Kinderlähmung - Poliomyelitis

[Birgitt]

Fälle von Kinderlähmung in Namibia

Bis Ende vergangenen Jahres wollte die Weltgesundheits-Organisation die Kinderlähmung ausrotten. Doch viele Menschen ließen sich nicht impfen. Jetzt breitet sich die Krankheit wieder in Afrika aus. In Namibia gibt es die ersten Fälle von Kinderlähmung seit zehn Jahren.

weiterlesen: NETZEITUNG


Informationen zu Poliomyelitis HIER


Gruß
Birgitt

[Birgitt]

Namibia launches mass polio drive

21.06.2006

Health workers in Namibia have started a three-day campaign to vaccinate the entire population against polio. The drive comes a month after the country's first polio outbreak in a decade, which has killed 15 people. Most of the victims were aged over 20 ........

weiterlesen: BBC News

Gruß :?
Birgitt

[Alexander]

oder die Meldung in Deutsch:

Start für flächendeckende Impfung gegen Kinderlähmung in Namibia
Bislang 15 Tote und 96 registrierte Erkrankte

Windhoek - Nach einem Ausbruch von Kinderlähmung im südwestafrikanischen Staat Namibia mit bisher 15 Toten und 96 registrierten Fällen hat die Regierung am Mittwoch eine landesweite Impfkampagne gestartet. mehr...

Grüsse
Alexander

[Birgitt]

Namibia impft gesamte Bevölkerung gegen Kinderlähmung

27.06.2006 - Windhuk (dpa) - Nach dem überraschenden Ausbruch der Kinderlähmung hat Namibia die gesamte Bevölkerung gegen Polio geimpft. Die erste Impfkampagne habe mehr als 100 Prozent der Bevölkerung erreicht, berichteten die Behörden in Windhuk. Der Überschuss komme durch Touristen und Geschäftsreisende zu Stande. Die Kinderlähmung war Anfang Mai erstmals seit zehn Jahren wieder in Namibia aufgetreten. Seitdem sind den Behörden zufolge 147 Menschen mit akuten Lähmungen ins Krankenhaus gekommen und 17 Patienten gestorben.

Gruß
Birgitt

[Alexander]

CONGO: Polio vaccinations for 400,000 children

BRAZZAVILLE, 4 July 2007 (IRIN) - The health ministry in the Republic of Congo has successfully vaccinated 400,000 children under the age of five against polio, officials said.

The campaign, which was mainly carried out to prevent the spread of polio from neighbouring Democratic Republic of Congo (DRC), took place in the administrative departments of Brazzaville, Pool in the south, Plateaux and Cuvette in the central region and Likouala in the north.

Congo's director-general of health, Damase Bozongo, said the June vaccination campaign was prompted by reports of new cases of wild poliomyelitis (polio) in the DRC in 2006.

"The wild polio virus was noticed in the DRC and it could reach us through border areas. We organised the vaccination campaign to prevent importation," said Bozongo. The campaign was supported by the UN World Health Organization (WHO) and the UN Children's Fund (UNICEF).

Before the sustained polio vaccination campaigns, the DRC had the highest number of polio cases globally. During the 1980s, about 8,000 Congolese children contracted the disease. New cases have been reported in the DRC and Angola in recent years, but no new cases of polio have been reported in the Republic of Congo since 2000.

Poliomyelitis is caused by the polio virus, which enters the body orally, infecting the intestinal lining. It may proceed to the blood stream and into the central nervous system, causing muscle weakness and often paralysis.

In areas with poor hygiene and sanitation, polio spreads through human contact, usually by faecally contaminated water or food, but the virus can also be spread through coughing and sneezing in crowded environments.

Symptoms include fatigue, sore throat, fever, vomiting, gastro-intestinal disturbances, headache and pain in the neck and extremities. Weakness of muscles often leads to permanent paralysis and deformity of the limbs.

Quelle: http://www.irinnews.org

Grüsse
Alexander

[Birgitt]

Schlechte Bilanz nach Impfung
Ministerium: Polio-Kampagne bleibt hinter Erwartungen zurück
03.07.2007

Windhoek – Die erste Runde der länderübergreifenden Polio-Impfkampagne vom 27. bis 29. Juni hat die Erwartungen der Verantwortlichen nicht vollständig erfüllt. „Der erste Lauf wurde anders beendet als erhofft“, erklärte gestern Tina Allies, Pressesprecherin des Gesundheitsministeriums, auf AZ-Nachfrage. Zwar sei die Kampagne in manchen Regionen sehr erfolgreich gewesen, in anderen habe die Beteiligung allerdings zu wünschen übrig gelassen. Genau Zahlen werde das Ministerium zwar erst in den kommenden Tagen veröffentlichen, Allies konnte aber vermelden, dass in der Karas-Region im Distrikt Mariental 96 Prozent der Bevölkerung geimpft worden seien. Hingegen sei an manchen Impfstellen im Norden des Landes während der drei Tage keine einzige Person erschienen ... mehr

Gruß :?
Birgitt

[Birgitt]

Polioepidemie durch Impfstoffviren in Nigeria
11.10.2007

Genf – In Nigeria sind 69 Kinder an einer Poliomyelitis erkrankt, die durch Impfstoffviren ausgelöst wurde. Die Epidemie begann bereits 2006, wurde von der Weltgesundheitsorganisation (WHO) jedoch lange Zeit nicht kommuniziert. Erst in den letzten Tagen wurden im Weekly Epidemiological Record (2007; 39: 3337-34) ausführliche Informationen veröffentlicht.

In den meisten Ländern wird die Polioimpfung noch mit dem älteren oralen Lebendimpfstoff durchgeführt, weil dies einfacher (wegen der oralen Gabe) und kostengünstiger ist. Von Vorteil ist auch, dass einige Geimpfte das abgeschwächte Impfstoffvirus über den Darm ausscheiden und auf diese Weise Angehörige mitgeimpft werden. In seltenen Fällen kann das Impfstoffvirus jedoch durch Spontanmutationen seine ursprüngliche Virulenz zurückerlangen und Lähmungen auslösen.

