February & March 2010

HEADLINES

• Global case count tumbles: As of 9 March, there have been 39 cases of polio globally this year, compared to 110 at the same time last year. The starkest difference is in Nigeria, which has recorded one case in 2010, compared to 50 cases spread across 19 states at this time last year. Seven countries have recorded polio cases in 2010, compared with 13 countries at the same time last year.
• Multi-country campaigns in Africa: Starting 6 March, 19 countries across Africa vaccinated more than 86 million children in an extraordinary, synchronized immunization campaign.
• Chad declares war on polio: The President of Chad, President Idris Deby Itno, declared "war today against polio" after launching the 6 March campaign by immunizing a child before the nation's media. The President publicly called on Governors, administrative authorities and traditional figures throughout the country to "rise up" against the virus. He was joined by UNICEF Goodwill Ambassador Mia Farrow and UNICEF Regional Director Gianfranco Rotigliano at the launch, where Ms Farrow spoke of the importance of vaccinating children against polio. "I have come here as a mother and as a grandmother and as an ambassador for UNICEF to tell all the women and fathers to be sure to bring their children in to be vaccinated," she said.
• Kick Polio Out of Africa, once and for all: On 23 February, a football with the logo "Kick Polio Out of Africa", signed by Archbishop Desmond Tutu, was kicked off on a journey through 22 African countries. The campaign pays tribute to the original efforts to "Kick Polio Out of Africa", when the first mass vaccination campaigns across the continent were launched by Nelson Mandela in 1996 and successfully stopped transmission of indigenous polio everywhere in Africa except Nigeria. More
• All endemic countries use new bivalent vaccine: Afghanistan, Pakistan, India and Nigeria have all launched their use of the groundbreaking bivalent oral polio vaccine (bOPV).
• India Prime Minister makes history by launching National Immunization Days: The Prime Minister of India, Dr Manmohan Singh, launched February's National Immunization Days, becoming the first Indian PM in history to do so. This landmark act was followed by the Federal Secretary of Health travelling to Bihar's Kosi River Area specifically to monitor the polio NIDs in this critical area.
• Iconic landmarks shout 'End Polio Now': Iconic landmarks around the world were illuminated with the End Polio Now message the week of 23 February in honor of Rotary's 105th anniversary. Landmarks lit up included the Pyramid of Khafre in Egypt; the Taipei Arena in Taiwan; the Cathedral of Santiago de Compostela in Galicia, Spain; and the Obelisk of Buenos Aires, Argentina. More

ENDEMIC COUNTRIES

India

• Uttar Pradesh and Bihar have not reported any cases of type 1 wild poliovirus for more than two months. India has now experienced its lowest type-1 transmission for the months of November, December and January.
• The 107-Block Plan, targeting those blocks in western Uttar Pradesh and Bihar with persistent transmission, is being rolled out, with the Secretary and Joint Secretary of Health having led discussions on the implementation of this plan in both key states. The 107-Block Plan is designed to ensure the highest quality polio immunization activities and the strengthening of routine immunization services, while launching new initiatives to address factors contributing to poliovirus transmission, such as interventions to improve water and sanitation conditions and reducing the prevalence of diarrhoea through promotion of ORS and zinc.
• Two rounds of NIDs have now been completed throughout India, using trivalent oral polio vaccine (tOPV). Sub-national Immunization Days (SNIDs) using monovalent and bivalent OPV will now focus on the areas of persistent transmission in western UP and Bihar.
• The most recent rounds were the Nationwide Immunization Days held on 10 January and 7 February. Block-level mop-ups have also been conducted around this year's two type-1 cases (in Maharashtra and West Bengal). SNIDs are now planned for western Uttar Pradesh and parts of Bihar on 21 March, using mOPV1.

Nigeria

• From 30 January-2 February, bivalent oral polio vaccine (bOPV) was used for the first time, in Nationwide Immunization-Plus Days (IPDs). Previous IPDs, during which bed nets and soap, for example, have been distributed, continue to show a positive upon general acceptance of polio vaccine. In Sokoto state, for instance, during the most recent campaign, mothers were seen asking the vaccinators to enter their houses and immunize their children.
• Dramatic decline in poliovirus in Nigeria is encouraging for the region. Trainings, workshops and planning meetings held – on social mobilization, vaccine security and logistics, for example – aim to boost capacity at sub-national level and ensure that the gains made are protected".
• Nigeria's football captain Nwankwo Kanu has filmed a Public Service Announcement requesting parents to immunize their children against polio "to kick polio out of Nigeria, forever!"

