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May 2006

Data as at 23 May 2006

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Headlines

Director-General of WHO passes away: Dr LEE Jong-wook, Director-General of WHO, passed away on 22 May, aged 61. It is with great sadness that the Global Polio Eradication Initiative bids farewell to one of its pioneers. Dr LEE's dedication to polio eradication spanned his entire career - from his management of immunization in WHO's Western Pacific Region to taking the programme under his wing as Director-General. That personal oversight ranged from his incisive technical insights to his advice on managing a programme with such a diverse array of partners. Dr LEE was the first UN agency head from the Republic of Korea . He began his five-year term as Director-General of WHO on 21 July, 2003 and is survived by his wife and son, two brothers and one sister and their families. Condolences can be sent to DrLee-tribute@who.int .
Tony Blair and Alpha Oumar Konaré named Polio Champions: British Prime Minister Tony Blair and Professor Alpha Oumar Konaré, African Union Chairperson, both received the prestigious Rotary International 'Polio Eradication Champion' awards, for their significant contributions towards a polio-free world.
Nigeria : trials of the new strategy to increase community engagement – Immunization Plus Days (IPDs) – were held in key districts. Five states in northern Nigeria (Bauchi, Jigawa, Kaduna , Kano and Katsina) account for two-thirds of all cases worldwide. This area remains the only place in the world with uncontrolled polio transmission.
India : trial administration of a birth-dose with monovalent oral polio vaccine type 1 (mOPV1) in key high-risk areas has been recommended by the India Expert Advisory Group (IEAG).
Democratic Republic of the Congo (DRC): a polio case is confirmed in DRC (in a district north of Angola ), the first in the country since December 2000. Genetic sequencing confirmed the type 1 virus – with onset of paralysis on 27 February – is an importation from Angola . An immunization response is currently being finalized.
Bill Sergeant honoured at World Health Assembly (WHA): on 23 May, William T (Bill) Sergeant of Rotary was honoured at the WHA. Mr. Sergeant, 86, is a founding personality in the global effort to eradicate polio, leading the programme overseeing polio eradication within Rotary International for more than 12 years. He has served in Rotary International for nearly six decades and received a personal citation from WHO at its annual assembly.
US$ 85 million funding gap: new contributions received between January and April have enabled plans to go ahead for part of the activities planned for 2006; an additional US$ 85 million will need to be mobilized by July in order to implement the remaining campaigns for the year.

Country focus

Nigeria

In 2006, 310 cases have been reported to date, compared to 77 cases for the same period in 2005.
Of the 37 states in Nigeria, five states in the north (Bauchi, Jigawa, Kaduna, Kano and Katsina) account for 86% of all cases in 2006 in Nigeria and more than two-thirds (70%) of all global cases. These states, where more than 40% of children have not received any doses of oral polio vaccine (OPV), form the only place in the world with uncontrolled transmission of wild poliovirus (where year-to-year incidence of polio continues to increase).
A trial for Immunization Plus Days (IPDs) was launched on 27 April, in key Local Governorate Areas (LGAs) in four states. IPDs are part of a new strategy to increasingly engage all communities in polio immunization and strengthen routine immunization.
IPDs across the north are to be launched on 25 May and again on 29 June.

India

27 cases have been reported in 2006 (compared with 14 for the same period in 2005), all in western Uttar Pradesh and Bihar .
One district in western Uttar Pradesh, Moradabad , accounts for 7 of the 27 cases this year. A review mission to Moradabad concluded that the increase in cases in the district is largely due to a decline in the quality of supplementary immunization activities (SIAs) during the last half of 2005. The review team noted improvements in the quality during the February and April 2006 SIAs.
The India Expert Advisory Group (IEAG), which convened in Delhi on 4-5 May, recommended specific activities to ensure a higher degree of oversight of activities in western Uttar Pradesh, as well as the administration of a birth-dose of mOPV1.
On 21 April, a fire at the global polio reference laboratory in Mumbai caused extensive damage. The lab is an integral part of the global polio surveillance network, conducting primary isolation from stool samples from acute flaccid paralysis (AFP) cases, from key endemic areas across Asia . It is anticipated that samples will again be processed through this lab within three months. Emergency contingency plans have already been put in place to ensure the impact on disease surveillance is minimal. Samples for primary virus isolation have been re-directed from the lab to other India network laboratories and some staff have also been temporarily assigned to assist other laboratories with handling the increased workload.

Pakistan and Afghanistan

In Pakistan , three cases have been reported this year, compared with seven for the same period last year. Pakistan 's most recent case had onset of paralysis on 28 April 2006.
In Afghanistan , six cases have been reported this year, compared with none for the same period last year. All cases are in the southern region of Kandahar , in the only remaining shared corridor of transmission with Pakistan (extending from Kandahar , into Pakistan 's Balochistan and southern Punjab /northern Sindh).
With polio restricted to border areas in both countries, all resources and efforts are focused in these areas, for intense 'mopping up' activities.
On 7 May, a synchronized mop-up was launched, to reach two million children in the hardest-to-reach areas of Afghanistan , and 14 million children in the hardest-to-reach areas of Pakistan . Staff from non-endemic areas in both countries were re-deployed to support the activity.

Nepal

In Nepal , a new polio case was reported from the west-central region in the interior of the country. It is the first case of wild poliovirus transmission in the country in 2006. Classification of a second case – from a contact (close to the border with Bihar state, India ) – remains outstanding. Both cases are undergoing genetic sequencing to determine their origins. An appropriate outbreak response to these most recent cases is currently being finalized.

Bangladesh

Bangladesh launched the first and second of three NIDs in April and May, in a rapid response to the recent importation of polio, to reach 18 million children under the age of five years. The third NIDs will be held in June.

Somalia and Ethiopia

In Somalia , 21 cases have been reported in 2006. Polio appears to be on the decline in Mogadishu , former epicentre of the outbreak. However, the virus has spread to new areas of the country, including to Lower Juba and Mudug regions. The risk of further spread across the Horn of Africa remains high.
In Ethiopia , two cases have been reported this year, in Somali and Amhara Regions. Coverage gaps during immunization activities continue to persist, especially in the Somali Region (where the most recent case was reported), close to the border with Somalia .
Somalia and Ethiopia will synchronize immunization campaigns, focusing efforts on reaching the hardest-to-reach populations. The first such synchronized campaigns will begin on 9 June.

The state of polio eradication

In 2005, the world passed several critical milestones towards polio eradication, including the successful introduction of the monovalent oral polio vaccines, visible progress in the hardest endemic areas and an end to west and central Africa's epidemic (outside Nigeria).

Only 4 countries are still polio-endemic - an all-time low: Nigeria , India , Pakistan and Afghanistan . Egypt reported its last poliovirus in an environmental sample in January 2005, and Niger 's cases in 2005 were all importations from Nigeria .

In addition to the endemic countries, eight countries have reported polio cases in 2006 due to importations ( Somalia , Yemen , Indonesia , Bangladesh , Ethiopia , Niger , Nepal and DRC).

The necessary tools to eradicate polio are in place. Stopping polio transmission can be completed rapidly, except in Nigeria , where at least an additional 12 months will be required to finish the job, due to intense transmission in key states.

The remaining challenges to a polio-free world are:

Curbing the intense transmission in the high-priority states in northern Nigeria
Sustaining campaigns to break the final polio chains in the other three endemic countries.
Rapidly stopping polio outbreaks in previously polio-free countries.
Addressing low routine immunization rates and surveillance gaps in polio-free areas
Maintaining funding and political commitment

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$4 billion global investment in eradication.