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End Polio Now Position - 23rd January 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.

Wild Polio virus:

WPV1

One WPV1 case reported this week in Afghanistan. Three positive WPV1 samples collected, two in Pakistan and one in Afghanistan. (For positive samples, the viral environmental presence lasts for 7-14 days.)  

 

  WPV1 cVDPV
2018 to 23 January 1 0
2017 to 24 January 2017 0 0
2017 to 23 January 2018
22 91
2016 full year
37 5
2015 full year 74 32
2014 full year 359 56

 

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 – 1 January 2018 - or 3 weeks since the onset of polio.
    • 1 case in 2018
    • 14 cases in 2017 vs. 13 cases at the same time in 2016.
    • A vaccination campaign was completed last week covering over 5 million children
  • In Pakistan - 15 November 2017 - 10 weeks since the onset of polio.
    • 8 cases in 2017 vs. 20 cases at the same time in 2016.
    • A vaccination campaign was completed last week covering 37 million children.
  • In Nigeria - 21 August 2016 - 74 weeks since the onset of polio.
    • No cases in 2017 vs. 4 cases at the same time in 2016.
    • o    An immunisation campaign was completed last week vaccinating over 26 million children using bOPV.

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

Virus genetically changed from the weakened virus contained in OPV which can emerge in under-immunised populations. The cases and the dates of onset of paralysis were:

cVDPV1

  • 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.

 cVDPV2

  • In the DRC: (Has not reported a case of wild poliovirus since 2011)
    • 17 cases in 2017 vs. no cases at the same time in 2016.
    • Most recent case – 20 November 2017 – or 10 weeks since the onset of polio.
    • Most cases in Haut Lomami province though 2 of the early cases were in Maniema province with onset of paralysis on 26 March then 18 April.
    • A recent resurgence after interventions mid year had stemmed the outbreak. Outbreak response continues.
  • In Syria: (There has not been a case of indigenous WPV since 1999. No WPV has been found since January 2014. VDPV cases arose with the defeat of ISIS when pockets of infection were discovered. There have been no cases since the outbreak response.)
    • 74 cases in 2017 vs. no cases at the same time in 2016.
    • Most recent case 21 September 2017 – or 18 weeks since the onset of polio.
    • The 2nd phase of the outbreak response using mOPV2 and IPV has been completed in all governorates.

cVDPV3

  • No cases since July 2013 when there was one in the Yemen.

 

Other comments (from the internet and other sources):

Last week two polio vaccinators (a mother-daughter team) were shot dead in Pakistan. The vaccinators, a 38-year-old woman and her 16-year-old daughter, were each shot in the head by motorcycle-riding assassins. Rotary’s Aziz Memon will go to Quetta to console the widower - a truck driver with six other children. In the past, Rotary has given the families of murdered vaccinators thousands of dollars.  It was the first time in two years that the polio eradication drive had been shaken by assassinations. While tragic, the killings will not seriously disrupt Pakistan’s eradication drive. Last year, Pakistan had only eight confirmed cases of polio paralysis and four years ago the nation had 306 cases. There is persistent hostility though between Pakistan’s military and clan militias in some mountainous border areas. These have never been fully under government control.

Also last week, officials dealing with anti-polio campaigns in the Peshawar district have lamented a lack of cooperation from the district administration. The move came after environmental samples consistently tested positive for three consecutive months. A Northern Corridor Action Plan (NCAP) has been formed and the risk factors identified.  Earlier in January, a three-day anti-polio campaign was launched in the province where around 5.7 million children were due to be vaccinated against the virus. However, the campaign missed 82,210 children. Of these, 20,870 were in Peshawar alone. Of the 20,870 children missed, parents of 3,665 children had turned vaccinators away. Peshawar is a major hub for the transmission of the virus from Afghanistan. The district of Peshawar has refuted the allegations and are pursuing those parents who had turned away vaccinators. There is no uniform reason for parents to refuse vaccination, nor are two refusal cases alike but most had turned away vaccinators due to non-medical or even non-conspiracy issues. After Peshawar, around 670 refusal cases were reported from other districts.

Positively though, there is an article “Protecting children on the move” on the GPEI website. Over the critical low transmission season, the polio programme is working feverishly to identify and vaccinate every high-risk mobile child. See:
http://polioeradication.org/news-post/protecting-children-on-the-move-pakistans-final-frontier/

From Africa, last week the BMGF agreed to pay off $76 million that Nigeria borrowed from Japan to fight polio. The huge debt will be paid off over the course of 20 years, starting this year. Nigeria, is which is recovering from its worst recession in 25 years, originally took the loan in 2014 for increased polio eradication efforts.  Nigeria has achieved more than 80% vaccination coverage in very high-risk areas.

In India meanwhile district medical and health departments have been gearing up for a national pulse polio immunisation programme to be conducted on 28 January. Vaccination of children below five years age will be administered bOPV at centres being set up at schools, anganwadi centres, bus stations, railway stations and in residential areas. Publicity banners will advertise the programme and on Saturday, mobile campaigning will be conducted with announcements on newspapers and television.

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 Zone Coordinator.

25 January 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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