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End Polio Now Position - 17th April 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.

Global position:

  WPV1 cVDPV
2018 to 17 April 2018
8 3
2017 to 18 April 2017 5 0
2017 full year
22 96
2016 full year
37 5
2015 full year 74 32
2014 full year 359 56

 The emphasis now is on:

  • Monitoring the date of the most recent onset of paralysis and the number of weeks elapsed.
  • The most recent positive environmental samples and the immunisation response.

Wild Polio virus:

WPV1

For polio-free certification purposes the start date for WPV monitoring is that of the onset of paralysis. For positive environmental samples, the viral presence lasts for 7-14 days.

No WPV1 cases this last week but two WPV1 positive environment al samples in Pakistan. Details of the most recent cases in each country are:

  • In Pakistan –  8 March 2018 – or 5 weeks since the onset of polio.
    • One case in 2018 vs. 2 cases at the same time in 2017. Total 8 cases in 2017.
    • SIDs held earlier in April have been concluded.
  • In Afghanistan – 3 March 2018 - or 6 weeks since the onset of polio.
    • 7 cases in 2018 vs. 3 cases at the same time in 2017. Total of 14 cases in 2017.
    • SIDs held earlier in April have been concluded.
  • In Nigeria – 21 August 2016 – or 86 weeks since the onset of polio.
    • No cases in 2018. No cases in 2017. Four cases in 2016.
    • Immunisation days took place last week synchronised with campaigns across the Lake Chad basin.

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

The virus is genetically changed from the weakened virus contained in OPV. No cVDPV2 cases this week but a cVDPV2 positive environmental sample in Kenya for which advance warning was given last week has been confirmed. Details of the most recent cases in each country are:

cVDPV1

  • No cases in 2017. Three cases reported in Laos in 2016.

 cVDPV2

  • The DRC:
    • 22 cVDPV2 cases in 2017. Three cases in 2018.
    • Most recent case – 31 January 2018 – or 11 weeks since the onset of polio. Surveillance and immunisation in neighbouring countries are being strengthened.
  • In Syria: VDPV cases arose after discovery of pockets of infection after the defeat of ISIS
    • 74 cases in 2017. There have been no cases since the outbreak response.
    • Most recent case 21 September 2017 – or 30 weeks since the onset of polio.

The earlier reported environmental samples in Somalia followed three VDPV2s isolated from two samples collected there in October and November 2017. The confirmation of a cVDPV2 positive environmental sample in Kenya this week is linked to that in Somalia. No AFP cases have been detected in either country.

cVDPV3

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

 

Other comments (from the internet and other sources):

Here I touch upon a seemingly unstoppable number of reports.

Mixed news

In 2017, the number of global WPV cases sank to its lowest level. Every year, supporters of the global effort to wipe out polio have made an optimistic declaration: This could be the year that polio ends. And this year, the 30th anniversary of the launch of the ambitious program, was no exception. But just three months into 2018, the projection was less rosy. Despite recent optimism, this year will not see the end of the disease. Michael Zaffran, director of polio eradication for the WHO hopes that polio spread in southern Afghanistan can be stopped. The northeast of the country though is an area in which deploying the vaccine and monitoring its use pose safety risks. On the other hand, developments in Nigeria are raising hopes that polio transmission will be interrupted there. Vaccinators have been able to reach more children, and that no cases were reported in people or in sewage samples in 2017.

Eight cases of polio have been reported this year, that’s three more than were seen over the same period last year and sewage surveillance in Pakistan and Afghanistan have had 28  WPV1 postive samples (now higher). Surveillance markers are improving in many countries but remaining gaps mean that progress is fragile. The number of cVDPV2 rose over the past 2 years, fuelled by outbreaks in the DR and Syria. Four of the six WHO regions have been certified as polio-free and the recent focus has been on countries in the Eastern Mediterranean and Africa. For 2017, 14 of 20 African countries and 5 of 6 countries in the Eastern Mediterranean evaluated met national surveillance indicators. Although overall performance improved national-level surveillance indicators masked sub-optimal surveillance at sub-national levels in both regions. Inaccessible and conflict areas are vulnerable to gaps in tracking.

