August 2006
Data as of 8 August 2006    English PDF     Version française en PDF
 

Headlines

• G8 re-affirms commitment to polio eradication: convening in St Petersburg, Russia, on 15-17 July 2006, leaders of the G8 countries pledged to "continue to work collectively and with bilateral and multilateral donors to close the funding gap for 2007-2008". The spearheading partners of the Global Polio Eradication Initiative welcome these statements, and urge rapid action: in addition to the 2007-2008 funding gap of US$ 400 million, US$ 85 million is required to ensure 2006 planned and outbreak response activities can proceed.
   
• Progress in stopping outbreaks puts spotlight back on 4 endemic countries: in 2006, 90% of all polio cases are from endemic countries (Nigeria, India, Afghanistan and Pakistan), with 10% of cases from re-infected countries. This is a reverse situation from 2005, when the bulk of all polio cases (65%) were found in re-infected countries. With outbreaks in re-infected countries increasingly stopped or significantly slowing, the success of the global polio eradication effort lies in urgently stopping indigenous polio transmission in the remaining four endemic countries.
   
• Western Uttar Pradesh (UP), India - outbreak increases risk of international spread of polio: in 2006, western UP is the only area in the world with a geographically expanding polio epidemic that is actively exporting polio to previously polio-free countries. Please see section 'India' below, for further information.
   

Nigeria

• The Expert Review Committee for Polio Eradication (ERC) convened on 13-14 July 2006 in Kano, to review the impact of the recent Immunization Plus Days (IPDs) on the epidemiology of polio in the north of the country.
• The ERC noted that the IPDs were popular with community leadership and resulted in some gains in routine EPI (DTP3 coverage).
• In particular, the ERC noted moderate increases in the number of children reached during the IPDs, particularly with the first dose of oral polio vaccine (OPV), compared to previous rounds in 2006. IPDs had been introduced by the Government of Nigeria, in response to intense polio transmission in the north of the country. By providing health interventions in addition to OPV during the IPDs, increased community engagement is likely to follow.
•  A new tactic called 'community dialogues' proved particularly successful in some states and local government areas (LGAs); traditional and community leaders were invited to workshops on the importance of IPDs and immunization in general, prior to the activity. However, while improvements were noted, they were not uniform across all states in the north. In particular, problems continued to be seen in Kano, Jigawa and Katsina states.
• The next IPDs will be held in early September. Focus will be on increased community dialogues, increased supervision, enhanced monitoring and additional interventions such as Vitamin A (and potentially de-worming tablets), and the use of impact evaluation.

• In 2006, 598 cases have been reported to date, compared to 308 cases for the same period in 2005.
  Five states – Bauchi, Jigawa, Kaduna, Kano and Katsina – account for over half (56%) of all cases worldwide (and 82% of cases in Nigeria).

India

• India has experienced an outbreak centred in and around Moradabad district, western Uttar Pradesh, resulting in significant increase in new cases in 2006, compared to previous year (155 cases compared to 25 for the same period in 2005).

• Moradabad and five neighbouring districts account for 70% of India's cases in 2006. Moradabad district is also the only known district with type 3 polio circulation in 2006.

• The current outbreak in and around Moradabad is increasing the risk of national and international spread of wild poliovirus. It is currently the only area of the world that is actively exporting poliovirus to other countries. Poliovirus originating from this area recently has been detected in Namibia, the Democratic Republic of the Congo (DR Congo), Bangladesh, Nepal, Angola (in 2005), as well as previously polio-free areas within India (Madhya Pradesh state).

• At the same time, however, strong progress continues to be achieved in Bihar state, demonstrating that polio eradication strategies, particularly with the recent introduction of monovalent oral polio vaccines (mOPVs) work, if implemented correctly.

• The increase in polio transmission in Moradabad and neighbouring districts is due to a decrease in the quality of supplementary immunization activities (SIAs) - monitoring data indicate an increase in 'missed children' during SIAs.

Pakistan and Afghanistan

• In Pakistan, 12 cases have been reported this year (the same as for the same period last year, but with reduced genetic diversity).

• In Afghanistan, 22 cases have been reported this year, compared with 4 for the same period last year.