Diese zirkulierenden, vom Impfstoff abstammenden Polioviren (circulating vaccine-derived poliovirus, cVDPV) können dann eine Polioepidemie auslösen. Der WHO sind in den letzten 10 Jahren 9 derartige cVDPV-Ausbrüche bekannt geworden, die zu rund 200 Polioerkrankungen geführt haben sollen. Alle Ausbrüche konnten schnell gestoppt werden, indem die Umgebung besonders intensiv gegen Polio geimpft wurde. Denn mit cVDPV infizieren sich in der Regel nur Menschen mit fehlendem Impfschutz. Von den jetzt in Nigeria erkrankten Kindern waren 87 waren nicht ausreichend geschützt, da sie drei oder weniger Dosierungen erhalten hatten, 40 Prozent hatten noch gar keine Impfung erhalten.

Nachdem der erste Fall im letzten Jahr beobachtet wurde, begann die WHO mit einer Impfkampagne. Da die in Nigeria isolierten cVDPV zum Typ 2 des Poliovirus gehörten, wurde vom monovalenten Impfstoff, der nur vor Typ 1 schützt, auf eine trivalente orale Vakzine gewechselt. Bis März 2007 wurden drei Impfungen durchgeführt, im September 2007 erfolgte in den 13 Hochrisikoregionen im Norden des Landes eine vierte Runde, da in einigen Gegenden weiterhin cVDPV beobachtet wird.

Aus berechtigter Sorge um die Impfbereitschaft der Bevölkerung – 2003 musste eine Impfkampagne über die Dauer von mehr als einem Jahr abgebrochen werden, weil die muslimische Bevölkerung eine „Vergiftung“ durch den christlichen Süden befürchtete – wurden der cVDPV geheim gehalten. Erst im März 2007 findet sich eine erste Mitteilung in einem Periodikum, das nur von Laborspezialisten gelesen wird. Erst jetzt, wo die größte Gefahr abgewendet scheint, wendet sich die WHO an die breitere medizinische Öffentlichkeit.

Die WHO versucht die Gefahr in die richtige Perspektive zu rücken. Den 200 Lähmungen durch Impf-Polio in den letzten 10 Jahren stünden etwa 33.000 Poliomyelitiserkrankungen bei Nichtgeimpften gegenüber. Und das Risiko, dass eine Impfung zur Selektion von cVDPV führt, sei angesichts von mehr als 10 Milliarden Impfdosierungen, die in den letzten 10 Jahren verabreicht wurden, doch sehr gering, argumentiert die WHO. Dazu muss man allerdings bemerken, dass nicht jede Infektion mit dem Poliovirus zu Lähmungen führt. Die Wahrscheinlichkeit wird mit 1 zu 200 angegeben. Es dürften sich deshalb mehr als die 69 erkrankten Menschen mit cVDPV infiziert haben. © rme/aerzteblatt.de

Quelle: Ärzteblatt

Gruß
Birgitt

[Birgitt]

Somalia is again polio-free
10 000 health workers stop polio virus through immunization

25 MARCH 2008 | GENEVA -- Somalia is again polio-free, the Global Polio Eradication Initiative (GPEI) announced today, calling it a 'historic achievement' in public health. Somalia has not reported a case since 25 March 2007, a major landmark in the intensified eradication effort launched last year to wipe out the disease in the remaining few strongholds.

Against a backdrop of widespread conflict, large population movements and a dearth of functioning government infrastructure, transmission of poliovirus in the country has been successfully stopped. This landmark victory is a result of the efforts of more than 10 000 Somali volunteers and health workers who repeatedly vaccinated more than 1.8 million children under the age of five by visiting every household in every settlement multiple times, across a country ranked one of the most dangerous places on earth.

The use of innovative approaches tailored to conflict areas was pivotal in stopping polio in the country. These included increased community involvement and the effective use of monovalent vaccines to immunize children in insecure areas with several doses within a short period of time.

"This truly historic achievement shows that polio can be eradicated everywhere, even in the most challenging and difficult settings," said Dr Hussein A Gezairy, Regional Director for the WHO Regional Office for the Eastern Mediterranean.

Polio, which can cause lifelong paralysis, has been stopped nearly everywhere in the world following a 20-year concerted international effort. Only four polio-endemic countries remain – Afghanistan, India, Nigeria and Pakistan – and the eradication of polio globally now depends primarily on stopping the disease in these countries.

Poliovirus travels easily and, in the world of modern travel, can cover long distances. Until transmission of the virus has been interrupted in the four remaining endemic countries, the risk to the rest of the world remains high. Somalia, which had already eradicated the disease in 2002, became re-infected in 2005 by poliovirus originating in Nigeria. This repeated success in Somalia indicates the disease can be stopped even in areas with no functioning central government.

“Somalia beat polio in the midst of more widespread conflict and poverty than that affecting Afghanistan and Pakistan,” according to Dr Maritel Costales, Senior Health Advisor, UNICEF New York. He cites insecurity and large population movements in those countries as challenges to reaching all children with vaccine. “But Somalia shows that when communities are engaged, children everywhere can be reached.” Afghanistan and Pakistan could be the first of the remaining endemic countries to stop polio; between them they account for 5% of all cases of polio in 2007.

Consistent financial commitment continues to be crucial to completing polio eradication. The global effort currently faces a shortage of US$ 525 million for 2008-2009, funding urgently needed to fight the disease in the remaining endemic areas and protect children in high-risk polio-free areas. Rotary International, the top private sector contributor and volunteer arm of the GPEI, has contributed US$ 9.2 million for polio eradication in Somalia, and US$ 700 million worldwide since 1985. “Somalia clearly shows that the tailored tools and tactics of the intensified eradication effort are working,” commented Mohamed Benmejdoub, Chair of Rotary's Eastern Mediterranean PolioPlus Committee. “A polio-free world is a feasible public health goal and a global public good. I urge governments across the world – and in particular the G8 countries – to rapidly make available the necessary resources. Together, we can ensure that no child need ever again suffer the terrible pain of lifelong polio-paralysis.”

