title: Challenges of maintaining polio-free status of the European Region.
abstract: BACKGROUND
  The European region, certified as polio free in 2002, had recent wild poliovirus (WPV) introductions, resulting in a major outbreak in Central Asian countries and Russia in 2010 and in current widespread WPV type 1 circulation in Israel, which endangered the polio-free status of the region.
  
  
  METHODS
  We assessed the data on the major determinants of poliovirus transmission risk (population immunity, surveillance, and outbreak preparedness) and reviewed current threats and measures implemented in response to recent WPV introductions.
  
  
  RESULTS
  Despite high regional vaccination coverage and functioning surveillance, several countries in the region are at high or intermediate risk of poliovirus transmission. Coverage remains suboptimal in some countries, subnational geographic areas, and population groups, and surveillance (acute flaccid paralysis, enterovirus, and environmental) needs further strengthening. Supplementary immunization activities, which were instrumental in the rapid interruption of WPV1 circulation in 2010, should be implemented in high-risk countries to close population immunity gaps. National polio outbreak preparedness plans need strengthening. Immunization efforts to interrupt WPV transmission in Israel should continue.
  
  
  CONCLUSIONS
  The European region has successfully maintained its polio-free status since 2002, but numerous challenges remain. Staying polio free will require continued coordinated efforts, political commitment and financial support from all countries.
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: Dina
authors.initials: D
authors.lastname: Pfeifer
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: Eugene
authors.initials: E
authors.lastname: Gavrilin
authors.affiliation: World Health Organization Regional Office for Europe, Copenhagen, Denmark.
authors.forename: Abigail
authors.initials: A
authors.lastname: Shefer
authors.affiliation: World Health Organization Regional Office for Europe, Copenhagen, Denmark.
authors.forename: Robb
authors.initials: R
authors.lastname: Butler
authors.affiliation: World Health Organization Regional Office for Europe, Copenhagen, Denmark.
authors.forename: Dragan
authors.initials: D
authors.lastname: Jankovic
authors.affiliation: World Health Organization Regional Office for Europe, Copenhagen, Denmark.
authors.forename: Roman
authors.initials: R
authors.lastname: Spataru
authors.affiliation: World Health Organization Regional Office for Europe, Copenhagen, Denmark.
authors.forename: Nedret
authors.initials: N
authors.lastname: Emiroglu
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia World Health Organization Regional Office for Europe, Copenhagen, Denmark.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003140:Communicable Disease Control / Q000191:economics / Q000379:methods / Q000458:organization & administration*; D060740:Disease Eradication / Q000191:economics / Q000458:organization & administration*; D004196:Disease Outbreaks; D005060:Europe / Q000453:epidemiology; D005260:Female; D006291:Health Policy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007391:International Cooperation; D008297:Male; D011051:Poliomyelitis / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission
keywords: European region; polio eradication; polio-free status; poliomyelitis