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  3. Thursday, 12 May 2011
Dear Colleagues, Please visit for regular updates on the Global Polio Eradication Initiative. Note that all data in this report refers to 04 May 2011. The French version will be available on 13 May 2011 on With best wishes. The Polio Eradication, External Relations Team Cher(e)s collègues, Merci de visiter notre site pour les informations détaillées et les derniers chiffres concernant les cas de poliomyélite par pays mis à jour chaque semaine. La version française du Rapport mensuel de l'Eradication de la Poliomyélite pour le mois de avril 2011 sera disponible le 13 mai 2011 sur Meilleures salutations. L'équipe de relations externes pour l'éradication de la polio Monthly Situation Report - APRIL 2011 All data as of 04 May2011 For the latest news and polio case data by country, updated every week: FACTS & FIGURES There have been 123 cases globally in 2011 (114 wild poliovirus type 1 - WPV1 - and 9 WPV3), compared with 115 cases at the same time in 2010 (66 type 1 and 49 type 3). HEADLINES IMB calls funding gap 'single greatest threat' and highlights need for 'heightened attention' at all levels: The Independent Monitoring Board (IMB) published in mid-April its assessment of progress towards polio eradication. The report calls the US$ 665 million funding gap through end-2012 the "single greatest threat to the GPEI's success". It notes "strong news": of 15 outbreaks with onset in 2009, all appear to have been stopped; and evidence so far suggests that none of the new outbreaks from 2010 last more than six months. However, of the remaining endemic and re-established transmission countries, the IMB considers only India on track to achieve its key milestone of stopping poliovirus transmission by end-2011. The IMB concludes that therefore, the end-2012 goal of global eradication is at risk. Despite these challenges, the IMB further concludes that polio eradication is feasible and "desperately needed" in the near term, and warned that this goal would only be achieved with "heightened attention" at all levels. Download full report in PDF. Type 3 outbreak in Côte d'Ivoire threatens region: Three cases of wild poliovirus type 3 (WPV3) have been detected in Côte d'Ivoire with dates of onset in January and February. Genetic analysis shows the virus is related to WPV3 last detected in mid-2008 in northern Nigeria, indicating undetected circulation in one or more areas and populations in west Africa. There is currently a high risk of further spread of WPV3 - both within and from - Côte d'Ivoire. More All is not quiet in the Horn of Africa: Although no cases have been reported from this group of countries this year, a single positive environmental sample collected in sewage in Aswan, Egypt in December 2010 has been genetically linked to virus circulating in Sudan in 2009. See Horn of Africa section below. ENDEMIC COUNTRIES AFGHANISTAN A workshop on high-risk cluster selection and planning for Kandahar and Hilmand provinces was held in April despite the prevailing security conditions. National Immunization Days (NIDs) on 2-4 May (using trivalent OPV and Vitamin A) were affected by a United Nations security alert which limited movement of staff. Despite these hindrances, the NIDs began on 2 May. International staff continued to support the round, maintaining contact with those in the field by phone. Access to more than 73.000 children in Zabul province was not assured due to obstruction by anti-government elements, which has continued despite intense efforts to negotiate access. INDIA The IMB report lauds India's systematic approach to and its domestic financial investment in polio eradication, warning that "there can be absolutely no room for complacency." The IMB judges India to be on track to interrupt polio transmission before the end of 2011, provided it sustains the energetic leadership at district, state and national level. Uttar Pradesh (UP) state in India has now gone a year without reporting a single case of polio. The state has traditionally been a major exporter of virus to other parts of India and the world, and has been described as one of the most difficult places to eradicate polio. While ceasing transmission in UP is a victory for polio eradication, the country remains cautious in the lead up to the high transmission season during the 2011 monsoon. It is essential that the high immunity level currently seen in the state (and in nearby Bihar) is maintained in order to prevent new cases emerging. Meanwhile, sewage sampling has not detected WPV at any of the sites in the country since November 2010. The country continues to treat India's sole polio case this year - the WPV1 case detected in West Bengal in January - as a serious event requiring a large-scale emergency outbreak response. More Mop-ups in key areas of West Bengal were staggered from 24 April and 1 May, to avoid conflict with State Assembly election dates. State-wide Sub-national Immunization Days (SNIDs) will be held again from 29 May. Key interventions have included a scale-up of human resources, including 36 Surveillance Medical Officers deployed by WHO and 2000 Social Mobilizers deployed by UNICEF to tackle resistance around SNIDs. New Bengali-language TV and radio PSAs have been produced, complimenting a dramatic increase in IEC visibility. IPC training has been held for new and existing social mobilizers and vaccinators, polio immunization kiosks have been established at Howrah and Sealdah railway stations, which carry more than 1 million passengers per day, leading Imams have agreed to inaugurate booths in Kolkata, while in the latest initiative, polio immunization messages are being carried on all electricity bills across the metropolis. NIGERIA The IMB report notes strong progress in the last two years in Nigeria, along with remaining important gaps in vaccination and surveillance quality. While noting that the country is not currently on