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26 November
Global advisory body urges
bold new initiatives to complete eradication
24 November 2008 – The Advisory Committee on Poliomyelitis Eradication (ACPE) –
the global advisory body to the Global Polio Eradication Initiative – has called
for bold new initiatives to complete the job of polio eradication. Reviewing the
epidemiology of poliovirus in the four remaining endemic countries Nigeria,
India, Pakistan and Afghanistan, the ACPE noted the range of difference in the
performance of eradication programmes in the remaining endemic countries, facing
unique epidemiological and operational challenges.
India has a very high performing programme, which faces unique epidemiological
challenges due to highly-efficient virus transmission coupled with suboptimal
efficacy of oral polio vaccine (OPV). The ACPE concluded that wild poliovirus
transmission will be rapidly interrupted, if the current efforts are sustained
and contingency plans to enhance programme performance are implemented. In
particular, supplementing monovalent OPV type 1 (mOPV1) campaigns with
inactivated polio vaccine (IPV) in key highest-risk districts of western Uttar
Pradesh state should be explored.
Afghanistan's eradication
programme benefits from top political commitment and engagement, community
determination and ongoing innovation which has resulted in transmission of virus
being largely restricted to the severely security-compromised areas in the
country's Southern Region. With virus transmission less intense in Afghanistan
than in both India and Pakistan, the ACPE noted that with modestly
increased-access to high-risk areas in the Southern Region, poliovirus
transmission will be stopped. To help secure this, a Presidential directive
should be issued to all non-governmental organizations (NGOs) operating in the
Southern Region, to make polio eradication a key priority.
Pakistan has a sound eradication programme, but because of very efficient virus
transmission, gaps in campaign quality and a deterioration in security in a key
transmission zone, requires further improvements in campaign quality and
continued innovation to complete eradication. Particularly important, according
to the ACPE, will be to achieve an appropriate balance among monovalent and
trivalent OPV in each infected area, conduct seroprevalence surveys to ensure a
clearer programme assessment, and ensure full and accountable oversight by
district-level political leadership.
In Nigeria, the new, high-level political commitment at the national level has
not yet led to field-level improvements in operational quality, as upwards of
30% of children remain unvaccinated in key areas in the north of the country
(notably in Kano state). This has led to a new outbreak of type 1 polio which
has spread internationally to six countries across west Africa. While the ACPE
noted improvements in those areas where ownership by state- and district-level
political leadership is evident, such engagement at these levels must be secured
across all northern high-risk states.
In re-infected areas, the ACPE noted that continued international spread of
polio and number of importations into polio-free countries remained unchanged
from 2007 and has indeed plateaued. The group highlighted that implementation of
new internationally-agreed outbreak response guidelines have markedly reduced
the consequences associated with new outbreaks (ie shorter outbreaks with fewer
associated cases). Given the ongoing risk of importations due to continued
indigenous circulation of wild poliovirus in northern Nigeria and India, the
group consequently put forward new immunization recommendations for travelers
to- and from polio-affected areas to reflect current knowledge of risks.
The ACPE strongly urged an interim review of progress against its
recommendations in April 2009.
For further information on the Global Polio Eradication Initiative, please visit
www.polioeradication.org.
07 November
Second issue of Polio
Pipeline published
See what's new in
the world of research in the Global Polio Eradication Initiative.
Polio Pipeline(pdf)
31 October
From manufacturer to mouth: what happens
during a vaccination campaign
A Rotarian stops to check if a child has been vaccinated
in Lucknow, India. Rotary
International/Rajesh
Kumar Singh
A new audio-visual
series from Rotary International focuses on sub-national polio immunization campaigns
held simultaneously along the
1800-kilometre border between India and Nepal. View
the first slide show
16 October
Studies
affirm technical feasibility of polio eradication: New England Journal of
Medicine
The New England Journal of Medicine today published two new research
papers which affirm the technical feasibility of polio eradication.
The first study, by researchers from the Egyptian Ministry of Health and
Population and national and international counterparts, demonstrates a
doubling of seroconversion rates in newborns receiving mOPV1. The
second, by researchers from Imperial College London, evaluates the
efficacy of monovalent oral polio vaccine type 1 (mOPV1) in northern
Nigeria. Investigating the immunity status of more than 20 000 children,
the study found mOPV1 to be four times as effective against type 1 polio than the traditionally-used trivalent OPV.
The programmatic implications of these studies are significant to the global
effort to eradicate polio, providing clear evidence of the effectiveness of
mOPV1. The seroconversion results indicate that in key endemic areas, such as
northern India, the immunity gap against WPV1 in the youngest children (who are
most vulnerable to polio) can be bridged more rapidly by mOPV1. The case-control
study results from northern Nigeria show that mOPV1 is a highly effective tool
against WPV1, with the capacity to stop this year's outbreak of type 1 polio if
vaccination campaign operations are improved.
With the technical feasibility of polio eradication now fully confirmed,
the focus is on rapidly overcoming the operational challenges to
reaching every child in the remaining endemic areas of northern Nigeria,
India, Pakistan and Afghanistan.
Read the full papers or fact sheets explaining the results and significance:
Monovalent type 1 oral poliovirus vaccine in newborns - More
Fact sheet
(pdf)
Effectiveness of immunization against polio in Nigeria - More
Fact sheet
(pdf)
14 October
Polio Hero: Saurabh Kumar Singh of
Bihar, India
The monsoon came early this year in India. Flooding left millions homeless and
official reports say nearly 1 500 people lost their lives. In the north-eastern
state of Bihar, one of the last areas in the world where polio still stalks
children, the Kosi River burst its banks. Swollen by heavy rains and melting
snow from the Himalaya, the river changed its course by more than 100
kilometres. Whole villages unprepared for such a deluge were washed away. In the
words of Indian Prime Minister Manmohan Singh, it was a "national calamity".
Survivors faced perilous days waiting to be rescued, perched on rooftops, in
trees or on any piece of dry land, often without food, clean water or shelter.
Among the hundreds working to rescue survivors and provide relief to stranded
communities was Saurabh Kumar Singh, a polio eradicator in Bihar.
A Field Volunteer for the National Polio Surveillance Programme (NPSP) in
Madhepura District, one of the hardest-hit by the floods, Saurabh is one of many
from NPSP who have worked tirelessly to support the Indian Government and
military services move people to safety.
Saurabh repeatedly risked his own life by plunging into the swollen Kosi River,
personally rescuing dozens of drowning women and children. His intimate
knowledge of the district was invaluable to rescuers; he was able to direct
rescue workers to scores of stranded people, to whom lifejackets from the polio
programme were distributed.
Polio hero Saurabh Kumar Singh, centre, with NPSP colleagues.
The organization provided essential support to the vast government rescue
operations.
Polio eradication maps help military
rescue operations
Saurabh's brave efforts were not the only way that the polio eradication
programme assisted the government's response. The most detailed available maps
of the area are hand-drawn maps used for polio eradication work, and these were
extensively referenced by the Indian Army to plan rescue operations.
Polio Surveillance Medical Officers and Field Volunteers also assisted the
Indian Government's flood relief efforts by providing transport, monitoring
disease outbreaks in camps and supporting emergency measles and tetanus
vaccination campaigns.
Based on polio campaign micro-plans, vaccinators were trained to distribute
purification tablets for wells and hand-pumps so rural communities could have
drinking water.
Hundreds of thousands remain homeless in Bihar, cramped into under-resourced
camps, many of them young children vulnerable to diseases such as cholera,
measles and polio. But thanks to true polio heroes like Saurabh and his
colleagues, thousands more will make the journey home this year as the waters
subside.
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