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End Polio Now Position - 6th February 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

Two WPV1 cases for which advance notification was given last week have now been officially recorded. Three positive WPV1 environmental 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 6 February 2018
3 0
2017 to 7 February 2017 1 0
2017 to 6 February 2018
22 92
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 – 8 January 2018 - or 4 weeks since the onset of polio.
    • 3 cases in 2018 vs. 1 case at the same time in 2017. Total 14 cases in 2017.
    • The next set of immunisation days is planned for 12 February.
    • Aimed to vaccinate 37 million children.
  • In Pakistan - 15 November 2017 - 12 weeks since the onset of polio.
    • No cases in 2018 vs. no cases at the same time in 2017.
    • 8 cases in 2017.
    • The next set of immunisation days is planned for 12 February synchronised with activities in Afghanistan.
  • In Nigeria - 21 August 2016 - 76 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 20 cases, 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)o 18 cases in 2017 vs. no cases at the same time in 2016.
    • Most recent case – 20 November 2017 – or 12 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 20 weeks since the onset of polio.
    • An IPV vaccination round is in progress. Children in Hasakah governorate who were missed by the mOPV2 first round vaccination will receive it in alongside of IPV.

cVDPV3

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

 

Other comments (from the internet and other sources):

A large number of contrasting articles appeared last week about effects of reducing investment vs. leveraging the GPEI polio infrastructure. From GPEI with the implications of the post transmission era and cut backs in the post certification era. From CDC about the need to reduce their spread of activity though the eradication of polio remains a firm commitment. From the endemic countries about renewed pushes for the eradication of polio. From private and public bodies about polio fund-raising plans and many articles on awareness of the efforts for polio eradication. In fact it is easy to portray what you want to but the undeniable fact is that polio infection is continuing to decrease.

Afghanistan is increasing the drive to track and understand the movement of the polio virus by expanding environmental surveillance – collecting and testing sewage samples for poliovirus in the laboratory – to all regions. At the end of 2017, a new environmental sampling site became operational in Kunduz province, becoming the 20th site since the collection and testing of sewage samples for poliovirus began in Afghanistan in 2013, with WHO support.

In 2017, 317 sewage samples were collected from all sites, and 30 of these showed that the poliovirus was present. This insight means that the polio eradication team knows where the virus is, without relying on the identification of paralysed children. Given that for every one polio victim there can be hundreds of ‘silent’ cases – children infected but with no symptoms – improved. For more information see:

http://polioeradication.org/news-post/afghanistan-expands-environmental-surveillance/

There is a series of short videos on the GPEI website entitled Coffee with Polio experts. These explain the difficulties maintaining polio surveillance in countries that are now polio-free. Members of the community have forgotten what polio was like and are focused on what they see as greater risks and this where the GPEI negotiations are taking place to explain the polio situation.

 

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.

8 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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