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30 June

India among top five in per-country contributions to Rotary Foundation,  type 1 polio on historic decline

From large-scale community development projects to polio eradication, Indian Rotarians are improving people's lives on a broad front through their support for The Rotary Foundation.  In the past three years, India has moved from ninth to fourth in per country total giving to the Foundation worldwide. More

An aggressive campaign against type 1 poliovirus has led to historic low levels of type 1 polio in India (5 cases to date).  Type 1 is the more paralytic of the two surviving types of wild poliovirus. Mindful of the fragility of this success, and as an additional measure to protect its own residents and the world from possible spread of polio, India now requires prospective pilgrims for the Hajj (annual Muslim pilgrimage to Mecca) to receive vaccination before applying for travel. By late May, nearly half the would-be pilgrims were vaccinated with oral polio vaccine. This new policy has cast the "vaccination net" wider than in previous years, when only those already accepted for Hajj were required to be vaccinated. Read more about this and other recent news from polio eradication in India.

18 June

Threat of international outbreak of polio from northern Nigeria
- Hajj pilgrims at risk

Northern Nigeria is currently affected by a new outbreak of type 1 wild poliovirus. As 
of 12 June, cases of type 1 in Nigeria have increased nine-fold in 2008 compared to 
the same period in 2007 (224 compared to 24 cases) and the country accounts for 
86% of type 1 cases in the world (224 of 259 cases). Type 1 polio is the more 
paralytic of the two surviving types of wild poliovirus and the priority target of the 
global eradication effort.

Over the past months, polio from northern Nigeria has already spread west to Benin, 
north to Niger and east to Chad; the risk of further spread from Nigeria is heightened 
by the upcoming rainy season – associated with increased transmission of poliovirus 
– and the mass travel of pilgrims across Africa heading to the Hajj (pilgrimage to 
Mecca, Saudi Arabia) in the second half of 2008. Saudi Arabia has been notified of 
the increased risk of polio infection to Hajj pilgrims. 

From 2003 to 2006, a similar outbreak in northern Nigeria spread to 20 previously 
polio-free countries, causing epidemics as far away as Indonesia and Yemen and 
paralysing 1,475 children across these countries. 

Recognizing the risk posed by this outbreak to the rest of the world, the World Health 
Assembly – the policy-setting body of the World Health Organization, convening in 
May 2008 – specifically called on Nigeria to reduce the risk of international spread by 
quickly stopping the outbreak in the north of the country through intensified 
eradication activities to ensure all children are vaccinated with oral polio vaccine.

Nigeria has planned two large-scale rounds of emergency polio immunization in the 
northern states in July and August 2008. Large-scale emergency polio immunization 
campaigns were conducted on 13-16 June in high-risk and border areas of Benin, 
Burkina Faso, Mali and Niger, to be followed by additional campaigns in July. 
Disease surveillance is being heightened in 'at-risk' countries, including in those re-
infected in 2003-2006. 

17 June

World Health Organization makes polio eradication 'top operational priority'
- Rotary International launches US$ 100 million fundraiser to help finish polio

World Health Organization (WHO) Director-General (DG) Dr Margaret Chan has made polio eradication the agency's 'top operational priority'. Dr Chan said in her keynote address to an international audience of 20,000 Rotary members and representatives of the world's press at the annual Rotary International Convention: "Polio eradication is not just about eradicating polio, it is about our ability as a society to reach all children to attain the United Nations Millennium Development Goals." The announcement was made as Rotary International launched a US$100 million fundraiser at the Convention, held this year in Los Angeles, USA.

Expressing the need for combined action across WHO, Dr Chan called on her senior staff at country, regional and headquarter levels, to ensure all administrative and operational bottlenecks within the Organization are unblocked. "The credibility of not just WHO, but of many other health initiatives, is on the line," she explained. 

This new prioritization comes twelve months into the intensified polio eradication effort, which has brought Asia to the brink of eliminating type 1 polio – the most dangerous strain of the disease. However, international concern is growing over a new type 1 outbreak in northern Nigeria, which is now threatening the global progress. 

"I will not permit another setback," commented Dr Chan. "Of every ten children paralysed by type 1 poliovirus this year, eight are in Nigeria. In some parts of the country, more than a quarter of the children have never been vaccinated. This is an operational problem, and it can be solved. It must be solved." 

Key to solving the operational problem is full political engagement and ownership, in particular in the highest-risk states and Local Government Areas (or districts) in the north of the country; as in any country, only local ownership can ensure every child is reached during every immunization campaign.

In her closing remarks at the Convention, Dr Chan personally thanked all 1.2 million Rotarians worldwide for their steadfast commitment to ridding the world of this ancient scourge. "Together, we will finish polio, forever," she concluded. 

More on the convention: speeches, video

13 June

India: advisory group confident that aggressive mop-ups will stop type 1 polio

As Western Uttar Pradesh reports first type 1 case this year

The Indian state of Uttar Pradesh reported in the past week its first case of type 1 polio since November 2007. Type 1 is the more paralytic of the two surviving serotypes of wild poliovirus and the priority target of the eradication effort. India is close to stopping type 1 transmission and sporadic cases are anticipated before the virus is finally eradicated. 

In anticipation of the possibility of a few more cases in the coming months, the India Expert Advisory Group (IEAG) on polio eradication, which reviewed the situation late last month, recommended immediate and intense mop-up vaccinations in response to any case to ensure elimination of type 1 virus by end-2008.

The risk of type 1 spread in the country’s most endemic area, western Uttar Pradesh, is mitigated by the highest ever levels of immunity to type 1 after intense immunization activities in the past 18 months. 

A sub-national immunization activity with type 1 monovalent oral polio vaccine (mOPV1) was completed in Uttar Pradesh one day before the onset of the new case (4 May) and counts as the first mop-up response round.  

Advisory group recommendations

The IEAG concluded last month that India could be the first endemic country to interrupt all type 1 wild poliovirus by the end of this year with aggressive mop-up vaccinations around such cases.

Underscoring the record-low levels of type 1 polio transmission (to date, five type 1 cases have been reported in 2008, compared with 34 type 1 cases for the same period in 2007), the IEAG has recommended innovative strategies to finish type 1 polio by the end of this year.  Critical 'polio emergency mop-up plans' will now be rapidly initiated  following notification of any further type 1 case. 

Report of a type 1 case will set into motion an immediate action plan: a full case investigation/risk assessment (including genetic sequencing) within 72 hours and a large-scale mop-up response consisting of at least three mOPV1 rounds, each reaching a minimum of five million children.  Planning and coordination of the mop ups will be managed by a Government of India multi-agency "Core Group" that will work with a similar core group convened in any affected states. 

Bihar

At the same time, the IEAG recommended the continuation of intensified efforts in Bihar, where there is a likelihood of ongoing, low-level type 1 polio transmission in isolated, key highest-risk areas. Bihar continues to receive increased technical support to implement strategies for reaching populations in access-compromised areas (such as the Kosi River basin).  

Reports from a mOPV1 mop-up in May in these areas suggests that these strategies along with the extra technical support are improving the quality of activities and successfully reaching children that were previously missed. A clear sign of ongoing strong commitment was provided by State Minister for Health and Family Welfare Nand Kishore Yadav through his recent public confirmation of polio eradication as a 'top priority' for the state government.

The IEAG convened in Delhi on 28-29 May. The full report can be downloaded here.

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