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POLIOMYELITIS - WORLDWIDE (32): INDIA (WEST BENGAL)
***************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 14 Feb 2011
Source: The Statesman [edited]
<http://www.thestatesman.net/index.php?o ... 3&catid=72>


New polio case forces fresh drive in 5 districts
------------------------------------------------
Alarmed at the detection of a fresh polio case in the state [West
Bengal] in the midst of an intensified campaign against the disease
the state government has been compelled to conduct a polio
immunisation drive in 5 selected districts, including Kolkata.

Officials said the polio immunisation drive has been ordered after an
18-month-old child of Panchla in Howrah [district] was found to be
suffering from poliovirus type 1 [infection]. In 2008, a child was
detected to be suffering from poliovirus type 3 in the same area.

A senior official of the state health department said the [decision]
has been taken to administer drops of monovalent type-1 poliovirus to
18 lakh [1.8 million] children in districts, including Howrah,
Hooghly, Kolkata, and North and South 24-Parganas. This special polio
immunisation drive started yesterday [13 Feb 2011] and will continue
till Tue 15 Feb 2011. A senior member of the World Health Organisation
and senior officials of the National Polio Surveillance Project (NPSP)
have reached the village to monitor the special polio immunisation
drive.

Ms Swati Dutta, chief medical officer of health (Howrah), said the
girl was admitted to Gabberia State General Hospital on 20 Jan 2011
with weakness in her legs. Doctors feared she might be suffering from
polio and prescribed the necessary tests. Reports of the tests,
conducted in the Enterovirus Research Centre (ERC) in Mumbai,
confirmed she was suffering from type 1 poliovirus infection. The
child has been transferred to Dr BC Roy Polio Clinic and Hospital,
Beliaghata today [14 Feb 2011] for further treatment. She said in such
cases it is important to know the origin of the disease and after
examining her strain it was found that the disease originated from
Delhi. Later, it was found that the child's father, who is an
embroidery worker, went to Delhi a few years ago.

An NPSP official said that earlier it was not possible to conduct the
polio immunisation drive properly in this area for various reasons and
necessary steps have been taken to create awareness among people of
the area in this regard.

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

[One new case (described above) was reported in the past week (WPV1
from Howrah district, West Bengal). It is the 1st confirmed case in
the country in 2011. The total number of cases for 2010 remains 42.

This most recent case is in a district next to the mega-metropolis
Kolkata [Calcutta]. A mop-up is currently underway in response to this
case, targeting 1.8 million children under the age of 5 years. To
support the mop-up and follow-up activities, 5 Surveillance Medical
Officers (SMOs) from Bangladesh, and 15 Bengali-speaking SMOs from
other parts of India, are in the process of being deployed to Howrah
and Kolkata.

The area of the case is in a part of Howrah with large mobile
population groups. Genetic sequencing of the virus indicates it is
related to a virus last detected in the 2nd half of 2010 in Delhi, in
an environmental sample. (For further details see the ProMED-mail post
Poliomyelitis - worldwide (29): India (Delhi) sewage, 20101207.4372).
As such, it is not linked to the separate outbreak currently affecting
Murshidabad, West Bengal.

India continues to report record-low levels of polio, in particular
in the traditional reservoir areas of Uttar Pradesh (last case: 21 Apr
2010) and Bihar (last case: 1 Sep 2010). However, confirmation of this
recent case linked to the Delhi environmental sample, along with 2
other known transmission chains (in Mumbai and Murshidabad)
underscores the very real risk ongoing low-level transmission
continues to pose to the country's eradication effort.

A map of the districts of West Bengal can be accessed at
<http://xpresso.in/wp-content/uploads/20 ... bengal.png>,
and a description of Kolkata district at
<http://en.wikipedia.org/wiki/Kolkata_district>. The
HealthMap/ProMED-mail interactive map of India can be accessed at
<http://healthmap.org/r/0utB>. - Mod.CP]

POLIOMYELITIS - WORLDWIDE (02): DEMOCRATIC REPUBLIC OF CONGO, ANGOLA, PAKISTAN
***********************************************
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] DR Congo - Kinshasa
[2] Angola
[3] Pakistan - Fata

******
[1] DR Congo - Kinshasa
Date: 26 Feb 2011
Source: Le Potentiel [trans. Mod.MPP, edited]
<http://www.lepotentiel.com/afficher_art ... ition=7055>


Two students at a school in Ward 7 in N'Djili town have died of a
disease whose symptoms resemble those of acute flaccid paralysis. The
health authorities in the zone confirmed the existence of an
epidemic. The health authority of the DRC moved quickly to block the spread.

Two suspicious deaths in the space of a month in a school with
primary, secondary and vocational [levels] in N'Djili, namely the
Bosembo Professional Institute, have created panic in the ranks of
the school community of this commune [county]. Some [individuals]
point to witchcraft as a probable cause of these deaths.

According to testimony gathered there, the 2 students have shown
similar symptoms: paralysis of upper and lower limbs, urinary
retention, etc. The 3rd case of this disease, not as yet diagnosed,
was hospitalized at the La Grace Medical Center in Ward 7 in N'Djili.

One of the [medical] center staff met at the office of the N'Djili
mayor on last Friday [25 Feb 2011?] to convey information to the
local authority and has certified the presence of an epidemic. It is
probably an epidemic of an advanced form of poliomyelitis, he said.
"We have received these cases. Initially, it was not clear exactly
what had happened. Only after the 2 deaths and the 3rd case have we
confirmed the existence of an outbreak. We asked the students not to
be in contact with the bodies of people who already have the disease.
Unfortunately, overly excited, they all believe that it is
witchcraft. That is why we have alerted the responsible health
officials of the area so that they are aware of this situation and
will alert the national health authorities."

Reached by telephone late yesterday [25 Feb 2011] afternoon, the
director of the N'Djili health zone confirmed the information. "We
are very aware of this epidemic. But it's in a technical file that
I'm limited to give you further explanation. You must see the medical
director of the health zone." That was all [we learned]. As of today,
no one knows exactly what is going on in the N'Djili school, located
within 100 meters from the town hall.

[At present] only 2 students have succumbed to this mysterious
disease. Another is in a hospital. But there are certainly other
students who were in contact with the 3 above [mentioned cases] and
probably could present with symptoms in the coming days. It is,
therefore, urgent to stop [the outbreak] before the situation reaches
alarming proportions.

In N'Djili, one does not yet feel the gravity of the disease that has
struck the town. That is because, to date, everyone has hidden behind
witchcraft as an explanation for these deaths in the Bosembo
Institute Bosembo. However, medical personnel, such as those in the
Grace Medical Center, are convinced that this is an epidemic -- as
yet unidentified -- but similar to acute flaccid paralysis.

Is it [related to] the wild poliovirus [WPV outbreak] or acute
flaccid paralysis that has recently erupted in the DRC town of
Kikwit, Bandundu?

Once eradicated, acute flaccid paralysis [AFP], an advanced form of
polio, had reappeared in Kikwit in December 2010, where it has caused
the deaths of 15 people.

Up through mid-December [2010], 36 cases of acute flaccid paralysis,
including 15 deaths, were already reported in Kikwit, Bandundu
province. The government had organized a campaign response to the epidemic.

But the deaths at the N'Djili Bosembo Institute show that the
epidemic could eventually reach the city of Kinshasa. The high
concentration of population in the communes to the east [of Kinshasa]
should cause us to fear the worst and push the authorities to act urgently.

[Byline: Faustin Kuediasala]

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

[One suspects that there will be confirmation of WPV activity in the
above mentioned outbreak in an eastern commune of Kinshasa, given the
above story. In the presence of a high population movement between
the provinces and Kinshasa and given the known circulation of WPV in
Kikwit, Bandundu province, it would not be surprising to have
introduction of the WPV into the capital region.

Three cases of an AFP illness in a school in several weeks is highly
likely to be due to WPV when transmission has been documented in
geographic areas with likely contact of individuals. Unfortunately,
in many countries where transmission of WPV has been interrupted,
vaccination coverages have been suboptimal following the
certification of polio eradication in the countries, in some because
routine vaccination activities do not provide the same level of
coverage the NIDs (National immunization days) did, in others, where
NIDs continued, the level of effort was reduced due to a combination
of reduced financial support as well as reduced motivation both on
the part of the health sector as well as the part of the population
when polio was no longer seen as a threat.

According to the Polio Eradication Website, there were 10 confirmed
cases of WPV-associated disease reported in the past week (as of 24
Feb 2011), of which all were WPV1. Four of the cases had onset of
disease in 2010, and 6 had onset in 2011. The majority of the cases
were from Bandundu, Katanga and Kinshasa. As of 24 Feb 2011, the
number of confirmed cases in 2011 is 7, and the total number of cases
for 2010 is 100. The most recent confirmed case had onset of
paralysis on [20 Jan 2011], a WPV1 from Bandundu.

Of note, there is mention that "discussions are underway to expand
the age-group of upcoming campaigns in Kinshasa, given the fact that
older-age cases have been identified in this area," (see
<http://www.polioeradication.org/Dataand ... sweek.aspx>).

For a map of the Congo DR showing provinces, see
<http://www.mapsofworld.com/democratic-r ... l-map.html>.
Bandundu is the neighboring province (to the east) of the capital region.

For the Google map showing the location of the N'Djili commune in
Kinshasa, see
<http://maps.google.com/maps?hl=en&biw=9 ... CCAQ8gEwAA>.

For the interactive HealthMap/ProMED map showing the location of
Kinshasa, see <http://healthmap.org/r/0rkV>. - Mod.MPP]

******
[2] Angola - Kuando Kubango
Date: 19 Feb 2011
Source: Times Live [edited]
<http://www.timeslive.co.za/africa/artic ... se-of-2011>


An Angolan health official says the country has registered its 1st
polio case of 2011, renewing concern over the resurgence of a disease
once thought to be eliminated.

"It's the 1st case in the country this year [2011], and that creates
a lot of concerns for us," Fernando Cassanga, health services
director for the southeastern province of Kuando Kubango, told state
radio station RNA on Friday [18 Feb 2011].

"We need to reinforce our epidemiological vigilance and teach our
mothers that they need to bring their children to vaccination centres."

Kubango said the victim was a 15-month-old child.

The new infection comes several weeks before Angola launches a
national vaccination drive aimed at reining in the crippling disease,
which the Angolan health minister acknowledged earlier this month
[February 2011] had spread from Angola to neighbouring Democratic
Republic of the Congo (DRC) and Congo.

According to the World Health Organisation, the DRC has already
registered 7 new polio cases this year [2011] in the provinces of
Bandundu, Katanga and Bas-Congo, all of which border Angola, and in
the capital, Kinshasa.

Congo has not officially registered any new cases in 2011.

After eliminating new polio cases for 3 years in a row, Angola saw a
strain of the virus reappear in 2005, thought to have been carried by
Indian workers employed on rebuilding projects launched after the
country's 27-year civil war ended in 2002.

Last year [2010], Angola registered 32 new polio cases, the DRC 93
and Congo 50, raising concern among anti-polio campaigners, who had
already considered the disease to be eradicated in all 3 countries.

Angola plans to immunise 5.6 million children in a vaccination drive
scheduled to kick off in March [2011].

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

[The following information from the polio eradication website
summarizes the situation in Angola, and the impact of prior WPV
activity in Angola on other countries in Africa:

"No new cases were reported in the past week [as of 24 Feb 2011]. The
total number of cases for 2011 remains one, and the total number of
cases for 2010 remains 33. The most recent case had onset of
paralysis on [7 Jan 2011] (WPV1 from Kuando Kubango province).

"Mop-ups will be conducted on [25-27 Feb 2011], in Kuando Kubango,
and other infected and high-risk areas, including Luanda and
Benguela. The activity will be followed by NIDs in March and April
[2011]. These activities are considered particularly crucial, also
with view of minimizing the risk of further international spread. In
2010, virus from Angola spread into the Democratic Republic of the
Congo (DR Congo) and the Republic of Congo; the most recent case in
Kuando Kubango is near the border with Namibia and Zambia. It is from
this area that polio spread into Namibia in 2006, causing a deadly
outbreak affecting primarily adults. Authorities in both Namibia and
Zambia have been alerted to this risk, and efforts are ongoing in
both countries to sensitize surveillance and assess population
immunity levels."

For a map of Angola with provinces, see
<http://www.mapsofworld.com/angola/angol ... l-map.html>. Kuanda
Kubango borders with Namibia and Zambia.

For the interactive HealthMap/ProMED map of Kuando Kumbango, see
<http://healthmap.org/r/0wCA>. - Mod.MPP]

******
[3] Pakistan - FATA
Date: 24 Feb 2011
Source: Polio eradication website [edited]
<http://www.polioeradication.org/Dataand ... sweek.aspx>


Four new cases were reported in the past week (all WPV1s, from
Federally Administered Tribal Areas -- FATA, Khyber Pakhtoon -- KP,
and Sindh), bringing the total number of cases for 2011 to 8. The
number of cases for 2010 remains 144. The most recent case had onset
of paralysis on [3 Feb 2011] (WPV1 from Khyber, FATA).

The next NIDs are scheduled for [7-9 Mar 2011], followed by SNIDs
[SubNational Immunization Days] April [2011]. Given widespread,
nationwide transmission of wild poliovirus (as underscored by the
recent isolation of polioviruses in environmental samples from
sampling sites across the country), the geographic extent of upcoming
supplementary immunization activities (SIAs) should be reviewed.

Additionally, efforts are continuing to focus on operationalizing the
polio emergency action plan (launched on [24 Jan 2011] by President
Asif Ali Zardari). A critical factor to success is to ensure
sufficient accountability and ownership at the provincial and district-level.

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

[Recent newswires captured by HealthMap Alerts and submitted to
ProMED by Corr.SB have discussed the observation that the majority of
cases of WPV-associated disease in the past 2 years in Pakistan have
been in the FATA region. (see
<http://www.thenews.com.pk/TodaysPrintDe ... 2985&Cat=2>).
According to that newswire, "out of 144 cases of polio in Pakistan in
2010, 74 occurred in Fata alone, with 84 cases of polio in 2009."

According to the above report from the Polio eradication website,
environmental sampling has demonstrated more widespread presence of
the WPV around the country. Hence, it is clear that there is the need
for nationwide efforts in order to interrupt the WPV transmission,
recognizing that while there are significant challenges in those
areas with civil unrest, other areas of the country are still
involved with WPV transmission.

For a map of Pakistan with provinces showing the FATA region, see
<http://upload.wikimedia.org/wikipedia/c ... an_Map.JPG>.

For the interactive HealthMap/ProMED map of Pakistan, see
<http://healthmap.org/r/00tj>. - Mod.MPP]

Gabun - Poliomyelitis
10.03.2011

Aus Gabun wird der erste Polio-Fall seit über 10 Jahren gemeldet. Eine Impfkampagne wurde Ende Februar in die Wege geleitet. Hygiene und Impfschutz (Polio) beachten. / Quelle: crm

POLIOMYELITIS - WORLDWIDE (03): REPUBLIC OF CONGO, PAKISTAN, AFRICA
*******************************************************************
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] Rep. Congo
[2] Pakistan
[3] Africa 2009-2010

******
[1] Rep. Congo
Date: 18 Mar 2011
Source: Morbidity & Mortality Weekly Report (MMWR), 18 Mar 2011,
60(10);312-313 [edited]
<http://cdc.gov/mmwr/preview/mmwrhtml/mm ... mm6010a4_w>


Notes from the Field: Poliomyelitis Outbreak --- Republic of the
Congo, September 2010--February 2011
--------------------------------
On [4 Nov 2010], a case of wild poliovirus type 1 (WPV1) was
confirmed in a resident of the port city, Pointe Noire, the 1st WPV
case in Republic of the Congo (ROC) in 10 years. The WPV1 isolate from
this resident was genetically most closely related to WPV1 isolated in
Angola in 2010. Subsequent investigation, including active case
finding, revealed increased acute flaccid paralysis (AFP) hospital
admissions beginning in September [2010].

Weekly admissions rose from approximately 10 AFP patients in early
October [2010] to approximately 80 by the end of October and November
[2010]. With response immunization activities, weekly AFP admissions
fell to fewer than 5 by the end of December [2010]. A provisional
total of 554 AFP cases were identified nationally, with paralysis
onset from [20 Sep 2010] to [27 Feb 2011]; 374 (68 percent) of the AFP
cases were among males. Overall, 465 (84 percent) AFP cases were among
residents of the neighboring departments of Kouilou and Pointe Noire,
where the outbreak apparently began and where approximately 21 percent
of ROC's 4.2 million persons reside. The case-fatality rate (CFR) in
Kouilou and Pointe Noire was 40 percent (187 deaths of 465 cases),
compared with 11 percent (10 of 89) elsewhere in ROC. Additionally,
the median age of patients with AFP in Kouilou and Pointe Noire was 20
years (range: 0--63 years), compared with 7.5 years (range: 1--68
years) elsewhere in ROC.