The GPEI is spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF. Since 1988, the incidence of polio has been reduced by more than 99%. At the time, more than 350 000 children were paralysed every year, in more than 125 endemic countries. Today, four countries remain which have never stopped endemic transmission of polio: Afghanistan, India, Nigeria and Pakistan. In 2007, 1308 cases have been reported worldwide (data as on 18 March 2008).

One of the 10 000 Somali volunteers and health workers is Ali Mao Moallim, who – more than 30 years ago on 26 October 1977 – became the last person on earth to contract smallpox. Over the past few years, working with WHO, he has travelled extensively throughout Somalia to immunize children against polio and foster community engagement during immunization campaigns. "Somalia was the last country with smallpox. I wanted to help ensure that we would not be the last place with polio too," he said.

Somalia's last case of indigenous polio was in 2002. On 12 July 2005, the country was re-infected by poliovirus originating in Nigeria, resulting in an outbreak of 228 cases in total. Systematic and widescale outbreak response activities, including intensive community engagement, successfully stopped the epidemic, and the last case was reported on 25 March 2007 in Mudug Province, in central Somalia.

Quelle: WHO

Gruß
Birgitt

[Birgitt]

Polio-Virus breitet sich aus
25.08.2008 - Gesundheitsnews

Während die Poliomyelitis - kurz Polio - in Deutschland und Europa ausgerottet ist, kämpfen andere Länder noch immer mit der Kinderlähmung. Bereits in diesem Jahr liegt die Zahl der registrierten Fälle doppelt so hoch wie im vergangenen Jahr. Vor allem in Afrika ist die Situation beunruhigend ... mehr

Gruß
Birgitt

[Birgitt]

POLIOMYELITIS (07): PAKISTAN, AFGHANISTAN, 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] Pakistan
[2] Afghanistan
[3] Nigeria

******
[1] Pakistan
Date: 19 Sep 2008
Source: Reuters AlertNet [edited]
<http://www.alertnet.org/thenews/newsdesk/ISL258471.htm>


Polio up in Pakistan as clashes impede vaccination
--------------------------------------------------
Fighting between the Pakistani army and Islamist
militants as well as hostility towards
vaccinating teams has led to a sharp increase in
polio cases in Pakistan this year [2008], health
workers said on Friday [19 Sep 2008]. Pakistan is
one of the few countries where the deadly,
crippling disease still exists. Polio spreads
through poor hygiene, and is also endemic in Nigeria, India and Afghanistan.

Pakistan has had 55 polio cases this year
compared with 32 last year and 39 in 2006.
Pakistani forces have been battling militants in
the northwest of the country, in areas on the
Afghan border, disrupting efforts to make sure
every child gets vaccination drops.

"Parts of Swat and parts of FATA, we haven't been
able to go and immunise children for quite some
time. So that means we have a build-up of
susceptible children that haven't been
immunised." said Melisa Corkum, a UNICEF communications officer.

FATA is the Federally Administered Tribal Areas,
7 semi-autonomous ethnic Pashtun dominated
regions in the northwest, where militants
fighting the Pakistani government and foreign
forces in Afghanistan have sanctuaries. Swat is a
valley in North West Frontier Province where fighting has also been intense.

"Vaccinators are really putting themselves at
risk in these areas," Corkum said.

Polio can be prevented with the use of vaccines
that have eliminated the virus as a public health
threat in most of the world. But as well as
fighting between the army and militants,
vaccinating teams also have to contend with
suspicion and even hostility from people who
believe the vaccination campaign against the
highly infectious disease is a plot.

Some Muslim clerics in the conservative tribal
belt along the Afghan border have opposed
anti-polio campaigns, saying it is a
foreign-funded ploy to sterilise people. Last
year [2007], a doctor and a health worker were
killed in a roadside blast in the Bajaur region
on the Afghan border, leading to the suspension
of a vaccinating campaign. A Health Ministry
official said vaccinators had even been attacked
during brief peace pacts between militants and government forces.

"During recent peace deals with the militants,
the government had tried to stop them from
attacking our vaccinators. But still they
attacked," said the official, who declined to be
identified. "During the last campaign one of our
doctors was kidnapped," he said.

Health authorities have run information campaigns
with the help of Muslim clerics in favour of
vaccination to try persuaded parents of the benefits of immunisation.

[Byline: Aftab Borka, Editing by Robert Birsel]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

******
[2] Afghanistan
Date: 18 Sep 2008
Source: Polio eradication website [edited]
<http://www.polioeradication.org/content ... tement.pdf>


UN agencies call for peace as polio vaccination
campaigns continue in Afghanistan
---------------------------------------------------------------------------------
As the International Day of Peace, [21 Sep 2008],
approaches the World Health Organisation (WHO),
the United Nations Children's Fund (UNICEF) and
the United Nations Educational, Scientific and
Cultural Organisation (UNESCO) are calling on all
parties to the conflict to take a pause on the
International Day of Peace to allow safe access
for vaccinators to carry out polio immunization
-- a life saving activity. The sanctity of
schools must be respected, the lives of students
and teachers must be protected, and the schools
must not be used by any parties to the conflict
for operations or political reasons.

Polio and lack of access to education affect
every family in Afghanistan. WHO and UNICEF are
urging the actors involved in the conflict not to
harm the vaccinators and allow the peace polio
immunizations to take place from [21-23 Sep 2008]
in order to vaccinate 1.8 million newborns and
children under the age of 5. More (pdf)

The vaccination campaigns are due to start a week
after a suicide bombing killed 3 people in a UN
convoy in Kandahar as they were preparing the
campaigns. ["Two doctors on WHO duty and their
driver were assassinated today by a vehicle-borne
suicide bomber in Kandahar province of southern
Afghanistan. Dr. Shamsul Haq MH Kakar, Dr. Mamoon
Taher Taheri, along with their driver Azizullah
Almas from the UN Assistance Mission in
Afghanistan, were on their way to prepare
logistics for a polio vaccination campaign in the
region next week when their convoy was
attacked." a quote from a news release on the
polio eradication website dated 14 Sep 2008,
<http://www.polioeradication.org/content ... 9.asp#AFGH>
- Mod.MPP]

In 2008 ([1 Jan - 17 Sep]), more than 18 cases of
polio have been reported mostly in Southern and
Eastern regions where accessing vulnerable
communities has been hindered due to the fighting
on the ground. Polio is the target of a global
eradication effort, and Afghanistan is one of
only 4 countries left with endemic polio. [the
other 3 countries are India, Pakistan and Nigeria. - Mod.MPP]

In safeguarding every child's rights to
education, UNESCO and UNICEF are urging
communities across Afghanistan to renew their
commitments in protecting schools and literacy
centres; students and teachers from attacks.

