Highlights and global details:
No polio cases have been reported this week. (The most recent report was on 28 March though the onset of polio was on 21 February.) Nor were any WPV1 positive environmental samples collected either. An Al Jazeera report stated there was suspected polio in the rural area of Deir al Zour in eastern Syria. There was a cluster of 23 AFP cases in Miadin district and one of the specimens is a possible VDPV. Samples have been sent to CDC in Atlanta for further testing.
| WPV | cVDPV | |
| 2017 to 16 May | 5 | 0 |
| 2016 to similar date | 15 | 3 |
| 2016 full year | 37 | 7 |
The most recent WPV1 cases with onset of paralysis were:
• In Afghanistan - 21 February 2017.
• In Pakistan - 13 February 2017.
• In Nigeria - 21 August 2016.
More details:
1. 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 campaigns.
2. WPV2 cases:
• Declared eradicated September 2015. (Last case in October 1999 from Aligarh, Uttar Pradesh.)
3. WPV3 cases:
• No cases reported since 10 November 2012. (That was in Nigeria.)
For cVDPV, the corresponding positions for onset of paralysis are:
• cVDPV2 cases in Pakistan - 17 December 2016.
• cVDPV2 cases in Nigeria - 28 October 2016
• cVDPV1 cases In Laos - 11 January 2016
1. 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.
2. 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 number of WPV1 positive environmental samples collected in 2017 is 40. The most recent sample was collected on 12 April in Khi Landhi, greater Karachi. (The environmental presence of viral particles lasts for 7-14 days.)
The source of polio virus transmission is infectious humans but only 1 in 200 infections leads to irreversible paralysis. Of those paralysed, 5% to 10% die when their breathing muscles become immobilised.
Other comments (from the internet and other sources):
In Pakistan: The current NIDs are 15-18 May 2017. (Except Karachi which will be 23-27 May.) The three-day polio eradication campaign in Azad Jammu and Kashmir includes details for Muzaffarabad (the capital city), where more than 120,000 children up to five years of age will be administered anti-polio drops. 338 mobile teams have been constituted. Polio teams at 58 fixed centres and 18 transit points will also administer the anti polio vaccine. Two control rooms have been setup to monitor the campaign. Reports also referred to the campaigns in other parts of the country. In Multan, Khanewal, Faisalabad, Hafizabad, and Rawalpindi districts the campaign focuses on more than 6.6 million children who will be vaccinated in Khyber Pakhtunkhwa and FATA. Also, over two million children will be vaccinated in thirty districts of Balochistan. In Gilgit-Baltistan, more than 236,000 will be vaccinated where as well as going door-to-door, health workers will be posted at railway stations, bus stands and public places to ensure that every child is vaccinated. In Punjab that remained polio-free during 2016 but had one case reported this year, a five-day anti-polio campaign has been launched and 18.6 million children will be vaccinated. The primary and secondary health department has constituted 45,584 polio two-member teams. 38,699 are mobile teams which would visit door to door, 4,480 fixed teams in the hospitals and health facilities while 2,405 polio teams administer anti-polio vaccine drops at the transit points coming from other provinces. In Islamabad, the Minister for National Health Services, Saira Afzal Tarar, urged the polio teams to pay special attention to the children residing in makeshift houses during the immunisation campaign. The minister also directed that injectable polio vaccine must be given to the children to enhance their immunity against polio. In her meetings with families, the minister impressed upon them to get their children vaccinated against diseases saying the vaccination is being provided free of cost for every Pakistani child against nine diseases and it was the responsibility of the parents to avail these services for the health and wellbeing of their children.
The Afghanistan Ministry of Public Health, in joint venture with the UNICEF and the WHO has launched the second spring round of NIDs for polio eradication in 2017. More than 9.5 million children under the age of five will be vaccinated against polio and more than 5.7 million children between the ages of 2 and 5 will receive Albendazole tablets during the campaign that runs until 19 May. The importance of this campaign is that the polio high-transmission season has started. This national campaign is being carried out by 67,000 polio workers who will go from house to house in their communities to vaccinate children. On Friday, polio teams will revisit households where children were missed the first time to ensure that all children are vaccinated and protected. Most of Afghanistan is polio-free, but wild poliovirus continues to circulate in localised geographical areas in the eastern, southern and south-eastern parts of the country.
