You are here: > > >

August 2009

All data as of 08 September 2009

Download: english | français

Headlines

Evaluation teams complete field visits: The Independent Evaluation of Major Barriers to Interrupting Polio Transmission is well under way, with teams having visited Nigeria, India, Pakistan, Afghanistan, Sudan and Angola. The teams are now collecting their observations, with team leaders expected to present their recommendations to the Oversight Committee at the end of September. The Evaluation Report will lead to area-specific action plans which will be incorporated into the 2010-2014 Global Polio Eradication Initiative (GPEI) Strategic Plan. More
Polio eradication receives Pakistan's stamp of approval: Pakistan President Asif Ali Zardari has requested that the photograph of the former Prime Minister, Benazir Bhutto, immunizing a child with oral polio vaccine be issued as a postage stamp to increase awareness of polio eradication efforts.
Festival season upon us: The lunar month of Ramadan began on 21 August and will end with Eid-ul-Fitr. While this usually means it is difficult to implement immunization campaigns, extra campaigns are taking place in Afghanistan and Pakistan in response to recent cases. Once again, the Kingdom of Saudi Arabia has declared that it requires all pilgrims from infected countries be vaccinated against polio. For Hindus, Diwali and a variety of local festivals take place in October and November. For all these occasions, large gatherings and mass movement of people are typical.
Polio remembers: World Humanitarian Day was held on 18 August to honour the dedication of people who work in the world's most challenging, dangerous locations and to remember those who have lost their lives while trying to assist others. From the very basic living conditions of the Kosi river basin in India to the physical dangers of Afghanistan or southern Sudan, GPEI staff continue to make profound sacrifices.
Prime Minister of India asks Health Minister "to eradicate polio": Dr. Manmohan Singh expressed concern over the spurt in polio cases in Uttar Pradesh and Bihar, and directed the Health Ministry to closely monitor the situation and take effective steps to eradicate the disease. The Government of India has set aside US$ 657 million from its budget for its polio eradication activities for 2010-2012. This follows similar financial commitments in past years by the Government of India".
New CDC boss urges involvement in polio campaigns: One of Dr Tom Frieden's first actions as the new Director of CDC was to call on staff to join the Stop Transmission of Polio (STOP) Program. "The polio eradication initiative requires additional qualified public health experts in the field to achieve success," Dr Frieden wrote to staff. "I strongly encourage qualified staff to apply and for supervisors to permit their participation as team members in the Enhanced STOP Initiative. Thank you for your continued support of CDC's efforts to help eradicate polio."

Endemic Countries

Nigeria

The number of cases for 2009 is 379: 73 type 1 cases, 304 type 3 cases, and two type 1/3 co-infections. Last year at the same time, Nigeria had 646 cases in total: 595 type 1 and 50 type 3.
Nigeria continues to make progress at significantly reducing transmission of type 1 polio - in the traditional, high-risk northern states of Kano, Kaduna, Katsina and Jigawa, no WPV1 cases have been reported in the past six months, indicating significant operational improvements in the delivery of immunization.
Nigeria has a significant outbreak of an ongoing type-2 circulating vaccine-derived poliovirus (cVDPV), with 143 cases confirmed for 2009. In response, the May and August campaigns were conducted with trivalent OPV.
The outbreak of violence in some northern states and logistics obstacles in others forced the program to stagger its Sub-national Immunization Plus Days (SIPDs) – initially planned to be held from 1-4 August – over three weeks. Continuing the improved political engagement, a number of State Governors and LGA chairmen launched the campaigns and generated media coverage.
The Expert Review Committee on Polio Eradication is meeting on 10-11 September, in Kaduna.
SIAs are planned for October, using mOPV3 across the northern and middle-belt states.

