Wüstenschiff

Tadschikistan - Polio
25.05.2010

Bei einem Ausbruch der Kinderlähmung sind ca. 400 Erkrankungsfälle gemeldet worden, 15 verliefen tödlich. Die tadschikische Eisenbahn verkauft keine Tickets an ausreisende Passagiere mit Kindern unter 6 Jahren. Nur Reisende mit geimpften Kindern über 6 Jahre dürfen eine Bahnreise antreten. Dringend Impfschutz gegen Polio überprüfen und ggf. auffrischen. / Quelle: crm

POLIOMYELITIS - WORLDWIDE (11): RUSSIA ex UZBEKISTAN, REQUEST FOR INFORMATION
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[1]
Date: 8 Jun 2010
Source: Regnum news [machine trans., edited]
<http://www.regnum.ru/news/medicine/1280202.html>


In the Urals, a citizen of Uzbekistan died from polio
-----------------------------------------------------
The Sverdlovsk Rospotrebnadzor [Russian Federal Agency for Protection
of Consumer Rights and Human Welfare] confirmed a death from polio. As
reported on [7 Jun 2010] by a correspondent of the IA Regnum News
office, a citizen of Uzbekistan, who came to the Urals on 25 May 2010,
died yesterday [7 Jun 2010] in Yekaterinburg [formerly Sverdlovsk]. He
is suspected of having had acute poliomyelitis. [Specimens have been
sent to] the Moscow National Laboratory Center for diagnosis of
poliomyelitis. All citizens, with whom he had contact, were examined
by infectious disease [specialists] and vaccinated against polio.

Meanwhile, according to the spokesperson of the Rospotrebnadzor
Voropaeva, Moscow experts confirmed that the cause of death was polio.

Currently, there is an active vaccination of migrants, mostly citizens
of Tajikistan. According to representatives of Rospotrebnadzor, the
epidemiological situation of polio is under control.

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******
[2]
Date: 8 Jun 2010
Source: News agency RIA Novosti [trans.,edited ATS; Mod.NR]
<http://www.rian.ru/incidents/20100607/243587917.html>


Rospotrebnadzor [Russian Federal Agency for Protection of Consumer
Rights and Human Welfare] has confirmed the 1st case of death from
poliomyelitis in the country in many years. A man died from polio in
Sverdlovsk district [now back to its original name Yekaterinburg].
Previously, it was reported that there was a suspected polio case from
Uzbekistan in a Yekaterinburg hospital. The laboratory tests in Moscow
confirmed poliomyelitis after his death.

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[If the above story is correct, and the case with polio came to the
Urals from Uzbekistan on 25 May 2010, then it is highly likely that
this person was infected with the poliovirus prior to travel to
Russia. Obvious questions include the genetic profile of the
poliovirus involved -- including whether the poliovirus isolated is a
wild virus or a vaccine derived virus, the age of the patient and the
route of travel from Uzbekistan to Russia.

The most recent weekly case counts for confirmed wildpoliovirus (WPV)
cases since 1 Jan 2010 available on the polio eradication website, are
as of 1 Jun 2010 (see <http://www.polioeradication.org/>) and are
presented below:

Country: Year-to-date 2010 / Year-to-date 2009 / Total in 2009 / Date
of onset of most recent case
Tajikistan: 152 / 0 / 0 / 8 May 2010
Pakistan: 20 / 17 / 89 / 30 Apr 2010
Senegal: 18 / 0 / 0 / 30 Apr 2010
India: 21 / 59 / 741 / 29 Apr 2010
Mauritania: 5 / 0 / 13 / 28 Apr 2010
Nigeria: 3 / 288 / 388 / 18 Apr 2010
Angola: 5 / 6 / 29 / 14 Apr 2010
Afghanistan: 9 / 7 / 38 / 11 Apr 2010
Chad: 14 / 1 / 64 / 5 Apr 2010
Niger: 2 / 13 / 15 / 1 Apr 2010
Mali: 2 / 1 / 2 / 30 Mar 2010
Liberia: 1 / 0 / 11 / 3 Mar 2010
Sierra Leone: 1 / 0 / 11 / 28 Feb 2010
Nepal: 1 / 0 / 0 / 19 Feb 2010

According to the information provided on the website, there are still
367 AFP (acute flaccid paralysis) cases pending confirmation studies
in Tajikistan, so the number of confirmed cases may continue to rise
in the coming weeks. In addition, the website mentions that all cases
reported to date are from the west/south-west of the country, mostly
around Dushanbe City and the Khatlon and Kulyab zones of Kurgan-Tube
oblast [district].

Additional newswires mention that there have been 23 AFP cases
identified in Uzbekistan since the beginning of the year, but to date
none of these cases have been confirmed to be due to WPV (see
<http://www.regnum.ru/news/medicine/1280202.html>, in Russian).

A recent CDC travel alert to the region mentions that there have been
AFP cases in Uzbekistan close to the border with Tajikistan (see
<http://wwwnc.cdc.gov/travel/content/out ... istan.aspx>.

More information on the above-mentioned polio fatality, including
epidemiologic and laboratory information as well as information on the
AFP surveillance results in Uzbekistan, would be greatly appreciated.

For the interactive HealthMap/ProMED map showing Yekaterinburg, in the
Urals, see
<http://healthmap.org/r/01ul>. If one moves the map around, one sees
the Yekaterinburg (on the map shown as Ekaterinburg) is near to the
border with Kazahkstan. To go overland from Uzbekistan to
Ekaterinburg, one would pass through Kazahkstan. - Mod.MPP]

POLIOMYELITIS - WORLDWIDE (12): RUSSIA, TAJIKISTAN
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******
Russia
Date: 10 Jun 2010
Source: Itar Tass [edited]
<http://itar-tass.com/eng/level2.html?Ne ... &PageNum=0>


Polio diagnosis confirmed in 2 Tajik children in Russia's Chelyabinsk region
----------------------------------------------------------------------------
Laboratory tests have proved polio diagnosis in 2 Tajik children in
Russia's Urals Chelyabinsk region, the press service of Russia's
consumer rights watchdog (Rospotrebnadzor) South Urals administration
told Itar-Tass on Thursday [10 Jun 2010].

