The Weekly Epidemiological Record (WER) 6 March 2009, vol. 84, 10 includes “Progress towards poliomyelitis eradication in Afghanistan and Pakistan, 2008” and “Poliomyelitis in Sudan: heightened risk of international spread.”
http://www.who.int/wer/2009/wer8410.pdf

Poliomyelitis in Sudan: heightened risk of international spread

The recent expansion of a prolonged outbreak of wild poliovirus type 1 (WPV1) in Sudan poses a very high risk of further international spread, requiring urgent and immediate outbreak response activities in the affected areas and heightened surveillance in countries at risk. Previously restricted to southern Sudan and western Ethiopia, the outbreak has now spread to Kenya, northern Sudan (in Khartoum and Port Sudan) andUganda.

Of particular concern is the confirmation of WPV1 in Port Sudan. It is from this area that, in 2004-2006, WPV1 spread to reinfect several countries, including Indonesia, Saudi Arabia, Somalia and Yemen, causing outbreaks that generated >1200 cases and >US$ 150 million in international emergency outbreak response costs. Given the historical international spread of polioviruses from Port Sudan, the new international spread from southern Sudan to Kenya and Uganda, and the suboptimal quality of outbreak response activities in southern Sudan and western Ethiopia (monitoring data indicate that >30% of children remain unimmunized or under-immunized with ≤3 doses of oral poliovirus vaccine, or OPV3), WHO assesses the risk of further international spread from the Sudan as being very high. Stopping this outbreak requires full implementation of international polio outbreak response standards, adopted by the World Health Assembly in May 2006, until transmission has been confirmed to be interrupted.

In northern Sudan, large-scale supplementary immunization activities (SIAs) began on 15 February, with additional campaigns planned for 23 March and again in late April. In southern Sudan, SIAs were held on 13 January and 23 February, with further activities planned for 23 March and late April, following which the onset of the rainy season in May could complicate the logistics of reaching all populations in this already difficult-to-access terrain. Consequently, particular attention is being given to closing the persistent gaps in drug coverage with OPV during the upcoming SIAs.

In coordination with the polio campaigns in the Sudan, plans for rapid outbreak response campaigns are being finalized for late March, late April and possibly again in late May in the affected areas of Kenya and Uganda. Genetic sequencing data suggest that the importations into these countries have been rapidly detected, improving the prospects for interrupting transmission in the near term if the campaigns are of sufficiently high quality to reach >90% of children in the affected areas.

It is important that countries across central Africa, the Horn of Africa and the Gulf strengthen surveillance for cases of acute flaccid paralysis, in order to promptly detect any new poliovirus importations and facilitate a rapid response. Countries should also analyse routine immunization coverage data to identify any subnational gaps in population immunity to guide catch-up immunization activities and thereby minimize the consequences of any new virus introduction. Priority should be given to areas at high risk of importations and to where routine coverage of OPV3/DTP31 is <80%.

Also reported as an MMWR summary at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5808a4.htm