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May 2010

All data as of 01 June 2010

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Headlines

World Health Assembly endorses Strategic Plan: The World Health Assembly (WHA) has welcomed the new Global Polio Eradication Initiative (GPEI) Strategic Plan 2010-2012, which directly addresses the remaining barriers to eradicating polio, using a combination of new geographic- and population-specific approaches to reach chronically missed children. The WHA noted the significant progress already achieved as a result of the new Plan, in particular in the traditional reservoirs of northern Nigeria and northern India, both of which are recording record-low levels of the disease. The WHA also expressed serious concern that insufficient financing for the new Plan is compromising its full implementation, as US$1.3 billion is still needed for 2010-2012. The dangers of not completing the job of polio eradication, the WHA said, were underscored by the confirmation in April of a large new polio outbreak following an importation into Tajikistan, in the WHO European Region which had been certified as polio-free in 2002.
High-quality immunization activities tackle Tajikistan outbreak: Tajikistan has responded aggressively to a type-1 wild poliovirus epidemic, conducting three national immunization activities to rapidly raise immunity to polio and quickly stop the outbreak. With 152 type-1 cases confirmed countrywide (as of 01 June 2010), Tajikistan has employed the Short Interval Additional Dose (SIAD) strategy, conducting campaigns from 1 May, 15 May and 1 June. International monitors report that the activities have been of good quality. More.
India responds swiftly to type-1 case: A type-1 case in West Bengal has resulted in swift action by the Indian Government, which has sent a representative to the state to investigate. Nine Surveillance Medical Officers from the East Region and a WHO HQ consultant have also been dispatched to Murshidabad - the poorest-performing of the West Bengal districts in terms of Supplementary Immunization Activity (SIA) quality. Large-scale mop-up activities are expected to be held in June and July, using mOPV1. Meanwhile, India's remaining two endemic states are currently experiencing their longest period in history without a case of type 1 concurrently. Uttar Pradesh (UP) recorded its most recent case in Moradabad on 13 November 2009, while Bihar's most recent case was in Lakhisarai on 29 October 2009. India has also recorded its first month - March - without a single polio case in more than a decade.
Remaining polio reservoirs shrink dramatically:The remaining reservoirs of wild poliovirus continue to shrink in both Asia and Africa. The number of districts infected with type 1 polio globally have shrunk from 148 at this time last year to 58, while the number of districts infected with type 3 polio globally have fallen from 154 districts at this time last year to 34.
Continued West Africa outbreak prompts addition of synchronized activities: In an effort to stop the outbreak in west Africa and meet the first Strategic Plan Milestone, 10 countries in west Africa that either have continued transmission, or are considered to be at high risk of re-infection - Senegal, Mauritania, Mali, Sierra Leone, Liberia, Guinea, Guinea-Bissau, Burkina Faso, Gambia and Niger - conducted synchronized immunization campaigns from 28 May to raise childhood immunity to polio as a block. Seven of those countries - Senegal, Mauritania, Liberia, Guinea, Gambia, and parts of Mali and Burkina Faso - will conduct a further round in June. See 'West Africa' below for more details.
Independent monitoring data online: Independent monitoring data of West and Central Africa's immunization campaigns are now available on our website.

Endemic Countries

India

The Global Polio Eradication Initiative welcomes Dr. Ajay Khera as the new Deputy Commissioner Maternal and Child Health, Government of India.
An international review of the acute flaccid paralysis (AFP) surveillance system in Delhi was conducted from 3-7 May. Overall, AFP surveillance in Delhi remains strong, though necessary improvements were identified to further strengthen the system's ability to detect polio transmission in migrant communities. This includes a new environmental sampling site in New Delhi, which is due to be operational within the next two months.
Mr Bill Gates - the co-chair of the Bill and Melinda Gates Foundation - visited the Kosi River area of Bihar in May to witness first-hand the challenges and the tremendous efforts taking place to reach every last child in this difficult-to-access flood plain.