Vaccination status was unknown for all but 149 of the 554 AFP
patients. Among those with known vaccination status, 107 (72 percent)
reported having received at least one oral polio vaccine (OPV) dose,
and 73 of those patients reported receiving at least 3 doses of OPV.

As of [8 Mar 2011], WPV1 had been confirmed virologically in
specimens from 70 AFP patients. Adequate stool specimens were not
available for 468 (84 percent) patients, of whom 190 died;
nonetheless, 32 (46 percent) of the 70 WPV cases were confirmed among
those 468 patients. Because investigation of the outbreak was
compromised by the collection of adequate specimens from only 16
percent of patients, the clinical classification algorithm of AFP
cases was used. Patients without adequate specimens who died, were
lost to follow-up, or had residual paralysis on follow-up were
considered to have clinically confirmed polio. This algorithm was
applicable when adequate stool specimens were collected for fewer than
65 percent of cases (4) and was last used in countries of the World
Health Organization African Region in 2000. Provisionally, 317
additional patients have been classified as having clinically
confirmed polio. Thus, as of [8 Mar 2011], the total number of
confirmed polio cases was 387, pending further laboratory
investigation, follow-up, and review.

Outbreak control efforts have included 4 rounds of national
supplementary immunization activities (SIAs) targeting the entire
population of ROC, beginning [12-16 Nov 2010] with a round of
monovalent type 1 OPV. Subsequent SIA rounds were conducted [3-7 Dec
2010], using monovalent type 1 OPV; [11-15 Jan 2011], using bivalent
(types 1 and 3) OPV; and [22-26 Feb 2011], using bivalent OPV. The 1st
3 SIA rounds were coordinated with areas of other countries
neighboring Kouilou (Cabinda in Angola and Bas-Congo in Democratic
Republic of the Congo), where outbreak cases subsequently were
reported; the 4th round was synchronized with neighboring Gabon, where
a WPV confirmed case occurred in January [2011].

This outbreak appears nearly controlled, with onset of the most
recent confirmed WPV case on [22 Jan 2011]. Only 14 AFP cases have
been reported provisionally in 2011, approximating the expected
background frequency in ROC. Preliminary results suggest that several
factors contributed to this outbreak 10 years after the last confirmed
WPV1 case in ROC. These include a low rate of childhood polio
vaccination among young adults and a protracted period without WPV1
transmission in the area. Vaccination coverage has been low over the
last 2 decades,* secondary to weaknesses in the delivery of
health-care and routine vaccination services, complicated by civil war
and conflict during 1997--1999. The last national SIA was in 2006.
Other possible contributing factors are crowding of residents and
severe limitations in water supply and sanitation. The high proportion
of cases among adolescents and adults (who are known to be at higher
risk for bulbar paralysis than children) might have contributed to the
high CFR, which might have been accentuated by suboptimal medical care
and delays in seeking care. CFRs of 12-32 percent have been observed
in previous WPV1 outbreaks involving adults (1--3). An investigation
is ongoing to determine reasons for the elevated CFR in Kouilou and
Pointe Noire.

All international travelers are advised to have completed a primary
series of polio vaccinations before travel (5,6). Travelers from the
United States to countries with recent WPV transmission or countries
neighboring them also should receive a single adult booster
inactivated poliovirus vaccine dose before departure.** Travelers who
are inadequately vaccinated against polio or whose past vaccination
history is uncertain should contact their physician to discuss polio
vaccination options before traveling. The World Health Organization
recommends that all travelers who reside in countries with WPV
transmission not only complete a course of vaccination against polio,
preferably with OPV, before leaving the country of residence, but also
receive an additional dose of OPV within 12 months before each
international trip (6). However, whether many travelers from countries
with WPV transmission follow these recommendations, except when
required (e.g., pilgrimage to Mecca), is uncertain (7).

Reported by:
Ministry of Health, Republic of the Congo; World Health Organization
Republic of the Congo Country Office, World Health Organization
Regional Office for Africa, Brazzaville; Republic of the Congo. Dept
of Polio Eradication, World Health Organization, Geneva, Switzerland.
Div of Viral Diseases and Global Immunization Div, National Center for
Immunization and Respiratory Diseases, CDC.

References
1. Prevots DR, Ciofi Degli Atti M, Sallabanda A, et al. Outbreak of
paralytic poliomyelitis in Albania, 1996. Clin Infect Dis
1998:26;419--25. [Abstract and 1st page available at:
<http://www.jstor.org/pss/4481370>]
2. CDC. Outbreak of poliomyelitis---Cape Verde, 2000. MMWR
2000;49:1070. [Available at:
<http://cdc.gov/mmwr/preview/mmwrhtml/mm4947a5.htm>]
3. CDC. Outbreak of polio in adults---Namibia, 2006. MMWR
2006;55:1198--201. [Available at:
<http://cdc.gov/mmwr/preview/mmwrhtml/mm5544a3.htm>
4. World Health Organization. Field guide for supplementary
activities aimed at achieving polio eradication. Geneva, Switzerland:
World Health Organization; 1997. Available at
<http://www.who.int/immunization_monitor ... lio_96.pdf>
Accessed [14 Mar 2011].
5. CDC. Travelers' health. Atlanta, GA: US Dept of Health and Human
Services, CDC. Available at <http://wwwnc.cdc.gov/travel>. Accessed
[14 Mar 2011].
6. World Health Organization. International travel and health 2010.
Geneva, Switzerland: World Health Organization Press; 2010. Available
at <http://www.who.int/ith/chapters/en/index.html> Accessed [14 Mar
2011].
7. World Health Organization. Health conditions for travellers to
Saudi Arabia for the pilgrimage to Mecca (Hajj). Wkly Epidemiol Rec
2010;85:425--36. [Available at:
<http://www.who.int/wer/2010/wer8543.pdf>

* Information available at
<http://apps.who.int/immunization_monito ... ountry=cod>

** Information available at
<http://wwwnc.cdc.gov/travel/content/in- ... reaks.aspx>.

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

[According to the Polio Eradication initiative website, as of 16 Mar
2011, one case of WPV1 in Kouilou province with onset of paralysis on
28 Nov 2010 was reported in the preceding week, bringing the 2010
total number of cases to 384. There has only been one case with onset
in 2011, a WPV1 case with date of onset 22 Jan 2011. There were NIDs
using bOPV (bivalent) held from 22 Feb 2011 (see
<http://www.polioeradication.org/Dataand ... sweek.aspx>).
Given the delays in reporting of cases, it appears too soon to declare
the outbreak over.

For a map of the Republic of the Congo, see
<http://mappery.com/maps/Congo-1986-Guide-Map.gif>. - Mod.MPP]

******
[2] Pakistan
Date: 22 Mar 2011
Source: The News [edited]
<http://www.thenews.com.pk/TodaysPrintDe ... 7380&Cat=4>


Two new cases of polio have been detected in Sindh, taking the total
number of such cases to 5 in the province and 20 in the entire
country, officials said.

In a rare case, a 17-year-old youngster in Tando Muhammad Khan has
been found suffering from the disease.

Besides, a one-year-old girl in District Badin has also been
diagnosed with polio virus despite the fact that she has received 6
routine and 3 supplementary doses, officials in the Expanded Programme
on Immunisation told The News on Monday [21 Mar 2011].

The fresh polio cases in the country have been reported at a time
when the 1st national immunisation campaign has concluded less than a
couple of weeks back, from [7-10 Mar 2011], and authorities claimed to
cover 95 per cent areas of each union council in the country.

Polio virus of type-A [WPV type 1?] was detected in a one-year-old
girl, a resident of District Badin, Mazhar Khamisani, the EPI Sindh
Director said.

He said that the child's vaccination status was 3 + 6; that means she
received 12 doses of the vaccine last year [2010], while she was found
infected with P-1 type virus.

On the other hand, a 17-year-boy was also found suffering from polio
in Tando Muhammad Khan, and initial investigation revealed that he
never had routine polio vaccination in his entire life.

Dr Khamisani said that earlier in 2008, a 27-year-old man was also
found suffering from polio in the Punjab, and now it was the 2nd case
in which an adult had become a victim of the dreaded disease.

"A 17-year-old boy whose limbs were weakening, and when tested, he
was found suffering from polio [in the village Somar, Tando Muhammad
Khan]," the EPI official added.

It is worth mentioning here that last week, a one-year-old [boy] of
the same area, Tando Muhammad Khan, was confirmed as the 3rd polio
victim in the province.

National EPI officials further confirmed to The News that 2 more
cases of polio were also detected in Peshawar and Nowshera in Khyber
Pakhtunkhawa, taking the total number of polio victims in the entire
country so far to 20.

While responding to queries about the latest polio case in Badin, the
female child who had 9 doses of vaccine, Dr Mazhar Khamisani said that
poor sanitary conditions and malnutrition could be the possible causes
of polio virus infection in the child.

"If sanitary conditions are not proper, and the child is suffering
from malnutrition, even 50 doses can't prevent him or her from getting
infected from the virus," he added.

Similarly, the 17-year-old boy was from the area where he never
received even a single dose of polio vaccine, and the virus attacked
him when he contacted it with no immunity against it.

[Byline: M. Waqar Bhatti]

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

[According to the Polio Eradication Initiative website, for the week
ending 16 Mar 2011, there had been 2 WPV1 cases reported in the
country, bringing the total number of cases in 2011 to 15. The most
recent confirmed case had onset of paralysis on 2 Mar 2011 in Killa
Abdulah, Balochistan, in the east of the country. By comparison, the
total number of confirmed cases in 2010 was 144. These 2 cases
mentioned in the above newswire are from Sindh province in the south
of the country (see the interactive HealthMap/ProMED map at
<http://healthmap.org/r/02SY>).

There was a nationwide vaccination campaign using trivalent [tOPV]
from 1-9 Mar 2011. Lot Quality Assurance Sampling (LQAS) results after
the campaign suggest continued quality issues, particularly in
high-risk districts, and are currently under investigation. The next
planned SIAs [supplementary immunization activities] will be SNIDs
[subnational immunization days] on 4-6 Apr 2011 using bOPV (bivalent).
Additional SIAs are planned for May and June 2011.

For a map of the location of polio cases confirmed in Pakistan during
2011 (as of 16 Mar 2011), see the worldwide distribution map at
<http://www.polioeradication.org/Dataandmonitoring.aspx>. - Mod.MPP]

******
[3]
Date: 18 Mar 2011
Source: Morbidity & Mortality Weekly Report 18 Mar 2011,
60(10);306-311 [edited]
<http://cdc.gov/mmwr/preview/mmwrhtml/mm ... mm6010a3_w>


Progress Toward Interrupting Wild Poliovirus Circulation in Countries
With Reestablished Transmission --- Africa, 2009--2010
-------------------------------------
Through efforts of the Global Polio Eradication Initiative (GPEI),
begun in 1988, indigenous transmission of wild poliovirus (WPV) had
been interrupted in all but 4 countries (Afghanistan, Pakistan, India,
and Nigeria) by 2006 (1). Since 2002, a total of 39 previously
polio-free countries experienced outbreaks following importation of
WPV of Indian or Nigerian origin (2--4). Most outbreaks were stopped
less than 6 months after confirmation. However, circulation in Angola,
Chad, Democratic Republic of the Congo (DRC), and Sudan persisted
greater than 12 months following importation before 2009 (3,4).

A key milestone of the GPEI 2010--2012 strategic plan (5) was to
interrupt WPV transmission in these African countries with
reestablished transmission by the end of 2010. As of [8 Mar 2011], the
milestone appeared to be on track only in Sudan. In Sudan, WPV type 1
(WPV1) was introduced in 2004, but no cases were detected for a
31-month period during 2005--2008. When resurgence occurred in 2008,
surveillance and eradication efforts were enhanced, and no case has
been detected since June 2009. In Chad, WPV type 3 (WPV3) transmission
has persisted since 2007, although undetected for 7 months in 2010. In
Angola, WPV1 circulation has persisted following importation in 2007,
and became more widespread in 2010, with subsequent importations into
DRC and Republic of the Congo (ROC).

In DRC, WPV1 circulation has persisted since introduction in 2006.
Achieving polio eradication depends on stopping WPV transmission in
the 4 endemic countries and overcoming substantial, ongoing
programmatic weaknesses in Chad, Angola, and DRC.

Methods of Tracking Progress
The 2010--2012 GPEI strategic plan set several milestones. These
included 1) stopping WPV transmission following importation in
countries with outbreaks in 2009 by mid-2010, 2) stopping WPV
transmission in subsequent outbreaks less than 6 months after
confirmation, 3) stopping WPV transmission in countries with
reestablished transmission by the end of 2010, 4) stopping WPV
transmission in at least 2 of the 4 WPV-endemic countries by the end
of 2011, and 5) stopping WPV transmission in all countries by the end
of 2012.

The World Health Organization (WHO) and UNICEF provide annual
estimates of routine coverage with 3 doses of oral poliovirus vaccine
(OPV) by age 12 months (OPV3) for each country.* WPV cases are
identified through acute flaccid paralysis (AFP) surveillance and
testing of stool specimens for polioviruses in WHO-accredited
laboratories. Quality standards for AFP surveillance include detection
of greater than or equal to 2 cases of nonpolio AFP (NPAFP) (AFP with
no WPV isolated from adequate specimens) per 100 000 population aged
less than 15 years in all provinces or states and adequate stool
specimen collection from greater than or equal to 80 percent of AFP
cases.**

Vaccination recall histories collected on children aged 6--35 months
with onset of NPAFP in 2010 are used to assess target population
vaccination status (the proportion with greater than or equal to 4 OPV
doses and the proportion with no OPV doses) at the time of AFP onset.
Independent monitors assess the quality of implementation of
supplementary immunization activities (SIAs)*** in areas considered at
high risk by surveying the proportion of children missed in the SIA.
Monitoring activities are variable; they are intended to provide a
crude assessment of SIA quality and to identify areas needing
improvement.

The Global Polio Laboratory Network provides comprehensive genomic
sequencing of WPV isolates (6), enabling tracing of the origins of
virus importations into previously polio-free areas**** and estimation
of the duration of circulation in chains of transmission. Angola,
Chad, DRC, and southern Sudan were identified in 2009 as having
reestablished WPV transmission (7) because genomic sequence analysis
had shown the persistence of one or more chains of WPV transmission
for greater than 12 months.

WPV Status by Country

Chad
WPV3 transmission persisted in Chad after importation from Nigeria in
2007 (1,3) resulting in 79 cases in Chad during 2009--2010 in 17 of 18
provinces ([see Table, Figures 1 and 2 at above given URL]) and
further spread to Cameroon and Central African Republic in 2009 (1,4).
The monthly case count decreased after improvements in SIA
implementation in 2010 (see Figure 2 at above given URL). No WPV3 case
was detected during [10 May-23 Dec 2010], but a related WPV3 case was
detected in December 2010, and genetic sequencing for an additional
WPV3 case detected in January 2011 is being conducted. A new WPV 1
importation from Nigeria in September 2010 resulted in 11 cases during
2010 (and 5 cases in 2011, as of [8 Mar 2011]).

Estimated OPV3 coverage in Chad was 36 percent; 52 percent of NPAFP
patients had greater than or equal to 4 doses of OPV, and 11 percent
had no doses. Independent monitoring of SIA coverage indicated that 26
percent of children were missed in the February 2010 SIA. Following an
initiative in March 2010, monitoring showed some SIA improvements in
Chad; the percentage of children missed decreased to greater than or
equal to 20 percent during 8 of the 10 SIAs implemented during
March--December 2010.

AFP surveillance met standards for case detection but not for
specimen collection ([see Table at above given URL]). Only 65 percent
of AFP cases had adequate stool specimens. Difficulties in
international shipment of specimens to an accredited Global Poliovirus
Network Laboratory contributed to greater than 20 percent of the
specimens arriving at the laboratory in poor condition.

Sudan
WPV1 of Nigerian origin was imported into Sudan via Chad in 2004,
resulting in transmission in northern and southern Sudan during
2004--2005 and importation into 8 other countries (2). Ongoing
transmission of WPV1 from this importation was not detected during
August 2005--March 2008. Subsequently, a total of 70 WPV1 cases were
reported in Sudan through June 2009, and associated WPV1 outbreaks
occurred in 2009 in Ethiopia, Kenya, and Uganda (1,3) (Figures 1 and
2). Since the 2004 importation, 226 related WPV1 cases have been
reported in Sudan, including 82 in southern Sudan ([see Table at above
given URL]). Following the 2008--2009 resurgence, extensive assistance
was provided to improve SIA implementation and AFP surveillance in
southern Sudan.

