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)
This week no new WPV1 cases were reported but an advanced notification of a WPV1 case was received from Afghanistan. This will raise the case count to 12 in the coming days.
5 WPV1 positive environmental samples were collected, three in Pakistan and two in Afghanistan. These bring the total number of WPV1 positive samples collected in 2017 to 96. One cVDPV2 case was reported in Syria and 2 cVDPV2 positive environmental collected too. The virus environmental presence lasts for 7-14 days.
| WPV | cVDPV | |
| 2017 to 10 October | 11 | 57 |
| 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 Pakistan - 21 August 2017 or 7 weeks since the onset of polio.
- 5 cases in 2017 vs. 15 cases at the same time in 2016. A vaccination campaign is underway targeting > 3.5 million children under 5 years of age. Another campaign in selected areas is targeting 200,000 more children.
- In Afghanistan – 10 July 2017 so 13 weeks since the onset of polio.
- 6 cases in 2017 vs. 9 cases at the same time in 2016. NIDS targeting 10 million children.
- In Nigeria - 21 August 2016 or 59 weeks since the onset of polio.
- No cases in 2017 vs. 4 cases at the same time in 2016. SNIDs took place last week providing protection to over 50% of children under five nationwide. Synchronised immunisation activities across the Lake Chad basin took place including efforts in markets, IDP camps and at international borders.
The numbers of cases of cVDPV this year together with the dates of onset of paralysis for the most recent case are:
- In Syria - 48 cases of cVDPV2 – 5 August 2017. All the Syrian cases had onset of paralysis between 3 March and 19 August, but these were before the outbreak response had started. Genetic sequencing suggests that the initial infection was before the switch from tOPV to bOPV. A nationwide immunisation day in October is aiming to reach more than 2.7 million children.
- Fourty-three cases are from Deir Ez-Zour governate. (36 from Mayadeen district.)
- Two cases from the Talabyad district in the Raqqa governate.
- One case from the Tadmour district in the Homs governate.
Another cVDPV2 positive environmental sample was recorded this week. The second immunisation round started 7 October and both mOPV2 and IPV are being used. (The first mOPV2 round was successfully carried out between 22-26 July. Independent post-campaign monitoring reflected coverage of 88.4%.)
The outbreak response in Syria includes immunisation of at-risk populations in northwest Syria, Turkey and Lebanon. IPV is being administered at border points for unvaccinated children crossing from Syria to Lebanon.
- In the DRC - Nine cases of cVDPV2 - 27 July.
- 2 cases in Maniema province. Onset of paralysis first 26 March and second 18 April.
- 7 cases in Haut Lomami province. The onset of paralysis of the most recent case was on 27 July.
- Outbreak responses continue using mOPV2. The next immunisation activity is scheduled for the end of October will use bOPV for 10 million children.
The WHO has indicated that, for both the DRC and Syria, the 2017 cVDPV2 cases reported were not unexpected and do not change the operational situation.
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):
Mostly about renewed commitments in Pakistan and somewhat dated reports on country pledges of support for the global eradication of polio made at or after the Rotary International Convention in Atlanta.
I attended the Rotary Institute for Zones 15,16,17 and 18A in Riga last week. The Institute was preceded by GETS, the Rotary Foundation Seminar and the concurrent Seminars for PR & Marketing and for the Council on Legislation. (Some overlapped with the concluding day for GETS.) There was also an early bird meeting on RLI. (Rotary Leadership Institute.) However, relevant from these is that Patrick O’Connor, from the Global Immunisation Division of WHO, spoke at both the Rotary Foundation Seminar and The Institute. Patrick was very convinced that polio will be eradicated but emphasised the continuing need for financial support and the importance of environmental sampling and full AFP testing as we move through the post polio transmission era. I hope I do bring the points out in these reports.
16 October 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).