Polio eradication update- Z. Wadood

Polio remains designated as a Public Health Emergency of International Concern. There was a significant reduction in genetic clusters and geography of Wild Poliovirus type 1 (WPV1) in 2022 and there is an unprecedented opportunity to interrupt its final chains of transmission. There is an unprecedented opportunity to interrupt final WPV1 chains of transmission. nOPV2 is retaining its enhanced genetic stability compared tomOPV2. Most isolates analyzed through whole genome sequencing indicate no or minimal changes in genetic structure of nOPV2. An estimated 60 cVDPV2 emergences would have been seeded if Sabin OPV2 was used at this scale instead of nOPV2. There were polio outbreaks in Ukraine, London and Israel during 2021-2023. In Ukraine, massive population movement due to ongoing war lead to difficulties in reaching children and keeping track of population numbers. There are limited human resources for polio response due to competing priorities like emergency health services. No country is free of the risk of poliovirus importation and transmission. Recent circulation of PV in Israel, UK and US raises concern about the possibility of undetected circulation in IPV-only countries. The increase in detected cVDPV2 globally is a threat to eradication. The national outbreak preparedness plans must be developed or updated. All the efforts must be made to boost AFP and introduce or optimize supplementary PV surveillance to timely detect PV. Countries need to work with the WHO European Regional Office to develop long term sustainability plans for laboratory-based PV surveillance and to ensure rapid detection through timely collection and shipment of samples.

Diphtheria in Europe: A returning threat- Jordi Borrell Pique

Diphtheria is an acute infectious disease caused by toxin-producing Corynebacterium species which can be treated with antibiotics and antitoxin (DAT). Its transmission occurs via airborne respiratory droplets, direct contact with respiratory secretions or with exudate from infected cutaneous lesions. It is a rare disease in the EU/EEA countries. Vaccination is the only effective method of preventing this disease and its occurrence in fully vaccinated individuals is very rare. In non-vaccinated individuals and especially if proper treatment is delayed, death can occur in up to 10% of clinical cases despite the administration of antibiotics and DAT. Different vaccine products against DTP are available, While the vaccine for young children contains a full dose of DTP, the vaccine in older children with completed primary vaccination, adolescents and adults contains a reduced diphtheria component. WHO recommends a 3- dose primary vaccination series with diphtheria containing vaccine followed by 3 booster doses. Recommendation for general diphtheria booster dose in EU/EEA countries excludes any specific recommendations for specific groups like pregnant women and there are variations in booster doses given in different parts of EU countries. In the period from 2010 to 2023, 756 confirmed diphtheria cases were reported in all the EU/EEA. Large outbreaks (231 cases) of diphtheria were reported across Europe in 2022 among migrants and majority of these presented with cutaneous form of the disease. Most of these cases are being reported among migrants residing in settings susceptible to crowds and where some individuals may be lacking a complete DTP vaccine scheme. Increased number of cases observed in most Member states is driven by multiple importations from diphtheria endemic countries. In response to reducing these outbreaks, it is important to check vaccination status of newly arrived migrants and provide vaccinations with diphtheria containing vaccines in accordance with national guidelines. It should be ensured that all personnel working in reception centers for migrants have their vaccination status up to date. Any close contacts to the infected individuals should be identified, tested and antibiotic treatment should be provided to them. Enhanced surveillance, molecular typing and whole genome sequencing of patient isolates should be performed.

Measles in Europe: progress, vulnerabilities and the path forward- Kate O’Brien

Measles outbreak increased during the pandemic in 2019 in the EU due to non pharmacological interventions and low DPT surveillance. Global coverage of the first routine measles vaccine (MCV-1) dropped to 81% in 2021 which leaves around 24.7 million children without MCV-1. 20 countries with lowest MCV1 coverage in 2021 include 10 of the IA2030 priority countries. By the end of 2022, there were an estimated 30.5 million measles-susceptible children less than 5 years of age in the 20 countries with lowest MCV-1 coverage. These countries also reported highest ratios of U5 measles susceptible children, approximating 22.5 million children less than 5 years of age. The existing surveillance systems have not recovered from Covd-19 disruptions and may not be capturing all measles cases. Measles vaccines is not the largest component of immunization program costs, but accounts for up to 75% of economic benefits and >80% of deaths are averted among VPDs. Effectiveness after one dose of MCV is 93% and 97% after 2 doses. Measles vaccination has prevented 56 million deaths worldwide since 2000 while in the EU region, 1,146,475 deaths have been averted.The COVID-19 pandemic showed that national and regional vulnerability can translate into global vulnerabilities. Closing measles immunity gaps in 2023 and 2024 needs to be a global, regional and national priority to prevent mortality and morbidity associated with measles virus infections and progress should be made towards achieving measles elimination.

41st Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID), 8-12 May, 2023