The GAVI Alliance Board approved providing support for the introduction of inactivated poliovirus vaccine (IPV) as part of routine immunisation programmes in the world’s 73 poorest countries.  GAVI noted that in May 2013, the World Health Assembly endorsed the new Polio Eradication & Endgame Strategic Plan 2013-2018, “calling on countries to introduce at least one dose of IPV and begin the phased removal of oral polio vaccines. Removing oral polio vaccines will eliminate the risk of vaccine-associated polio outbreaks.  Introducing IPV is a critical step to manage any risks associated with this phased removal. Adding IPV to routine immunisation programmes will improve immunity and help prevent new vaccine-associated outbreaks from emerging. At the same time, it will hasten eradication of wild polio serotypes in the remaining endemic countries of Afghanistan, Nigeria and Pakistan….”
The GAVI Board “endorsed opening a window of support for IPV for all GAVI-eligible countries and those graduating from GAVI support. Given the global health priority of polio eradication, the Board agreed to a number of policy exceptions for IPV, such as encouraging but not requiring countries to co-finance IPV introduction.”

   The Jeffrey Modell Foundation (JMF) announced “an unprecedented surveillance study…to shed light on important questions about vaccine-derived polioviruses throughout the globe…” This study will include 25 sites across a wide geographical range involving  patient population for this surveillance, including JMF Centers in Argentina, Brazil, Colombia, Mexico, China, Hong Kong, India, Israel, Iran, Kuwait, Russia, Poland, Turkey and Tunisia. JMF “will work alongside the World Health Organization (WHO), The Centers for Disease Control and Prevention (CDC), Task Force for Global Health (TFGH), and the Bill & Melinda Gates Foundation.” The study will ”…focus on patients with Primary Immunodeficiencies (PI) who have either received the Oral Polio Vaccine (OPV), a live-weakened form of the virus, or have been exposed to it. Due to little or no immune system, when a patient with PI receives OPV, he or she is unable to create an immune response and therefore, cannot clear the intestinal vaccine virus infection, which is typically excreted within six to eight weeks by individuals with healthy immune systems. After prolonged periods of time, the virus may no longer be the same as the original vaccine-virus as it can genetically alter. This is called Vaccine Derived Poliovirus (VDPV). Although rare, it is expected that patients with PI are at risk of developing Vaccine Associated Paralytic Poliomyelitis (VAPP) and VDPV excretion, which could lead to possible exposure to the community…Once wild poliovirus is eradicated globally, vaccine-viruses will be the only type of live poliovirus in the community and could potentially lead to an outbreak. In order to prevent this occurrence, the Polio Antivirals Initiative (PAI), an essential part of the TFGH’s Polio Eradication effort, aims to create an efficient and inexpensive antiviral.”
More information about PI: www.info4pi.org
Full media release: NEW YORK, Nov. 18, 2013 /PRNewswire/   http://www.prnewswire.com/news-releases/global-polio-study-begins-232335041.html

WHO: Global Alert and Response (GAR) – Disease Outbreak News
http://www.who.int/csr/don/2013_03_12/en/index.html
:: Middle East respiratory syndrome coronavirus (MERS-CoV) – update 18 November 2013
:: Wild poliovirus in Cameroon 21 November 2013
Excerpt
21 November 2013 – Wild poliovirus type 1 (WPV1) has been confirmed in Cameroon, the first wild poliovirus in the country since 2009. Wild poliovirus was isolated from two acute flaccid paralysis (AFP) cases from West Region. The patients developed paralysis on 1 October and 19 October 2013. Genetic sequencing indicates that these viruses are linked to wild poliovirus last detected in Chad in 2011.
An emergency outbreak response plan is being finalized, including at least three national immunization days (NIDs), the first of which was conducted on 25-27 October 2013. Subnational immunization days (SNIDs) will be implemented in December 2013, followed by two subsequent national immunization days in January and February 2014. Routine immunization rates are reported to be approximately 85.3 percent for oral polio vaccine (OPV3).      A response in neighbouring countries is also being planned, notably in Chad and Central African Republic…
…This event confirms the risk of ongoing international spread of a pathogen (wild poliovirus) slated for eradication. Given the history of international spread of polio from northern Nigeria across West and Central Africa and subnational surveillance gaps, WHO assesses the risk of further international spread across the region as high…
http://www.who.int/csr/don/2013_11_21/en/index.html

