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  3. Wednesday, 09 March 2011
Dear Colleagues, Please visit for regular updates on the Global Polio Eradication Initiative. Note that all data in this report refers to 01 March 2011. The French version will be available on 10 March 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 février 2011 sera disponible le 10 mars 2011 sur Meilleures salutations. L'équipe de relations externes pour l'éradication de la polio Monthly Situation Report - February 2011 All data as of 1 March 2011 For latest news and polio case data by country, updated every week: FACTS & FIGURES There have been 34 cases globally* in 2011 (all wild poliovirus type 1 – WPV1), compared with 34 cases at the same time in 2010 (7 type 1 and 27 type 3). To date there have been 975 cases reported globally* for 2010 (888 type 1 and 87 type 3), compared with 1606 cases at the end of 2009 (479 type 1 and 1,124 type 3, and 3 mixtures). The endemic states of Uttar Pradesh and Bihar in India have not reported cases in more than six months. The most recent case had onset of paralysis on 01 September. HEADLINES Gabon reports first case in 10 years: Gabon has reported its first case of polio in more than ten years, a WPV1 with date of onset 15 January 2011. This serves as a reminder that even polio-free countries are not safe from the virus until the disease is completely eradicated. Genetic sequencing is under way to determine the origin of the virus. President of DRC expresses commitment to eradicating polio: At the invitation of President Laurent Kabila Kabange, the Director-General of the World Health Organization (WHO), Dr Margaret Chan, and the WHO Regional Director for Africa, Dr Lu?s Gomes Sambo, visited the Democratic Republic of the Congo in February. Dr Chan and Dr Sambo met President Kabila, who expressed his government's firm commitment to ending the current polio outbreak; they also met with donors, partners and government officials to discuss emergency response plans. Rotary celebrates 106th anniversary: On 23 February, Rotary International celebrated its 106th Anniversary. In celebration, the organization lit up around 20 of the world's most recognizable landmarks with the slogan 'End Polio Now'. The illuminated landmarks included the Trevi Fountain in Italy, the parliament building in the Hague, Netherlands and Charminar in India. More Polio eradication mourns loss of Bill Sergeant: Former Vice-President of Rotary International, William 'Bill' Sergeant, passed away on 13 February. Mr Sergeant was chairman of Rotary's International Polio Plus Committee of the Rotary Foundation from its inception in 1994 until 2006. The polio eradication champion's dedication was honoured by the World Health Assembly in 2006. More * The Government of Congo has nearly completed the process of classifying status of 523 AFP cases lacking adequate specimens, of which approximately 300 are expected to be confirmed as polio. ENDEMIC COUNTRIES Afghanistan •Afghanistan has reported one case in 2011, WPV1 in Kandahar with onset of paralysis 11 January. •Activity plans for the next 12 months were finalized during the national planning meeting that was held on 13-14 February. Plans include a more systematic application of the Short Interval Additional Dose (SIAD)strategy and the monthly updating of district-level planning. •Efforts have focused on increasing access to the 13 high-risk districts of the Southern Region - the only districts in the country which remain affected by indigenous transmission of the virus. •National Immunization Days (NIDs) are planned for 13-15 March. India •No new cases were reported in February. Therefore, the total number of cases for 2011 remains 1 (wild poliovirus type 1 (WPV1), Howra, West Bengal). However this one case continues to raise concerns, given that it is in a district next to the densely populated city of Kolkata, within a highly mobile population. A mop-up round was held on 05 February in the highest risk areas surrounding the case, vaccinating 1.8 million children under 5 years of age. While the mop-up was regarded as generally successful, a number of operational improvements need to be implemented including strengthening microplans; sensitizing independent monitoring; ramping up transit strategy; and, increasing social mobilization to further engage communities. •The endemic states of Uttar Pradesh and Bihar have not reported a case in over six months. The most recent case was a wild poliovirus type 1 (WPV1) case with onset of paralysis on 01 September 2010 in Champaran East district, Bihar. •A joint UNICEF/National Polio Surveillance Project (NPSP) assessment was undertaken in mid-February, examining public perceptions of polio immunization in order to better tailor social mobilization campaigns. •NIDs took place from 27 February, using a