Overall, 78 percent of children with NPAFP in Sudan were reported to
have received greater than or equal to 4 doses of OPV; estimated OPV3
coverage was 84 percent; 3.8 percent of NPAFP cases nationwide had no
OPV doses. Among children with NPAFP residing in the 10 states of
southern Sudan, 7.3 percent had received no OPV doses. Limited
independent SIA monitoring data indicated less than 15 percent of
children were missed in all but one state in November 2010 and less
than 10 percent in all states in December [ 2010].

Surveillance indicators did not meet standards in early 2009. In
2010, however, all 25 states met surveillance quality targets,
including the 10 states of southern Sudan, which had a NPAFP rate of
4.2 per 100 000 population aged less than 15 years and an adequate
stool collection rate of 94 percent.

Angola
In less than a decade, Angola has had 3 separate WPV importations
related to WPV last isolated from cases in India. A 2005 WPV1
importation resulted in an outbreak that lasted until 2007 and led to
outbreaks in Namibia, DRC, Central African Republic, and Burundi
(3,4). A 2nd WPV1 importation was associated with 74 polio cases in
Angola during 2007--2010 ([see Table at above given URL]), and this
reestablished transmission has continued into 2011. A WPV3 importation
in 2008 was followed by transmission in Angola in 2008 and cases in
DRC during 2008--2009 (1,3). Of the 29 WPV1 cases in Angola with onset
during 2009, a total of 14 (48 percent) were reported from the
capital, Luanda, and 14 (48 percent) from the western provinces.
During 2010, a total of 18 of 32 (56 percent) WPV1 cases were detected
in central Angola and at the eastern border with DRC, leading to
spread to DRC ([see Table, Figures 1 and 2 at above given URL]) and
into ROC (387 provisionally confirmed cases) in 2010 (8 ).

Estimated OPV3 coverage in Angola was 73 percent *****; 30 percent of
NPAFP patients reported having received greater than or equal to 4
doses, and 13 percent of NPAFP patients reported no doses. Independent
monitoring after SIAs in 2010 indicated that 7--17 percent of children
were missed in SIAs, overall; greater than 33 percent of provinces
consistently have greater than or equal to 10 percent children
missed.

AFP surveillance indicators met performance targets in 2009 and 2010
([see Table at above given URL]). However, genomic sequence analysis
of WPV1 isolates suggested multiple instances of undetected
transmission in Angola.

DRC [Democratic Republic of the Congo]
WPV1 cases occurred during 2006--2008 after being introduced from
Angola, with no WPV1 case detected in 2009. During 2010, 6 WPV1
cases were identified in Katanga Province in southeastern DRC, where
Tanzania and DRC are separated by Lake Tanganyika.
The cases were genetically most closely related to
WPV1 detected in DRC in 2008 and 2 related WPV1 cases reported from
Burundi in 2009 ([see Figure 1 at above given URL]) (1,4). This
indicates periods of undetected transmission in eastern DRC and
bordering areas. No further related cases have been identified since
October 2010. Early in 2010, a new importation of WPV1 from Angola
resulted in an outbreak that started in a southern border province of
DRC and spread to neighboring provinces. Two additional WPV1
importations from Angola were identified in Bas-Congo Province in
2010. Four WPV3 cases linked to 2 2008 importations from Angola
occurred during October 2008--June 2009 (Table, Figure 1).

Estimated OPV3 coverage in DRC was 73 percent; 28 percent of patients
with NPAFP reported having received greater than or equal to 4 doses
of OPV, and 12 percent of NPAFP patients reported having received no
doses. Subnational SIAs implemented in 2010 covered 20--65 percent of
the national aged less than 5 years target population; independent
monitoring data for the 2 most recent targeted 2010 SIAs in Bandundu
and Kasai-Occidental provinces indicated 11--16 percent of children
were missed. Independent monitoring of the 2 most recent 2010
subnational SIAs indicated that 8 percent of children were missed.

AFP surveillance met standard detection targets in 2010 throughout
DRC, and 75 percent of AFP cases had adequate specimen collection.
However, genomic sequence analysis of WPV isolated from patients in
Katanga Province substantiate that AFP surveillance missed chains of
transmission in the eastern provinces.

Reported by:
Polio Eradication Dept, World Health Organization, Geneva,
Switzerland. Div of Viral Diseases, Global Immunization Div, National
Center for Immunization and Respiratory Diseases, CDC.

MMWR Editorial Note
The 2010 GPEI 2010--2012 strategic plan milestone of ending
reestablished transmission by the end of 2010 appears to be on track
in Sudan.****** The milestone was missed in Angola and is at high risk
for being missed in Chad and DRC. Persistent WPV transmission in
Angola, Chad, DRC, and Sudan has led to outbreaks in 8 polio-free
countries, some resulting in substantial morbidity and mortality, as
in ROC (3,4,8 ), and outbreak response activities have diverted limited
resources. Achieving the GPEI milestone of ending all WPV transmission
by the end of 2012 depends on progress being made in Angola, Chad,
DRC, and the 4 WPV-endemic countries during 2011. Progress toward
other milestones of the strategic plan is broadly on track. Among the
4 endemic countries, India and Nigeria made notable progress during
2010.*******

Among countries with outbreaks following importation, all 15
countries affected by outbreaks in 2009 had their last WPV case before
mid-2010. Of the 11 countries with new importations in 2010, 7 appear
to have stopped transmission within 6 months of confirmation, and the
others with more recent transmission also appear to be on track to
meet the milestone. One importation has been reported to date in 2011;
a WPV1 case was recently confirmed in Gabon, with onset in January
2011, related to the outbreak in ROC (8 ).

In Chad, southern Sudan, Angola, and DRC, the health infrastructure
is weak, routine vaccination coverage in multiple areas is very low,
and SIAs repeatedly have failed to reach a sufficient proportion of
children in critical areas. SIA quality improvements during 2009--2010
in southern Sudan were the result of more effective governmental
engagement and increased external support. All 4 countries with
reestablished WPV transmission have experienced civil war in the
recent past. Southern Sudan continued to have civil unrest, but
security has improved within the last 2 years. In January 2011, voters
in southern Sudan passed a referendum for independence. The security
situation in southern Sudan will require close monitoring as the
anticipated transition progresses.

Areas of insecurity and civil unrest remain in eastern Chad and in
eastern DRC, and resources are scarce. Angola, however, has had both
the stability and resources to improve the quality of SIA
implementation and AFP surveillance. Angola recently served as the WPV
source for active outbreaks in 3 countries. Continued WPV transmission
during 2010--2011 in Angola, Chad, and DRC indicates that sufficient
improvements in polio eradication activities have not occurred.
Virologic evidence of undetected transmission has demonstrated
deficiencies in surveillance, sometimes even when performance
indicators meet international standards. These deficiencies signify
ongoing weaknesses in AFP detection, investigation, specimen
collection, and/or transport in major areas of the country.

Urgent, coordinated efforts by governmental and external partners are
needed to immediately address the substantial, ongoing weaknesses in
SIAs and surveillance in Angola and DRC, and to redouble efforts in
Chad to continue the progress toward eliminating WPV. Sustaining
polio-free status also requires strengthening routine immunization. At
the outset of 2011, GPEI partner agency leaders visited heads of state
of Angola and DRC to emphasize the urgency of the situation, advocate
for increased efforts, and extend offers of further support. To
achieve measurable operational improvements and interrupt WPV
transmission in these countries, these renewed efforts must begin
immediately.

References
1. CDC. Progress toward interruption of wild poliovirus
transmission---worldwide, 2009. MMWR 2010;59:545--50. [available at:
<http://cdc.gov/mmwr/preview/mmwrhtml/mm5918a1.htm>]
2. CDC. Resurgence of wild poliovirus type 1 transmission and
consequences of importation---21 countries, 2002--2005. MMWR
2006;55:145--50. [available at:
<http://cdc.gov/mmwr/preview/mmwrhtml/mm5506a1.htm>]
3. CDC. Wild poliovirus type 1 and type 3 importations---15
countries, Africa, 2008--2009. MMWR 2009;58:357--62. [available at:
<http://cdc.gov/mmwr/preview/mmwrhtml/mm5814a1.htm>]
4. CDC. Outbreaks following wild poliovirus importations---Europe,
Africa, and Asia, January 2009--September 2010. MMWR 2010;59:1393--9.
[available at: <http://cdc.gov/mmwr/preview/mmwrhtml/mm5943a1.htm>]
5. World Health Organization. Global Polio Eradication Initiative:
strategic plan 2010--2012. Geneva, Switzerland: World Health
Organization; 2010. Available at
<http://www.polioeradication.org/content ... y.2010.pdf>
Accessed [8 Mar 2011].
6. CDC. Laboratory surveillance for wild and vaccine-derived
polioviruses---worldwide, January 2008--June 2009. MMWR
2009;58:950--4. [available at:
<http://cdc.gov/mmwr/preview/mmwrhtml/mm5834a3.htm>]
7. World Health Organization. Conclusions and recommendations of the
Advisory Committee on Poliomyelitis Eradication, November 2009. Wkly
Epidemiol Rec 2010:85;1--11. [Available at
<http://www.who.int/wer/2010/wer8501_02.pdf>]
8. CDC. Poliomyelitis outbreak---Republic of the Congo, 2010. MMWR
2011;60:312--3. [see [1] Rep. Congo report above, or go to
<http://cdc.gov/mmwr/preview/mmwrhtml/mm6010a4.htm>]

* Reported coverage data and WHO/UNICEF estimates are available at
<http://www.who.int/immunization_monitor ... select.cfm>.

** AFP surveillance quality is monitored by performance indicators.
Certification standard WHO targets are a NPAFP detection rate of one
case per 100 000 population aged under 15 years and adequate stool
specimen collection from 80 percent of AFP cases, in which 2 specimens
are collected 24 hours apart, both within 14 days of paralysis onset,
shipped on ice or frozen ice packs, and arriving in good condition
(without leakage or desiccation) at a WHO-accredited laboratory.
National data might mask surveillance system weaknesses at subnational
levels. The GPEI strategic plan operational target in countries with
current or recent WPV transmission is NPAFP 2, both nationally and in
each province/state. Data reported are for AFP cases with onset during
December 2009--November 2010.

*** Mass campaigns conducted for a brief period (days to weeks),
during which one dose of OPV is administered to all children aged
under 5 years, regardless of vaccination history.

**** Countries with no evidence of indigenous WPV transmission for
over 12 months and subsequent cases determined to be of external
origin by genomic sequencing analysis.

***** Surveys to corroborate reported administrative infant coverage
have not been conducted recently in Angola and DRC, and reported
administrative data might not be accurate.

****** At least 12 months must pass without confirmed WPV cases and
with AFP indicators meeting performance targets before WPV
transmission can be considered provisionally interrupted.

******* Current progress is reported at
<http://www.polioeradication.org>.

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

[According to the Polio Eradication Website report from 16 Mar 2011,
results of genetic sequencing of a WPV 1 isolate from the south-east
of Angola on 7 Jan 2011 was confirmed to be a continuation of the
re-established WPV1 circulation. (see
<http://www.polioeradication.org/>. There is also mention that in
Chad, there is a case of polio due to WPV3 with onset on 30 Jan 2011
that is under investigation as representing possible continued
transmission of re-established WPV circulation. And in DR Congo,
transmission of its re-established WPV1 is known to have continued
through at least December 2010. (see
<http://www.polioeradication.org/Dataand ... sweek.aspx>).

There were 2 new WPV1 cases reported in DR Congo in the weekly report
on 16 Mar 2011, one from 2010, and one from 2011, bringing the total
number of cases in 2011 to 21, and to 101 for 2010. The most recent
case had onset of paralysis on 15 Feb 2011, in Biyela, Kinshasa.

As of 16 Mar 2011:
(<http://www.polioeradication.org/Dataand ... sweek.aspx>)
Total Cases: Year to date 2011 / Year to date 2010 / Total in 2010
Globally: 55 / 47 / 1294
In endemic countries: 18 / 29 / 232
In non-endemic countries: 37 / 8 / 1062

The above statistics suggest that while significant progress has been
made in the 4 endemic countries, with a greater than 50 percent
reduction in confirmed cases than in the same time frame as in 2010,
there has been a greater than 4-fold increase in confirmed cases in
non-endemic countries in this same time frame when compared with 2010.
Of note, in 2010, there were 232 confirmed cases in endemic countries,
while there were 1062 confirmed cases in non-endemic countries, an
almost 5-fold difference in absolute cases. These figures suggest that
while there are 4 countries where WPV transmission has never been
interrupted, those countries that had interrupted transmission have
been challenged in maintaining high enough levels of coverage with
polio vaccine to prevent re-introduction of WPV and subsequent
significant transmission of the re-introduced WPV.

For the map of polio cases confirmed in 2011, see
<http://www.polioeradication.org/Dataandmonitoring.aspx>. - Mod.MPP]

POLIOMYELITIS - WORLDWIDE (04): PAKISTAN, NIGERIA, WORLD
********************************************************
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] Pakistan
[2] Nigeria (Kebbi, Jigawa)
[3] World: Polio eradication initiative: week of 30 Mar 2011

******
[1] Pakistan
Date: Mon 4 Apr 2011
Source: World News, UN Integrated Regional Information Networks
(IRIN) News report [edited]
<http://article.wn.com/view/2011/04/04/I ... _Pakistan/>


The World Health Organization (WHO) said on [30 Mar 2011], 4 new
cases of wild poliovirus type 1 have been reported in Pakistan,
bringing the total for 2011 to 24.

Media reports said the virus had also been discovered in water
samples from 5 cities. "WHO doesn't test drinking water for polio
viruses; however, environmental surveillance has been established in
Peshawar since June 2010 and sewage water samples from 2 sites are
regularly tested by the NIH [National Institute of Health, Pakistan]
polio laboratory," Gul Afridi, WHO Pakistan media and advocacy
officer, said.

"Wild polioviruses have been continuously isolated from these sites,"
Afridi added. The 2 sites are Shaheen Muslim Town near Total Petrol
Pump, and Larama village near Bakhshoo Pull. One sample is tested from
each on a monthly basis.

Until 2007 when 32 cases were detected, Pakistan had appeared to be
winning its battle against polio.

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

[This newswire reflects the data reported on the polio eradication
website as of 30 Mar 2011. This case count is twice that seen for the
same period in 2010 when there were 12 cases reported. It also
represents an increase in 4 cases since the last ProMED-mail polio
update (see Poliomyelitis - worldwide (03): Rep. Congo, Pakistan,
Africa 20110323.0919.)

For the interactive HealthMap/ProMED map of Pakistan, see
<http://healthmap.org/r/00tj>. - Mod.MPP]

******
[2] Nigeria (Kebbi, Jigawa)
Date: Wed 6 Apr 2011
Source: Next [edited]
<http://234next.com/csp/cms/sites/Next/H ... /story.csp>


4 new cases of the wild polio virus have been recorded in Kebbi and
Jigawa States, in a shocking reversal that underscores the continued
threat posed by the disease in Nigeria.

The new cases bring to 5 the number of cases of the wild poliovirus,
which cripples and even kills children, recorded so far in the country
in 2011.

Nigeria is one of only 4 countries across the world where the wild
poliovirus is still found. The others are Afghanistan, Pakistan and
India.

Reacting to the discovery of the new cases of the wild poliovirus in
the 2 northern states, the executive director of the National Primary
Health Care Development Agency (NPHCDA), Muhammed Ali Pate, said the
affected states are conducting a "mop-up" vaccination campaign with
the support of the NPHCDA and international development partners to
eradicate the virus.

Mr Ali Pate also said that despite Nigeria's progress in polio
eradication, the virus is still a threat to the Nigerian child. He
called for the support of state and local government to ensure that
every single child under 5 years of age receives the polio vaccine.

"Not only must we vaccinate every child, we must also find solutions
to every new polio case. If one child is paralyzed, it means 200 more
children would have the virus," he said. "Therefore in polio
eradication, sensitive surveillance and our collective effort are
critical to fighting the polio virus and finally stopping it."

The emir of Argungu, Muhamadu Samai'la Mera, who is also the deputy
chairman of the northern leaders committee on Health Care Delivery,
noted that the continuous transmission of poliovirus in Nigeria is
because some children still evade healthcare providers during
vaccination campaigns.

He advised his colleagues not to rest on their oars until the country
is certified polio free and pledged that the traditional leaders will
continue to convince their people to participate in the immunization
process.

After a period of suspicion about the efficacy of the polio
vaccination, northern religious and traditional rulers have thrown
themselves into the campaign to ensure widespread immunization of
children. Jigawa State has made a lot of progress against the
poliovirus, and the last time it recorded any case of the virus was in
October 2009.

