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SEPTEMBER 2010

All data as of 05 October 2010 Download: english ¦ french

FACTS & FIGURES There have been 706 cases globally this year (635 type 1 and 71 type 3), compared with 1 126 cases at this time last year (387 type 1, 735 type 3, four type 1/3 mixtures). 17 countries have reported cases in 2010, compared with 21 at this time last year. As of 28 September, 151 districts have been infected with wild poliovirus in 2010 – an almost 65% reduction compared with the 408 districts infected at the same time last year. In September, Sierra Leone and Liberia came off the active outbreak list (no cases in the past six months) while Russia and Turkmenistan were added to the list. There has been a 90% decrease in the number of wild poliovirus type 3 (WPV3) cases globally in 2010 (71 cases in 2010 compared with 735 at this time last year). In Africa in the past four months, only Nigeria, Angola and the Democratic Republic of the Congo have reported cases.

FACTS & FIGURES

There have been 706 cases globally this year (635 type 1 and 71 type 3), compared with 1 126 cases at this time last year (387 type 1, 735 type 3, four type 1/3 mixtures). 17 countries have reported cases in 2010, compared with 21 at this time last year.
As of 28 September, 151 districts have been infected with wild poliovirus in 2010 – an almost 65% reduction compared with the 408 districts infected at the same time last year.
In September, Sierra Leone and Liberia came off the active outbreak list (no cases in the past six months) while Russia and Turkmenistan were added to the list.
There has been a 90% decrease in the number of wild poliovirus type 3 (WPV3) cases globally in 2010 (71 cases in 2010 compared with 735 at this time last year).
In Africa in the past four months, only Nigeria, Angola and the Democratic Republic of the Congo have reported cases.

HEADLINES

Polio immunization reaches flood victims in Pakistan: In Pakistan, the polio infrastructure is supporting the relief and rebuilding effort following the devastating floods, with polio-funded technical staff helping to establish early warning systems for diseases and providing essential medicines and broad immunization services. The Federal Minister for Health kicked off a special oral polio vaccine and measles vaccinations campaign in the 37 worst-affected districts due to floods, with NIDs being rolled out in two phases from 27 September. It is critical that these activities reach as many children as possible, with the floods having the potential to spread the virus to previously polio-free areas. Under the Prime Minister's Action Plan for Polio Eradication, which focuses on inter-sectoral collaboration, vaccination is also being delivered through the Motorway Police, 57 tollway plazas across the country, the National Database and Registration Authority (operating from its 188 special mobile registration vehicles throughout the country), and City Traffic police of Islamabad, Faisalabad, Peshawar, Multan and Lahore for the NIDs, who are handing out upwards of 300 000 information leaflets from 68 polio check points.

Russia announces cases as Bono, Medvedev stand together against polio: With polio from Tajikistan having spread to Russia and Turkmenistan, Bono – development activist and lead singer of the rock band U2 – underlined the importance of tackling the virus in a meeting with Russian President Dmitri Medvedev. Bono referred to polio eradication as "low-hanging fruit", as it "is nearly eradicated". President Medvedev replied that "polio is an issue that should be of concern to all governments". Twelve wild poliovirus cases have been detected in the Russian Federation – of which five cases represent local transmission and seven appear to be sporadic importations from infected neighbouring countries. The cases in Chechnya, given their close proximity to other countries of the Caucasus, represent a significant risk of further international spread. Neighbouring countries are encouraged to ensure all children under five years of age are fully immunized against polio. For details, see Central Asia and Russia below.

Expanding outbreaks in Angola and DR Congo threaten progress in Africa: In the past four months, only three countries in Africa – Angola, Democratic Republic of the Congo and Nigeria – have recorded any polio cases. Chad recorded its most recent case on 10 May, while the most recent case from the 2009-2010 West African outbreak was in Mali on 1 May. However, expanding outbreaks in Angola and DR Congo are seriously undermining this progress. As a result, WHO has alerted Member States of the increasing risk associated with these outbreaks through the International Health Regulations mechanism. Angola has conducted a staggering 29 immunization activities since its outbreak began in April 2007, clearly indicating that urgent action is required to improve the quality of campaigns.

Polio Eradication forges path to reach MDGs: The Global Polio Eradication Initiative's (GPEI) efforts to reach every last child in the most difficult-to-access migrant and underserved populations have clear lessons for reaching the Millennium Development Goals. That was the message delivered at a special side event of the Millennium Development Goals Summit in New York in September. WHO Director-General Margaret Chan, in her keynote address, underlined the strength that comes from innovative partnerships, the critical role civil society plays in ensuring access and accountability, and highlighted the ongoing need for funding. The event was organized by the International Federation of Red Cross and Red Crescent Societies (IFRC) in collaboration with spearheading partners and the Bill & Melinda Gates Foundation.

