The polio eradication endgame: Why immunization and continued surveillance is critical

The poliovirus is very close to being eradicated from the world. To this end, the four main objectives of the World Health Organization's Polio Eradication & Endgame Strategic Plan 2013-2018 are to: detect and interrupt all poliovirus transmission; strengthen immunization systems and withdraw oral polio vaccine; contain poliovirus and certify interruption of transmission; and plan polio's legacy. There is a need to maintain vigilance for circulating vaccine-derived polioviruses as well as maintaining both epidemiological and laboratory surveillance for polio at this critical point in history. Despite the elimination of indigenous wild poliovirus transmission in Canada, the risk of wild poliovirus importation from endemic countries, and the risk of importation of circulating vaccine strains remains. Due to this ongoing risk, active surveillance of acute flaccid paralysis (AFP) in children less than 15 years of age remains important. At least one stool specimen from all suspect AFP cases should be sent to the National Microbiology Laboratory at the Public Health Agency of Canada for polio isolation and testing to support and verify Canada's polio-free status. An added benefit of this is that it may also help identify other non-polio enteroviruses, such as enterovirus D68.