[Byline: Ajewole Ebenezer]

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

[The newswire above reflects the data available on the polio
eradication website as of 30 Mar 2011 where there are a total of 5
confirmed cases in 2011 -- 3 WPV1 and 2 WPV3 related cases (see
<http://www.polioeradication.org/Dataand ... sweek.aspx>).

For the interactive HealthMap/ProMED map of Nigeria, see
<http://healthmap.org/r/007*>. For a map of Nigeria with states, see
<http://naijan.com/wp-content/uploads/20 ... ates-2.gif>.
- Mod.MPP]

******
[3] World: Polio eradication initiative: week of 30 Mar 2011
Date: Wed 30 Mar 2011
Source: Global Polio Eradication Initiative (GPEI) [edited]
<http://www.polioeradication.org/Dataand ... sweek.aspx>


Afghanistan
-----------
- No new cases were reported in the past week. The total number of
cases for 2011 remains one. The most recent case (wild poliovirus type
1 - WPV1), from Kandahar province, had onset of paralysis on [11 Jan
2011] .

- The most recent supplementary immunization activities (SIAs) were
national immunization days (NIDs) held on [13-15 Mar 2011]. Health
workers will vaccinate children against polio using trivalent oral
polio vaccine (tOPV) and will administer vitamin A during NIDs planned
for [2-4 May 2011].

- The Afghanistan/Pakistan Technical Advisory Group (TAG) met last
week [week of 21 Mar 2011] in Islamabad, Pakistan. The TAG found that
Afghanistan is making great progress, but that several improvements
could be made. The TAG recommended that, in order to reach more
children in the southern region, a flexible approach should be
implemented including the use of the short interval additional dose
(SIAD) strategy, permanent posts at transit points into and out of
inaccessible areas and the tracking and vaccination of all internally
displaced children. Further recommendations included a focus on
reaching migrant, mobile and under-served groups, and on maintaining
routine immunization in polio-free areas.

India
-----
- No new cases were reported in the past week. There has only been
one case reported for 2011 -- a case of WPV1 with onset of paralysis
on [13 Jan 2011], from Howra district, West Bengal. This case is one
of only 3 cases reported in the last 6 months.

- Sub-national immunization days (SNIDs) using bOPV [bi-valent oral
polio vaccine] are currently taking place (27-31 Mar 2011), covering
the majority of the states of Uttar Pradesh, Bihar, and outbreak areas
of West Bengal. Further SNIDs are planned for April and May [2011].

- Bill Gates, co-founder of the Bill & Melinda Gates Foundation, made
a high profile visit to India last week [week of 21 Mar 2011]
accompanied by fellow billionaire-philanthropist, Warren Buffet.
During the trip Mr Gates engaged the country's leadership including
prime minister Manmohan Singh and the chief minister of Bihar, and
wrote a letter to the chief minister of West Bengal, calling upon them
all to ensure the nation's dedication to polio eradication, especially
the maintenance of polio funding.

- An acute flaccid paralysis (AFP) surveillance review of northern
West Bengal concluded last week [week of 21 Mar 2011]. While no major
deficiencies were identified, it was stressed that surveillance needs
to remain a core function of the NPSP, and government involvement
needs to be increased.

Nigeria
-------
- 3 new cases were reported in the past week (one WPV1 and 2 WPV3),
bringing the total number of cases for 2011 to 5. The 2 most recent
cases both had onset of paralysis on [12 Mar 2011] -- a WPV1 from
Aleiro, Kebbi and a WPV3 from Gwandu, Kebbi [see [2] above].

- 11 out of 12 high-risk northern states carried out SIAs using bOPV
from [26-29 Mar 2011]. The round was postponed in Borno so that the
government could distribute long lasting insecticidal mosquito nets
(LLINs). Borno will immunize all children under 5 in the state with an
additional dose of bOPV on [4-8 Apr 2011].

- A Maternity and Neonatal Child Health Week (MNCHW) will be held
from [14-17 May 2011] during which children will be vaccinated using
trivalent oral polio vaccine (tOPV). A nested mop-up with bOPV in 6
high-risk states will be conducted at the same time as the MNCHW. The
mop-up will ensure that immunization activities in the states of
Kebbi, Sokoto, Zamfara, Kano, Yobe, and Borno will be held to a higher
standard than normal SIAs with any LGA [local government area] in
these states reporting less than 90 percent coverage of children less
than 5 years of age being re-covered. Provided that there are no
further health worker strikes, the MNCHW in May [2011] will be the 1st
time the states of Taraba, Cross River, and Oyo have held SIAs since
the strikes began in November 2010.

- Nigeria is currently reviewing its surveillance network and taking
a number of important steps to improve its sensitivity. A surveillance
desk review is currently underway which will be followed by a series
of rapid surveillance assessments in high risk areas of the country.
National AFP guidelines and training materials are being reviewed and
updated while refresher training for Disease Surveillance Notification
Officers is planned for late April [2011].

Pakistan
--------
- 4 new cases were reported in the past week (all WPV1s), bringing
the total number of cases for 2011 to 24 [see [1] above]. The most
recent case, in Lakki Marwat, Khyber Pakhtunkhwa, had onset of
paralysis on [13 Mar 2011] . No WPV3 has been reported in Pakistan
since November 2010.

- NIDs using tOPV took place on [7-9 Mar 2011]. The next SIAs will be
SNIDs on [4-6 Apr 2011] (using bOPV).

- The Afghanistan/Pakistan Technical Advisory Group (TAG) and cross
border meeting was held in Islamabad on [24-25 Mar 2011]. The TAG
expressed concerns about the 33 highest risk districts of Pakistan,
which remain responsible for 80 percent of the country's WPV cases.
The Federally Administered Tribal Areas (FATA) was found to be of
particular concern, especially given the frequent population movement
both within FATA and to other areas of Pakistan. Accessibility remains
a problem in parts of FATA; however the fact that cases have been
reported in accessible areas indicates gaps in campaign quality. The
TAG's key recommendations included aggressive response to a) the
current WPV1 outbreak in Central/Southern Sindh, b) any WPV3 anywhere
in the country, and c) any WPV1 outside the persistent transmission
zone. The TAG also strongly urged the new 'prime minister's polio
monitoring cell' to establish and use standard indicators to issue and
share district polio 'report cards' with the prime minister, chief
ministers, and governors.

Angola
------
- No new cases were reported in the past week. The total number of
cases for 2011 remains 2.

- Angola's revised emergency action plan for polio eradication will
be presented to the meeting of the IMB this week [week of 30 Mar
2011], following the announcement that the country had officially
missed its end-2010 milestone of the Global Polio Eradication
Initiative's Strategic Plan 2010-2012 -- cessation of all polio
outbreaks with onset in 2009.

- Angola will participate in synchronized rounds with Congo, DR
Congo, and Namibia on 28-30 Apr 2011, and with DR Congo, Namibia, and
Zambia on 26-28 May 2011.

Central Asia and Russian Federation
-----------------------------------
- This region has not reported a case of wild poliovirus in more than
6 months. The most recent case had onset of paralysis on 29 Sep 2010,
in the Russian Federation.

- Russian Federation: SNIDs covering the northern Caucasus using tOPV
were planned to begin this week [week of 30 Mar 2011].

- Tajikistan has NIDs planned for 18-22 April 2011 using tOPV.

- Turkmenistan: NIDs are planned for 25-28 April 2011 using tOPV.

- Kazakhstan held its last SIAs from 21-27 Feb 2011 (SNIDs using
mOPV1).

- Kyrgyzstan and Uzbekistan are planning NIDs using tOPV for April
2011.

Chad
----
- No cases were reported this week -- therefore the total number of
cases for 2011 remains 16. The most recent case was a WPV1 in Moundou,
Logone Occidental, with onset of paralysis on [20 Feb 2011].

- In Chad, continuation of re-established wild poliovirus type 3
(WPV3) transmission was confirmed by genetic sequencing of WPV3
isolated from a case with onset on 30 Jan 2011 in the east of the
country. This means that the GPEI Strategic Plan 2010-2012 milestone
for cessation of all re-established poliovirus transmission by the end
of 2010 has not been met in Chad. In addition to the re-established
transmission of WPV3, Chad is also affected by a new outbreak of wild
poliovirus type 1 (WPV1) following an importation from Nigeria in
September 2011.

- Alarmed at the ongoing transmission of its re-established WPV3 and
the new WPV1 outbreak since September [2010], the Government of Chad
at the start of 2011 developed an urgent operational plan to address
the situation. The new plan sees resources and support allocated to
identified high-risk areas. In a major shift, district heads will be
personally charged with overseeing implementation of supplementary
immunization activities (SIAs) by their respective provincial
governors. At the national level, monthly implementation reports will
be prepared by the Ministry of Health and shared with the office of
the prime minister. The major elements of the new operational plan
will be presented to the GPEI's Independent Monitoring Board (IMB) on
31 Mar-1 Apr 2011.

Congo and Gabon
---------------
- No cases were reported in the past week in Congo. The total number
of cases for 2011 remains one (WPV1 with onset of paralysis 22 Jan
2011).

- Congo will vaccinate children and adults against polio in southern
provinces on [28-30 Apr 2011], as part of a synchronized campaign with
Angola, DR Congo, and Namibia.

- Gabon: the case reported last month [February 2011] -- WPV1
imported from Congo with onset of paralysis on [15 Jan 2011] --
remains the only case to be seen in the country in more than 10
years.

- NIDs using mOPV1 were held in Gabon from [22 Mar 2011].

Democratic Republic of Congo (DRC)
----------------------------------
- 4 cases were reported in the past week -- all WPV1 from Kinshasa.
This brings the total number of cases for 2011 to 26. The most recent
case had onset of paralysis on [6 Mar 2011] in the Police district.

- DR Congo is currently considered to be at high risk of missing its
end-2010 milestone (cessation of all re-established poliovirus
transmission): transmission of its re-established WPV1 is known to
have continued into at least November [2010], and 2 cases reported
from the area of re-established transmission in December [2010] are
pending sequencing results. The Government of DR Congo intends to
present their emergency action plan for polio eradication at the
meeting of the IMB this week [31 Mar-1 Apr 2011].

- Of the 11 cases seen in Kinshasa, 9 were young adults aged between
15 and 25. In order to combat this outbreak effectively, the SNIDs
which were held in Kinshasa from [24-27 Mar 2011] were expanded to
cover the entire population. The next round will also target the
entire population of t his city of around 8.4 million people.

- DR Congo will take part in synchronized campaigns with Angola,
Congo, and Namibia on [28-30 Apr 2011], and with Angola, Namibia, and
Zambia on [26-28 May 2011].

Horn of Africa
--------------
- No cases have been reported from this group of countries this year
[2011].

- Southern Sudan carried out SIAs from [29 Mar 2011], and northern
Sudan's next round will take place on [2 Apr 2011] (both using tOPV).
These activities will be particularly important, given confirmation of
cases in eastern Chad, close to the border with Sudan.

- The 1st phase of SIAs in Somalia took place from [20 Mar 2011].
While this round aimed to cover as much of the country as possible
with tOPV, it was severely hampered due to security issues and much of
the south and central zones remained inaccessible. The 2nd phase is
planned for [24-27 Apr 2011] (also using tOPV).

- Plans for the synchronized SNIDs along the Uganda/Kenyan border
have been altered. Both countries have now postponed their rounds
until May [2011].

West Africa
-----------
- No new cases have been reported from this group of countries in the
past week. Last week [week of 21 Mar 2011], Niger reported the 1st
case for this group of countries in almost 6 months (WPV3 with onset
of paralysis on [19 Jan 2011] in Birni Nkonni, Tahoua).

- Synchronized campaigns, using a combination of vaccines, were held
across most of west Africa on [25 Mar 2011]. Similar synchronised
multi-country campaigns will also be held on [29 Apr 2011].

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

[For the global map showing locations on confirmed polio cases as of
30 Mar 2011, see
<http://www.polioeradication.org/Dataandmonitoring.aspx>.

According to the most recent available data on the Global Polio
Eradication Initiative (GPEI) website, the total number of confirmed
cases due to infection with WPV as of 30 Mar 2011 is 78, compared with
55 reported during the same time frame during 2010. As seen in the
prior polio update (see archive Poliomyelitis - worldwide (03): Rep.
Congo, Pakistan, Africa 20110323.0919),

- the total number of confirmed cases due to WPV infection in endemic
countries as of 30 Mar 2011 is 31, compared with 40 during the same
time frame in 2010,

- while the total number of confirmed cases due to WPV infection in
non-endemic countries as of 30 Mar 2011 is 47, compared with 15 during
the same time frame in 2010.

These figures represent an increase in confirmed polio cases in
non-endemic countries, while there is a decrease in confirmed cases in
endemic countries. This trend reflects the challenges seen with
importation and continued transmission of the WPV in countries that
had previously interrupted WPV transmission, where there are now
cohorts of susceptibles due to decreased vaccination coverage after
achievement of interruption of WPV transmission. - Mod.MPP]

Wild poliovirus in Côte d'Ivoire
21.04.2011 - WHO

Côte d'Ivoire is experiencing an outbreak of wild poliovirus type 3 (WPV3) with three new cases reported with onset of paralysis on 27 January, 24 February and 27 February this year.

Genetic sequencing of the isolated viruses show that they are linked to WPV3 last detected in mid-2008 in northern Nigeria. They are the first WPV3 recorded in Côte d'Ivoire since 2000. In 2008-2009, Côte d'Ivoire was affected by a wild poliovirus type 1 (WPV1) outbreak affecting west Africa (and which was recently stopped).

There is currently a high risk of further spread of WPV3 - both within and from - Côte d'Ivoire. It is the first time since 2000 that WPV3 has been recorded in this part of west Africa (WPV3 transmission has been limited to northern Nigeria and parts of Niger, and since 2008 also in parts of Mali and one case in Benin). The outbreak response may be constrained by the current security situation in Côte d'Ivoire. Due to the persistence of subnational surveillance gaps in Côte d'Ivoire and other areas of west Africa, undetected further circulation cannot be ruled out at this time.

Detection of these WPV3 cases underscores the risk suboptimal surveillance poses to the global polio eradication effort. Globally, WPV3 transmission is at its lowest level in history, with only nine cases reported worldwide in 2011 - efforts to rapidly interrupt all remaining chains of WPV3 transmission is a key priority for the global polio eradication effort.

The overriding priority is to urgently stop the WPV3 outbreak, while maintaining high population immunity across west Africa to WPV1. Two rounds of coordinated, multi-country supplementary immunization activities (SIAs) with bivalent oral polio vaccine (bOPV) and trivalent oral polio vaccine (tOPV) across west Africa have been/are being implemented on 25 March 2011, and again on 29 April 2011, in 15 countries across west Africa (except Côte d'Ivoire, see next paragraph). A further outbreak response is currently planned in six countries, over and beyond these two multi-country SIAs. Such a further response could see planned SIAs scheduled for the fourth quarter to be brought forward to earlier in the year.

In Côte d'Ivoire, the end-March SIA did not take place due to the current security and political situation. A response round is proposed in the affected province using bOPV in late April 2011, to be followed by two National Immunization Days (NIDs), as soon as the situation permits. Planning is underway to ensure capacity (ie technical, vaccine, operational) is in place for this emergency response. Coordination with other United Nations (UN) organizations and non-governmental organizations (NGOs) operating in Côte d'Ivoire is ongoing, to ensure that OPV is added to any planned immunization activity, in particular for displaced populations. Ongoing transmission will be monitored, and mop-ups implemented as epidemiology dictates.

An investigation is ongoing to more clearly identify surveillance gaps in the region, including among mobile, migrant and underserved populations. Measures will be implemented to strengthen sub-national surveillance, to ensure that all groups and areas, particularly high-risk populations, are covered by high-quality surveillance.

As per recommendations outlined in WHO's International travel and health, travellers to and from Côte d'Ivoire, and other polio-affected countries of west Africa, should be fully protected by vaccination. Travellers who have in the past received three or more doses of OPV should be offered another dose of polio vaccine before departure. Any unimmunized individuals intending to travel to should have a complete course of vaccination. Travellers from Côte d'Ivoire, and other polio-affected countries of west Africa, should have a full course of vaccination against polio before departure, with a minimum one dose of OPV before departure.

POLIOMYELITIS - WORLDWIDE (05): COTE D'IVOIRE, PAKISTAN
*******************************************************
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] Pakistan
[2] Worldwide - Official data as of 20 Apr 2011


******
[1] Pakistan
Date: 16 Apr 2011
Source: Express Tribune [edited]
<http://tribune.com.pk/story/150147/seve ... -in-sindh/>


Another polio case detected in Sindh
------------------------------------
An 18 month old girl has been diagnosed with polio in Karachi,
bringing the number of polio cases in Sindh to 7 this year [2011]. The
girl [is a resident of Baluch Colony in Orangi Town].

