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Polio eradication and laboratory
containment
(Last revised:
May 26, 2011 )
Background
In 1988, the World Health Assembly adopted the resolution calling for global eradication of poliomyelitis. A global goal of disease eradication has previously only been accomplished for smallpox.
In June 2002, the World Health Organization (WHO) European Region was certified as free of indigenous wild poliovirus transmission, joining the WHO Regions of the Americas and the Western Pacific. The world will be declared free of wild poliovirus transmission when the Global Commission for Certification of the Eradication of Poliomyelitis is satisfied that all WHO Regions have documented the absence of wild poliovirus circulation for at least three consecutive years and all wild poliovirus materials in laboratories are adequately contained.
In this context, all countries are required to survey, prepare an inventory of laboratories that retain wild poliovirus infectious and/or potentially infectious materials and instruct them to implement appropriate biosafety measures for safe handling. Laboratories to be surveyed include not only those associated with traditional poliovirus laboratory functions but also laboratories in other sectors that could potentially have materials in storage collected during a time and in a place when wild poliovirus was circulating. The probability of a laboratory-associated poliovirus infection is small, but the consequences grow greater with time. After stopping vaccination, a chance reintroduction of poliovirus from one of these laboratories into the community could represent a public health threat of global proportions.
Laboratory
Survey and Inventory Phase in Belgium
The National Laboratory Containment survey has been conducted in Belgium during
period from June 2002 to November 2002. A total of 411 institutions have been
surveyed.
Taking into account the risk assessment performed on the non-responders and
their exclusion from the survey, it has finally been considered that a 100%
response rate has been achieved.
The laboratory survey has identifed 8 laboratories
holding wild poliovirus materials. In June 2004, the number of laboratories
retaining wild poliovirus materials was reduced to 5 and to 4 in 2006.
A report on "Demonstrating
the Quality of Implementing Polio Laboratory
Containment Requirements" (PDF file: report
without annexes), requested
by
WHO
in
October
2003 has
been
drawn
up.
This report aims to document the thoroughness and accuracy of conducting the
Laboratory
Survey
and establishing the National Inventory of laboratories that wish to retain wild
poliovirus infectious.
A scientific report has been published in 2005: Sneyers M, Herman P & Moens W. Polio eradication and laboratory containment program of wild polioviruses in Belgium: Laboratory survey and inventory phase. Archives of Public Health 2005, 63 : 57-65.
Joint Containment - Polio Labnet WHO/EURO Meeting. St. Julians, Malta, 20-22 February 2007: Poliovirus Laboratory Containment Activities - Belgian Experience (power point presentation, PDF file)
WHO requirements for laboratory containment of wild
polioviruses
The Global Commission has established the requirements for laboratory containment of wild polioviruses.
WHO
global action plan for laboratory containment of wild polioviruses. Second
edition. Department of Vaccines and Biologicals. World Health Organization,
Geneva, 2003. (WHO/V&B/03.11) (PDF file: in
english)
WHO
global action plan for laboratory containment of wild polioviruses. First
edition. Department of Vaccines and Biologicals. World Health
Organization, Geneva, 1999. (WHO/V&B/99.32) (PDF file: in
english - in
french)
- Guidelines
for implementing the pre-eradication phase of the global action plan for
laboratory containment of wild polioviruses. Surveying laboratories. Establishing
inventories. World Health Organization, Geneva, April 2000. (WHO/V&B/00.21)
(PDF file: in
english)
- Guidelines on how to implement the requirements have also been issued and adapted by the WHO European Region.
- Guidelines
for Implementation of Laboratory Containment of Wild Poliovirus. Laboratory
Survey and National Inventory. World Health Organization, WHO Regional Office
for Europe, May 2000. (EUR/00/5018753. E69379) (PDF file: in
english)
Containment verification of large-scale polio vaccine production and quality control facilities following the interruption of endemic poliomyelitis transmission (Discussion group on global containment strategies). 29-30 July, 2003. WHO, Geneva. (PDF file: in english)
Useful Links
World Health Organization - Poliomyelitis
- World
Health Organization Regional Office for Europe - Polio
eradication and European
laboratory network and containment guidelines - News and events.
Article (scientific journalism)
Reynolds T. Polio: An end in sight? BMJ - Infectious diseases- 2007, 335 : 852-4.
Selected References (frequently updated)
Eichner M & Dietz K. Eradication of poliomyelitis: When can one be sure that Polio virus transmission has been terminated? Am J Epidemiol. 1996, 143 (8): 816-22.
Minor PD. Biosafety consequences of eradication of wild-type polioviruses. Lancet. 2001, 358(9277):166-8.
