GPEI Update: Polio this week – As of 12 February 2014

Update: Polio this week – As of 12 February 2014
Global Polio Eradication Initiative
Full report:

[Editor’s extract and bolded text]
:: Celebrating 3 years polio-free in India: on 11 February, dignitaries from around the world came together at a celebratory event in Delhi. The President of India, Shri Pranab Mukherjee, was joined in the celebrations by Prime Minister Dr Manmohan Singh, Union Health and Family Welfare Minister Ghulam Nabi Azad, Chairperson of the National Advisory Council Sonia Gandhi, Leader of the Opposition Shushma Swaraj, WHO Director-General Dr Margaret Chan, Rotary International President Ron D Burton and other high-level representatives. The Regional Certification Commission (RCC) for the Southeast Asia Region is expected to convene at end-March and review data from the entire Region, to determine if it will be officially certified as polio-free.
:: In Afghanistan, an immunization response is ongoing to last week’s reported case in Kabul. It was the first case in the province since 2002, and is linked to transmission in neighbouring Pakistan. Afghanistan continues to make strong progress towards polio eradication. This latest case in Kabul underscores the ongoing risk polio continues to pose to children everywhere.

:: One new wild poliovirus type 1 (WPV1) case was reported in the past week. The total number of WPV1 cases remains 14 for 2013, but is now two for 2014. The most recent WPV1 case had onset of paralysis on 15 January 2014 from Badakhstan province, Northern Region.

:: One new cVDPV2 case was reported in the past week. The total number of cVDPV2 cases for 2013 is now 4. The most recent cVDPV case had onset of paralysis on 24 December (from Maiduguri, Borno).
:: An appropriate response to this most recent cVDPV2 case in Borno is now being planned. The cVDPV2 case is linked to previous transmission in Chad from 2013.
:: The persisting transmission of two separate strains of cVDPV2 (from AFP cases and from the environment) in northern Nigeria and in north-West Pakistan is of concern to the GPEI since the ‘withdrawal’ of type 2 OPV vaccine (the ‘tOPV to bOPV switch’), planned for early 2016, will not be possible unless all persistent cVDPV2 transmission has been stopped.

:: Two new WPV1 cases were reported in the past week, both from North Waziristan in FATA (with onset of paralysis on 17 and 25 January 2014). The total number of cases for 2013 remains 93. The total number of cases in 2014 is now nine. The most recent case had onset of paralysis on 25 January 2014 (WPV1 from North Waziristan).
:: North Waziristan is the district with the largest number of children being paralyzed by poliovirus in the world (both wild- and VDPV2). Immunization activities have been suspended by local leaders since June 2012. It is critical that children in all areas are vaccinated and protected from poliovirus. Immunizations in neighbouring high-risk areas are being intensified, to further boost population immunity levels in those areas and prevent further spread of this outbreak.
:: The densely populated Peshawar valley is considered to be the main ‘engine’ of poliovirus transmission, alongside North Waziristan, due to large-scale population movements through Peshawar from across this region, and into other areas of Pakistan. The quality of operations must be urgently improved in Peshawar, and immunizations resumed in North Waziristan.
However, at the same time, concerning trends have been noted in greater Karachi, Sindh and in Quetta, Balochistan. Environmental positives isolates from every major city of Punjab confirm widespread virus circulation.
:: In Quetta, genetic sequencing of a positive environmental sample collected on 28 December 2013 indicates that it is linked to virus last detected in Afghanistan in July 2012, suggesting undetected circulation. Subnational analyses of surveillance sensitivity and immunity profiles are ongoing in both countries to ascertain more clarity. This further underscores the risk ongoing transmission anywhere, including low-level transmission, poses to the polio eradication efforts of both countries.

Horn of Africa
:: The Horn of Africa Technical Advisory Group (TAG) convened last week in Nairobi, Kenya, to evaluate impact of current outbreak response activities. The TAG underscored that the initial response to the outbreak was appropriate, however expressed grave concern that gaps in SIA quality and surveillance remained in key infected areas of the region. Consequently, the group concluded there is a serious risk of the outbreak continuing and of further spread both within and beyond countries of the Horn of Africa. The group recommended that infected countries should focus efforts on high-risk and infected areas, by conducting high-quality SIAs no more than four weeks apart.
:: An assessment of outbreak response activities in Ethiopia indicates significant ongoing vaccination coverage gaps in key areas, notably in parts of Somali region of the country. All efforts must be made to fill these vaccination coverage gaps as urgently as possible, which are threatening the regional outbreak response efforts.