The case came only days after a 5-day polio immunization drive
concluded in the province. This was the 3rd drive in the province
since the turn of the year. Last year 27 cases of polio were detected
in Sindh.

According to sources, [the girl] contracted the disease after having
received 7 courses of polio drops. As a signatory to the Millennium
Development Goals, Pakistan was supposed to have eradicated the virus
in the year 2000.

This was the 7th reported case of polio virus in Sindh despite the
fact that polio campaigns are being launched every month to control
it.

Pakistan, along with Afghanistan, India and Nigeria are the last
remaining endemic countries. 144 cases of polio were reported in
Pakistan in 2010.

--
communicated by:
HealthMap Alert via ProMED-mail
<promed@promedmail.org>

[For the HealthMap/ProMED map of Sindh, Pakistan, see
<http://healthmap.org/r/02SY>. - Mod.MPP]

******
[2] Worldwide - official data as of 20 Apr 2011
Date: 20 Apr 2011
Source: Polio Eradication Initiative [edited, see URL for full
information]
<http://www.polioeradication.org/Dataand ... sweek.aspx>


Wild Poliovirus cases confirmed as of 20 Apr 2011
-------------------------------------------------
Total cases: Year-to-date 2011/ Year-to-date 2010 / Total in 2010*
Globally: 103 / 71 / 1292
- in endemic countries: 38 / 42 / 232
- in non-endemic countries: 65 / 29 / 1060

*Data in WHO as of 20 Apr 2010 for 2010 data and 19 Apr 2011 for 2011
data.

Polio this week - as of Wednesday 20 April 2011
-----------------------------------------------
Afghanistan
- No new cases were reported in the past week. The total number of
cases for 2011 remains one. The most recent case was wild poliovirus
type 1(WPV1) with onset of paralysis on [11 Jan 2011] in Kandahar
province in the south of the country.
- Afghanistan has been able to limit transmission to just one case in
the 1st quarter of 2011 (by this time last year [2010] Afghanistan had
reported 8 cases). However, the country must remain vigilant, given
continuing transmission in neighbouring Pakistan.
- national immunization days (NIDs) were conducted on [13-15 Mar
2011]. The next NIDs are planned for 2-4 May 2011, and will use
trivalent oral polio vaccine (tOPV) and Vitamin A.

India
- No new cases were reported in the past week. The country's 1st and
only case of WPV reported for 2011 (WPV1) had onset of paralysis on
[13 Jan 2011], in Howrah district, West Bengal.
- The historically polio-prone state of Uttar Pradesh has gone a year
without a single case of polio (the most recent reported case was on
[21 Apr 2010], in Ferozabad). Meanwhile, environmental sampling has
not detected WPV at any of the 3 sites in Mumbai and 5 sites in Delhi
since November 2010.
- The country remains cautious and continues to regard the WPV1
detected in West Bengal as a serious event requiring a large scale
outbreak response. The West Bengal outbreak response team is currently
training vaccinators, improving microplans and continuing social
mobilization efforts in preparation for the sub-national immunization
days (SNIDs) to start this Sunday, [24 Apr 2011] in West Bengal and
other high risk areas of India. Activities have been staggered to
avoid conflicts with election dates in West Bengal.

Nigeria
- A total of 3 new cases were reported in the past week, bringing the
total number of cases for 2011 to 8. The most recent case was a WPV1
with onset of paralysis on [18 Mar 2011] in the Sabon Birni district
of Sokoto province, in the north west of the country.
- Violence has erupted in response to the results of the recent
elections, affecting several northern states including Gombe, Kaduna,
Kano and Katsina. All WHO staff have been reported to be safe;
however, many state offices remain closed. Mop-ups in Kano and Zamfara
were interrupted by the violence.
- The insecurity may also affect plans for state-wide mop-up rounds
in Kebbi, Jigawa, Borno and Zamfara, due to take place in early May
[2011]. However, resources have been mobilized so that vaccination
activities can resume the moment the situation improves.
- A sub-national Child Health Week, including a combination of tOPV
and bOPV, will take place from [14-17 May 2011].
- Rapid assessments of AFP surveillance are planned to take place in
the high-risk states in the 2nd half of May.

Pakistan
- A total of 2 new cases were reported in the past week, bringing the
total number of cases for 2011 to 28. The most recent case (WPV1) had
onset of paralysis on [1 Apr 11] in the Khyber district of the
Federally Administered Tribal Areas (FATA).
- The next activity will be NIDs, with bivalent OPV, on [9-11 May
2011].

Angola
- No new cases were reported in the past week. The total number of
cases for 2011 remains 2. The most recent case (WPV1) had onset of
paralysis on [4 Feb 2011].
- While Congo, the Democratic Republic of the Congo, and Zambia are
sticking to the original plans for the synchronised rounds scheduled
for April and May [2011], Angola is considering delaying the activity
in some flood affected provinces due to the beginning of the wet
season. Namibia has confirmed that it will postpone its rounds for the
same reason until the flooding has subsided.

Central Asia and Russian Federation
- This region has not reported a case of wild poliovirus in more than
6 months. The most recent case had onset of paralysis on 25 Sep 2010
in the Russian Federation.
- In the Russian Federation, SNIDs covering the northern Caucasus
using tOPV took place on [4-9 Apr 2011]. Further SNIDs are planned for
[3-7 May 2011].
- NIDs are planned for Turkmenistan for 25-28 Apr 2011 using tOPV.
- Kazakhstan held its last SIAs from [21-27 Feb 2011] (SNIDs using
monovalent oral polio vaccine type 1-mOPV1). The country's next round
is planned for [25-28 Apr 2011], using mOPV1.
- Kyrgyzstan, Tajikistan and Uzbekistan are all currently carrying
out NIDs using tOPV.

Chad
- No new cases were reported in the past week. The total number of
cases for 2011 remains 20. The most recent case had onset of paralysis
on [28 Feb 2011] (WPV1 in Logone Occidental).
- Chad presented its new emergency plan for polio eradication to the
recent meeting of the IMB. The country is currently facing outbreaks
of both remaining types of wild poliovirus and appears to have missed
transmission of WPV3 for 8 months. A strengthened plan will be crucial
in improving the country's ability to fight off polio.
- SNIDs using bOPV were planned for [15 - 18 Apr 2011]. NIDs are
planned for May [2011].

Congo and Gabon
- No new cases were reported in the past week. The total number of
cases for 2011 remains one in the Republic of Congo (WPV1 with onset
of paralysis [22 Jan 2011]); and one in Gabon (WPV1 with onset of
paralysis on [15 Jan 2011]).
- The Republic of Congo will vaccinate children and adults against
polio in southern provinces on [28-30 Apr 2011].
- Gabon held a national round using mOPV1 from [22 Mar 2011].

Democratic Republic of Congo (DRC)
- A total of 8 new cases were reported in the past week, bringing the
total number of cases for 2011 to 36. The most recent case had onset
of paralysis on [26 Mar 2011] (WPV1 from Selembao, Kinshasa).
- The outbreak in Kinshasa continues to affect an unusually high
number of teenagers and young adults. Almost 10 million residents of
Kinshasa were vaccinated using mOPV1 at the end of March [2011], and
the next round in Kinshasa will also target the entire population
(instead of children less than 5 years old). A 3rd whole-population
round may be required.
- DR Congo will take part in synchronized campaigns with Congo (and
possibly Angola) on [28-30 Apr 2011].

Horn of Africa
- No cases have been reported from this group of countries this year.
However, a single positive environmental sample collected in December
2010 from Aswan, Egypt has been genetically linked to virus
circulating in Sudan in 2009.
- A surveillance review has just been completed in southern Sudan
which noted improvements in AFP detection and stool collection across
all states and recommended further efforts to ensure that the network
can identify AFP among mobile and migrant populations. Following the
detection of the WPV positive environmental sample in Egypt, an
international mission to investigate surveillance quality in northern
Sudan has now been launched, with particular focus on possible
sub-population or migrant groups which may have been missed by the
surveillance system.
- SIAs were carried out in southern Sudan from [28 Mar 2011] and
northern Sudan from [11 Apr 2011]. Further rounds in May [2011] are
now being discussed. Sudan remains at risk of polio, both due to
potential undetected circulation and ongoing transmission in
neighbouring Chad.
- Efforts are ongoing to interrupt any residual transmission related
to a 2009 outbreak from Kenya (which was detected again in September
2010 in Uganda). So far, 3 SIAs have been conducted in the
Uganda/Kenya border area, and a 4th activity is planned for May
[2011]. SIAs are also being held in Ethiopia and Somalia, to boost
immunity levels and minimise the risk/consequences of any
importations.

West Africa
- 2 new cases were reported in the past week -- both WPV3 from Cote
d'Ivoire. Cote d'Ivoire has seen a total of 3 cases in 2011. The most
recent case had onset of paralysis on [27 Feb 2011].
- Mali is the only other west African country to have seen a polio
case this year. Mali has reported a single case (WPV3), with onset of
paralysis on [8 Feb 2011].
- Genetic analysis of the Cote d'Ivoire case shows it is linked to
WPV3 last detected in northern Nigeria in mid-2008, indicating
undetected circulation. The Mali case is closely related to 2010 WPV3
transmission in Nigeria, Niger and Mali.
- Stopping these WPV3 outbreaks completely is the overall priority.
Meanwhile it is crucial that high population immunity to WPV1 is
maintained (a multi-country WPV1 outbreak in west Africa in 2010 has
only been recently stopped).
- Coordinated multi-country SIAs were conducted in late March [2011],
and a further multi-country campaign is planned for [29 Apr 2011]. An
additional emergency response is currently planned in 6 countries over
and beyond these 2 multi-country SIAs. Such a further response could
see planned SIAs scheduled for the 4th quarter brought forward to
earlier in the year.
- The current insecurity in Cote d'Ivoire prevented it from taking
part in the end-March multi-country SIA. The [29 Apr 2011] SIA will be
conducted with bivalent OPV in the affected province of the country,
to be followed by 2 NIDs on [14 May 2011] (with bivalent OPV) and 12
June (with trivalent OPV). Ongoing transmission will be monitored, and
mop-ups implemented as epidemiology dictates.
- A rapid assessment is being carried out in the southwest of the
country, and in Liberia, to determine access in particular to
displaced populations. WHO Geneva and the WHO Regional Office for
Africa are coordinating with its humanitarian response units (who are
currently supporting activities in Cote d'Ivoire) and are in contact
with other UN organizations. Coordination is ongoing with other UN
organizations and NGOs operating on the ground and in neighbouring
countries (in particular Liberia, which may be receiving large numbers
of displaced populations), to ensure OPV is added to any planned
immunization activities.

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

[For the map of confirmed polio cases in 2011, see
<http://www.polioeradication.org/Dataandmonitoring.aspx>.

The current situation with polio is very disconcerting, as events of
the past 12 months are highlighting the added challenges of undetected
wild poliovirus (WPV) circulation going on for about 12 months in
Kenya and Uganda, for 3 years in Nigeria and Cote d'Ivoire, and for 2
years in Sudan and Egypt. Questions arise as to the efficacy of the
AFP (acute flaccid paralysis) surveillance activities in the post
interruption of transmission phase in lower resource countries in
Africa. From the data available on confirmed cases of polio in the
world, one sees that the majority of confirmed cases in 2011 are in
non-endemic countries -- those countries that have interrupted
transmission of the WPV in the past for at least 3 years.

The repeated finding of WPV isolates genetically related to viruses
last identified 12 or more months preceding the isolate highlights the
challenges in WPV surveillance. While one would like to be able to
conclude that the challenges relate to continued circulation of the
WPV without clinical cases (remembering that there is an observed
average paralytic to non-paralytic infection ratio of 1 to 200 with
WPV), a review of non-polio AFP rates in WPV endemic regions shows
there are countries with suboptimal indicators (a non-polio AFP rate
should be greater than or equal to 2 per 100 000 population under age
15 years in endemic regions) (see
<http://www.polioeradication.org/Dataand ... ators.aspx>).
Of note, while Kenya and Uganda have reported adequate AFP indicators,
there was still undetected circulation of WPV for approximately 12
months (see Poliomyelitis - worldwide (23): Uganda 20101027.3900).

In addition, there are countries in non-endemic regions with
suboptimal AFP surveillance activities (a non-polio AFP rate should be
greater than 1 per 100 000 population less than 15 years of age in
non-endemic regions) (see
<http://www.polioeradication.org/Dataand ... ators.aspx>).


A disconcerting situation. - Mod.MPP]

POLIOMYELITIS - WORLDWIDE (06): SOUTH AFRICA, STOLEN VIRUS ALERT
****************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Wed 4 May 2011
Source: The Gazette, Montreal, Agence France-Presse (AFP) report
[edited]
<http://www.montrealgazette.com/news/Pol ... story.html>


Poliovirus missing after South Africa carjacking
------------------------------------------------
A shipment of potentially infectious poliovirus destined for a South
African research centre is missing after the vehicle carrying it was
hijacked in Johannesburg, officials said Wednesday [4 May 2011]. The
potentially deadly virus is considered a biohazard, said South
Africa's National Institute for Communicable Diseases (NICD), though
the government research centre's deputy director downplayed the threat
of a polio outbreak.

"The risk is fairly small, but we'd like to advise that if the
package was found for the public not to tamper with it. Simply return
it to the NICD or to the police," Adrian Puren told AFP [Agence
France-Presse]. He said there was no risk the package could be used in
a terrorist attack and that the carjackers who stole the courier
vehicle carrying it probably did not realize what the box contained --
stool specimens from the Congo being sent to the NICD for polio
testing. The NICD said the vehicle was stolen Tuesday [3 May 2011] and
later recovered, but that the specimen shipment was missing.
Carjacking is a pervasive problem in South Africa, which has some of
the highest crime rates in the world. Nearly 14 000 carjackings were
reported to police last year [2010].

--
Communicated by:
Jas Mantero, MD MPH PhD
Expert Epidemic Intelligence
Surveillance and Response Support Unit
European Centre for Disease Prevention and Control (ECDC)
Tomtebodavagen 11 A, 17183 Stockholm
Sweden
<jas.mantero@ecdc.europa.eu>

[It is unlikely that this incident has any bioterrorism connotations.
Fecal samples from Congolese patients could have no commercial value
and in any case are replaceable. However, until the material is
located its loss constitutes a biohazard. It is likely that some of
the samples, presumably originating from patients with symptoms of
poliomyelitis, could contain virulent poliovirus and are a danger to
any unimmunised person interfering with the packaging, or to others if
the package is abandoned. Poliovirus samples, particularly in
protective packaging for transmission of diagnostic samples, could
retain their infectivity for an appreciable period. Publication of the
incident and recovery of the package should be priorities. Anyone with
knowledge of the incident should contact the South African National
Institute for Communicable Diseases (Tel: +27 11 386 6000) and/or the
police immediately. - Mod.CP]

Poliomyelitis in Chad
10.06.2011 - WHO

Chad is experiencing outbreaks of both wild poliovirus type 1 (WPV1 – 65 cases in 2011) and wild poliovirus type 3 (WPV3 - three cases).

The WPV3 outbreak has been ongoing since November 2007, and Chad is therefore considered to have re-established WPV3 transmission. A WPV1 outbreak began in September 2010 (as a result of a newly-imported virus from northern Nigeria), and has since been intensifying. Originally restricted to the greater N'Djamena area, WPV1 has spread in 2011 to other areas of the country, to the south (including areas bordering Central African Republic and Cameroon) and to the east (including areas bordering Sudan).

Historically, Chad has been associated with further international spread of poliovirus. Between 2004 and 2006, WPV1 spread from eastern Chad into Sudan, and subsequently to other areas of the Horn of Africa, Saudi Arabia, Yemen and Indonesia, resulting in 1,230 cases in these countries and over US$500 million in international emergency outbreak response costs. Additionally, in 2008 and 2009, WPV3 from southern Chad spread into Cameroon and CAR.

The two outbreaks in Chad require urgent action to improve the quality of vaccination activities in order to reach a higher proportion of children with oral polio vaccine (OPV) across the entire country, and particularly in the greater N'Djamena area, in the south and in the east of the country. Due to gaps in the quality of acute flaccid paralysis (AFP) surveillance at subnational levels, additional undetected WPV circulation cannot be ruled out.