Melinda Gates also encourages polio lessons for MDGs: Speaking at a TEDxChange event on 21 September, Melinda French Gates, Co-chair of the Bill & Melinda Gates Foundation, talked about lessons that the polio programme could apply towards reaching the Millennium Development Goals, lessons learned from the field, and the importance of timely access to accurate surveillance data for effective local response. Mrs Gates pointed to the risks of "polio fatigue" by the donor community and voiced her desire to "put polio fatigue behind us for good" by eradicating polio. Meanwhile, in an open letter published in his Annual Report letter to stakeholders and partners, the Bill & Melinda Gates Foundation's Chief Executive, Jeff Raikes, argued that this is a “make-or-break time for polio eradication” and reiterated that polio was one of his top priorities because it prevented suffering, saved billions of dollars and demonstrated "what is possible with a global effort". For the full letter, click here.

Funding gap is US$ 810 million: The September issue of the Financial Resource Requirements (available at www.polioeradication.org) reports that for 2010-2012, the GPEI's core running costs, planned supplementary activities and emergency response contingencies amount to US$ 2.6 billion -- which is unchanged since the most recent update in May -- against which the funding gap is US$ 810 million. The most pressing requirement is for flexible funding for surveillance, technical assistance and outbreak response.

WHO Regional Committee meeting launches Africa Immunization Week: Health Ministers at WHO's Regional Committee for Africa meeting adopted a resolution on immunization and polio eradication in Malabo, Equatorial Guinea, last month, pledging to build on the recent gains in the region through greater financial contributions by governments and the establishment of an Annual African Immunization Week. However, success in the continent depends on tackling ongoing transmission in Angola and DR Congo through fostering increased sub-national political ownership to rapidly improve Supplementary Immunization Activity (SIA) operations.

Call for grant applications: The Bill & Melinda Gates Foundation is now accepting grant applications for US$ 100 000 through the Grand Challenges Explorations initiative on the topic: “The Poliovirus Endgame: Create Ways to Accelerate, Sustain and Monitor Eradication”. The grant program is open to anyone from any discipline, from student to tenured professor, and from any organization – colleges and universities, government laboratories, research institutions, non-profit organizations and for-profit companies. The initiative uses an agile, accelerated grant-making process with short two-page applications and no preliminary data required. Applications are submitted online and must be received by 2 November 2010. More information available at www.grandchallenges.org.

Reaching Every District Microplanning Guide Launched: The successful 'Reaching Every District' approach is now available through the release of the RED microplanning guide. Officially titled Microplanning for immunization service delivery using the Reaching Every District (RED) strategy, the guide outlines a set of easy-to-follow steps for healthcare workers dealing with immunization and is an essential tool for all health workers. Copies will be distributed to WHO Regional and Country Offices; for more information click here, or order copies from epitraining@who.int.

ENDEMIC COUNTRIES

AFGHANISTAN

17 cases in 2010 (9 WPV1, 8t WPV3). 22 cases at this time in 2009 (15 WPV1, 7 WPV3).
Most recent SIA: mop-up in northern States on 3-5 September using mOPV1. Next NIDs: 3-5 October using bOPV

Afghanistan reported its first case in Kunduz – in the far north of the country – since 2002. Widely expected to be related to the Tajikistan outbreak across the border, genetic sequencing showed that the case was in fact related to transmission in Khyber Pakhtunkhwa (North West Frontier Province) in Pakistan. A mop-up activity targeting 1.5 million children with mopv1 was held in five northern provinces from 5-7 September.
A surveillance review for acute flaccid paralysis (AFP) has been held in all Regions except in the Southern Region and found that poliovirus transmission in the review areas was "very unlikely" to go undetected.
In preparation for the October NIDs, staff from the regional to the community level have been trained on interpersonal communication skills. New communications materials and mass media spots have been produced to incorporate information about the addition of de-worming tablets to be administered to 24-59 months old children during the 3-5 October NIDs.

INDIA

39 cases in 2010 (16 WPV1, 23 WPV3). 395 cases at this time in 2009 (51 WPV1, 343 WPV3, 1 WPV1/3).
Most recent SNIDs: from 19 September in Bihar, UP, Delhi and parts of Jharkhand, West Bengal and Maharashtra. Next SNIDs: from 3 October in Bihar.

