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End Polio Now Position - 30th 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

No WPV1 cases reported this week but advance notification of two cases in Afghanistan has been received. Eight positive WPV1 environmental samples collected, three in Pakistan and five in Afghanistan. (For positive samples, the viral environmental presence lasts for 7-14 days.)

 

  WPV1 cVDPV
2018 to 30 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 4 weeks since the onset of polio.
    • 1 case in 2018 vs. no cases at the same time in 2017.
    • 14 cases in 2017 vs. 13 cases at the same time in 2016.
    • The next set of immunisation days is planned for early February.
  • In Pakistan - 15 November 2017 - 11 weeks since the onset of polio.
    • No cases in 2018 vs. no cases at the same time in 2017.
    • 8 cases in 2017 vs. 20 cases at the same time in 2016.
    • The next set of immunisation days is planned for early February.
  • In Nigeria - 21 August 2016 - 75 weeks since the onset of polio.
    • No cases in 2018. No cases in 2017 vs. 4 cases at the same time in 2016.
    • The next set of immunisation days are set for March.

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 11 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.
    • The next set of supplementary immunisation days is planned for late February.
  • 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 19 weeks since the onset of polio.
    • The 2nd phase of the outbreak response reached 96% of the target. The next immunisation round will use IPV.

cVDPV3

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

 

Other comments (from the internet and other sources):

Last week Rotary announced giving of $53.5 million in grants to support immunisation and surveillance activities led by the GPEI. With 22 confirmed cases in 2017 to date then, and just one case in 2018, the world is on the brink of eradicating polio, a vaccine-preventable disease that once paralysed hundreds of thousands of children each year. More than half of the funds will support efforts to end polio in two of the three countries where polio remains endemic. (Afghanistan $12.03 million and Pakistan $19.31 million.) The other funds will support efforts to keep the two recent outbreak counties of the DRC and Syria and another 8 high risk countries polio-free. (Cameroon, the CAR, Chad, Ethiopia, Iraq, Niger, Somalia and South Sudan.) Additional funds are to be given for research to be conducted by the WHO and for technical assistance in West and Central Africa.

In Lahore Punjab Chief Secretary has warned officials that negligence will not be tolerated in efforts to eradicate polio from the province. Public cooperation will be of key importance in efforts to combat polio and all relevant departments should play an active role in enhancing public awareness about this crippling disease. Rs100 billion will be spent for polio eradication in Punjab in next five years. 1,700 polio workers had been hired while 2,300 more will be recruited to expedite anti-polio activities in the province.

In New Delhi on 27 January, President Ram Nath Kovind launched the Pulse Polio programme for 2018 by administering polio drops to children less than five years old. This was on the eve of the NID during which more than 170 million children of less than five years across the country will be given polio drops as part of the drive of Government of India to sustain polio eradication from the country. It is this NID that the RIBI and other RI teams will be assisting with. It was stated that all the possible efforts to protect children from more and more diseases are being made. The immunity against polio infection is maintained through National and Sub-National Polio rounds along with sustained high quality polio surveillance. To provide additional protection to our children, the Government has also introduced the injectable Inactivated Polio Vaccine (IPV) into its routine immunisation program which focuses on protecting children from more diseases than ever before. Several new vaccines have been introduced like Pneumococcal Conjugate Vaccine, Rotavirus vaccine, and Measles-Rubella in the recent past. Strengthening of the immunisation programme has significantly contributed to the decline of Infant Mortality Rate from 39 in 2014 to 34 per 1,000 live births in 2016.

The polio Post-Certification Strategy is being developed to define the global technical standards or core set of activities that will be needed to sustain a polio-free world after global certification of wild poliovirus eradication. It will be presented at the World Health Assembly in May 2018 and will specify the technical standards for functions that will be essential to maintain a polio-free world in the decade following certification. The strategy has three goals:

  • Contain polioviruses: Ensure potential sources of poliovirus are properly contained.
  • Protect populations: Withdraw the OPV from use and immunize with IPV.
  • Detect and respond: Promptly detect any poliovirus respond to prevent transmission

 

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.

2 February 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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