18 August 2006

Polio outbreak in Southern Afghanistan

Afghanistan has seen a six-fold rise in the number of polio cases over last year (25 cases confirmed in 2006, compared to 4 cases in the same period in 2005). All but one of these cases is in the southern region of the country, where the current security situation has made it nearly impossible for health teams to reach children.

The polio eradication campaign is one of the few public health initiatives still maintaining some degree of operations in the southern region of the country. Tribute must be paid to health workers on the ground, who are operating under extremely difficult and dangerous conditions, risking their lives in efforts to reach every child with polio vaccine.

The transmission of virus is made easier by frequent population movements into and from neighbouring Pakistan, one of the three other polio-endemic countries. This "corridor of transmission" stretches from the Southern Region, into Pakistan's Balochistan and northern Sindh/southern Punjab. In response, Afghanistan and Pakistan continue to synchronize Supplementary Immunization Activities (SIAs).

As the situation in southern Afghanistan is rapidly evolving, it is difficult to plan complex operations. The immediate goals of the polio eradication programme are to ensure the safety of staff working in the field and to maintain the highest levels of continuity of operations possible under the circumstances, in order to make sure that polio transmission does not spread out of Southern Region.

To this end, the polio teams in the country are working with all sectors of society at the district, state and national level to negotiate increased access to children. More local community members are being recruited as vaccinators and supervisors. Teams are also taking advantage of any windows of opportunity when areas can be accessed to conduct rapid and focused mop-up activities, in addition to the planned large scale SIA rounds.

Large-scale SIAs are continuing in all other areas of the country to prevent spread of polio out of the southern region. Other antigens such as Vitamin A are also distributed during activities, and the active Acute Flaccid Paralysis (AFP) surveillance network is used to help identify other diseases of public health importance.

In total this year, 3 National Immunization Days have been held (5 March, 2 April and 20 August), and 4 sub-national activities (sNIDs: 22 January, 7 May, 4 June and 19 July). Thanks to these efforts, geographical spread of polio has largely been restricted to the southern region of the country. However, the risk of spread remains high, and Afghanistan's 7.1 million children under the age of five are vulnerable.

More activities are planned in the second half of the year, for which US$ 700,000 is needed for campaign operations and disease surveillance.

Experience in other countries of civil conflict shows that polio eradication strategies work even in the most challenging settings, as the disease has been eradicated from such countries as Sierra Leone, Côte d'Ivoire and Liberia. Ultimately, however, political ownership must be strong at all levels and across political lines in order to secure access to all communities.

Click here for current global case count of polio

17 August 2006

Update on Immunization Plus Days in Nigeria

Nigeria currently accounts for 70% of the global cases of polio this year, and over 80% of these cases are in five northern states of the country.

As one of only a handful of areas worldwide that have never uprooted wild poliovirus, northern Nigeria has been honing its immunization campaigns to counter the intense transmission of the virus. Analysis of the first Immunization Plus Days(IPDs) shows a measurable improvement in the proportions of children covered and an increase in public demand for vaccination.

While country teams now report that the IPD approach is working to curb the intensity of poliovirus transmission, they also warn that this improvement is uneven across the north and that refinements in operations and timely funding are required to handle the vastly more complicated logistics of offering several health inputs at once.

Reaching more children

IPDs were introduced by the Government of Nigeria in May as a refinement of the previous National Immunization Days, which concentrated only on polio vaccination. By bundling health interventions to communities during polio vaccinations – such as measles and other immunizations, insecticide-treated bed nets or de-worming tablets – it was hoped that community engagement and turn-out would increase. Following two IPDs in May and June, in 11 northern states, teams in the field report that communities are more eager to bring their children for the variety of benefits offered and many political and health leaders are increasingly identifying themselves with the gains in immunization coverage.

Local ownership

One of the several innovations during the IPDs was the formal engagement in dialogue with community leaders before the campaigns were held. These community dialogues, implemented in time for the June IPDs, provided an opportunity for the community to feed into the planning, and created greater local ownership of the package of health care interventions. Parents were then much more interested in procuring vaccinations for their children. One example of this is in the Sandamu local government area (LGA) of Katsina State, where the proportion of missed children declined from 38% in the May IPDs to 7.5% in the June IPDs.