According to the Rospotrebnadzor administration, one of the sick
children was 8 years old, the other one was 17 [years old]. Both were
illegal migrants. One lived in Magnitogorsk, the other in Chelyabinsk.

"The 2 turned for medical help in due time. They were hospitalized in
infectious disease clinics. Later, parents of the 17-year-old patient
took him back to Tajikistan, while the 8-year-old child is still in
hospital, in a satisfactory condition," the press service said.

Neither of the 2 left Russia in 2010 and might have contracted the
disease while staying on the territory of the Chelyabinsk region
through contacts with other Tajik citizens arriving from Tajikistan,
the press service said and added that local health authorities were
taking measures to contain polio hotbeds.

It is highly likely that the local health administration will stage
polio inoculation of all Tajik citizens residing in the Chelyabinsk
region.

These are not the 1st polio cases to be registered in Russia's Urals
region. Previously, poliomyelitis was diagnosed in a 20-year-old Tajik
citizen, who was then hospitalized, and now, according to medics, is
in a stable condition.

The polio situation is worsening both in Tajikistan and Russia. Thus,
according to Rospotrebnadzor, more than 500 polio cases have been
registered in Tajikistan. As of now, 15 polio patients have died.

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Global polio eradication initiative launches 2010-2012 strategic plan for interrupting polio worldwide
New polio strategy builds on 99% drop in Nigeria cases but faces 50% funding shortfall
17.06.2010 - WHO

GENEVA -- In Geneva this Friday, a broad range of stakeholders will formally launch the new Strategic Plan 2010-2012 for eradicating wild poliovirus.

Polio eradication sits at a critical juncture

Across Africa, 10 of the 15 previously polio-free countries re-infected in 2009 have successfully stopped their outbreaks [1]. Key endemic countries are witnessing historic gains against the disease. Nowhere is progress more evident than Nigeria, where case numbers have plummeted by more than 99% – from 312 cases at this time last year, to three in 2010. In India, for the first time ever, the remaining endemic states of Bihar and Uttar Pradesh have not reported any wild poliovirus type 1 cases concurrently for more than six months.

Time to build upon gains already made in 2010

This meeting in Geneva is being held to build on the gains already made in 2010 and to galvanize new action on polio eradication. Last month, the World Health Assembly welcomed the new plan while expressing deep concern about the US$ 1.3 billion funding shortfall (out of a budget of US$ 2.6 billion) over the next three years. This financing shortfall is a serious risk to the eradication of polio – activities are already being cut back or postponed due to a lack of funds.

The Ministers of Health of Nigeria, Afghanistan, Angola and Senegal, among a number of other senior health ministry officials, existing and potential funders, vaccine manufacturers and key partner organizations will attend the meeting – co-hosted by WHO Director-General Margaret Chan and the new UNICEF Executive Director Tony Lake – to discuss the implementation, monitoring, economics and financing of the new plan.

WHO Director-General Dr Margaret Chan called on the international funding community to stand tall for polio eradication. "The next three years, and especially the next 12 months, are critical to the polio eradication initiative and, by extension, the entire international public health agenda."

Plan builds on major lessons learnt

The new plan builds on major lessons learnt to date, including findings from a major independent evaluation examining the remaining barriers to eradication. It introduces district- and area-specific strategies to target the ever-shrinking remaining reservoirs of poliovirus, exploits the game-changing bivalent oral polio vaccine to increase the impact of immunizations, and tackles health system weaknesses. The success of this plan now hinges on implementation of activities at field level and the provision of adequate financing.

Adequate resources needed to eradicate polio

Partners in the Global Polio Eradication Initiative are examining every possible option to seek fresh funding while managing existing cash flow to limit any threat to the immunization plan. The risk of not stopping polio in endemic countries was made clear when a large type-1 outbreak originally from India spread to Tajikistan early in 2010 where, to date, it has paralysed 239 children. Tajikistan had been polio-free since 1997. This highlights the urgency of capitalizing on recent gains made in the polio-endemic countries.

“Polio eradication remains an urgent priority for our foundation,” said Tachi Yamada, president of global health at the Bill & Melinda Gates Foundation. “We call on donor governments to also prioritize polio as we seek to eliminate these last, most difficult cases.”

“The complete eradication of polio is an absolute goal and it requires absolute commitment from us all,” said UNICEF Executive Director Tony Lake.

“Rotary believes the new Strategic Plan provides the blueprint to achieving the goal of polio eradication,” said Carl-Wilhelm Stenhammar, 2010-11 Chair, The Rotary Foundation. When Rotary initially launched the effort in 1985, 1 000 children were being paralyzed daily by polio across 125 countries each year. Rotary has since contributed more than US$900 million in that time, and the incidence of polio has fallen by more than 99%.

Global Polio Eradication Initiative

The Global Polio Eradication Initiative (GPEI) is spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF. Since 1988 (the year the GPEI was launched), the incidence of polio has been reduced by more than 99%. In 1988, more than 350 000 children were paralyzed each year in more than 125 endemic countries. In 2009, 1 595 children were paralyzed in 24 countries. Only four countries remain endemic: Afghanistan, India, Nigeria, and Pakistan.

For more information please contact:

Sona Bari
WHO Geneva
Health Systems and Services
Mobile: +41 79 475 5511
E-mail: baris@who.int
_______________

[1] Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Côte d'Ivoire, Guinea, Kenya, Togo and Uganda.

POLIOMYELITIS - WORLDWIDE (13): TAJIKISTAN, RUSSIA
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Date: 23 Jun 2010
Source: Winnipeg Free Press [edited]
<http://www.winnipegfreepress.com/life/h ... -outbreak-
in-tajikistan-raises-risk-of-reigniting-spread-elsewhere-journal-96975939.html>


Polio outbreak in Tajikistan raises risk of reigniting spread elsewhere
-----------------------------------------------------------------------
A large polio outbreak in Tajikistan -- Europe's 1st in years -- has
the potential to further spread the dangerous virus to other regions
of the world, the Canadian Medical Association Journal warned
Wednesday [23 Jun 2010]. [While Tajikistan is geographically located
in Asia, it is a member of EURO -- the European Regional Office of
the World Health Organization, hence the statement that it is the 1st
outbreak in Europe in years. - Mod.MPP] Top editors of the journal
suggested the outbreak, the largest since 2005 in a country where
polio is not endemic, serves as a reminder that until polio is
eradicated, the risk of renewed spread remains.

