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May 2008

All data as of 14 May 2008

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Headlines

New funding gap figures announced: Thanks to generous contributions from key donors, the Global Polio Eradication Initiative (GPEI) funding gap for 2008 has been reduced to US$ 135 million. For the 2008-2009 period, the global funding gap now stands at US$ 490 million. More.
Report on 2007 milestones published: A report on milestones set in The Case for Completing Polio Eradication is now published, and provides the roadmap to overcoming remaining challenges to polio eradication. More.
Angola demonstrates ongoing risk of importations: The type 3 poliovirus detected in Angola (a new importation from India) underlines the ongoing risk that endemic countries pose to the rest of the world. Details below.
India's Kosi River plan off to an encouraging start: Developed to improve access to children in remote areas of India's Bihar State, the Kosi River plan has rolled out with 20 additional surveillance medical officers (SMOs) deployed and initial reports of high coverage during supplementary immunization activities (SIAs) in April. Details below.
World Health Assembly (WHA) to discuss polio eradication: Delegates to the WHA have received a report on polio eradication and a resolution by the Executive Board on the mechanism for management of potential risks to eradication, for their consideration. More

Country Focus

India

In 2008, 222 cases have been reported (4 type 1 and 218 type 3).
Technical support to Bihar has been scaled-up in order to meet the primary objective of stopping type 1 poliovirus transmission in this key reservoir. The increased support is focused primarily on the high-risk blocks of Bihar, particularly access-compromised areas such as the Kosi River basin. Initial reports from the 27 April SIAs indicate strong technical and supervisory presence and high coverage rates in all visited areas.
The type 3 outbreak in Bihar is waning (148 cases reported in Quarter 1 2008, from 416 in Quarter 4 2007). The majority of type 3 cases in Bihar in recent weeks are in blocks with only one round of SIAs using type 3 monovalent oral polio vaccine (mOPV3). The most recent mOPV3 round was at the end of March.
The April SIAs used a mix of type 1 monovalent and trivalent oral polio vaccine (mOPV1 and tOPV), to maintain the pressure on type 1 transmission. Uttar Pradesh has passed a historic 5 months without any type 1 polio detected in the state; Bihar has reported 1 case of type 1 this year (January). However, mop-up vaccination response to type 1 in Delhi, Orissa and West Bengal has been limited, leaving these areas at risk of further type 1 transmission.
The Minister of Health held a review meeting of the polio eradication programme on 3 April, concluding that progress in stopping type 1 was encouraging and that the type 3 outbreak had been controlled.

Nigeria

In 2008, 167 cases have been reported (150 type 1 and 17 type 3).
The upsurge in type 1 cases in Nigeria to date this year is close to that of the entire year in 2007 (116), although transmission is geographically more limited. Over a fifth of the type 1 cases in 2008 are in Kano state (25 cases). Immunization Plus Days (IPDs) were held in ten northern high-risk states on 5-8 April, using mOPV1, followed by 19-22 April in high-risk districts of other states. This staggering of activities is to ensure that the highest-risk areas benefit from full concentration of human resources.
Improvements in operational quality and vaccination coverage are urgently necessary during the IPDs planned before Ramadan.
While Nigeria accounts for 84% of all type 1 polio cases in the world, transmission of type 3 is at low levels, with 8 reported this year. SIAs continue to intersperse mOPV1 and mOPV3 with tOPV to curb type 1 transmission in the north and stop the small type 3 outbreak around Oyo state.

Pakistan and Afghanistan

In 2008, 7 cases have been reported in Pakistan (all type 1 in Sindh province); and 6 cases have been reported in Afghanistan (4 type 1 and 2 type 3, all in the southern region).
In Afghanistan, national immunization days (NIDs) were held on 13-15 April, using a mix of mOPV3 and tOPV. The new strategy of Short Interval Additional Dose (SIAD) – introduced in January to deliver an extra dose to communities living in known transmission zones who are difficult to reach due to security conditions – was repeated on 20-22 April. The most severely security-challenged areas of the southern region have a target population of 750 000 children under the age of 5 years, out of a national target population of 7.6 million.
In Pakistan, all cases this year have been from Sindh province, from northern through central Sindh to Karachi in the south. Strategies to further improve operations in this province were discussed at the Regional Technical Advisory Group meeting in Cairo (12-13 April). These include the systematic concentration of technical support in highest-risk districts and greater reliance on independent monitoring and objective indicators such as finger-marking to guide SIA assessment.
SNIDs were held in transmission zones in Pakistan on 8-10 April, using a mix of mOPV3 and tOPV.

Re-infected countries

Angola

In 2008, 5 cases have been reported, 1 type 1 and 4 type 3. This is the first importation of type 3 poliovirus into Angola. Genetic sequencing indicates that the first type 3 case detected (with onset of paralysis on 19 March) is related to virus from Uttar Pradesh, India.
All cases have been in the Luanda area, where the second mop-up of the year was carried out on 18-20 April with mOPV1; a mix of mOPV1 and mOPV3 will be used during NIDs scheduled for 16-18 May due to the presence of type 3 poliovirus.

Central African Republic (CAR)

CAR has reported its first case – a type 1 – since November 2004. Genetic sequencing is awaited to determine the origin of the virus.
Detection of polio after a gap of over 3 years emphasizes the continued importance of sensitive surveillance, especially in the vicinity of endemic countries. NIDs were held on 4 April.

Chad

With 2 cases reported this year, both type 3, Chad remains a high risk country for polio transmission due to weak operations during its 2 SIAs this year, conducted in the midst of insecurity. Following a meeting between government and partners in early April, SIAs have been scheduled in staggered phases across the country due to security constraints: the first of these took place in the last week of April; the next are due to take place end-May and end-June. It is critical to boost population immunity before the onset of the rains in June.

Democratic Republic of Congo

Two cases have been reported this year, both type 1. The most recent is from the previously uninfected province of North Kivu; genetic sequencing is awaited to determine whether this represents a new importation.
Following a mop-up targeting 400 000 children on 10-12 April, using mOPV1, large-scale SIAs are planned for 8-10 May and again in June (also with mOPV1).

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, 4 SIAs have been held between December 2007 and April 2008, and no cases have been reported since 16 February. Niger's most recent campaigns were on 5 April, using mOPV1 along its border with Nigeria.

Horn of Africa

Two polio cases were reported in the Ethiopia/south Sudan cross-border area, the first polio reported this year to the east of Chad.
Confirmation of these cases, which are genetically related to previously circulating virus, underscores the need to sustain campaigns in this difficult-to-access area, and to urgently fill subnational surveillance gaps across central Africa. Although current population immunity levels across the Horn of Africa are higher than in 2004-2005, there is a risk of further polio spread, facilitated by frequent population movements.
A combined cross-border outbreak response is currently being planned. Two large-scale SIAs covering the whole of southern Sudan (targeting 2.5 million children) and 52 districts of south-western Ethiopia bordering southern Sudan (targeting 400 000 children) will be held in early May and again in early June, using mOPV1. Longer-term plans, also to strengthen sub-national surveillance gaps across several countries in central Africa, are being formulated.

Polio eradication in 2008

The intensified polio eradication effort launched in February 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.