track for the end-2011 milestone, the IMB considers that strong plans exist – what is needed is expedited implementation. The IMB cautions that there is not a sufficient sense of urgency, and recommends that planned activities be expedited and that state governors be called upon to re-engage as leaders of polio eradication activities after the election is completed. Following election-related violence, planned mop -up activities in several states, including Kebbi, Jigawa and Borno have been rescheduled to start 3 May. A training and field test was held in the last week of April for the use of Global Positioning System tracking devices to better monitor team performance and help identify possibly poorly covered areas during mop-up activities: 250 of the devices have arrived in the country. Nigeria is finalizing a national desk review of acute flaccid paralysis (AFP) surveillance which will be used by the country to further identify and address surveillance gaps. PAKISTAN In the past month, the federal and provincial governments have taken a number of critical steps to put the plan into action. President Asif Ali Zardari convened an extraordinary meeting with the top administrators of some of the 33 high-risk districts of the country. The Office of the President has set up a Polio Oversight Committee charged with monthly reporting to the president. The Prime Minister has written to provinces and regions which have reported cases this year expressing concern over the increasing number of polio cases. The Chief Minister of Sindh has established a polio monitoring cell. The aim is to speed up full implementation of the emergency action plan. The IMB warns that Pakistan's progress lags far behind other endemic countries, and that the country is not on track to meet the end-2011 milestone. In all 33 high-risk districts, the IMB emphasizes, the real problem is not one of universally poor coverage but of variability between sub-districts (union councils). The IMB concludes that the emergency action plan is strong, commends the initial steps to begin implementation and calls for urgent further implementation of the plan. The World Health Organization polio eradication team in Pakistan is implementing a revised staffing plan in sync with the National Emergency Action Plan, including the appointment of a senior-level technical coordinator. A security alert has been issued in the wake of the killing of Osama bin Laden, calling for all international UN staff to be relocated to Islamabad, and for all national staff to work from home. This is likely to affect planning for the upcoming NIDs, scheduled for 9-11 May. In Bajour Agency, the Short Interval Additional Dose strategy is being piloted in the first half of May to take advantage of an opportunity to reach children. RE-ESTABLISHED TRANSMISSION COUNTRIES The IMB report notes that one of the four countries with re-established transmission, Sudan, has not reported cases since 2009. It concludes that Angola and Chad have missed the end-2010 milestone to stop transmission of re-established poliovirus transmission, while the Democratic Republic of the Congo is at risk of doing so. The report recommends that no real distinction be made between this set of countries and endemic countries. ANGOLA The IMB recommends that Angola very urgently implement a solid corrective plan which is focused on polio eradication and which integrates a frequent reporting mechanism, asking governors to report to the President on progress against key indicators. These key indicators have been agreed by the Inter-country Coordinating Committee and submitted to the Minister of Territory Administration who coordinates the Governors activities. They include, among others: the monthly provincial rate of Non Polio AFP (target> 2/100,000 inhabitants); the percentage of municipalities with more than 5% of missed children during National Immunization Days/Sub-national immunization Days (target: 0 Municipalities); the monthly proportion of households with access to potable or clean water (70% target); and the proportion of municipalities with adequate funds and timely payment of operational costs for routine immunization and supplementary immunization campaigns (target of 100%). Angola held synchronized campaigns with neighbouring DR Congo, Zambia and the Republic of Congo in late April, in which the United States Ambassador to the country participated. A second synchronized round is planned for late May. CHAD In its report, the IMB expresses particular alarm at the polio situation in Chad, calling it a public health emergency and noting that the country has not stopped its re-established transmission and presents an international risk. In particular, the Board notes that the country's emergency action plan needed more concrete detail for actions, as well as mechanisms to ensure monitoring and accountability. The Board urges that the recommendations from the November 2010 Technical Advisory Group (TAG), which provide high-quality and detailed recommendations, be incorporated into the emergency action plan. The Minister of Health communicated immediately with the Prime Minister, apprising him of the IMB's recommendations. The next NIDs are due to be held on 15-17 May. DEMOCRATIC REPUBLIC OF THE CONGO (DRC) The IMB considers that the end-2010 milestone for DR Congo has likely been missed, but the corrective plan is of sufficient quality. To make the best of the plan rapidly, the IMB recommends that the role of provincial governors be strengthened. On 25 April, the governors of the eleven provinces pledged to deploy the powers of their offices to eradicate polio and strengthen the Expanded Programme on Immunization. Their Declaration of Engagement was presented at a meeting with the Vice-Prime Minister and the Minister of Public Health. The governors also requested the central government set up regular information-sharing meetings between government institutions. A weekly teleconference has