Please visit http://www.polioeradication.org
for regular updates on the Global Polio Eradication Initiative. Note that all data in this report refers to 30 March 2011. The French version will be available on 08 April 2011 on http://www.polioeradication.org
With best wishes.
The Polio Eradication, External Relations Team
Merci de visiter notre site http://www.polioeradication.org
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 mars 2011 sera disponible le 08 avril 2011 sur http://www.polioeradication.org
L'équipe de relations externes pour l'éradication de la polio
Monthly Situation Report - MARCH 2011
All data as of 30 March 2011
For latest news and polio case data by country, updated every week: http://www.polioeradication.org
FACTS & FIGURES
There have been 78 cases globally in 2011 (73 wild poliovirus type 1 - WPV1 - and 5 WPV3), compared with 55 cases at the same time in 2010 (19 type 1 and 36 type 3).
To date there have been 1294 cases reported globally for 2010 (1207 type 1 and 87 type 3), compared with 1604 cases at the end of 2009 (482 type 1 and 1122 type 3).
Liberia and Mali have not reported cases in more than six months. The last case seen in Liberia had onset of paralysis on 8 September 2010 and the last case seen in Mali had onset of paralysis of 17 September 2010.
Serious obstacles continue in re-established transmission countries
: Serious obstacles and risks are continuing in the re-established transmission countries of Angola, Chad and the Democratic Republic of the Congo (DR Congo). In Angola, genetic sequencing of a 7 January 2011 wild poliovirus type 1 (WPV1) in the south-east of the country confirmed it to be a continuation of its re-established WPV1, meaning that the end-2010 milestone of the GPEI Strategic Plan 2010-2012, which called for the cessation of all re-established transmission, has not been met in the country. In Chad, continuation of re-established wild poliovirus type 3 (WPV3) transmission was confirmed by genetic sequencing of WPV3 isolated from a case with onset on 30 January 2011 in the east of the country; meaning that it had also did not meet the end-2010 milestone. DR Congo is also at high risk of missing the end-2010 milestone, as transmission of its re-established WPV1 is known to have continued into at least December 2010. All three countries are putting in place urgent measures to address the situation. Southern Sudan, the fourth re-established transmission country, has not reported a case since June 2009 and is considered to be 'on track'. See 're-established transmission countries' section below for more.
IMB publishes first report
: The Independent Monitoring Board (IMB) has published its first report summarizing its 21-22 December inaugural meeting in Geneva. The initial meeting focussed on three areas: the board’s method of work, the status of the GPEI Strategic Plan 2010-2012 milestones and process indicators, and the emergency action plans of Angola, the Democratic Republic of the Congo and Pakistan. The group will next meet in Geneva on 31 March-1 April, to review the epidemiological situation, in particular to review the progress in India and Nigeria, as well as emergency plans prepared to address uncontrolled transmission in Pakistan, Angola, Chad and DR Congo.
Congo cases classified
: The total number of polio cases for 2010 in the Republic of Congo has been officially raised to 384, following review by the National Polio Expert Committee (NPEC) of 325 cases of acute flaccid paralysis (AFP) for which no adequate specimens were collected. The NPEC, convened by the government, classified 317 as polio compatible and exceptionally, these were confirmed as polio based on their geographic and temporal association with the WPV1 outbreak.
UNICEF Executive Director visits DR Congo
: In early March, UNICEF Executive Director Anthony Lake visited the Democratic Republic of Congo and met with the Prime Minister and the Minister of Health to discuss the government’s vital role in putting an end to polio.
Organizational restructure at WHO
: Dr Bruce Aylward has been appointed Assistant Director General of a new WHO cluster that will bring together the agency’s work in polio eradication, humanitarian response and country cooperation. Dr Aylward is currently Director of the Polio Eradication Initiative and will continue to lead and oversee WHO's work on polio eradication, particularly related to strategy, policy and advocacy, with Chris Maher assuming the day-to-day management of polio operations from 1 April.
Rotary's Polio Plus Chair meets with Pakistan President
: Dr Robert Scott, chair of Rotary International's PolioPlus committee, is currently visiting Pakistan at the invitation of President Asif Ali Zardari. On 23 March, President Zardari presented Dr Scott with the Sitare-e-Khidmat - an award for service to the country. Former District Governor of Rotary's Pakistan and Afghanistan District (3270), Aziz Memon, was presented with the prestigious 'President of Pakistan - Pride of Performance' award at the same ceremony.
SAGE IPV working group meets
: The Strategic Advisory Group of Experts on Immunization (SAGE) Inactivated Polio Vaccine (IPV) Working Group met in Geneva, Switzerland on 17-18 March. The SAGE IPV Working Group was specifically established in late 2008 to advise SAGE on policy for IPV-use in the post-eradication era in low- and middle-income settings. Outcomes of the group's discussions will be presented at the upcoming SAGE meeting in early April.
