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June 2011

All data as of 28 June 2011                                                                Download: english ¦ french   


 FACTS & FIGURES

  • There have been 241 cases globally in 2011 (216 wild poliovirus type 1 - WPV1 - and 25 WPV3), compared with 456 cases at the same time in 2010 (399 WPV1 and 57 WPV3).

  • Over 80% of cases this year come from just three countries: Chad, the Democratic Republic of the Congo and Pakistan.

 

 

HEADLINES

IMB convenes in London: The Independent Monitoring Board (IMB) is convening its third quarterly meeting in London, UK, on 30 June to 1 July. The meeting follows the IMB's end-March meeting, during which it offered a frank assessment of the global epidemiological situation. In addition to reviewing the emergency plans launched in countries deemed to be off-track at the most recent meeting, the Board will analyse the situations in India, Nigeria and Afghanistan. The Board will also review actions taken by the spearheading partner agencies - the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF - as well as the Bill & Melinda Gates Foundation, in response to specific recommendations from its March meeting.
Outbreak in Chad threatens to spread: Chad now has the highest number of polio cases of any country in the world, and with cases reported from across the country - including close to the border with Sudan - WHO updated its risk assessment of potential international spread via the International Health Regulations 2005 (IHR 2005) mechanism. With the Hajj (pilgrimage to Mecca, Kingdom of Saudi Arabia) expected to begin in early November and Ramadan in early August, it is anticipated that pilgrims are now beginning to move across west and central Africa, further increasing the risk of polio spread. To address the situation, the Government of Chad has now finalized a six-month national polio emergency plan. See 'Chad' section below, for more details.
NEJM publishes vision for post-eradication era: The New England Journal of Medicine (NEJM) published an article outlining the vision for the post-eradication era. Authored by Bruce Aylward, WHO Assistant Director-General and Tachi Yamada, President of the Global Health Program at the Bill & Melinda Gates Foundation, the article 'The Polio Endgame' outlines the strategic direction the Global Polio Eradication Initiative (GPEI) is taking to prepare for the management of post-eradication risks. "Preventing new polio outbreaks in a 'post-eradication era' will require more than biocontainment measures," the article states. "It will eventually require stopping routine immunization with oral polio vaccine (OPV) and eliminating vaccine-derived polioviruses (VDPVs)." More.
India - new West Bengal Chief Minister commits to polio eradication: Newly-elected Chief Minister of West Bengal, Mamata Banerjee, committed to provide the necessary leadership to ensure polio outbreak response is fully implemented in her state. Banerjee, who also holds the health portfolio, made the commitment at a high-level meeting organized by Rotary International, and representatives of WHO and UNICEF. Banerjee subsequently officially launched the latest supplementary immunization activities (SIAs) in the state on 26 June. "We have to take the vaccine so there are no cases of polio - we have to eradicate the virus from wherever it is in existence," she said, moments before undertaking what she called "the proud privilege" of immunizing four children in front of the assembled media. West Bengal is the location of India's only case in 2011 (from January), and intensified outbreak response efforts have been ongoing.
EMRO TAG reviews polio in Afghanistan and Pakistan: The Eastern Mediterranean Regional Technical Advisory Group (TAG) met from 22-23 June in Egypt. The TAG meeting followed the Afghanistan-Pakistan TAG in March and the Horn of Africa TAG in May. The Regional TAG offered a detailed assessment of the challenges facing both Afghanistan and Pakistan; however, the TAG focused on Pakistan, which has significantly more cases in 2011 compared to 2010 and is moving into the high-transmission season. The TAG endorsed the recommendations put forth in March but was concerned at the slow pace of implementation of the National Emergency Action Plan and the limited progress made to address sub-district level SIA quality in Pakistan. The TAG also considered the situation of WPV isolation from a December 2010 sewage sample in Aswan, Egypt that was linked genetically with a 2009 WPV type 1 case from Khartoum, Sudan, and 2008 WPV1 from southern Sudan. The TAG was satisfied with the investigation and subsequent Sub-national Immunization Days (SNID) response in Aswan governorate and border states of Sudan. The TAG also agreed to the proposed contingency measures to vaccinate more than 800,000 inaccessible target children in Somalia. The group endorsed the Horn of Africa TAG recommendations from May which called for strengthening of surveillance activities, including cross-border planning and implementation, and endorsing additional rounds of both NIDs and SNIDs in Sudan.
Tachi Yamada, long-serving polio advocate at Gates Foundation, steps down as President of Global Health Program: Dr Tachi Yamada has stepped down from his position as President of the Global Health Program at the Bill & Melinda Gates Foundation. In his role, Dr Yamada has been instrumental in scaling up the Foundation's support to the GPEI, especially at the critical juncture in the programme as it researched, prepared and rolled out the new Strategic Plan 2010-2012. "Tachi Yamada's leadership and personal engagement in polio eradication has made a huge difference to the programme," said Dr Bruce Aylward, WHO Assistant Director-General. "His drive and vision helped elevate polio eradication to the new level of attention it now has with leaders everywhere - ultimately, this is what will secure a polio-free world." More
  


