Polio Update

Polio this week - As of 31 July 2013

In Nigeria, the Presidential Task Force has reviewed the latest epidemiology of poliovirus transmission and strategies to overcome remaining challenges. A new risk-classification system of low-performing areas aims to focus resources where they are most needed. See ‘Nigeria’ section for more.

In Pakistan, the outbreak in Federally Administered Tribal Areas (FATA) is continuing, with a new case reported from Khyber Agency. The current outbreak is threatening progress achieved elsewhere in the country, as well as efforts in neighboring Afghanistan. See ‘Pakistan’ section for more.

Wild Poliovirus (WPV) cases

Total cases	Year-to-date 2013	Year-to-date 2012	Total in 2012
Globally	170	103	223
- in endemic countries	65	98	217
- in non-endemic countries	85	5	6

Case breakdown by country

Countries	Year-to-date 2013				Year-to-date 2012				Total in 2012	Date of most recent case
	WPV	WPV3	W1W3	Total	WPV1	WPV3	W1W3	Total
Pakistan	22			22	20	2	1	23	58	3-Jul-13
Afghanistan	3			3	15			15	37	6-Jun-13
Nigeria	40			40	46	14		60	122	9-Jul-13
Somalia	95			95					0	10-Jul-13
Kenya	10			10					0	6-Jul-13
Chad					5			5	5	14-Jun-12
Niger									1	15-Nov-12
Total	170	0	0	170	86	16	1	103	223
Total in endemic countries	65	0	0	65	81	16	1	98	217
Total outbreak	105	0	0	105	5	0	0	5	6

Data in WHO as of 31 July 2012 for 2012 data and 30 July 2013 for 2013 data.

Afghanistan

No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains three. The most recent WPV case had onset of paralysis on 6 June (WPV1 from Nangarhar).

All three WPV cases this year were reported from Eastern Region. In the high-risk Southern Region, no WPV cases have been reported since November 2012.

No new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains three. The most recent cVDPV2 case had onset of paralysis on 13 March (from Kandahar, Southern Region).

Subnational immunization days (SNIDs) were held on 1-3 July, with resources focusing on Southern and Eastern Region. Planning is underway for nationwide activities in August.

Nigeria

Five new WPV cases were reported in the past week (four WPV1s from Kano state and one WPV1 from Yobe state), bringing the total number of WPV1 cases for 2013 to 40. The most recent WPV1 case had onset of paralysis on 9 July (WPV1 from Kano).

No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (with onset of paralysis on 6 June from Borno). Although this cVDPV2 case is linked to cVDPV2 currently circulating in Chad which has also been detected in Cameroon, cVDPV2 linked to this transmission chain had previously been isolated from an environmental sample in Kano in March (indicating circulation in Nigeria).

The latest epidemiology and strategies were discussed at last week’s Presidential Task Force meeting on 23 July in Abuja. The meeting underscored that more than half of this year’s cases are from two states: Borno and Yobe.

Performance during Immunization Plus Days (IPDs) continues to improve in all high-risk states. However, vaccination coverage gaps persist in low-performing Local Government Areas (LGAs), particularly in Kano, Borno and Yobe.

Although Borno and Yobe are affected by insecurity, polio eradication activities are continuing in most LGAs of Borno and all LGAs of Yobe. Special strategies are being evaluated for these areas, including conducting ‘wall fencing’ immunizations around insecure areas, use of permanent health teams and increased use of Short Interval Additional Dose (SIADs) campaigns, as and when opportunities arise. Social mobilization activities are being targeted, to increase community demand for polio vaccination.

Efforts must continue to improve micro planning, reaching ‘absent’ children, and further engaging communities and traditional leaders to address non-compliance.

At the same time, more needs to be done to foster subnational political engagement – the involvement of LGA Chairpersons remains inconsistent across high-risk states. Engagement at state-level is also inconsistent, as measured by the Abuja Commitments.

A new risk classification system will improve the delivery of resources to areas where they are most needed. Across the high-risk states, 129 LGAs have now been classified as ‘very very high risk’, ‘very high risk’, or ‘special situation’ (security-affected LGAs in Borno and Yobe).

The next subnational IPD in northern states is planned for early September using bivalent OPV. Measles vaccine will also be offered during this round.

Pakistan

One new WPV1 case was reported in the past week (WPV1 from Khyber Agency, Federally Administered Tribal Area – FATA), bringing the total number of WPV1 cases for 2013 to 22. It is the most recent WPV1 case in the country and had onset of paralysis on 3 July.

No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains five. The most recent cVDPV2 case had onset of paralysis on 8 May (from Gadap town, greater Karachi, Sindh).

Additionally, one new WPV1 environmental sample was isolated from Peshawar, Khyber Pakhtunkhwa (KP), collected in early July. In total, 22 environmental samples have tested positive for WPV1 in 2013 from various sites across Pakistan, the bulk from Peshawar (9) and Hyderabad, Sindh (5).

Federally Administered Tribal Areas (FATA) is the major WPV1 reservoir in Pakistan at the moment, accounting for 13 of this year’s 22 cases in the country. Khyber Agency is particularly affected, with nine cases, and in particular Bara tehsil of Khyber. This outbreak is threatening progress achieved elsewhere in the country and in neighboring Afghanistan. In 2011 and 2012, Bara was the epicentre of a major outbreak which also spread to other areas.

Chad, Cameroon and Central African Republic

In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on 14 June 2012 (WPV1 from Lac). No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains four (the most recent cVDPV2 case had onset of paralysis on 12 May from Ennedi).

The four cVDPV2 cases were reported from various parts of the country, indicating widespread transmission. In some areas, only one immunization round has been conducted in response. A more comprehensive outbreak response to these cVDPV2 cases must be planned and implemented. The risk of further spread within Chad and further international spread remains high (cVDPV2 circulating in Chad has also been detected in Cameroon and Nigeria).

In Cameroon, no new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains two. The most recent cVDPV2 case had onset of paralysis on 27 May (from Extreme-Nord).

Emergency outbreak response is ongoing in both countries.

Central African Republic (CAR) continues to be at risk of re-infection, due to proximity with Chad and in some areas insecurity. To minimize the risk and consequences of potential re-infection, two subnational immunization campaigns were conducted in border areas with Chad, in June and July using trivalent OPV.

Horn of Africa

24 new WPV1 cases were reported in the past week (23 from Somalia and one from Kenya), bringing the total number of WPV1 cases in the region to 105 (95 from Somalia and ten from Kenya). The most recent case in the region had onset of paralysis on 10 July (from Somalia).

Eleven of the newly-reported cases are from Banadir, which remains the epicentre of the outbreak, accounting for more than half of all cases associated with this outbreak.

Four of the newly-reported cases are from Lower Shabelle, areas of which are inaccessible due to insecurity. Special strategies continue to be implemented for these areas, including increased local-level access negotiations, immunizing older age groups and setting up vaccination posts at entry/exit points of inaccessible areas.

In Somalia, nationwide campaigns were conducted last week, targeting children under the age of five years. In Kenya, SIAs are currently ongoing (27-30 July), aiming to reach host communities around the Dadaab camps.

Immunization campaigns across the Horn of Africa, including in Ethiopia and Yemen, will continue throughout August.
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West Africa

No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on 15 November 2012.

Multi-country immunization campaigns are planned in West Africa for mid-October, as well as SNIDs in parts of Mali and Niger in July and September, respectively.