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  3. Tuesday, 18 October 2011
Dear colleagues,? Please find attached the Monthly Situation Report as usual and visit for regular updates on the Global Polio Eradication Initiative. Note that all data in this report refer to 5 October 2011. The French version will be available on 14 October 2011 on With best wishes,? The Polio Eradication 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 2011 sera disponible le 14 octobre 2011 sur Meilleures salutations,? L'équipe pour l'éradication de la poliomyélite MONTHLY SITUATION REPORT - SEPTEMBER 2011 All data as of 5 October 2011 NEW! Vacancies in polio eradication For latest news and polio case data by country, updated every week: FACTS & FIGURES Reduction in cases globally in 2011 compared with the same time in 2010: 40%. 429 cases?( 370 wild poliovirus type 1 - WPV1 - and 59 WPV3) vs. 706 cases (635 WPV1 and 71 WPV3). Months since the Russian Federation's most recent case of WPV: 12 (onset of paralysis on 25 September 2010). Months since a case of WPV in Angola: 6 (onset of paralysis on 27 March 2011). Days since India reported its most recent case: 265 and counting Years since the last case of polio in the Americas: 20 GLOBAL OVERVIEW Greatest-ever number of 'Stoppers' to be deployed: The 38th STOP Team deployment will be the largest in the history of the programme, with 114 'Stoppers' to be sent out around the world. STOP - or Stop Transmission of Polio - is a programme jointly run by the US Centers for Disease Control and Prevention (CDC) and WHO, that trains volunteers to assist in the implementation of effective polio vaccination campaigns. These volunteers have a range of backgrounds including public health, communications and data management. China conducts aggressive outbreak response: Within 15 days of confirmation that WPV1 had been detected, a 'level two' health emergency had been declared, both the Minister and Vice-Minister of Health had travelled to the affected province, almost 150 health professionals from around China had been deployed, five million doses of trivalent oral polio vaccine (tOPV) had been airlifted to the province, more than 200,000 hospital records had been reviewed and the first vaccination round had commenced. 10,000 call for polio's eradication as World Polio Day approaches: The Global Poverty Project (GPP) has received more than 10,000 signatures for their petition calling on world leaders to eradicate polio. For every signature, the Rotary Club of Crawley is donating one dose of oral polio vaccine. Visit the GPP website to sign the petition or to view their inspiring video - Piper and the End of Polio. Meanwhile preparations are under way for World Polio Day on 24 October, and Rotary International's website includes some novel ideas on what you can do to help raise awareness for polio eradication. The GPP has also announced the line-up of international and Australian musicians for 'The End of Polio Concert' to be held in Perth, Australia to coincide with both World Polio Day and the Commonwealth Heads of Government Meeting in the Western Australian capital. Indian Minister of Health thanks Rotary: India's Minister of Health and Family Welfare, the honourable Ghulam Nabi Azad, was invited by Rotary International to their headquarters in Evanston, Illinois, USA, on 23 September. The Minister reaffirmed his country's commitment to polio eradication and thanked Rotarians for their assistance: "My country has benefited greatly from your support and I thank all of you. India has not had a case of polio since January 2011." Nigerian round 'flagged-off' by Vice-President: Nigeria's Immunization Plus Days (IPDs) were launched by the country's Vice President, Arc Namadi Sambo, on 24 September. On behalf of President Goodluck Jonathan, Vice President Sambo called the persistence of polio in the country 'unacceptable', and ordered the urgent implementation of measures to eliminate polio transmission in the country by 2012 at the latest. At the official inauguration, the Vice President launched the 'polio-free torch' campaign, symbolically lighting a torch which will travel to all states in the model of the Olympic torch. Bill Gates, Co-chair of the Bill & Melinda Gates Foundation, visited Nigeria and Chad at the end of the month to discuss polio eradication and routine immunization with key leaders. More on Mr Gate's trip. Afghan President launches vaccination round: President Hamid Karzai of Afghanistan showed his support for polio eradication by personally launching the National Immunization Days (NIDs) on 17 September. Afghanistan's Minister of Public Health, Dr Suraya Dalil, who was also present at the launch, called on governors, district chiefs, mayors, police heads, highway police, tribal elders and influential figures to cooperate with the vaccinators. The Regional Director of WHO's Eastern Mediterranean Region, Dr Hussein Gezairy, attended the campaign launch during a visit to the country. Sanofi Pasteur donates seed strain: Sanofi Pasteur has donated to WHO a vaccine seed-strain used for the production of oral polio vaccine (OPV). The type 3 polio seed-strain is the original viral seed used to produce large quantities of OPV to protect against type 3 poliovirus. More US$ 10 million for polio eradication arrives from Saudi Arabia, as