Meeting of multi-country TAG in Zambia
: The multi-country Technical Advisory Group (TAG) for Angola, the Democratic Republic of the Congo, Namibia and Zambia met on 17 March. The TAG made the following recommendations: continued engagement of national and sub-national political authorities; continued mobilization of local resources; inclusion of data-driven communication and social mobilization components into SIA and routine immunization plans; inclusion of baseline social and behavioural research to guide communication planning and evaluation for routine and SIAs; and establishment of a mechanism to implement and follow up on TAG recommendations.
Rotary and Itzhak Perlman celebrate with Concert to End Polio
: On 7 March, polio survivor and violin virtuoso Itzhak Perlman joined members of the Chicago Symphony Orchestra for a Concert to End Polio. World-renowned conductor, James DePreist - also a polio survivor - conducted the evening's benefit performance, to raise funds for polio eradication. More
Children across the country were vaccinated against polio with bivalent oral polio vaccine (bOPV) and provided with deworming tablets during National Immunization Days (NIDs) held 13-15 March.
Five districts of Zabul province were reported as inaccessible during the latest round due to security concerns. Negotiations are under way to secure access to these districts and it is hoped that supplementary immunization activities (SIAs) can be resumed shortly.
The acting Minister of Public Health, Dr Suraya Dalil, presided over a ceremony to launch the latest NIDs, also attended by heads of CIDA and USAID, as well as several ambassadors. In addition, the Ministry of Public Health signed a memorandum of understanding with the Afghan Red Crescent Society to work together towards polio eradication.
NIDs using trivalent oral polio vaccine (tOPV) are planned for 2-4 May, during which time health workers will also administer vitamin A.
Sub-national Immunization Days (SNIDs) using bOPV are currently underway. Further SNIDs are planned for April and May.
In response to India's sole poliovirus case in 2011 -- a WPV1 case in Howrah district of West Bengal -- a multi-agency outbreak plan is being implemented jointly by UNICEF, WHO and Rotary International, with the Government of West Bengal in the 36 high-risk blocks of the state. Thirty-five Surveillance Medical Officers (SMOs) have been assigned to 21 high-risk blocks in eight districts of West Bengal. Some high-risk blocks have up to five SMOs assigned to oversee polio eradication activities.
Two prominent Muslim Imams have been engaged in the West Bengal outbreak response and their appeals are being distributed to community mobilisers and vaccinators to counter any resistance on religious grounds. These Imams agreed to open booths in key resistance areas on Sunday, 27 March.
With millions of Indian families returning to their homes for the Holi Festival last week, WHO and UNICEF supported the Uttar Pradesh (UP) and Bihar State Governments in establishing immunization at important train stations. At Bihar’s 27 train stations, vaccination and social mobilization teams were deployed to immunize every child getting onto or off trains across the week of Holi. In the 66 highest-risk blocks of UP, houses which were marked as ‘vacant’ or ‘locked’ at the recent NIDs were attended by vaccination and social mobilization teams to immunize any returning children. Polio advocacy interventions were done at all prominent mosques in UP and Bihar on the occasion of the Prophet Mohammad’s birthday on 16th February and the annual Urs celebrations. At the Urs-e-Razvi in Bareilly, polio messages were omnipresent at the gathering of more than 1 million Muslim men.
The Expert Review Committee on Polio Eradication and Routine Immunization (ERC) met on 7-8 March in Abuja and determined that: 1) Nigeria is at a cross-roads with a time-limited (6-9 months) opportunity to eradicate polio before accumulated susceptible cause new outbreaks; 2) Nigeria has the support and full complement of strategies, tactics and tools (bOPV & tOPV) to achieve polio eradication; and 3) Nigeria cannot finish eradication unless gaps in mop-ups, SIAs and AFP surveillance quality are addressed immediately, especially in Borno, Kebbi, Zamfara, Sokoto, Kano and Kaduna. The ERC outlined the following as immediate priorities: Intensive mop-up strategy; close surveillance gaps; action to address known problems with SIAs in high risk LGAs; development of a mobile/migrant population strategy and maintaining immunity in polio-free areas. All operational activities will now be underlined by a significantly-enhanced independent monitoring network, with results of all key activities communicated directly to the National Primary Health Care Development Agency (NPHCDA) within eight days.
The ERC further recommended that there should be bi-monthly LGA-level and State-level public reporting on the Abuja Commitments for Borno, Kebbi, Zamfara, Sokoto, Kano and Kaduna; systematic engagement of Traditional Leaders in mop-ups; and surveillance sensitivity should be doubled for 12 months in areas with orphan virus (WPV or cVDPV).
