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December 2006

Data as of 28 November 2006

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Headlines

  • New Director-General of World Health Organization pledges to eradicate polio: Dr Margaret Chan of China was appointed WHO Director-General in Geneva on 9 November 2006. During her first address to the World Health Assembly, Dr Chan vowed: "We will complete polio eradication". Before this appointment as Director-General, Dr Chan was Assistant Director-General for Communicable Diseases. Dr Chan has been with WHO since 2003, and her career in public health spans 30 years. Dr Chan's appointment follows the sudden death of Director-General Dr LEE Jong-wook in May.
  • Independent body says polio eradication is feasible in the four remaining polio endemic countries, citing added advantages of powerful new eradication tools: In October, the Advisory Committee for Polio Eradication (ACPE) highlighted in October that the monovalent oral polio vaccines (mOPVs), available since mid-2005, provide immunity more rapidly than the standard trivalent OPV and that new laboratory diagnostic procedures can detect and confirm polio infection twice as quickly, enabling a more rapid outbreak response.
  • The ACPE commended the engagement of Afghanistan President Hamid Karzai, who recently took oversight for polio eradication in the country. The ACPE highlighted the need for head of state oversight in Nigeria, India and Pakistan to ensure that during polio campaigns every child is immunized.
  • Saudi Arabian health directives for Hajj include polio vaccination for pilgrims: The Ministry of Health of the Kingdom of Saudi Arabia recommends that all Hajj travellers from the remaining polio-endemic countries Nigeria, India, Afghanistan and Pakistan - irrespective of age and previous immunization history - be immunized with oral polio vaccine (OPV) prior to departure for Saudi Arabia. All travellers from these countries - irrespective of age and previous immunization status - will also be required to receive an additional dose of OPV upon arrival in Saudi Arabia. Similar vaccination requirements are being applied to all persons under the age of 15 years, arriving from polio-infected countries.
  • Funding shortfall: Outbreak response activities have put a tremendous strain on the financial resources of the Global Polio Eradication Initiative. US$ 50 million is urgently needed by December for activities in the first quarter of 2007, with US$ 390 million still required for the balance of 2007 and 2008.

