Australia's polio risk.

Australia, like all polio-free countries and regions, remains at risk of a wild poliovirus importation until polio is eradicated globally. The most probable route of importation will be through a traveller arriving in Australia either by air or sea from a polio-endemic or re-infected country. While the overall risk of an imported wild poliovirus infection leading to transmission within Australia is assessed as being low, some areas of the country have been identified as at increased risk. Local areas with relatively high arrivals from polio endemic countries, areas of low vaccination coverage and the potential for transmission to occur when these 2 factors are combined, were identified by this review as Australia's main polio risk. The risk of an importation event leading to locally acquired cases is mitigated by generally high polio vaccination coverage in Australia. This high coverage extends to residents of the Torres Strait Islands who are in close proximity to Papua New Guinea, a country identified as at high risk of poliovirus transmission should an importation occur. In 2012, all states and territories had vaccination coverage of greater than 90% at 1 year of age and all exceeded 93% at 2 years of age. Population immunity to wild poliovirus type 1, which remains the major cause of paralysis globally, has been estimated at 82%. This is sufficient to prevent outbreaks of this type in Australia. Of the 211 eligible non-polio acute flaccid paralysis (AFP) cases classified between 2008 and 2011, 91% (193) were vaccinated against polio at least once. High quality surveillance for AFP, which is supplemented by sentinel enterovirus and environmental surveillance activities, gives confidence that an imported case would be detected and appropriate public health action would ensue.