Facility-Associated Release of Polioviruses into Communities—Risks for the Posteradication Era

Risks for the Posteradication Era

Ananda S. Bandyopadhyay; Harpal Singh; Jacqueline Fournier-Caruana; John F. Modlin; Jay Wenger; Jeffrey Partridge; Roland W. Sutter; Michel J. Zaffran


Emerging Infectious Diseases. 2019;25(7):1363-1369. 

In This Article

Abstract and Introduction


The Global Polio Eradication Initiative continues to make progress toward the eradication target. Indigenous wild poliovirus (WPV) type 2 was last detected in 1999, WPV type 3 was last detected in 2012, and over the past 2 years WPV type 1 has been detected only in parts of 2 countries (Afghanistan and Pakistan). Once the eradication of poliomyelitis is achieved, infectious and potentially infectious poliovirus materials retained in laboratories, vaccine production sites, and other storage facilities will continue to pose a risk for poliovirus reintroduction into communities. The recent breach in containment of WPV type 2 in an inactivated poliovirus vaccine manufacturing site in the Netherlands prompted this review, which summarizes information on facility-associated release of polioviruses into communities reported over >8 decades. Successful polio eradication requires the management of poliovirus containment posteradication to prevent the consequences of the reestablishment of poliovirus transmission.


In 1988, the World Health Assembly resolved to eradicate poliomyelitis by the year 2000.[1] Much progress has been made toward this goal. Two of the 3 wild poliovirus (WPV) serotypes are either certified as eradicated (WPV type 2 [WPV2]) or have not been detected globally since 2012 (WPV type 3 [WPV3]). WPV type 1 (WPV1) continues to circulate only in parts of Afghanistan and Pakistan.[2] The eradication goal appears within reach.

Once the eradication of poliomyelitis is achieved, apart from rare cases of poliovirus excretors among immunodeficient persons,[3,4] polioviruses will only exist as virus stocks, cultures, and reagents in laboratories, vaccine production sites, and other facilities where live poliovirus stocks are maintained. An essential consideration for the certification of eradication of poliomyelitis as described in the Polio Eradication and Endgame Strategic Plan 2013–2018[5] and the Global Action Plan for Poliovirus Containment (GAPIII)[6] is the safe and secure containment of poliovirus within facilities designated by their governments for the posteradication retention of poliovirus materials. The declaration of the certification of WPV2 eradication in September 2015[7] accelerated the implementation of containment work as described in GAPIII. The withdrawal of Sabin poliovirus type 2 from the oral poliovirus vaccine (OPV) in April 2016 highlighted the importance of containment, and annual meetings of the Global Certification Commission (GCC) for the Eradication of Poliomyelitis beginning in September 2015, and especially in October 2017, clarified the GCC oversight responsibilities for containment.[8,9]

A laboratory accident involving the release of WPV2 from an inactivated poliovirus vaccine (IPV) manufacturing site in the Netherlands in April 2017[10–12] motivated this historical review to describe the frequency and consequences of similar breaches. Our objective is to remind management and workers at all laboratory and manufacturing facilities of their responsibility to assess the risks of stored materials.[13]