 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 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 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 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 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 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 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 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 of poliovirus.


  • 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 with OPV.


  • 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 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 of years.