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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.

 

Past  reports


The Global Eradication of Polio