March 2009

All data as of  07 April 2009   English (pdf ) French (pdf)

• Horn of Africa Responds to Outbreak: Uganda and Kenya have made commendably fast responses to the spread of wild poliovirus type 1 from southern Sudan into those countries and northern Sudan. This spread of poliovirus led the president of southern Sudan, His Excellency Salva Kiir Mayardit, to declare the outbreak a national emergency during a public address on television and radio last week. The risk of international spread from the outbreak in this region remains high, particularly from Port Sudan. More
  

• Seven West African Countries Tackle Polio Together: The seven-country synchronized cross-border response to the West Africa outbreak has successfully completed two rounds. International observers have reported that the rounds have been of good quality. A further synchronized immunization activity is being planned for Nigeria, Niger, Benin, Burkina Faso, Cote d'Ivoire, Togo and Mali at the end of April or early May.
  

• Doors Opening to Pakistan's "Inaccessible" Children: More than 280,000 children under five years old in the conflict-affected district of Swat, in north Pakistan, will be immunized for the first time since July, 2008, following a landmark agreement between the Government of Pakistan and the Taliban group controlling Swat. A Taliban spokesman confirmed there would be no ban imposed on polio vaccination, saying,: "Parents are free to administer anti-polio drops to their children."
  

• ITH Recommendations Include Polio: The 2009 edition of the World Health Organization's International Travel and Health (ITH) Recommendations have been released, with a strong emphasis on the necessity to be immunized against poliomyelitis in light of continuing transmission in endemic countries. This update is particularly timely given the current outbreaks of imported polio in the Horn of Africa and West Africa. More
  

• Workshop on Evidence-based Communication for Polio Endemic Countries: A workshop was held on 16-20 March in Nepal, involving polio teams from Afghanistan, India and Nigeria. Country teams developed planning tools, constructed social theories to guide strategies and objectives and determined research needs for all stages of the programme. Follow up activities in India used the concepts from the workshop to inform the 2009 strategy and research efforts. 

Nigeria

• The total number of cases for 2009 is 123 - 37 type 1 wild polio virus cases, 85 type 3, and one type 1-type 3 mixture. The most recent case had onset of paralysis on 17 March (WPV3 from Kaduna).

• The number of type 1 cases - the most dangerous form of poliovirus due to its higher rate of paralysis and greater propensity to spread - is considerably lower than last year, with 37 cases to date in 2009 compared to 75 cases last year. 

• For the first time ever, the 10 highest-risk states in Nigeria have reduced the number of children who have received zero doses of oral polio vaccine to below 10% (Q1, 2009). In Kano State, 85% of children have now been covered with at least one dose. 

• Nigeria joined the seven-country cross-border synchronised immunization campaigns from 27 February-2 March and 28-31 March in west Africa. It immunized 25 million children with monovalent oral polio vaccine type 1 (mOPV1) in 15 states, with initial reports from international monitors indicating improvements in service delivery and local ownership. A National Immunization Day (NID) is planned for 9-12 May.

• Nigeria's vice president Dr Jonathan Goodluck launched the most recent immunization campaign on behalf of the President, together with Health Ministers Professor Babatunde Osotimehin and Dr Aliyu Idi Hong and Federal Capital Territory Minister, Senator Adamu Aliero. Prof Osotimehin declared the government of Nigeria would make the necessary sacrifices to eradicate polio.

• The global polio eradication initiative has provided several epidemiological and technical staff to assist in fighting the meningitis outbreak in Nigeria. More than 17,450 people have contracted meningitis since January 10 in Africa's most populous country. More than 960 have died.

• A communication review was held in Abuja on 1-2 March 2009. Recommendations focused on broadening community engagement to improve service delivery and increasing local level advocacy. 

India 

• India continues its positive start to the year, with just 22 cases for the year to date - nine type 1 and 13 type 3 cases - compared with 178 cases at the same time last year. The most recent case had onset of paralysis on 18 March. 

• A SNID was held in the first week of March, targeting 30.5 million children in Uttar Pradesh, Bihar and selected high-risk districts, using mOPV1. A further SNID, in the same areas and including Delhi, was held on 5 April, using mOPV1. The next SNID is planned for 24 May.

• Small-scale (20,000-50,000) outbreak response activities continue to take place in the immediate vicinity of each of the cases in what appears to be an excellent tactic in tackling the spread of polio.

• The new Joint Secretary of Health, Amit Prasad, has quickly made several key decisions, including agreeing upon supplementary immunization activities this year, agreeing on estimated vaccine demands through March 2010, and proactively proposing additional immunization activities if necessary.

• A meeting between the Bihar and Uttar Pradesh social mobilization teams took place on 24-25 March. Teams shared lessons learned and best practices, and set in plans for better collaboration over the next year. 

• The next round of social research is scheduled to take place in April 2009, with a focus on high risk populations in the northern transmission zones.
  

Pakistan

• The total number of cases for 2009 is nine - four type 1 cases and five type 3 cases. The most recent case, a type 3 in Sindh, had onset of paralysis on 25 February.

• A Sub-National Immunization Day (SNID) will be held on 13-15 April, using mOPV1. An NID is planned for 17-19 May, using trivalent oral polio vaccine (tOPV), with a further SNID planned for 21-23 June, using mOPV3.

