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May 2009

All data as of 04 June 2009

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Headlines

  • Extraordinary cooperation to tackle polio outbreaks: In the last 10 days of May, a total of 222,270,331 children in 22 countries were immunized against polio. This included more than 74 million children in 11 west African countries immunized by 400,000 polio vaccinators last weekend in a synchronized response to a wild poliovirus (WPV) outbreak from northern Nigeria that has swept as far westwards as Guinea. A further 70 million children in northern India, 29 million in Pakistan and 49 million children in Ethiopia, Kenya, Somalia, Sudan, DR Congo, Eritrea, Djibouti, Yemen and Nepal received oral polio vaccine. UNICEF's West and Central Africa Regional Office has developed an innovative interactive tool to follow the West Africa campaigns on googlemaps.
  • Pakistan polio team moves to immunize "inaccessible" children: Pakistan's polio program has been moving to immunize thousands of internally displaced (IDP) children fleeing the ongoing military conflict in North West Frontier Province (NWFP). As of 26 May, 71,671 children under five years of age had been vaccinated by transit teams on key routes out of the conflict area or in the 26 IDP camps established by UNHCR. But with more than 2.1 million people housed with host families or living in schools and other public buildings, emergency outreach immunization sessions are being undertaken - in addition to the Nationwide Immunization Days (NIDs) held last weekend - to reach all children under five. Swat has been inaccessible to immunization teams since October, 2008, meaning the current displacement of the population provides both an opportunity to reach under-immunized children and the possibility these children are carrying poliovirus out of inaccessible areas.
  • World Health Assembly, Africa Union and OIC express deep concern about spread of polio: The World Health Assembly has given a strong commitment to completing polio eradication, with WHO Director-General Margaret Chan urging global health ministers to "finish the job of polio eradication" and members showing deep concern over continued transmission in endemic countries - particularly in Nigeria - and the resultant international spread across west Africa and the Horn of Africa (more). Prior to the WHA, the African Union Ministers of Health met in Addis Ababa and reaffirmed their commitment to eradicating polio, requesting assistance to resolve operational challenges in polio-infected countries. And finally, from 23-25 May, the Organization of the Islamic Conference (OIC) Council of Foreign Ministers met in Damascus and urged the OIC to work closer with the Global Polio Eradication Initiative (GPEI) in providing greater assistance in the last remaining polio-endemic countries.
  • Blueprint for Eradication Drawn Up: The GPEI has published its latest Financial Resource Requirements 2009-2013 and Programme of Work - a blueprint for operations for 2009. Activities outlined in the Programme of Work 2009 are budgeted at US$ 785 million, part of a two-year US$ 1.43 billion budget. For 2009-2010, the GPEI faces a global funding gap of US$ 345 million (US$ 100 million of which is needed in 2009). The FRR and Programme of Work 2009 are available on our website.
  • Polio Network Keeps Eye on H1N1: Polio's vast surveillance networks continue to be used to search for cases of H1N1 infection, especially in sub-Saharan Africa and the Asian sub-continent. Polio staff at HQ, regional and country offices were also used throughout May to tackle the new influenza strain.


Endemic Countries

Nigeria

  • The total number of cases for 2009 is 288 – 68 type 1 wild polio virus cases (compared to 206 at this time last year), 219 type 3, and one type 1-type 3 mixture. Nigeria also has a significant outbreak of circulating vaccine-derived poliovirus, with 71 cases confirmed for 2009.
  • Nationwide Immunization Plus Days (IPDs) were held from 30 May-2 June, using trivalent OPV (tOPV), and initial reports suggest they were of improved standard. New IPD Preparation Guidelines were followed, independent monitors trained by WHO were in place to verify micro-plans, and in most high-risk states, Governors showed genuine commitment to ensuring a high-quality campaign. This may be attributed to the planning and support demonstrated by the Minister for Health when he chaired a meeting of all State Task Forces on 7 May in Abuja to ensure implementation of the Expert Review Committee recommendations.
  • Supplementary Immunization Plus Days are planned for 4-7 July, using mOPV1, 1-4 August, using tOPV, and 10-13 October, using mOPV3.

