End Polio Now Position - 28th August 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 28 August 2018
15 33
2017 to 29 August 2017 9 47
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: 15 cases in 2018

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.

WPV1 - 15 cases

One WPV1 case reported this week from Afghanistan.

The most recent WPV1 cases in each country were:

  • In Afghanistan – 17 July 2018 – 6 weeks since the onset of polio.
    • 12 cases in 2018 vs. 6 cases at the same time in 2017. Total of 14 cases in 2017.
  • In Pakistan – 18 May 2018 – 14 weeks since the onset of polio.
    • 3 cases in 2018 vs. 2 cases at the same time in 2017. Total 8 cases in 2017.
  • In Nigeria – 21 August 2016 – 105 weeks since the onset of polio.
    • No cases in 2018. No cases in 2017. Four cases in 2016.

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 - 33 cases in 2018

The virus is genetically changed from the weakened virus contained in OPV. Details of the most recent cases in each country are:

cVDPV1 - 6 cases

  • Two more cases this week in PNG. The total in 2018 is now 6.

  • Onset of paralysis of the most recent case - 26 July. Previously 3 cases in 2016 (in Laos).

 cVDPV2 - 24 cases

  • In Nigeria: 8 cases in 2018. Three cases this week.
    • Onset of paralysis on 27 July 2018 – 4 weeks ago
  • In the DRC: 13 cases in 2018 vs. 22 cases in 2017.
    • Most recent case – 22 July 2018 – 6 weeks since the onset of polio.
    • Immunisation in neighbouring countries is being strengthened.
  • In Somalia: 3 cases in 2018. No cases in 2017.
    • Most recent onset of paralysis 10 July 2018 - 7 weeks ago.
  • In Syria: 0 cases in 2018
    • 74 cases in 2017. Arose after discovery of pockets of infection after the defeat of ISIS. There have been no cases since the outbreak last year.
    • Most recent case 21 September 2017 – or 47 weeks since the onset of polio.

cVDPV3 - 3 cases

  • In Somalia: 3 cases in 2018
    • Onset of paralysis for the most recent case was 23 May – 13 weeks ago.
    • The first cases since July 2013 when there was one in the Yemen.

Confirmation of cVDPV environmental samples in Kenya have not isolated the virus from any AFP cases or their contacts. Also, recent cVDPV2 samples in Nigeria and DRC.

 

Other comments (from the internet and other sources):

Polio eradication to be topmost priority of the Pakistan government:

Pakistan has made a remarkable progress in protecting every child from polio disease, reducing number of the polio cases from almost 20,000 every year in the early 1990s to only eight last year. This was stated by Federal Minister of National Health Services during a high-level briefing at the National Emergency Operations Centre for the Polio Eradication. The minister said that the new polio cases have dropped by an amazing 99 per cent – from 306 in 2014 to three this year and they must sustain these gains and continue to ensure every child was reached in every vaccination campaign. The programme is driven by high-quality data and comprehensive, real-time risk assessment and monitoring. Expressing confidence in the quality, efficacy and safety of the oral polio vaccine, the minister advised the programme to constantly educate people on need to vaccinate all under five children in every campaign. The minister appreciated efforts including 260,000 frontline workers and termed them as heroes striving for health of future.

 

Kenya determined to remain polio free.

Following a finding of a cVDPV in an environmental water sample in Nairobi last April.
Kenya has had a polio campaign covering 12 counties at risk and targeting 2.8 under five children. Round Zero of the SIA was done 800,000 children in Nairobi. Round One done in July vaccinated 2.5 million children in the 12 counties. Other efforts to keep the virus at bay have been escalated including surveillance activities, border watchfulness, awareness-creation and a strengthened routine immunization through a 100-day Rapid Result Initiative intended to increase immunization uptake countrywide. A synchronized regional polio campaign is also planned for September and will involve Kenya and its neighbouring countries - South Sudan, Ethiopia and Somalia. The virus found in an environmental site was closely linked to the poliovirus isolated from similar samples collected in October and November 2017 and January 2018 in Banadir Province, Mogadishu Somalia. WHO Representative Dr Rudi Eggers stated. “It emphasizes the importance of population movements between the countries and the need to address polio eradication activities as a sub-region, not only in a single country like Kenya.” Speaking at the national Launch of Round Two polio campaign this week, Governor Charity Ngilu urged the community to bring their children aged below five years for the important vaccination. In addition, she asked caregivers and community to report any cases of people who develop sudden weakness/paralysis with no cause to the nearest health facility to ensure that appropriate investigation was done.

The national and county governments in Kenya had been investing heavily on the immunization programme to ensure availability of vaccines for all children at no cost, hence protecting children from Vaccine-Preventable Diseases. All countries in the Horn of Africa have been working tirelessly and collaboratively to ensure the region was free of the disease.

 

Polio vaccinations underway across six PNG provinces

There are now six confirmed cases of polio in Papua New Guinea, with two more identified in the past week, one in Madang and the other in Eastern Highlands. PNG, which had been declared free of polio for 18 years, found a child in Morobe with the disease in June. Systematic vaccination programmes have since revealed more victims and dozens of others with a suspected polio infection. The government said the risk of further spread within the country is high. Working with the WHO, UNICEF and the GPEI, PNG health officials are vaccinating hundreds of thousands of children throughout the country over the coming weeks, starting in six provinces this week. They are Enga, Western Highlands, Southern Highlands, Chimbu, Jiwaka and Hela.