 

ENDEMIC COUNTRIES

AFGHANISTAN

  • Strong progress continues to be achieved in Afghanistan. With eight cases reported this year (compared to 12 for the same period in 2010), efforts are continuing to focus on increasing access to all populations in high-risk districts of Southern Region.
  • The district-level planning approach is continuing, with local level negotiations ongoing with all parties to secure safe passage by vaccination teams during SIAs. Such efforts have significantly increased access in key high-risk districts of southern Afghanistan this year, however during the most recent Subnational Immunization Days (SNIDs) on 12-14 June, upwards of 100,000 children of were again inaccessible in Southern Region, mainly in Kandahar but also Uruzgan province.
  • At the same time, special tactics for security-compromised areas continue to be implemented. Immediately preceding and following the most recent SNIDs on 12-14 June, the Short Interval Additional Dose (SIAD) strategy was used in high-risk areas of Helmand, Zabul, Farah and Nimroz provinces. The SIAD strategy exploits the availability of monovalent oral polio vaccines (OPV) to shorten the interval between SIAs, and thereby build up population immunity more rapidly. The approach is particularly useful in areas of insecurity, to rapidly administer an additional dose to children during any eventual lull in conflict.

INDIA

  • With only one case reported in 2011 (in January in West Bengal), the India Expert Advisory Group on Polio Eradication and Routine Immunization (IEAG) is expected to meet in July, to discuss additional ways to capitalise on the current epidemiological opportunity.
  • At the same time, SNIDs continue to be regularly conducted in West Bengal, Uttar Pradesh, Bihar, Delhi and other high-risk areas. The latest activity was held on 26 June.
  • As in previous campaigns, technical support from polio-free areas of the country was again re-deployed to West Bengal to support the planning, monitoring and implementation of the activity.