In 2008 ([1 Jan - 10 Sep]) ­ total of 199 school
attacks have taken place resulting in 37 deaths and 33 injured.

UNICEF, UNESCO, and WHO are urging all factions
and communities to take 21 Sep 2008 as an
opportunity to renew their commitments and
respect for children's rights to life through
receiving essential health services including the
life-saving polio vaccine and in gaining safe
access to education away from politics and conflict on the ground.

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

******
[3] Nigeria
Date: 16 Sep 2008
Source: Polio eradication website [edited]
<http://www.polioeradication.org/content ... ecount.pdf>


As of 16 Sep 2008 there have been 655 cases of
polio reported from Nigeria. The date of onset of
the most recent case was 24 Aug 2008, and
involved a wild poliovirus type 1. The date of
onset of most recent wild poliovirus type 3 was 24 Jul 2008.

The following information is from the monthly
situation update, 26 Aug 2008, available at:
<http://www.polioeradication.org/content ... sitrep.asp>

- In 2008, 597 cases have been reported (547 type 1 and 49 type 3).

- The highest number of type 1 polio cases in
any state in the country this year are from Kano (204 of 547 type 1 cases).

- With recent confirmation of a polio case in
Burkina Faso caused by wild poliovirus with
origin in northern Nigeria, the current type 1
outbreak affecting northern Nigeria threatens to
spread further. Transmission of the virus remains
intense, and large-scale population movements are
expected for the upcoming Hajj season (pilgrimage to Mecca, Saudi Arabia).

- To minimise the risk of international spread
and as part of urgent efforts to stop the current
type 1 outbreak, the Government of Nigeria has
recently established high-level Task Forces, to
rapidly overcome the operational challenges which
continue to mar polio campaigns, and to ensure
that state and local government leaders are held
accountable to polio eradication efforts.

- While this restructuring is encouraging, it
must now translate urgently into improvements in campaign quality.

- Further efforts must be made to achieve
operational improvements, including better
vaccinator selection and supervision, enhanced
and coordinated social mobilization efforts, and
increased use of independent out-of-house monitoring of activities.

The following information is from the Polio News
published 1 Sep 2008, available at:
<http://www.polioeradication.org/content ... News31.pdf>

Presidential action following international alert
on spread of polio from Nigeria
---------------------------------------------------------------------------------
The government of Nigeria has set in motion new
emergency measures to respond to an escalating
type 1 polio outbreak that is a major threat to
its polio eradication efforts, as President Umaru
Yar'Adua publicly stated his intention "to do
everything humanly possible to ensure that polio
is finally and totally eradicated from Nigeria."
Backed by a Presidential Initiative for
Immunization and Child Survival, a Steering
Technical Committee on Polio Eradication --
headed by the Minister of Health of Nigeria -- is
now to be advised by a high-level Task Force
mandated to improve eradication activities in the country.

On the heels of this development, the Expert
Review Committee on Polio Eradication and Routine
Immunization in Nigeria (ERC) met in Kano and
concluded that the outbreak is due to a failure
to vaccinate: only 42 percent of children in
states with a high burden of polio have 3 or more
doses of vaccine, against 87 percent in
polio-free states. The outbreak is concentrated
in the north; over a third of the 483 cases
reported from Nigeria to date this year [2008]
are from Kano state alone. The ERC stressed that
mechanisms are needed to ensure that the
high-level political commitments are translated
into local government accountability for
high-quality implementation of polio campaigns.

Over the past months, polio from northern
Nigerial has spread west to Benin, north to Niger
and east to Chad, and the possibility of further
spread is magnified by large-scale population
movements across Africa for the Hajj (annual
pilgrimage to Mecca, Saudi Arabia). The WHO has
officially notified its Member States of this growing risk.

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

[According to the most recent data available on
the polio eradication website (as of 16 Sep 2008)
there were a total of 1210 cases of polio
reported from 14 countries since 1 Jan 2008
<http://www.polioeradication.org/casecount.asp>.
The 4 endemic countries (India, Nigeria, Pakistan
and Afghanistan) account for 1135 (93.8 percent)
of the cases reported this year, with the
remaining 75 reported cases in 10 countries
related to importations from Nigeria and India
(see below). From the newswire in [1] above, it
appears as though an additional 11 cases have
been identified in Pakistan in the past few days
since the weekly global statistics on polio cases was compiled.

Total cases: Year-to-date 2008 / Year-to-date 2007 / Total in 2007
Globally: 1210 / 497 / 1315
- in endemic countries: 1135 / 433 / 1208
- in non-endemic countries: 75 / 64 / 107

Case breakdown by country
Country: Year-to-date 2008/ Year-to-date 2007 /
Total in 2007/ Date of onset of most recent case
India: 420 / 223 / 874 / 30 Aug 2008
Nigeria: 655 / 188 / 285 / 24 Aug 2008
Pakistan: 44 / 13 / 32 / 24 Aug 2008
Sudan: 5 / 0 / 1 / 15 Aug 2008
CAR: 2 / 0 / 0 / 8 Aug 2008
DRC: 4 / 28 / 41 / 5 Aug 2008
Afghanistan: 16 / 9 / 17 / 5 Aug 2008
Chad: 16 / 5 / 22 / 28 Jul 2008
Nepal: 5 / 0 / 5 / 27 Jul 2008
Angola: 25 / 10 / 8 / 14 Jul 2008
Niger: 13 / 2 / 11 / 7 Jul 2008
Benin: 2 / 0 / 0 / 30 Jun 2008
Burkina Faso: 1 / 0 / 0 / 6 Jun 2008
Ethiopia: 2 / 0 / 0 / 27 Apr 2008
Myanmar: 0 / 11 / 11 / 28 May 2007
Somalia: 0 / 8 / 8 / 25 Mar 2007

