title: Simulation exercises to strengthen polio outbreak preparedness: experience of the World Health Organization European Region.
abstract: BACKGROUND
  Poliovirus importations and related outbreaks continue to occur in polio-free countries, including those in the World Health Organization (WHO) European Region. National preparedness plans for responding to poliovirus introduction are insufficient in many countries of the European Region. We describe a series of polio outbreak simulation exercises that were implemented to formally test polio outbreak preparedness plans in the European Region.
  
  
  METHODS
  We designed and implemented the exercises, reviewed the results, made recommendations, and assessed the role of outbreak simulation exercises in maintaining regional polio-free status. In addition, we performed a comprehensive review of the national plans of all WHO Member States in the European Region.
  
  
  RESULTS
  Three exercises, delivered during 2011-2013 (for the Balkans, United Kingdom, and the Caucasus and Ukraine), revealed that participating countries were generally prepared for poliovirus introduction, but the level of preparedness needed improvement. The areas in particular need of strengthening were national preparedness plans, initial response, plans for securing vaccine supply, and communications.
  
  
  CONCLUSIONS
  Polio outbreak simulation exercises can be valuable tools to help maintain polio-free status and should be extended to other high-risk countries and subnational areas in the European Region and elsewhere.
authors.affiliation: Public Health England.
authors.forename: Hilary J
authors.initials: HJ
authors.lastname: Moulsdale
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Nino
authors.initials: N
authors.lastname: Khetsuriani
authors.affiliation: World Health Organization Regional Office for Europe, Copenhagen, Denmark.
authors.forename: Sergei
authors.initials: S
authors.lastname: Deshevoi
authors.affiliation: World Health Organization Regional Office for Europe, Copenhagen, Denmark.
authors.forename: Robb
authors.initials: R
authors.lastname: Butler
authors.affiliation: Public Health England Institute of Psychiatry, King's College.
authors.forename: John
authors.initials: J
authors.lastname: Simpson
authors.affiliation: Department of Health, London, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Salisbury
mesh_terms: D002959:Civil Defense / Q000379:methods*; D003198:Computer Simulation; D004196:Disease Outbreaks; D005060:Europe / Q000453:epidemiology; D006302:Health Services Research; D006801:Humans; D011051:Poliomyelitis / Q000453:epidemiology* / Q000517:prevention & control*; D014944:World Health Organization
keywords: polio eradication; polio outbreak simulation exercise (POSE); poliovirus; preparedness exercise