To urgently address the situation, the Government of Chad with the technical support of partners has just finalized a 6 month national polio emergency plan. National Immunization Days (NIDs) using bivalent OPV have been conducted in May, with further supplementary immunization activities (SIAs) planned for June. The Government of Chad and partners are working to ensure that technical support is allocated to priority areas; special strategies will be used to reach high-risk populations and technical capacity to fill subnational surveillance gaps will be scaled up. As part of efforts to increase accountability for programme implementation, key indicators will be regularly monitored. Under the National Polio Emergency Plan, heads of district administrations will be charged with overseeing implementation reviews following each SIA, and providing summaries with clear outcomes and recommendations to provincial governors, whose offices will oversee direct oversight of the operationalisation of the plan. At the national level, monthly implementation reports will be prepared by the Ministry of Health and shared with the office of the Prime Minister.

Throughout 2010 and 2011, countries neighbouring Chad – notably Cameroon, CAR and Sudan – have all conducted multiple SIAs, to minimise the risk of re-infection. 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 timely response. Countries should also continue to boost routine immunization coverage against polio to further strengthen population immunity and minimize the risk of any importation.

Potential for international spread:

In 2010 and 2011, outbreak response has been inadequate. Given the uncontrolled and widespread geographic transmission of both WPV serotypes, historical spread to neighbouring countries, recent geographic expansion of WPV1 across Chad (including close to the borders with CAR and Sudan), the World Health Organization (WHO) rates as high the risk of further international spread. With the Hajj (pilgrimage to Mecca, Kingdom of Saudi Arabia) expected to begin in early November and Ramadan in early August, it is anticipated that pilgrims are now beginning to move across west and central Africa, further increasing the risk of polio spread. The Kingdom of Saudi Arabia last month issued polio vaccination requirements for travellers to the Hajj.

WHO Recommendation:

WHO recommends that all travellers from polio-infected areas be fully vaccinated prior to travel. As per recommendations outlined in WHO's International travel and health (ITH), travelers to and from Chad should be fully protected by vaccination. Travelers to Chad who have in the past received three or more doses of OPV should be offered another dose of polio vaccine before departure. Any unimmunized individuals intending to travel to Chad require a complete course of vaccine. Travelers from Chad should have a full course of vaccination against polio before leaving Chad, with a minimum one dose of OPV before departure. Some polio-free countries may also require travelers from Chad to be immunized against polio in order to obtain an entry visa.

Quelle: WHO

Gruß
Birgitt

POLIOMYELITIS - WORLDWIDE (08)
**********************************************
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] Pakistan
[2] Global update: Global Polio Eradication Initiative

******
[1] Pakistan
Date: Fri 10 Jun 2011
Source: The News International [edited]
<http://thenews.com.pk/NewsDetail.aspx?ID=16798>


Geo News reported Thursday [9 Jun 2011] that 2 new cases of polio
have been confirmed in Peshawar and Bannu.

Deputy Director EPI [Expanded Programme on Immunization], Dr Janbaz
talking exclusively to Geo News said a 3-year old girl, who is a
resident of Qaziabad, was confirmed to have contracted poliovirus.

The 2nd case of polio was confirmed in Mir Mast area of Bannu where a
15-year old infant was found affected by the contagious disease.

Dr Janbaz said so far 3 cases of polio had been reported in Peshawar
during 2011.

He said a 3-day polio campaign would be undertaken in Khyber
Pakhtunkhwa from [13 Jun 2011].

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

[According to The Global Polio Eradication Initiative website, as of
8 Jun 2011 there have been 49 cases of WPV1 associated polio in
Pakistan (see
<http://www.polioeradication.org/Dataand ... sweek.aspx>).
In the accompanying update text (see [3] below) there is mention that
in the one week period ending 8 Jun 2011, there were 6 cases of polio
confirmed, all residents of Balochistan and Khyber Pakhtoon and Gilgit
Baltistan. The 2 cases mentioned in the newswire above are from
Peshawar and Bannu, both situated in Kyhber Pakhtoon (formerly known
as NorthWest Frontier Province or NWFP) so it is unclear if these are
included in the 6 confirmed cases or if they are additional cases.

For a map of Pakistan showing provinces, see
<http://en.wikipedia.org/wiki/Administra ... f_Pakistan>. For
the interactive HealthMap/ProMED map of Pakistan, see
<http://healthmap.org/r/00tj >. For a map of Kyhber Pakhtoon showing
districts, see
<http://forum.urduworld.com/f109/*-home- ... hwa-26664/>.
- Mod.MPP]

******
[2] Global update: Global Polio Eradication Initiative
Date: Thu 9 Jun 2011
Source: Global Polio Eradication Initiative [edited]
<http://www.polioeradication.org/Dataand ... sweek.aspx>


Wild poliovirus (WPV) cases confirmed as of 8 Jun 2011
------------------------------------------------------
Total cases: Year-to-date 2011 / Year-to-date 2010 / Total in 2010*
Globally: 195 / 288 / 1288
- in endemic countries: 64 / 56 / 232
- in non-endemic countries: 131 / 232 / 1056
* Data in WHO as of 8 Jun 2010 for 2010 data and 7 Jun 2011 for 2011
data.

Afghanistan
- One new case was reported in the past week (WPV1 from Hilmand),
bringing the total number of cases for 2011 to 4. The most recent case
had onset of paralysis on [9 May 2011] (WPV1 from Hilmand).
- 2 areas of south western Afghanistan (parts of Farah and all of
Zabul) conducted additional SIAs from [5-7 Jun 2011]; planned SIAs
will cover the same areas again from [12-14 Jun 2011].
- Following high-level visits by members of the Ministry of Public
Health, access was reportedly improved in a number of key, high-risk
areas, notably in Zabul province (which was inaccessible during
previous supplementary immunization activities - SIAs).

India
- No new cases were reported in the past week. There has been one
case reported this year [2011], with onset of paralysis on [13 Jan
2011] in West Bengal (WPV1) -- more than 4 months ago.
- Preparations are ongoing for the next SNIDs [supplementary national
immunization days] on [26 Jun 2011], with bivalent OPV, in key
high-risk states, notably Uttar Pradesh, Bihar, and West Bengal.
Technical support is again being redeployed from polio-free areas to
support the planning, implementation and monitoring of the activities
in the highest-risk districts.

Nigeria
- No new cases were reported in the past week. The total number of
cases for 2011 remains 10. The most recent case had onset of paralysis
on [15 Apr 2011] (WPV3 from Kebbi).
- 6 of this year's 7 WPV1 cases are all genetically linked to
circulation of virus in Borno in 2010 and 2011 (3 Borno cases, 2
Jigawa cases from the same Local Government Area (LGA), and one case
from Sokoto). The 7th WPV1, from Kebbi state, is linked to circulation
in that state from last year [2010]. All 3 of this year's WPV3 cases
are also from Kebbi state. Mop-ups are being conducted in these and
other high-risk states to further strengthen population immunity
levels.
- In a 1st-of-its kind study in Nigeria, the field work for a
seroprevalence study in Kano has been completed. The outcomes of this
study will provide critical insight into population immunity levels
and efficacy of strategic implementation. Similar seroprevalence
studies conducted in 2010 and 2009 in India and Pakistan provided
crucial insight into those countries' eradication efforts, and helped
sensitize strategic approaches.
- The next polio immunization plus days (IPDs) are tentatively
planned for [25-28 Jun 2011], in 20 high-risk states, using bivalent
OPV.

Pakistan
- 6 new cases were reported in the past week (all WPV1s), from
Balochistan and Khyber Pakhtoon and Gilgit Baltistan, bringing the
total number of cases for 2011 to 49. The most recent case had onset
of paralysis on [23 May 2011] (WPV1 from Balochistan).
- The case in Gilgit Baltistan (the 1st in this part of Pakistan in
more than 12 years) is linked to virus transmission in the Federally
Administered Tribal Areas (FATA). 2 large-scale outbreak response
campaigns are currently planned.
- The next SNIDs will take place on [13-15 Jun 2011], using bivalent
OPV.

Angola
- No new cases were reported in the past week. The total number of
cases for 2011 remains 4. The most recent case (WPV1) had onset of
paralysis on [27 Mar 2011] in Kuando Kubango.
- A 2nd synchronized round with the Democratic Republic of the Congo
was held from [27-29 May 2011], using bivalent OPV. Further activities
in high-risk areas are tentatively planned for July [2011], in
highest-risk areas, again using bivalent OPV.

Central Asia and Russian Federation
- This region has not reported a case of wild poliovirus in more than
6 months. The most recent case had onset of paralysis on [25 Sep 2010]
in the Russian Federation.

Chad
- 3 new cases were reported in the past week (all WPV1s), bringing
the total number of cases for 2011 to 63. The most recent case had
onset of paralysis on [4 May 2011] (WPV1 from Logone Occidental).
- Chad is experiencing outbreaks of both WPV1 (60 cases in 2011) and
WPV3 (3 cases in 2011). The WPV3 outbreak has been ongoing since
November 2007 while the WPV1 outbreak began in September 2010 (due to
a newly-imported virus from northern Nigeria).
- The WPV1 outbreak is of particular concern. Originally restricted
to the greater N'Djamena area, it has spread in 2011 to other areas of
the country, including to the south (close to the border with Central
African Republic) and to the east (close to the border with Sudan).
Historically, Chad has been associated with extensive international
spread of polio.
- To urgently address the situation, the Government of Chad has just
finalized a 6 month national polio emergency plan. Staggered NIDs took
place in the 2nd half of May [2011], using bivalent OPV. Further
activities are planned in July [2011]. SIAs are also taking place in
neighbouring countries, to minimise the risk and consequences of
potential spread of polio from Chad.

Congo and Gabon
- No new cases were reported in the past week. Both countries have
only reported one case each this year (both WPV1). This most recent
case in the Republic of Congo was reported with onset of paralysis on
[22 Jan 2011], and the case in Gabon had onset of paralysis on [15 Jan
2011].

Democratic Republic of Congo (DRC)
- 4 new cases were reported in the past week (3 WPV1s from Kinshasa
and one WPV1 from Bas-Congo), bringing the total number of cases for
2011 to 54. The most recent case had onset of paralysis on [9 May
2011] (WPV1 from Kinshasa).
- The Democratic Republic of the Congo participated in a synchronized
campaign with Angola from [26-28 May 2011]. Further activities in
high-risk areas are tentatively planned for June [2011]. It is
anticipated that the entire population would again be targeted in
Kinshasa.

Horn of Africa
- No cases have been reported from this group of countries this year
[2011]. However, a single positive environmental sample collected in
December 2010 from Aswan, Egypt was found to be genetically linked to
virus circulating in Sudan (Khartoum, northern Sudan, and Jonglei,
southern Sudan) in early 2009, indicating undetected circulation.
- Given the link with the Aswan environmental positive, and
intensification of the WPV1 outbreak in neighbouring Chad, Sudan is
carrying out several rounds to help counter any undetected
transmission. Trivalent OPV was added to a measles campaign in
Northern Darfur, Western Darfur, and Southern Darfur states held from
[14 May 2011], and SNIDs using bivalent OPV are planned for Northern,
Red Sea, Khartoum, and Nile States to be held from [20 Jun 2011].
- Additionally, immunization posts are being set up at key border
crossings and gathering sites, including in the Darfur provinces in
western Sudan and in Port Sudan, on the Red Sea coast (from where many
populations leave towards the Arabian peninsula).
- At the same time, substantial subnational surveillance gaps remain
in some areas, notably along the Uganda/Kenya border area (affected by
an outbreak in 2009 which went undetected into 2010) -- undetected
circulation cannot be ruled out at this stage. SNIDs were held in
border areas of Uganda on [16 May 2011] and in Kenya on [4 Jun 2011].
Last month's [May 2011] Horn of Africa TAG [Technical Advisory Group]
put forward key recommendations, both to improve population immunity
levels, and to rapidly fill subnational surveillance gaps.

West Africa
- No new cases were reported in the past week. A total of 8 cases
(all WPV3s) have been reported from west Africa in 2011 (one from
Burkina Faso, 3 from Cote d'Ivoire, 3 from Mali, and one from Niger).
The most recent case had onset of paralysis on [20 Mar 2011] (WPV3
from Mali).
- Response to the WPV3 outbreak is continuing across west Africa.
Multi-country synchronized campaigns are planned for [23 Jun 2011] in
10 countries of the region, with a further activity planned in Cote
d'Ivoire in July [2011].

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

[Reviewing the weekly cumulative case counts by country as of 8 Jun
2011, there are 4 countries with double-digit case reports since 1 Jan
2011: Pakistan (49 cases), Nigeria (10 cases), DR Congo (54 cases),
and Chad (63 cases). These 4 countries represent a combined total of
176 reported cases or 90.3 percent of all reported cases to date this
year (2011). 2 of these countries are considered endemic countries
(Pakistan and Nigeria) while the other 2 are not (DR Congo and Chad),
but were re-infected after interruption of transmission. Countries
with dates of onset of most recent case in 2011 include: Pakistan,
Afghanistan, Nigeria, India, DR Congo, Chad, Angola, Mali, Cote
d'Ivoire, Burkina Faso, Congo, Niger, and Gabon -- the 4 endemic
countries (Pakistan, Afghanistan, Nigeria, and India), and 9
additional non-endemic countries, all in Africa.

For a map of polio cases in the world as of 7 Jun 2011, see
<http://www.polioeradication.org/Dataand ... dwide.aspx>.
- Mod.MPP]

Poliomyelitis in Pakistan
07.07.2011 - WHO

Pakistan has reported wild poliovirus type 3 (WPV3) isolated from a 16-month old child with onset of paralysis on 9 June 2011, from a conflict-affected, inaccessible area of Khyber Agency, Federally Administered Tribal Areas (FATA). This is the only case of WPV3 detected in Asia in 2011. WPV3 transmission in Asia is on the verge of elimination, with the last case occurring more than six months ago, on 18 November 2010 (also from Khyber Agency, FATA).

Confirmation of continuation of WPV3 transmission in tribal areas of Pakistan has significant implications for the global effort to eradicate WPV3, particularly as Asia is on the verge of eliminating circulation of this strain. The detection of WPV3 in Pakistan represents the risk that it may spread from this transmission focus to other WPV3-free areas of Asia and beyond. Globally, WPV3 transmission is at historically low levels in 2011, with other circulation of this strain restricted to parts of west Africa (17 cases in Côte d'Ivoire, Guinea, Mali and Niger), Nigeria (five cases) and Chad (three cases). The risk of onward spread of WPV3 is deemed as high by the World Health Organization (WHO), particularly given large-scale population movements within Pakistan, between Pakistan and Afghanistan, and expected large-scale population movements associated with Umrah and the upcoming Hajj (pilgrimage to Mecca, Kingdom of Saudi Arabia) in the coming few months.

In 2011, supplementary immunization activities (SIAs) in Pakistan have been inadequate in quality in key high-risk areas and a significant proportion of children remained inaccessible in conflict affected tribal areas. In FATA, particularly in Khyber agency, nearly 50% of children have been regularly missed during SIAs for the last two years. In addition to challenges relating to reaching children in insecure areas of Khyber Pakhtunkhwa and FATA, significant operational challenges continue to mar the quality of SIAs in accessible areas of Khyber and in other key transmission areas of the country, notably in the provinces of Balochistan and Sindh. In addition to confirmation of the only WPV3 case in Asia in 2011, Pakistan is affected by country-wide geographical transmission of wild poliovirus type 1 (WPV1), with 57 confirmed WPV1 cases in 2011 (as at 5 July 2011), compared with 14 WPV1 cases for the same period in 2010.

To urgently address the situation, the Government of Pakistan has this year launched a National Polio Emergency Action Plan, under the auspices of His Excellency the President. However, the Independent Monitoring Board (IMB), set up at the request of the World Health Assembly (WHA) in 2010 to independently monitor progress towards a polio-free world, in April 2011 expressed alarm that the Plan is taking too long to implement, a conclusion echoed by the Technical Advisory Group (TAG) of the Eastern Mediterranean in June 2011.

To rapidly build up immunity to both wild poliovirus strains, a Short Interval Additional Dose Strategy (SIAD) SIA with bivalent OPV is being conducted in Khyber Agency , the first passage on 4 July and the second on 12 July. It is expected that, as during the most recent SIAs in mid-June, 45% (89,449) of target children in Khyber Agency (80% in Bara Tehsil, i.e. approximately 73,000) will remain inaccessible during the SIADs. National Immunization Days (NIDs) will be conducted in the country on 18-20 July, using bivalent OPV (containing type 1 & 3 serotypes). However, key to success will be to overcome remaining operational challenges in fully-accessible areas and to implement special outreach strategies with full community participation to increase access to populations in security-compromised areas. To minimise the risk of WPV3 re-infecting Afghanistan, Subnational Immunization Days (SNIDs) - including in border areas with Pakistan - will be conducted in the country on 10-12 July, also using bivalent OPV.