• In Afghanistan, increasing insecurity is significantly hampering access to all populations, particularly in the southern region of the country (Kandahar, Uruzgan and Hilmand). During the week of 19 July, subnational immunization days (SNIDs) were held in the southern region of the country, targeting 2.3 million children under the age of five years.

• Due to increased insecurity during SIAs, the primary focus at this time is to geographically restrict polio transmission as much as possible, and to implement strategies to optimise coverage during activities in time of conflict.

Namibia, Angola and DR Congo

• In Namibia, 20 cases have been virologically confirmed to be wild poliovirus type 1 (age distribution of cases: between 14 years and 51 years). More than 150 cases of acute flaccid paralysis (AFP) are still being investigated.

• In Namibia, the second of three National Immunization Days (NIDs) were held on 18-21 July, targeting the entire population (rather than the usual under-five year old segment), as the outbreak is primarily affecting adults.

• In Namibia, coverage data of this second round NID is not yet available; the first NIDs reached well over 90% coverage. Demand for mOPV1 was again high during this second round. The next NIDs will be held on 22 August; the target population of this third NID is yet to be finalized.

• In DR Congo, 8 cases of polio have been confirmed. DR Congo suffered two separate, individual importations from Angola, the first into Bas-Congo province, and a second, separate importation into Kasai province. The possibility of a fourth round is currently being discussed.

• In Angola, while no cases have been reported in 2006, ongoing virus circulation cannot be ruled out due to subnational surveillance gaps. The cases in both DR Congo and Namibia have been genetically linked to virus originating in Angola; Angola became re-infected in April 2005 by poliovirus originating in western Uttar Pradesh, India.

• DR Congo and Angola will synchronize their next SIAs on 18 August.

Somalia and Ethiopia

•  In Somalia, 28 cases have been reported in 2006.

• In Ethiopia, 8 cases have been reported in 2006.

• Additionally, pre-notification of 4 cases has been received; the origin of these cases (eg northern Somalia or the Somali region of Ethiopia) remains under investigation.

• Thanks to strong efforts in both countries, the epicentre of the outbreaks now appears to be limited to a cross-border region in the northern areas of Somalia (most notably Mudug region), as well as Somali region of Ethiopia. In both areas, limited access has led to persistent coverage gaps. Both countries are continuing to synchronize immunization campaigns in efforts to address these coverage gaps.

• A special Horn of Africa Technical Advisory Group (TAG) will convene in Addis Ababa, Ethiopia, on 14-15 August. Among other issues, the TAG will discuss additional specific strategies to increase coverage in the cross-border region with ongoing polio transmission.

•  A Horn of Africa Communication Planning Workshop will be held in Nairobi, Kenya, on 21-25 August (Ethiopia, Somalia, Sudan, Djibouti, Yemen).

Bangledesh

• In Bangladesh, with further recent spread of polio, the Government has announced an additional, aggressive SIA schedule to stop the outbreak.

• In addition to the fourth NIDs launched on 6 August, additional rounds will be conducted in November and December, as well as in 2007.

• In Bangladesh, 10 cases have been reported in 2006.

The state of polio eradication

In 2005, the world moved several critical milestones closer to polio eradication, including the successful introduction of the monovalent oral polio vaccines, visible progress in the hardest endemic areas and an end to west and central Africa's epidemic (outside Nigeria).

Only 4 countries are still polio-endemic - an all-time low: Nigeria, India, Pakistan and Afghanistan.

In addition to the endemic countries, nine countries have reported polio cases in 2006 due to importations (Somalia, Yemen, Indonesia, Bangladesh, Ethiopia, Namibia, Niger, Nepal and DR Congo).

The strategies and tools to eradicate polio are known. Challenges to stopping polio transmission can be met.

The remaining challenges to a polio-free world are:

• Curbing the intense transmission in the high-priority states in northern Nigeria and western Uttar Pradesh, India.

• Sustaining campaigns to break the final polio chains in the other two endemic countries.

• Rapidly stopping polio outbreaks in previously polio-free countries.

• Addressing low routine immunization rates and surveillance gaps in polio-free areas.

• Maintaining funding and political commitment.