POLIO [to 19 July 2014]

GPEI Update: Polio this week – As of 9 July 2014
Global Polio Eradication Initiative
Editor’s Excerpt and text bolding
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: Momentous opportunity for Africa: In its 2-3 July meeting, the Central African Technical Advisory Group noted that there is now a “momentous opportunity” for Africa to be polio-free and warned that there is a lack of urgency to capitalize on this opportunity.
:: New case in Afghanistan of Pakistan origin: A child who had onset of polio-paralysis in Khost Province of Afghanistan is a member of the displaced community from Pakistan’s North Waziristan Agency, where children have not had access to vaccination for two years. Ahead of and during military action in that Agency, the population has largely left the area and moved into surrounding areas of Pakistan and into Afghanistan. Massive vaccination operations are taking place at the transit points out of North Waziristan in order to protect Waziri children and the rest of Pakistan from polio.
Afghanistan
:: One new case of wild poliovirus type 1 (WPV1) was reported in the past week, from Khost Province. The child is from a Pakistani family from polio-endemic North Waziristan who fled to Afghanistan to escape conflict at home. Already ill with fever when leaving Pakistan, the child developed paralysis on 16 June, 2014, in Khost province, one day after arrival from N. Waziristan. Including this most recent case, Afghanistan has reported eight polio cases to date in 2014, compared to three at this time in 2013.
:: Khost Province borders Pakistan, where communities displaced by military action have been leaving North Waziristan Agency. In preparation for the displacement of people – and possible movement of the virus – ahead of the Pakistan military’s actions in North Waziristan, health authorities in surrounding districts of Pakistan and across the border in Afghanistan have been vaccinating displaced children: more than 35,000 displaced children under the age of 10 are reported to have received a dose of bivalent oral polio vaccine (bOPV) as they entered the Afghan provinces of Paktyka and Khost.
Nigeria
:: Two new cVDPV2 cases were reported in the past week, from Borno and Kano states. The total number of cVDPV2 cases for 2014 is now 13, and for 2013 is four. The most recent cVDPV2 case was the one from Damboa in Borno, which had onset of paralysis on 9 June. The continuing circulation of cVDPV2, as evident both from AFP and environmental surveillance , reflects very low levels of routine coverage with tOPV (and therefore very low immunity against type 2 poliovirus) in the north of the country and the need for increased use of type-2 containing vaccine (tOPV) during SIAs. It is also urgent that the quality and coverage of SIAs in northern Nigeria continue to improve this year
Pakistan
:: Four new wild poliovirus type 1 (WPV1) cases were reported in the past week, bringing the country’s total case count to 94. The most recent cases had onset of paralysis on 24 June, one from Khyber Agency of the Federally Administered Tribal Areas (FATA), one from Peshawar in Khyber Pakhtunkhwa province and one from Sanghar in Sindh province.
Central Africa
:: In its 2-3 July meeting, the Central African Technical Advisory Group noted that there is now a “momentous opportunity” for Africa to be polio-free, given the decline in cases in Nigeria, and warned that there is a lack of urgency to capitalize on this opportunity. The group recommended systematic engagement with the Heads of State and a region-wide alert on the potential spread of polio to ensure countries reduce their vulnerability and are prepared to deal with importation of poliovirus.
:: The entire population of Equatorial Guinea, regardless of age, will be vaccinated starting 23 July. A house-to-house search for acute flaccid paralysis cases will be conducted during the campaign; a similar search is currently taking place in Gabon. Cameroon, the Central African Republic, the Democratic Republic of the Congo (DR Congo), Gabon and the Republic of Congo also have mass vaccination campaigns planned for July. DR Congo, Equatorial Guinea and Gabon are also planning to carry out campaigns in August.
Horn of Africa
:: Three new cases of wild poliovirus type 1 were reported in the past week. Five cases have been reported in the Horn of Africa to date in 2014 – one WPV1 in Ethiopia and four WPV1 in Somalia. The most recent case had onset of paralysis on 3 June in Mudug, Somalia.
:: The three new cases reported from Mudug in Somalia bring the total no. of cases reported from the Mudug Region (Jariban) this year to four and indicate that the polio outbreak in Somalia continues. The cases are caused by virus closely related to that previously detected in Mogadishu in July 2013. No cases have been detected in the epicentre of the outbreak, in Mogadishu, Banadir region, since 19 July 2013.
:: Mudug is a remote area with challenging conditions to plan and implement immunization campaigns and with hard-to-reach, under-served nomadic populations. While the proportion of children with three or more doses of oral polio vaccine has risen since 2012, it is still below 80%. None of the children paralyzed in Mudug had ever been vaccinated against polio.
Special outreach is currently taking place to reach and vaccinate nomadic communities, as well as to map of these communities to ensure their inclusion in vaccination plans.

Pakistanis use fake polio vaccination cards to travel overseas
Thomson Reuters Foundation | 11 July 2014
Excerpt
NEW DELHI, July 11 (Thomson Reuters Foundation) – Pakistanis seeking to travel overseas have used fake polio vaccination certificates to circumvent rules put in place to stem the spread of the crippling virus, the Dawn newspaper reported.
The World Health Organisation (WHO) in May advised Pakistan, Syria and Cameroon to put in place emergency travel measures as they pose the greatest risk of exporting the virus and undermining a U.N. plan to eradicate polio by 2018.
The WHO recommended that residents and long-term visitors to these three countries be vaccinated and show proof of vaccination before being allowed to travel.
But since the rule was put in place in Pakistan in June, immigration staff at Islamabad’s Benazir Bhutto International Airport told the Dawn newspaper they had found around 150 polio certificates to be counterfeit.
An airport official, who declined to be named, said that some people had obtained fake certificates because they believed the vaccine could endanger their health…

Editor’s Note: Please note “comment” articles on polio from the current issue of Nature in Journal Watch below:
:: Within reach — A redoubling of efforts should swiftly eradicate polio from its last strongholds
Nature editors
:: Infectious disease: Polio eradication hinges on child health in Pakistan
Zulfiqar Ahmed Bhutta