Highlights and global details:
No new WPV1 cases this week. OneWPV1 positive environmental sample was collected in Pakistan. There were two cVDPV2 cases – one in DRC and one in Syria.
| WPV | cVDPV | |
| 2017 to 19 September | 10 | 49 |
| 2016 to similar date | 24 | 3 |
| 2016 full year | 37 | 7 |
For polio-free certification purposes the start date for WPV monitoring is that of the onset of paralysis. The most recent WPV1 cases with onset of paralysis were:
• In Pakistan - 11 August 2017 or 6 weeks since the onset of polio.
• In Afghanistan – 10 July 2017 so 10 weeks since the onset of polio.
• In Nigeria - 21 August 2016 or 56 weeks since the onset of polio.
1. WPV1 cases:
• 4 cases in Pakistan vs. 13 cases at the same time in 2016. NIDs in progress are targeting more than 37 million children.
• 6 cases in Afghanistan vs. 8 cases at the same time in 2016. NIDS targeting 10 million children.
• No cases in Nigeria. There were 3 cases in Nigeria confirmed at this time last year.
• No other cases though there is much immunisation activity now in the Lake Chad countries following the Nigerian cases in August 2016.
The WPV1 positive environmental sample collected this week in Pakistan brings the total
collected in 2017 to 81. (The environmental presence of viral particles lasts for 7-14 days.)
2. WPV2 cases:
• Declared eradicated September 2015. (Last case was in October 1999.)
3. WPV3 cases:
• No cases reported since 10 November 2012. (That was in Nigeria.)
The number of cases of cVDPV this year together with the dates of onset of paralysis for the most recent case are:
• In Syria 40 cases of cVDPV2 – 27 July 2017.
• In the DRC 9 cases of cVDPV2 – 13 July 2017.
1. cVDPV1 cases:
- No cases in 2017. Three cases reported in Laos in 2016. In 2015 there were ten cases in Madagascar, eight cases in the Lao Republic and two cases in the Ukraine.
2. cVDPV2 cases:
- Nine cases in total in DRC in two separate outbreaks:
o 7 cases in Haut Lomami province. The onset of paralysis of the most recent case was on 10 July.
o 2 cases in Maniema province. Onset of paralysis on 26 March and 18 April. - Fourty cases in Syria.
o Thirty-eight cases are from Deir Ez-Zour governate. (30 from Mayadeen district.)
o One case from the Talabyad district in the Raqqa governate.
o One case from the Tadmour district in the Homs governate.
o All the Syrian cases had onset of paralysis between 3 March and 13 July. The outbreak response in Syria is including immunisation of at-risk populations in northwest Syria, Turkey and Lebanon.
The WHO have indicated that for both the DRC and Syria the recent cVDPV2 cases reported should not have been unexpected and do not change the operational situation.
Polio is an infectious, crippling and potentially fatal disease. There is no cure, but there are effective vaccines. The strategy to eradicate polio is based on preventing infection by immunising every child until transmission stops and the world is polio-free. The source of polio virus transmission is infectious humans but only 1 in 200 infections leads to irreversible paralysis. Of those paralysed, 5% to 10% die when their breathing muscles become immobilised.
Other comments (from the internet and other sources):
Polio vaccines reach vulnerable children in hard to reach areas of Syria:
Despite challenges, polio vaccination campaigns have been carried out in Syria in response to an outbreak of vaccine-derived poliovirus. Three mass immunisation rounds have been carried out in Deir Ez-Zor and Raqqa governorates, Syria, in response to an outbreak of circulating vaccine-derived poliovirus type-2 (cVDPV2). The latest round, targeting resident, refugee and internally displaced children less than five years in Deir Ez-Zor concluded 28 August.“The detection of circulating vaccine-derived poliovirus indicates that there has been low population immunity in affected areas for a considerable period of time,” said Chris Maher, manager of WHO’s regional polio eradication programme based in Amman, Jordan. “WHO is working with all parties on the ground to ensure access to and vaccination of all children under five in these areas, to put an end to this outbreak as quickly as possible,” he said. As of the end of August, 39 cases of cVDPV2 have been confirmed in Syria ‒ 37 cases from Deir Ez-Zor governorate, and 1 case each from Raqqa and Homs governorates. All three governorates are affected by active conflict. “Conflict and inaccessibility continue to hamper efforts to raise population immunity levels in areas across the country. These same factors that paved the way for the outbreak of wild poliovirus in Syria in 2013,” said Maher. “We are using the same approaches to achieving access that were successfully used in responding to the 2013 outbreak, and working together with all partners to make sure that children can be reached with vaccine,” he added.
In addition to ensuring access for vaccination teams, innovative methods have been used to increase response reach and effectiveness. The advertising of campaigns through bakeries, and engagement of a local ice cream factory to assist with the daily freezing and refreezing of ice packs for vaccinator cold boxes, are examples. “Vaccinators on the ground in Deir Ez-Zor and Raqqa continue to face difficult circumstances, but their efforts show clear dedication to protect children against this preventable disease,” said Maher. “We must maintain this high level of commitment and drive,” he said. Deir Ez-Zor has carried out two mass immunization rounds in July and August while Raqqa has carried out one. The second round for Raqqa is planned for after the Eid holiday.Inactivated polio vaccine (IPV) is being given to targeted children in each of the second rounds along with the oral vaccine to maximize individual and community protection. “These local polio vaccination campaigns represent a significant step that has culminated in the close cooperation between WHO, UNICEF and local health partners to reach all targeted children under five in Ar-Raqqa and Deir Ez-Zor governorates,” said Elizabeth Hoff, WHO Representative in Syria.
