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February 2008

All data as of 26 February 2008

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Headlines

WHO DG in Nigeria and Angola to support eradication efforts: WHO Director-General Dr Margaret Chan travelled to Nigeria and Angola during the week of 18 February, meeting with the presidents of both to support these countries' polio eradication efforts. Dr Chan has now visited each of the remaining polio-endemic countries in the past 12 months. Her visit to Angola coincided with recent confirmation of polio in the country. More
New FRR published: To assist financial partners in their medium-term planning, the GPEI has published its Financial Resource Requirements document, outlining a five-year plan and budget. For 2008-09, the GPEI faces a global funding gap of US$ 525 million against a budget of US$ 1.3 billion, of which US$ 175 million is needed for 2008. Details.
Progress evident halfway through intensified eradication effort: A review of 2007 data shows both endemic and re-infected countries reached key epidemiological landmarks since the intensified eradication effort was launched last year. Polio cases were reduced by 63% over 2006, and cases due to type 1 wild poliovirus – the most dangerous of the two remaining serotypes – have fallen 84%. The absence of type 1 polio from western part of Uttar Pradesh state, India, is a particularly striking development as this is the only area in India which had never interrupted indigenous poliovirus transmission. Polio has been cut by 76% in northern Nigeria; and 25 of the 27 countries re-infected between 2003-2007 have stopped transmission of imported poliovirus.
High risk of international spread of polio from Angola: With recent confirmation of polio in Angola, the risk of international spread is considered high. Angola is one of only two countries (along with Chad) not to have stopped its outbreak following re-infection. Internationally-agreed outbreak response guidelines must be fully and urgently implemented. See below for further details.
Executive Board highlights need for coordinated post-eradication planning: Recognizing the progress achieved in 2007 towards polio eradication, the Executive Board to the World Health Assembly (WHA), convening in Geneva, Switzerland in January 2008, highlighted the need for internationally-coordinated action to minimize the long-term poliovirus risks in the post-eradication era. Discussions will be continued at the upcoming WHA in May 2008. Details.

Country Focus

India

For 2007, 864 cases have been reported (80 type 1, 781 type 3, and 3 cases positive for both types). For 2008, 82 cases have been reported (all type 3).
Type 1 polio continues to decline. Success depends on preventing the re-infection with type 1 of areas which now appear to be type 1 polio-free, such as western Uttar Pradesh. In Q4 2007, despite the high season for polio transmission, only one type 1 case was reported in all of Uttar Pradesh
In a display of ongoing political engagement, Uttar Pradesh Chief Minister Mayawati reiterated that polio eradication was a top priority. "My government is committed to polio eradication," she told more than 8,000 people at a mini-marathon organized in her state capital. More.
Rapidly stopping type 1 polio in Bihar (the only area of India with ongoing low-level type 1 transmission, in well-defined access-compromised blocks) remains the strategic priority. It will be critical to interrupt the remaining chains of type 1 transmission by June, before the rainy season.
Strengthened engagement by the Government of Bihar is evident in increased local government involvement during polio campaigns.
The type 3 outbreak in Bihar is waning following two large-scale vaccination rounds with monovalent oral polio vaccine type 3 (mOPV3). Experience in western Uttar Pradesh shows that rapid implementation of mOPV3 campaigns has a significant impact on type 3 transmission.
Technical support to Bihar is being scaled-up, and campaigns are being staggered in the high-risk blocks, to enable re-deployment of additional technical officers from non-high risk areas. However, more needs to be done to rapidly and fully implement the specific strategy developed for reaching more children in access-compromised areas and stopping type 1 polio by June.