Country Focus

Nigeria
  • In 2006, northern Nigeria continues to account for the majority of global cases (1004 of 1723 cases). Six states in the north of the country - Bauchi, Jigawa, Kaduna, Kano, Katsina and Zamfara - remain the global epicentre of polio, with nearly half of all global cases.
  • Immunization Plus Days (IPDs) have been credited with increases in coverage for polio vaccination. While data for the 3rd quarter of 2006 indicates around 28% of children in the six states with the highest polio burden have never had a dose of OPV, this is an increase over the 40% never vaccinated as of the last quarter of 2005. Similarly, the proportion of children who have had more than four doses of vaccine nearly doubled in the same period. OPV was added to the measles campaign in early October. Immunization Plus Days (IPDs) were held 16-20 November.
  • In December, the Expert Review Committee on Polio Eradication (ERC) will scrutinize the impact of the IPD strategy over the last months and recommend the most appropriate schedule and type of supplementary immunization activities to rapidly end polio transmission.
  • The Sultan of Sokoto, a strong advocate for polio eradication in Nigeria, and a polio eradication officer from WHO/Nigeria, were among the victims of an air crash in late October. Col Sada Maccido, younger brother of the late Sultan, has been appointed as the new Sultan of Sokoto.
  • Independently of the activities of the Global Polio Eradication Initiative, a leading religious figure in western Africa has been touring northern Nigeria addressing his followers on the importance of immunization and their role in polio eradication. Imam Cheikh Hassan Cissé of Senegal, spiritual head of a large portion of the Muslims in the region, addressed mass gatherings of up to 20,000 people, and met with religious and traditional leaders in key northern states as well as with President Olusegun Obasanjo to discuss the religious responsibility to immunize children and the safety and effectiveness of the vaccine.
India
  • The outbreak originating in western Uttar Pradesh is on the wane in its epicentre but has spread to the eastern part of the state and several polio-free states. India has ten times as many cases in 2006 as in the same period last year. India's share of the global burden of the disease has risen to 30%, in contrast with only 3% of global cases at the same time in 2005.
  • While extensive, this outbreak is the smallest of recent outbreaks – 548 cases in comparison to 1600 recorded in the 2002 outbreak – thanks to better implementation of campaigns, increased number of staff and the use of mOPVs in the high-risk areas. The supplementary immunization activity (SIA) of 12 November was expanded to include all districts reporting cases in 2006 and neighbouring states at highest risk, covering nearly 80% of the country. The Union Minister of Health visited Bihar before the 12 November campaigns.
  • A collaborative study by researchers at Imperial College, London, the Entero-virus Research Centre (Indian Council for Medical Research), the World Health Organization and the National Polio Surveillance Project of India released on 16 November examines the unique environmental, sanitation and demographic factors contributing to intense transmission of wild poliovirus in Uttar Pradesh and Bihar. The results of the study underline the appropriateness of mOPV in this environment in order to confer immunity much faster in younger children, including the mucosal immunity needed to interrupt transmission.
  • The India Expert Advisory Group will meet 11-12 December to discuss and endorse new strategies for the upcoming "low" season for polio transmission, which presents a unique opportunity to interrupt transmission at a time when the virus is at its most vulnerable and when large numbers of children have been protected by the recent outbreak and vaccination campaigns.
Afghanistan and Pakistan
  • An outbreak of polio in Afghanistan's Southern Region (which has resulted in 29 cases in 2006) appears to be declining rapidly. Outside the Southern Region, only one other case has been reported in 2006, in the north eastern province of Nangarhar, which is in a corridor that sees much travel to and from Pakistan's North West Frontier Province (NWFP).
  • A technical consultation for Afghanistan and Pakistan's polio eradication efforts will take place in Oman on 6-7 December.
  • In Pakistan, 33 cases have been reported this year (compared with 22 cases for the same period in 2005) with the most intense transmission in the only two endemic areas of North West Frontier Province (15 cases) and Balochistan (9 cases). However, poliovirus is more geographically and genetically restricted than ever before (15 districts compared to 18 in 2005 and 49 in 2003), indicating progress.
Horn of Africa
  • Countries in the Horn of Africa continue to synchronize immunization campaigns in response to the outbreak in the region. Nomadic children of Somali populations remain at highest risk of polio transmission. While progress has been made in curbing the outbreak, recent confirmation of a case in Kenya - the first in the country in 22 years – underscores the fragility of progress and the ongoing risk polio continues to pose to children anywhere.

The state of polio eradication

Global polio eradication depends on the engagement of the leaders of the only four countries which have never stopped polio: Nigeria, India, Pakistan and Afghanistan.

In addition to the endemic countries, 12 countries have reported polio cases in 2006 due to importations (Somalia, Yemen, Indonesia, Bangladesh, Ethiopia, Kenya, Angola, Cameroon, Namibia, Niger, Nepal and DR Congo).

The strategies and tools to eradicate polio are better than ever. The programme now has vaccines which are twice as effective and diagnostic tools that detect and track poliovirus twice as fast as before.

The remaining challenges to a polio-free world are:
  • Strengthening political oversight at national, state and district level.
  • Curbing the intense transmission in the high-priority states in northern Nigeria and western Uttar Pradesh, India.
  • Increasing access to reach enough children with vaccine to break the final chains of transmission.
  • Continuing to apply the rapid response strategies to stop polio outbreaks in previously polio-free countries.
  • Addressing low routine immunization rates and surveillance gaps in polio-free areas.
  • Maintaining funding.

Polio eradication will only succeed with strong political commitment in polio-affected countries and if the necessary funds are made available. More than 10 million children will be paralysed in the next 40 years if the world fails to capitalize on its US$ 4 billion global investment in eradication.

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