November 2005
Data as at 9 November 2005
PolioSitRepNovember2005ENG.pdf
PolioSitRepNovember2005FR.pdf
Headlines
* UN Secretary-General Kofi Annan:
During a high-level United Nations visit to Geneva on 6 October, UN
Secretary-General (UNSG) Kofi Annan was briefed at the World Health Organization
(WHO) on the global effort to eradicate polio. Meeting with WHO Director-General
Dr LEE, Jong-wook, and the WHO Representative for Polio Eradication, Dr David
Heymann, the UNSG gave his assurance of the UN's continued support, in
particular to help secure the necessary financial resources to rapidly eradicate
polio.
* Polio epidemic in 10 west and central African countries appears
stopped:
The polio epidemic which swept across west and central Africa since
mid-2003 appears to have been stopped in Benin, Burkina Faso, Cameroon, Central
African Republic, Chad, Côte d'Ivoire, Ghana, Guinea, Mali and Togo. Emergency
efforts over the past 18 months, led under the auspices of the African Union
with support from the European Commission, Canada and Sweden, underscore the
soundness of outbreak control strategies, as no new cases in the region -
outside endemic Nigeria and Niger - have been reported since June. A further
series of synchronized polio immunization campaigns are starting on 11 November
across the region. Such campaigns will need to continue until polio transmission
is interrupted in Nigeria. Efforts to stop the 2nd and 3rd wave epidemics, which
began respectively in mid/late 2004 in the Horn of Africa, and in 2005 in
Indonesia, Yemen and Somalia, are ongoing.
* Efforts to stop epidemics in Indonesia, Yemen and Somalia are ongoing.
Protecting the Horn of Africa and the polio-free Western Pacific Region is
critical.
* A funding gap of US$ 200 million for 2006 must be urgently filled:
US$ 75 million of this is required by the end of this year to ensure
immunization activities in the first quarter of next year can proceed.
* Polio infrastructure supports earthquake relief efforts in Pakistan:
please see below under 'Pakistan'.
Priority countries
Nigeria
* Nigeria is the greatest risk to the overall global eradication
effort. With 550 confirmed cases, the country accounts for 37% of global cases.
Virus transmission is primarily limited to the north of the country, with only
two cases confirmed in southern states this year. Efforts are focused on
reaching every child by re-deploying staff to the northern states during the
upcoming polio immunization campaigns.
* Nigeria is participating in the 28-country synchronized immunization campaigns
across Africa starting 11 November.
India
* Strong progress continues in India. The number of cases reported in
2005 is just over half that for the same period in 2004 (45 compared with 81),
despite intensified surveillance. Preparations for the subnational immunization
campaign on 27 November are ongoing. Monovalent oral polio vaccine (mOPV) will
be used extensively.
Pakistan
* In 2005, strong progress continues. No type 3 virus was reported in
the year and the number of cases is half that of last year, with 19 cases
reported, compared to 36 cases for the same period in 2004.
* The polio eradication infrastructure was deeply involved in the earthquake
relief efforts. More than 50 polio epidemiologists and surveillance officers
were among the first relief workers to arrive in the earthquake-affected areas,
with 15 vehicles, radio equipment, satellite phones, vital medicines, vaccines,
potable water tanks and sleeping bags. Immediate focus was on rapid assessment,
emergency rescue and first aid, setting up of treatment camps, and transport of
patients to treatment camps. Subsequent focus was on establishment of early
warning systems for diseases and outbreaks, development of outbreak preparedness
plans, and organization of mass immunization campaigns for measles, tetanus and
polio.
Afghanistan
* No cases have been reported since June 2005.
* The primary risk to Afghanistan's polio eradication effort is difficulty in
accessing children due to insecurity in Southern Region. All four type 3 cases
this year have occurred in this region.
Egypt
* Egypt's last polio virus was detected from an environmental sample
collected in January 2005. The next National Immunization Days (NID) will be
held on 20-22 November.
Niger
* Niger has confirmed 6 polio cases in 2005, compared with 21 cases
for the same period in 2004. The most recent case was a type 1 virus from Zinder
province, with onset of paralysis on 20 September. Available genetic evidence of
viruses detected in 2005 in Niger indicates northern Nigerian origin.
Indonesia
* The epidemic continues to geographically expand, as cases are
confirmed in Aceh province and Riau province, near the border with Singapore.
The risk of further spread to countries across Asia remains. The Ministry of
Health of Indonesia has confirmed that a third NID will be held in late 2005. 20
million doses of mOPV will be used (covering most of Sumatra and Java islands,
with the rest of the country using trivalent OPV).
Somalia
* 42 cases have been confirmed in Somalia, all in Mogadishu. The last
NID was conducted end-September. The next nationwide campaign using mOPV will be
held 6-12 November.
Other countries/regions
Ethiopia
* Ethiopia's last NID was conducted on 28 October. Seventeen cases
have been reported in 2005. The country's next NID will be held on 25 November.
Angola
* With nine cases confirmed in Angola, the Ministry of Health confirmed a fourth
NID will be held in late 2005.
Yemen
* Yemen has the most cases of any country with importations in 2005
(473 cases). The outbreak is considered to be under control.
Minnesota, USA
* Currently, a potential immunodeficient excretor of vaccine-derived
polio (iVDPV) is under investigation in Minnesota, USA. In September, the
Minnesota Department of Health identified type-1 poliovirus in stool samples of
an unvaccinated, immunocompromised 7-month old infant. Genetic sequencing of the
isolated poliovirus has identified it as a VDPV. Poliovirus has since been
isolated also in stool samples of four contacts. Investigation is ongoing to
determine the origin of the VDPV. None of the five children have displayed any
symptoms of polio-paralysis.
The state of polio eradication in 2005
* Commitment to polio eradication is high
thanks to visible progress in the hardest endemic areas and powerful
new tools like monovalent oral polio vaccines.
* Of the 6 countries considered endemic at the start of 2005, 5 are
reporting polio cases in 2005 (Nigeria, India, Pakistan, Niger and
Afghanistan). The 6th (Egypt) reported its last poliovirus in an environmental
sample in January 2005. Additionally, 11 previously polio-free countries are
reporting polio cases in 2005 (Somalia, Yemen, Indonesia, Sudan, Ethiopia,
Angola, Mali, Cameroon, Chad, Eritrea and Nepal).
* The necessary tools to eradicate polio are now in place. Stopping
polio transmission can be completed rapidly, except in Nigeria. Nigeria will
need an additional 12 months to finish the job, due to a 12-month suspension of
immunizations in 2003-04.
The remaining challenges to a polio-free world are:
1. Primary challenge: Breaking the final chains of polio transmission
in the endemic countries.
2. Acute challenge:
Quickly stopping polio outbreaks in previously polio-free countries.
3. Cross-cutting challenges:
o Maintaining funding and political commitment;
o Addressing low routine immunization rates in polio-free countries;
o Ensuring sufficient vaccines are available.
Polio eradication will only succeed if the necessary funds are made
available, and with strong political commitment in polio-affected countries.
Failure to finish polio will result in more than 10 million paralysed
children in the next 40 years and a failure to capitalize on the US$4 billion
global investment in a polio-free world.
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