January 2008

All data as of 29 January 2008   English (pdf ) | Français (pdf)

• Recommendations of Advisory Committee on Polio Eradication bear financial implications: The independent body providing strategic guidance to the Global Polio Eradication Initiative (GPEI) endorsed continuing the intensified eradication effort in 2008-2009. This will mean a 60% increase in the budget to provide for significant ramping-up of both the quantity and quality of supplementary immunization activities – in remaining endemic areas as well as zones at high risk of importations  – in a bid to rapidly stop polio once and for all.  Full financing is critical to success. 
  
  

• New budget and funding gap: To assist financial partners in their medium-term planning, the GPEI has drawn up a five-year plan and budget. For 2008-09, the GPEI faces a global funding gap of US$525 million against a budget of US$ 1.3 billion, of which US$175 million is needed for 2008.  The full 5-year Financial Resource Requirements are available at: polioeradication.org/fundingbackground.asp.
  
  

• Most dangerous polio serotype beaten back: more than half of the 2.2 billion doses of oral polio vaccine (OPV) given to children during vaccination campaigns in 2007 were of monovalent oral polio vaccine type 1 (mOPV1), as a strategic priority to eradicate type 1 wild poliovirus, which has the higher paralytic attack rate of the two remaining serotypes and spreads more easily.  Thanks to this tactic, the year 2007 is likely to set a record for the lowest-ever incidence of type 1 polio, with a decrease of 84% from 2006. Large areas of the remaining endemic countries now appear to be free of this serotype, including the western end of Uttar Pradesh, India, where the virus has been more entrenched than anywhere else on earth. Final data for 2007 will be available in March. 
  
  

• Over 400 million children vaccinated against polio in 2007: as the intensified eradication effort zeroed in on remaining reservoirs of poliovirus last year, 164 vaccination campaigns were held during the year in 23 countries. The bulk of these campaigns were in the endemic countries of Afghanistan, India, Nigeria and Pakistan. 
  
  

• Role of communication sciences recognized as critical in intensified phase: Acknowledging the role that data-driven communications has played in progress against polio so far, communication and social mobilization activities to support polio immunization were discussed in some depth at November's global Advisory Committee on Polio Eradication and at Africa's Task Force for Immunization (TFI) yearly meeting in December. Both panels recommended UNICEF and partners should support countries to intensify their communication activities and to develop communication indicators to be systematically used in polio eradication activities in all countries.  In Africa, progress towards achieving these indicators should be presented at the 2008 TFI meeting.

India 

• For 2007, 831 cases have been reported (76 type 1 , 752 type 3 and three cases positive for both types), a total increase of 23% compared to 2006. The increase is due to a rise in type 3, whereas type 1 has decreased by 88%. The first cases of 2008 are 8 type 3s. 
  
  

• A significant risk to the programme is that the outbreak of type 3 in Bihar could negatively affect the current high levels of commitment in that state. The outbreak is not unexpected, given the strategic priority placed on eradication of type 1. The impact of two large-scale Supplementary Immunization Activities (SIAs) with mOPV3 – the most recent on 9 December – should be apparent by mid-February. Experience with mOPV3 in western Uttar Pradesh and in parts of Bihar demonstrates that rapid, large-scale mOPV3 campaigns have significant impact on type 3 transmission.
  
  

• Transmission of type 1 polio in Bihar is primarily in hard-to-reach areas, such as embankments in the Kosi River basin.  Increased focus on these areas is the linchpin of a new strategic plan, which includes the deployment of additional personnel to improve mapping, micro-plans, training and monitoring.  Due to the difficulties of travel to these areas, the plan also proposes tailored logistic arrangements such as contractual agreements for boat and motorcycle transportation and regular overnight stays.
  
  

• National Immunization Days (NIDs) were held 6-11 January, using mOPV1 or trivalent OPV depending on the area. Sixty high-risk blocks in Bihar held their round one week later to allow for greater focus on these persistently infected areas. Rotary members from several countries will join their fellows in India during the February SIAs.

Nigeria 

• For 2007, 279 cases have been reported (111 type 1 and 168 type 3), representing a 75% decline in cases compared to the same period in 2006 and a 90% decline in type 1 polio alone. One case has been reported for 2008, a type 1.
  