As a result of such initiatives, Katsina State was able to achieve the intermediate goal of reducing the proportion of missed children in the June campaign to less than 10%. Similar success stories of local solutions to the low coverage rates in high risk districts were reported from several other LGAs in other states. It is expected that the impact of this increased coverage will soon be confirmed by a decline in cases.

Added benefits

An added benefit to the IPDs has been stronger and more reliable data on the number of children reached. Unlike house-to-house NIDs, counting children present at fixed vaccination sites has yielded more credible numbers. Since trained health workers are required to administer vaccinations such as measles, data collection is also of better quality. The improvement in data quality is useful for all other child health interventions.

Timely funding is critical

An important improvement between the May and June IPDs was the timely arrival of funds, allowing for better planning, training and logistical arrangements.

However, in some LGAs, increased commitment from local authorities is required in order to achieve the levels of coverage necessary to interrupt polio transmission. In Jigawa state, for example, the proportion of children missed during the IPD was over 35% in June.

In the May and June IPDs, not all of the additional health interventions were available in all areas. This was due to a combination of short planning time and a lack of necessary funds. For the IPDs to reach the proportions of children necessary to eradicate polio, funding must be in place on time to ensure that the additional interventions are available.

The next round of IPDs, planned for September, will cover a larger area of the north, including the same high-priority states as the previous IPDs.
 

16 August 2006

Efforts are intensified in India, as new outbreak threatens to spread

The latest in a series of mass polio immunization campaigns was launched on 30 July 2006 in the remaining polio-infected areas of India. For four days, hundreds of thousands of health workers and volunteers went house-to-house in western Uttar Pradesh and Bihar states, to reach more than 32 million children under the age of five years with polio vaccine.

The campaign comes amid fears that a new outbreak centred around Moradabad district, in western Uttar Pradesh, could cause epidemics of international scale. Western Uttar Pradesh has experienced a spike in new polio cases in 2006, suffering a four-fold increase in new disease over the same period last year. Alarmingly, Moradabad and its surrounding areas form the only place in the world that is actively exporting poliovirus to other countries - polio originating from this area has recently been detected in a number of previously polio-free countries, including as far away as Namibia, the Democratic Republic of the Congo (DR Congo), Bangladesh and Nepal.

The task of eradicating polio in western Uttar Pradesh is daunting, due to extremely high population density and low sanitation infrastructure. With a population of more than 180 million people, and 500,000 children born each month, the conditions are ideal for polio to transmit among communities across the state. The increase in polio transmission has been attributed to a marginal increase in 'missed' children during immunization activities in late 2005, which led to a surge in poliovirus transmission in 2006.

Despite this increase in the numbers of new cases in western Uttar Pradesh, however, polio transmission in other parts of India is increasingly coming under control. Bihar state, the only other remaining reservoir of indigenous poliovirus circulation, has made strong progress in 2006, reporting only a single case of polio over the past three months. The historical polio reservoir in Mumbai was finally cleared in 2005, following the introduction of a new monovalent oral polio vaccine, which offers higher protection for fewer doses than the traditionally-used trivalent oral polio vaccine. Such successes underscore that the eradication strategies work, if implemented effectively, and underline the feasibility of polio eradication even in the most technically-challenging settings.

Key to stopping the outbreak in and around Moradabad district is to reach each and every child under the age of five years during each immunization campaign. The World Health Organization (WHO), together with its partners Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF, are continuing to support the Government of India in its efforts to protect the country's children from this paralysing disease. In an expression of their strong committment to polio eradication, the Government of India announced recently that they will be allocating over US$ 210 million in domestic resources for polio eradication activities in 2006-2007.

04 August 2006

New cases of polio prompts further immunization drive in Bangladesh

Government of Bangladesh has ordered a further three polio NIDs this year in response to at least 10 new cases of polio detected in the country.

Press release

04 August 2006

Summer 2006 Polio News

In this issue: the passing of WHO Director-General Dr LEE, Jong-wook, a true polio hero; Namibia's model response to importation; India's new approach to polio eradication in western Uttar Pradesh; Government of Nigeria introduces Immunization Plus Days in northern Nigeria; and G8 leaders re-commit to polio eradication. And our regular updates on immunization campaigns, case numbers, financial contributions and new publications.
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