GPEI Update: Polio this week – As of 9 April 2014
Global Polio Eradication Initiative
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
[Editor’s extract and bolded text]
:: First mass vaccination campaigns started in the Middle East since a polio case was reported in Iraq. Polio vaccination campaigns commenced in Syria, Iraq and Egypt on 6 April and Turkey on 7 April, aiming to reach more than 20 million children over five days. For Iraq, this is the first nationwide vaccination campaign since a case of polio in a six-month-old boy from northern Baghdad was confirmed by the Ministry of Health on 30 March.
:: Last week, WHO’s Strategic Advisory Group of Experts on immunization (SAGE) convened in Geneva. In addition to reviewing the global epidemiology of polio transmission, SAGE endorsed the updates made to the existing WHO vaccination recommendations for travelers from polio-infected countries in International Travel and Health (ITH). Additionally, SAGE reviewed progress towards setting a confirmed date for the trivalent to bivalent OPV switch, which requires the absence of persistent circulating vaccine-derived poliovirus type 2 (cVDPV2) for at least six months globally.
:: SAGE expressed alarm at the persistent cVDPV2s in northern Nigeria and Pakistan, highlighting that these areas overlapped with some of the last wild poliovirus (WPV) reservoirs in the world. Stopping circulating of both cVDPV2s and WPVs requires addressing gaps in supplementary immunization activity (SIA) quality, increasing access and using an appropriate mix of trivalent and bivalent OPV over the coming months. A summary of the SAGE meeting is available here. The full SAGE meeting report will be published in the WHO Weekly Epidemiological Record (WER) on 23 May 2014.
Pakistan
:: Three new WPV1 cases were reported this week from North Waziristan, Federally Administered Tribal Areas – FATA, and one new WPV1 from Bannu district, Khyber Pakhtunkhwa (KP), bringing the total number of cases for 2014 to 43. The most recent reported case had onset of paralysis on 20 March from North Waziristan.
:: One new cVDPV2 case was reported in the past week with onset of paralysis on 21 February, from FR Bannu, FATA. The total number of cVDPV2 cases is 45 for 2013, and seven for 2014
Central Africa
:: A new WPV1 case was reported this week from Malabo, the capital of Equatorial Guinea, with onset of paralysis on 19 March. The total number of WPV1 cases reported from Equatorial Guinea for 2014 is two.
:: Due to continued poliovirus circulation in Cameroon, gaps in surveillance quality and influx of vulnerable populations from Central African Republic (CAR), WHO had elevated the risk assessment of international spread of polio from Cameroon to ‘very high’ in March of 2014.
:: Since confirmation of the outbreak in Cameroon in October, five nationwide campaigns have been conducted. However, the quality of implementation varied greatly by region, and serious coverage gaps remain. As many as 40% of children remain under-immunized (with 30% having received zero doses) during SIAs.
:: The recent confirmation of new cases in Cameroon has resulted in planning additional emergency outbreak response activities, including converting a subnational immunization campaign to a full nationwide activity on 11-13 April, and implementing nationwide campaigns in May and June. Critical to success will be to ensure substantial improvement in the quality campaigns so that all children are reached multiple times with OPV. Equally important will be efforts to rapidly improve the quality of surveillance so that the full extent of the outbreak can be determined and tracked.
:: Immunity levels and surveillance sensitivity are also being assessed in neighboring countries, in particular in Gabon and the Republic of Congo, and additional immunization activities are being planned in these countries in April (Gabon) and May (Republic of Congo).