"In all countries certified as polio-free, including Canada, the
Tajikistan outbreak should be clanging alarm bells," editor-in-chief
Dr. Paul Hebert and Dr. Noni MacDonald, section editor for public
health, wrote in the editorial which was published online. "The key
message here is pretty straightforward. You can't let your guard down
on this one because . . . if you do, pop! There it goes. Another
outbreak," Hebert said in an interview.

Others questioned whether the risk to Canada is as grave as Hebert
and MacDonald suggested, but agreed with the overall principle that
no country is safe from polio while the virus continues to spread in
parts of the globe.

"It clearly is a wake up call," said Dr. John Spika, director general
of the Public Health Agency of Canada's centre for immunization and
respiratory infectious diseases. Spika said Canadian polio vaccine
coverage rates are generally high enough to prevent spread, but he
acknowledged there are pockets of children who aren't vaccinated,
either because of religious reasons or because their parents
subscribe to anti-vaccine sentiments. "The incredible success of
immunization programs is leading to some complacency," he said. "And
therefore our challenge is really how do we continue to maintain high
coverage in the face of that very low perceived risk of disease and
growing perceived risk that there's injury following vaccination?"

The Tajikistan outbreak is the latest in a string of setbacks for the
global polio eradication initiative, the 22-year-old campaign aimed
at permanently stopping the spread of the disease. The campaign,
jointly run by the World Health Organization, Rotary International,
the U.S. Centers for Disease Control and UNICEF, has to date spent
USD 8 billion trying to achieve the goal.

Only 4 countries remain on the list of nations that have never
interrupted spread of polio -- Nigeria, India, Pakistan and
Afghanistan. And after years of setbacks, enormous progress has been
made in these countries this year [2010]. But then in April [2010]
polio was found in Tajikistan. Analysis of the viruses show the
outbreak was the product of an importation from northern India.

As of Wednesday [23 Jun 2010], there have been 275 confirmed cases in
the outbreak and lab results are pending on about 300 more suspected
cases, said Dr. Bruce Aylward, the Canadian who heads WHO's polio
eradication team. "This is a big one, that's for sure," he said of
the outbreak in an interview from Geneva.

The last outbreak of this size in a previously polio-free country was
in Yemen in 2005, when 478 cases were reported, he said. "Outbreaks
of this size are very rare now. You see them in India and Nigeria.
But outside of that, you never see an outbreak this big anymore.
Very, very rare." Aylward said there are signs the outbreak is coming
under control. There have been no new cases reported in the past 10
days. But control doesn't count in polio, he said; stopping
transmission has to be the goal.

And that's the message of the editorial Aylward wanted to highlight.
Given the tremendous cost of the effort and the fact that the virus
continues to foil the Herculean efforts to wipe it out, some
scientists have questioned whether eradication is achievable. It
would be better, some suggest, to try to aim for controlling polio at
low levels and use the money devoted to eradication for broader
public health purposes.

Aylward said the Tajikistan outbreak shows the shortcomings of that
argument. The world is currently spending USD 800 million a year to
keep polio to fewer than 1000 cases a year, he said. "(But) it's not
going to stay there if you don't finish. Those funds are going to
disappear." He likened the continued spread of polio viruses to
sparks from a fire. "They don't always catch. But then when it
catches, it can explode."

And pockets of unvaccinated individuals in Canada or other developed
countries could provide those sparks an opportunity to ignite,
Aylward said -- though he, like Spika, believes polio vaccine
coverage rates are high enough here that a large outbreak is
unlikely. "It's harder for the spark to catch," said Aylward. "But
the bigger point they're making -- that look, we are still at risk of
the disease -- is very, very true."

[Byline: Helen Branswell]

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[Canada's concern about pockets of susceptibles is not without merit,
as the last polio outbreak in Canada in 1978/1979 involved pockets of
susceptibles not vaccinated due to religious objection. At that time
there were 11 paralytic cases among unimmunized individuals in
religious groups in Ontario, Alberta and British Columbia, who had
contact with imported cases. Bijkerk H. Poliomyelitis epidemic in the
Netherlands, 1978. Dev Biol Stand. 1979;43:195-206. (see
<http://www.phac-aspc.gc.ca/im/vpd-mev/p ... is-eng.php>).

The importations were related to an outbreak in the Netherlands where
there were 110 cases among members of the same religious group that
were unimmunized (see <http://www.ncbi.nlm.nih.gov/pubmed/230110>).
There were 15 cases in the USA, among similar religious groups, also
unimmunized in the USA during 1978/1979 related to this outbreak as
well. MMWR. Epidemiologic Notes and Reports Follow-Up on
Poliomyelitis -- United States, Canada, Netherlands. 19 Dec 1997.
46(50);1195-1199 {From the July 27, 1979, MMWR} (see
<http://www.cdc.gov/mmwr/preview/mmwrhtml/00050435.htm>). - Mod.MPP]

******
[2] WHO EURO
Date: 24 Jun 2010
Source: WHO EURO website [edited]
<http://www.euro.who.int/en/what-we-do/h ... l-response>


As of 11 Jun 2010, Tajikistan had reported 607 acute flaccid
paralysis (AFP) cases; 239 were laboratory confirmed for wild
poliovirus type 1, and 22 had been confirmed negative. There had been
11 deaths among the 239 confirmed poliomyelitis (polio) cases (4.6
percent). A total of 3 rounds of national immunization days (NIDs)
had taken place in Tajikistan and 2 rounds in Uzbekistan. In both,
coverage was extremely high: more than 99 percent of the targeted
populations. Further rounds are expected in both countries, and
Kyrgyzstan will begin an immunization campaign in July [2010].