Nigeria

Nigeria has recorded three cases of WPV in 2010, compared with 288 cases at the same time last year.
Nigeria has reported its first type 1 case since November 2009 - in Sokoto state, in the far north-west. This case, together with the re-infection of Niger in April with type-1 polio of Nigerian origin, underscores the fragility of the progress in Nigeria and is a stark reminder not only of the dangers of residual low-level transmission, but the necessity to maintain the intensity of eradication activities until Nigeria is polio-free. An investigation around this case suggested ongoing coverage gaps, with upwards of 50% of children under-immunized in this area. Gaps like these must be closed for Nigeria to become polio-free.
Professor Christian Onyebuchi Chukwu has been confirmed as Nigeria's new Minister of Health. During his address to the Senate, Professor Chukwu, an active Rotarian, committed to stopping polio transmission in the next 14 months.
June's sub-national Immunization Plus Days (IPDs) are being staggered to allow technical staff to be redeployed to the highest-risk areas to ensure the most effective planning, implementing and monitoring support can be provided. Meanwhile, the Public Service Announcement filmed by Nigerian football legend Nwankwo Kanu, a UNICEF Ambassador, is being shown in Nigeria during this World Cup month. More
During May, the National Primary Health Care Development Agency and partners readied the scale-up of the "Majigi" - the popular edutainment community mobile video shows about polio. Using a combination of drama, interviews with medical experts, and testimonials from families affected by polio, the videos explain the effect and threat of polio and the reasons why every child must be vaccinated every time during Immunization Plus Days. The Majigi is a community event and involves traditional, religious, political and community leaders, health workers, and families. NPHCDA is sponsoring Majigi sessions for settlements in the 85 very/high-risk Local Government Areas (LGAs) in advance of the June IPDs.
The Polio National Social Mobilization Working Group (NSMWG) has developed and distributed to all high-risk states and LGAs new guidelines to support local-level high-risk operational plans. The guidelines include Q&As, a revised Inter-Personal Communication module, key messages for opinion leaders, care givers, vaccinators and policy makers.
Implementation of the 2010 nationwide Knowledge-Attitude-Practices (KAP) survey has started.
UNICEF has completed a capacity building and work planning meeting with the Journalists Against Polio, which uses mass media to promote immunization acceptance. A similar meeting is planned with the Forum of Muslim Women of Nigeria, the National Orientation Agency, Red Cross and Rotary volunteers.
Nigeria has issued its first "Polio Alert" - a one-page summary of the latest WPV1 case in Sokoto, aimed at journalists and polio eradication stakeholders. The Alert was widely covered in the Nigeria's major papers. The "Polio Alert" signalleld NPHCDA's intention of treating every polio case in Nigeria this year as an emergency.

Pakistan

Rotary met with the Chief Secretary of Balochistan Ahmed Bakhsh Lehrat in Quetta on 1 May and discussed the cases occurring in the province in 2010. This followed a Polio Awareness Seminar in Quetta, attended by the Health Secretary, where Pakistan's stunted progress against polio, in comparison to the strides made elsewhere in the world, was highlighted. The Chief Secretary agreed to call quarterly meetings at district level to closely monitor polio activities.
Following the success of the Torkham Cross-Border shelter, Rotary will build another two shelters - one in Chaman, Balochistan, and the other on the Afghan side of the border in Kandahar - to reduce the number of missed children during NIDs.
A joint WHO-UNICEF mission visited Punjab to review the routine immunization programme in 14 selected districts. The team, comprised of global, regional and national experts, reported at a meeting in Lahore on 19-20 May that the province has the potential to quickly improve routine immunization, given that many of the major problems related to service delivery and supervision, which could be tackled with existing resources.
The Technical Advisory Group on Polio Eradication in Pakistan and Afghanistan (TAG) met in Islamabad on 11-12 May, and acknowledged that while the district-specific planning approach in Pakistan has led to recent improvements, polio eradication now hinges on improving quality of vaccination activities in the persistent transmission districts. Regular meetings are being held to track the progress of the implementation of the area-specific plans of the 15 highest risk districts/towns/tribal agencies.
The Director of Health Services of the Federally Administered Tribal Areas (FATA) convened a meeting to look for solutions to ensure children can be accessed in conflict-affected areas. Emphasis was placed on Bajour, Khyber and Mohmand, where persistent transmission is reflected by access issues. In Bara Tehsil, for instance, where a 15-month-old boy was paralyzed last week, the target population has been inaccessible to vaccination teams due to security concerns since October 2009. Eight of the nine type-1 polio cases in Pakistan in 2010 are from North-West Frontier Province (Khyber- Pukhtoonkhwa) and FATA; the highest number in the endemic areas in the world.
Polio Control Cell - a media partnership to build awareness of polio campaigns through media and provide a mechanism for parents of missed children to take action to ensure their children are immunized - was awarded the 'most visible brand of the year' award by Prime Minister Yousaf Raza Gillani during an awards ceremony this month. More than 25,000 additional children are immunized during every polio campaign as a result of this initiative, which has also helped raise the visibility of the polio programme.