It is important that countries across Asia and the Eastern Mediterranean strengthen disease surveillance for acute flaccid paralysis (AFP), in order to rapidly detect any poliovirus importations and facilitate a rapid response should importation occur. Countries should also continue to boost routine immunization coverage against all strains of polio to minimize the consequences of any introduction.

As per recommendations outlined in WHO's International travel and health, travellers to and from Pakistan should be fully protected by vaccination. Travellers to Pakistan who have in the past received three or more doses of OPV should be offered another dose of polio vaccine before departure. Any unimmunized individuals intending to travel to Pakistan should complete a full course of vaccination. Travellers from Pakistan should have a full course of vaccination against polio before leaving Pakistan, with a minimum one dose of OPV before departure. Some polio-free countries may also require travellers from Pakistan to be immunized against polio in order to obtain an entry visa.

With Hajj and Umrah season already started, and Umrah expected to increase during Ramadan (in August) and Hajj in early November, the Kingdom of Saudi Arabia has vaccination requirements for travellers (all ages) for Umrah and Hajj. These requirements are in line with recommendations outlined in WHO's International travel and health, with the addition that travellers of all ages from polio endemic countries are required to show proof of vaccination with OPV six weeks before travel to the Kingdom of Saudi Arabia, and will receive a further dose of OPV upon their arrival.


Gruß
Birgitt

POLIOMYELITIS - WORLDWIDE (09): INDIA, PAKISTAN, NIGERIA
********************************************************
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] India: VDPV (vaccine derived poliovirus)
[2] Pakistan: vaccine refusal
[3] Nigeria: vaccine refusal
[4] Global update: Global Polio Eradication Initiative

******
[1] India - VDPV (vaccine derived poliovirus)
Date: Sun 7 Aug 2011
Source: The Times of India (TOI), Times News Network (TNN) [edited]
<http://timesofindia.indiatimes.com/indi ... 511191.cms>


5 children contract polio from vaccine
--------------------------------------
From being labelled the world's lone polio exporter in 2006 to
reporting just one positive case till the 8th month of this year
[2011], the polio scenario has never looked better for India. But
celebrations are not in offing as the country is now faced with the
challenge of fighting the vaccine derived poliovirus [VDPV] rather
than the wild virus itself.

Simply put, the small quantity of the weakened poliovirus present in
the oral polio vaccine [OPV] (to activate immune response) is the one
seemingly causing polio in children now. At least, 5 children from
Chhattisgarh, Punjab, Rajasthan, [Uttar Pradesh, and Madhya Pradesh]
have been struck by the vaccine derived polio, whereas only one child
from West Bengal has tested positive for the wild poliovirus. The
child from Chhattisgarh, who had a congenital anomaly and was highly
immunodeficient, recently died. There were 21 cases of vaccine derived
polio in 2009 that came down to 6 in 2010.

But, experts are of the view that even though cases of vaccine derived
polio are a cause of worry, it is not as scary as the wild poliovirus
that India has been fighting for decades. A senior official from the
ministry of health and family welfare, New Delhi, told TOI, "We are
aware of the vaccine derived poliovirus cases. But, all the 5 cases
are isolated and they do not seem to be circulating the virus in the
community," the official said. He, however, admitted the virus in the
vaccine can "mutate" and cause paralysis. "But, it is much easier to
bring vaccine derived polio under control," the official said.

Yet, some experts say the government should have been better prepared
for such a scenario as it was alerted at least a decade back that
there will be a stage when vaccine derived virus will be a bigger
danger. Former chairman of the India Expert Advisory Group Dr T Jacob
John said vaccine derived polio has a tendency to "become wild-like",
and experts had informed the policy-makers about it long ago. He,
however, added that India not reporting any wild poliovirus from
environment sampling in the last 8 months is a very positive sign.

According to sources in the health ministry, deliberations are on as
to how to tackle this. Since all the 5 cases of vaccine derived polio
are of type II [2] strain, there were discussions of stopping the
trivalent immunizations (dosage for all 3 polio strains) for a while
so that the type II virus is not fed in the community. But, the idea
was soon aborted thinking it could lead to an outbreak in the
low-immune population. "The situation is more like a double-edged
sword now," said Dr John, adding that benefits of OPV still outweigh
cases of vaccine derived poliovirus.

[byline: Sumitra Deb Roy]

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

[The newswire above refers to the 5 additional paralytic cases
reported in 2011 as being due to infection with vaccine derived
polioviruses (VDPV). The newswire also mentions that these cases are
sporadic, and not associated with "circulating vaccine derived
poliovirus (VDPV)". More detailed information on each of the cases was
not provided so that it was not clear to this moderator if these cases
were classified as VAPP (vaccine associated paralytic polio) cases,
where the individuals were those who developed paralysis after
directly receiving a dose of the oral polio vaccine (OPV), versus
those individuals who did not have a history of recent receipt of a
dose of OPV, but had paralytic disease where a vaccine derived
poliovirus was obtained from stool specimens. In the latter instance,
the cases would be classified as associated with circulating VDPV
(cVDPV).

According to Andrus and colleagues, the rate of VAPP in Latin America
during the period 1989-1991 was found to be one case per 1.5-2.2
million doses of vaccine administered, compared with 1 case per 2.5
million doses distributed in the USA during the period 1980-1989, and
1.4 doses of vaccine administered in England and Wales during the
period 1985-1991 (Andrus JK, Strebel PM, deCuadros CA, Olive JM. Risk
of vaccine-associated paralytic poliomyelitis in Latin America,
1989-91. Bull World Health Organ. 1995; 73(1): 33-40;
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2486585>).

The Technical Consultative Group to the WHO on the eradication of
polio gives an estimated rate of VAPP as 1 case per 1 million live
births (see Technical Consultative Group to the World Health
Organization on the Global Eradication of Poliomyelitis. "Endgame"
issues for the global polio eradication initiative. Clin Inf Dis.
2002; 34(1): 72-7;
<http://cid.oxfordjournals.org/content/34/1/72.long>.) (For an
interesting discussion on these estimates in India, see Jacob John's
letter to the editor Vaccine associated paralytic polio in India, Bull
World Health Organ. 2002, 80(11): 917;
<http://www.who.int/bulletin/archives/80%2811%29917.pdf>).

With respect to cVDPV, according to data available on the Global Polio
Eradication Initiative website, during the period 2000-2011, 77 cases
due to cVDPV-1 have been reported (cases reported from Mozambique,
Myanmar, Indonesia, China, Philippines and DOR/Haiti), 442 cases due
to cVDPV-2 (cases reported from Nigeria, Somalia, Afghanistan, Chad,
DR Congo, Niger, India, Ethiopia, and Madagascar), and 9 cases due to
cVDPV-3 (cases reported from Ethiopia and Cambodia). (Of note,
according to the data available on the Polio Eradication Initiative
website, the most recent cVDPV-2 virus isolated in India was on 18 Jan
2010 -- the 5 cases mentioned above have not been included in the
database (see
<http://www.polioeradication.org/Dataand ... virus.aspx>
for tables with number of cases by country, year, and VDPV virus
type.) In addition, only 2 cases of VDPV were reported from India in
2010.

On further investigation, this moderator found that according to the
data available on the Indian National Polio Surveillance Project
(NPSP) website, there have been 5 cases of VDPV associated paralytic
disease in 2011 -- one each in Chhattisgarh, Madhya Pradesh, Punjab,
Rajasthan, and Uttar Pradesh as mentioned in the newswire above.
(<http://www.npspindia.org/bulletin.pdf>). With respect to VAPP cases,
according to the NPSP data, there have been 573 type 1, 397 type 2,
612 type 3, and 480 mixed vaccine virus types isolated in 2011 as of
the week ending 30 Jul 2011, in association with acute flaccid
paralysis cases. Hence, the "apparent" discrepancy is most likely
related to the definition of cVDPV as a VDPV associated with at least
2 cases, whereas the VDPV cases in India in 2011 are single,
non-related cases.

Of note, there have been no cases of paralytic polio due to infection
with WPV-2 (wild poliovirus type 2) since October 1999. Looking at a
risk benefit assessment, it appears as though the risk of paralytic
polio due to infection with WPV-2 worldwide is presently zero (and has
been since the last isolate in October 1999), whereas there have been
442 cases of paralytic polio due to infection with a VDPV-2. Perhaps
the time has come to re-evaluate the use of a trivalent OPV, and
consider using a bivalent OPV with vaccine virus types 1 and 3 -- the
2 WPV types presently in circulation and responsible for all paralytic
polio cases due to WPV infections.

For a map of India with states, see
<http://www.theindiatravelguide.com/test/indiamap1.JPG>. For the
HealthMap/ProMED map of India, see <http://healthmap.org/r/008o>. -
Mod.MPP]

******
[2] Pakistan: vaccine refusal
Date: Thu 4 Aug 2011
Source: Dawn.com (Pakistan) [edited]
<http://www.dawn.com/2011/08/04/anti-pol ... uly-2.html>


Anti-polio drive in KP: Over 16 000 refusal cases recorded in July
[2011]
------------------------------------------------------------------
The health department's failure to educate the parents on the efficacy
of oral polio vaccine (OPV) has been resulting in large-scale refusals
against immunisation of children, officials say.

"In the last 3-day campaign in July [2011], 16 721 children could not
be immunised mainly because of the parents' misperceptions about the
efficacy of the OPV," the officials said.

They said that refusals against the OPV were so widespread that except
Kohistan and Chitral, the rest of 23 KP [Khyber Pakhtunkhwa,
previously known as the North-West Frontier Province] districts had
been regularly registering refusal cases.

Several measures taken by the government are yet to yield results
because there is no field campaign to prevail upon the parents that
vaccination is meant to safeguard their children against the crippling
ailment. For instance, the parents refuse vaccination of their
children on the argument that the OPV is a ploy designed to turn the
recipient children infertile and impotent.

The health department doesn't have any mechanism to clearly prove that
the OPV is safe and contains no agent that causes impotency. As a
result, in areas where literacy rate is very low the parents continue
to resist polio vaccination of their children.

Several donor organisations, spearheaded by the WHO and UNICEF, have
been financing the polio campaign from the past 15 years, but still
achieving the goal of polio eradication seems to be a difficult task.

Last year [2010], when the Khyber Pakhtunkhwa and the Federally
Administered Tribal Area (FATA) together recorded 100 cases of the
total 142 cases in the country, the donor organisations expressed
concern over the surge in polio cases and threatened to stop funding
the campaign if the crippling disease was not eradicated this year
[2011]. On its part the government has been changing strategies to
cope with the situation, but instead of recording any improvement
Pakistan is inching towards being known as the polio endemic country.

Officials in the UN said that the Khyber Pakhtunkhwa had previously
been giving militancy and violence as the reasons for the poor
vaccination campaigns, but most of refusal cases were now emerging
from peaceful areas. They said that over Rs 500 million [USD 5.8
million] was being spent on each of the 9 campaigns every year to
provide the OPV to about 5 million children.

The UN agencies also argue that Pakistan has been the main source of
transportation of polioviruses to the countries long declared
polio-free and urging the government to apply political commitment to
wipe out the disease as early as possible.

The Khyber Pakhtunkhwa government has implemented its own polio
eradication strategy with the claim that the disease will be
eliminated by end of 2011, but the province has so far recorded 6
cases of the total 60 in the country and indications are that the
disease would continue to haunt the children.

The government has also been making efforts to involve the religious
figures and teachers in the campaign, but some officials claim such
steps fail to produce any tangible results.

However, Dr Jan Baz Afridi, the top polio officer in the Khyber
Pakhtunkhwa, argues that they have brought down refusal cases from 26
000 to 16 000 during the past 6 months and are well on the way to end
such cases by convincing the parents in due course of time. "The
refusal cases have not increased, but we have strengthened our
reporting system to record every child. Earlier, the system of
reporting was not so strong to cover the maximum children," he said.

[byline: Ashfaq Yusufzai]

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

[The apparent high number of refusals for vaccination with OPV in an
endemic country such as Pakistan is disturbing. While the newswire
mentions that there is an improvement, with a prior estimated 24 000
refusals now "down to" 16 000 refusals, one cannot help but remember
what happened when the northern states of Nigeria had large numbers of
refusals of vaccination for similar spurious rumors back in 2004, and
the subsequent impact on many other countries that had previously
interrupted transmission of wild poliovirus (see prior ProMED-mail
posts listed below). There were over 14 countries with importations
and local transmission of WPV related to viruses of Nigerian origin.
(If one looks at the weekly update presented in item [4] below, one
can see that during the period 1 Jan 2010 through 2 Aug 2011, there
were 20 non-endemic polio countries that had cases due to WPV
infections related to importations from endemic countries.

For a map of Pakistan with administrative divisions, see
<http://www.columbia.edu/itc/mealac/prit ... kadmin.jpg>.
For the HealthMap/ProMED map of Pakistan, see
<http://healthmap.org/r/02S_>. - Mod.MPP]

******
[3] Nigeria: vaccine refusal
Date: Tue 2 Aug 2011
Source: The Sacramento Bee, Associated Press (AP) report [edited]
<http://www.sacbee.com/2011/08/02/381149 ... efuse.html>


Nigeria: hundreds of parents refuse polio vaccines
--------------------------------------------------
An independent monitor says hundreds of parents are defying threats of
jail time by refusing polio vaccines for their children in a high-risk
northern Nigerian state.

Muhammad Abdu Zango, Kano state coordinator of Journalists Against
Polio, said Tuesday [2 Aug 2011] that more than 200 parents refused
the vaccine in one district alone.

Vaccinator Amina Ahmed says dozens more refused in another district.

The 4-day drive targeted some 6 million children in a state that has
recorded 2 new polio cases this year [2011].

Authorities last week [week of 25 Jul 2011] said noncompliant parents
would be prosecuted. Parents have given various reasons to resist the
vaccine.

Polio is largely eradicated in most of the world, but health officers
say even a few vaccine holdouts can compromise an eradication
campaign.

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

[As mentioned above, in 2004 there was massive refusal to vaccinate
with OPV in the northern states of Nigeria. This persisted for several
years, during which time there were more than 14 countries that had
previously interrupted WPV circulation, which had imported WPV
associated paralytic cases due to viruses related to those circulating
in Nigeria. It is nice to see that the situation has changed in
Northern Nigeria, with a government stance of intolerance for vaccine
refusal.

For a map of Nigeria with states, see
<http://us-africa.tripod.com/nigeriamap.gif>. For the HealthMap/ProMED
map of Nigeria, see <http://healthmap.org/r/0rCH>. - Mod.MPP]

******
[4] Global update: Global Polio Eradication Initiative
Date: Wed 3 Aug 2011
Source: Global Polio Eradication Initiative [edited
<http://www.polioeradication.org/Dataand ... sweek.aspx>


Wild poliovirus (WPV cases)
Total cases: Year-to-date 2011 / Year-to-date 2010 / Total in 2010*
Globally: 303 / 597 / 1349
In endemic countries: 96 / 77 / 232
In non-endemic countries: 207 / 520 / 1117

Year-to-date 2011 // Year-to-date 2010 //
Countries: WPV1 / WPV3 / Total // WPV1 / WPV3 / Total // Total 2010* /
Date of most recent case

Afghanistan: 11 / 0 / 11 // 4 / 8 / 12 // 25 / 28 Jun 2011
Nigeria: 16 / 8 / 24 // 3 / 3 / 6 // 21 / 24 Jun 2011
Pakistan: 59 / 1 / 60 // 17 / 17 / 34 // 144 / 22 Jun 2011
India: 1 / 0 / 1 // 7 / 18 // 25 // 42 / 13 Jan 2011
DR Congo: 71 / 0 / 71 // 2 / 0 / 2 // 100 / 3 Jul 2011
Chad: 90 / 3 / 93 // 0 / 14 / 14 // 26 / 27 Jun 2011
Angola: 4 / 0 / 4 // 17 / 0 / 17 // 33 / 27 Mar 2011
Cote d'Ivoire: 0 / 28 / 28 // 0 / 0 / 0 // 0 / 26 Jun 2011
Burkina Faso: 0 / 2 / 2 // 0 / 0 / 0 // 0 / 15 Jun 2011
Mali: 0 / 5 / 5 // 3 / 0 / 3 // 4 / 10 Jun 2011
Guinea: 0 / 1 / 1 // 0 / 0 / 0 // 0 / 14 May 2011
Congo: 1 / 0 / 1 // 0 / 0 / 0 // 441 / 22 Jan 2011
Niger: 0 / 1 / 1 // 0 / 2 / 2 // 2 / 19 Jan 2011
Gabon: 1 / 0 / 1 / 0 / 0 / 0 // 0 / 15 Jan 2011
Uganda: 0 / 0 / 0 // 0 / 0 / 0 // 4 / 15 Nov 2010
Russian Federation: 0 / 0 / 0 // 0 / 0 / 0 // 14 / 25 Sep 2010
Liberia: 0 / 0 / 0 // 1 / 0 / 1 // 2 / 8 Sep 2010
Nepal: 0 / 0 / 0 // 5 / 0 / 5 // 6 / 30 Aug 2010
Kazakhstan: 0 / 0 / 0 // 0 / 0 / 0 // 1 / 12 Aug 2010
Tajikistan: 0 / 0 / 0 // 452 / 0 / 452 // 457 / 4 Jul 2010
Turkmenistan: 0 / 0 / 0 // 0 / 0 / 0 // 3 / 28 Jun 2010
Senegal: 0 / 0 / 0 // 18 / 0 / 18 // 18 / 30 Apr 2010
Mauritania: 0 / 0 / 0 // 5 / 0 / 5 // 5 / 28 Apr 2010
Sierra Leone: 0 / 0 / 0 // 1 / 0 / 1 // 1 / 28 Feb 2010

Total: 254 / 49 / 303 // 535 / 62 / 597 // 1349
Total in endemic countries: 87 / 9 / 96 // 31 / 46 / 77 // 232
Total outbreak: 167 / 40 / 207 // 504 / 16 / 520 // 1117

Data in WHO as of 3 Aug 2010 for 2010 data and 2 Aug 2011 for 2011
data

*The 2010 total for Congo includes cases with inadequate specimens
that have been exceptionally classified as confirmed polio based on
their association with the WPV1 outbreak

Country weekly updates:

Afghanistan
- No cases were reported this week. The total number of cases for 2011
remains 11. The most recent case (wild poliovirus type 1 -- WPV1) had
onset of paralysis 28 Jun 2011 in Musa Qala district of Hilmand
province.
- Sub-national Immunization Days (SNIDs) took place from 10-12 Jul
2011. Bivalent oral polio vaccine (bOPV) was used to vaccinate
children in high risk districts. The next supplementary immunization
activities (SIAs) will be National Immunization Days (NIDs) in
September [2011].