 

Professor Nicholas Grassly and Dr Isobel Blake, from Imperial College, London have just published research in the New England Journal of Medicine calling for intensified global efforts to eradicate cases of VDPV.

Polio is not going away without a fight – it’s vital we step up our defences

The global initiative to eradicate polio has been extraordinarily successful. Over the last thirty years the number of polio cases across the world have dwindled from over 350,000 cases a year to just 20. The terrible toll on victims, such as lifelong paralysis and disability, are a fading memory for many countries, and it’s estimated around 16 million people have been saved from paralysis thanks to the vaccination programme. But the virus is not going without a fight. In a tiny handful of instances (one in 500 million children vaccinated), the vaccine can trigger outbreaks of something called vaccine-derived poliovirus (VDPV). This only happens in poorer areas of the world, where there is no robust health system and vaccination is patchy. Although scientists changed the vaccine, the historical legacy of this continues to represent an urgent threat to permanently banishing polio. The authors reveal why urgent action is needed to banish polio to the confines of history.

How could the polio vaccine have led to cases of the disease?

The oral polio vaccine contained three types, or strains, of the virus (types one, two and three). The vaccine, given to young children, is dropped onto the tongue, where it then travels through the stomach and digestive system. The live viruses in the vaccine have been weakened, so that it can’t cause disease. However, in very rare cases, and only in populations where immunisation rates are low, the vaccine virus can mutate in the intestines and regain the ability to cause paralysis, resulting in VDPV. The most common of the three vaccine strains causing VDPV has been the type 2 strain.

Although the person who received the vaccine does not develop polio, the reactivated polio vaccine leaves their body in faeces and can potentially infect others.

This is not a risk with the injectable polio vaccine, such as the one given in the UK, as the virus has been inactivated and doesn’t enter the gut. However, this vaccine cannot be used alone in places at risk of polio and where immunity is low. Although it protects an individual from paralysis, it does not prevent the virus being transferred from person to person – an important benefit of the oral vaccine

What did scientists do when they realised the risk?

Experts realised the only way to reduce the risk of VDPV was to stop using the oral vaccine that contained type 2 polio. This was possible as the type 2 'wild' poliovirus was last detected in 1999.  Instead, people would only be vaccinated against types 1 and 3 with the oral vaccine. However, the only way to remove this vaccine without triggering outbreaks of type 2 poliovirus was for the whole world to stop using the vaccine at the same time. And so, in an incredible feat of worldwide coordination, in 2016 the Global Polio Eradication Initiative implemented what is now known as ‘The Switch’. Over the course of just two weeks, health teams across the globe stopped using the oral vaccine that contained all three types of polio virus, and swapped to an oral vaccine that contained only types 1 and 3.

Was ‘The Switch’ successful?

This is exactly what the latest research has evaluated. The study, supported by the WHO and the Bill & Melinda Gates Foundation, showed this amazing global effort worked. The oral vaccine virus can be detected in children’s faeces soon after they have received the vaccine. After analysing stool samples from around 300,000 children taken between 2013 and 2018, it was revealed that the type 2 virus, but not types 1 and 3, disappeared very quickly from the world. However, the surveillance also revealed there is still VDPV2 circulating among communities. Although most strains are hangovers from before ‘the switch’ – and are not new strains that have emerged since 2016 - they pose a big problem. For the first-time ever, in 2017, there were more cases of VDPV compared to wild-type - 96 compared to 22.

What’s the implication of this?

In areas where there was a good level of protection against polio – and where there had been efficient vaccination programmes, this is not a problem. However, in poorer areas of the world immunity against polio is low, so the VDPV can infect others.

This is why there have been VDPV outbreaks in the Democratic Republic of Congo, Pakistan, Syria, Nigeria Somalia and Kenya. This could potentially cause a large-scale epidemic, and put young children at risk of paralysis where the injectable vaccine uptake has not been high.

And so now we have a new problem – many children have now not received the oral polio vaccine against type 2 polio. Yet we still have cases of type 2 polio in the form of VDPV. Therefore we have a group of young children who could potentially be exposed to polio, and the need is to urgently stamp out remaining cases of VDPV, before they become more widespread.

How can we eliminate the cases of vaccine-derived polio?

There is a reserve stock of oral vaccine that protects against just type 2 polio held by the World Health Organisation which can be used to tackle outbreaks of VDPV. Used effectively this vaccine can rapidly stop VDPV outbreaks. In Syria, the VDPV outbreak has been effectively controlled, despite the challenges of operating in a country at war. However, failure to achieve high coverage risks prolonging outbreaks, like in Democratic Republic of the Congo, and potentially further cases of VDPV.

In the longer term, scientists are also working on a new type 2 oral polio vaccine that contains a strain of the virus that is less likely to revert to paralytic strains. Trials with these vaccine candidates has successfully been completed in Belgium in 2017 and further clinical development is on-going. This is a critical moment in the global vaccination programme – and the findings show it urgently needs heightened support and investment. Polio will not go quietly – and it will not go without a fight. We need a show of strength as a global community, and to intensify efforts to ensure the disease, and its terrible legacy, are eradicated for good.


Reg Ling

Rotary Club of Chandler's Ford and Itchen Valley.

Rotary District 1110 (Central Southern England, the Channel Islands and Gibraltar).

Rotary Region 19 (Southern England and Gibraltar) End Polio Now Coordinator.

1 September 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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