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[According the most recent polio eradication website case count
update (as of 15 Jun 2010), there have been 239 confirmed cases of
polio in Tajikistan (see
<http://www.polioeradication.org/casecount.asp> for the case count
table by country). While the table does not list cases in Russia
related to this outbreak, there is a summary statement below the
table that mentions that wild poliovirus type 1 (WPV1) has been
identified in 4 AFP cases in Russia, and epidemiologic studies of
these cases are presently underway to determine source of exposure
and possible relationship to the ongoing outbreak in Tajikistan.

There have been a total of 349 cases of WPV confirmed polio in the
world since January 2010, of which 58 were in endemic countries, and
291 were in non-endemic countries. Below is a table from on the
reported cases by country for 2010 as of 15 Jun 2010 from
polioeradication case count website.

Country: Year-to-date 2010 / Year-to-date 2009 / Total 2009 / Date of
onset most recent case
Pakistan: 24 / 18 / 89 / 29 May 2010
Tajikistan: 239 / 0 / 0 / 21 May 2010
Afghanistan: 10 / 8 / 38 / 15 May 2010
Angola: 8 / 9 / 29 / 3 May 2010
Senegal: 18 / 0 / 0 / 30 Apr 2010
India: 21 / 67 / 741 / 29 Apr 2010
Mauritania: 5 / 0 / 13 / 28 Apr 2010
Nigeria: 3 / 312 / 388 / 18 Apr 2010
Chad: 14 / 1 / 64 / 5 Apr 2010
Niger: 2 / 13 / 15 / 1 Apr 2010
Mali: 2 / 1 / 2 / 30 Mar 2010
Liberia: 1 / 1 / 11 / 3 Mar 2010
Sierra Leone: 1 / 0 / 11 / 28 Feb 2010
Nepal: 1 / 0 / 0 / 19 Feb 2010

In the last update on this outbreak posted by ProMED-mail on 12 Jun
2010 (see archive 20100612.1972), there had been 564 AFP cases
reported of which 183 had laboratory confirmation of WPV1 infection,
and 14 cases were negative for WPV. According to the WHO EURO update
in part [2] of this posting, there is mention that as of 11 Jun 2010
there have been 607 AFP cases reported of which 239 were confirmed to
be due to WPV1 infection and 22 had been confirmed as not due to
polio ("negative"). Hence, there remain 356 known AFP cases still
pending confirmatory results, suggesting that the numbers of
confirmed cases of polio in this current outbreak will most likely
continue to increase as more information on these cases becomes available.

For a map of Tajikistan see
<http://www.lonelyplanet.com/maps/asia/tajikistan/>. For the
interactive HealthMap/ProMED map of Tajikistan, see
<http://healthmap.org/r/00Fa>. - Mod.MPP]

Tadschikistan - Polio
28.06.2010

Der Polio-Ausbruch in Tadschikistan scheint allmählich unter Kontrolle zu sein. Durch Impfkampagnen, die unmittelbar nach Bekanntwerden der ersten Fälle eingeleitet wurden, konnte die Anzahl der Neuerkankungen deutlich reduziert werden. Seit Beginn des Ausbruchs in der 1. Maihälfte wurden 607 Erkrankte registriert. Unter den bestätigten Fällen kam es zu 11 tödlichen Verläufen. Dringend Impfschutz gegen Polio überprüfen und ggf. auffrischen. / Quelle: crm

Tadschikistan - Polio
12.07.2010

Der Polio-Ausbruch in Tadschikistan scheint allmählich unter Kontrolle zu sein. Durch Impfkampagnen, die unmittelbar nach Bekanntwerden der ersten Fälle eingeleitet wurden, konnte die Anzahl der Neuerkankungen deutlich reduziert werden. Seit Beginn des Ausbruchs in der 1. Maihälfte wurden 643 Erkrankte registriert, bei 334 konnte Polio Wildvirus Typ 1 nachgewiesen werden. Unter den bestätigten Fällen kam es zu 14 tödlichen Verläufen. Dringend Impfschutz gegen Polio überprüfen und ggf. auffrischen. / Quelle: crm

Polio in Angola – high risk of international spread
19.07.2010 - WHO

Situation

As of 19 July the Ministry of Health of Angola has reported 15 cases of wild poliovirus type 1 (WPV1) since the beginning of 2010, signalling an expansion of an ongoing outbreak. All of these cases have been detected since February in the capital Luanda or in provinces which were previously polio-free (Bie, Bengo, Huambo, Lunda Norte and Lunda Sul). One genetically-related case was detected in the Democratic Republic of the Congo (in Kasai Occidentale province, which borders Angola), with onset of paralysis on 25 May.

The country has had a persistent outbreak of poliovirus type 1 (WPV1) since 2007, where 8 cases were reported that year, and 29 cases each in 2008 and 2009.

Given the persistent and widespread transmission of wild poliovirus, ongoing sub-national surveillance gaps and recent further spread of WPV1 internationally, WHO considers as high the risk of further international spread into neighbouring countries. As per recommendations outlined in WHO's International Travel and Health recommendations, travellers to and from Angola should be fully protected by vaccination.

Actions

Angolan Minister of Health Dr José Vieira Dias Van-Dúnem re-affirmed Angola's strong commitment to stop polio transmission by end-2010.

In 2010, Angola has conducted a sub-national supplementary immunization round using monovalent OPV type 1 (mOPV1) targeting high risk provinces from 7-9 May, a national immunization round from 11-13 June using a combination of trivalent OPV (tOPV) and mOPV1, and mop-up immunization campaigns with mOPV1 in response to WPV1 cases (on 23-25 April in Bie, and on 4-6 June and 18-20 June in Lunda Norte and Lunda Sul). Further national immunization rounds are planned for early August and September. The Democratic Republic of the Congo conducted mop-ups on 4 June and 18 June with mOPV1, and further outbreak response is currently being planned.

Recommendations

In 2009 and 2010, immunization coverage has been sub-optimal, with as much as 25% of children regularly missed during supplementary immunization activities (SIAs) Urgent action is needed to ensure that all children in Angola are reached with oral poliovirus vaccine during the SIAs taking place in August and September, through strengthened engagement and ownership of SIA operations by provincial- and district-level political and administrative leadership.

