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 new WPV1 cases reported this week. One positive WPV1 environmental sample in Afghanistan but it had been collected in September 2017.
(For positive samples, the viral environmental presence lasts for 7-14 days.)
| WPV1 | cVDPV | |
| 2018 to 13 February 2018 |
3 | 0 |
| 2017 to 14 February 2017 | 1 | 0 |
| 2017 to13 February 2018 |
22 | 95 |
| 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 – 6 January 2018 - or 5 weeks since the onset of polio.
- 3 cases in 2018 vs. 1 case at the same time in 2017. Total 14 cases in 2017.
- A set of immunisation days started on 12 February aiming to vaccinate children across 24 provinces.
- In Pakistan - 15 November 2017 - 13 weeks since the onset of polio.
- No cases in 2018 vs. no cases at the same time in 2017.
- 8 cases in 2017.
- A set of immunisation days began on 12 February aiming to vaccinate 37 million children and synchronised with activities in Afghanistan.
- In Nigeria - 21 August 2016 - 77 weeks since the onset of polio.
- No cases in 2018. No cases in 2017 vs. 4 cases at the same time in 2016.
- Post-campaign date from January SIAs is being collated. (The aim was to vaccinate over 26 million children.)
- The next immunisation days are set for early 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)
- 21 cVDPV3 cases in 2017 (three last week) vs. no cases at the same time in 2016.
- Most recent case – 1 December 2017 – or 10 weeks since the onset of polio.
- 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 21 weeks since the onset of polio.
- An IPV vaccination round has successfully been concluded. 233,518 children received IPV.
- Environmental surveillance began in December. Results are available for five samples but with no isolation of VDPV2.
- Three VDPV2s were isolated from two environmental samples collected in Somalia but no AFP cases associated with these cVDPV2 samples have been detected. Outbreak response campaigns have been implemented
cVDPV3
- No cases since July 2013 when there was one in the Yemen.
Other comments (from the internet and other sources):
Many of the Pakistan newspapers have highlighted the polio eradication campaign starting this week. In some areas the campaign had to be suspended owing to security threats. In others, families who previously refused polio drops for their children have been placated. The programme of NIDS and SNIDS in Pakistan through the low season for transmission is: Feb 12 -14 NIDs, Mar 12-14 SNIDs, Apr 9-11 NIDs and May7-9 SNIDs.
Finding and closing remaining gaps in national health system capacities to pick up traces of the poliovirus is critical. The threat of poliovirus resurgence remains very real in countries with a history of importation of poliovirus. To ensure that surveillance systems are up-to-scratch and sensitive enough to detect and report cases of acute flaccid paralysis (AFP) the WHO regularly leads expert reviews. Technical officers and polio surveillance experts recently met in Khartoum to share their findings and recommendations after scrutinizing Sudan’s surveillance performance. Sudan has not seen a case of polio for almost nine years however certain factors put it at considerable risk of poliovirus importation and outbreaks. Sudan is the third largest country in Africa and home to over 40 million people. Insecurity, forced displacement, frequent nomadic population movement and inaccessibility in some areas make it challenging for health workers to consistently reach all children with vaccines to build immunity. Refugee influxes across porous borders with conflict-affected neighbouring countries exacerbate the risk of disease and compound pressures on the country’s stretched health system. In addition, high sub-Saharan temperatures and rough expansive terrain can make timely collection and transportation of stool specimens for laboratory testing difficult. In refugee camps, vaccination posts have provided an opportunity to screen for children with AFP, and collaboration and sensitisation of non-government organisation staff has helped to improve reporting of AFP cases. Overall conclusions were that the system is meeting global AFP surveillance targets and it is unlikely for polio to circulate undetected. However, gaps were identified that need to be addressed. Sudan witnessed its last case of indigenous wild poliovirus in 2001. Since then it has been exposed to several wild polio importations from Chad and Ethiopia with its most recent case in March 2009.
The poliovirus remains in just a few small pockets around the world. Disease detectives are working to find every last virus in the hard to reach places. Some areas are vast and sparsely populated, such as the broad plains and river beds making up areas of the Lake Chad region. Others are densely packed residential areas of Afghanistan, where security issues can sometimes make immunisation difficult. In areas of Syria, civil war continues to rage through towns, communities, and families. Experts look for the virus in children with symptoms of AFP and also in water samples from sewage systems. Insecurity, weather and challenging landscapes can be obstacles. Diverse methods also strengthen surveillance in countries where the security situation is rapidly changing. By building networks in camps for internally displaced families and by recruiting surveillance volunteers at the key points of entry and exit into the worst of the conflict zones, the surveillance system is the eyes and ears of polio eradication, showing where to focus efforts to vaccinate every last child.
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.
16 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.