A worldwide program to eradicate polio, the Global Polio Eradication Initiative, (GPEI) began in 1988. Since then polio has steadily disappeared from countries around the world, leaving only four with endemic polio by 2006: Afghanistan, India, Nigeria, and Pakistan.
Until polio is eradicated, however, all countries remain at risk for imported polio cases--especially those countries with low vaccination rates. In 2009, increased circulation of wild polioviruses in Nigeria led to imported cases and outbreaks in 12 countries in West Central Africa, three of which (in Mali, Mauritania, and Sierra Leone) continued into this year.
Recently the reintroduction of polio into the European region, which has been polio-free since 2002, has also become a concern. In June 2009, the European Regional Commission for the Certification of Poliomyelitis Eradication specifically identified Tajikistan as an area at high risk for polio transmission if wild poliovirus was introduced to the region, particularly because of low immunization rates. In April of this year, wild poliovirus type 1 was identified in stool specimens from individuals with acute flaccid paralysis cases in Tajikistan. As of November 1, 458 laboratory-confirmed cases of wild poliovirus type 1 had been reported in Tajikistan, with 26 deaths, of whom 15 were less than five years old. More