As of last week, the third case of wild poliovirus has been reported in as many weeks from the same block: Champaran East, in Bihar, less than 10 kilometres from the Nepal border. These cases are closely related to cases across the border in Nepal. Two Short-Interval Additional Dose immunization activities are being held in response.
Dozens of highly experienced Surveillance Medical Officers (SMOs) have been deployed to Malegaon (Nasik), Pakur (Jharkhand) and Murshidabad (West Bengal) to assist with training, microplan revision, and monitoring during the Sub-national Immunization Days (SNIDs). More than 700 volunteers have been mobilized by UNICEF to conduct Social Mobilization activities in Murshidabad and two other high-risk districts. Reports from Pakur and Murshidabad reporting that the quality of the most recent immunization activity had shown improvement. A partners meeting, attended by WHO-NPSP, UNICEF and Rotary was held in Nasik to finalize and implement a coordinated plan to improve the SIA quality in Malegaon.
A surveillance review is scheduled to take place in southern West Bengal from 4-11 October.
Large areas of Delhi and western Uttar Pradesh have been affected by monsoon flooding, postponing SNIDs in some areas. Combined with the movement of people anticipated during the Commonwealth Games, this is a reminder that intense surveillance and quality SIAs are necessary to protect the progress made in India this year.

NIGERIA

8 cases in 2010 (4 WPV1, 4 WPV3). 382 cases at this time in 2009 (73 WPV1, 307 WPV3, 2 WPV1/3).

Most recent SIAs: from 18-21 September. Next NIDs: 23-26 October, in high-risk northern states, using bOPV.

The next meeting of the national Expert Review Committee on Polio Eradication and Routine Immunization (ERC) is scheduled for 4-5 October. The group will discuss strategies to capitalize on the current positive epidemiological situation.
Heavy rainfall, flooding and a cholera outbreak hampered preparations for the recent SIAs in some areas and resulted in the postponement of the activities in the states of Sokoto and Kebbi.
The Rotary International PolioPlus Summit, held in Abuja on 21 September, declared a "zero-tolerance policy for polio". Rotary International President Ray Klinginsmith and Rotary Foundation Trustee Vice Chair John Germ attended the Summit to recognize Nigeria's 99% reduction in polio cases in 2010 compared with 2009 and to encourage Rotarians and government officials to finish the job.
Legendary singer-songwriter and Rotary Ambassador Dr Adamu Dan Maraya Jos shone the national spotlight on polio when he launched the September Immunization Plus Days (IPDs) in Jigawa state. The singer met with the Emirs of Dutse and Ringim – both of whom launched IPDs by publicly immunizing children – before Dr Maraya Jos performed from the balcony of the Emir of Dutse's palace.

PAKISTAN

69 cases in 2010 (50 WPV1, 19 WPV3). 62 cases at this time last year (40 WPV1, 21 WPV3, 1 WPV1/3).

Most recent NIDs: from 27 September. Next SNIDs: 11-13 October, using bOPV.

With the large-scale population movements and expected intensified transmission of poliovirus due to the floods, concerns are growing over widespread polio transmission. More than 9 million children in the 36 districts worst-affected by the recent flooding were reached and immunized with mOPV1 and measles vaccine from 15 September. All polio-funded technical staff and 60% of administrative staff have been mobilized to assist with the response to the flood emergency, which has devastated health facilities and the vaccine cold chain. Pakistan polio team leader Dr Ni'ma Abid said the flood damage was "really beyond imagination".
The Federal Ministry of Health contacted key administrative officials in the Federally Administered Tribal Areas (FATA) to highlight the sharp increase in polio cases and urge the full implementation of the operational plan developed by the civil and military Polio Crisis Taskforce.
WHO's Eastern Mediterranean Regional Director Dr Gezairy visited Pakistan from 4-7 September and met with the Prime Minister, discussing polio eradication and ways to improve vaccination coverage.

RE-ESTABLISHED TRANSMISSION COUNTRIES

ANGOLA

25 WPV1 cases in 2010. 26 WPV1 cases at this time last year.
Most recent SIA: on 6-8 August, using bOPV Next NIDs: 1-3 October, using bOPV.

Efforts are underway to urgently address the operational gaps in immunization activities -- with upwards of 20% of children regularly missed during SIAs, particularly in Luanda, Kuanza Sul and Kuanza Norte -- by strengthening microplans and vaccinator selection and training. Key to ultimate success, however, will be strengthened engagement by the provincial and district-level leadership.

CHAD

14 WPV3 cases in 2010. 24 WPV3 cases at this time last year.

Next NIDs: October and November, using bOPV.