been established between provinces to share information and coordinate polio eradication activities. DR Congo is currently experiencing three outbreaks, centred in: Katanga (related to re-established polio transmission in the east); Kasai Occidental/Bandundu/Kinshasa (related to transmission introduced into DR Congo in 2010 from northern Angola); and Bas Congo (related to transmission introduced into DR Congo in 2010 from the Republic of Congo and Angola). As the outbreak in Kinshasa continues to affect an unusually high number of teenagers and young adults, the next vaccination round in the area will again target the entire population (instead of children less than 5-years-old). Community awareness of the first round in late March was high, thanks partly to the participation of the national football team (more). A third whole-population round may be required. DR Congo took part in synchronized campaigns with Congo on 28-30 April. The launch in DRC took place in the presence of the Prime Minister and Ambassador John Lange of the Bill & Melinda Gates Foundation, as well as the Special Representative of the Secretary General (SRSG) for the DR Congo Roger Meece. The Prime Minister stated that the government is instructing all local administrative and health authorities to engage fully in the effort and would hold all accountable for this. At the conclusion of the launch ceremony, the Minister of Health vaccinated the Prime Minister, who in turn vaccinated the SRSG and Ambassador Lange. IMPORTATION COUNTRIES REPUBLIC OF CONGO AND GABON While no new cases have been reported in either country since 22 January, vaccination campaigns continue to take place –most recently in Congo, synchronized with DR Congo – and surveillance quality closely monitored. HORN OF AFRICA Although no cases have been reported from this group of countries this year, a single positive environmental sample collected in sewage in Aswan, Egypt in December 2010 has been genetically linked to virus circulating in Sudan in 2009. The Technical Advisory Group for the region met on 3-6 May to focus on concrete steps to fix surveillance gaps and to advise on response activities. The priority for the countries of the Horn of Africa is to come up with systematic mapping of population groups that are likely to be missed by AFP surveillance, SIAs and routine immunization. A surveillance review has been completed in southern Sudan which noted some improvements in AFP detection and stool collection across all states and recommended further efforts to ensure that the network can identify AFP among mobile and migrant populations, who move from any part of Sudan to Egypt to other countries. Initial feedback from a rapid assessment in northern Sudan -- with particular focus on mobile and migrant populations – indicates AFP surveillance to be sensitive in the areas visited. While the official report is awaited, these initial findings suggest that it is unlikely the virus circulated undetected in the north. Northern Sudan conducted polio NIDs on 11-13 April targeting 6.76 million children. Further rounds in May are now being discussed. Sudan remains at risk of polio, both due to potential undetected circulation and ongoing transmission in neighbouring Chad. Efforts are ongoing to interrupt any residual transmission related to a 2009 outbreak from Kenya (which was detected again in September 2010 in Uganda). Three SIAs have been conducted in the Uganda/Kenya border area, and a fourth activity is planned for May. SIAs are also being held in Ethiopia and Somalia, to boost immunity levels and minimise the risk/consequences of any importations. CENTRAL ASIA AND RUSSIA This region has not reported a case of wild poliovirus in more than six months. The most recent case had onset of paralysis on 25 September 2010 in the Russian Federation. Vaccination campaigns are taking place in May in Kazakhstan, Kyrgyzstan, the Russian Federation, Tajikistan, Turkmenistan and Uzbekistan. WEST AFRICA In April, WPV3 was reported from both Côte d'Ivoire (three cases) and Mali (one case). This is the first WPV3 in Côte d'Ivoire since current record-keeping. Genetic analysis shows that the virus is linked to WPV3 last detected in mid-2008 in northern Nigeria, indicating undetected circulation in one or more areas and populations in west Africa. There is currently a high risk of further spread of WPV3 - both within and from - Côte d'Ivoire. More Confirmation of WPV3 in Côte d'Ivoire is particularly significant, as it is the first time that WPV3 has been recorded in this part of west Africa since 2000 (in recent years, WPV3 in west Africa has been limited to northern Nigeria, parts of Niger, and also isolated cases in Mali and Benin). Additionally, global levels of WPV3 are at record-low levels in 2011, with only nine WPV3s reported worldwide. Efforts to rapidly interrupt all remaining chains of WPV3 transmission is a key priority for the global polio eradication effort. The Global Polio Eradication Initiative has launched an emergency appeal for US$ 10.5 million to respond to the outbreak. More The Mali case is closely related to 2010 WPV3 transmission in Nigeria, Niger and Mali. Mali's previous WPV3 was in September 2010. Coordinated multi-country vaccination campaigns across west Africa were implemented in late March and late April, and further response is being planned. In Côte d'Ivoire, due to the security and political situation, only the infected province was covered in April. Future campaigns are being planned for May and June. Once the immediate crisis has passed, a thorough review of surveillance in the sub-region is planned, concentrating on known areas with sub-optimal surveillance (especially western Côte d'Ivoire), and with a particular focus on mobile, migrant, and under-served populations who may have been able to sustain transmission undetected for so long, and to move the virus such long distances.

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