Afghanistan

In addition to National Immunization Days (NIDs) conducted in May (in conjunction with delivery of Vitamin A), mop-up activities have been held along the northern border with Tajikistan. Additional supervision has moved to this area and vaccination posts established at border crossings to maximize immunity to polio in light of Tajikistan's outbreak. Afghanistan has not reported a case of type-1 polio since 8 January 2010.
During the most recent NIDs on 2-4 May, increased access in key high-risk areas of the Southern Region was recorded. However, difficulties remain to reach all populations due to a variety of issues, including heavily mined roads.
Following the national vaccination week at the end of April, advocacy and communication efforts were continued in 22 provinces and 38 districts to promote immunization and polio vaccination.
On 1 May, the Afghanistan and India national cricket teams played each other in St. Lucia, as part of the ICC T20 Tournament. UNICEF India and Afghanistan country offices organized a joint press briefing during which captains of both teams exchanged “Bowl Out Polio” bats and showed their commitments to fighting polio by relaying polio messages back home prior to the match. PSAs involving the Afghan cricketers were broadcast on national television during the match to reinforce the message of the Afghan team as well as key messages on polio.
During the 2-4 May NID, a communication campaign was conducted throughout the country, involving mass media, social mobilization, inaugural events, and the distribution of print and visual materials to the communities.
The Afghanistan and Pakistan TAG held in Islamabad focused on development and implementation of specific communication plans in 13 high-risk districts in the southern region, part of accelerating the development of more comprehensive district-specific plans for the 13 'persistent transmission' districts by end-July. It also urged the development of a comprehensive strategy to enhance the coverage of all mobile populations, whether inside or outside the persistent-transmission or high-risk districts, by mapping, tracking, microplanning and immunization of these populations.

Re-ESTABLISHED TRANSMISSION Countries

Angola, Democratic Republic of Congo

Angola has reported four cases in May, including two cases in the newly infected province of Lunda Norte, in the north-east mining area close to the border with DR Congo. With frequent population movements across the border, the risk of virus spreading back into DR Congo remains high. Two cross-border mop-up immunization activities are planned to cover the case in Lunda Norte, Lunda Sul, and across the border in southern DR Congo on 4 June and 18 June, using mOPV1.
Angola's priority remains to rapidly fill key vaccination coverage gaps in the Luanda-Benguela corridor. Strengthened technical support is focusing on addressing operational issues such as better micro-planning and more effective vaccinator selection and training, and supervision.
Sub-national Immunization Days were held from 7-9 May in six provinces. The Governor of Luanda, Francisca do Espírito Santo, participated in the SNIDs, while the military was actively engaged as independent monitors of the campaign. However, with consistent transmission of polio in Angola since 25 April 2005 (the current chain of transmission has been active since 2007), Angola must continue to take considerable strides to improve their activities to stop transmission.
Angola's vice-minister of Health has agreed to chair all Inter-agency Coordination Committee (ICC) meetings.
DR Congo is planning to hold SNIDs in June and July (with bivalent OPV and trivalent OPV, respectively) in key areas of Nord and Sud Kivu, Bas-Congo, Kasai Orientale and Kasai Occidental.

Chad

Nationwide Immunization Days planned for 21 May were postponed, however staggered SNIDs were held in Chari Baguirmi from 3-12 May and in N'Djamena from 8-20 May. A mop-up activity was also conducted in Doba and Bebedja districts of Logone Oriental on 30-31 May. NIDs will now be held from 7-9 June, with the President of Chad expected to launch the campaigns, in conjunction with the arrival of Rotary's famous 'Kick Polio Out of Africa' ball (Ctrl-click here for details.).
The country continues to focus on improving SIA operations in key areas, particularly in the greater N'Djamena area (the epicentre of transmission in the country). Following new commitments by the President and subsequently provincial governors in March, operational improvements were noted during the April campaigns, and this momentum needs to be further built upon. In particular, more effective microplanning and vaccinator performance was observed.