The tragic event in Afghanistan involving the
killing of polio eradication team workers is hard
to reconcile. This moderator agrees with the
statement on the polio eradication website, "This
tragic incident -- and recent armed attacks which
injured 2 polio workers in Somalia -- are stark
reminders of the sacrifices made daily by public
health and humanitarian workers around the world.
We mourn our colleagues and acknowledge the
courage and devotion of all those who are working
in difficult and dangerous circumstances to make
the world a better place for children." - Mod.MPP]

[Birgitt]

POLIOMYELITIS ( 08 ): INDIA, PAKISTAN, WORLDWIDE
**********************************************
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: (Uttar Pradesh, Bihar), wild poliovirus type 1
[2] Pakistan
[3] Worldwide: case count as of 7 Oct 2008

******
[1] India: (Uttar Pradesh, Bihar), wild poliovirus type 1
Date: Sat 11 Oct 2008 [accessed Mon 13 Oct 2008]
Source: The Telegraph [edited]
<http://www.telegraphindia.com/1081011/j ... 953344.jsp>


Polio virus surfaces in UP after 10 months
------------------------------------------
The most common form of the [poliovirus] that health officials
believed was on the verge of eradication from India has resurfaced in
Uttar Pradesh (UP), defying a new vaccination strategy introduced 3 years ago.

The National Polio Surveillance programme has detected 32 cases of
polio caused by the P1 poliovirus [wild poliovirus type 1, (WPV1)] in
7 districts of Uttar Pradesh from June through September this year
[2008], after 10 months of no P1 [WPV1] anywhere in the state.

The P1 virus (WPV1) -- one of 3 serotypes of the wild poliovirus --
has returned despite intensive immunisation of children in Bihar and
Uttar Pradesh with a new monovalent oral polio vaccine (mOPV) over
the past 2 years. India's health ministry had introduced mOPV about 3
years ago after studies had shown that it is a sharper and more
effective tool against the poliovirus than the trivalent OPV.

"We've seen some great progress in recent months, but the appearance
of P1 [WPV1] in UP is disappointing," said T Jacob John, head of the
India Expert Advisory Group [IEAG], a panel that advises the
government on how to conduct its war on polio.

The actual size of the resurgence -- the total number of children
infected -- would be higher than 32, he said. "Each case of polio
indicates about 160 other susceptible, or unprotected, children
infected," John said.

Polio programme officials said the mOPV has performed very well and,
as expected, better than the trivalent OPV. They said genetic studies
on the virus circulating in Uttar Pradesh have shown that P1 [WPV1]
slipped into the state's Badaun district from Bihar.

"It is because of mOPV that the most endemic part of India -- western
UP -- had been able to stop P1 [WPV1] transmission for more than 18
months," said Hamid Jafari, project manager of the National Polio
Surveillance Project [NPSP], a joint programme of the Indian
government and the World Health Organisation (WHO).

"The P1 [WPV1] cases in Badaun reflect reduced frequency and
increased interval between mOPV immunisation rounds in 2007 to tackle
an outbreak of (polio caused by) P3," Jafari said.

"This allowed an increase in (the number of) susceptible children in
the young age group who had not received sufficient doses of mOPV."

In a meeting in May this year [2008], the IEAG had said that
following intensive vaccination activities by the government in UP
and Bihar during 2007 and 2008, the [WPV1] P1 strain of polio was "on
the verge of eradication from India."

Until June 2008, the NPSP had detected only 4 cases of P1 [WPV1] this
year -- one each in Bihar, Delhi, Orissa, and Bengal. And 3 districts
in Uttar Pradesh -- Moradabad, Meerut, and Muzaffarnagar -- dubbed by
polio programme managers as the historical centre of P1 [WPV1] in
India and the toughest place in the world to eradicate polio, had not
reported P1 since November 2006.

"The P1 circulation in UP can again be stopped by aggressive use of
mOPV, while ensuring that P1 is also stopped in Bihar," Jafari said.
The IEAG had cautioned earlier this year [2008] that P1 could be
detected after several months. It P1 persists, the most likely period
for its detection would be between July to November 2008, the IEAG
had said, calling for intense surveillance.

"The mOPV has shown that P1 [WPV1] transmission can be stopped in its
stronghold," said Nicholas Grassly, an infectious disease expert at
Imperial College, London, who had published research to show that
mOPV would be better than trivalent OPV.

"There was no P1 [WPV1] transmission in western UP for 18 months,
from November 2006 until June 2008. This had never been achieved
before," Grassly told The Telegraph.

The national polio surveillance effort has detected 449 cases this
year [2008]. The number of confirmed polio cases last year was 874.

Genetic studies on poliovirus strains have shown that virtually all
of P1 [WPV1] in India originates in western Uttar Pradesh. Scientists
in Mumbai looking for poliovirus in sewage water have detected only a
single P1 [WPV1] strain since the beginning of this year [2008].

The sewage scan is intended to detect poliovirus excreted by infected
individuals in Mumbai, a city that attracts people from across the
nation. In previous years, they used to detect P1 [WPV1] several times a year.

"A decreased frequency of P1 [WPV1] in Mumbai's sewage is an
indicator of the progress the nation is making against polio," IEAG
chairman John said.

[Byline: GS Mudur]

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

[The polio eradication website weekly report from 7 Oct 2008 has the
additional following information on India (see
<http://www.polioeradication.org/casecount.asp>):
- 15 new cases were reported in the past week (10 WPV1s and 5 WPV3s),
bringing the total number of cases for 2008 to 464. The most recent
case had onset of paralysis on [17 Sep 2008] (WPV1 from Uttar Pradesh).
- A supplementary immunization activities (SIAs) schedule for the
next 3 months is currently being finalized. The highest priority is
given to stopping the current WPV1 outbreak in western Uttar Pradesh.
- In Bihar state, a mop-up SIA with monovalent OPV type 1 (mOPV1) was
completed last week. High quality was achieved, despite the onset of
renewed heavy rains towards the end of the campaign.
- During the upcoming festival season in October and early November
[2008], which is typically associated with large-scale population
movements between Uttar Pradesh and Bihar, special transit
vaccination teams will be deployed to major travelers gathering sites
and transit points.