It is important that countries across central Africa, in particular those bordering Angola, strengthen disease surveillance for AFP, in order to rapidly detect any poliovirus importations and facilitate a rapid response. Countries should also continue to boost routine immunization coverage against polio to minimize the consequences of any introduction.


Gruß
Birgitt

Polio in Tajikistan – Update
23.07.2010 - WHO

The Ministry of Health of the Republic of Tajikistan has since 1 January 2010 reported 430 cases of polio following the importation of a wild poliovirus type 1 into the country. Nineteen of the cases were fatal. Seven virologically related cases have been detected in the Russian Federation, the only other country in the WHO European Region to confirm cases. The poliovirus causing the outbreak originated in northern India. This is the first outbreak of polio since the Region was certified polio-free in 2002.

In response to the outbreak, four rounds of national immunization days (NIDs) with oral polio vaccine have been held in Tajikistan. Coverage was reported to be high and confirmed by independent monitors. The most recent round was conducted on 15–19 June (except in Dushanbe and six surrounding regions, where it started on 13 June). Preliminary data report nationwide coverage of 99.3%. Coverage higher than 97% is reported from all regions and in the groups aged 0–6 and 7–15 years.

The most recent polio case had onset on 12 June, and the number of new cases of acute flaccid paralysis (AFP) – of which polio can be one of the causes – being detected and reported to WHO has dropped sharply. However, there is not sufficient virological testing data from the recent AFP cases to revise WHO's assessment of the risk for further international spread, which remains 'high'.

A joint national/international surveillance review is under way, under the auspices of the Ministry of Health, to further inform the current risk assessment and guide additional surveillance and immunization activities. The need for additional rounds of mass oral polio vaccine (OPV) immunization will be based on an ongoing evaluation of epidemiological and laboratory data. International travellers to and from polio affected areas should continue to be adequately immunized against polio as recommended in Chapter 6 of International Travel and Health guidance.

The European Regional Commission for the Certification of Poliomyelitis Eradication met in Copenhagen, Denmark, on 28–29 June 2010. Addressing the meeting, Ms Zsuzsanna Jakab, WHO Regional Director for Europe, noted that the outbreak in Tajikistan threatens both the polio-free status of the Region and the eradication of polio globally.

The Commission recognized that the European Region has reached a critical juncture and its polio-free status is in jeopardy. The gravity of the situation requires that all Member States reinforce their polio surveillance so that any spread will be detected rapidly and effective control measures instituted at the earliest possible moment.

Neighbouring countries are responding to the outbreak by heightening surveillance while reviewing immunization status of children and conducting necessary supplementary immunization activities. Uzbekistan has held three national rounds of supplementary immunization with efforts to synchronize these rounds with Tajikistan in May and June. The first round of nationwide NIDs started in Turkmenistan on 12 July 2010, and Kyrgyzstan started its first round on 19 July.

Tadschikistan - Polio
26.07.2010

Der Polio-Ausbruch in Tadschikistan scheint allmählich unter Kontrolle zu sein. Durch Impfkampagnen, die unmittelbar nach Bekanntwerden der ersten Fälle eingeleitet wurden, konnte die Anzahl der Neuerkankungen deutlich reduziert werden. Seit Beginn des Ausbruchs in der 1. Maihälfte wurden 643 Erkrankte registriert, bei 430 konnte Polio Wildvirus Typ 1 nachgewiesen werden. Unter den bestätigten Fällen kam es zu 19 tödlichen Verläufen. Dringend Impfschutz gegen Polio überprüfen und ggf. auffrischen. / Quelle: crm

POLIOMYELITIS - WORLDWIDE (17): ANGOLA, REQUEST FOR INFORMATION
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Date: 3 Aug 2010
Source: Radio Nacional de Angola [trans. by Mod.MPP, edited]
<http://www.rna.ao/canalA/noticias.cgi?ID=36058>


Minister says there isn't an outbreak of polio
----------------------------------------------
The Minister for Family and Women's Promotion, Dr. Genoveva Lino,
said that the reported cases of polio in the country do not
constitute an outbreak and that the situation is under control.
"Angola does not have an outbreak of polio, because the situation is
under control," said Genoveva Lino, on the sidelines of a visit to
Expo 2010 in Shanghai, China, where it is within the celebrations of
the African Women's Day, which is Saturday [7 Aug 2010].

The official stressed that "the program of vaccination for prevention
of polio is done regularly and it is extended to the entire country.
The Government has a multisectoral program, involving not only the
Health Ministry but all those ministries that have a direct
involvement in stabilizing the environment for the well-being of
families," he said.

Genoveva Lino said that the task of the Ministry is being responsible
for raising awareness of women to take their children for
vaccination, providing they are informed and are attentive not only
to the preventive programs of vaccination campaigns, but also that
they should follow the schedule routine vaccinations of children.

"Even though they are far from health clinics, vaccination campaigns
are carried out throughout the country, door to door," he said,
acknowledging however that the country "is now undergoing
reconstruction, and is now organizing itself, and there are still
families living in hardship circumstances."

On the other hand, Genoveva Lino said that the country there are
"many single-parent families headed by women. Therefore, they have
all the responsibility of the family," he noted, admitting that
"sometimes giving more priority to their income generating activities
and resulting in delaying the vaccination schedules for their children."

"It is with these people that we have to continue to work and wake
up," defended the minister of Family and Women Promotion.

Angola has reported 17 cases of poliomyelitis since the beginning of
the year [2010], a contagious disease caused by a virus that causes
paralysis that can be fatal, and all cases are related to the capital
city, Luanda.

--
Communicated by:
HealthMap Alerts via ProMED-mail
<promed@promedmail.org>

[The newswire mentions 17 reported cases of polio in Angola since the
beginning of 2010. According to our last ProMED-mail posting on the
polio situation in Angola on 19 Jul 2010, this represents an increase
of 2 cases in approximately 2 weeks. (see prior ProMED-mail posting
Poliomyelitis - worldwide (14): Angola, alert 20100719.2426). The
most recent information available on the polio eradication website is
dated 27 Jul 2010, and shows 16 confirmed cases with date of most
recent onset of cases 16 Jun 2010 (see
<http://www.polioeradication.org/casecount.asp>).