combination of bivalent Oral Polio Vaccine (bOPV) and trivalent Oral Polio Vaccine (tOPV). Sub-national Immunization Days (SNIDs) are planned for March. Nigeria •No cases have been reported so far for 2011. This significant progress, however, is undercut by the findings of independent monitoring in the highest risk districts which shows that the quality of Supplementary Immunization Activities (SIAs) (especially mop-ups) needs to be improved. •Nationwide Immunization Plus Days were held on 23-26 February using tOPV and measles vaccine. Borno state, which had not been part of the Immunization Plus Days which took place in January due to health worker strikes, carried out immunization activities from 02 February. This was the first SIA to take place in Borno since strikes began in October 2010. Staggered SNIDs were also held in Gombe and Akwa Ibom from 12-15 February using a combination of tOPV and bOPV. •The next Expert Review Committee on Polio Eradication and Routine Immunization (ERC) is scheduled for 7-8 March. The ERC will review the latest epidemiology, and recommend an appropriate SIA strategy, including approaches to address the ongoing high-risk areas. Pakistan •Pakistan has not been able to rein in transmission of polio, reporting a total of 11 cases for 2011 (all WPV1). The country continues to be affected by geographically wide-spread transmission of polio, as underscored by the isolation of polioviruses in environmental samples from sampling sites across the country. •Reports from the SNIDs that took place from 31 January - 02 February indicate that serious operational gaps remain despite President Asif Ali Zardari's release of the polio emergency action plan last month. While the plan has re-invigorated efforts at the federal level, sufficient accountability and ownership at the provincial and district-levels is crucial. •NIDs using tOPV will be held on 7-9 March, followed by SNIDS in April. RE-ESTABLISHED TRANSMISSION COUNTRIES Angola •Angola reported one case in February, the first for the year. If genetic sequencing confirms that the case is related to virus circulating in Angola in 2010, the country will be considered to have missed the milestone of interrupting re-established polio transmission by end-2010. •This most recent case is in the south-east of the country, close to the borders with Namibia and Zambia. It is from this area that polio spread into Namibia in 2006, causing a deadly outbreak affecting primarily adults. Authorities in both Namibia and Zambia have been alerted as to the proximity of this latest case close to their borders, and efforts are ongoing in both countries to further sensitize disease surveillance and assess population immunity levels. A Technical Advisory Group meeting for Angola, the Democratic Republic of the Congo, Namibia and Zambia is scheduled to meet on 14-15 March. •Mop-ups using monovalent Oral Polio Vaccine type 1 (mOPV1) were held on 18-20 February in Luanda, Benguela, Bengo and Kuanza Norte - the first campaigns to be conducted in response to the latest cases in Luanda and Benguela in November. Further mop-ups were conducted on 25-27 February, in Kuando Kubango, and other infected and high-risk areas, including Luanda and Benguela. The next scheduled SIAs will be nationwide campaigns to take place in March and April. These activities are considered particularly crucial to minimizing the risk of further international spread. Chad • Genetic sequencing is under way to determine whether a case of WPV3 reported with date of onset 23 December 2010 in Dar Sila in the east of the country is related to virus last seen in southern Chad on 10 May 2010. Due to sub-national surveillance gaps, ongoing undetected transmission cannot be ruled out. •Chad is also affected by a WPV1 outbreak, due to a new importation from September 2010. Chad has seen 5 cases of WPV1 for the year so far. An outbreak response plan is currently under development. •NIDs using bOPV took place on 10-12 February. Independent monitoring was implemented in highest-risk areas, including in the greater N'Djamena area. Democratic Republic of the Congo (DR Congo) •DR Congo has already reported 13 cases for 2011. None of these cases are from Katanga province, the locus of the re-established polio transmission in the country. While genetic sequencing is awaited, it is likely these cases represent continuation of the new Bandudu-centred outbreak. •Given the appearance of adult cases in Kikwit, Bandundu, it was decided that SIAs conducted in the region should be expanded to cover the whole population (instead of vaccinating only children under five years of age). The entire population of sixteen districts of Bandundu were vaccinated using mOPV1 during SNIDs on 20 January and 24 February, and discussions are under way to expand the age-group of upcoming campaigns in Kinshasa. In