If one checks the table with information on wild poliovirus
identification by country (see
<http://www.polioeradication.org/content ... ecount.pdf>)
according to information available as of 7 Oct 2008, the most recent
WPV1 identified in India was from a case with date of onset 17 Sep
2008, and most recent WPV3 identified was from a case with date of
onset 13 Sep 2008, confirming the circulation of both wild poliovirus
types in the country.

The strategy to use monovalent oral polio vaccine type 1 (mOPV1) was
implemented in India in 2004/2005 and resulted in significant
reductions in the overall numbers of cases reported as well as
appeared to have interrupted the transmission of WPV1. Not totally
unexpected, with the use of mOPV1, there was a noted shift to a
predominant wild poliovirus type 3 (WPV3) isolation from cases. The
present observed reappearance of WPV1 in Uttar Pradesh is disturbing.
Hopefully a renewed effort with enhanced vaccination campaigns will
be able to interrupt its transmission. (For a good information sheet
on the rationale of vaccine choice as part of the polio eradication
effort, see
<http://www.polioeradication.org/content ... l.2005.pdf>).


For a map of India with states, see
<http://www.lib.utexas.edu/maps/middle_e ... _pol01.jpg>.

For the interactive HealthMap/ProMED map of India with links to other
recent postings on events in India and surrounding areas, see
<http://healthmap.org/promed?v=22.9,79.6,5>. - Mod.MPP]

******
[2] Pakistan
Date: Mon 13 Oct 2008
Source: UN Office for the Coordination of Humanitarian Affairs
(OCHA), Integrated Regional Information Networks (IRIN) News [edited]
<http://www.irinnews.org/report.aspx?ReportId=80827>


Pakistan: why is polio spreading?
---------------------------------
The refusal by parents to get their children vaccinated against polio
in Pakistan is only a minor contributory factor explaining the rise
in the number of polio cases among children, say health experts.

In the past few weeks several polio cases have been detected in the
conflict-affected Federally Administered Tribal Area (FATA) and in
the North West Frontier Province (NWFP). The most recent case was
that of an Afghan child -- taking the number of cases in the NWFP and
FATA this year [2008] to 28, Pakistani media reported. Officials said
the case was confirmed by the National Institute of Health. The
9-month-old child had received 7 doses of polio drops during special
campaigns but did not get vaccinated during routine immunisation.

According to the World Health Organization (WHO), the number of polio
cases this year as of [5 Oct 2008] was 70, of which half were
registered in August and September [2008]. In 2007, 32 cases were
detected, and 40 in 2006. Pakistan, Nigeria, India, and Afghanistan
are the only 4 countries in the world where the debilitating disease
remains endemic.

Health workers attribute the recent rise in the number of cases to
the fighting between the Pakistani army and militants. "There are
many factors that are beyond the control of the polio programme,
including the security situation in NWFP/FATA and southern
Afghanistan. Recently we have seen cases in Swat. The vaccinators
have not been able to go to some of these areas to immunise children
for nearly a year due to the security situation," said Nima Abid,
WHO's polio team leader in Pakistan. The biggest hurdles in the NWFP
range from "insecurity and the low proportion of female teams, to
pockets of refusals, and lack of independent monitoring, due again to
insecurity in the area", said Abid, who also cited other factors:
"Poor service delivery in some districts and agencies, very variable
routine immunisation coverage, pockets of refusals in a few key
districts, rapid turnover of district health leaderships, and low
public demand for immunisation. Poor sanitation and high population
density, which lead to a high prevalence of diarrhoeal disease and
enteroinfections, also interfere with the uptake of the oral polio
vaccine in the intestines of children. All these factors have
hampered the eradication efforts," Abid said. "Refusal is a
significant problem in only a few districts and agencies like, Killa
Abdullah, Bajaur, Mohamand, Swat, and few others. Overall less than
one percent of the targeted children are missed because of refusals,
so it cannot be the [main] cause of the resurgence [in the number] of
polio cases. An independent study of refusals highlighted that
management and service delivery issues were also an issue," she said.

"Attention must be given to the main reasons for missed children
[during anti-polio drives]," said Chris Morry, a UN Children's Fund
(UNICEF) communication specialist, at a recent communication review
meeting organised by UNICEF. Mubina Agboatwala, in charge of the
polio clinic at Karachi's Civil Hospital, said at the meeting that it
was all down to campaign fatigue, noting that some houses had been
missed out during house-to-house calls. "This is not just true for
Sindh but all across Pakistan," she said, adding: "Strict monitoring
is the only solution." That sentiment was echoed by Abid. "Good
selection of team and field supervisors as well as close monitoring
by district management is crucial for successful campaign
implementation," she said. NWFP's minister for health, Syed Zahir Ali
Shah, expressed concern about the growing number of polio cases and
called for a policy review given that the polio cases were not only
arising in inaccessible areas. However, Abid pointed out that the
polio programme in Pakistan was not a failure as significant strides
had been made since it was launched in 1994, when the caseload was over 1000.

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

[The polio eradication website weekly summary of 7 Oct 2008 provides
the following additional information (see
<http://www.polioeradication.org/casecount.asp>):
- Three new cases were reported in the past week (all WPV1s),
bringing the total number of cases for 2008 to 70. The most recent
case had onset of paralysis on [18 Sept 2008] (WPV1 from Islamabad).
- To further increase population immunity levels across the country,
the planned Subnational Immunization Days (SNIDs) on [13-15 Oct 2008]
will now be full NIDs (National Immunization Days). These NIDs will
be of critical importance, particularly in the recently re-infected
areas of Punjab and Islamabad. With recent increases in insecurity in
some areas of the country and associated population movements,
polio-free areas across Pakistan are at increased risk of
re-infection. In Sindh, focus will be on filling operational gaps in
campaign quality.
- On [10 Oct 2008], an urgent consultation of experts will be held at
EMRO (WHO Eastern Mediterranean Regional Office) in Cairo, Egypt, to
review the epidemiological situation and discuss ways to address the
recent increase of new polio cases affecting Pakistan.