NIGERIA

  • In Nigeria, as of 21 June, 16 cases have been reported, compared to three cases for the same period in 2010. Despite progress seen over the past 18 months, efforts are ongoing to reverse the recent trend of increased cases. The trend is particular concerning given this month's confirmation of both remaining types of wild poliovirus ( WPV1 and WPV3) in Kano state - the first WPV case of any kind in Kano since September 2010. Nigeria continues to be affected by transmission of all three serotypes: WPV1, WPV3 and an ongoing circulating VDPV type 2. Virus transmission is affecting primarily the north-east (Borno state), the north-west (Sokoto and Kebbi) and the north-centre (Kano and Jigawa).
  • On 25-28 June, the most recent polio Immunization Plus Days (IPDs) were held in 19 high-risk states of the country plus the Federal Capitol Territory. In newly-infected Local Government Areas (LGAs) and surrounding at risk areas, additional supervision and resources were deployed to ensure the activity was of 'mop-up' standard. Following Expert Review Committee on Polio Eradication and Routine Immunization (ERC) recommendations, any Ward with greater than 10% 'missed' children (per enhanced independent monitoring) was redone to ensure quality of the campaign.
  • A national polio emergency plan has also been finalized, and disseminated to state commissioners, to address the increase in cases. The new operational approaches in the plan help to align efforts of all stakeholders and clearly defines roles and responsibilities for national, state and local government authorities. The plan will also focus on areas highlighted by the IMB's April report including implementation of a national mass media strategy, fast tracking activities to close surveillance gaps and additional attention to improving quality of polio eradication activities in Kano.
  • Efforts to strengthen subnational surveillance sensitivity are ongoing. Rapid surveillance assessments have been completed in key areas, notably Kano, Kebbi, Katsina and Plateau states. These assessments identified major gaps, and findings are already being used to improve and fine-tune surveillance, including by expanding the reporting networks.
  • In a first-of-its kind study in Nigeria, the field work for a seroprevalence study in Kano has been completed. The outcomes of this study will provide critical insight into population immunity levels and efficacy of strategic implementation.
  • Following national elections in April, a high-level advocacy plan to re-engage all subnational leaders has been developed and is being implemented. The newly-formed High Level Advocacy Team, comprised of the Executive Director of the National Primary Healthcare Development Agency (NPHCDA), heads of partner agencies and members of the Traditional and Religious Leadership convened on 7 June, and immediately paid a courtesy call on the Director General of the Governor's Forum. State visits with high-level state representatives are also planned.
  • There are concerns that increasing insecurity in some parts of the country will potentially begin to impact polio eradication activities. UN security staff are regularly monitoring the situations.   

PAKISTAN

  • Pakistan continues to be affected by widespread geographic transmission of polio, affecting most of the country. This is confirmed not just by high numbers of cases, notably in the reservoir areas of Balochistan, Sindh and Federally Administered Tribal Areas (FATA), but also by isolation of poliovirus from collected environmental samples in six large cities of the four major provinces.

  • One of the newly-reported cases from this month is from Gilgit Baltistan (mountainous northern area), the first polio case in this part of Pakistan in more than 12 years. The virus is linked to 2009 transmission in Swat, and the child affected is from an underserved population group originally from FATA.

  • SNIDs were conducted on 13-15 June, but were postponed for one week due to a cyclone warning in some districts of Sindh including Karachi and due to inadequate preparations in a number of key districts in Khyber Pakhtunkhwa (KP) and Balochistan.

  • In Karachi, a special strategy is now being developed to increase outreach to marginalized and underserved population groups.

  • Aseefa Bhutto, daughter of Benazir Bhutto and ambassador for polio eradication, on 20 June officially launched immunization campaigns. President Asif Ali Zardari was present at the ceremony, to mark the partnership of polio eradication. In her address to health experts, international donor agencies and the diplomatic community, Bhutto called for collective partnership and volunteerism in order to completely banish polio from the country.  


RE-ESTABLISHED TRANSMISSION COUNTRIES

ANGOLA

  • Although no new cases have been reported since 27 March, due to ongoing subnational surveillance gaps undetected transmission cannot be ruled out in the country.
  • Efforts are ongoing to further boost immunity levels in the country, with SIAs planned for 8-10 July in Luanda, Kuando Kubango and Cunene, using bivalent OPV.
  • The country has set in motion a revised strategy for delivering supplementary immunization rounds based on Municipal and Communal oversight of activities. It is critical that this revised strategy is fully implemented.
  • The programme has carried out a risk assessment identifying 24 Municipalities as being at risk for either sustaining transmission or being re-infected. The most significant risk in Angola is continuation of WPV circulation within the country, in particular in Luanda and Benguela, but also in more sparsely populated areas of recent circulation from which it could return to these highly populated provinces.  

