END POLIO NOW - February 1st, 2011 update

Citing dramatic gains achieved with polio vaccines, Prime Minister David Cameron joins Bill and Melinda Gates to call on world leaders to finish the job

UK Government Doubles Polio Funding - Bill Gates call for a final push to end polio, joins UK Prime Minister David Cameron to announce contributions: New funding from the United Kingdom and the Crown Prince of Abu Dhabi will help reduce the US$720 million funding gap of the Global Polio Eradication Initiative, but Mr Gates, co-chair of the Bill & Melinda Gates Foundation, reminded readers of his annual letter that eradicating polio requires "funding from a range of donors, to support an aggressive program that will get the job done." Mr Cameron also called on other donors to back polio eradication: noting the question of international development assistance in the current financial climate, Mr Cameron said, "There is never a wrong time to do the right thing."

President of Pakistan kicks off emergency plan to stop polio.

Rotary International News -- Friday, January 28, 2011The only polio-endemic country where case numbers rose in the past year, Pakistan has developed a national emergency action plan that outlines area-specific strategies and accountability mechanisms. President of Pakistan kicks off emergency plan to stop polio: President Asif Ali Zardari formally launched the emergency plan on 24 January. The only polio-endemic country with an increase in cases in 2010, Pakistan has struggled in the past six months to slow the transmission of poliovirus. The number of children paralyzed by the virus jumped by 60% (from 88 in 2009 to 144 in 2010, as of 1 February 2011).

Polio in Retreat: New Cases Nearly Eliminated Where Virus Once Flourished

End-2010 data shows a reduction in new cases in 2010 over 2009 in three of the four endemic countries (India, Nigeria and Afghanistan); the apparent cessation of all polio outbreaks in 15 countries in with onset 2009 by mid-2010; the apparent stopping of ten of the eleven new outbreaks (with 2010 onset) within six months; and progress in two of the four countries with re-established transmission (southern Sudan and Chad).

New cases in key Indian states are hovering near zero—unprecedented, historic lows—suggesting that a long-time goal of eliminating the virus is within reach in parts of world where it has long been considered intractable

The world's largest, most intractable source of polio may be on the brink of elimination. In India the states of Bihar and Uttar Pradesh have produced more polio cases this decade—nearly 5,000—than any other location worldwide that has an active immunization campaign. Nigeria saw a handful more cases than the two Indian states because it effectively ceased immunizing in 2003 for a time due to false fears of the vaccine.

Now, even at the peak of polio season, new cases in Bihar, Uttar Pradesh and indeed all of India hover near zero—unprecedented, historic lows. In the past decade the peak months of August and September have seen an average of roughly 140 people, usually children, stricken by poliomyelitis, which attacks motor neurons in the nervous system and can cause paralysis. But for the past four weeks running, Bihar and Uttar Pradesh have hung zeros on the polio scoreboard, according to reports published as recently as October 28 by the Global Polio Eradication Initiative.


There have been 950 cases globally* in 2010 (864 type 1 and 86 type 3), compared with 1,595 cases at the same time in 2009 (477 type 1 and 1,116 type 3 and 2 mixtures). 20 countries reported cases in 2010, compared with 23 in 2009.

ANGOLA: Renewed leadership commitment: President Jose Eduardo dos Santos reaffirmed the Government´s and his personal commitment to eliminating polio in a meeting with the UNICEF Executive Director and senior leadership from the Bill & Melinda Gates Foundation and WHO African Regional Office. The President agreed to spearhead the country's 2011 vaccination campaigns; this pledge was echoed by Vice Ministers, Vice Governors and civil society organizations, who agreed they would work across the country to improve vaccination coverage. *Many of the 540 cases of acute flaccid paralysis (AFP) reported from Congo do not have stool specimens but are clinically compatible with polio. When definitively classified, these cases will add to the yearly total.