DEMOCRATIC REPUBLIC OF THE CONGO (DRC)

24 cases in 2010 (23 WPV1, 1 WPV3), 3 WPV3 cases at this time last year.

Most recent SIA: from 23-25 September. Next NIDs: from 21-30 October DR Congo is experiencing a severe outbreak in Kasai Occidental, the result of polio transmission from across the Angolan border.

SIAs were held in response from 19-21 August and 23-25 September in the west, south and east of the country. These followed 'preventive' mop-ups conducted in June and July in anticipation of cross-border infection resulting from the outbreak in Angola.
Staggered SIAs are currently being planned to be held from 21-30 October.
WHO's AFRO Regional Director has written to the President of DR Congo, highlighting the risk of further spread within the country and the need for emergency action to stop the outbreak and strengthen surveillance.

SUDAN

0 cases in 2010. 45 WPV1 cases at this time last year.

Next NIDs: from 1 November in the north (bOPV) and 5 November in the south (tOPV).

In Southern Sudan, the most recent reported case was 27 June 2009. Due to enhanced eSTOP and CDC/WHO technical support, there has been a significant increase in the number of reported AFP cases over the past six months. Nationally, the AFP rate has doubled in 2010 compared to 2009, and all states have an AFP rate of >2 cases/100 000. In August, Southern Sudan implemented a nation-wide micro-planning process for three rounds of routine immunization acceleration campaigns in September, October and November, to improve routine immunization coverage rates by the end of 2010.

IMPORTATION COUNTRIES

CENTRAL ASIA AND RUSSIA

Tajikstan: 458 WPV1 cases in 2010. Next NIDs: 4-8 October (tOPV).
Turkmenistan: 3 WPV1 cases in 2010. Most recent NIDs: 20-29 September.
Russia: 12 WPV1 cases in 2010. Next SNIDs: October, using tOPV.

The large outbreak of wild poliovirus type 1 in Tajikistan this year (456 of 581 WPV1 cases globally in 2010) has slowed dramatically, but not before poliovirus from Tajikistan spread to infect Turkmenistan and Russia. The most recent case in Tajikistan had onset of paralysis on 4 July. While two cases were reported in Tajikistan in September, both cases had onset of paralysis in May and had already been covered by two immunization activities.
Turkmenistan's three cases are clustered together in Lebap Province in the far south-east, with infection of all three cases occurring within eight days of each other in June. These cases have already been covered by three immunization activities.
12 cases have been reported in the Russian Federation with seven of these cases attributed to separate unique importations from neighbouring polio-infected countries. Three cases in Chechnya represent a significant risk of further international spread. Countries of the Caucasus have been recommended to ensure all children under five are fully immunized against poliovirus.
Uzbekistan will immunize nine million children under 15 with mOPV1 from 25-31 October. Kazakhstan held NIDs from 6 September, while Kyrgyzstan has conducted two rounds of NIDs.

NEPAL

6 WPV1 cases in 2010.

Most recent SIA: from 18-19 September, using mOPV1. Next mop up SNIDs: 2-3 October and 30-31 October, using mOPV1.

The outbreak in Nepal continues, with a new case reported with onset of paralysis on 30 August. All cases have occurred in two of eight high-risk districts bordering India (Rautahat, with five cases, and Mahottari with one case). It is from Rautahat district that this outbreak has spread to re-infect northern Bihar. Rautahat district remains at risk of ongoing transmission or re-infection due high levels of population movements to and from the now infected East Champaran of Bihar, India. Recognizing the ongoing outbreak, the Government of Nepal has called for emergency measures in the high-risk district and has added an additional SIA at the end of October. Three SNIDs are now being held in a six-week period in the high-risk areas in order to rapidly raise immunity.

WEST AFRICA

30 cases in 2010 (all type 1 except 2 WPV3 cases in Niger): Senegal 18, Mauritania 5, Mali 3, Niger 2, Liberia 1, Sierra Leone 1. 124 cases in 11 countries at this time last year.

Next NIDs: 29 October, using bOPV, in 12 countries. In November, a three-country round will be held in countries bordering north and western Nigeria, using tOPV.

Preparations for an 11-country synchronized immunization campaign to be held from 29 October are ongoing, targeting 29 500 000 children under five in Niger, Benin, Burkina Faso, Senegal, Mauritania, Mali, Cote d'Ivoire, Liberia, Sierra Leone, Gambia and Guinea. Focus is on improving the quality of campaigns based on lessons learned in previous activities through strengthening microplans, maximizing capacity in identified high-risk border areas, and introducing strategies to access all difficult-to-reach populations.