vaccination requirements for Hajj are published: This is a first instalment of the $30 million commitment to the Global Polio Eradication Initiative (GPEI). The funds will be used in 2011 by UNICEF for vaccines. The World Health Organization (WHO) expects to shortly sign a memorandum for another US$5 million to support campaign operations. Countries benefiting from the funds include several members of the Organization of Islamic Cooperation countries, such as Yemen, Somalia and Sudan. As people begin to travel towards Mecca, Saudi Arabia for the annual Hajj (pilgrimage), the country is once again requiring all travellers arriving from polio-endemic countries and re-established transmission countries to provide proof of vaccination status before entering the kingdom and to receive an additional dose of polio vaccine upon entry. More Independent Monitoring Board meets in London: The Independent Monitoring Board (IMB) met on 28-30 September to review progress against the milestones of the Global Polio Eradication Initiative Strategic Plan 2010-2012. The IMB will issue its next report in mid-October. Twenty years without polio in the Americas: On 5 September 1991, a Peruvian boy named Luis was the last child in the Americas to be paralysed by indigenous WPV. As recently re-infected countries such as China, Russia and Tajikistan are now painfully aware, being certified 'polio free' is no guarantee that polio cannot come back. The World Health Organization (WHO) Region for the Americas therefore remains on the lookout for any new importations. More ENDEMIC COUNTRIES AFGHANISTAN After a strong start to the year, transmission in Afghanistan is starting to pick up pace and the number of cases reported this year is currently double the number of cases reported at this time last year (36 compared to 18). Two previously polio-free provinces reported cases in September - Badghis and Parwan. In fact, this was the first case seen in Badghis since 2001. Genetic sequencing of the Badghis case found that it matches closely with virus from Balabluk district of Farah province of Western region. Badghis borders Turkmenistan and shares intensive transport and trade links with that country. The province is relatively less connected to Afghanistan's polio-endemic southern region. The country responded to the Parwan case by sending additional technical assistance to the province to assist in the planning and implementation of the NIDs held from 17-19 September. Genetic sequencing found that the Parwan case was related to virus last seen in Karachi. Both Parwan and Badghis conducted short interval additional dose (SIAD) rounds following the NIDs. Risks identified by the review included the failure to consistently reach children with vaccine in the transmission zone and the risk of WPV being imported from Pakistan into currently polio free areas. A broad strategic approach was drawn up in order to guide Afghanistan's polio eradication activities from September 2011 until June 2012. The overall goal is to stop transmission in the remaining infected areas of Afghanistan, while ensuring that all other areas remain polio-free. Under the new strategy, the 'transmission zone' will be redefined to include only those districts that play a role in sustaining transmission. Given the success of the SIAD strategy, this will be utilized to rapidly boost immunity in this newly redefined transmission zone. The plan stipulates that all provinces, including those outside the transmission zone, should continue to concentrate on achieving the highest possible quality of surveillance and supplementary immunization activities (SIAs). Routine immunization programmes should be strengthened as per national plans. As of August, staff from UNICEF and WHO are working in shared offices in Kabul, facilitating closer cooperation. INDIA It has now been more than eight months since India reported its last case (in West Bengal with date of onset on 13 January). Samples taken from sewage continue to be negative for WPV, and have been since November last year. In response to the spread of Pakistani virus to China, the Government of India has set up vaccination booths at major border crossings. More than 75 million children were vaccinated against polio during sub-national immunization days held from 25 September. Surveillance reviews are planned to take place in several key areas, including western Uttar Pradesh and central Bihar, throughout October, November and December. These surveillance reviews will seek out, and find ways to address, any gaps in the acute flaccid paralysis (AFP) surveillance network in order to ensure that any transmission of poliovirus can be promptly identified. NIGERIA Bill Gates, co-chair of the Bill & Melinda Gates Foundation, met with WHO, UNICEF and UN officials in Abuja during his visit to Nigeria, to express his sincere condolences to those families and friends who lost loved ones in last month’s bombing of the UN building. Mr. Gates also travelled to the northern states of Kebbi and Kano, observed the recent Immunization Plus Days (IPDs) and met with state and traditional leaders to better understand the challenges they are facing in prioritizing polio efforts and strengthening routine immunization. Mr Gates observed as Vice President Namadi Sambo and Chibuike Rotimi Amaechi, Governor of Rivers State and