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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.

Principal polio focus: (Where GPEI surveillance and immunisation activities continue)

The advanced notification of a WPV1 case in Afghanistan last week has been confirmed but another advanced notification of a WPV1 case there has been reported. This will not be shown in the records till next week. Meanwhile the WPV1 case count this year is now 13. Five more WPV1 positive environmental samples were collected, two in Pakistan and three in Afghanistan. These bring the total number of WPV1 positive samples collected in 2017 to 109. Two cVDPV2 cases were reported this week, one in the DRC and one in Syria. No cVDPV2 positive environmental samples were collected. The number of cVDPV2 cases in Syria is 53 and the total in the DRC is 10. (For positive environmental samples, the viral environmental presence lasts for 7-14 days.)

 

  WPV1 cVDPV2
2017 to 31 October 13 63
2016 to similar date 27 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 by country with onset of paralysis were:

  • In Afghanistan – 2 October 2017 - so 3 weeks since the onset of polio.
    • 8 cases in 2017 vs. 9 cases at the same time in 2016.
    • Three positive environmental samples collected last week.
    • The next SNIDS will be in the first half of November. The campaign will cover 34 provinces using bOPV, protecting over 9 million children from polio.
  • In Pakistan - 21 August 2017 - 9 weeks since the onset of polio.
    • 5 cases in 2017 vs.15 cases at the same time in 2016. The number of AFP stool specimens tested this year is 7,224 with 406 specimens Awaiting tests.
    • SNIDs are underway aiming to protect over 21 million children from polio using bOPV. Planning has begun for the next set of NIDs scheduled for later this month.
  • In Nigeria - 21 August 2016 - 61 weeks since the onset of polio.
    • No cases in 2017 vs. 4 cases at the same time in 2016.
    • For the next SNIDs, bOPV will be used to protect over 10 million children under the age of 5 years from polio.  

The numbers of cases of cVDPV2 this year and the dates of onset of paralysis are:

  • In Syria - 53 cases of cVDPV2 – 25 August 2017. All the cases had onset of paralysis between 3 March and 25 August. Genetic sequencing puts the initial infection to before the switch from tOPV to bOPV. Most of the cases occurred before the outbreak response started.
    • The bulk of the cases are from Deir Ez-Zour governate. (42 from Mayadeen district and 6 in the Boukamal district.)
    • Other cases have been from the Talabyad district in the Raqqa governate and the Tadmour district in the Homs governate.
    • 223,001 children between 2-23 months of age have been vaccinated. Plans for any potential breakthrough cases in known outbreak zones or the spread of the virus to new areas of the country have been drawn up.
  • In the DRC - 9 cases of cVDPV2 – 27 July 2017.
    • 2 cases in Maniema province. Onset of paralysis for the first was 26 March and the second 18 April.
    • 8 cases in Haut Lomami province. The onset of paralysis of the most recent Case was on 14 September.
    • The next immunisation activity to take place in November aims to protect over 800,000 children from polio.

Other polio activity positions: (Where no activity beyond surveillance is expected.)

WPV2 cases:

  • Declared eradicated September 2015. (Last case was in October 1999.)

WPV3 cases:

  • No cases reported since 10 November 2012. (That was in Nigeria.)

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.

 

Other comments (from the internet and other sources):

According to a recent USA Today article, Bill Gates believes the last case of polio could be in 2017 and polio will become the second disease after smallpox to completely disappear. A significant achievement from the 350,000 cases (of polio) 30 years ago. The success of the eradication can be traced to a few people and organisations beginning with Dr. Jonas Salk, the man who developed the first safe and effective polio vaccine in 1955. In 1985, Rotary International began the first mass vaccination initiative called PolioPlus. Three years later, the Global Polio Eradication Initiative was created, and in 2007 the Bill and Melinda Gates Foundation pledged nearly $3 billion to the effort.

Pakistan and Germany have inked agreements for the support of 10 million Euros for vaccination and 10 million Euros for the eradication of polio. The agreements will help improve the performance of Pakistan National Polio Emergency Plan, vaccination and other such sectors. The German ambassador said that these agreements were aimed at making Pakistan’s vaccination system more effective. He said around 21.6 million children would benefit from these agreements and added Germany would continue support for making Pakistan polio free.

On Monday 31 October, when kicking off a five-day polio vaccination drive, the Karachi Health Director urged the parents to have polio drops administered to children, saying the crippling virus was found in sewage samples taken for routine testing from five different areas of the metropolitan last month. He urged the people to cooperate with polio teams in a bid to eradicate the virus from Pakistan once and for all.  During this polio vaccination drive, also known as Sub-National Immunisation Days, as many as 7,127,711 children under the age of five will be given OPV drops in 21 districts and towns in Sindh. The total target for this campaign is 1,748,244 children. The district administrations and town health management teams have significantly improved the situation with respect to the polio vaccination but there is no room for complacency as the virus could return at any time. It has been suggested to make an Expanded Programme on Immunisation Centre in hospitals more attractive for the patients.

On 27 October, as part of the ongoing efforts to revamp routine immunisation in Nigeria, the European Union, commissioned equipment, vehicles and solar refrigerators to support routine immunisation activities in the 23 states. Speaking on behalf of development partners, the WHO country representative commended the EU for being a long standing global partner especially in the area of polio eradication. In a recent global effort to shore up more resources to eradicate polio, the EU pledged the sum of fifty five million €s.

2 November 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).