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Highlights and global details:

No polio cases have been reported this week. (The most recent reported case was on 28 March though the onset of polio in that case was on 21 February.) However, 2 WPV1 positive environmental samples were collected this week in Pakistan in Sindh. A total of 40 positive environmental samples have been collected in 2017.

  WPV cVDPV
2017 to 9 May 5 0
2016 to similar date 14 3
2016 full year 37 7

 

The most recent WPV1 cases had onset of paralysis on:
•    In Afghanistan - 21 February 2017.
•    In Pakistan - 13 February 2017.
•    In Nigeria - 21 August 2016.

For cVDPV, the most recent cases had onset of paralysis on:
•    cVDPV2 cases in Pakistan - 17 December 2016.
•    cVDPV2 cases in Nigeria - 28 October 2016
•    cVDPV1 cases In Laos - 11 January 2016

In more detail:


The most recent WPV1 positive environmental sample was collected on 12 April 2017.

WPV1 cases:
•    2 cases in Pakistan vs. 9 cases at the same time in 2016. During 2017 over 2,000 cases of infant acute flaccid paralysis tested which is another aspect of how donations to polio eradication are used.
•    3 cases in Afghanistan vs. 5 cases at the same time in 2016.
•    No cases in Nigeria. There were no cases in 2015 but cases were identified in 2016 as a result of new initiatives in the northern States where Boko Haram had made access difficult. No new cases since August 2016.
•    No other cases though there is much immunisation activity now in the Lake Chad countries following the Nigerian cases in August 2016.  Also, from 25 to 28 March, synchronised polio campaigns took place across 13 countries in west and central Africa including Nigeria, Chad, Cameroon, Guinea, Mali and Niger. Over 190,000 vaccinators  immunised more than 116 million children over the course of the campaigns.

WPV2 cases:
•    Declared eradicated September 2015. (Last case in October 1999 from Aligarh, Uttar Pradesh.)

WPV3 cases:
•    No cases reported since 10 November 2012. (That was in Nigeria.)

cVDPV1 cases:
•    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 cases:
•    In 2016 two cases in Nigeria and two cases in Pakistan. In 2015 there were twelve cases, seven in Guinea, two in Myanmar, two in Pakistan and one in Nigeria.

The source of polio virus transmission is infectious humans but only 0.5% of infected persons show any symptoms of polio.


Other comments (from the internet and other sources)


The Federal Capital Territory Administration (FCTA) in Nigeria has declared its intention to work to combat poliomyelitis and to leverage the very wide network of the National Orientation Agency in the fight against polio. The WHO has deployed 190 Polio Eradication Initiative officers to Sokoto State in Nigeria to support the fight against Cerebro Spinal Meningitis. PEI officers, drawn from the country office and field offices, would be working with the Sokoto team at the Polio Emergency Operating Centre to plan for the response to the outbreak. (In the last two months, Nigeria had been experiencing widespread epidemic of meningitis.) A micro plan has targeted 770,000 susceptible young persons aged 1 to 21. Over 3,687 of suspected meningitis were reported in all the 23 local government areas of Sokoto State as at May 1, 2017 with more than 80 per cent of the cases in the 1 to 20 years cohort. Four days into the reactive vaccination, 560,000 of the target had been vaccinated, representing 76 per cent coverage. The Ogun State, South Western Nigeria, is continuing its’ strategy aimed at ensuring children under the age of five are immunised against polio. The state has not recorded any case of polio since 2009. Religious leaders, schools, houses visited as well as the parents and guardians have been receptive of government effort which could have not recorded huge success without the support of people.


Taking stock of Pakistan’s progress in the fight against polio, the International Monitoring Board for GPEI has assessed the all-time low virus transmission intensity as a unique opportunity to rid the world of the crippling disease forever. Last year, the IMB recognised the transformative improvements in performance of the Pakistan polio eradication programme and had urged the country to maintain the momentum. The threat of polio in conflict-hit areas of Pakistan can be reduced through a package of community-based strategies that integrate maternal child health services and routine immunisations. Research conducted by health experts tested a range of interventions in 387 insecure areas of the where children are especially vulnerable to contracting polio. The interventions included the introduction of pictorial health awareness campaigns, community mobilisation and engagement through local volunteers and the running of holistic health camps. Low-cost but accurate health information was disseminated. The study disproved that providing an anti-polio injection – the inactivated poliovirus vaccine (IPV) – alongside polio drops – the oral poliovirus vaccine – would result in opposition from the community. Eight out of 10 families agreed to their child receiving the IPV when it was delivered as part of a comprehensive health package that provided vital hygiene, nutrition and antenatal services to mothers and children. Steps to organise temporary health camps providing broad-based health services ensured that two-thirds of the targeted children and families were provided with booster injections to ensure that every child stayed on track with the four-dose schedule.

Does this sound familiar? The CDC is collaborating with the US Department of Health and Human Services on global efforts to eradicate polio, measles, and rubella. The WPV2 was certified eradicated in 2015, and WPV3 has not been detected since November 2012. Only WPV1 remains in circulation today. In 2016, 155 countries were able to remove WPV2 from the oral polio vaccine. The main challenge in any eradication program is the need to consider all affected countries at the same time. The elimination of measles and rubella is at an earlier stage. The Global Measles and Rubella Strategic Plans are to achieve and maintain a world without the diseases by 2020. Increased vaccination efforts from 2000 to 2015 have resulted in a 75% reduction in measles incidence and a 79% reduction in measles deaths, with an estimated 20.3 million deaths averted. The rubella elimination program is not as far advanced and some countries with large populations, such as India and Indonesia, only started to introduce rubella vaccine in 2017. Despite the significant advances, milestones are not being met. To address the shortfalls additional efforts to increase country ownership, global political will and laboratory support for surveillance are needed. An indication of the polio legacy?


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 Coordinator (EPNC).