Pakistan

• A type-3 case recorded in Swat in February is the first of its type in the district since 2000. With renewed access to the district, the Short Interval Additional Dose (SIAD) strategy will be employed, to raise immunity to type 3. This strategy, used to tackle an outbreak of type-1 polio between July and October, 2009, has resulted in no cases of type 1 being reported since October 2009.
• Bivalent OPV was used for the first time in Pakistan in NIDs held from 15-17 February, which were coordinated with SNIDs in southern Afghanistan. The campaigns were highlighted by the Prime Minister, Syed Yusuf Raza Gillani, administering polio drops to children at a ceremony at Prime Minister House, before calling for a redoubling of efforts to improve vaccination coverage, especially in districts with sub-optimal performance.
• Telecom giant Mobilink has joined the polio eradication effort, providing a highly innovative solution for campaigns - allowing parents of missed children to text message if their house or area has been missed, with an immunization team dispatched to these "missed" areas within one hour. During the campaigns from 15-17 February, 15,000 text messages were received.
• District-specific plans for the 15 highest-risk districts have been developed with emphasis on locally-appropriate strategies. The Inter-Provincial Committee on Polio (IPCP) endorsed the plans and resolved to ensure regular follow-up in monitoring of progress in their implementation ensuring accountability.

Afghanistan

• SNIDs across the southern districts were held from 14-16 February, using bOPV, in coordination with Pakistan. In the Hilmand districts of Musa Qala and Sanguin, the campaigns were postponed by one week due to insecurity.
• District-level plans have been developed to maximise access to children by vaccination teams, particularly in the highest-risk, security-compromised districts in Southern Region.
• NIDs will be held from 14-16 March, using bOPV.

RE-INFECTED COUNTRIES

• West Africa

• Pre-planned, synchronized campaigns are being held across West Africa to tackle an ongoing wild poliovirus outbreak.
• Several heads of state launched these campaigns, including the Presidents of Guinea, Mali and Liberia, the Prime Ministers of Senegal and Gambia, and the First Lady of Ghana. Health Ministers helped launch the campaigns in several other countries. The Regional Director for the WHO Regional Office for Africa, Dr Luis Gomes Sambo, joined the President of Mali at the launching of the synchronized SIAs in that country.
• The SIAD strategy is being employed on 24 March to tackle the outbreak and raise immunity in six key countries: Burkina Faso, Guinea, Liberia, Mauritania, Senegal and Sierra Leone.
• A further synchronized immunization activity will be held in 19 countries across west and central Africa from 24 April.
• To date in 2010, Mauritania and Senegal are the only West African countries to have reported polio cases.
• Senegal's first cases of polio since 1998 represent an importation from neighbouring Mauritania. In response to the importation, large-scale outbreak response mop-ups were held in Senegal and Mauritania on 12 and 15 February respectively, with both countries using mOPV1. Senegal benefits from high routine immunization levels.

Horn of Africa

• No cases have been reported across the Horn of Africa since July 2009. All cases across the Horn have been followed by at least two rounds of SIAs.
• A coordination meeting for the Horn of Africa was held in Nairobi on 5-6 March, followed by a meeting of the Technical Advisory Group on 8-9 March. The meeting was attended by Chad, Djibouti, Eritrea, Ethiopia, Kenya, Somalia, northern Sudan and southern Sudan. The meeting acknowledged the progress made in the last year and made specific recommendations to verify interruption of virus transmission, address surveillance gaps and improve population immunity.
• Northern Sudan conducting SIAs on 22 February using bOPV while southern Sudan conducted SIAs from 17 February using mOPV1. The next rounds will be held from 26 March in southern Sudan, using bOPV.

Angola, DR Congo

• Upcoming planned SIAs in Angola are nationwide rounds in June and July using trivalent OPV, and subnational rounds with bivalent OPV in May and August. In DR Congo, two subnational rounds (with bivalent OPV and trivalent OPV) will cover at minimum Nord and Sud Kivu and Orientale in the north, and Bas-Congo in the south.
• The Technical Advisory Group (TAG) meeting was held for Angola, DR Congo, Namibia and Zambia, and found that positive developments both programmatically and epidemiologically had set the stage for making these countries polio-free by end-2010. The TAG highlighted, however, that there was still a high risk of continued, undetected poliovirus transmission particularly in the Luanda-Benguela corridor and also in Oriental, South and North Kivu in DR Congo.
• The TAG was impressed that there had been substantive developments to close gaps in SIA performance, particularly in the key Luanda-Benguela corridor in Angola, with the systematic use of independent monitoring (with finger-marking) to identify poorly performing areas, the engagement of the military in to enhance monitoring (and even vaccination in some areas), and the increasing visible engagement of the subnational political leadership in eradication activities (e.g. the Governor of Benguela).
• The Chairman of the TAG, Dr Ciro De Quadros, met with the Honourable Governor of Luanda Province, to share the TAG's findings and recommendations, to offer thanks for the Hon. Governor's support to date and to request a further intensification of that support during the critical period of upcoming campaigns. The Governor confirmed her commitment and that of her staff to completing eradication and announced her intention to, among other things, personally open the upcoming May SNID.

Chad, CAR, Cameroon

• After not conducting an immunization activity for more than five months, Chad has now conducted two nationwide rounds in three weeks, with nationwide rounds using tOPV held in the second week of February, and the 6 March synchronized rounds using mOPV3. The President of Chad launched the campaigns, declaring "war on polio". Chad will also take part in the 19-country synchronized campaigns planned for 24 April.
• Cameroon and CAR took part in the 19-country synchronized campaigns from 6 March, and will join the campaigns from 24 April.