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End Polio Now Position - 30th May 2017

Highlights and global details:

No WPV cases now for 14 weeks! The most recent report of a WPV1 case was on 28 March though the onset of polio was on 21 February. For polio-free certification purposes the start date is for onset of paralysis. There was though one WPV1 positive sample collected in Pakistan. A new article on the GPEI website describes the steps necessary to end any outbreak. See:

2017 to 30 May 5 4
2016 to similar date 16 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.

Wild Polio Virus (WPV)

WPV1 cases:

•    2 cases in Pakistan vs. 11 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.

    The total number of WPV1 positive environmental samples collected in 2017 is 51.
    The most recent sample was collected on 12 May. (The environmental presence of
    viral particles lasts for 7-14 days.)

WPV2 cases:

•    Declared eradicated September 2015. (Last case was in October 1999.)

WPV3 cases:

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


Vaccine Derived Polio Virus (cVDPV)

For cVDPV, the corresponding positions for onset of paralysis are:
•    cVDPV2 cases in DRC - 18 April 2017.
•    cVDPV2 cases in Pakistan - 17 December 2016.
•    cVDPV2 cases in Nigeria - 28 October 2016.
•    cVDPV1 cases In Laos - 11 January 2016.


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 2017 two separate outbreaks have occurred, both in the DRC. Four cases in total and the most recent had outbreak of paralysis was 18 April.

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):

The WHO and outside experts are making arrangements to send an experimental Ebola vaccine to the DRC should officials there say they need it to quell the outbreak. The DRC has not yet requested the vaccine, and it’s unclear if or when it will. The country’s drug regulatory agency would also have to authorize emergency use of the vaccine, which is not yet licensed. But the WHO and Gavi say the experimental vaccine is ready for use and are being made on a parallel track with investigations in DRC into the scale of the outbreak.

New adjuvanted, reduced-dose, inactivated polio vaccines developed in Denmark have been found to exhibit safety and efficacy profiles comparable to the standard comparator IPV. Based upon the results of the phase 2 clinical trial, it was decided to bring the 1/10 dose forward into phase 3 clinical trials. These trials are presently recruiting in Panama and the Philippines; a positive outcome will be used to obtain WHO prequalification for the product. It is expected that the reduced antigen dose used in the vaccine will make polio vaccination more accessible, thereby facilitating polio eradication efforts.

The Global Polio Eradication Initiative (GPEI) was launched in 1988, following the adoption for a resolution for the worldwide eradication of polio at the Forty-first World Health Assembly. Since then, the number of polio cases has fallen by over 99.9%. The initiative has also strengthened countries’ capacities to tackle other health issues, for example through better disease surveillance; immunisation and health systems strengthening; early warning, emergency and outbreak response. At the Seventieth World Health Assembly last week, delegates paid tribute to ongoing efforts to end polio transmission in the last three endemic countries. They expressed concern about the continued shortage of inactivated poliovirus vaccine, and noted the urgent need to contain polioviruses in safe facilities, destroy unneeded materials, and appropriately contain resources that can be used for research or other purposes. Delegates also addressed the challenge of scaling down the global polio response as eradication becomes closer.

Tedros Adhanom Ghebreyesus was elected last week to be the next director-general of the WHO but a sobering sense of reality has set in. Huge challenges face WHO. The question of how to secure the cash the agency needs to do the job expected of it is top of the list. This may be made that much more difficult by the belief that many of the WHO’s major donor countries supported another candidate. The WHO has to show that the Director General is dedicated to reform. Last week, the annual meeting of the WHO’s 194 member countries, approved the agency’s budget for the next two years, agreeing to a 3 percent increase in the assessed contributions all countries must pay, the first increase in these dues in a over a decade. In many budget cycles countries flatly turn down the WHO’s request for increases. In a press conference Wednesday, Tedros was asked about threatened global health funding cuts outlined in the Trump administration’s 2018 budget blueprint that had been released. The assessed contributions make up about 20 percent of the WHO’s budget; the majority of the rest of the agency’s budget is raised through voluntary contributions from countries or charitable sources. The campaign to eradicate polio appears poised to end transmission of the paralysing virus, but the campaign will have several years of work left to do to ensure the virus is gone. At some point early in the next decade, the GPEI will start winding down which could trigger a huge funding hit. Currently one out of every four dollars the WHO brings in is dedicated to the polio fight. In developing countries, a number of other programs piggyback off the polio money, for instance, routine childhood immunisation efforts. Tedros may have to decide what tasks the WHO should retain responsibility for, and which it can leave to other organizations. Ensuring that the WHO is ready for the next disease crisis will be key to establishing confidence in the world’s capitals. Over the past five years there has been an acceleration of outbreaks and epidemics of emerging and re-emerging infectious diseases. The WHO needs to make improvements to increase its capacity to respond to epidemics.

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).

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