A key activity of the polio eradication effort is "acute flaccid
paralysis" surveillance (AFP), with an expected rate of greater than
1 non-polio AFP case per 100 000 population as an indicator of a good
AFP surveillance system in a country. According to the most recent
data available on the WHO Global Polio Eradication Initiative website
(as of 30 Jul 2010), since the beginning of 2010, there have been 203
AFP cases reported with a non-polio AFP rate of 3.6 per 100 000
population, and 94 percent of AFP cases having adequate specimens
obtained for laboratory confirmation studies, and 16 confirmed cases.

Information not provided is the number of AFP cases still pending
laboratory results to know if there are still indicators suggesting
continued transmission of the wild poliovirus or if there is evidence
that transmission has been interrupted.

For a map of Angola, see
<http://www.un.org/Depts/Cartographic/ma ... angola.pdf>. For
the interactive HealthMap/ProMED map of Angola, see
<http://healthmap.org/r/00BZ>. - Mod.MPP]

Polio in Angola and the Democratic Republic of the Congo
08.09.2010 - WHO

Angola and the Democratic Republic of Congo (DR Congo) are experiencing outbreaks of wild poliovirus type 1 (WPV1).

In Angola, the outbreak which began in April 2007, has this year spread to re-infect previously polio-free areas in Angola (the provinces of Bie, Bengo, Huambo, Lunda Norte, Lunda Sul and Uige), as well as to neighbouring DR Congo, re-infecting Kasai Occidental province which borders Angola. This outbreak is classified as 're-established' transmission, as it has persisted for a period greater than 12 months.

In DR Congo, in addition to newly-imported virus from Angola this year, a case detected in Katanga province with onset of paralysis on 20 June 2010, in the east of the country, has been genetically-linked to virus previously imported from Angola, last detected in eastern DR Congo in 2008. In 2009, a case was detected in Burundi, which was linked to the same transmission chain. DR Congo was previously regarded by the Advisory Committee on Poliomyelitis Eradication (ACPE) has having 'suspected' re-established transmission, and this suspicion is now confirmed.

Given the recent progress achieved in Nigeria (99% reduction in cases this year compared to the same period in 2009), west Africa (no cases since 1 May 2010) and the Horn of Africa (no cases in more than 12 months), central Africa is now considered to be the greatest risk to Africa's polio eradication efforts. Angola's outbreak is currently the only geographically expanding outbreak in Africa. This situation increases the risk to achieving the next global milestone of the new Global Polio Eradication Initiative (GPEI) Strategic Plan 2010-2012, the cessation of all re-established WPV transmission by end-2010.

There is currently a high risk of international spread of WPV from Angola and DR Congo, given the limited impact to date of control measures and the historical cross-border spread from both countries. In 2010, outbreak response in both countries has been inadequate to stop transmission of the imported viruses. Independent monitoring of supplementary immunization activities (SIAs) indicate as many as 25% of children are regularly missed during SIAs in key areas of Angola (including Luanda, Lunda Norte and Lunda Sul). In DR Congo, no response activities have been conducted in the east of the country since November 2009. The outbreaks require urgent action to reach a higher proportion of children with oral polio vaccine (OPV) across Angola and DR Congo and improve surveillance across Angola and DR Congo. Due to sub-national surveillance gaps, further undetected circulation of WPV1 cannot be ruled out. Given the increasingly widespread transmission of WPV1 in Angola and documented spread to DR Congo, the World Health Organization (WHO) considers the risk of further international spread as high. Given persistent undetected transmission of WPV1 in eastern DR Congo, and historical evidence of international spread, WHO considers the risk of further international spread as high.

Urgent improvements are needed during SIAs and to fill sub-national surveillance gaps for acute flaccid paralysis (AFP), through strengthened engagement and ownership by provincial- and district-level political and administrative leadership. In Angola, National Immunization Days (NIDs) are planned for September, and additional responses are being discussed. In DR Congo, SIAs are being carried out in response to the new importations, and an urgent SIA and surveillance strengthening plan is being developed in response to the detection of the new case in the east of the country which confirmed persistent undetected transmission in that area.

It is important that countries across central Africa and the Horn of Africa strengthen AFP surveillance, in order to rapidly detect any poliovirus importations and facilitate a rapid response. Countries should also strengthen population immunity levels to minimise the consequences of any virus introduction. As per recommendations outlined in WHO's International Travel and Health, guidance travelers to and from Angola and DR Congo should be fully protected by vaccination.

POLIOMYELITIS - WORLDWIDE (19): DEMOCRATIC REPUBLIC OF CONGO
************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
[1] Democratic Republic of Congo
[2] Polio eradication initiative weekly summary

******
[1] Democratic Republic of Congo
Date: 30 Sep 2010
Source: Radio Okapi [trans. by Mod.MPP, edited]
<http://radiookapi.net/actualite/2010/09 ... -detectes/>


New cases of wild polio detected in Kasai-Occidental
----------------------------------------------------
A total of 7 new cases of wild polio virus have been reported during
the vaccination campaign in Kasai Occidental, which closed Sun 26 Sep
2010. This was announced on Wed 29 Sep 2010 by the head of the Kananga
sub-office of the World Health Organization (WHO).

The affected children are all under 15 years old, according to the
source. Dr. Honore Lukunku encourages parents not to neglect the
routine immunization sessions.

