End Polio Now Position - 4th September 2018

Rotary International is committed to continue the eradication of polio campaign until the WHO declares polio is eradicated. By this it means the interruption of the transmission of polio viruses for at least three years, in the presence of certified surveillance and when all polio virus stocks have been contained.

Global position:

  WPV1 cVDPV
2018 to 4 September 2018
15 36
2017 to 6 September 2017 10 47
2017 full year
22 96
2016 full year
37 5
2015 full year 74 32
2014 full year 359 56

 The emphasis now is on:

  • Monitoring the date of the most recent onset of paralysis and the number of weeks elapsed.
  • The most recent positive environmental samples and the immunisation response.

Wild Polio virus: 15 cases in 2018

For polio-free certification purposes the start date for WPV monitoring is that of the onset of paralysis. For positive environmental samples the viral presence lasts for 7-14 days.

WPV1 - 15 cases

One WPV1 case reported this week from Afghanistan.

The most recent WPV1 cases in each country were:

  • In Afghanistan – 17 July 2018 – 7 weeks since the onset of polio.
    • 12 cases in 2018 vs. 6 cases at the same time in 2017. Total of 14 cases in 2017.
  • In Pakistan – 18 May 2018 – 15 weeks since the onset of polio.
    • 3 cases in 2018 vs. 2 cases at the same time in 2017. Total 8 cases in 2017.
  • In Nigeria – 21 August 2016 – 106 weeks since the onset of polio.
    • No cases in 2018. No cases in 2017. Four cases in 2016.

WPV2

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

WPV3

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

Circulating Vaccine Derived Polio Virus - 36 cases in 2018

The virus is genetically changed from the weakened virus contained in OPV. Details of the most recent cases in each country are:

cVDPV1 - 9 cases

  • Three more cases this week in PNG. The total in 2018 is now 9.

  • Onset of paralysis of the most recent case - 26 July. Previously 3 cases in 2016 (in Laos).

 cVDPV2 - 24 cases

  • In Nigeria: 8 cases in 2018.
    • Onset of paralysis on 27 July 2018 – 5 weeks ago
  • In the DRC: 13 cases in 2018 vs. 22 cases in 2017.
    • Most recent case – 22 July 2018 – 7 weeks since the onset of polio.
    • Immunisation in neighbouring countries is being strengthened.
  • In Somalia: 3 cases in 2018. No cases in 2017.
    • Most recent onset of paralysis 10 July 2018 - 8 weeks ago.
  • In Syria: 0 cases in 2018
    • 74 cases in 2017. Arose after discovery of pockets of infection after the defeat of ISIS. There have been no cases since the outbreak last year.
    • Most recent case 21 September 2017 – or 48 weeks since the onset of polio.

cVDPV3 - 3 cases

  • In Somalia: 3 cases in 2018
    • Onset of paralysis for the most recent case was 23 May – 14 weeks ago.
    • The first cases since July 2013 when there was one in the Yemen.

Confirmation of cVDPV environmental samples in Kenya have not isolated the virus from any AFP cases or their contacts. Also, recent cVDPV2 samples in Nigeria and DRC.

 

Other comments (from the internet and other sources):

The Emergency Committee under the International Health Regulations regarding the international spread of poliovirus met on August 15. Its’ report is very interesting. In part it confirms the situation as I have been reporting it and it also gives recommendations. It is a lengthy report but is worth reading. See:

https://www.infectioncontroltoday.com/infectious-diseases-conditions/ihr-emergency-committee-issues-statement-international-spread

The principle elements are:

  • Continued progress in WPV1 eradication but many countries remain vulnerable to WPV importation. There is a risk of growing global complacency as the eradication becomes a tangible reality.
  • The risk of international spread of WPV has diminished but, should it now occur, the impact on progress towards eradication would be to delay certification and to prolong the requirements for resources to support of the efforts.
  • Gaps in population immunity is evidenced by the number of cVDPV outbreaks. These only emerge when polio population immunity is low as a result of deficient routine immunization programs.
  • Inaccessibility to vaccination programs is amplified by population movement, whether for family, social, economic or cultural reasons, or in the context of populations displaced by insecurity and returning refugees.
  • There is an increasing number of countries in which immunization systems have been weakened or been disrupted by conflict.  These threaten the completion of global polio eradication during its end stage. A regional approach and cross­-border cooperation will be required as much international spread of polio occurs over land borders.
  • Commitment in Pakistan and Afghanistan and the planning to cease transmission are a key to success in achieving WPV eradication. It is four years since there has been international spread outside of these two epidemiologically linked countries.
  • Pakistan has sustained the reduction in the number of cases and a fall in the proportion of environmental samples that have tested positive for WPV1. In Afghanistan there has been an increase in the number of cases. This reversal in progress heightens concerns. The increased insecurity resulting in nearly 1 million being inaccessible is a significant part of the reason for the increase.
  • Inaccessible and trapped children in Borno, Nigeria. It is now two years since the last WPV1 was detected, the outbreaks of cVDPV2 underlines the vulnerability of northern Nigeria. Some of the populations have not received polio vaccine since WPV1 was detected in 2016.
  • The countries in the Lake Chad basin have been affected by the Boko Haram insurgency. The countries; Cameroon, Chad, the CAR, Niger and Nigeria are committed to sub-regional coordination of activities. However, there are widespread gaps in population immunity across these countries, and the ongoing population movement in the sub-region and insecurity are major challenges.
  • The outbreak of cVDPV1 in PNG highlights that there are vulnerable areas of the world not usually the focus of eradication efforts.
  • Control of the outbreaks in the DRC are difficult. The virus has emerged after OPV2 withdrawal in 2016. The detection of cVDPV2 in Ituri Province far from previously detected cases and adjacent to the border with Uganda is an example that the virus can spread long distances. The outbreaks of Ebola virus disease further complicate the response.
  • The outbreaks of cVDPV2 in Somalia and Kenya are an international spread. They have a highly diverged cVDPV2 that appears to have circulated undetected for up to four years. There are high-risk populations in South and Central zones of Somalia where population immunity and surveillance are compromised by conflict.

The report goes on to enumerate actions region by region for which significant financial support will be required.


Reg Ling

Rotary Club of Chandler's Ford and Itchen Valley.

Rotary District 1110 (Central Southern England, the Channel Islands and Gibraltar).

Rotary Region 19 (Southern England and Gibraltar) End Polio Now Coordinator.

8 September 2018

 

Polio is a highly infectious, crippling and potentially fatal viral disease which mainly affects young children. 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 spread mainly through the faecal-oral route or, less frequently, by a common vehicle (e.g. contaminated water or food) and multiplies in the intestine, from where it can invade the nervous system and can cause paralysis. But, less than 1 in 200 infections leads to this. Of those paralysed, 5% to 10% die when their breathing muscles become immobilised.

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