Dowdle WR, Gary HE, Sanders R & van Loon AM. Can post-eradication laboratory containment of wild polioviruses be achieved? Bull World Health Organ. 2002, 80(4):311-6.
Centers for Disease Control and Prevention (CDC). Global progress toward certifying polio eradication and laboratory containment of wild polioviruses - August 2002-August 2003. MMWR Morb Mortal Wkly Rep. 2003, 52(47):1158-60.
Centers for Disease Control and Prevention (CDC). National laboratory inventory for global poliovirus containment - United States, November 2003. MMWR Morb Mortal Wkly Rep. 2004, 53(21): 457-9.
Sneyers M, Herman P & Moens W. Polio eradication and laboratory containment program of wild polioviruses in Belgium: Laboratory survey and inventory phase. Archives of Public Health 2005, 63 : 57-65.
Pallansch MA & Sandhu HS. The eradication of Polio - Progress and Challenges. N Engl J Med 2006, 355: 2508-2511.
Heymann DL, Sutter RW & Aylward RB. A vision of a world without polio: the OPV cessation strategy. Biologicals. 2006, 34(2): 75-9.
Bruce Aylward R, Sutter RW, Cochi SL, Thompson KM, Jafari H & Heymann D. Risk management in a polio-free world. Risk Anal. 2006, 26(6): 1441-8.
Martín J. Vaccine-derived poliovirus from long term excretors and the end game of polio eradication. Biologicals. 2006, 34 (2): 117-22.
Dowdle W, van der Avoort H, de Gourville E, Delpeyroux F, Desphande J, Hovi T, Martin J, Pallansch M, Kew O & Wolff C. Containment of polioviruses after eradication and OPV cessation: characterizing risks to improve management. Risk Anal. 2006 26(6): 1449-69.
Lahariya C. Global eradication of polio: the case for "finishing the job". Bull World Health Organ 2007, 85(6): 487-92.
Chumakov K, Ehrenfeld E, Wimmer E & Agol VI. Vaccination against polio should not be stopped. Nat Rev Microbiol. 2007, 5 (12): 952-8.
Centers for Disease Control and Prevention (CDC). Update on vaccine-derived polioviruses worldwide, January 2006-August 2007. MMWR Morb Mortal Wkly Rep. 2007, 56 (38): 996-1001.
Khan MM. Economics of polio vaccination in the post-eradication era: Should OPV-using countries adopt IPV? Vaccine. 2008, 26 (16): 2034-40.
Butcher J. Polio eradication nears the end game. Lancet Neurology. 2008, 7 (4) : 292-293.
Thys B, De Palma AM, Neyts J, Andries K, Raf Vrijsen R, Bart Rombaut B. R75761, a lead compound for the development of antiviral drugs in late stage poliomyelitis eradication strategies and beyond. Antiviral Research. 2008, 78 (3): 278-281.
De Palma AM, Pürstinger G, Wimmer E, Patick AK, Andries K, Rombaut B, et al. Potential use of antiviral agents in polio eradication. Emerg Infect Dis. 2008, 14 (4): 545-551. Available from http://www.cdc.gov/EID/content/14/4/545.htm
Centers for Disease Control and Prevention (CDC). Progress Toward Interruption of Wild Poliovirus Transmission Worldwide, January 2007-April 2008. MMWR Morb Mortal Wkly Rep. 2008,57 (18): 489-494.
Thompson KM, Tebbens RJ, Pallansch MA, Kew OM, Sutter RW, Aylward RB, Watkins M, Gary HE Jr, Alexander J, Jafari H, Cochi SL. The risks, costs, and benefits of possible future global policies for managing polioviruses. Am J Public Health. 2008, 98 (7): 1322-30.
Collett MS, Neyts J, Modlin JF. A case for developing antiviral drugs against polio. Antiviral Res. 2008 May 13.
Nathanson N. Chapter 1 the pathogenesis of poliomyelitis: what we don't know. Adv Virus Res. 2008, 71: 1-50.
Arita I, Nakane M. Road map for polio eradication - establishing the link with Millennium Development Goal no. 4 for child survival. Jpn J Infect Dis. 2008, 61 (3): 169-74.
Roberts L. Polio eradication: Looking for a Little Luck. Science. 2009, 323 (5915): 702-705.
Modlin JF. The bumpy road to polio eradication. N Engl J Med. 2010, 362 (25): 2346-2349.
Nathanson N, Kew OM. From emergence to eradication: The epidemilogy of poliomyelitis deconstructed. Am J Epidemiol. 2010, 172 (11): 1213-1229.
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