• Despite the worsening security situation in Pakistan, several exciting new initiatives are increasing engagement with the polio program. Mobilink, one of Pakistan’s largest mobile telephone operators, is sending text messages to its 14 million subscribers urging them to immunize their children against polio and providing details of polio campaigns; tickertape messages run constantly across the bottom of several participating TV channels during immunization campaigns, urging residents to call the control cell if their homes are not attended by immunization teams. In the most recent NID, 14,427 calls alerted relevant health authorities who dispatched vaccinators to the missed areas in less than an hour. As a result, more than 22,000 missed children were subsequently immunized; and Pakistan's National Database and Registration Authority, charged with establishing a national database of all Pakistani citizens, has agreed for its 185 mobile registration vehicles to also act as polio immunization booths as they go about their business.

Afghanistan

• The total number of cases in Afghanistan for 2009 is five - all type 1 wild poliovirus and all located in the Southern Region. The most recent case had onset of paralysis on 2 March (WPV1 from Hilmand).

• The next SNID will be held from 12-14 April across southern Afghanistan, using mOPV1. An NID will follow from 17-19 May, using mOPV1, with a further SNID planned for southern Afghanistan in June.

• Afghanistan's polio program benefits from excellent high-level political support. President Hamid Karzai and Minister of Health Dr Amin Fatimie personally launched the National Immunization Days held from 15-17 March, targeting 7.7 million children with trivalent OPV. Dr Fatimie, concerned that unrest in the south would prevent children being immunized, called on all Afghans to co-operate with the polio immunization teams, saying polio eradication was "an Islamic and national duty".

•  Innovative community level social mobilization strategies continue to expand in remote and difficult to access areas. For example, the community women initiative, where local female health workers are trained and supported to meet with women in their own houses, has helped improve access to young children and ensure that households participate fully in polio campaigns.

West Africa

• To date, West Africa has reported 33 cases in 2009 (type 1: 11 in Benin, six in Burkina Faso, three in Togo, one in Mali, one in Cote d'Ivoire and one in Ghana; type 3: 10 cases in Niger). The most recent case, a WPV3 from Niger, had onset of paralysis on 1 March.

• All reported cases have been covered by at least two immunization activities, with the second round of the historic seven-country cross-border immunization campaign having been successfully completed from 27-30 March. All told, more than 53 million children were immunized.

• A further synchronised immunization activity is currently being planned for the end of April or early May, in conjunction with Nigeria, the source of the outbreak.
  Horn of Africa 

• There are 29 polio cases across the Horn of Africa in 2009 - all type 1 - with 25 cases reported in Sudan, four in Kenya and six in Uganda. The most recent case in the region had onset of paralysis on 15 March (WPV1 from southern Sudan).

• Sudan, Kenya, Uganda, DRC, Ethiopia and Somalia are responding to the outbreaks with a concerted, synchronized immunization campaign. A SNID was held in Kenya on 8 March and Uganda on 10-12 March, using mOPV1. An NID was held in both countries on 21 March, using mOPV1, with further rounds planned for 25 April.

• In southern Sudan, a SNID was held on 23 February, using mOPV1, and an NID was held on 23 March, using tOPV. Another round is planned for 27 April (mOPV1). 

• In northern Sudan, where three cases in Port Sudan resulted in the international community being officially alerted to the risk of the spread of polio virus, an NID using tOPV was held on 23 March, with a further SNID planned for central and northern Sudan from 27-29 April. 

• In Ethiopia, a SNID took place using mOPV1 on 27 March, with another planned for 24 April. In Somalia and eastern Ethiopia, an immunization activity using tOPV will take place in May or June. 
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Central Africa (Angola, DR Congo and CAR)

• In Angola, four type 1 cases have been reported in 2009, the most recent having onset of paralysis on 18 February. None of these cases have yet been covered, with discussions continuing with the Government of Angola about the critical importance of covering at least the three infected districts - Luanda, Benguela and Namibe - as soon as practicable. 

• At this stage, it appears a mop-up activity in parts of the three infected provinces will be held from 26-28 April, using tOPV. Further nationwide immunization activities using tOPV are planned for May, June (in conjunction with a measles campaign) and July.

• DRC has reported its first case since 18 October 2008 - a type 3 virus in Kamonia, Kasai Occidental, with onset of paralysis on 10 February. An outbreak response is continuing, with staggered rounds confirmed for 2 April in Kasai Occidental, using mOPV3. An SIA using tOPV in the west and south-east and mOPV1 in the north-east is planned on the same day. 

Chad

• No new cases have been reported in Chad since 26 December (type 3 from Logone Oriental). However, due to sub-optimal response activities in quality, scope and timeliness and due to sub-national surveillance gaps, it is believed there is widespread geographic spread of both type 1 and type 3 poliovirus.

• A staggered NID using tOPV in conjunction with a measles campaign has been completed. A further NID using tOPV is expected to take place in May.
  

Asia (Nepal) 

• The most recent case in Nepal had onset of paralysis on 15 October. 

• Nepal remains at risk of importation from neighbouring India, particularly with the type 1 case being reported this year in the Araria District of Bihar, close to the Nepalese border.

• Sub-national campaigns are planned for April..

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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.