Chairman of the Nigeria Governors’ Forum, signed a communiqué adopting and re-confirming the 2009 Abuja Commitments. Those commitments lay out clear steps for Executive Governors and Local Government Area Chairmen to ensure that polio is stopped and immunization services are reaching more children. Understandably, working conditions are still not 100 per cent back to normal in the wake of the bombing, and the UN House building has been damaged to the point where it may take months or even years to repair. New offices have now been identified for the interim until a permanent solution can be found. Early in the month Dr Luis Sambo, the Regional Director for WHO's African Region, visited Abuja to provide support to colleagues at the WHO Nigeria office while they reorganized and resumed operations. Chris Maher, Acting Director of Polio Eradication, Monitoring and Research at the WHO, also visited Abuja to assist in the process. Two WHO security officers were deployed in order to support local risk assessments and assist the office to regain basic functionality.WHO's African Region, visited Abuja to provide support to colleagues at the WHO Nigeria office while they reorganized and resumed operations. Chris Maher, Acting Director of Polio Eradication, Monitoring and Research at the WHO, also visited Abuja to assist in the process. Two WHO security officers were deployed in order to support local risk assessments and assist the office to regain basic functionality. The Expert Review Committee (ERC) meeting for polio eradication and routine immunization which had previously been postponed will now be held on 13-14 October. Twenty-one consultants and members of STOP (Stop Transmission of Polio) teams are scheduled to arrive in Nigeria in the coming weeks to provide intensified international support. The Immunization Plus Days (IPDs) which began on 24 September were disrupted in several states by industrial action and other issues. Yobe, Borno and Bauchi states postponed the activity by a week, Plateau state began on 29 September, Kaduna state conducted the campaign from 2 October and Adamawa is yet to announce when it will hold the activity. PAKISTAN Technical support is being scaled up to help deal with the outbreak affecting Balochistan. An international consultant has been deployed to the province and will assist in polio eradication activities over the next three months. Technical experts on polio eradication from WHO and UNICEF headquarters are currently visiting the country to assist in planning Balochistan's outbreak response and to help refine SIA micro-planning and implementation in high-risk Union Councils (UCs) of Quetta block districts. A total of 21.3 million children in 93 districts of the country were targeted during Sub-national Immunization Days (SNIDs) which began on 19 September. In Khyber Pakhtunkhwa, the Governor and Chief Minister inaugurated the campaign, while in Balochistan, the Provincial Health Secretary presided over the launch. Parts of Sindh affected by severe flooding have postponed the round. Despite the flooding, trivalent oral polio vaccine was provided alongside measles vaccine to children under five years of age in camps for internally displaced persons in Sindh. In collaboration with the Inter-Religious Council for Health, the commissioner of Quetta division chaired advocacy sessions with key religious leaders of districts Killa Abdullah, Pishin and Quetta in Balochistan. The religious leaders resolved to take necessary steps to enhance awareness in the community about the importance of polio vaccination, including among families that have refused vaccination in the past. RE-ESTABLISHED TRANSMISSION COUNTRIES ANGOLA Angola, a country which is classified as having 're-established transmission', has gone six months without reporting a case. A rapid surveillance assessment conducted in July found surveillance gaps, however additional training on acute flaccid paralysis (AFP) and measles surveillance has since been provided to hospital and health centre staff. Five supplementary immunization activities have been conducted since the last case was reported. Child Health Days (CHDs) were conducted from 9-22 September. Children under five visiting the vaccination posts received trivalent oral polio vaccine, measles vaccine, vitamin A and de-worming tablets. CHAD Chad continues to account for the largest number of cases of WPV of any country in the world. So far this year the country has reported 111 cases of WPV type 1 and three cases of WPV type 3. However, it has now been more than six month since the country's last case of WPV3 (10 March). A joint high-level WHO/UNICEF/CDC mission reported greatly increased capacity, with new staff and consultants for both WHO and UNICEF in place to support the government. After his visit to Nigeria, Bill Gates, Co-Chair of the Bill & Melinda Gates Foundation, went on to visit Chad. Mr Gates advocated for national leaders and health officials to prioritize polio eradication and routine immunization and concluded, "Chad can eradicate polio." The risk of importation of virus to Chad's southern neighbour, the Central African Republic is very real, particularly given recent monitoring data which states that, so far in 2011 in the Central African Republic, more than 40% of AFP cases aged between 6 months and 5 years