Regarding sewage sampling, Afghanistan has had WPV1 from four genetic clusters in five provinces, and in Pakistan, 13% of samples have been positive. But 3 of 22 specimens from Afghanistan and Pakistan were considered orphan isolates, with a lower level of genetic relatedness, hinting at possible gaps in AFP surveillance. Regarding recent cVDPV2 strains, it has been observed the viruses have diverged from the Sabin parent strain. In Africa, recent positive samples included cVDPV2—from Nigeria's Borno state in 2016 and from Somalia in 2017. Though conflict situations limit standard health-facility surveillance, community-based surveillance has been effective at finding AFP cases. The global supply of injectable polio vaccine is starting to increase, with more producers and more supply is expected in 2020.The need for strong polio surveillance will remain beyond eradication certification and well after the oral poliovirus vaccine has been phased out globally.

Meanwhile, preparations are in hand for the next polio eradication campaign. In Jamshoro District (Hyderabad) for example, the plan is to immunise 112,258 children of under 5 years of age in the drive from 7–10 May. 335 teams had been constituted including 290 visiting teams, 28 teams on the fixed points and another 17 teams at the entry and exit roads. Some 30 medical officers at the union council level and 81 area in charges in addition to the officials of the district administration and health department would supervise the drive.  The ADC also instructed the polio teams to immunise children at the public transport stops and she asked the district police to provide complete security to the polio teams.

Nigeria

Islamic extremists made villages in north eastern Nigeria too dangerous for health workers to vaccinate against polio. Families have fled to displacement camps. Health teams are going from tent to tent, inoculating youngsters against the polio. Some of the families are from areas where polio vaccinators have not been able to visit for six years. Boko Haram has disrupted life in the northeast. The insurgency began in the state capital, but its reach has expanded to neighbouring Niger, Chad and Cameroon. In Borno state there is little or no surveillance data. Unless there is a breakthrough to reach these areas, the entire polio program is at risk. The WHO had declared Nigeria polio-free in September 2015 but in 2016 fresh polio cases broke out in Borno state. No new cases were reported in Nigeria in 2017 or so far this year. WHO be spending $127 million toward eradicating polio in Nigeria between 2018 and 2019.

Rotary's program is helping that effort by targeting some 2.1 million children in 24 accessible local governments. But there are still three areas in Borno state that are not included. For the unreachable areas, the vaccinators train Nigerian soldiers in how to administer the vaccines.

Bill Gates, speaking at the joint forum of the Commonwealth Head of Government Meeting in Westminster this week said Nigeria is one of the most difficult places in the world. to wipe out polio but it was achievable. India was declared Polio-free in 2014 and the lessons learnt from there have helped Nigeria get to zero cases in 2017.  Now Pakistan, which still has few cases is taking those experiences, particularly at the challenges of dealing with insecurity, and they have their cases down to the lowest areas ever.

Namibia gets ready for polio outbreak

Recently the WHO trained health officers from different ministries, civil society organisations and development partners in Namibia on standard operating procedures (SOPs) for the polio virus and its outbreak response. This was in line with the polio eradication and endgame strategic plan 2013-2018. In May 2012, the WHA declared the completion of polio virus eradication to be a programmatic emergency for global public health and called on the director general of the WHO to develop a comprehensive polio end-game strategy to develop the capacity of healthcare providers and partners in line with the SOPs, and review and update the polio virus preparedness and response plan. Following the globally coordinated switch from tOPV to bOPV, conducted from 17 April to 1 May 2016, all countries are required to conduct a polio simulation exercise to assess the robustness of the country polio preparedness and response plan. Participants at the Namibia workshop expressed gratitude for the training, indicating that some principles can be applied in most (disease) outbreaks.

 

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.

19 April 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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