India

The number of cases for 2009 is 284: 38 cases are type 1, 245 are type 3 and one is a type 1/type 3 co-infection. Last year at the same time, India had 397 cases: 20 type 1 and 377 type 3.
Sub-national Immunization Days (SNIDs) began on 9 August, with Uttar Pradesh using mOPV3 vaccine in most areas and mOPV1 in some districts with recent WPV1 cases. Bihar used tOPV except in those districts with recent WPV1 transmission where mOPV1 was used.
While type 3 transmission is consistently high, it is focused around the traditional high-intensity transmission districts of western UP. As interrupting type 1 remains the overarching priority, the strategic choice of vaccine alternates between mOPV1 and mOPV3, with preferential use of mOPV1 in targeted areas.
As part of Bihar's Kosi River Task Force, which is designed to increase access in this difficult-to-reach area, the Munger sub-regional office has been relocated to Khagaria to be closer to the high- risk areas.
SNIDs ran from 9 August, with Uttar Pradesh using mOPV3 vaccine in most areas and mOPV1 in some districts surrounding recent WPV1 cases. Bihar used tOPV except in those districts with recent WPV1 transmission.
The next Supplemental Immunization Activities (SIAs) are scheduled for 10 September in UP and 13 September in Bihar, using mOPV1. Following that, it is hoped that SIAs in early November will use the new bivalent oral polio vaccine, which will tackle both WPV1 and WPV3 serotypes concurrently.
Four VDPVs have been confirmed in 2009. Three VDPV type 2, and one VDPV type 1. There is no evidence of secondary spread with any of these VDPVs

Pakistan

Pakistan has reported 49 cases in 2009 – 30 type 1 cases, 18 type 3 cases, and one type 1/type 3 co-infection-compared with 43 cases at the same time last year, 34 type 1 cases and nine type 3.
SNIDs were held from 17-19 August, targeting 17.4 million children using a combination of mOPV3 and mOPV1 vaccine. While access to children was improved in Malakand, no Supplemental Immunization Activities (SIAs) were conducted in south Waziristan due to a deteriorating security situation.
The recent increase in newly reported cases is associated with an improved access to previously inaccessible areas of North West Frontier Province, including SWAT and Bajour.
A case response mop-up is scheduled from 11-13 September, targeting 8.5 million children in 28 districts of Sindh, NWFP/FATA and Punjab. This follows the reporting of a type-1 polio case from North Waziristan - a locality that shares borders with Afghanistan, meaning six bordering districts of Khost province in south-east Afghanistan will conduct a campaign in the same week.
Further NIDs using tOPV are planned for October and November.

Afghanistan

Afghanistan has reported 20 cases in 2009, 15 type 1 and five type 3, compared with 16 cases at the same time last year - 11 type 1 cases and five type 3.
With long-running security concerns around the Presidential elections held on 20 August, the polio eradication team has prepared for months for possible impacts on activities. Ahead of the elections, in keeping with UN security protocols, international staff moved out of the country. National staff, however, continued to provide support to the day-to-day operations of the programme, including surveillance, coordination with NGOs and vaccine supply matters.
The polio eradication programme continues to monitor the situation closely, adapting activities, utilizing windows of opportunities and responding to UN security directives.
As a goal to protect children of all communities from poliovirus, the eradication programme actively seeks the support of parties on both sides of the conflict, and the team on ground works hard to maintain that support.
SNIDs will be held from 13-15 September. This activity initially aimed to vaccinate children in 13 high-risk districts of the Southern Region, but following recent detection of a type-1 case in the Western region, will be expanded to include up to 30 districts.
The immunization activity is aimed to revolve around International Peace Day (20 September)-a nationwide campaign revolving around the theme "What are you doing for peace?" Created by a resolution of the UN General Assembly, International Peace Day is "a day of global ceasefire and non-violence.”

