July 2007
Data as of 17 July 2007        English PDF        Version français en PDF
 

• GAVI Alliance re-programmes funds: the GAVI Fund Alliance finalized a reprogramming of US$ 104.6 million, to support the current intensified polio eradication efforts.  These funds had originally been earmarked for the post-eradication era, and while they do not constitute new funding, they do free up much-needed cash to maintain surveillance and campaign activities through the rest of the year.   These re-programmed funds, together with new contributions including from Austria, Italy, Japan, Kuwait, Liechtenstein, Monaco, New Zealand and the World Bank Investment Partnership for Polio (for Pakistan), have significantly reduced the global funding gap for 2007.  However, the Global Polio Eradication Initiative is still short approximately US$ 60 million for the rest of this year and a further US$ 355 million is needed for activities in 2008.  In particular, the Global Polio Eradication Initiative is looking to G8 countries to rapidly take action on commitments made at their June Summit in Heiligendamm, Germany. 
• Bill Gates Sr. pays tribute to Rotary:  William H. Gates Sr., co-chair of the Bill & Melinda Gates Foundation, has again paid tribute to Rotary's polio eradication efforts.  Addressing thousands of Rotarians at the annual Rotary International convention in Salt Lake City, USA on 20 June, Gates Sr. called polio eradication the "answer to the charge of naïve optimism", and noted that it showed the most ambitious of goals could be achieved with perseverance and cooperation.  At the same time, he said polio eradication inspired such human endeavours as the fight against HIV/AIDS and the effort to make vaccines available to every child on earth.  For further information, please also visit www.rotary.org .   
• Wild poliovirus from Pakistan confirmed in Australia: on 13 July, type 1 polio was isolated from a 22-year old Pakistani student living in Australia.  The man had recently been on holiday in his native Pakistan, before returning to Australia to continue his studies.  Genetic sequencing of the isolated poliovirus confirmed it originated in North West Frontier Province (NWFP), Pakistan.  The risk of onward spread of polio in Australia is low, particularly thanks to Australia's strong routine immunization system and sanitation infrastructure.  However, this case highlights the risk wild poliovirus continues to pose to all countries, until it is eradicated globally.   
• Type 1 polio in Chad: on 11 July, two polio cases were reported from Chad, one of which in the east of the country, close to the border with Darfur, Sudan.  In May 2004, poliovirus originating in northern Nigeria in this same area spread into Darfur, leading to a major outbreak across Sudan, and which subsequently re-infected further countries, including Yemen and Indonesia.  Urgent efforts are underway to minimise the risk of further polio spread from Chad, as Chad and Sudan are planning an extensive, cross-border emergency outbreak response.  The risk of polio spread could be further compounded by the upcoming Omra season (beginning in September) and its large population movements.  These latest cases further underline the risk polio continues to pose to polio-free countries around the world, until the disease has been eradicated in the remaining endemic hotspots.  See below under 're-infected countries' section for further details. 
• Progress in curbing type 1 polio continues in last type 1 reservoirs: wide-scale use of monovalent oral polio vaccine type 1 (mOPV1) continues to have a significant impact on curbing transmission of this particular virus serotype.  The more dangerous of the two remaining virus types, given its historically higher disease burden and ability to spread internationally, only three type 1 cases have been reported this year from the western part of Uttar Pradesh state, India, arguably the most historically entrenched type 1 reservoir in the world.  At the same time, no type 1 cases have been reported in Kano, Nigeria, since October 2006 - a remarkable achievement, given that Kano was the original epicentre of a major international epidemic which re-infected 20 previously polio-free countries across the world, in 2003-2006. 

Nigeria

• In 2007, 122 cases have been reported (31 type 1s and 91 type 3s). 
• In the three 'very high risk' states of Jigawa, Katsina and Kano, only two type 1 polio cases have been reported this year (one in Jigawa, one in Katsina and none in Kano).  At the same time, however, type 1 transmission is continuing in other areas of the country.  Of particular concern is ongoing type 1 transmission in Borno state, in the northeast of the country.  In late 2006, virus from Borno state spread across the border, causing importations in Cameroon and Chad. 
• The next Immunization Plus Days (IPDs) will be held on 27-29 July.  In response to the increasing type 3 disease burden, monovalent oral polio vaccine type 3 (mOPV3) will be used in ten key states in the north.
• Focus remains on improving key operational challenges, including increasing use of community dialogues and increasing engagement of Quranic schools, more effective microplanning and better vaccinator/supervisor training.  In particular, vaccination teams should be trained on more effective engagement with families, to accurately ascertain how many children under five years of age live in a given household and what the true reasons for non-compliance might be.  At the same time, more detailed maps of areas would facilitate the work of both vaccinators and supervisors, and reduce the number of missed areas during IPDs. 
• In ongoing interregional collaboration, 20 consultants from EMRO continue to be in place in key areas in Nigeria, to support the planning, implementation and monitoring of activities. 

