Asia
India
* Monovalent oral polio vaccine type 1 (mOPV1) appears to be having a positive effect, as no type 1 cases have been reported since early May.
* Two type 3 wild poliovirus cases were confirmed in Rampur and Shahjanpur districts, Uttar Pradesh, the first polio type 3 cases in the country this year. Immunization campaigns with trivalent oral polio vaccine (tOPV) will be conducted in Rampur and neighbouring districts at the end of July. Additional rounds with tOPV will be held in August, late September and November.
Pakistan
* All cases reported since 9 May were from southern Punjab. Poliovirus has been found in all four provinces of Pakistan in 2005, and three separate genetic lineages continue to circulate.
* Commitment at national, provincial and district levels is key to maintaining and further improving the quality of supplementary immunization activities (SIAs). Focus must be on reaching young infants, particularly in high-risk districts, and improving supervision.
Afghanistan
* In Afghanistan, all 3 cases in 2005 have occurred in Uruzgan and Hilmand provinces, two areas of the country where access is hampered due to security concerns. SIAs targeting these provinces will be conducted in August.
Indonesia
* Indonesia continues to conduct immunization campaigns in response to the outbreak. A 2nd round campaign in West Java, Banten and Jakarta on 28-29 June followed the first-round 31 May to 2 June mop-up.
* The next SIA will be expanded, following the identification of a case in Sumatra and Central Java provinces. Precise dates and extent of the campaigns are being finalized.
Africa
* Stopping transmission by the end of 2005 will require extraordinary and rapid improvement in the quality of immunization campaigns, especially in northern Nigeria and countries affected by civil unrest.
* The further spread of polio is a continuing risk, particularly to the Democratic Republic of Congo, Djibouti, Eritrea and Somalia.
Nigeria
* Cases are down by 25% over the same period last year. The number of infected states is down from 30 to 18. There is evidence, particularly in the southern states, of improvements in immunization status.
* Improvements are evident in SIA quality. Between October 2004 and May 2005, the percentage of Local Government Authorities (LGAs) monitored rose from 25% to 80%; the percentage of 'missed' children during SIAs decreased from nearly 50% in 2004, to 6.6 % in the 2005 May round, according to independent monitoring data.
Niger
* Niger participated in sub-regional surveillance reviews from 27 June to 1 July, along with other countries of west and central Africa (see below).
Egypt
* Egypt is continuing to conduct SIAs using mOPV type 1 - the next National Immunization Day (NID) will be held on 10-12 July.
* The Technical Advisory Group (TAG) which met in Cairo on 1-3 June recommended a response to any potential reported viruses with immediate implementation of large-scale mop-up campaigns.
* No positive environmental samples have been reported since January.
West and central Africa
* Mali reported its first case this year. Date of onset is 20 March, before the last two NIDs. Cameroon and Mali are the only two non-endemic countries from this sub-region reporting cases this year.
* Subnational surveillance gaps remain. Surveillance reviews were conducted in Burkina Faso, Guinea, Liberia, Mali, Mauritania, Niger and Sierra Leone.
East Africa and the Horn of Africa
* Sudan's most recent reported polio case had onset of paralysis on 10 April.
* Somalia continues to be considered at high risk of polio re-infection. A second wave of preventive NIDs using mOPV1 was conducted on 24 June to urgently boost population immunity levels.
* Ethiopia has reported 13 cases since the beginning of the year. Cases have been genetically linked to Sudan. Ethiopia's next SIA is scheduled to begin on 29 July.
Angola
* Angola reported two polio cases, the first cases since September 2001. The first case, a 17-month old girl, lives in the greater Luanda area. The second case has recently been identified in Lobito.
* Preventive NIDs were already scheduled for 29-31 July and 26-28 August to respond to the spread of polio in Africa in 2003-2004; additional emergency campaigns are under discussion. The last previously-conducted SIAs in Angola were held in August 2004.
* mOPV1 will be used in Luanda, Lobito and the adjacent area of Benguela.
Middle East
Yemen
* Yemen accounts for nearly half of all cases worldwide at end-June. The 2nd round of immunization campaigns will be launched on 12 July. This will be the 3rd round this year in total. The epidemic is being brought under control, as evidenced by the significant decline in the number of reported cases.
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The state of global polio eradication in 2005
* Members states at the World Health Assembly in May expressed overwhelming confidence in the programme. The target-date of stopping transmission by end-2005 will be reviewed in October.
* There are 6 countries with endemic polio (Nigeria, India, Pakistan, Niger, Afghanistan and Egypt) and 6 countries where transmission has been re-established (Burkina Faso, Central African Republic, Chad, Côte d'Ivoire, Mali and Sudan).
* Success depends on reaching the groups of children that remain under-immunized. In every country, these children are poor, young and living in communities that receive little or no basic
healthcare.
* The greatest challenges to a polio-free world are:
1. Rapidly stopping polio transmission in the remaining endemic areas which continue to export virus into polio-free areas such as Angola and Indonesia.
2. Preventing the further spread of polio in Africa, particularly into Somalia.
3. Ensuring multi-year pledges are in place for 2006-2008 activities. Most notably, US$75 million must be made available by November 2005, for activities in the first quarter of 2006.
More than the end of a disease is at stake. Polio eradication would validate a US$4 billion, 17-year global investment
and prove the world can work together to reach a shared public health goal.
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