--
Communicated by:
ProMED-EAFR
<promed-eafr@promedmail.org>

******
[2] Polio eradication initiative weekly summary
Date: 28 Sep 2010
Source: Polio eradication initiative website [edited]
<http://www.polioeradication.org/casecount.asp>


Total cases: Year-to-date 2010 / Year-to-date 2009
Globally: 682 / 1087
- in endemic countries: 120 / 827
- in non-endemic countries: 562 / 260

Case breakdown by country
Country: Year-to-date 2010 / Year-to-date 2009 / Total in 2009 / Date
of onset most recent case
Pakistan: 59 / 58 / 89 / 10 Sep 2010
India: 37 / 367 / 741 / 1 Sep 2010
Nepal: 6 / 0 / 0 / 30 Aug 2010
Afghanistan: 17 / 22 / 38 / 29 Aug 2010
DRC: 15 / 3 / 3 / 24 Aug 2010
Angola: 24 / 25 / 29 / 20 Aug 2010
Russian Federation: 12 / 0 / 0 / 10 Aug 2010
Nigeria: 7 / 380 / 388 / 5 Aug 2010
Tajikistan: 458 / 0 / 0 / 4 Jul 2010
Turkmenistan: 3 / 0 / 0 / 28 Jun 2010
Chad: 14 / 24 / 64 / 10 May 2010
Mali: 3 / 5 / 2 / 1 May 2010
Senegal: 18 / 0 / 0 / 30 Apr 2010
Mauritania: 5 / 0 / 13 / 28 Apr 2010
Niger: 2 / 15 / 15 / 1 Apr 2010
Liberia: 1 / 10 / 11 / 3 Mar 2010
Sierra Leone: 1 / 2 / 11 / 28 Feb 2010
Guinea: 0 / 24 / 42 / 3 Nov 2009
Burkina Faso: 0 / 13 / 15 / 25 Oct 2009
Cameroon: 0 / 1 / 3 / 15 Oct 2009
Burundi: 0 / 0 / 2 / 12 Sep 2009
CAR: 0 / 14 / 14 / 9 Aug 2009
Cote d'Ivoire: 0 / 27 / 26 / 6 Aug 2009
Kenya: 0 / 18 / 19 / 30 Jul 2009
Sudan: 0 / 45 / 45 / 27 Jun 2009
Uganda: 0 / 8 / 8 / 10 May 2009
Benin: 0 / 20 / 20 / 19 Apr 2009
Togo: 0 / 6 / 6 / 28 Mar 2009

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[According to the above newswire, during the vaccination campaign
aimed at interrupting transmission of the wild poliovirus (WPV) in the
Democratic Republic of Congo (DRC), there were 7 new cases identified.
It is unclear if those 7 cases are included in the 29 Sep 2010 update
available on the Polio Eradication Initiative website.

Other new reports of WPV cases since the last ProMED-mail update
include an additional 16 cases in Pakistan, 5 cases in India, 4 cases
each in Angola and the Russian Federation, 3 cases each in
Turkmenistan and Afghanistan, 2 cases in Tajikistan, 1 case each in
Nigeria and Nepal.

For a map of Kasai Occidental Province, DRC, see
<http://www.un.org/Depts/Cartographic/ma ... rcongo.pdf>. For
the interactive HealthMap/ProMED map of Kasai Occidental Province,
DRC, see
<http://healthmap.org/r/08dF>. - Mod.MPP]

POLIOMYELITIS - WORLDWIDE (20): AFGHANISTAN, ANGOLA
***************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
[1] Afghanistan
[2] Angola: WHO

******
[1] Afghanistan
Date: Wed 6 Oct 2010
Source: UN Integrated Regional Information Networks (IRIN) News [edited]
<http://www.irinnews.org/Country.aspx?Country=AFG>


Afghanistan: polio risk from 2 directions
-----------------------------------------
Hopes for a polio-free northern Afghanistan have been dashed after a
case was reported in the northern Kunduz Province in August [2010],
almost a decade since the last one. The crippling virus has been
eliminated in most parts of the landlocked country, except in the
insecure south and eastern provinces.

A total of 18 polio cases have been confirmed this year [2010]: 15 in
the southern Kandahar, Helmand, Farah, and Urozgan provinces; 2 in
eastern Nangarhar Province; and now a 13-month-old boy in Kunduz.
Initially, health officials assumed the virus could have migrated from
neighbouring Tajikistan where more than 450 polio cases have been
reported this year [2010]. However, laboratory tests pointed to
another direction. "The virus is closely linked with the current
circulation in the FATA [Federally Administered Tribal Areas] of
Pakistan, a probable indication of importation from there," Arshad
Quddus, an official of the UN World Health Organization (WHO), told
IRIN. The Kunduz boy has been permanently paralyzed, officials said.
It is now believed he was infected in Pakistan from where his family
returned to Kunduz Province earlier this year. At least 69 polio cases
have been reported in Pakistan from January to September 2010.
Millions of Afghan refugees live in Pakistan and tens of thousands of
people move across the 2400 km [approx. 1500 mi] porous border every
day.

Also a major outbreak of wild poliovirus has been reported in
Tajikistan, which has spilled over to Turkmenistan and Russia,
according to UN agencies. "We are gravely concerned about the spread
of poliovirus from Tajikistan to Afghanistan," Suraya Dalil, the
acting health minister of Afghanistan, said during the launch of a
3-day nationwide polio immunization campaign on Sun 3 Oct 2010. The
campaign, funded by UN agencies and other donors, targeted 7.8 million
children in all 34 provinces. The situation in Tajikistan as well as
the reported polio case in Kunduz Province have resulted in enhanced
border surveillance and immunization, officials said. "We vaccinate
every person -- children and adults -- who crosses the
Afghanistan-Tajikistan border," Nabi Azeem, Kunduz health director,
told IRIN, adding that health posts had been established at several
border points. The type 1 poliovirus in Tajikistan is linked to a
strain also seen in India's Uttar Pradesh Province, health officials
said.

In Afghanistan, types 1 and 3 have been in circulation for which
bivalent oral polio vaccines have been used since December 2009.
Afghanistan has been struggling to wipe out polio with several rounds
of immunization every year. War, lack of access to every child, and
low awareness among families are the major obstacles towards
eradication, experts say.

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

******
[2] Angola: WHO
Date: Fri 1 Oct 2010
Source: Reuters Africa [edited]
<http://af.reuters.com/article/topNews/i ... 9Y20101001>


[The following health alert may constitute a public health event of
international concern per the WHO Interim Guidance for the use of
Annex 2 of the International Health Regulations (2005)
(<http://www.who.int/ihr/Annex_2_Guidance_en.pdf>)]

Angola polio outbreak threatens neighbours: WHO
-----------------------------------------------
A persistent outbreak of polio in Angola is now a matter of
international concern and health authorities there must step up their
efforts to stamp it out, the World Health Organisation (WHO) said on
Friday [1 Oct 2010]. The WHO's spokeswoman on polio eradication, Sona
Bari, said an outbreak of the crippling virus, which started in 2007
after Angola had been polio-free for 6 years, now has "international
consequences" if it is not stopped. So far this year [2010] Angola has
had 24 cases of polio -- a virus which attacks the nervous system and
can cause irreversible paralysis -- adding to 29 in 2009 and 29 in
2008, she said. "It is the only expanding outbreak in all of Africa,
spreading both within Angola and into the Democratic Republic of
Congo," Bari said in a telephone interview. "It's a high threat to
neighbouring countries." The Democratic Republic of Congo has had 15
polio cases so far this year [2010] after having just 3 in the whole
of 2009.

