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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. This raises the case count to 12. Four cVDPV2 cases were reported in Syria bringing the total to 52. 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 101. The virus environmental presence lasts for 7-14 days.

 

  WPV cVDPV
2017 to 10 October 12 61
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 8 weeks since the onset of polio. 
    • 5 cases in 2017 vs.15 cases at the same time in 2016. The number of AFC stool specimens tested is 6,735 and there are 397 tests still to be done.

    • A vaccination campaign is underway targeting > 3.5 million children under 5 years of age. Another localized campaign is targeting 200,000 more children.

  • In Afghanistan – 15 September 2017 so 5 weeks since the onset of polio. 
    • 7 cases in 2017 vs. 8 cases at the same time in 2016.
  • In Nigeria - 21 August 2016 or 60 weeks since the onset of polio.
    • No cases in 2017 vs. 4 cases at the same time in 2016. The most recent SNIDs provided protection to over 50% of children under five nationwide. Synchronised immunisation activities continue across the Lake Chad basin 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:

  1. In Syria - 52 cases of cVDPV2 – 25 August 2017. All the cases had onset of paralysis between 3 March and 25 August. Genetic sequencing suggests that the initial infection was 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.
    • The second nationwide immunisation round started 7 October and both mOPV2 and IPV are being used to reach more than 2.7 million children. (The first mOPV2 round was successfully carried out between 22-26 July. Independent post-campaign monitoring reflected coverage of 88.4%.) Altogether six cVDPV2 positive environmental samples had been recorded. 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.
  2. 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):

I think pride of place must go to the RI announcement of yesterday of donating $49.5 million to the eradication of polio. See:

            https://www.rotary.org/en/rotary-gives-495-million-help-eradicate-polio

18 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).