Global Polio Eradication Initiative
Monthly Situation Report - JANUARY 2011
All data as of 1 February 2011
For latest news and polio case data by country, updated every week: www.polioeradication.org
fACTS & fIGURES
There have
been 950 cases globally* in 2010 (864 type 1 and 86 type 3), compared
with 1,595 cases at the same time in 2009 (477 type 1 and 1,116 type 3
and 2 mixtures). 20 countries reported cases in 2010, compared with 23 in 2009.
HEADLINES
President of Pakistan kicks off emergency plan to stop polio:
President Asif Ali Zardari formally launched the emergency plan on 24
January. The only polio-endemic country with an increase in cases in
2010, Pakistan has struggled in the past six months to slow the
transmission of poliovirus. The number of children paralyzed by the
virus jumped by 60% (from 88 in 2009 to 144 in 2010, as of 1 February
2011). More
Renewed leadership commitment in Angola: President
Jose Eduardo dos Santos reaffirmed the Government´s and his personal
commitment to eliminating polio in a meeting with the UNICEF Executive
Director and senior leadership from the Bill & Melinda Gates
Foundation and WHO African Regional Office. The President agreed to
spearhead the country's 2011 vaccination campaigns; this pledge was
echoed by Vice Ministers, Vice Governors and civil society
organizations, who agreed they would work across the country to improve
vaccination coverage. More
Bill Gates call for a final push to end polio, joins UK Prime Minister David Cameron to announce contributions: New
funding from the United Kingdom and the Crown Prince of Abu Dhabi will
help reduce the US$720 million funding gap of the Global Polio
Eradication Initiative, but Mr Gates, co-chair of the Bill & Melinda
Gates Foundation, reminded readers of his annual letter
that eradicating polio requires "funding from a range of donors, to
support an aggressive program that will get the job done." Mr Cameron
also called on other donors to back polio eradication: noting the
question of international development assistance in the current
financial climate, Mr Cameron said, "There is never a wrong time to do
the right thing." More
*Many of the
540 cases of acute flaccid paralysis (AFP) reported from Congo do not
have stool specimens but are clinically compatible with polio. When
definitively classified, these cases will add to the yearly total.
ENDEMIC COUNTRIES
AFGHANISTAN
•In the past nine
months, no WPV3 has been recorded in Afghanistan. The recent WPV1
detected in December is a new importation from neighbouring Pakistan.
•The first Subnational
Immunization Days (SNIDs) of the year were held on 30 January to 2
February, in synchronization with Pakistan.
•Efforts were focused on
reaching all populations in the 13 high-risk districts of the Southern
Region. Access during supplementary immunization activities (SIAs) in
the latter half of 2010 had improved, and this trend needs to continue
in 2011. During the last three SIAs, less than 10% of the target
population was inaccessible, compared to more than 25% at the start of
2010.
INDIA
•India continues to
report record-low levels of both WPV1 and WPV3, particularly in the
traditional endemic reservoir areas. In Uttar Pradesh, no cases of WPV3
have been reported since April 2010; the most recent WPV1 is from
October 2009. In Bihar, no cases of WPV1 have been reported since 1
September 2010; it has been more than 12 months since Bihar reported a
WPV3.
•The outbreak in West
Bengal has persisted for nearly 12 months and is the longest running
outbreak in a previously polio-free area experiencing a WPV importation
in 2010. Confirmation was received in January of a WPV1 environmental
sample collected in November in Mumbai. For these reasons, urgent
efforts are under way to close any residual immunity gaps, especially in
high-risk areas of West Bengal, and with special strategies to reach
mobile population groups.
•In January, over 15,000
children were immunized during the Ganga Sagar festival in the South 24
Parganas district of West Bengal. As part of the renewed emphasis on
reaching migrant and nomadic populations, social mobilizers pointed
festival goers to the vaccination teams. The fair saw 620,000 people
coming in from other states and from neighbouring countries. A mop-up
is being held on 5 February in high-risk districts of West Bengal.