India

  • The total number of cases for 2009 is 59, compared to 251 at this time last year. Of these, 18 cases are type 1 (compared to four type 1 cases at this time last year) and 41 are type 3.
  • A number of type 1 cases from Saharsa, Bihar, has resulted in the Kosi River Operational Plan being revived to tackle the operational challenges in the area, largely revolving around a lack of infrastructure. Several satellite offices will again be set up as a result to ensure as many children as possible can be reached in upcoming immunization activities.
  • Following the recent elections, a new Union Minister of Health and Family Welfare, Mr Ghulam Nabi Azad, has been appointed.
  • The National Polio Surveillance Project (NPSP) is keen to replace 72 Surveillance Medical Officers (SMOs) after the on-loan senior figures were recently recalled by their state governments. These positions have played an essential role in ensuring the efficacy of the immunization activities.
  • A large-scale clinical trial in Moradabad, northern India, is being completed. This trial aims to evaluate the residual immunity gaps among young children in western Uttar Pradesh (UP) to enable the polio programme to adapt strategies to close this gap, using either higher-potency mOPV1 or inactivated poliovirus vaccine (IPV) or both. More than 1000 children aged six to nine months from low socio-economic backgrounds have been recruited for the trial.
  • A Sub-National Immunization Day (SNID) was held in UP, Bihar, and key high-risk and re-infected areas on 24 May, targeting 69.1 million children with mOPV1. It was a challenging round, with activities interrupted in west Bengal and the Kosi River basin due to cyclonic rains and flooding. In Punjab, activities were hampered by a curfew due to riots while in Delhi, the necessary house marking was banned due to the Indian elections.
  • The next supplementary immunization activity (SIA) is currently proposed for 28 June.

Pakistan

  • Pakistan has reported 17 cases in 2009, 10 type 1 cases and seven type 3.
  • A large mop-up, using mOPV3 and targeting 2.2 million children in response to a WPV3 case in northern Sindh, was conducted in early May, while the NIDs, targeting 29 million children using tOPV, were completed from 28-30 May.
  • With two cases of type 1 and two cases of type 3 polio in Karachi this year, the area continues to act as a key polio reservoir despite the fact immunizers have access to all children around the city. It is essential that district-level health teams improve their implementation and management of the polio immunization campaigns in the Karachi townships to prevent the spread of polio within the country.
  • Pakistan's National Control Cell, which uses TV stations to advertise immunization days and to monitor the performance of the NIDs, enabling "missed" children to subsequently be immunized, has been recognized by the Innovations in Journalism Conference being held at Stanford University. The cell played a vital role in raising the profile of the immunization campaign, as well as monitoring its operational efficiency. In addition, the National Highways and Motorways Police and National Database and Registration Authority (NADRA) provided teams to immunize children, while Pakistan's largest mobile phone operator, Mobilink, sent out millions of short text messages supporting the NID.
  • A SNID is planned from 22-24 June, using mOPV1.

Afghanistan

  • Afghanistan has reported seven cases in 2009, all of them wild poliovirus type 1 (WPV1). The most recent case, from Kandahar, had onset of paralysis on 19 April. All but one of the cases are located in the Kandahar and Hilmand provinces in the south-east. The case reported in the eastern province of Nooristan is an importation from Pakistan's North West Frontier Province.
  • A NID was held from 23-25 May, using tOPV, however initial monitoring reports suggest immunization teams continued to be obstructed by anti-government forces in some key southern areas, with 196,000 children missed as a result. At the Pakistan and Afghanistan TAG meeting in Cairo last week, significant developments were reported towards the possibility for holding Days of Tranquillity in southern Afghanistan to tackle this issue.
  • Further sub-national immunization days are planned for 21-23 June in selected southern districts, using mOPV1.

