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May 2007

Data as of 15 May 2007

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Headlines

WHA urges intensification of polio efforts: At the World Health Assembly (WHA) in Geneva, Member States adopted a resolution urging an intensification of eradication efforts to rapidly interrupt the remaining chains of indigenous transmission and further limit potential international spread of the virus.
'Case for polio eradication' presented at WHA: In follow-up to the WHO Director-General (DG) Dr Margaret Chan's 28 February Urgent Stakeholder Consultation, a side meeting with key stakeholders was held in the margins of the WHA, to discuss the DG's final 'Case for Completing Polio Eradication'. The 'Case' document summarizes the financial and humanitarian benefits of completing polio eradication, and is setting the stage for intensive resource mobilization activities to fill the 2007-2008 global funding gap of US$ 540 million. "Finishing the job of polio eradication is our best buy," said Dr Chan in her opening remarks to the WHA. "We must do it. We are leaving a perpetual gift to generations of children to come." The 'Case' document is available at http://www.polioeradication.org/content/general/TheCase_FINAL.pdf .
Immediate injection of cash urgently needed: By July 2007, the Global Polio Eradication Initiative will have a negative cash flow, which if not addressed will require an immediate reduction in planned polio eradication activities in the remaining infected countries. Even a temporary cutback would result in the reinfection of polio-free areas, delays in outbreak response, a surge in polio-paralyzed children and an increase in overall costs. Insufficient funds at this late stage imperil the entire 20-year eradication effort, as well as related gains in routine childhood immunization, global communicable disease control, preparedness and response, and other child survival and international health activities. For further information, please visit www.polioeradication.org/fundingbackground.asp .
WHO DG meets Afghanistan and Pakistan heads of state on polio : On 29 April and 1 May, WHO Director-General Dr Margaret Chan and EMRO Regional Director Dr Hussein A Gezairy met with President Hamid Karzai of Afghanistan, and Prime Minister Shaukat Aziz of Pakistan. Discussions focused on both countries' combined efforts to interrupt the final chains of polio transmission which straddle their common border. In particular, the leaders discussed new approaches to increasing access to all populations, including the use of Days of Tranquility in Afghanistan, engaging semi-autonomous populations in Pakistan and reaching mobile populations travelling across the common border. In Afghanistan, Dr Chan also met with NATO and the International Security Assistance Force to explore ways of negotiating pauses in conflict to allow polio vaccination teams safe passage during campaigns. For further information, please click here.
Lancet studies show cost-effectiveness of polio eradication and efficacy of monovalent OPV type 1: The Lancet published two studies with important implications for the Global Polio Eradication Initiative. The first study, by Kim Thompson et al from Harvard University, demonstrates the cost-effectiveness of polio eradication, both from an economic and public health point of view. The second study, by Nick Grassly et al from the Imperial College of London, highlights the greater efficacy of the new monovalent oral polio vaccine type 1 (mOPV1) compared with trivalent OPV. For detailed interpretations of both studies, please click here.
Polio confirmed in Myanmar: a polio case is confirmed in Myanmar, the first wild polio in the country since 2000 and is most likely an importation. (See 'Re-infected countries' section below, for further details.)
Less type 1 than type 3 polio in 2007: In 2007, for the first time ever, there are fewer type 1 polio cases than type 3 cases in the endemic areas (see 'Nigeria', 'India' and 'Pakistan' sections below). This suggests that the strategy of large-scale use of monovalent oral polio vaccine type 1 (mOPV1) to prioritize the eradication of this virus, given its historically higher disease burden and potential to spread internationally, is working.

Country Focus

Nigeria

In 2007, 73 cases have been reported, of which 56 are due to type 3 poliovirus.
The government's National Programme for Immunization (NPI) has now been integrated with the National Primary Health Care Development Agency. All efforts must be undertaken to ensure that this move does not adversely affect the gains made in polio eradication and routine immunization over the past 12 months.
The Expert Review Committee on Polio Eradication (ERC) convened in Abuja on 3-4 May. The ERC noted the steep decline (78%) in type 1 polio in 2007 compared to previous year, as well as progress achieved towards strengthening of routine immunization and polio eradication. At the same time, however, the ERC highlighted the need to close the immunity gap in critical northern states (some of which still have 25% of children below five years of age who have never received a dose of OPV), through higher quality immunization campaigns achieving consistently high coverage.
The next Immunization Plus Days (IPDs) will be held on 23-26 June.