India

• In 2007, 103 cases have been reported, 39 type 1s and 64 type 3s.
• The core highest-risk districts of western Uttar Pradesh have not reported type 1 polio since October 2006.  In the rest of western Uttar Pradesh, there have only been three type 1 cases reported in 2007. 
• On 1-6 July, subnational immunization days (SNIDs) were held in key infected areas; in response to the increasing type 3 disease burden, a combination of mOPV1 and mOPV3 was used.  Such selected use of mOPV3 in 2007, in combination with continued wide-scale use of mOPV1, has geographically restricted type 3 transmission to a handful of districts in western Uttar Pradesh, while significantly curbing type 1 in that part of the state.
• At the same time, however, persistent transmission of type 1 is continuing in the northern part of Bihar, and central/eastern Uttar Pradesh is continuing to be affected by the tail-end of last year's type 1 outbreak.  Northern Bihar and central/eastern Uttar Pradesh account for 30 of India's 39 type 1 cases in 2007.
• The next SNIDs will be held on 5-10 August.  The focus remains on reaching young children in key high risk areas of both remaining endemic states, Bihar and Uttar Pradesh.

Afghanistan and Pakistan 

• In 2007, 10 cases (4 type 1s and 6 type 3s) have been reported in Pakistan, and 4 cases (all type 1) have been reported in Afghanistan. 
• In 2006 and 2007, poliovirus has been limited to known reservoir areas that straddle both countries and must be tackled together.  Both countries continue to synchronize activities, focusing on reaching mobile populations, and those living in border areas and in areas of insecurity.  In particular, insecurity is increasing in the Southern Region in Afghanistan and the cross-border areas along the tribal regions of North West Frontier Province (NWFP), Pakistan.   
• Despite these challenges, polio staff in both countries are continuing to achieve progress, and the above-mentioned incidents underline the extremely dangerous and difficult conditions under which they work, in their efforts to eradicate polio.  Polio teams are also actively supporting extensive measles mass immunization campaigns, launched in early July, in key high-risk districts of Balochistan.   

Re-infected countries

• Following confirmation of polio in Chad, close to the border with Darfur, Sudan (see above under 'headlines' section), both countries are planning an extensive emergency outbreak response, as part of urgent efforts to minimise the risk of further polio spread from Chad.  A team of epidemiologists are currently conducting emergency case investigations.  National Immunization Days (NIDs) in Chad will be held on 3-5 August, and again on 7-9 September.  Sudan is planning to synchronize its preventive supplementary immunization activities (SIAs) with Chad.  Technical support will be deployed to priority districts to support the planning, implementing and monitoring of the activities.  A risk assessment is ongoing to determine the general population immunity levels in the two infected areas of Chad. 
• In Angola (6 cases) and the Democratic Republic of the Congo (23 cases), outbreak response activities are continuing.  The next synchronized campaigns will be held on 25 July.  Emergency planning for these campaigns is ongoing in Angola, in urgent efforts to improve the quality of this next campaign; the country's last activity was severely marred by major operational challenges, including inadequate vaccinator training and supervision.    
• In the Horn of Africa, outbreak response activities are continuing.   While no new cases have been reported since March (in Somalia) and November 2006 (in Ethiopia), undetected circulation of polio due to subnational surveillance gaps cannot be ruled out.
• In Myanmar, 11 cases have now been reported, all from Rakhine province, across the border from Bangladesh.  Internationally coordinated, cross-border outbreak response activities are continuing on both sides of the border.  Bangladesh is currently considering returning to using mOPV1 during its outbreak response activities, following use of trivalent OPV during recent campaigns.     
• Niger and Nepal remain at particular risk of repeated, isolated polio importations, due to their geographic proximity to endemic areas (northern Nigeria, and Bihar and Uttar Pradesh, India). 

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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.