•In the past nine months, no WPV3 has been recorded in Afghanistan. The recent WPV1 detected in December is a new importation from neighbouring Pakistan.
•The first Subnational Immunization Days (SNIDs) of the year were held on 30 January to 2 February, in synchronization with Pakistan.
•Efforts were focused on reaching all populations in the 13 high-risk districts of the Southern Region. Access during supplementary immunization activities (SIAs) in the latter half of 2010 had improved, and this trend needs to continue in 2011. During the last three SIAs, less than 10% of the target population was inaccessible, compared to more than 25% at the start of 2010.
•India continues to report record-low levels of both WPV1 and WPV3, particularly in the traditional endemic reservoir areas. In Uttar Pradesh, no cases of WPV3 have been reported since April 2010; the most recent WPV1 is from October 2009. In Bihar, no cases of WPV1 have been reported since 1 September 2010; it has been more than 12 months since Bihar reported a WPV3.
•The outbreak in West Bengal has persisted for nearly 12 months and is the longest running outbreak in a previously polio-free area experiencing a WPV importation in 2010. Confirmation was received in January of a WPV1 environmental sample collected in November in Mumbai. For these reasons, urgent efforts are under way to close any residual immunity gaps, especially in high-risk areas of West Bengal, and with special strategies to reach mobile population groups.
•In January, over 15,000 children were immunized during the Ganga Sagar festival in the South 24 Parganas district of West Bengal. As part of the renewed emphasis on reaching migrant and nomadic populations, social mobilizers pointed festival goers to the vaccination teams. The fair saw 620,000 people coming in from other states and from neighbouring countries. A mop-up is being held on 5 February in high-risk districts of West Bengal.
•National Immunization Days (NIDs) were launched on 23 January by the President of India. In response to the West Bengal outbreak, more than 1,140 NGO volunteers were deployed to deliver focused community mobilization in the highest-risk areas of Murshidabad and South 24 Parganas ahead of and during the NIDs.
•A second NID is scheduled for 27 February. These two nationwide rounds will be followed by SNIDs in March, April, May and June.
•Nigeria continues to report record-low levels of both WPV1 and WPV3 transmission, with a 95% decrease in cases in 2010 compared to 2009.
•However, transmission of a circulating vaccine-derived poliovirus (cVDPV) continues. Transmission of all types of virus, both vaccine-derived and wild, particularly in the northeast of the country (Borno state, bordering Chad), and in the northwest (Zamfara, Kebbi and Sokoto states) threaten neighbouring countries. It is historically from these areas which poliovirus spread internationally into west Africa and into Chad. The progress in Nigeria is fragile until transmission in these areas is stopped.
•The first nationwide Immunization Plus Days (IPDs) in 2011 were conducted on 26 January (in key northern states, the activity also included an integrated measles campaign). The activity in Borno was delayed until 2 February; Borno has not conducted any immunization activities since October 2010, due to a health worker strike.
•The next nationwide IPD is planned for 23 February using tOPV and will be followed by subnational activities in March. These two campaigns will be critical, as national elections will be held in April, and the rainy season will commence in May, both factors which may compromise immunization activities at that time.
•The next Expert Review Committee on Polio Eradication and Routine Immunization (ERC) is tentatively scheduled for 7-8 March. It is expected that the ERC will review the latest risk assessments and agree on action plans to interrupt all strains of transmission as rapidly as possible.
•Pakistan is the first country to report cases in 2011 and the only endemic country to report more cases in 2010 than in 2009. Over half the cases of 2010 are from the Federally Administered Tribal Agencies (FATA). Five positive environmental samples found in 2010 at sites as disparate as Lahore, Quetta and Karachi provide further evidence that polio transmission is widespread.
•NIDs were conducted on 28-30 December, using bivalent OPV. Access to all children in FATA was again a hurdle, with 26% of the target population inaccessible.
•To urgently address the increase in transmission in the country over the past 12 months, the National Emergency Action Plan for polio eradication was presented to the Prime Minister on 14 January and launched by President Asif Ali Zardari on 24 January.
•Turning the plan into action will depend on increased engagement and ownership at all levels, and especially at the district-level (where the plan is ultimately implemented). The plan is available at http://www.polioeradication.org/Portals/0/Document/InfectedCountries/Pakistan/PakistanStrategy/NationalEmergencyActionPlan.pdf
•Coordination has started with the Inter-religious Council for Health (IRCH) in 27 intervention districts on mother and child health issues, with special emphasis on polio eradication and immunization.
•The first SNIDs of the year were launched on 31 January, in synchronization with Afghanistan.
•The outbreak in Angola, which has this year spread to DR Congo and the Republic of Congo, continues to pose a significant risk to Africa's eradication effort, particularly given the strong progress achieved elsewhere on the continent (in particular in Nigeria and west Africa). A mop-up was held on 14-16 January in Cabinda in response to the Republic of Congo outbreak.
•President Jose Eduardo Dos Santos has stated his personal commitment to stopping polio in the country and his intention to spearhead the 2011 SIA schedule. The Executive Director of UNICEF and the President of the Global Health Programme at the Bill and Melinda Gates Foundation, accompanied by the WHO Assistant Regional Director for Africa, welcomed these commitments and expressed the support of their organizations.
•Mop-ups will be held on 18-20 February in Luanda, Benguela, Bengo and Kuanza Norte: these are the first campaigns to be conducted in response to the latest cases Luanda and Benguela in November.
•Chad is the first country in Africa to report cases in 2011. Since September 2010, Chad is experiencing an expanding WPV1 outbreak. During Supplementary Immunization Activities (SIAs) in which any type 1-containing vaccine was used, coverage was insufficient. Chad is at high risk of further spread of this current importation.
•The percentage of missed children during SIAs has increased from a low of 8% in March after the President's launch, to a high of 15% at the end of the year. The proximity of Logone Oriental and Occidental (which have reported the recent cases) to neighbouring Cameroon and Central African Republic further increases the risk of this expanding outbreak.
•It is important to note that this WPV1 outbreak represents a new outbreak, and is unrelated to the re-established virus transmission chain (WPV3) affecting the country since November 2007. No cases linked to that transmission chain have been reported since May 2010.
•A high-level round table for the media was held on 20 January, to ensure clear communication on the urgency of the outbreak. The event was presided over by the Secretary of State for Public Health with participation from the country representatives of WHO and UNICEF, the President of the N'Djamena Rotary Club and the Vice-President of the Chad Red Cross.
•NIDs will be conducted on 10-12 February; it will be critical to increase the sensitivity of independent monitoring, to assure a clear picture of the outbreak response activities.
•DR Congo is experiencing a severe outbreak in Kasai Occidentale and Bandundu, the result of polio transmission from across the Angolan border. At the same time, separate outbreaks are ongoing in Bas-Congo (related to the Republic of Congo outbreak) and in the east of the country (related to 2009 transmission).
•An emergency plan is currently being finalized by the government. On an official visit to DR Congo on 7-8 February, WHO Director-General Dr Margaret Chan met President Laurent Kabila, who stated his intention to combat the current poliovirus circulation "without mercy." Dr Chan also discussed the agency's support to the government's response plan with the Prime Minister and Minister of Health.
•Many of the 540 cases of acute flaccid paralysis (AFP) reported from Congo do not have stool specimens but are clinically compatible with polio. Final classification of these cases is expected by March.
•In the epicentre of the outbreak in Pointe Noire and Kouilou, the large number of cases without stool samples are now being reviewed and classified, many of which will likely be confirmed as polio.

