You are here: > > >

November 2008

All data as of 25 November 2008

Download: english | français

Headlines

Global advisory body urges bold new initiatives to complete eradication: the Advisory Committee on Poliomyelitis Eradication (ACPE), the global advisory body to the Global Polio Eradication Initiative, has called for bold new initiatives to complete the job of polio eradication. The group noted the range of difference in the performance of eradication programmes facing unique epidemiological and operational challenges in each of the four remaining endemic countries, and provided clear country-specific recommendations to achieve success once and for all. The ACPE urged an interim review of progress against its recommendations in April 2009. More
India expert group optimistic at stopping type 1 polio: the India Expert Advisory Group on Polio Eradication (IEAG), convened in Delhi on 10-11 November, expressed optimism at the feasibility of interrupting type 1 polio transmission everywhere in the country during the coming low transmission season (dry season) in 2009. To cement gains made as a result of aggressive use of monovalent oral polio vaccine type 1 (mOPV1), the group urged the implementation of key contingency plans, including exploring the use of inactivated polio vaccine (IPV) as a supplement to mOPV1 campaigns in highest-risk areas. See 'India' section below for further details.
Gates commends Government of India: On a visit to India on 5 November, Bill Gates, Co-Chair of the Bill and Melinda Gates Foundation - a key supporter of the global eradication effort - praised the Government's commitment to polio eradication, saying India is on track to rid the country of polio and could be a model for other nations still struggling with the disease. "It's amazing what a large task this is," he said "Despite the challenges, I'm more convinced than ever that India will lead the way to the successful eradication of polio."
In Nigeria, new head of NPHCDA appointed, as country re-invigorates effort to stop type 1 outbreak:HE President of Nigeria Umaru Yar'Adua has appointed a new Executive Director of the National Primary Health Care Development agency (NPHCDA), the agency of Nigeria's Federal Ministry of Health with responsibility for immunization activities including polio eradication. Dr Muhammad Ali Pate assumed his new responsibilities on 14 November 2008. Nigeria has embarked on a re-invigorated effort to urgently stop this year's type 1 polio outbreak, which has spread further across west Africa with new cases reported in Mali and Togo. See 'Nigeria' and 're-infected countries' sections below, for further details.
Saudi Arabia steps up Hajj vaccination requirements: to minimise the risk of international spread of polio during the expected large-scale population movements for the upcoming Hajj (pilgrimage to Mecca, Saudi Arabia), the Kingdom of Saudi Arabia has published more stringent polio immunization requirements. All travellers from the four remaining polio endemic countries – regardless of age - must be immunized prior to departure for Saudi Arabia, and will receive an additional dose of OPV upon arrival. More than 350,000 Hajj pilgrims from Nigeria, India, Pakistan and Afghanistan are expected to travel to Saudi Arabia in early December. Travellers under the age of 15 years from re-infected countries will be subject to the same requirements. More

Endemic Countries

Nigeria

In 2008, 758 cases have been reported (697 type 1 and 60 type 3)In 2008, 496 cases have been reported (59 type 1 and 437 type 3).
In Nigeria, the ACPE noted that the re-invigorated high-level political commitment at the national level needed to be urgently translated into field-level improvements in operational quality.
State-level planning to address key operational challenges which continue to mar the quality of polio campaigns, has been intensified. As many as 60% of children remain under-immunized (≤3 doses) in key high-risk areas in the north.
Such state-level planning – coupled with increased political engagement at state- and local government area (LGA) level – has resulted in marked improvements in some areas. Of note are improvements thanks to renewed state governor engagement in Bauchi, Borno and Jigawa. Such state-level ownership however is not evident across other high-risk states in the north, where operations continue to be of low quality.
The key to rapidly improving the quality of campaigns and thereby stopping the current type 1 outbreak (and reducing further international spread – see ‘re-infected countries’ section below) is increased engagement and accountability by state governors and LGA Chairpersons across the highest-risk states of Kaduna, Kano, Katsina and Zamfara.
Kano state remains the global epicentre of type 1 polio. With 261 type 1 cases reported to date this year, it accounts for nearly one-third of all type 1 cases worldwide.
Nationwide, staggered integrated measles campaigns with mOPV1 were launched at the end of November (in the north), with the second wave to be held in December (in the south). Additional polio Immunization Plus Days (IPDs) in twelve high-risk LGAs in the north are planned for 17-21 December.

India

In 2008, 518 cases have been reported (65 type 1 and 453 type 3).
According to the ACPE, India has a very high performing programme which faces unique challenges due to highly-efficient poliovirus transmission coupled with suboptimal efficacy of OPV in some areas. The ACPE concluded that if current efforts are sustained and contingency plans recommended by the IEAG are implemented, wild poliovirus transmission will be rapidly interrupted.
Noting the low-levels of type 1 transmission at the end of this current ‘high season’ (rainy season), the highest priority identified by the IEAG is to continue the intensified type 1 outbreak response in western Uttar Pradesh. To cement the gains made against type 1 as a result of aggressive use of monovalent OPV type 1 (mOPV1), the use of inactivated polio vaccine (IPV) should be explored, as a supplement to mOPV1 rounds, in highest-risk areas of western Uttar Pradesh.
A plan was also finalized for the eradication of type 3 polio, during the 12-month period from mid-2009 onwards.
The IEAG finalized plans for early 2009, focusing on the continued aggressive mOPV1 use. Between July 2008 and March 2009, ten large-scale mOPV1 campaigns will have been implemented in both Uttar Pradesh and Bihar.

