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  3. Sunday, 14 November 2010
Dear colleagues, Please visit for regular updates on the Global Polio Eradication Initiative. Note that all data in this report refers to 09 November 2010. This report has been developed jointly with Rotary International, CDC and UNICEF. The French version will be available on 17 November 2010 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 septembre 2010 sera disponible le 17 novembre 2010 sur Meilleures salutations. L'équipe de relations externes pour l'éradication de la polio Global Polio Eradication Initiative: Monthly Situation Report: October/NOVEMBER 2010 All data as of 9 November 2010. For latest news and polio case data by country, updated every week: Facts & figures There have been 767 cases globally this year (692 type 1 and 75 type 3), compared with 1,337 cases at this time last year (432 type 1, 905 type 3 and four type 1/3 co-infections). Nineteen countries have reported cases in 2010, compared with 23 at this time last year. 177 districts have been infected with wild poliovirus in 2010 –a 60% reduction from the 431 districts infected at this time in 2009. HEADLINES Polio outbreak in Republic of Congo: The country has reported 201 cases of acute flaccid paralysis and 97 deaths. Four cases have been confirmed to have been caused by wild poliovirus type 1 and laboratory testing continues. Most cases are in young adults: among those cases for which age data is available (85) at this time, 66% are between the ages of 15-25 years. The Government of Congo has alerted the public to the outbreak and launched an emergency response plan, with support from key partners, including WHO, UNICEF and the US CDC. The first vaccination response starts on 12 November; at least three nationwide vaccination campaigns are expected, using monovalent oral polio vaccine and targeting the entire population. West Africa outbreak response continues, as new case is reported from Liberia: From 26 October, 10 countries across Africa took part in a synchronized immunization campaign across west and central Africa to tackle the remaining low-level transmission of last year's multi-country outbreak and raise immunity to polio as a block. This latest campaign - the third such synchronized effort in Africa this year - comes in the wake of confirmation of a type 1 wild poliovirus case (WPV1) in Liberia, the first in the region since 1 May, and a type 3 wild poliovirus case (WPV3) in Mali - the first in that country since 2001. While the Liberia case has been linked to previous transmission in the country earlier in the year, the Mali case is clearly a new importation and underscores the reality that all countries must maintain immunity to both WPV1 and 3 in order to guard against reinfection. Additional rounds for these countries are planned for November 2010. New study confirms efficacy of 'game-changing' bivalent oral polio vaccine (bOPV): A study published in October in the medical journal The Lancet confirms the increased efficacy of the new bOPV. Large-scale use of the new vaccine, coupled with operational improvements, has led to a dramatic decrease this year in both WPV1 and WPV3 cases in Nigeria and India. Of note, this study confirms the efficacy of the new vaccine not just in a clinical trial, but provides crucial evidence of field efficacy. The biggest challenge now is to ensure sufficient funding is rapidly made available to enable more children to benefit from the new vaccine. WHO Director-General launches NIDs in Pakistan's tribal area: On 28 October, WHO Director-General Dr Margaret Chan launched polio National Immunization Days in tribal areas of Pakistan, together with the Chief Minister Khyber Pakhtunkhwa, Ameer Haider Khan Hoti. The DG and RD also attended a meeting with the political agents and agency surgeons of FATA. Earlier in the week, Dr Chan, together with the Regional Director of the WHO Eastern Mediterranean office, Dr Hussein A Gezairy, held meetings with President Asif Ali Zardari, Federal Minister of Health Makhdoom Shahabuddin and Provincial Minister for Health Sindh Dr Sagheer Ahmad, where all underlined the importance of rapidly completing the job of polio eradication. Polio reported in Uganda: Uganda has reported its first case of polio since 10 May 2009, with genetic sequencing of the WPV1 case showing it is related to transmission in Turkana Valley, Kenya, in early 2009. Emergency response plans are being formulated, including three rounds of supplementary immunization activities (SIAs) in eastern Uganda and western Kenya starting in late November. The case underscores the critical need to strengthen sub-national surveillance levels, particularly across the sub-Saharan "polio importation belt". New global polio website launched: The website of the Global Polio Eradication Initiative (GPEI) has been redesigned: features the weekly data and relevant epidemiological information with which users are familiar, matched with more materials and information for a non-technical user, in a modern and attractive design. Polio researchers sought: The Polio Research Committee (PRC) is currently soliciting research proposals on a variety of polio-related topics. In particular, the PRC is interested in innovative proposals focusing on operational research to improve key field operations. For more information, click here: . ENDEMIC COUNTRIES AFGHANISTAN: 20 cases in 2010 (12 WPV1, 8 WPV3). 