Priority countries

Nigeria
* Nigeria is the greatest risk to the overall global eradication effort. After immunization campaigns were suspended for 12 months (from mid-2003 to mid-2004), it will take a further 12 months to stop transmission.
* Progress has been steady since late 2004. Cases are down 26% in Nigeria, compared to the same time in 2004 (419 cases, compared to 526 cases).
* The quality of campaigns continues to improve; the percentage of 'missed children' during polio campaigns has been reduced to 15% in the northern states, compared to an estimated >50% in 2004.
* 'Missed children' during campaigns in the northern states remains the greatest risk to Nigeria's programme. Building on the gains of 2005 with greater quality and quantity of SIAs in 2006 will be the solution to stopping polio in Nigeria.

India
* In India, strong progress continues to be achieved. Despite stronger surveillance, the number of cases reported is lower than for the same period in 2004 (29 compared to 54, respectively).
* mOPV1 has been used successfully in at least three rounds in Bihar and key areas of Uttar Pradesh and Mumbai.
* Monovalent OPV type 3 (mOPV3) will be used in selected districts from November, to eliminate India's last type 3 virus.
* Highly efficient virus transmission remains the primary risk to India's polio programme. Maintaining high coverage levels and using monovalent OPV vaccines are showing concrete results in overcoming this risk.

Pakistan
* Strong progress continues to be achieved in Pakistan in 2005.
* mOPV1 will be used for the first time in Pakistan during the 27-29 September campaigns. No type 3 polio has been found in Pakistan in 2005.
* The primary risk to Pakistan's polio eradication effort remains hampered access due to insecurity in some areas of the country, most notably the tribal areas bordering Afghanistan in North West Frontier Province, southern Punjab and northern Sindh. Intensive work with local leaders to open access to under-immunized communities and improve SIA quality is helping to solve this issue.

Afghanistan
* The primary risk to Afghanistan's polio eradication effort is insecurity in Uruzgan and Hilmand. It is in these areas that all four of this year's cases have occurred.
* A special meeting was convened in Kandahar on 1 August, specifically to address problems of access in these key areas of the country.

Egypt
* Egypt's last polio virus was detected from an environmental sample collected in January 2005.
* Egypt will conduct its third NIDs with mOPV1 on 25 September.

Niger
* Niger has confirmed 3 polio cases in 2005, compared to 19 cases for the same period in 2004. The most recent case had onset of paralysis on 26 June (from Zinder province), following the country's last NIDs held on 14 May. Genetic sequencing of the case indicates it is related to virus circulating in northern Nigeria.

Indonesia
* The country launched NIDs on 30 August. The activity was officially inaugurated by Indonesia's First Lady, who administered OPV to children, on national television.
* Although the rounds reached high numbers of children, in many areas large pockets of children were missed. While a directive was issued by the government that all children - explicitly including sick children - should be immunized, this directive did not reach all health workers at district levels. This issue must be effectively managed ahead of the next NIDs on 27 September.
* Other countries in Asia, including the Philippines and Vietnam, are holding immunization campaigns to prevent importations of polio from Indonesia.

 Other countries/regions

West and central Africa
* The epidemic which began in 2003 is being curbed.
* In west and central Africa, the first area hit by the outbreak that originated in Nigeria, only 5 cases have been reported (outside polio-endemic Nigeria and Niger), in Cameroon, Chad and Mali. This is compared to 53 cases in 8 countries for the same period in 2004.
* An analysis of the quality of polio campaigns in 2005 suggests very little community resistance to vaccination. Rather, the primary reason for 'missed children' remains operational issues, in particular relating to houses not visited or re-visited during the activities.

Ethiopia and Horn of Africa
* A case has been confirmed in Mogadishu, Somalia, with onset of paralysis on 12 July.
* In Ethiopia, the outbreak continues to geographically expand, with 15 cases now confirmed, two of which are near the border with Somalia.
* In Eritrea, a case was confirmed with onset of paralysis on 23 April. The case is genetically linked to a December virus from Sudan.
* A new series of immunization campaigns will be held across eight countries in the region between September and November 2005.

Angola
* With 7 cases confirmed in Angola, the country held its second NIDs on 26 August. Anecdotal feedback from the campaign suggests varied quality from province to province.
* With cases reported in Lunda Sul, close to the border with the Democratic Republic of the Congo (DRC), risk of further spread into DRC remains high. A mop-up campaign in DR Congo on the border region is being considered, to synchronize with Angola.

Yemen
* Yemen accounts for 37% of all cases worldwide at end-August (458 of 1,219 global cases). However, epidemiological evidence demonstrates the epidemic is being brought under control.
* On 21 August, Yemen conducted its third NIDs in response to the outbreak.

The state of polio eradication in 2005

* Commitment to polio eradication is at its highest ever thanks to visible progress in the hardest endemic areas and powerful new tools like monovalent oral polio vaccines.
* There are 6 countries with endemic polio (Nigeria, India, Pakistan, Niger, Afghanistan and Egypt) and 10 countries which have been re-infected (Somalia, Yemen, Indonesia, Sudan, Ethiopia, Angola, Mali, Cameroon, Chad and Eritrea).
* Success depends on reaching the groups of children that remain under-immunized. In nearly every polio-infected 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 6 remaining endemic countries which continue to export virus into polio-free areas such as Angola and Indonesia. Governments must be absolutely committed to overcoming remaining obstacles, including insecurity and inadequate SIA quality, particularly in Nigeria.
2. 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.
3. Swift outbreak response and preventing further spread of polio into polio-free countries.

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.