•The network Al-Jazeera English broadcast a moving documentary on the obligation to complete polio eradication, illustrating the tragedy of paralysis and death that polio can cause through the stories of two young men affected by the outbreak. The full 25-minute programme can be viewed here:

•An international mission of technical experts is taking place in early February, to finalize an SIA plan and review operational plans to strengthen disease surveillance in both Kenya and Uganda. This is critical, as in some areas of Kenya, upwards of 20% of children were missed during outbreak response activities in 2010, and the outbreak from 2009 continued undetected into 2010. Corrective actions, including the deployment of additional STOP team members, have begun.
•Ethiopia is preparing for a second phase of Child Health Days in February; the first was held in October. In Somalia, preparations are also under way for NIDs in late March and late April. Both countries continue to be at risk of polio, given ongoing WPV transmission in the Uganda/Kenya border area, and evidence of a cVDPV in Ethiopia in early 2010.
•Six months have passed since the most recent case in Tajikistan (4 July 2010), the first site of the outbreak in Central Asia.
•The European Regional Certification Commission met in January in St. Petersburg and discussed further SIAs, surveillance and analysis of risks.
•Comprehensive outbreak response is continuing in all four countries, with a focus on the North Caucasus region of Russia.
•Mop-ups are continuing in highest-risk border districts with India. All cases in 2010 were from the Central Development Region (CDR), in Rautahat and Mahottari districts, bordering Bihar, India.
•NIDs will be conducted in Nepal in February and March 2011.
•The outbreak appears to be slowing, as four months have passed since the most recent case. In order to protect these gains, NIDs took place in Niger (14 January) and Burkina Faso (4 February), and SNIDs in Guinea (17 January). Further rounds across west Africa are planned for 25 March and 22 April. = false;

Source: Rotary International

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