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July
2006
Data as at 04 July 2006
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Headlines
- Namibia conducts
high-quality NIDs:
in response to an unusual outbreak affecting primarily adults, the
Government of Namibia launched the first of three National Immunization Days
(NIDs) on 21 June. Targeting the entire population, rather than the usual
under-five-year old segment, the vaccination campaign reached an estimated
95% of the target population with monovalent oral polio vaccine type 1
(mOPV1).
- India: Moradabad
district, in western Uttar Pradesh, accounts for 42% of India's cases in
2006:
reporting 31 of the country's 73 cases, it is the highest case-count ever
for a single district during the first six months of a year in India.
- Nigeria launches
its second Immunization Plus Days (IPDs):
review of first-round IPDs indicates only marginal increase in coverage.
- Polio case
confirmation time significantly reduced:
the Global Polio Laboratory Network is
implementing plans to significantly reduce the time to confirmation of the
presence of wild polioviruses in stool samples from acute flaccid paralysis
(AFP) cases. Field trials conducted in reference polio laboratories in India
and Pakistan have shown an acceleration in confirming wild poliovirus by as
much as 10 days (from an average of 20 days, to 10 days), while maintaining
high levels of virus detection sensitivity. Transferring the lessons learnt
from the field trials to other laboratories will require investment in
equipment and staff training. Improvement in case confirmation time will
have a dramatic public health impact, as outbreak responses can now be
conducted significantly more rapidly.
- G8 expected to
discuss polio eradication:
at the upcoming G8 Summit in St
Petersburg, Russia (15-17 July), leaders of the G8 countries are expected to
again discuss polio eradication. Polio eradication has been on the G8's
agenda since its 2002 Summit in Canada. The G8 is the largest donor base to
the Global Polio Eradication Initiative, representing 52% of the US$ 4.1
billion budget to date. The group's combined leadership has been integral in
mobilizing other partners around the world.
Country Focus
Nigeria
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In 2006, 526 cases have been reported
to date, compared to 194 cases for the same period in 2005.
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Five states – Bauchi, Jigawa, Kaduna,
Kano and Katsina – account for over two-thirds (67%) of all cases
worldwide.
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The second round Immunization Plus
Days (IPDs) were held on 29 June, in 11 northern states. IPDs were
introduced by the Government of Nigeria, in response to the intense
polio transmission in the north of the country. Communities receive
extra health benefits during IPDs, such as Vitamin A, de-worming
tablets, in addition to polio, measles and DPT vaccination. Although
full coverage data is not yet available, anecdotal feedback suggests
that - as during the May IPDs - coverage was only marginally higher than
during most recent polio Supplementary Immunization Days (SIAs), with
between 25% to 35% of children missed.
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The Expert Review Committee for Polio
Eradication (ERC) will convene in Kano on 12 - 13 July, to review the
full impact the May and June IPDs had on the epidemiology of the disease
and circulation of the virus. The ERC is expected to agree and finalize
the immunization strategy for the latter half of 2006.
India
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While India has experienced a significant
increase in new cases reported in 2006 compared to the previous year (73
cases compared to 20 cases for the same period in 2005, nearly half of these
cases are in a single district of western Uttar Pradesh: Moradabad.
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The increase in polio transmission in
Moradabad is likely due to a decrease in SIA quality in the latter half of
2005 and into early 2006. To urgently address this, additional strategies
are being actively implemented in Moradabad, including: deployment of
surveillance medical officers (SMOs) from non-endemic areas of the country
to support SIAs in Moradabad, as well as the administration of a birth dose
of monovalent oral polio vaccine type 1 (mOPV1). Campaign quality has
already begun to improve again, particularly since the February 2006 round.
Pakistan and Afghanistan
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In Pakistan, 7 cases have been reported
this year, compared with 10 for the same period last year.
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In Afghanistan, 14 cases have been
reported this year, compared with 3 for the same period last year.
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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 28 June, confirmation was received of a polio case in the western
region of the country, a previously uninfected area.
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Due to the increasing insecurity, the
primary focus at this time is to prevent a large-scale and geographically
widespread outbreak.
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With frequent population movements across
the border with Pakistan, both countries are continuing to synchronize
immunization activities. In mid-July, the Technical Advisory Groups (TAGs)
of both countries will jointly convene in Islamabad, Pakistan, to discuss
strategies to increase access to all populations, including increasing
ownership of the programme, down to the village level. With recent
confirmation of a type 3 case in North West Frontier Province, the TAG is
also expected to discuss optimizing use of monovalent and trivalent OPVs.
Namibia
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13 cases have been virologically
confirmed to be wild poliovirus type 1. More than 100 cases of acute flaccid
paralysis (AFP) are still being investigated.
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Following the deployment of the
international and regional rapid response team to support the Government of
Namibia, the first of three NIDs were held on 21 June, targeting the entire
population (rather than only the usual under-five year old segment). The
outbreak is unusual because it is primarily affecting adults; the cause for
this is still being investigated.
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Independent monitoring has confirmed that
well over 90% coverage was achieved, with demand for mOPV1 high. If the two
subsequent NIDs in July and August are equally successful, the outbreak
should be stopped relatively quickly.
Bangladesh
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The third of three NIDs was completed
during the week of 11 June, with reported coverage of over 90%. One new
polio case was reported from the centre of the country, bringing the total
number of cases associated with this outbreak to 4. This most recent case
had onset of paralysis prior to the second and third NIDs.
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Bangladesh will conduct an additional NID
round starting on 6 August, using mOPV1.
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Bangladesh is continuing to further
strengthen its AFP surveillance network, while maintaining high population
immunity to minimize the risk of further importations.
Somalia and Ethiopia
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In Somalia, 26 cases have been reported
in 2006. Polio appears to be on the decline in Mogadishu, formerly the
epicentre of the outbreak.
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The most recent case of polio was
reported in Mudug, in the north of the country. Preliminary investigation of
the case, in addition to three other cases, shows that the infection
happened in the Somali region of Ethiopia. The risk of further spread across
the Horn of Africa remains high, further magnified by limited access to all
populations.
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In Ethiopia, 6 cases have been reported
this year, the most recent cases in Somali Region, bordering Somalia.
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Limited access and persistent coverage
gaps remain in both countries, most notably in Mudug, Somalia, and Somali
Region, Ethiopia.
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To urgently address these coverage gaps,
both countries continue to synchronize immunization campaigns. The next
synchronized SIAs in key high risk areas will take place on 16 July.
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 DRC).
The necessary tools to
eradicate polio are in place. Stopping polio transmission can be completed
rapidly, except in Nigeria, where at least an additional 12 months will be
required to finish the job, due to intense transmission in key states.
The remaining challenges to a polio-free world are:
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