Headlines
* Polio-affected countries* reduced by half during 2005: with the help of two new monovalent vaccines, the number of countries reporting polio was halved during 2005. The outbreaks in 15 of the 21 countries re-infected since 2003 have been successfully stopped, with only six of these countries continuing to report cases in the second half of 2005 (Angola, Ethiopia, Indonesia, Nepal, Somalia and Yemen). In addition, only five of the six polio-endemic countries reported cases last year. The sixth - Egypt - recorded its most recent poliovirus from an environmental sample collected in January 2005, marking one year without polio.
*NOTE: full endemic/importation country status will be reviewed in late January 2006.
* Monovalent oral polio vaccine type 3 used for the first time: mOPV3 was used for the first time in the eradication initiative, during subnational immunization days (SNIDs) in India.
* US$ 150 million funding gap for first part of 2006: the newly published Financial Resource Requirements (FRR) points out that to fully implement planned immunization and surveillance activities, a US$ 150 million funding gap for 2006 must be filled by July 2006. Of this, US$ 75 million is needed by March, to ensure activities in the early part of the year can proceed.
* Outbreak spreads in Somalia: Cases are reported beyond Mogadishu, making Somalia the only country with a geographically expanding polio outbreak.

Country Focus

Nigeria
* Extensive transmission of both type 1 and type 3 poliovirus continues in the northern part of the country. With 727 cases, Nigeria accounts for 40% of global cases.
* The Supplementary Immunization Activity (SIA) schedule for the spring of 2006 is currently being finalized. Campaigns are likely to take into consideration a planned national population census in March.
* The primary challenge remains ongoing coverage gaps during immunization campaigns, in the north of the country. For 2006, focus is on replicating the improvements achieved at national and state levels, at the district and ward levels to ensure every child is reached during activities.

India
* In India, the number of cases reported is less than half that for the same period in 2004 (64 compared with 130, respectively), even with intensified surveillance.
* Monovalent OPV type 3 was used in selected districts on 25 December, to speed the elimination of India's last type-3 virus. It is the first time mOPV3 has been used in the eradication initiative. The vaccine was used following the confirmation from Moradabad, Uttar Pradesh, of a type-3 polio case (onset of paralysis on 12 November), the first such case since June 2005 in India.
* The primary challenge remains ongoing and efficient transmission in key reservoir areas. For 2006, focus continues to be on reaching every child with mOPV.

Pakistan
* In 2005, 27 cases have been reported, compared with 48 for the same period in 2004.
* The primary risk to Pakistan's polio eradication effort remains restricted access due to insecurity in some areas of the country, most notably the tribal areas bordering Afghanistan in North West Frontier Province (NWFP), Balochistan, and areas in southern Punjab and northern Sindh.
* Extensive SNIDs were conducted in December throughout southern Punjab, Balochistan and NWFP. The first National Immunization Days (NIDs) in 2006 are scheduled for 24-26 January.
* For 2006, focus will be on working closely with all leaders and levels of civil society to ensure increased access to all populations.

Afghanistan
* The primary risk to Afghanistan's polio eradication effort is difficulty in accessing children due to insecurity in Hilmand and Uruzgan - the only two remaining polio-infected areas of the country. An extensive SNID in the highest-risk areas was conducted in mid-December. The next round is scheduled for 22-24 January.
* For 2006, focus will be on working closely with all leaders and levels of civil society to ensure increased access to all populations.

Egypt
* Egypt marks one year without polio, the most recent virus detected from an environmental sample collected in January 2005 (data available through November 2005).
* With more than 12 months since the last reported poliovirus in Egypt, the primary challenge will be to minimize the risk of importations from a polio-affected country. The focus for 2006 will be on maintaining high population immunity. Surveillance remains a priority and is maintained at a very high standard.

Niger
* In Niger, all cases reported in 2005 have been genetically linked to poliovirus circulating in northern Nigeria, rather than due to indigenous transmission.
* The primary challenge remains potential importations from neighbouring Nigeria. The focus for 2006 will be on maintaining high population immunity.

Indonesia
* The country launched its third round of NIDs on 30 November. Initial data suggests that at least 87% coverage was achieved, with some areas exceeding 95%.
* Monovalent oral polio vaccine type 1 was used in the affected areas of Sumatra and Java islands, with the rest of the country using trivalent OPV. Social mobilization activities were dramatically scaled-up.
* The SIA schedule for early 2006 is currently being finalized.
* The primary challenge remains ensuring an adequate number of immunization campaigns are conducted in 2006. Focus for 2006 will be on high-quality campaigns, particularly in the affected area of Banten.

Horn of Africa
* In Somalia, the number of cases has risen to 154. With recent confirmation of a few cases outside Mogadishu, including 2 cases in the north of the country, the risk remains of continued spread of wild poliovirus in Somalia, and potential for spread to neighbouring countries, mainly because of prevailing security problems limiting access to many areas.
* In Ethiopia, with recent confirmation of 2 additional cases in Oromia province, Ethiopia's outbreak now counts 20 cases for 2005. Discussions on the SIA schedule for early 2006 are ongoing with the government.
* Yemen has the most cases of any country with importations in 2005 (478 cases). Although the epidemic was brought under control quickly, the date of onset of the most recent case on 17 November indicates the possibility that a breakthrough in the transmission has occurred following the end-September NID.
* A primary challenge remains limiting further spread of polio within the Horn of Africa. Focus for 2006 will be on increasing access to all populations in Somalia, and ensuring a sufficient number of high-quality campaigns are held in Ethiopia and Yemen.

Angola
* Angola's most recent polio case had onset of paralysis on 13 November 2005. The primary challenge remains potential ongoing, low-level transmission and subnational surveillance gaps. Focus for 2006 will be to further increase population immunity levels and strengthen disease surveillance at the subnational level.

The state of polio eradication in 2005

Commitment to polio eradication was high thanks to visible progress in the hardest endemic areas and powerful new tools like monovalent oral polio vaccines.
Of the six countries considered endemic at the start of 2005, five reported polio cases in 2005 (Nigeria, India, Pakistan, Niger and Afghanistan).  Egypt reported its last poliovirus in an environmental sample in January 2005.  Eleven previously polio-free countries reported polio cases in 2005 (Somalia, Yemen, Indonesia, Sudan, Ethiopia, Angola, Mali, Cameroon, Chad, Eritrea and Nepal).
The necessary tools to eradicate polio are now in place. Stopping polio transmission can be completed rapidly, except in Nigeria. Nigeria will need at least an additional 12 months to finish the job, due to a 12-month suspension of immunizations in 2003-04.

The remaining challenges to a polio-free world are:
1. Primary challenge: Breaking the final chains of polio transmission in the endemic countries.
2. Acute challenge: Quickly stopping polio outbreaks in previously polio-free countries.
3. Cross-cutting challenges:
* Maintaining funding and political commitment;
* Addressing low routine immunization rates in polio-free countries;
* Ensuring sufficient vaccine is available.