  

• The northern state of Kano has seen a stunning decline in type 1, from 304 cases in 2006 to only 7 in 2007.  Much of this progress in a state which was the epicentre of a multi-country outbreak is due to the ever-increasing ownership of polio eradication by local authorities, resulting in improved implementation of SIAs and facilitating systematic engagement of Quranic school teachers. Almost 30% of the entire target group of children under the age of 5 are being immunized in these schools in 8 urban local government areas of Kano
  
  

• Nigeria's first National Immunization Plus Days of 2008 were held 26-29 January, using mOPV1 and with detailed preparations in high-risk states. More than 41 million children under five years are targeted for vaccination during the round. Another national round one month later will use mOPV3. Rotarians from around the world will join their fellow members in Nigeria for the February activities.
  
  

• The Secretary General of the Organization of the Islamic Conference, His Excellency Eklemeddin Ihsanoglu, a recently-named Polio Eradication Champion, included high-risk polio-endemic states of Nigeria on his January tour of West Africa. 

Pakistan and Afghanistan

• For 2007, 32 cases have been reported in Pakistan (19 type 1 and 13 type 3) – 8 fewer than the same period last year – and 17 cases in Afghanistan (6 type 1 and 10 type 3) – a 45% decline over the same time in 2006.
  
  

• In Afghanistan, two type 1 cases occurred in December, the country's first since June 2007.  However, thanks to creative engagement with all parties in the conflict in the southern region, the proportion of missed children declined by a quarter. 
  
  

• The Minister of Public Health of Afghanistan held an emergency high-level meeting in Kabul on 15 January with national health authorities and representatives from the provinces of Hilmand, Kandahar, Nangarhar, Kunar, Laghman, and Farah. Discussion focused on access-compromised areas and potential solutions, which included a call to urgently re-convene the national Polio Action Group established by President Hamid Karzai. Mop-ups with mOPV3 have been completed on 16 January in high-risk blocks with recent type 3 transmission, and sub-national immunization days (SNIDs) were held 22-24 January. Reports suggest that access to children in the southern region has been better than in most of 2007.
  
  

• In Pakistan, the majority of the cases occurred in districts identified to be at high risk. Of the 32 cases in 2007, 13 (40%) occurred in November and December. The spurt of cases in NWFP relates to continued inaccessibility to children in security compromised areas; most of the 12 cases from Sindh indicate prolonged weak operations in some districts of that province. Mop-ups were conducted in December and January and an NID was completed on 25 January.

Re-infected countries 

• Chad: With 19 cases in 2007 and 7 SIAs, Chad has seen in November 2007 the first type 3 in the country for a year. Recent cases have been reported from the previously polio-free southern province of Tandjile, which was subsequently covered in the 26 January SIAs. Spread to the south of the country threatens the neighbouring Central African Republic, and will require the implementation of SIAs in that country.
  
  

• Democratic Republic of Congo: Although it has the highest number of cases of any re-infected country (41), DRC's most recent case was in November, and it has not reported any cases following the last two SIAs. An SIA along the Congo River, which serves as the central transport artery and has enabled spread of the virus, took place from 24-26 January.
  
  

• Nepal: The country's first cases for 2007 were reported this month, 4 type 3s right on the border with Bihar State in India, where a type 3 outbreak is occurring. NIDs are planned for 2-3 February, using mOPV3 in 20 districts surrounding the cases and mOPV1 elsewhere. Nepal remains at high risk for importations due to its proximity to and population exchange with endemic parts of India.

Polio eradication in 2008

The intensified polio eradication effort launched in February 2007 has reduced type 1 wild poliovirus by over 80% and restricted transmission to parts of four countries.

Reaching a polio-free world requires:
1. Increasingly intensified immunization activities  in endemic areas with a mix of monovalent and trivalent vaccines.
2. Further improving the ability to reach every child, particularly in northern Nigeria, Bihar in India, southern Afghanistan and parts of Pakistan.
3. Rapidly securing multi-year commitments for the financial resources necessary to implement polio eradication strategies.
4. Swift outbreak response activities in the remaining re-infected countries and steps to minimize the risk and consequences of international spread of polio.
5. Strengthen AFP surveillance at sub-national levels in central Africa and parts of Asia.

_____________________________________________________________________________________________________
Polio eradication will only succeed if the necessary funds are made available, and with strong political commitment in polio-affected countries. More than 10 million children will be paralysed in the next 40 years if the world fails to capitalize on its >US$5 billion global investment in eradication.