The above newswire describes the variety of factors that are
contributing to the continued circulation of WPV in the
country. These factors include civil unrest leading to security
issues preventing vaccination teams from entering affected zones,
ineffective infrastructure impeding routine and vaccine campaign
activities, pockets of population refusing vaccinations, high
prevalence of concurrent gastrointestinal infections in the target
population that compete with the vaccine for gastrointestinal
receptor sites and "campaign fatigue" both on the part of the
vaccinators as well as the population, contributing to reduced
coverages during the campaigns.

Of interest is that if one checks the table with information on wild
poliovirus identification by country (see
<http://www.polioeradication.org/content ... ecount.pdf>)
according to information available as of 7 Oct 2008, the most recent
WPV1 identified in Pakistan was from a case with date of onset 18 Sep
2008, and most recent WPV3 identified was from a case with date of
onset 16 Sep 2008, confirming the circulation of both wild poliovirus
types in the country similar to as seen in India.

For a map of Pakistan, see
<http://www.lib.utexas.edu/maps/middle_e ... l_2002.jpg>.

For the interactive HealthMap/ProMED map of Pakistan with links to
other recent postings on events in India and surrounding areas, see
<http://healthmap.org/promed?v=30,69.4,5>. - Mod.MPP]

******
[3] Worldwide: case count as of 7 Oct 2008
Date: Tue 14 Oct 2008
Source: Global Polio Eradication Initiative, polio eradication website [edited]
<http://www.polioeradication.org/casecount.asp>


Total cases: Year-to-date 2008 / Year-to-date 2007 / Total in 2007
Globally: 1341 / 572 / 1315
- in endemic countries: 1259 / 505 / 1208
- in non-endemic countries: 82 / 67 / 107

Case breakdown by country
Country: Year-to-date 2008 / Year-to-date 2007 / Total in 2007 / Date
of onset of most recent case
Pakistan: 70 / 15 / 32 / 18 Sep 2008
India: 464 / 281 / 874 / 17 Sep 2008
Afghanistan: 20 / 11 / 17 /10 Sep 2008
Nigeria: 705 / 198 / 285 / 2 Sep 2008
Chad: 22 / 5 / 22 / 21 Aug 2008
Sudan: 6 / 0 / 1 / 15 Aug 2008
Central African Republic: 2 / 0 / 0 / 8 Aug 2008
DR Congo: 4 / 30 / 41 / 5 Aug 2008
Nepal: 5 / 0 / 5 / 27 Jul 2008
Angola: 25 / 9 / 8 / 14 Jul 2008
Niger: 13 / 4 / 11 / 7 Jul 2008
Benin: 2 / 0 / 0 / 30 Jun 2008
Burkina Faso: 1 / 0 / 0 / 6 Jun 2008
Ethiopia: 2 / 0 / 0 / 27 Apr 2008
Myanmar: 0 / 11 / 11 / 28 May 2007
Somalia: 0 / 8 / 8 / 25 Mar 2007

[Additional information available at the polio eradication website
weekly update includes the following country specific information:]
Endemic countries
Afghanistan
-----------
- No new cases were reported in the past week. The total number of
cases for 2008 remains 20. The most recent case had onset of
paralysis on [10 Sep 2008] (WPV1 from Kandahar).
- Preparations are ongoing for the next National Immunization Days
(NIDs) on [19-21 Oct 2008], using trivalent oral polio vaccine (OPV).
Efforts will focus on increasing access to all populations,
particularly in security-compromised areas of the Southern Region.

Nigeria
-------
- 14 new cases were reported in the past week (13 WPV1s and one
WPV3), bringing the total number of cases for 2008 to 705. The most
recent case had onset of paralysis on [2 Sep 2008] (WPV1 from Kwara).
- State-level operational plans for upcoming campaigns are currently
being strengthened, strategically driven by epidemiological profiles.
- A supplementary immunization activity (SIA) calendar for the rest
of the year is in development and will be submitted for endorsement
to the Expert Review Committee for Polio Eradication and Routine
Immunization, scheduled to meet on [27-28 Oct 2008]. Currently, it is
planned to add OPV to already-planned measles SIAs in November and
December [2008], with separate Immunization Plus Days (IPDs) to be
held in high-risk areas in the north in December [2008].


Importation countries

Angola
------
- No new cases were reported in the past week. The total number of
cases for 2008 remains 25. The most recent case had onset of
paralysis on [14 Jul 2008] (WPV3 from Benguela province).
- On [26-28 Sep 2008], a mop-up with monovalent OPV type 3 (mOPV3)
was held in key high-risk areas. The next NIDs will be conducted with
mOPV1 on [24-26 Oct 2008].

Central African Republic (CAR)
------------------------------
- No new cases were reported in the past week. The total number of
cases for 2008 remains 2. The most recent case had onset of paralysis
on [15 Aug 2008] (WPV1 from RS3 province).
- Two nationwide campaigns have been conducted this year (2008), and
further activities are being planned.

Chad
----
- One new case was reported in the past week (WPV3), bringing the
total number of cases for 2008 to 22. The most recent case had onset
of paralysis on [21 Aug 2008] (WPV3 from Mayo-Kebbi).
- A supplementary immunization activities (SIA) schedule has been
developed. One round of staggered campaigns will be conducted in Q4
[4th quarter] 2008, in the southern and northern areas of the
country. A 2nd round, potentially also including the west and east of
the country, is scheduled for 2009.
- The risk of further spread of polio within Chad and internationally
is high, as outbreak response activities are inadequate both in
extent and quality. As many as 40 percent of children were missed in
key areas during the most recent activities in August [2008].
- High-level and local level political ownership and engagement is
urgently needed, to address the situation.

Democratic Republic of the Congo (DRC)
--------------------------------------
No new cases were reported in the past week. The total number of
cases for 2008 remains 4. The most recent case had onset of paralysis
on [5 Aug 2008] (WPV1 from Sud-Kivu).
- Trivalent OPV was added to a measles SIA held on [18 Sep 2008],
with further activities planned for November [2008].