Nigeria used measles vaccines and tOPV to implement phase two of an integrated measles campaign targeting 13 million children in 17 Southern States and 50 million children for OPV vaccines in the 36 States and the Federal Capital Territory (FCT) from 23 to 27 February 2011. Phase one was implemented in January 2011.
Mop-up activities have been conducted in early March in three local government areas of Borno (Maiduguri Metropolitan Council, Jere and Marte) in response to the Marte case (onset of paralysis on 7 February).
The latest supplementary immunization activities (SIAs) are SNIDs using bOPV in 12 high-risk northern states. Eleven of the 12 states held the round on 26-29 March; however, the round has been postponed in Borno until 4-8 April. Borno has decided to delay the round in order to distribute long lasting insecticidal mosquito nets (LLINs) at the next round.
Health worker strikes in Katsina state are jeopardizing preparations for the upcoming SNIDs. Provided that there are no further strikes, the CHW in May will be the first time the states of Taraba, Cross River and Oyo have been covered by SIAs since the strikes began in November 2010.
The Federal Minister for Information and Broadcasting, Dr Firdous Ashiq Awan, has launched the country’s first national polio drive under the new National Emergency Action Plan for polio eradication on 5th March 2011 in Islamabad. While launching the campaign, she highlighted the need for aggressive implementation of the national emergency action plan at all levels. She emphasized that polio eradication is not only governmental responsibility, but a national responsibility, while urging media and civil society to come forward and support health department in implementation of the plan. The Federal Secretary of Health, Mrs Nargis Sethi, and Executive Director of NIH, Dr Birjees Kazi, were present at the ceremony which was also attended by international partners including WHO Country Representative Dr Guido Sabatinelli, UNICEF Consultant Mr Dennis King, Bill & Melinda Gates Foundation and Rotary International. The Governor of Khyber Pakhtunkhwa, Barrister Masood Kausar, also showed his support by personally vaccinating children at a ceremony held at the Governor's house on 7 March. This is the first nationwide campaign since the action plan was launched in January.
Early anecdotal feedback from the March NIDs suggested stronger oversight at the district level, but Lot Quality Assurance Sampling (LQAS) results suggest continued quality issues, particularly in high-risk districts. The reasons for the quality gaps are currently being investigated.
The Afghanistan/Pakistan Technical Advisory Group (TAG) and cross border meeting was held in Islamabad on 24-25 March. The TAG expressed concerns about the 33 highest risk districts of Pakistan, which remain responsible for 80% of the country's WPV cases. The Federally Administered Tribal Areas (FATA) was found to be of particular concern, especially given the frequent population movement both within FATA and to other areas of Pakistan. Accessibility remains a problem in parts of FATA, however the fact that cases have been reported in accessible areas indicates gaps in campaign quality. The TAG's key recommendations included aggressive response to a) the current WPV1 outbreak in Central/Southern Sindh, b) any WPV3 anywhere in the country, and c) any WPV1 outside the persistent transmission zone. The TAG also strongly urged the new 'Prime Minister's polio monitoring cell' to establish and use standard indicators to issue and share district polio 'report cards' with the Prime Minister, chief ministers and governors.
The leadership of Punjab has shown a much greater commitment to polio eradication in the last few rounds, and this is reflected in much-improved results from lot quality assurance sampling (LQAS). However, Sindh and FATA remain of concern, and efforts are underway to engage the leadership of both areas in improving the quality of upcoming rounds.
The next SIAs will be SNIDs on 4-6 April (using bOPV). Further rounds are planned for May and June.
UNICEF Pakistan has announced the creation of an independent programme unit fully dedicated to UNICEF's polio eradication activities. Over the coming weeks and months, staffing across the country will be rapidly ramped up to increase UNICEF communication and social mobilization capacity in the country office and provincial teams.
RE-ESTABLISHED TRANSMISSION COUNTRIES
Genetic sequencing of a 7 January 2011 wild poliovirus type 1 (WPV1) in the south-east of Angola confirmed it to be a continuation of that country's re-established WPV1, meaning that the end-2010 milestone (cessation of all re-established poliovirus transmission) of the GPEI Strategic Plan 2010-2012 had not been met in Angola.
Anticipating this risk, Angola had already at end-2010 initiated a review and revision of its emergency action plan for polio eradication. The major elements of the plan were presented by the Honourable Minister of Health to the GPEI's Independent Monitoring Board (IMB) on 21-22 December 2010. Since then, the President of Angola has met with leaders of GPEI partner agencies and informed them of his plan to personally oversee the programme going forward to ensure the full engagement of provincial Governors to rapidly fill ongoing gaps in the operationalization of the emergency plan. This plan is being further refined with the country's Technical Advisory Group (TAG) in advance of the Government discussing it with the IMB again on 31 March 2010.