Katanga, a logistically difficult area to operate in, strategies are being tailored to increase outreach to hard-to-reach areas. IMPORTATION COUNTRIES Republic of Congo •One case has been reported for 2011, a WPV1 with onset of paralysis on 22 January. The final classification of 523 AFP reported during the 2010 outbreak for which no adequate specimens were collected is almost complete. The Government of Congo has indicated that the classification process should be completed in the first half of the month. It is expected that approximately 300 of these cases will be confirmed as polio. Presently, the total for 2010 stands at 66. •The most recent NIDs were held from 22 February using bOPV. Horn of Africa •An international risk assessment for polio eradication in the Horn of Africa has been finalized. In addition to ongoing risks in the Uganda/Kenya border area (with confirmed ongoing transmission of WPV1), other areas of the Horn of Africa were assessed to be at very high risk for re-infection. In particular, parts of Somalia have been inaccessible during SIAs over the past two years due to insecurity, and a large susceptible population now exists, particularly in the southern part of the country and in/around Mogadishu. Upwards of 800,000 children have not been accessible for over a year. Parts of Ethiopia are also deemed to be at risk, particularly in the southern part of the country. •Following a successful January referendum for independence that was associated with huge (and on-going) migrations into Southern Sudan from the north and neighboring countries, the first round of polio NIDs using tOPV was conducted from 22-25 February, while the second round is planned for 29 March - 01 April. Southern Sudan has not recorded any WPV cases for over 20 months now but with the ongoing situation across the borders in Uganda, Congo and DRC, keeping this status requires the maintenance of high quality polio campaigns and AFP surveillance. Communication support for polio eradication activities has been boosted with the recruitment of 10 polio communication officers to support data-driven planning and implementation of advocacy and social mobilization activities with special focus at community levels in all the States. •In Ethiopia, a vaccine-derived poliovirus (VDPV) type 3 (with onset of paralysis on 4 November) was found to be unrelated to a circulating VDPV type 3 from the early part of 2010. It is important to note that no secondary cases have been reported. •In Kenya, an international mission of technical experts met early in the month, finalizing SIA plans and reviewing operational plans to strengthen disease surveillance. •Ethiopia completed the second phase of Child Health Days including tOPV (the first was held in October). In Somalia, preparations are also underway for NIDs in late March and late April. Both countries continue to be at risk of polio, given ongoing WPV transmission in the Uganda/Kenya border area, and evidence of a cVDPV in Ethiopia in early 2010. Sudan is currently carrying out NIDs using tOPV. Central Asia and Russia •Central Asia and Russia have not seen any cases in more than four months; however constant vigilance is crucial to ensure that no more children from this region will suffer from polio. •Tajikistan, Turkmenistan and Kazakhstan are all conducting nationwide immunization activities in April, and Russia is planning SNIDs in the Caucasus. Kazakhstan held SNIDs last week. Nepal •No cases have been reported for 2011, and the last case had date of onset 30 August 2010. •NIDs were held from 12-13 February and will be followed by further NIDs from 12-13 March. West Africa •Burkina Faso held NIDs on 04 February. Further rounds are planned for 25 March and 22 April for Mali, Liberia, Senegal, Mauritania, Sierra Leone, Guinea, Côte d'Ivoire, Togo and Ghana using a combination of bOPV, tOPV and mOPV 1, depending on recent epidemiology and priority. •The key now is to further raise population immunity levels to both type 1 and type 3 poliovirus, to minimize the consequences of any further international spread of virus into west Africa. Gabon •Gabon has reported its first case in more than ten years, a WPV1 from Ogooue-lolo province with onset of paralysis on 15 January. •Outbreak response immunization activities have already begun, with NIDs using bOPV held from 22 February, and further SIAs planned for March. Myanmar •Myanmar is carrying out a response to the single vaccine-derived poliovirus (VDPV) case detected in Yamethin Township in Mandalay Division in December 2010. Two rounds of SIAs are planned, to vaccinate 3.4 million children under the age of 5 years with oral polio vaccine (tOPV) in 115 Townships in Myanmar. No secondary spread has been found and there is active surveillance going on to verify this.

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