Pakistan and Afghanistan

In 2008, 103 cases have been reported in Pakistan (75 type 1 and 28 type 3); and 31 cases have been reported in Afghanistan (24 type 1 and seven type 3).
The ACPE noted that Afghanistan's eradication programme benefited from top political commitment and engagement, community determination and ongoing innovation, which has resulted in transmission of virus being largely restricted to security-compromised areas in the country's Southern Region (where 27 of this year's 31 cases have occurred). With increased access to high-risk areas here, polio transmission will be stopped.
A Presidential directive should be issued to all non-governmental organizations (NGOs) operating in the Southern Region to help secure increased access and to make polio eradication a key priority.
In Pakistan, the ACPE commended the solidity of the eradication programme, but noted that, like India, efforts faced the challenge of highly-efficient poliovirus transmission, which requires further improvement of the quality of polio campaigns through continued innovation (including a clearer programme assessment through seroprevalence surveys) and full and accountable oversight by district-level political leadership.
To address operational challenges in North West Frontier Province (NWFP), the Secretary of Health of NWFP convened a high-level strategy meeting with district-level health authorities in November. A similar task force was held by the Chief Minister of Punjab, to address ways to stop the current outbreak in this previously polio-free province.
Prime Minister Syed Yousuf Raza Gillani officially launched the latest nationwide immunization campaigns on 24 November, stating that operational issues needed to be addressed by the district administration to stop polio in the country. Similar high-level launches were held in the provinces by the provincial-level political leadership, and negotiations had taken place ahead of time among key stakeholders to increase access in security-compromised areas.

Re-infected countries

Highlighting that the risk of importations into polio-free areas remains high, the ACPE noted that fully implementing the internationally - agreed outbreak response guidelines (as recommended by the World Health Assembly in 2006) resulted in markedly reducing the consequences of new importations (ie leading to shorter outbreaks with fewer associated cases)

West Africa

In 2008, 24 cases have been reported from six countries (all type 1: two in Benin, one in Burkina Faso, five in Ghana, one in Mali, 14 in Niger and one in Togo).
The confirmation of new polio cases in Mali and Togo, as well as recent spread to Ghana, underscores the fact that west Africa continues to be at risk of international spread of polio from northern Nigeria. In 2003-2007, poliovirus originating from northern Nigeria re-infected 20 countries worldwide, causing outbreaks in countries as far away as Indonesia and Yemen.
Emergency, cross-border outbreak response activities across west Africa are ongoing. Three rounds of synchronized campaigns in the border areas of Benin, Burkina Faso, Mali and Niger have already been held (the most recent on 4 November), and activities are being planned in Ghana and Togo.

Chad

In 2008, 27 cases have been reported (one type 1 and 26 type 3).
Chad is affected by both type 1 and type 3 circulation. With suboptimal outbreak response activities implemented in 2008 (in quality, scope and timeliness of activities), the risk of further spread of polio within Chad and internationally is high.
Following recommendations by the recently-held Technical Advisory Group on Polio Eradication (TAG), Subnational Immunization Days (SNIDs) were held on 14 November in the west of the country, using mOPV1, and on 24 November in the east with mOPV3.

Horn of Africa

In 2008, 11 cases have been reported from two countries (one type 3 in West Darfur, Sudan; and 10 type 1s from the southern Sudan/western Ethiopia cross-border area).
Outbreak response campaigns were held on 24 November across northern Sudan and the southern Sudan/western Ethiopia cross-border area, using a mix of mOPV1 and trivalent OPV.
The overriding priority is to stop the type 1 outbreak in southern Sudan/western Ethiopia. Outbreak response campaigns continue to be marred by vaccination gaps; the key challenge is to increase access to populations in remote and/or conflict-affected areas.

Central Africa (Angola, DR Congo and CAR)

In Angola, 26 cases have been reported, three type 1 and 23 type 3.
SNIDs were held on 14 November using mOPV1, as part of ‘accelerated routine immunization activities’, during which a range of vaccines were offered to communities using a ‘fixed site’ approach. Further campaigns are planned for December.
In the Democratic Republic of Congo (DR Congo), four cases have been reported (all type 1).
The most recent outbreak response activity was held on 25 November with mOPV1 in the east of the country, and in Orientale and Equatorial provinces.
Increased insecurity in the east and associated large-scale population movements have hampered the activities. Key is to prevent spread of polio east into Burundi, Rwanda or Uganda.
In Central African Republic (CAR), two cases have been reported (both type 1)In the Democratic Republic of Congo (DR Congo), four cases have been reported (all type 1).
Three nationwide campaigns have been held, the latest on 24 November, and the next activity is planned for 18 December. The risk of further importations from both Chad (to the north) and the Democratic Republic of Congo (to the south) remains high.

Asia (Nepal)

In 2008, six cases have been reported (all type 3). Nepal remains at risk of importations from India, underscored again with a new case reported from the border district of Rupandehi this month. Nepal continues to conduct preventive immunization activities as well as case-responsive mop-ups.

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.