“Despite security challenges, WHO is committed to ensure the distribution of polio vaccines and the implementation of the local campaigns as planned with a view to achieving sound wellbeing and growth for children with a special attention given to the affected governorates,” Hoff added. In addition to supporting the response, WHO and partners are also working with neighbouring countries to enhance immunization and disease surveillance activities in high-risk areas. Circulating vaccine-derived poliovirus can occur in rare instances when population immunity against polio is very low. In these settings, the weakened virus found in the oral polio vaccine can spread between under-immunised individuals and over time, mutate into a virulent form that can cause paralysis. The only way to stop transmission of vaccine-derived poliovirus is with an immunisation response, the same as with any outbreak of wild polio. With high levels of population immunity, the virus will no longer be able to survive and the outbreak will come to a close.
The Sindh Chief Minister expresses concern over the most recent polio case.
Minister Syed Murad Ali Shah expressed his serious reservation over the emergence of one polio case in Karachi. In 2016 there were eight polio cases in Sindh and this year only one case had been reported. Syed said it had undone all the hard work that was put in to make the city polio free. He was presiding over a meeting of Task Force for Polio Eradication at the New Sindh Secretariat. Provincial Coordinator Emergency Operation Centre for Polio, Fayaz Jatoi, while giving presentation, said that Karachi had made huge progress towards polio eradication and the environment samples were clear until March 2017 when the virus reappeared and subsequently resulted in a case of polio in a seven-month-old child whose family had refused their child to be vaccinated. Fayaz proposed that in order to reverse the situation, all efforts should be made, including the engagement of 5,000 newly recruited medical staff, making health facilities functional in underserved areas and increasing the accountability of low performing officers. Legislation was proposed for making it compulsory for parents to get their children vaccinated against polio. The chief minister stressed that local community elders and religious leaders should be involved in the campaign to motivate the parents that polio vaccine was necessary to eradicate the crippling diseases. He directed the health department to make all their health facilities functional by appointing necessary staff. The chief minister was told that people from Khyber Pakhtunkhwa and FATA frequently visited Karachi. They are the carriers of polio virus that’s why a new case has emerged in the city. It was pointed out in the meeting that positive environmental samples in Kambar were found in August 2017. The chief minister directed minister for health to remove the district Health Officer of Kambar immediately. Fayaz Jatoi, while briefing the chief minister on situation in Karachi, said that seven out of nine environmental sample sites in 2017 have been found positive.
Syed said that operational weaknesses, increasing number of refusal and high migration from high risk areas were contributing factors of polio virus transmission. Fayaz said that in the city 152,406 children were still missed from polio vaccine. Giving their details he said 51,233 were not available in their homes when polio teams visited them, 24,970 refused and 76,203 missed. National Coordinator of Polio Programme Dr Rana Safdar said “we are in an uncomfortable position but we have the capacity to change the situation”. The next polio campaign in Sindh starts from the 16th of September in Karachi and 18th of September in all other districts of the province. The target population of under-five is 8.4 million children, including 2.3 million in Karachi. The Directorate of Inspection and Registration of Private Institutions, School Education and Literacy Department of Government of Sindh has issued a directive to all schools in the province that they are to cooperate with polio eradication teams.
Rotary’s PolioPlus Program: Lessons Learned, Transition Planning, and Legacy
Judith Diment has alerted me to a lengthy report published in The Journal of Infectious Diseases ( Volume 216, 1 July 2017) that I draw you attention to. This had contributions from many you know; John Sever, Mike McGovern, Robert Scott, Carol Pandak, Amy Edwards and David Goodstone, See: https://academic.oup.com/jid/article-lookup/doi/10.1093/infdis/jiw556
The introduction starts with: Hundreds of thousands of Rotary volunteers have provided support for polio eradication activities and continue to this day by making financial contributions to the Rotary PolioPlus program, participating in national immunisation days, assisting with surveillance, working on local, national, and international advocacy programs for polio eradication, assisting at immunisation posts and clinics, and mobilizing their communities for immunisation activities Rotary has contributed more than $1.6 billion for the global eradication of polio. When polio is finally gone, we will have the knowledge from the lessons learned with PolioPlus, such as the value of direct involvement by local Rotarians, the program for emergency funding, innovative tactics, and additional approaches for tackling other global issues, even those beyond public health.
And the concluding comments on legacy: Through Rotary’s polio eradication efforts, the organisation has learned how to raise funds with coordinated campaigns, and raise awareness with innovative communications methods and celebrity engagement. In addition, Rotary members learned how to work with other organisations to implement large-scale projects that required advocacy, security planning, and coordination in the field. Finally, the launch of PolioPlus as Rotary’s flagship project has a legacy of uniting Rotary members around the world behind a common goal. Ending polio will be a major stepping stone for the United Nations’ sustainable development goals, particularly goal 3, to “ensure healthy lives and promote well-being for all at all ages”. When polio is finally gone, we will have the blueprint for tackling other global issues, even those beyond public health.
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I neglected to mention last week that the health response to widespread flooding in Benue, Nigeria, has been strengthened by polio infrastructure. Existing structures and local health workers are helping to intensify disease surveillance and reporting, assess potential infection sources, and engage communities in disease prevention. With 8,957 personnel involved in polio eradication activities in the state, it is hoped that these actions will considerably aid efforts to support victims of the flood. Also, in Borno, an emergency response team continues to use the polio infrastructure to react to the recent cholera outbreak.
21 September 2017
Reg Ling
Rotary Club of Chandler's Ford and Itchen Valley.
Rotary District 1110 (Central Southern England and the Channel Islands).
Rotary Zone 18A (Southern England and Gibraltar) End Polio Now Coordinator (EPNC).