1 figure, 1 table omitted
Since the World Health Assembly launched the Global Poliomyelitis Eradication
Initiative in 1988 (see sidebar), the number of countries in which wild poliovirus
is endemic has decreased from 125 to 10 in 2001. Three of the six World Health
Organization (WHO) regions (Americas, European, and Western Pacific) have
been certified as free of wild poliovirus transmission.1-4 The
Global Commission for the Certification of the Eradication of Poliomyelitis
will declare the world polio-free when all regions have documented the absence
of wild poliovirus transmission for at least 3 consecutive years and when
laboratories with wild poliovirus–containing materials have implemented
appropriate containment conditions.5 This report describes preparations
for laboratory containment and the creation of a global inventory of laboratories
and institutions retaining wild poliovirus and summarizes global progress
since July 2001.6 The data indicate that substantial progress has
been made in identifying laboratories with wild poliovirus–containing
materials and in conducting national wild poliovirus inventories.
In 1999, the World Health Assembly recommended that all member states
"begin the process leading to laboratory containment of wild poliovirus."7 As of August 2002, a total of 138 (64%) of 214 countries and areas
had appointed national task forces for laboratory containment activities,
compared with 110 (51%) in June 20016; 121 (57%) countries and
areas were conducting surveys of laboratories, and 76 (36%) had completed
surveys and submitted national inventories to regional certification commissions,
compared with 11 (5%) in June 2001. These inventories have identified 1,242
laboratories with wild poliovirus materials.
Laboratory containment activities are of the highest priority in those
regions that have been certified as free of wild poliovirus transmission.
In the Americas, laboratory surveys are ongoing in 14 (29%) of the region's
48 countries. Canada completed a survey of approximately 1,700 institutions
in 2001 and is following up with 22 (1%) laboratories that reported holding
wild poliovirus–containing materials. In 2002, the United States completed
a pilot survey of 306 institutions with 2,951 laboratories, 47 (2%) of which
reported retaining wild poliovirus–containing materials; in October
2002, a nationwide survey began of 30,097 clinics, 450 academic institutions,
637 biomedical institutions, 56 state and local health departments, and 12
federal government departments. Completion of the inventory is anticipated
In 2001, containment activities in the European Region were accelerated
in anticipation of the region being certified polio-free in June 2002.4 Each of the region's 51 countries has established a national task
force, created a plan of action, compiled a list of laboratories, and initiated
a national survey, and 41 (80%) countries have submitted national inventories
to the European Regional Certification Commission. The 10 (20%) countries
that have not yet submitted inventories are highly industrialized Western
European nations that face substantial logistical challenges in contacting
a large number of biomedical institutions.
In 2001, Germany enacted legislation requiring laboratories with wild
poliovirus materials to comply with the survey and with recommended biosafety
procedures. Approximately 3,500 institutions were identified and surveyed;
the response rate was 100%. The contents of approximately 7,000 deep freezers
were reviewed. Wild poliovirus–containing materials were reported in
54 (2%) laboratories, 26 (48%) of them in academic institutions; 30 (56%)
laboratories destroyed the materials, and 24 (44%) retained them under the
required biosafety conditions.
In the Western Pacific, the first WHO region to begin containment activities,
31 (86%) of 36 countries have submitted national inventories; 69 of 13,178
surveyed laboratories reported stocks of materials containing wild poliovirus.
Of the five countries with surveys still in progress, the three countries
(Australia, China, and Japan) with the largest numbers of laboratories in
the region face logistical challenges similar to those facing countries in
Western Europe and North America. The other two countries (the Philippines
and Malaysia) also face challenges in identifying correct contact information
for many unregistered laboratories.
Laboratory containment activities also are under way in the three regions
(African, Eastern Mediterranean, and South East Asian) that have not yet been
certified as polio-free. Countries in regions that have not reported polio
cases in several years have been encouraged to begin containment activities.
Seven African countries have established national task forces, with Cameroon
and Uganda serving as pilot countries, and 17 Eastern Mediterranean countries
and five South East Asian countries have initiated surveys. Four countries
in the Eastern Mediterranean Region have submitted national inventories to
the Eastern Mediterranean Region Certification Commission.
Vaccines and Biologicals Dept, World Health Organization, Geneva, Switzerland.
Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases;
Global Immunization Div, National Immunization Program, CDC.
Considerable progress has been made toward completing the global inventory
of laboratories and institutions retaining wild poliovirus–containing
materials. Countries in all six WHO Regions are implementing laboratory containment
activities, and the WHO Global Action Plan for Laboratory Containment has
been revised to incorporate the lessons learned from these experiences.8 The experience in Germany illustrates the challenges countries with
a long history of biomedical research and decentralized health structures
face in compiling inventories. The action plan recommends that the number
of laboratories with wild poliovirus–containing materials be decreased
but allows such materials to be retained by laboratories listed on the national
inventory that meet prescribed biosafety conditions, including having basic
biosafety level (BSL-2) facilities and practices, limited laboratory access,
polio vaccination of personnel, and accurate records of poliovirus materials.
When global wild poliovirus transmission is interrupted, laboratories
will be notified that high-containment laboratory (BSL-3/polio) measures are
required for all laboratory activities involving known wild poliovirus–containing
materials. The same measures are required for all activities involving poliovirus
replication in permissive cells or animals using potential wild poliovirus–infectious
materials (e.g., fecal, respiratory, and environmental samples collected for
any purpose when and where wild poliovirus was known or suspected to be present).
For all other activities with potential wild poliovirus–infectious materials,
the requirements remain unchanged. Bacteriology and parasitology laboratories
may continue to work with potential wild poliovirus–containing materials
under BSL-2/polio conditions, which include the use of standard class II biological
These biosafety recommendations are anticipated to remain in effect
as long as current global polio vaccination policies continue. However, the
plan recognizes that the consequences of a reintroduction of wild poliovirus
from a laboratory will increase after polio vaccination is stopped within
a country or region. Containment requirements under this scenario will be
reexamined and increased for wild poliovirus and oral poliovirus vaccine materials.
Laboratory containment of wild poliovirus–containing materials
is an essential component for the eradication of wild poliovirus. Countries
are cooperating successfully to implement laboratory containment activities,
and the goal of identifying laboratories with wild poliovirus materials is
being achieved. All countries in which polio is not endemic are anticipated
to complete a national inventory of laboratories holding wild poliovirus–containing
materials by the end of 2003.
The Global Poliomyelitis Eradication Initiative (GPEI) was launched
in 1988 by the World Health Assembly following the success of poliomyelitis
elimination efforts in the Americas. The goal of GPEI is to protect all children
from a debilitating and sometimes fatal disease and to build an infrastructure
that can support other disease control efforts. CDC will continue to provide
poliovirus vaccine and epidemiologic and laboratory support for this important
GPEI is led by the World Health Organization (WHO), Rotary International,
the United Nations Children's Fund (UNICEF), and CDC in partnership with health
ministries from WHO member states, donor governments, foundations, the World
Bank, the European Union, private-sector donors, other United Nations agencies,
and nongovernment organizations. In 2001, approximately 10 million volunteers
helped vaccinate 575 million children as part of the final push to interrupt
transmission of wild poliovirus worldwide.
Progress through late 2002 confirms that transmission of all three serotypes
of wild poliovirus can be interrupted globally. Three WHO regions (Americas,
European, and Western Pacific) with a total population of >3 billion persons
in 134 countries, territories, and areas have been certified as polio-free
(i.e., having no indigenous polio caused by wild viruses). Wild polioviruses
are circulating in the lowest number of countries in history, with six countries
reporting ongoing polio transmission through October 2002; 90% of all polio
cases have been reported from nine of 76 states and provinces in India, Nigeria,
and Pakistan. Type II wild poliovirus has not been detected since October
The challenges to stopping the final chains of wild poliovirus transmission
include vaccination of children isolated by conflict, geography, or minority
status and ensuring adequate political and financial support to implement
eradication strategies fully. Work is ongoing to minimize the risks for inadvertent
laboratory release of wild poliovirus and to determine when it will be feasible
to end vaccination with oral polio vaccine, which is a major goal of the program.
Additional information about GPEI is available at http://www.polioeradication.org.
References: 8 available
Global Progress Toward Laboratory Containment of Wild Polioviruses—July 2001–August 2002. JAMA. 2003;289(4):415-417. doi:10.1001/jama.289.4.415