--
Communicated by:
HealthMap Alerts via ProMED-mail
<promed@promedmail.org>

[For a statement of the current global situation readers are referred
to the preceding post and earlier posts in this thread.

The HealthMap/ProMED-mail interactive maps of Afghanistan and Angola
can be accessed at <http://healthmap.org/r/0c2A>
and <http://healthmap.org/r/00BZ> respectively. - Mod.CP]

POLIOMYELITIS - WORLDWIDE (21): INDIA
*************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this posting:
[1] India
[2] Worldwide: Global Polio Eradication Initiative case count

******
[1] India
Date: Wed 6 Oct 2010
Source: MSN News India, Press Trust of India (PTI) report [edited]
<http://news.in.msn.com/national/article ... id=4442973>


With one more polio case reported from Beed district, the number of
polio cases in Maharashtra has gone up to 5 in the last 10 months,
health officials said [in Mumbai] today [6 Oct 2010].

An 11-month-old child from a ''banjara (migrant)'' family in Beed was
reported to be suffering from polio, state Health Directorate
additional director CM Kulkarni said.

The child had received 3 doses of oral polio in June, July, and
September [2010]. However, he developed paralysis on [16 Sep 2010]
and was admitted to a hospital at Umargaon in Osmanabad, he said.

"Although Uttar Pradesh and Bihar were reported for the last few
years as the breeding ground for poliovirus, this year [2010], out of
the total 16 cases of P-1 type (more harmful and spreads faster)
polio [also known as wild poliovirus type 1 or WPV1], 5 are from
Maharashtra, 7 from Mushirabad in West Bengal, one from Jammu and
Kashmir, and 3 from Bihar," director of the Enterovirus Research
Institute of ICMR [India Council of Medical Research] JM Deshpande said.

From January to September [2010], a total of 38 polio cases were
reported from across the country, Deshpande said.

--
Communicated by:
HealthMap Alerts via ProMED-mail
<promed@promedmail.org>

[For a map of India with states, see
<http://www.mapsofindia.com/maps/india/i ... al-map.htm>.
For the interactive HealthMap/ProMED-mail map of Maharashtra, India, see
<http://healthmap.org/r/00Zs>. - Mod.MPP]

******
[2] Worldwide: Global Polio Eradication Initiative case count
Date: Tue 5 Oct 2010
Source: Global Polio Eradication Initiative [edited]
<http://www.polioeradication.org/casecount.asp>


Wild poliovirus weekly update - 5 Oct 2010
------------------------------------------
Total cases: Year-to-date 2010 / Year-to-date 2009
Globally: 706 / 1126
- in endemic countries: 134 / 861
- in non-endemic countries: 572 / 265

Case breakdown by country
Country: Year-to-date 2010 / Year-to-date 2009 / Total in 2009 / Date
of onset most recent case
Pakistan: 69 / 62 / 89 / 21 Sep 2010
India: 39 / 395 / 741 / 16 Sep 2010
Afghanistan: 18 / 22 / 38 / 4 Sep 2010
DRC: 24 / 3 / 3 / 2 Sep 2010
Nepal: 6 / 0 / 0 / 30 Aug 2010
Nigeria: 8 / 382 / 388 / 27 Aug 2010
Angola: 25 / 26 / 29 / 20 Aug 2010
Russian Federation: 12 / 0 / 0 / 10 Aug 2010
Tajikistan: 458 / 0 / 0 / 4 Jul 2010
Turkmenistan: 3 / 0 / 0 / 28 Jun 2010
Chad: 14 / 24 / 64 / 10 May 2010
Mali: 3 / 8 / 2 / 1 May 2010
Senegal: 18 / 0 / 0 / 30 Apr 2010
Mauritania: 5 / 0 / 13 / 28 Apr 2010
Niger: 2 /15 / 15 / 1 Apr 2010
Liberia: 1 / 10 / 11 / 3 Mar 2010
Sierra Leone: 1 / 2 / 11 / 28 Feb 2010
Guinea: 0 / 23 / 42 / 3 Nov 2009
Burkina Faso: 0 / 13 / 15 / 25 Oct 2009
Cameroon: 0 / 2 / 3 / 15 Oct 2009
Burundi: 0 / 1 / 2 / 12 Sep 2009
CAR: 0 / 14 / 14 / 9 Aug 2009
Cote d'Ivoire: 0 / 27 / 26 / 6 Aug 2009
Kenya: 0 / 18 / 19 / 30 Jul 2009
Sudan: 0 / 45 / 45 / 27 Jun 2009
Uganda: 0 / 8 / 8 / 10 May 2009
Benin: 0 / 20 / 20 / 19 Apr 2009
Togo: 0 / 6 / 6 / 28 Mar 2009

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[According to the most recent data available on the polio eradication
website presented above, as of 5 Oct 2010 there have been 39
confirmed cases of polio attributable to wild poliovirus infection
(WPV) in India since January 2010 -- representing one tenth of the
number of confirmed cases as of the same date in 2009. It is a major
achievement for the global polio eradication effort and for India if
this can be sustained. More information available at the polio
eradication website mentions that there were 2 new cases reported in
the past week, one a WPV type 1 in Maharashtra (the case mentioned in
the newswire above) and the other, a WPV type 3 in Jharkhand.

On a more sobering note, there were 10 new cases (all WPV1) reported
in Pakistan in the past week. The polio eradication website points
out that Pakistan is the only endemic country to have seen more cases
this year [2010] than at this point in 2009. - Mod.MPP]