India
- India has not reported a single case in more than 6 months. The most
recent case had onset of paralysis on 13 Jan 2011 in West Bengal
(WPV1).
- SNIDs took place beginning 26 Jun 2011 in Uttar Pradesh, Bihar,
Delhi, and parts of West Bengal and other high-risk areas. The next
SIAs will be SNIDs using bivalent oral polio vaccine (bOPV) in August
2011.
- India has also gone 8 months without detecting any wild poliovirus
from environmental sampling. The last positive environmental sample
was taken from Mumbai in November 2010.

Nigeria
- No new case was reported in the past week. The total number of cases
for 2011 remains 24. The most recent case (WPV3) had onset of
paralysis on 24 Jun 2011 in Sabon-Gari, Kaduna State. This is the 1st
wild poliovirus detected in Kaduna in 2011.
- A 6th round of supplementary immunization activities (SIA) took
place 28-31 Jul 2011 in 11 states using a mix of bivalent and
trivalent OPV. The quality of this round is currently being evaluated.
Any Ward with greater than 10 per cent missed children will redo the
activity to ensure that as many children are reached as possible.

Pakistan
- No new case was reported in the past week. The total number of cases
for 2011 remains 60. The most recent case (WPV1) had onset of
paralysis on 22 Jun 2011 in Quetta, Balochistan.
- The latest NIDs performed took place 18-25 Jul 2011 using bOPV.
- The next SIAs will be SNIDs using bOPV and are scheduled from 19-21
Sep 2011.

Angola
- No new cases were reported in the past week. The total number of
cases for 2011 remains 4. The most recent case (WPV1) had onset of
paralysis on 27 Mar 2011 in Kuando Kubango.
- SNIDs using bOPV took place on 8-10 Jul 2011, in Luanda, Kuando
Kubango, Cunene, and 3 municipalities of Uige. The next SIAs will be
Child Health Days (CHDs) to be held on 9-22 Sep 2011. Trivalent OPV
will be distributed to children under 5 along with measles vaccine,
vitamin A and deworming tablets.

Chad
- 4 new cases were reported in the past week (all WPV1). The total
number of cases for 2011 is now 93. The most recent case (WPV1) had
onset of paralysis on 27 Jun 2011 in Doba, Logone Oriental.
- The "Staggered SIA" approach continues to be utilized in Chad in
order to maximize technical staff support in each area. The latest
staggered round commenced 29 Jul 2011 using bivalent oral polio
vaccine (bOPV).
- The next round is scheduled for September 2011, with exact dates to
be confirmed.

Democratic Republic of the Congo (DRC)
- No new cases were reported in the past week. The total number of
cases for 2011 remains 71. The most recent case had onset of paralysis
on 3 Jul 2011 in Kimvula, Bas-Congo.
- The 2nd of the 2 short interval additional dose (SIAD) campaigns
took place 27 Jul-1 Aug 2011 in 48 high-risk districts of Bandundu,
Bas-Congo, and Kinshasa. Monovalent OPV type 1 (mOPV1) was used. The
1st SIAD round was carried out in 13 high-risk districts of Bandundu
and Bas-Congo from 13-15 Jul 2011.
- SNIDs using mOPV1 are being planned for August 2011.

Horn of Africa
- No cases have been reported from this group of countries this year
[2011].
- Polio-funded staff continue to assist in the response to the
drought. The Horn of Africa coordination meeting taking place in
Nairobi this week [week of 3 Aug 2011] will not only discuss and plan
upcoming SIAs but will look at how polio infrastructure can be
utilized in the response to the drought.

West Africa
- One new case was reported in Burkina Faso. The most recent case had
onset of paralysis on 15 Jun 2011 in Djibo, Dori.
- 11 new cases were reported in Cote d'Ivoire the past week. The most
recent case had onset of paralysis on 26 Jun 2011 in Zoukougbe, Haut
Sassandra.
- One new case was reported in Mali. The most recent case had onset of
paralysis on 10 Jun 2011 in Bankass, Mopti.
- This brings the total number of cases for 2011 in the West Africa
region to 37 (all WPV3 -- 2 from Burkina Faso, 28 from Cote d'Ivoire,
one from Guinea, 5 from Mali, and one from Niger).
- A multi-country campaign started on 24 Jul 2011 in Burkina Faso,
Cote d'Ivoire, Guinea, Liberia and Mali. A combination of bOPV and
mOPV3 is being used to help combat the outbreak of WPV3.
- Cote d'Ivoire along with 6 neighbouring countries (NIDs in Sierra
Leone and SNIDs in Burkina Faso, Ghana, Guinea, Liberia, and Mali) are
planning a further round in August 2011.

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

[Noteworthy is the observation that 207 of the 303 (68 per cent)
reported cases of WPV associated polio during the period 1 Jan through
2 Aug 2011, are outbreak associated cases in non-endemic countries. In
addition, of the 96 WPV associated cases reported in endemic countries
during the period 1 Jan through 2 Aug 2011, 60 (63 per cent) were in
Pakistan, 24 (25 per cent) were in Nigeria, 11 (11 per cent) were in
Afghanistan, and only 1 (1 per cent) was in India.

For the map of locations of wild poliovirus associated polio cases in
2011 as of 2 Aug 2011, see
<http://www.polioeradication.org/Dataandmonitoring.aspx>. - Mod.MPP]

POLIOMYELITIS - WORLDWIDE (10): COMMENT
***************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Mon 8 Aug 2011
Source: GIDEON (Global Infectious Disease & Epidemiology Network)
[edited]
<http://www.gideononline.com>


[re: Poliomyelitis - worldwide (09): India, Pakistan, Nigeria
20110808.2402]
-------------------------------------------------------------
A growing contribution of Nigeria and Pakistan to the global incidence
of poliomyelitis reflects decreasing incidence in India, rather than
an absolute increase in Nigeria and Pakistan. [1-4] See graphs:
<http://www.gideononline.com/wp/wp-conte ... -India.png>
and
<http://www.gideononline.com/wp/wp-conte ... -India.png>.

These trends clearly illustrate the relative success of mass
vaccination, as illustrated in the following 2 graphs*:
<http://www.gideononline.com/wp/wp-conte ... vsVacc.png>
and
<http://www.gideononline.com/wp/wp-conte ... vsVacc.png>

Health care workers in Nigeria and Pakistan may find the last 2 graphs
useful in convincing citizens who hesitate to vaccinate their
children.

* Custom graphs are generated using an interactive module in Gideon
<http://www.gideononline.com/cases/video/multi-graphs/>.

References
----------
1. Berger SA: Infectious Diseases of India, 2011. 480 pp, 65 graphs,
3503 references. Gideon e-books series.
<http://www.gideononline.com/ebooks/coun ... -of-india/>
2. Berger SA: Infectious Diseases of Nigeria, 2011. 410 pp, 60 graphs,
1684 references. Gideon e-books series.
<http://www.gideononline.com/ebooks/coun ... f-nigeria/>
3. Berger SA: Infectious Diseases of Pakistan, 2011. 354 pp, 39
graphs, 1243 references. Gideon e-books series.
<http://www.gideononline.com/ebooks/coun ... -pakistan/>
4. Berger SA: Poliomyelitis: Global Status, 2011. 540 pp, 867 graphs,
994 references. Gideon e-books series.
<http://www.gideononline.com/ebooks/dise ... al-status/>

--
communicated by:
Dr Steve Berger
Geographic Medicine
Tel Aviv Medical Center
Israel
<mberger@post.tau.ac.il>

[ProMED-mail would like to thank Dr Berger for his continued
contributions and sharing of the GIDEON database with the ProMED-mail
subscribers. Dr Berger is correct when he points out that the
increased proportion of cases in Nigeria and Pakistan reflect a
decrease in cases in India. - Mod.MPP]

POLIOMYELITIS - WORLDWIDE (12): WHO CHINA, KENYA
************************************************
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] China: WHO confirmation
[2] Worldwide: as of 31 Aug 2011

******
[1] China: WHO confirmation
Date: Thu 1 Sep 2011
Source: WHO Global Alert and Response (GAR) [edited]
<http://www.who.int/csr/don/2011_09_01/en/index.html>


Wild poliovirus confirmed in China 1 Sep 2011
---------------------------------------------
The Ministry of Health in China has informed WHO that wild poliovirus
type 1 (WPV1) has been isolated from 4 young children, aged between 4
months and 2 years, with onset of paralysis between 3 and 27 Jul 2011.
All 4 cases are from Hetian prefecture, Xinjiang Uygur autonomous
region, China. Genetic sequencing of the isolated viruses indicates
they are genetically related to viruses currently circulating in
Pakistan. The last WPV case in China, reported in 1999, was due to an
importation from India. The last indigenous polio case occurred in
China in 1994.

A national team of clinicians, laboratory experts, epidemiologists,
and public health experts has been dispatched to the affected region,
to assist in the investigation and planning of response activities,
and this team will be joined by international support as required.
National, Xinjiang autonomous region and local public health
authorities are currently conducting an epidemiological investigation,
including collection of stool specimens from contacts and evaluation
of vaccine coverage.

The Ministry of Health plans to conduct an initial response
vaccination campaign in early September [2011], targeting 3.8 million
children aged under 15 years in the key affected outbreak area, and
children aged under 5 years in other areas of Xinjiang. This website
will be updated as more information becomes available.

--
communicated by:
ProMED-mail rapporteur Marianne Hopp

[For the interactive HealthMap/ProMED-mail map of Xinjiang Uygur
autonomous region, China, see <http://healthmap.org/r/1aQE>. In the
prior post on these cases, the newswire mentioned that the WPV
identified in this cluster was the same as a WPV circulating in
Pakistan in 2009. The notice above mentions the virus involved is
similar to those currently circulating in Pakistan, hence this
moderator's previous observation that the virus had most likely been
circulating silently in the region for 2 years might have been
erroneous. - Mod.MPP]

******
[2] Worldwide: as of 31 Aug 2011
Date: Wed 31 Aug 2011
Source: Global Polio Eradication Initiative [edited]
<http://www.polioeradication.org/Dataand ... sweek.aspx>


- Genetic sequencing of a case of WPV1 in Nyanza province, western
Kenya, continues. While it is therefore an "advance notice case" and
not officially reported, this case has significant implications for
polio eradication in the Horn of Africa. The most recent WPV found in
the greater Horn of Africa area was from Uganda, with onset of
paralysis on [15 Nov 2010]. This was a continuation of the 2009
outbreak in the Turkana region of northern Kenya.

Afghanistan
-----------
Five new cases were reported in the past week, bringing the total
number of cases for 2011 to 18 (all WPV1). All 5 cases were due to
wild poliovirus type 1 (WPV1) and all were in districts that had not
yet reported cases in 2011 -- Nad Ali in Hilmand or Shah Wali Kot and
Panjwayi in Kandahar. The most recent case had onset of paralysis on
[15 Aug 2011] in Panjwayi district, Kandahar province, in the
country's south.

India
-----
India has reported just one case this year [2011] -- WPV1 with onset
of paralysis on [13 Jan 2011] in West Bengal. The country has gone
more than 7 months without reporting a single case.

Nigeria
-------
One case was reported in the past week. The total number of cases
reported from Nigeria in 2011 is now 26 (19 WPV1, 7 WPV3), compared to
6 at this time last year [2010]. This week's case was reported with
onset of paralysis on [18 Jul 2011] in Nguru Local Government Area
(LGA), Yobe state. This is the 1st case to be reported in Nguru this
year [2011]. The most recent case remains the WPV1 reported in Bagudo
LGA, Kebbi State, with onset of paralysis recorded on [20 Jul 2011].

Pakistan
--------
Five cases (all WPV1) were reported this week, bringing the total
number of cases for 2011 to 77 (76 WPV1 cases and one WPV3 case). The
most recent case (WPV1) had onset of paralysis on [17 Aug 2011] in
Peshawar district of Khyber Pakhtunkhwa in north west Pakistan.

Angola
------
No new cases were reported in the past week. The total number of cases
for 2011 remains 4. The most recent case (WPV1) had onset of paralysis
on [27 Mar 2011] in Kuando Kubango.

Chad
----
Nine cases were reported in the past week, all WPV1. The total number
of cases for 2011 has risen to 109 (106 WPV1, 3 WPV3). The most recent
case had onset of paralysis on [31 Jul 2011] in Koumra district of
Mandoul province. This is the 1st case this year to be reported in
Mandoul. Newly infected districts this week include Moissala district
of Mandoul province along with Abou Deia and Haraze Manuegne in
Salamat province.

Democratic Republic of the Congo
--------------------------------
No new cases were reported in the past week. The total number of cases
for 2011 remains 75 (all WPV1). The most recent case had onset of
paralysis on [25 Jul 2011] in Kimvula, Bas-Congo.

Horn of Africa
--------------
No wild poliovirus cases have been officially reported this week. The
total number of cases officially reported in 2011 remains zero.
However, the Ministry of Health of Kenya has alerted WHO that it has
isolated WPV1 from an AFP [acute flaccid paralysis] case with onset of
paralysis on [30 Jul 2011] in Nyanza Province, on Lake Victoria,
western Kenya. This is exactly 2 years since Kenya reported its last
case.

West Africa
-----------
Five cases were reported from this region in the past week -- 3 WPV3
from Cote d'Ivoire, one WPV3 from Mali, and one WPV1 from Niger. The
total number of cases for 2011 in the West African region is now 46 (2
from Burkina Faso, 34 from Cote d'Ivoire, 2 from Guinea, 6 from Mali,
and 2 from Niger). All but one of the WPV cases reported in West
Africa this week are in districts that had not previously reported any
WPV cases this year. The case reported in Niger is the 1st case of
WPV1 reported from West Africa this year. The most recent case remains
the WPV3 reported in Siguiri district of Kankan province, Guinea, with
onset of paralysis on [27 Jul 2011].

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

[The continued identification of cases in endemic countries in
geographic areas that have not confirmed cases recently is
disconcerting, as is the continued identification of WPV associated
disease in countries that had been considered polio free and are now
identifying cases. The identification of a WPV case in Kenya now 2
years since the last case, following in the footsteps of having
identified a WPV case in Uganda in November 2010 genetically similar
to a virus that had circulated in Kenya the previous year suggests
that there continues to be undetected circulation of WPV in Kenya and
Uganda that is not being detected through surveillance activities.

For the global map showing geographic location of wild poliovirus
(WPV) associated disease worldwide, see
<http://www.polioeradication.org/Dataandmonitoring.aspx>. - Mod.MPP]

China - Polio
05.09.2011

Nachdem China 11 Jahre lang poliofrei war, erkrankten im Juli 4 Kinder zwischen 4 Monaten und 2 Jahren. Es bestehen genetische Ähnlichkeiten zu einem Virusstamm, der aktuell in Pakistan vorkommt. Impfschutz beachten. / Quelle: crm

Gruß
Birgitt