Mop-up immunization activities (using mOPV1) were conducted on 25-27 February around the Kuando Kubango case and in other infected and high-risk areas, including Luanda and Benguela. NIDs using bOPV were held on 25-27 March and further SIAs are planned for 6-8 May. Angola will participate in synchronized rounds with Congo, DR Congo and Namibia on 28-30 April, and with DR Congo, Namibia and Zambia on 26-28 May.
In Chad, continuation of re-established WPV3 transmission was confirmed by genetic sequencing of WPV3 isolated from a case with onset on 30 January 2011 in the east of the country. This means that the GPEI Strategic Plan 2010-2012 milestone for cessation of all re-established poliovirus transmission by the end of 2010 has not been met in Chad. In addition to the re-established transmission of WPV3, Chad is also affected by a new outbreak of wild poliovirus type 1 (WPV1) following an importation from Nigeria in September 2011.
Alarmed at the ongoing transmission of its re-established WPV3 and the new WPV1 outbreak since September, the Government of Chad at the start of 2011 developed an urgent operational plan to address the situation. The new plan sees resources and support allocated to identified high-risk areas. In a major shift, district heads will be personally charged with overseeing implementation of supplementary immunization activities (SIAs) by their respective provincial governors. At the national level, monthly implementation reports will be prepared by the Ministry of Health and shared with the office of the Prime Minister. The major elements of the new operational plan will be presented to the GPEI's Independent Monitoring Board (IMB) on 31 March - 1 April 2011.
SIAs are currently being planned to avoid the period surrounding the upcoming presidential elections.
DEMOCRATIC REPUBLIC OF THE CONGO (DRC)
DR Congo is currently considered to be at high risk of missing its end-2010 milestone (cessation of all re-established poliovirus transmission) because transmission of its re-established WPV1 is known to have continued into at least December. The Government of DR Congo intends to present their emergency action plan for polio eradication at the IMB meeting.
SNIDs were carried out in Kinshasa and nine districts of Kasai Occidental from 24-27 March. Given that four out of the six cases seen in Kinshasa in 2011 have been adults, the SNIDs in Kinshasa were expanded to cover the entire population of the greater urban area (rather than children less than five years of age).
DR Congo will also take part in synchronized campaigns with Angola, Congo and Namibia on 28-30 April, and with Angola, Namibia and Zambia on 26-28 May.
REPUBLIC OF CONGO AND GABON
NIDs using bOPV were held from 22 February. Congo will vaccinate children and adults against polio in southern provinces on 28-30 April, as part of a synchronized campaign with Angola, DR Congo and Namibia.
The case reported in Gabon last month - WPV1 imported from Congo with onset of paralysis on 15 January - remains the only case to be seen in the country in more than 10 years. NIDs using mOPV1 were held from 22 March.
HORN OF AFRICA
The first phase of a nationwide round in Somalia took place from 20 March; the second phase is planned for 24-27 April (both phases will use tOPV). While these SIAs will aim to cover the entire nation, escalating conflict may hamper access to the south and central zones including Mogadishu.
Southern Sudan is currently carrying out a round of SIAs, and northern Sudan's next round will take place on 2 April (both using tOPV). Sudan has not reported a case since 27 June 2009, however given the confirmation of cases in eastern Chad, close to Sudan's border, it is important that the country maintains keen surveillance and that upcoming rounds are well carried out.
Plans for the synchronized SNIDs along the Uganda/Kenyan border have been altered. Both countries have now postponed their rounds until May.
CENTRAL ASIA AND RUSSIA
No country in this region has reported a case in 2011.
Russia has SNIDs using tOPV planned for 28 March - 2 April.
In Tajikistan, NIDs are planned for 18-22 April using tOPV.
NIDs are planned for Turkmenistan on 25-28 April using tOPV.
Kazakhstan held SNIDs using mOPV1 from 21-27 February.
Kyrgyzstan and Uzbekistan are planning NIDs using tOPV for April.
A nationwide round using tOPV was held on 12-13 March.
Niger has reported the first case from this group of countries in almost six months. This case is a WPV3 with onset of paralysis on 19 January in Birni Nkonni, Tahoua. Genetic sequencing is ongoing to determine its origin - Niger has in the past been subjected to repeated importations from neighbouring Nigeria.
Synchronized campaigns, using a combination of vaccines, were held across most of west Africa from 25 March. Similar synchronised multi-country campaigns will also be held from 29 April.
Liberia has not reported a case in over six months. The most recent case had onset of paralysis on 8 September 2010.