Polio may seem to be an illness of the past in Thailand however the flow of people could allow polio to come back any time. The possibility of polio returning is like the Sars outbreak that spread in the region a few years ago or measles in the US and Ebola in some countries. Like any non-profit organisation, Rotary International faces challenges. In addition to finding outside sponsors, Rotary International also has to be creative in raising funds for the eradication of polio. Aside from charity dinners and events, Rotary organises fund-raising projects such as bicycle rides. (This summary was taken from press reports of John Germ’s recent discussions in Thailand.)
Targets of Eradication: In a commentary on developments in the field of infectious diseases, John Bartlett described the pathogens that have been or are global targets of eradication.
1. Smallpox: It remains the only human infectious disease to be completely eliminated from Earth. The vaccine was developed by William Jenner. He observed that girls who milked cows often developed cowpox, which he believed was similar to smallpox in both virology and clinical expression. Cowpox was benign and it protected the dairy maids from becoming infected with smallpox. Even with an effective vaccine, smallpox continued to have serious consequences. The disease was highly contagious; was clinically expressed with a disfiguring, deep scarifying rash; and had a 30% mortality rate. In 1967, the WHO estimated that there were 500 million smallpox deaths in the twentieth century. A global plan to control smallpox, masterminded the massive smallpox immunisation program that resulted in disease eradication. Although no cases exist, caution must still be exercised. Smallpox could be used as a powerful biologic weapon, particularly because vaccine protection has long been discontinued. The success raises the possibility that other serious infectious diseases could be eliminated. The two prime candidates are polio and dracunculiasis (Guinea worm disease).
2. Polio: Because polio is transmitted from person to person through nasal and oral secretions, it is highly contagious. Most people infected with poliovirus are asymptomatic, but 1% to 5% develop aseptic meningitis, and 0.1% to 0.5% develop paralytic polio with lifelong morbidity. President Franklin D. Roosevelt was left with permanent leg paralysis, but other patients experienced worse consequences, in the form of respiratory paralysis that meant a lifetime spent in an iron lung. The global polio eradication program has involved two types of vaccine: inactivated polio vaccine and oral polio vaccine. The largest ever public–private partnership was formed—with 20 million volunteers—to achieve the ambitious goal of vaccinating 3 billion children. There are three immunologically distinct strains of poliovirus. Type 2 poliovirus has been eradicated and progress toward the elimination of types 1 and 3 has been impressive. The combined 350,000 cases fell to 237 in 2015 and 37 in 2016 when cases persisted in Pakistan, Afghanistan and Nigeria. These countries continue to have major problems as a result of weak healthcare systems and poor sanitation.
3. Dracunculiasis: The pathogenesis of parasitic Guinea worm disease starts with the ingestion of contaminated water containing fleas infected with the worm larvae. When the fleas are swallowed, the worm larvae released penetrate the intestines. Male worms mate with female worms, which then navigate to tissues adjacent to the bones of extremities. The worm grows to be 2 to 3 feet long and then penetrates the skin surface, which forms a painful blister. The worm is extracted by wrapping it in gauze or winding it around a stick each day as it emerges gradually from the skin; this process can take days to weeks. It is not a lethal infection but is extremely painful, disrupts education and normal childhood activities, and can last for years. Prevention of this infection involves the use of cloth nets to filter drinking water infested with the worm larvae. This effort has been championed by the Jimmy Carter Fund and the CDC and progress continues. In 2011, 1,058 cases were reported in endemic areas but by 2016, this fell to 22 to 25 cases. In 2016, dracunculiasis remained endemic in just four countries: Chad (9 cases), Ethiopia (3 cases), Mali (5 cases), and South Sudan (5 cases).
Which Disease Is Next? The two pathogens that are candidates are very different in terms of clinical consequences, geographic areas of disease, and challenges in prevention, but both show incredible progress toward elimination, with a reduction in cases of more than 99%. It appears that the major question is no longer whether a disease can be eliminated, but which one will be next?
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).