Horn of Africa
--------------
- One new case was reported in the past week (WPV1 from southern
Sudan), bringing the total number of cases for 2008 to 8 (one WPV3
from West Darfur, Sudan; and 7 WPV1s from the southern Sudan/western
Ethiopia cross-border area). The most recent case had onset of
paralysis on [15 Aug 2008] (WPV1 from Juba, southern Sudan).
- Large-scale outbreak response activities will be held in late
October [2008] and again in November [2008] in northern Sudan, and in
the cross-border southern Sudan/western Ethiopia area.

Nepal
-----
- No new cases were reported in the past week. The total number of
cases for 2008 remains 5. The most recent case had onset of paralysis
on [27 Jul 2008] (WPV3 from Mid-West Development Region).
- The next SIA will be a mOPV3 campaign starting [26 Oct 2008].

West Africa
-----------
- No new cases were reported in the past week. The total number of
cases for this region in 2008 remains 16 (2 in Benin, one in Burkina
Faso, and 13 in Niger). The most recent case had onset of paralysis
on [7 Jul 2008] (WPV1 from Niger).
- Following 2 synchronized SIAs in the border areas of Benin, Burkina
Faso, Mali, and Niger in June and July [2008], a 3rd round will be
conducted on [24 Oct 2008], with additional activities in November [2008].

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

[As can be seen in the table above and the following weekly
summaries, there are 4 endemic countries that have not as yet
interrupted transmission of wild poliovirus (Pakistan, India,
Afghanistan, and Nigeria), and 10 countries that had interrupted wild
poliovirus for 2 or more years in the recent past, but as a result of
importations, have identified wild poliovirus from cases with dates
of onset in 2008 (Chad, Sudan, Central African Republic (CAR),
Democratic Republic of Congo (DRC), Nepal, Angola, Niger, Benin,
Burkina Faso, and Ethiopia). Of note, in this latter group of
countries with recent importations, the dates of onset of cases with
most recent WPV isolates were predominantly in June, July, and August
2008 - that is, within the last 4 months.

For a good map showing wild poliovirus infected districts worldwide,
current as of 7 Oct 2008, see
<http://www.polioeradication.org/content ... tricts.pdf>.
- Mod.MPP]

[Birgitt]

Ist Namibia poliofrei?
Kommission wird bald entscheiden – WHO warnt vor Virus-Übertragung durch Angola
22.10.2008 - AZ online

Ob Namibia zu einem poliofreien Land erklärt wird, wird sich in den nächsten Tagen herausstellen. Gestern hat Gesundheitsminister Richard Kamwi die 10. Konferenz der für Afrika zuständigen Bescheinigungs-Kommission (ARCC) zur Bekämpfung von Polio offiziell eröffnet. Bei dieser Versammlung werden sechs Länder unter die Lupe genommen, die beweisen müssen, Polio erfolgreich ausgerottet zu haben ... mehr

Gruß
Birgitt

[Birgitt]

Nigeria - Poliomyelitis
01.12.2008

Nachdem die Fallzahlen im vorigen Jahr zurückgegangen waren, zeichnet sich im Norden des Landes ein erneuter Anstieg ab. 758 Erkrankungen wurden in diesem Jahr bereits gemeldet, davon die meisten durch Wildvirus Typ 1, der in den letzten Jahren für die Reimporte in zahlreiche Länder verantwortlich war. Nach neueren Untersuchungen gibt es in den nördlichen Bundesstaaten noch immer Schlüsselregionen mit hohem Risiko, in denen 20% der Kinder nicht geimpft sind. Nachweislich zwei Fälle wurden von dort bereits in diesem Jahr wieder in die Nachbarländer Benin und Niger importiert. Impfschutz bei Reisen weiterhin beachten. / Quelle: crm

[Birgitt]

Poliomyelitis in Nigeria and West Africa
WHO - 06.01.2009

From 2003 to 2007, type 1 polio originating in northern Nigeria spread to cause outbreaks in 20 previously polio-free countries, including across west Africa, the Horn of Africa, and as far away as Indonesia and Yemen. The outbreaks in these 20 countries resulted in 1,517 cases, and cost upwards of 500 million US Dollars in international emergency outbreak response funds.

In 2008, northern Nigeria is experiencing an outbreak of wild poliovirus type 1, which has spread internationally into nearby countries in west Africa. Since April 2008, cases due to type 1 polio genetically linked to viruses from northern Nigeria have been detected in Benin, Burkina Faso, Ghana, Niger, Mali and Togo. In 2008, Nigeria accounts for 80% of type 1 polio cases in the world. In addition to international spread of type 1 polio, wild poliovirus type 3 originating from northern Nigeria has also been reported in Chad and Niger.

The risk of additional importations into these west African countries depends fully on the quality of outbreak response activities in Nigeria and the re-infected countries themselves.

In the second half of 2008, Nigeria has conducted large-scale rounds of emergency polio immunization campaigns in the northern states in July and August, as well as in November when oral polio vaccine (OPV) was added to an integrated measles vaccination campaign. Additional nationwide campaigns are planned for late January and again in February.

To minimize the risk of onward spread of polio from Ghana, in particular into Côte d'Ivoire, Ghana has conducted large-scale polio immunization campaigns in October, November and December. The feasibility of conducting preventive campaigns in Côte d'Ivoire is currently being explored. Elsewhere in west Africa, large-scale polio immunization campaigns have been carried out and/or are being planned in Benin, Burkina Faso, Mali, Niger and Togo.

Given these risks, it is important that countries across west Africa strengthen disease surveillance for acute flaccid paralysis (AFP), in order to rapidly detect any poliovirus importations and facilitate a rapid response. Countries should also continue to boost routine immunization coverage against polio to minimize the consequences of any introduction.

[Birgitt]

W Africa starts anti-polio drive
12.02.2009 - BBC

An operations has started to vaccinate some 20 million children in West Africa over the next month in a major effort to eradicate polio. Hundreds of thousands of volunteers have been mobilised in eight countries to help administer the oral vaccine ... mehr

Gruß
Birgitt