2014.ISDS.Abstracts.Final.pdf


ISDS Annual Conference Proceedings 2014. This is an Open Access article distributed under the terms of the Creative Commons Attribution-
Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all non-commercial use, distribution, 
and reproduction in any medium, provided the original work is properly cited.

160

ISDS 2014 Conference Abstracts

Protecting Australia from Future Polio Outbreaks
Beverley J. Paterson*1, Nicolee Martin2 and David N. Durrheim1

1Hunter Medical Research Unit, University of Newcastle, Newcastle, NSW, Australia; 2Australian Government Department of Health 
and Ageing, Canberra, ACT, Australia

Objective
Few countries have tested the sensitivity of their polio surveillance 

systems, undertaken a comprehensive risk assessment or questioned 
whether existing polio surveillance strategies are the optimal 
surveillance at this stage of the global eradication initiative. To 
address this issue, a risk assessment and review of Australia’s polio 
surveillance systems were undertaken to assess the potential risk of 
polio introduction by an infected person, product or specimen.

Introduction
The occurrence of global polio is at its lowest level, yet the goal 

of eradication remains elusive with the ongoing circulation in the 
three remaining endemic countries. Developed countries have a low 
index of suspicion for polio – relying on astute clinicians to detect 
imported cases and high immunisation rates to prevent community 
outbreaks. Australia, like all polio-free countries, remains at risk of 
a polio importation until polio is eradicated globally. Gaps in routine 
immunisation coverage coupled with weaknesses in surveillance may 
put developed countries, such as Australia, at risk of high impact polio 
outbreaks.

Methods
Methods utilised in the surveillance review and risk assessment 

included document review and semi-structured key informant 
interviews. Data were sourced from various published and unpublished 
government reports including immunisation coverage, movements of 
travellers, population immunity, population settlement statistics and 
polio surveillance data. Interviews were recorded, transcribed and 
thematically analysed.

Results
Vaccination coverage for polio in Australia is generally high but 

varies by geographical area, age group and Indigenous status. Lower 
areas of coverage have been identified among the general population. 
The potential for importation of a wild poliovirus exists in Australia 
with arrivals of travellers from polio endemic or re-infected countries, 
however serosurvey results indicate that there is sufficient herd 
immunity to prevent outbreaks of type 1 and type 2 poliovirus.

Australia meets some but not all of its polio surveillance objectives 
and there continues to be room for improvement, particularly stool 
sample surveillance targets. Case detection and outbreak mitigation 
were considered key reasons to undertake polio surveillance. 
Identified issues included: importance of supplemental environmental 
and enterovirus surveillance systems; potential high outbreak response 
costs resulting from an importation; continued importation risks; 
low stool sample collection rates; possible biosecurity inadequacy 
for imported samples and laboratory storage of biological samples 
containing poliovirus; and opportunities for improved legislative 
controls around polio. With most of the arrivals from polio endemic 
or re-infected countries settling in major cities, supplemental 
environmental surveillance in at least one major city would be useful.

Conclusions
Results from this work demonstrate that, while Australia has an 

impressive polio surveillance system, there are some gaps or risks 

that needed to be addressed. While the threat of an importation is 
low, ensuring that travellers and immigrants from areas where polio 
continues to occur are vaccinated against polio will help to address the 
risk. Polio vaccination coverage in Australia is high but there continue 
to be pockets where immunisation coverage is less than ideal, putting 
families at risk if an imported case were to be introduced into their 
area.

Recommendations from this work have resulted in improvements 
to surveillance, changes in biosecurity requirements for product 
importations that may contain wild poliovirus, and amendments to 
vaccination policies; all helping to protect Australia from future polio 
outbreaks.

Keywords
Surveillance; Polio; Needs assessment; Australia

Acknowledgments

The authors would like to acknowledge Dr Bruce Thorley and the team at 
the National Enterovirus Reference Laboratory at the Victorian Infectious 
Diseases Reference Laboratory.

*Beverley J. Paterson
E-mail: beverley.paterson@hnehealth.nsw.gov.au    

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * (1):e203, 201