POLIO [to 29 November 2014]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 26 November 2014
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: In response to the outbreak of circulating vaccine-derived poliovirus (cVDPV) in South Sudan, over 19,000 children were vaccinated last week in Bentiu Poc, where the two cases were reported. Outbreak response plans are in place to hold three rounds of supplementary immunization activities (SIAs) in high risk areas to stop transmission of the virus.
:: In the north of Madagascar, SIAs are planned for December in response to the outbreak of cVDPV. National Immunization Days are planned for January. The aim is to boost immunity across the country against all strains of poliovirus.
:: A planning meeting was held in Pakistan last week to develop a strategy for the low poliovirus transmission season, December 2014 to May 2015, using lessons learned from high risk areas. There is national consensus for the low season plan, including increased support from the Pakistan law enforcement and security services. The structure of the planned Emergency Operations Centre for polio eradication at the Federal and Provincial levels is being finalized.
:: For the first time ever, only 1 case of wild poliovirus has been reported in Africa in the last 4 months, despite the high season for polio transmission. The most recent case had onset of paralysis on 11 August in Somalia.
Afghanistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week in Afghanistan in Kandahar district, with onset of paralysis on the 5 November. The total number of WPV1 cases for 2014 in Afghanistan is now 21.
Pakistan
:: Fourteen new wild poliovirus type 1 (WPV1) cases were reported in the past week. Five were from the Federally Administered Tribal Areas (FATA) (2 in Khyber Agency, 2 in South Waziristan Agency and 1 in Frontier Region Bannu); 3 from Balochistan province (1 in Quetta district, 1 in Killa Abdullah district and 1 in Khuzdar district, which has not previously been infected in 2014); 5 from Khyber Pakhtunkhwa province (4 from Peshawar district and 1 from Karak district, which has not reported cases so far in 2014); and 1 from Karachi Site town in Sindh province. The total number of WPV1 cases in Pakistan in 2014 is now 260, compared to 64 at this time last year. The most recent WPV1 case had onset of paralysis on 11 November, from Quetta district, Balochistan.
:: Immunization activities are continuing with particular focus on known high-risk areas, in particular newly opened previously inaccessible areas of FATA. At exit and entry points of conflict-affected areas that are still inaccessible during polio campaigns, 100 permanent vaccination points are being used to reach internally displaced families as they move in and out of the inaccessible area. Over 1 million people have been vaccinated in the past few months at transit points and in host communities, including over 850,000 children under 10 years old.
Horn of Africa
:: Following confirmation of two cases of circulating vaccine derived poliovirus type 2 (cVDPV2) in a refugee camp area of Unity state, South Sudan, outbreak response plans are in place to hold rounds of supplementary immunization activities (SIAs) in high risk areas. Over 19,000 children were vaccinated on 13 – 15 November in Bentiu Poc where the 2 cases were reported in September. The objective is to rapidly stop the cVDPV2 in the infected area, while further boosting immunity to type 1 wild poliovirus and to minimize the risk of renewed outbreaks following virus re-introduction from infected countries and areas.
West Africa
:: The Ebola crisis in western Africa is impacting on the implementation or polio eradication activities in Liberia, Guinea and Sierra Leone. Supplementary immunization activities in these countries have been postponed and the quality of acute flaccid paralysis surveillance has markedly decreased this year.
:: Even as polio programme staff across West Africa support efforts to control the Ebola outbreak affecting the region, efforts are being made in those countries not affected by Ebola to vaccinate children against polio.
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The Weekly Epidemiological Record (WER) for 28 November 2014, vol. 89, 48 (pp. 529–544) includes:
:: Performance of acute flaccid paralysis (AFP) surveillance and incidence of poliomyelitis, 2014 :: Review of the 2014 influenza season in the southern hemisphere
http://www.who.int/entity/wer/2014/wer8948.pdf?ua=1
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Polio Crisis Deepens in Pakistan, With New Cases and Killings
By DECLAN WALSH
New York Times
NOV. 26, 2014
LONDON — Pakistan’s polio crisis has reached new depths this year, health officials say, intensified by a deadly mix of ruthless militant violence, large-scale refugee displacement and political chaos that has cemented the country’s role as the central global incubator of a disease that other conflict-torn countries have managed to hold in check.

The number of new Pakistani polio cases this year hit 260 this week, four times as many as at the same point last year, making a mockery of promises by Prime Minister Nawaz Sharif and other politicians from across the spectrum to halt the galloping progress of the disease.

Even as domestic vaccination drives and extensive international aid have put huge numbers of anti-polio workers in the field, Pakistan’s militants have seen it as an opportunity to strike at symbols of authority, portraying the workers as agents in a sinister Western plot. On Wednesday, four more health workers were gunned down, bringing the death toll among anti-polio workers to 65 since the first targeted attack in December 2012.

The attackers, who struck in Quetta, the capital of Baluchistan Province, opened fire on the workers’ vehicle after demanding to know if they were involved in the anti-polio campaign. Television footage showed emergency workers carrying three other wounded workers from a van that contained abandoned slippers and blood-smeared iceboxes with polio vaccines.

The wounded, and three of the dead, were women, whose greater access to private households in conservative rural areas of Pakistan have put them in high demand as health workers.

The attackers escaped, and there was no claim of responsibility, although a Taliban splinter group said it had carried out a gun attack near Peshawar on Monday that wounded a polio worker and a student. Polio vaccinations are “dangerous to health and against Islam,” a spokesman for that group, Jamaat-e-Ahrar, said after the attack, echoing longstanding claims that Western countries are using immunization to sterilize Muslim children…