Southern Sudan

From 18-20 May, a meeting was held to review the February and March 2010 NIDs, AFP surveillance and routine EPI. The Acting Under-Secretary, Ministry of Health, Government of Southern Sudan, chaired the meeting. Key recommendations were agreed upon for implementation, including reducing the number of missed children during polio SIAs, improving AFP case reporting, addressing 'silent counties', strengthening ownership and leadership by local government administrations and improving accountability for resources.
While Sudan has not reported any cases since 27 June 2009, there remains the risk of undetected circulation of poliovirus as a result of sub-national surveillance gaps. The upscaling of CDC/WHO technical support is closing these gaps through the introduction of systems including active case searches in under-reporting counties, the collection of stool samples from contacts of AFP cases, and ,the collection of samples from healthy children in any 'silent' county. All of these factors are resulting in a marked increase in reported cases.
eSTOP teams are also providing training to improve data management capacity in southern Sudan - a key factor in being able to address and improve poor routine immunization coverage.
Children under five will be immunized with tOPV as part of the Child Health Days (CHDs) scheduled for 14-16 June, which will include other interventions, namely deworming and the distribution of health promotion messages.

Importation countries

Tajikstan

Tajikistan has employed the Short Interval Additional Dose strategy, conducting four NIDs in the space of six weeks to rapidly raise immunity to polio and quickly stop the type-1 outbreak. The first two NIDs, from 1 May and 17 May, immunized 1.1 million children under six years old (with 99.4% coverage reported) while the final two rounds will immunize all children under 15.
As of 1 June, the total number of laboratory-confirmed cases for 2010 to 152 WPV1 cases. However, 367 acute flaccid paralysis cases remain to be tested; meaning the number of laboratory-confirmed cases can be expected to continue to rise significantly. All cases reported to date are from the west/south-west of the country, mostly around Dushanbe City and the Khatlon and Kulyab zones of Kurgan-Tube oblast.
WHO's European Regional Director Ms Zsuzsanna Jakab flew to Tajikistan to participate in the first NIDs and to meet with the President, HE Emomali Rahmon. Ms Jakab, together with UNICEF's Regional Office Europe Deputy Director are visiting Uzbekistan to launch its second SIA from 1 June, immunizing 1.9 million children. Kyrgyzstan conducted Immunization Week activities in May, and has two SNIDs planned, focusing on the areas bordering Tajikistan. Kazakhstan and Turkmenistan will also hold polio immunization activities in June.
A nine-month old child who arrived from Tajikistan on 1 May to Irkutsk, Russia, tested positive for wild poliovirus. In response, Russia is testing all children arriving from Tajikistan.

Nepal

Nepal has reported one WPV1 case this year, with onset of paralysis on 19 February.
NIDs were held from 15 May, again using bOPV. A sub-national round is planned for June, using mOPV1.

Horn of Africa

No wild poliovirus cases have been reported across the Horn of Africa for 2010. It is now more than 12 months (10 May 2009) since Uganda has reported any wild poliovirus cases. Kenya's last case was on 30 July 2009.

West Africa

Niger has once again been re-infected with type-1 wild poliovirus by northern Nigeria.
In the outbreak countries, wild poliovirus transmission now appears limited to Senegal, Mali and Mauritania.
Poliovirus found in Senegal and Liberia has been traced to Guinea, and reflects a trade route which runs from Liberia through Guinea to Mali, Burkina Faso and Niger. This transportation corridor, in conjunction with significant operational gaps in these areas of highest risk, poses a significant risk of spread.
To tackle this threat - and to meet the first Strategic Plan Milestone - a 10-country synchronized campaign took place from 28 May in countries with continued transmission or considered to be at high risk of re-infection: Senegal, Mauritania, Mali, Sierra Leone, Liberia, Guinea, Guinea-Bissau, Burkina Faso, Gambia and Niger. A further activity will take place in June in Senegal, Mauritania, Liberia, Guinea, Gambia, and parts of Burkina Faso and Mali.
Preparations for these campaigns focused on addressing identified operational gaps in key areas, including parts of Senegal, Guinea, Mali (particularly in Bamako) and Liberia (particularly in Monrovia).
At the WHA, Senegal's Minister of Health expressed strong commitment to stopping the polio outbreak and to working with community leaders to ensure that all children are vaccinated. The Ministers of Health and key officials of Liberia, Guinea, Mali and Burkina Faso underlined the critical need of stopping the outbreaks before the rainy season in July, and expressed the need to urgently close existing vaccination gaps, especially reaching children outside the homes and migrant populations, and for enhancing their surveillance efforts in the border regions.

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$8 billion global investment in eradication.