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In a remarkable global health achievement, poliomyelitis, commonly known as polio, has been virtually eradicated from all corners of the world, save for Afghanistan and Pakistan. However, the triumph over polio is accompanied by a lesser-known menace: non-polio enteroviruses, capable of inducing the same debilitating symptoms of acute flaccid paralysis (AFP). While vaccination efforts and surveillance have been robust against polio, the absence of formal systems to monitor and manage these enteroviruses presents a looming threat to global health.
At the ESCMID Global Congress in Barcelona, Prof Thea Kølsen Fischer of Nordsjællands Hospital & University of Copenhagen, Denmark, brought attention to the persisting risks posed by polio and other enteroviruses. Prof Fischer emphasized the establishment of the European Non-Polio Enterovirus Network (ENPEN) in 2017 as a pivotal initiative aimed at comprehensively understanding the burden of enteroviruses, including those causing polio-like paralysis.
The success story of polio elimination is commendable, with WHO estimating that over the past decade, approximately 10 billion oral polio vaccines prevented an estimated 6.5 million children from experiencing polio-induced AFP. However, sporadic cases of poliovirus-induced AFP still occur, even in regions declared polio-free. Recent instances in Israel and London underscore the persistent threat of poliovirus transmission, necessitating supplementary vaccination campaigns in affected areas.
Despite advanced surveillance systems in many countries, the detection of AFP cases caused by poliovirus remains a concern. Additionally, the emergence of vaccine-derived polioviruses, particularly in high-income settings, poses challenges to eradication efforts. Over the decade spanning 2014-2023, WHO Europe reported 25,687 AFP cases, including 741 linked to vaccine-derived polio, primarily in Russia, Ukraine, and Turkey.
Prof Fischer’s research, in collaboration with ENPEN, sheds light on the circulation of paralytic enteroviruses such as enterovirus D68 and enterovirus A71 across Europe. Their findings suggest genetic changes in enterovirus D68 may contribute to increased virulence, with documented rises in seroprevalence over time. Prof Fischer warns of the severe complications, including lasting paralysis, associated with enterovirus infections, emphasizing the urgent need for surveillance and preventive measures.
Despite the effectiveness of polio surveillance and vaccination programs, the lack of similar initiatives for non-polio enteroviruses is concerning. Prof Fischer advocates for routine testing of all AFP cases to identify the scale of the threat posed by these viruses. Without proper surveillance systems and vaccine development, the risk of non-polio enterovirus-related complications remains unchecked.
In conclusion, while strides have been made in polio eradication, the battle is far from over. The emergence of non-polio enteroviruses underscores the fragility of global health security. Prof Fischer’s call to action resonates: vigilance is imperative, and comprehensive surveillance and vaccination strategies are essential to confront the evolving threats posed by both polio and its lesser-known counterparts.