Re-infected countries

West Africa

While the outbreak in the far west of Africa (Côte d'Ivoire, Guinea, Liberia and now Sierra Leone) continues, no new cases have been reported in Benin, Burkina Faso, Ghana, Niger or Togo since May, clearly indicating that when implemented thoroughly, the established outbreak response plans work quickly and effectively.
West Africa has reported 114 cases in 2009 (Benin 20; Burkina Faso 12; Côte d'Ivoire 25; Guinea 21; Liberia 9; Mali 2; Niger 17; Sierra Leone 2; and, Togo 6).
All of these cases are type 1, with the exception of Niger, which has one type 1 case and 16 type 3 cases.
Aggressive, multi-country outbreak responses continue: A multi-country SIA was held from 14 August in Côte d'Ivoire, Guinea, Liberia, Sierra Leone and parts of Niger, and followed a synchronized SIA on 24 July in Benin and Burkina Faso.
Further activities were held in parts of Mali (mOPV1) and Niger (tOPV) from 4-7 September and in Benin, Burkina Faso, Cote d'Ivoire, Liberia, Guinea, Sierra Leone and parts of Mali from 2-5 October, using mOPV1.

Horn of Africa

Sudan reported a case in the first week of September and Kenya reported a case in the second week of September. These are the first cases reported across the Horn of Africa since 30 May, indicating that the spread of polio has decreased significantly.
The Horn of Africa has reported 70 cases in 2009 (Kenya: 17; Sudan: 45; and, Uganda: 8).
Plans are under way to deploy seven Stop Transmission of Polio (STOP) team members to southern Sudan by October in efforts to strengthen operations and campaign quality.
SIAs took place in high-risk districts in northern Uganda from 7-9 August, in north-west Kenya from 17 August, using mOPV1; and in five states of southern Sudan from 19-21 August, using mOPV1.
Short-Interval Additional Doses were also held in the Rift Valley from 8 August and 17 August, reaching 345,000 children twice in two weeks with mOPV1.
SIAs in September, October and November are being confirmed

Angola, DR Congo

Angola has recorded 19 type-one cases in 2009. However, undetected type-3 circulation can not be ruled out, due to a combination of sub-national surveillance gaps and the fact that recently recorded type=3 cases in neighbouring DR Congo is genetically linked to previous type-3 circulation in Angola.
In Angola, NIDs were held from 14-16 August using tOPV, and will be followed by a nationwide round (again with tOPV) from 30 September-4 October.
DR Congo has recorded three type-3 cases in 2009.
In DR Congo, two SIAs using mOPV3 have taken place since the most recent case on 24 June, while SIAs were held in Kasai Occidental and Kasai Oriental (in response to low immunization coverage and the risk of circulating vaccine-derived poliovirus) from 13 August, and in Katanga from 27 August, using tOPV. A further mop-up campaign using mOPV3 is proposed for Bas Congo this month. OPV will also be given in conjunction with Child Health Days in four provinces in November.

Chad, CAR, Cameroon

Chad has reported 15 cases in 2009, all type 3 and mostly in the greater N'Djamena area. Central African Republic (CAR) has reported 13 cases - the last on 22 June. The newly infected Cameroon has reported one case, its first since 2006. Genetic sequencing is currently underway to determine the virus' origin, and an immunization response is being planned.
Due to ongoing sub-national surveillance gaps in Chad, undetected circulation (of both type 1 and type 3 serotypes) is possible.
All cases in Chad have been covered by at least one round of SIAs. The next SIAs, in the south and west of the country, including the greater N'Djamena area, are planned for 11-13 September, using mOPV3. NIDs are planned for October and November.
The key to the Chad program is to improve operations in the greater N'Djamena area, where the vast bulk of cases have occurred this year, and yet where upwards of 50% oc children are missed during immunization activities. There are no access issues here, so improving operations should be feasible if the political leadership in N'Djamena becomes actively involved. When that occurs, Chad could rapidly become polio-free again.
In CAR, the most recent NIDs started on 31 July, using mOPV3, which had quickly followed a small campaign centred on the infected district of RS3 two weeks earlier. The next NIDs start 4 September, using mOPV3, followed by Child Health Days in November

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.