24 cases at this time in 2009 (15 WPV1, 9 WPV3). No cases were reported this month in Afghanistan. A nationwide immunization round was organized in Afghanistan from 3-5 October. Bivalent OPV was used to immunize an estimated target of 7.8 million children in 34 provinces of the country. 22,402 teams consisting of 52,251 personnel, including volunteers, covered children living in high-risk areas, urban locations, transient settlements and mobile populations through a mix of strategies: house-to-house visits, and immunization at fixed posts, bus stops, shrines, markets and border areas. The introduction of chewable de-worming tablets for children between the ages of 2 and 5 years of age was inaugurated as an added intervention during the October round by the minister of public health, H.E. Dr. Suraya Dalil. During the week of 21 October, the regional Technical Advisory Group for Afghanistan and Pakistan convened in Cairo, Egypt, to review the latest epidemiology and further sensitize strategies to increase access to populations, in particular in conflict-affected areas. INDIA 39 cases in 2010 (16 WPV1, 23 WPV3). 568 cases at this time in 2009 (68 WPV1, 499 WPV3, 1 WPV1/WPV3 mix). No cases were reported in India in the past four weeks – an extraordinary achievement, given September/October are usually the heart of the "high season" for wild poliovirus transmission. During the first week of November, the India Expert Advisory Group on Polio Eradication (IEAG) convened to discuss additional measures to interrupt the remaining strains of polio in the country. The group concluded that the country has never had a better opportunity to complete the job, with extremely low levels of transmission being sustained primarily by mobile population groups. The group recommended an aggressive mop-up strategy in response to any further wild poliovirus from any source.Technical assistance continues to be deployed from polio-free areas of the country to high-risk, re-infected and endemic areas.The surveillance review conducted in West Bengal has expressed confidence in the quality of surveillance in the state. Further refinements were nevertheless recommended. A 2010 Study on community Knowledge, Attitudes and Practices (KAP) in the 107 highest risk blocks of UP and Bihar has just been completed. The study surveyed over 11,000 parents in high-risk areas as well as the highest risk groups of migrant, nomads and slum-dwellers covered for the first time in a KAP. Data shows continued high rates of community ownership and commitment towards the goal of polio eradication and identifies strategic shifts for the 2011 communication campaign, which was endorsed by the IEAG. NIGERIA 10 cases in 2010 (5 WPV1, 5 WPV3). 383 cases at this time in 2009 (73 WPV1, 308 WPV3, 2 WPV1/3). New cases will now be responded to with an aggressive mop-up strategy. To this effect, the Executive Director of the National Primary Healthcare Development Agency (NPHCDA) has inaugurated a Mop-up Task Team.Kano State reported its first case of WPV1 since January 2009, which genetic sequencing showed to be an importation from Borno. Response activities begin on 6 November.The Expert Review Committee on Polio Eradication and routine Immunization (ERC) met 4-5 October. The group discussed strategies to capitalize on the current positive epidemiological situation, but also highlighted the risk of ongoing transmission.The Chairmen of high-risk Local Government Areas (LGAs) have issued a joint statement, committing to providing active leadership to polio eradication, allocating adequate human and financial resources to activities, and reporting to their respective state governors. PAKISTAN 111 cases in 2010 (89 WPV1, 22 WPV3). 76 cases at this time last year (52 WPV1, 23 WPV3, 1 WPV1/3). Pakistan has more cases in 2010 than the other three polio-endemic countries combined (69).The second phase of NIDs was carried out in the 45 worst flood-affected districts from 11-13 October. The polio infrastructure in the country continues to support the flood relief efforts, while actively continuing to pursue the goal of polio eradication. In response to the expanding outbreak affecting the country, the Governor and Chief Minister of Khyber Pakhtunkhwa (KP - formerly NWFP) urgently convened a meeting in early October to discuss the need for greater collaboration with the military and civil sector to secure access to children in KP and the Federally Administered Tribal Areas (FATA). A high-level task force, headed by the Chief Secretary, has been established to ensure necessary arrangements are in place to celebrate the 2011 as 'Polio Eradication Year’. A follow up meeting in this regard was chaired by the Chief Secretary on 29th October in which it was decided that Polio Eradication Plan (PEP) focusing at Union Council (UC) – the lowest administrative level – and sub-UC levels to be sent to the provincial leadership by 15th December 2010. UNICEF engaged the Inter-religious Council for Health (IRCH) in 27 high-risk districts on mother and child health issues, with special emphasis on polio eradication and