Update: Polio this week – As of 23 November 2013
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]
:: In the Middle East, a comprehensive outbreak response continues to be implemented across the region. Seven countries and territories are holding mass polio vaccination campaigns targeting 22 million children under the age of five years. In a joint resolution, all countries of the WHO Eastern Mediterranean Region have declared polio eradication to be an emergency, calling for support in negotiating and establishing access to those children who are currently unreached with polio vaccination. WHO and UNICEF are committed to working with all organizations and agencies providing humanitarian assistance to Syrians affected by the conflict. This includes vaccinating all Syrian children no matter where they are, whether in government or contested areas, or outside Syria.
:: In southern Afghanistan, the traditional endemic region in the country, no WPV cases have been reported for one year. All nine cases in the country this year are from Eastern Region, linked to cross-border transmission with Pakistan. For more, please click here.

Pakistan
:: Four new WPV1 cases were reported in the past week. Two of the cases are from Federally Administered Tribal Areas (FATA), one from Punjab and one from Sindh. The total number of WPV1 cases for Pakistan in 2013 is now 63. The most recent WPV1 case had onset of paralysis on 21 October (from Punjab).
:: The situation in North Waziristan is increasingly alarming. It is the area with the largest number of children being paralyzed by poliovirus in all of Asia. Immunization activities have been suspended by local leaders since June 2012. It is critical that children in these areas are vaccinated and protected from poliovirus. Immunizations in neighboring high-risk areas are being intensified, to further boost population immunity levels in those areas and prevent further spread of this outbreak.

Horn of Africa
:: Three new WPV1 cases were reported in the past week (from Somalia), bringing the total number of WPV1 cases in the Horn of Africa to 203 (183 from Somalia, 14 from Kenya and six from Ethiopia). The most recent WPV1 case in the region had onset of paralysis on 9 October (from Lower Shabelle, Somalia).
:: Outbreak response across the Horn of Africa is continuing. As a result of concerted outbreak response efforts, the impact of the response is beginning to be seen, as the number of newly-reported cases from Banadir, Somalia (the epicentre of the outbreak) has declined. All efforts continue to be made to reach all children everywhere.

Middle East
:: In Syria, no new WPV1 cases were reported in the past week. The total number of WPV1 cases remains 13. Wild poliovirus was last reported in Syria in 1999.
:: A comprehensive outbreak response continues to be implemented across the region. On 24 October, an already-planned large-scale supplementary immunization activity was launched in Syria to vaccinate 1.6 million children against polio, measles, mumps and rubella, in both government-controlled and contested areas.
:: Implementation of a supplementary immunization campaign in Deir Al Zour province commenced promptly when the first ‘hot’ acute flaccid paralysis (AFP) cases were reported .

Editor’s Note: See New England Journal of Medicine below in Journal Watch:
Editorial
No Country Is Safe without Global Eradication of Poliomyelitis
Trevor Mundel, M.D., Ph.D., and Walter A. Orenstein, M.D.
Original Article
Identification and Control of a Poliomyelitis Outbreak in Xinjiang, China
Hui-Ming Luo, M.D et al

The Weekly Epidemiological Record (WER) for 22 November 2013, vol. 88, 47 (pp. 501–508) includes:
:: Progress towards poliomyelitis eradication in Pakistan, January 2012– September 2013
http://www.who.int/entity/wer/2013/wer8847.pdf

CDC/MMWR Watch [to 23 November 2013]
A serogroup B meningococcal vaccine is being considered for use at Princeton University. FDA is allowing the use of the vaccine at Princeton University under an Investigational New Drug application. Get the latest information and additional questions and answers about the outbreak from the University and the New Jersey Department of Health  [9 pages]
   MMWR November 22, 2013 / Vol. 62 / No. 46
:: Progress Toward Poliomyelitis Eradication — Afghanistan, January 2012–September 2013
:: Progress Toward Poliomyelitis Eradication — Pakistan, January 2012–September 2013