Re-infected countries

West Africa

  • West Africa has reported 64 cases in 2009 (type 1: 19 in Benin, 14 in Cote d'Ivoire, 10 in Burkina Faso, six in Togo, one in Guinea and one in Mali; type 3: 13 cases in Niger). After a type 1 case was confirmed in Guinea (the first polio case in that country since 2004), eight West African countries have now been re-infected with polio in the past 12 months.
  • The vast majority of cases had onset of paralysis prior to the start of the large-scale, multi-country synchronized outbreak response campaigns held in late February and March. Currently, seven cases had onset of paralysis after the March round and are thus considered "breakthrough" cases - of these, five are in Cote d'Ivoire, one in Benin and one in Guinea. It is hoped that the end-of-May synchronized outbreak response in 11 countries (including preventive campaigns in Sierra Leone and Liberia) will stop the outbreaks. A further immunization activity will be held in Guinea - probably in conjunction with several neighbouring countries - in late June.
  • Benin postponed its participation in the synchronized round due to a health workers strike - a serious situation given Benin's number of type 1 cases and the fact it has already reported a "breakthrough" case since the March NID. Negotiations are ongoing to resolve the situation rapidly. Everything is in place (vaccine, vaccination teams, microplans, etc) to start the NIDs as soon as the situation is resolved.

Horn of Africa

  • The Horn of Africa has reported 56 cases in 2009 – all type 1 – with 35 cases in Sudan, 13 in Kenya and eight in Uganda.
  • Outbreak response is continuing across the Horn of Africa. An SIA was held in southern Sudan on 26 May, with further activities in the pipeline for late June.
  • In Uganda, a NID (in conjunction with a measles campaign) using tOPV is to be held from 6-8 June. Kenya held SNIDs from 23-27 May in key districts along the Rift Valley, using mOPV1, with another round planned for the end of June. Both Uganda and Kenya also have plans for the addition of OPV to nationwide measles activities during the course of 2009.
  • Ethiopia held an SIA in high-risk areas from 22-25 May, using mOPV1 and tOPV, with another round planned in the Somali Region from 15 June and mid-July. Eritrea held an SIA on 6 May, its first since December 2005, using tOPV, Somalia held an NID on 25 May, while Djibouti and Yemen are planning SIAs in June.

Central Africa (Angola, DR Congo and CAR)

  • To date, Angola, DR Congo, and CAR have reported 14 cases in 2009 (type 1: six cases in Angola; type 3: eight cases, seven in CAR and one in DR Congo).
  • CAR is tackling a significant outbreak of type 3 polio in an area close to the border with Chad. The NID planned in CAR for late May using tOPV has been postponed until 5 June. Further immunization activities, in conjunction with a measles campaign, will be held in July.
  • Although no type 3 polio has been reported in Angola this year, the detection of two type 3s in southern DR Congo, closely related to the Angolan outbreak, suggests that transmission of this serotype is ongoing. Angola conducted a mop-up in parts of Benguela and Namibe from 24-26 April. The Luanda case will be covered by NIDS planned for 15-28 June (in conjunction with a measles campaign), July and August, all with tOPV.
  • DR Congo held a SNID on 7 May, with further SNIDs planned for 4 June and 9 July, using a mix of mOPV1, mOPV3 and tOPV, depending on the risk and circumstances.

Chad

  • A type 3 case from Chari-Baguirmi remains the only case in 2009, with onset of paralysis on 1 April.
  • The AFRO Regional Director, Director of Polio Eradication at WHO, Chair of the Africa Interagency Coordinating Committee and Chair of the Africa Regional Certification Committee visited Chad in May to review the challenges facing the polio program and meet with the Government.
  • A staggered, nationwide campaign using tOPV and mOPV1 was completed from 15-17 May. A further sub-national round is planned for the south-west from 19-21 June, using mOPV3, with NIDs using tOPV planned for October and November.

Nepal

  • Nepal has no reported cases of polio in 2009. It conducted the second round of a NID on 29 May, using tOPV1.


Polio eradication will only succeed if the necessary funds are made available, and with strong political commitment in polio-affected countries. More than 10 million children will be paralysed in the next 40 years if the world fails to capitalize on its >US$5 billion global investment in eradication.