immunization. After a national-level workshop earlier this year, provincial workshops were held in which religious leaders from Muslim, Christian, Sikh and Hindu communities were given an orientation on polio eradication, immunization and other mother and child health issues. Information booklets and brochures on these issues, authored by the religious leaders themselves, were finalized this month. IRCH will orient/train a total number of 16,200 religious leaders (both male and female) to sensitize 26 million people, urban and rural, across the country, including in FATA.The Federal Minister for Health and Provincial Minister for Health Sindh jointly chaired a meeting with the district level leadership from areas having a recent surge in polio cases and urged the District Coordination Officers to give their personal engagement to overcome local issues and ensure uniformly high quality vaccination activities at the sub-district level. RE-ESTABLISHED TRANSMISSION COUNTRIES ANGOLA 26 WPV1 cases in 2010. 28 WPV1 cases at this time last year. Efforts are underway to urgently address the operational gaps in immunization activities – with upwards of 20% of children regularly missed during SIAs, particularly in Luanda, Kuanza Sul and Kuanza Norte – by strengthening microplans and vaccinator selection and training. Key to ultimate success, however, will be strengthened engagement by the provincial and district-level leadership.There has been greater involvement of the military enabling vaccination teams to reach the most difficult areas. Google maps are used to ensure that no settlements are missed. These additional quality approaches have contributed to the reduction of missed children in the key province of Luanda from 26% in the August round to 13% in the October round. The aim is to implement these innovations more vigorously to further reduce the proportion of missed children. The risk of outbreak has been underlined by the spread to the Republic of Congo. CHAD 14 WPV3 cases in 2010. 33 WPV3 cases at this time last year. (Last case was 10th of May 2010) Next NIDs: October and November, using bOPV. DEMOCRATIC REPUBLIC OF THE CONGO (DRC). 30 WPV1 cases in 2010, 3 WPV3 cases at this time last year. DR Congo is experiencing a severe outbreak in Kasai Occidentale, the result of polio transmission from across the Angolan border. SIAs were held from 19-21 August and 23-25 September in the west, south and east of the country. These followed 'preventive' mop-ups conducted in June and July in anticipation of cross-border infection resulting from the outbreak in Angola.Another round was held on 28th to 30th October in the areas not previously covered. The same areas will be coved in November 2010. WHO's AFRO Regional Director has written to the President of DR Congo, highlighting the risk of further spread within the country and the need for emergency action to stop the outbreak and strengthen surveillance. IMPORTATION COUNTRIES HORN OF AFRICA 1 case in 2010. 71 WPV1 cases at this time last year. The Horn of Africa reported its first case, a WPV1 from Uganda, genetically linked to the WPV1 outbreak which occurred in northern Kenya from February to July 2009.The detection of this case is an alert that the 2009 circulation in Kenya has continued undetected into 2010. Due to sub-national surveillance gaps in parts of Kenya, undetected circulation cannot be ruled out. Three rounds of large-scale outbreak response campaigns are planned synchronized between Uganda and Kenya. The proposed dates are first round 19th to 21st of November second round 10th to 12th of December 2010 and the 3rd 15th to 17thof January. CENTRAL ASIA AND RUSSIA Tajikstan: 458 WPV1 cases in 2010. Turkmenistan: 3 WPV1 cases in 2010. Russia: 14 WPV1 cases in 2010. > Kazakhstan: 1 WPV1 case in 2010. The large outbreak of WPV1 in Tajikistan this year has slowed dramatically, but not before poliovirus from Tajikistan spread to infect Turkmenistan, Russia and Kazakhstan. The most recent case in Tajikistan had onset of paralysis on 4 July. Comprehensive outbreak response is continuing in all four countries, to stop residual transmission of the outbreak. NEPAL 6 WPV1 cases in 2010. Mop-ups are continuing in highest-risk border districts with India. All cases this year are from the Central Development Region (CDR), in Rautahat and Mahottari districts, bordering Bihar, India. WEST AFRICA 32 cases in 2010 (all WPV1 except 2 WPV3 cases in Niger and 1 WPV3 case in Mali): Senegal 18, Mauritania 5, Mali 4, Niger 2, Liberia 2, Sierra Leone 1. 133 cases in 11 countries at this time last year. More than 72 million children were immunized against polio across 15 west African countries. The campaign is the latest in a series of cross-country outbreak response activities, which has significantly curbed the multi-country outbreak which began last year.Detection of a new case in Liberia, related to transmission earlier this year, underscores the ongoing danger of residual transmission, and the need to continue to maintain high population immunity and strong disease surveillance. At the same time, a new importation of a WPV3 is still being investigated to determine its origin, though it is likely to be related to WPV3 from Niger.

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