CHAD

  • Chad is experiencing outbreaks of both WPV1 and WPV3. The WPV3 outbreak has been ongoing since November 2007 while the WPV1 outbreak began in September 2010.
  • The WPV1 outbreak is of particular concern. Originally restricted to the greater N'Djamena area, it has spread in 2011 to other areas of the country, including to the south (close to the border with Central African Republic) and to the east (close to the border with Sudan).
  • Historically, Chad has been associated with extensive international spread of polio. Between 2004 and 2006, WPV1 spread from eastern Chad into Sudan, and subsequently to other areas of the Horn of Africa, Saudi Arabia, Yemen and Indonesia. In 2008 and 2009, WPV3 from southern Chad spread into Cameroon and the Central African Republic.
  • WHO has notified its Member States of an increased risk of spread of polio from Chad via the IHR 2005 mechanism. WHO recommends that all travellers from polio-infected areas be fully vaccinated prior to travel (www.who.int/ith/en/). Other areas are also taking measures to minimise the risk of re-infection. The Kingdom of Saudi Arabia last month issued polio vaccination requirements for travellers to the Hajj.
  • To urgently address the situation, the Government of Chad has just finalized a six-month national polio emergency plan. Staggered NIDs took place in the second half of May, using bivalent OPV. Further activities are planned for July.  

DEMOCRATIC REPUBLIC OF THE CONGO (DRC)

  • DR Congo has reported 60 cases of WPV1 in 2011. The country is affected by three separate outbreaks, centred in Katanga (related to re-established transmission in the east); Kasai Occidental / Bandundu / Kinshasa (related to transmission introduced into DR Congo in 2010 from northern Angola); and, Bas Congo (related to transmission introduced into DR Congo in 2010 from the Republic of Congo and Angola).
  • Recent cases in the Kinshasa area are now among young children (previously young adults were affected). SIAs took place on 25 June in Kinshasa, Bas Congo and parts of Bandundu, Kasai Occidental, Kasai Oriental and Katanga.
  • Additionally, two rounds of SIAD campaigns will be held on 13 and 27 July, respectively, in Bas Congo, in response to recent cases there. The activity will also cover Kinshasa.  
     



IMPORTATION COUNTRIES

   

HORN OF AFRICA  

  • With the increased risk of polio spread from Chad, more activities are taking place to protect areas of the Horn of Africa. In Sudan in particular, additional immunization campaigns are planned, notably in the Darfur provinces in the west. In May, trivalent OPV was added to a sub-national measles campaign in the three Darfur provinces. In addition, SNIDs were conducted in four key northern states starting 20 June. Additionally, immunization posts are being set up at key border crossings and gathering sites, including in the Darfur provinces and in Port Sudan on the Red Sea cost (from where many populations leave towards the Arabian peninsula).
  • Efforts to raise immunity levels in other high-risk areas are also ongoing. In Somalia, Child Health Days using trivalent OPV were held on 5 June, however access to large parts of central and southern Somalia continues to be severely restricted due to security conditions.
  • Elsewhere, efforts are ongoing to strengthen subnational surveillance, notably in the Uganda/Kenya border area. Further to recommendations from the May Horn of Africa Technical Advisory Group (TAG), district-specific plans have been developed for high-risk border areas. 

WEST AFRICA  

  • West Africa continues to be affected by transmission of WPV3. Outbreak response is ongoing, but it is being conducted in such a way as to also maintain immunity levels to type 1 polio (a multi-country WPV1 outbreak from 2009-2010 was only recently stopped in the region). A total of 17 WPV3 cases have been reported in 2011 (11 from Côte d'Ivoire, one from Guinea, four from Mali and one from Niger).
  • Multi-country outbreak response campaigns were conducted on 23 June in ten countries of the region. Further activities are planned for July.
  • In Côte d'Ivoire, the outbreak has spread to other areas of the country, from the originally-infected province Bas Sassandra in the southwest. While the security situation is beginning to normalise itself and outbreak response is continuing, the situation remains volatile in some areas of the country, notably in the southwest near the border with Liberia.