India

In 2007, 48 cases have been reported. In Uttar Pradesh state, one of only two remaining endemic states (along with Bihar), 18 of the state's 28 cases are due to type 3 poliovirus. No type 1 polio has been reported in the five traditional high-risk districts of western Uttar Pradesh (Moradabad, JP Nagar, Bareilly, Rampur, Badaun), since 2 October 2006.
Four large-scale immunization campaigns have already been conducted in 2007 with mOPV1. To support campaigns in key high risk districts, WHO surveillance medical officers (SMOs) from polio-free areas are routinely re-deployed.
A recent campaign on 8 April was made possible in part thanks to a rapid, last-minute effort by polio partners Rotary and the National Polio Surveillance Project (NPSP). During the planning stages of the campaign, it became apparent that a vaccine-shortfall of more than four million doses was going to affect 17 districts in Bihar. To ensure this shortfall was filled in time of the campaign, Rotary arranged for special permission from Union Railway Minister Laloo Prasad Yadav, to transport 3.3 million doses of vaccine from Delhi, Haryana, Punjab and Uttar Pradesh, on the high-speed Rajdhani Express train. At the same time, a Rotary-hired truck took 700,000 doses of vaccine from Lucknow, Uttar Pradesh, to Patna, Bihar.
New Chief Minister of Uttar Pradesh, Mayawati, called polio eradication a state priority, as she launched the most recent campaigns.

Afghanistan and Pakistan

In 2007, in Pakistan, 7 cases have been reported; 2 cases has been reported in Afghanistan. In Pakistan, 5 of the 7 cases are due to type 3 polio.
A joint Afghanistan/Pakistan Technical Advisory Group (TAG) convened in Islamabad on 17-19 April, to review epidemiological and programmatic data. The TAG highlighted that real progress was achieved in 2006, with the virus now limited to known reservoirs that straddle the two countries and which must be tackled together. The TAG's recommendations focused on intensifying efforts in areas of known polio transmission, and increasing access to populations living in insecure areas, semi-autonomous populations and mobile populations.
In April, Pakistan and Afghanistan coordinated the fourth large-scale immunization campaign of 2007 (following activities in January, February and March), collectively reaching nearly 50 million children under the age of five years. Focus was again on increasing access to populations in border areas and mobile populations. Nomadic routes were mapped, and vaccination points were set up at key gathering places and at major border-crossings.
Officially launching polio immunization activities in Pakistan, Prime Minister Shaukat Aziz re-affirmed the government's commitment, vowing: "Pakistan is committed to eradicate polio from the country very soon."
An audio-slideshow of polio vaccination campaigns along the Afghanistan-Pakistan border is available for viewing (and in downloadable format) at www.polioeradication.org .

Re-infected countries

Myanmar is currently planning a targeted polio immunization campaign as a rapid response to a probable importation from neighbouring Bangladesh, and in advance of the onset of the rainy season in July. Three large-scale, internationally-coordinated cross-border campaigns with Bangladesh are being planned, the first of which was held in mid-May. Active disease surveillance activities are also ongoing in the area, to rapidly detect any further cases.
In the Democratic Republic of the Congo (DR Congo), 2 of the 3 outbreaks due to imported poliovirus from Angola appear to have been stopped, with expanded outbreak response activities continuing to address the ongoing transmission in Bandundu/Equateur provinces. A total of 12 cases have been reported in DR Congo this year. Although no new cases have been reported from Angola this year, undetected circulation cannot be ruled out due to ongoing subnational surveillance gaps (as confirmed by genetic sequencing of the 2006 cases in Angola and some of the 2007 cases from DR Congo). At an Angola TAG meeting held in April, rapidly filling these surveillance gaps was discussed.
In the Horn of Africa, outbreak response activities are continuing to stop the two known areas of ongoing transmission, in the cross-border area in northern Somalia and the Somali region of Ethiopia, and central Somalia. At a Horn of Africa TAG meeting in April, the need for intensified cross-border activities was highlighted.
Niger and Nepal continue to be at particular risk of repeated, isolated polio importations, due to their geographic proximity to endemic areas (northern Nigeria, and Bihar and Uttar Pradesh, India).

The state of polio eradication

The world now has a second and best chance to eradicate polio: almost all outbreaks in re-infected countries after the international spread of 2003-2006 have been stopped. Only four parts of four countries have never interrupted indigenous wild poliovirus transmission: Nigeria, India, Pakistan and Afghanistan. Global polio eradication depends on the engagement of the leaders of these four countries.

The 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.

Policies to minimize the risks and consequences of international spread of poliovirus are now in place: travellers to and from polio-endemic countries are advised to be fully vaccinated before travel.

The remaining challenges to a polio-free world are:

Rapidly overcoming the remaining operational challenges to reaching every child in the four endemic areas of Nigeria, India, Pakistan and Afghanistan.
Rapidly making available the necessary financial resources to fully implement polio eradication strategies.
Continue outbreak response activities in the remaining re-infected countries, and minimise the risk and consequences of further international spread of polio.
Increasing polio vaccination coverage through routine immunization services.
Maintaining high quality AFP surveillance in all countries.

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.