Nigeria

For 2007, 286 cases have been reported (116 type 1 and 170 type 3). For 2008, 19 cases have been reported (11 type 1, 5 type 3, and 3 cases positive for both serotypes).
In 2007, polio cases overall declined by 75% in Nigeria, compared with 2006. Cases due to type 1 polio declined by 86%.
Nigeria's second Immunization Plus Days (IPDs) of 2008 were held on 23-26 February, using mOPV3. This latest activity was officially launched by WHO DG Dr Margaret Chan, together with the Sultan of Sokoto, Alhaji (Dr) Sa’ad Abubakar III, the First Lady of Nigeria Hajia Turai Yar'Adua and WHO Regional Director for Africa Dr Luís Gomes Sambo.At the ceremony, Dr Chan called for increased engagement of Local Government Area (LGA) leaders, stating: "In every country, success against polio comes when local government leaders, community leaders and elders make the health of children a top priority. It is local ownership that solves the problems and ensures success."
As for the January IPDs (with mOPV1), operational improvements (including more effective micro-planning, supervision and vaccinator training) had focused on identified high-risk LGAs. In 2007, across the north, 18% of children remained un-immunized in key high-risk LGAs. Efforts must in particular be further strengthened in high-risk LGAs in Borno, Jigawa, Kano, Katsina, Kebbi and Zamfara states.

Pakistan and Afghanistan

For 2007, 32 cases have been reported in Pakistan (19 type 1 and 13 type 3); and 17 cases in Afghanistan (6 type 1 and 11 type 3). For 2008, 2 cases have been reported in Pakistan (both type 1); and 2 cases have been reported in Afghanistan (both type 1).
On 3-4 February, the technical consultation on polio eradication in Afghanistan and Pakistan in Cairo, Egypt, noted improvements in accessing populations in the southern region of Afghanistan. In some areas, including Pakistan's North West Frontier Province (NWFP), limited access is leading to an under-estimation of the proportion of missed children' during polio campaigns.
Despite existing challenges, strong work continues on both sides of the border. In addition to large-scale campaigns, focused and extended mop-ups using a mix of mOPV1 and mOPV3 were conducted in February in key areas, including in the southern region of Afghanistan and Pakistan's NWFP. As many as 2.5 million children were reached during such mop-ups.
Both countries continue to coordinate both campaign and disease surveillance, to maximize the impact of activities.

Re-infected countries

Angola - A polio case from 2008 has been confirmed in Luanda. The virus is genetically linked to Angola's previous case, from July 2007. Due to sub-national surveillance gaps, undetected circulation cannot be ruled out. The risk of international spread from Angola remains high; previous viruses had re-infected both Democratic Republic of Congo and Namibia. The outbreak must be finally stopped and the sub-national surveillance gaps filled.
Chad - Recent insecurity has increased the risk of spread of polio to neighbouring Cameroon and the Central African Republic (CAR). In response, vaccination is being conducted in Cameroon, along the border with Chad, and campaigns in CAR are being planned. All efforts must be undertaken in Chad to stop the outbreak in the country once and for all – a special emergency plan is currently being developed.
DR Congo - Although it has the highest number of cases of any re-infected country (41) in 2007, DR Congo has not had a case since November. While the absence of reported viruses for four months is encouraging, outbreak response activities are continuing.
Nepal and Niger - Both countries continue to be exposed to repeated importations, due to their proximity to endemic areas of India and northern Nigeria respectively. Both also continue outbreak response activities; in Nepal, the quality of activities has been affected by recent deterioration in security conditions.
Somalia - Somalia conducted its first National Immunization Days (NIDs) of 2008, on 28 January. Feedback indicates overall good quality was achieved, particularly on social mobilization and microplanning. Improvements on vaccine cold-chain were also seen. As a result of such strong efforts, despite challenging circumstances, Somalia has not reported a polio case in nearly 12 months (most recent case: 25 March 2007), following its re-infection in July 2005.

Polio eradication in 2008

The intensified polio eradication effort launched 2007 has reduced type 1 wild poliovirus by over 80% and restricted transmission to parts of four countries.

Reaching a polio-free world requires:

Further intensifying immunization activities in endemic areas with a mix of monovalent and trivalent vaccines.
Improving the ability to reach every child, particularly in northern Nigeria, Bihar in India, southern Afghanistan and parts of Pakistan.
Rapidly securing multi-year commitments for the financial resources necessary to implement polio eradication strategies.
Swiftly and fully implementing outbreak response guidelines in the remaining re-infected countries and taking steps to minimize the risk and consequences of international spread of polio.
Strengthening AFP surveillance at sub-national levels in central Africa and parts of Asia.

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.