either had unknown vaccination status or had not received a single dose of oral polio vaccine. The Central African Republic will hold two rounds of National Immunization Days in September and October in order to boost immunity and prevent the spread of virus from Chad. The first of these rounds took place from 30 September to 2 October. DEMOCRATIC REPUBLIC OF THE CONGO Recent cases have all been from areas with physically difficult terrain and limited road capacity. While these difficulties can be a hurdle to vaccinators reaching children, it is also a hurdle to transmission spreading. The transmission in Kimvula, for example, has been limited geographically, due to the isolation of the infected area. The priority remains to clamp down on the persistent transmission of poliovirus in the eastern part of the country. Nationwide rounds are taking place from 6-8 October. As part of a surge in technical support, six international consultants and six 'STOPpers' have been deployed to the country. Through working with local communities and churches, a UNICEF social mobilization campaign succeeded in bringing down numbers of refusals in Katanga. IMPORTATION COUNTRIES CHINA Ten polio cases (all WPV type 1) have now been reported in China. All are in the Xinjiang Uygur autonomous region and all but one are in Hotan prefecture. The latest case, with onset on 6 September, was reported in neighbouring Bazhou prefecture. Unfortunately, one of the ten cases has died. Initial outbreak response supplementary immunization activities (SIAs) have been conducted. From 8-12 September over 4 million children aged under 15 were vaccinated with trivalent oral polio vaccine in the immediate outbreak area, while children under five were targeted in other areas of Xinjiang. The next vaccination round will begin on 8 October. China is currently looking at the possibility of producing its own monovalent oral polio vaccine type 1. Monovalent OPV type 1 is the OPV which produces the strongest immune response against WPV1. China uses it own unique oral polio vaccine which is produced in dragee form. Polio usually strikes children under five; however four cases have been seen in China in people aged in their twenties. Transmission among an older age-group sometimes occurs when there is a pocket of people who grew up in an era with little circulating WPV (so they did not build natural immunity) but before regular vaccination against polio increased. Once large scale immunization campaigns started, these people were already older than the target age group. In order to avoid a repeat of the outbreak in the Republic of the Congo last year (when the vast majority of the 441 cases were among teenagers and young adults), China has conducted SIAs targeting 5.5 million people aged between 15 and 39 in Hotan and south Xinjiang. HORN OF AFRICA Kenya conducted its first supplementary outbreak response vaccination round from 24-28 September. More than one million children in 32 districts surrounding the case were vaccinated using mOPV1. Initial reports suggest that the SIAs were well implemented. Further rounds, this time targeting four million children in 67 districts, are being planned to take place on 22-26 October and 19-23 November. Given the Kenyan case's links to Ugandan virus and trade links with Tanzania, both Tanzania and Uganda will hold supplementary immunization activities in order to boost immunity to the virus in districts neighbouring Kenya. Uganda will utilize the Short Interval Additional Dose (SIAD) strategy to quickly boost immunity in eight districts neighbouring Kenya. Two vaccination rounds will be held in quick succession - the first on 1-3 October and the second on 15-17 October. Uganda has further rounds planned for November and December, targeting eastern districts designated as being at high risk of reinfection with wild poliovirus. Tanzania held a sub-national vaccination round in six councils near to the border with Kenya on 24-27 September. The round was timed to coincide with the round in Kenya. More than 390,000 children under five received oral polio vaccine during the round. Tanzania will also hold Child Health Days on 4-7 November. WEST AFRICA Ten countries of west Africa vaccinated children using bivalent OPV during the multi-country round which began on 30 September.?A further multi-country round is planned for 28 October, and a further activity for November has been proposed. Five technical staff-members from WHO HQ were deployed to west Africa to assist in the planning and implementation of the end-September rounds. Niger's most recent case was located in the Tchin-Tabaraden district of the Tahoua region in the west of the country and was linked to virus previously seen in Chad. In response to the case in Niger, SNIDs using bOPV were conducted in six districts surrounding the case from 8 September. The government of Côte d'Ivoire has shown renewed vigour in its commitment to the fight against polio since the meeting of WHO's Regional Committee for Africa held in late August/early September. The Minister of Health has asked to be personally updated on polio eradication data including surveillance indicators. Côte d'Ivoire has accounted for the majority of WPV3 cases this year, however it has now not reported a case since 24 July.

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