•National Immunization
Days (NIDs) were launched on 23 January by the President of India. In
response to the West Bengal outbreak, more than 1,140 NGO volunteers
were deployed to deliver focused community mobilization in the
highest-risk areas of Murshidabad and South 24 Parganas ahead of and
during the NIDs.
•A second NID is
scheduled for 27 February. These two nationwide rounds will be followed
by SNIDs in March, April, May and June.
NIGERIA
•Nigeria continues to
report record-low levels of both WPV1 and WPV3 transmission, with a 95%
decrease in cases in 2010 compared to 2009.
•However, transmission
of a circulating vaccine-derived poliovirus (cVDPV) continues.
Transmission of all types of virus, both vaccine-derived and wild,
particularly in the northeast of the country (Borno state, bordering
Chad), and in the northwest (Zamfara, Kebbi and Sokoto states) threaten
neighbouring countries. It is historically from these areas which
poliovirus spread internationally into west Africa and into Chad. The
progress in Nigeria is fragile until transmission in these areas is
stopped.
•The first nationwide
Immunization Plus Days (IPDs) in 2011 were conducted on 26 January (in
key northern states, the activity also included an integrated measles
campaign). The activity in Borno was delayed until 2 February; Borno
has not conducted any immunization activities since October 2010, due to
a health worker strike.
•The next nationwide
IPD is planned for 23 February using tOPV and will be followed by
subnational activities in March. These two campaigns will be critical,
as national elections will be held in April, and the rainy season will
commence in May, both factors which may compromise immunization
activities at that time.
•The next Expert Review
Committee on Polio Eradication and Routine Immunization (ERC) is
tentatively scheduled for 7-8 March. It is expected that the ERC will
review the latest risk assessments and agree on action plans to
interrupt all strains of transmission as rapidly as possible.
PAKISTAN
•Pakistan is the first
country to report cases in 2011 and the only endemic country to report
more cases in 2010 than in 2009. Over half the cases of 2010 are from
the Federally Administered Tribal Agencies (FATA). Five positive
environmental samples found in 2010 at sites as disparate as Lahore,
Quetta and Karachi provide further evidence that polio transmission is
widespread.
•NIDs were conducted on
28-30 December, using bivalent OPV. Access to all children in FATA was
again a hurdle, with 26% of the target population inaccessible.
•To urgently address the
increase in transmission in the country over the past 12 months, the
National Emergency Action Plan for polio eradication was presented to
the Prime Minister on 14 January and launched by President Asif Ali
Zardari on 24 January.
•Turning the plan into
action will depend on increased engagement and ownership at all levels,
and especially at the district-level (where the plan is ultimately
implemented). The plan is available at http://www.polioeradication.
•Coordination has
started with the Inter-religious Council for Health (IRCH) in 27
intervention districts on mother and child health issues, with special
emphasis on polio eradication and immunization.
•The first SNIDs of the year were launched on 31 January, in synchronization with Afghanistan.
RE-ESTABLISHED TRANSMISSION COUNTRIES
ANGOLA
•The outbreak in
Angola, which has this year spread to DR Congo and the Republic of
Congo, continues to pose a significant risk to Africa's eradication
effort, particularly given the strong progress achieved elsewhere on the
continent (in particular in Nigeria and west Africa). A mop-up was held
on 14-16 January in Cabinda in response to the Republic of Congo
outbreak.
•President Jose Eduardo
Dos Santos has stated his personal commitment to stopping polio in the
country and his intention to spearhead the 2011 SIA schedule. The
Executive Director of UNICEF and the President of the Global Health
Programme at the Bill and Melinda Gates Foundation, accompanied by the
WHO Assistant Regional Director for Africa, welcomed these commitments
and expressed the support of their organizations.
•Mop-ups will be held on
18-20 February in Luanda, Benguela, Bengo and Kuanza Norte: these are
the first campaigns to be conducted in response to the latest cases
Luanda and Benguela in November.
CHAD
•Chad is the first
country in Africa to report cases in 2011. Since September 2010, Chad is
experiencing an expanding WPV1 outbreak. During Supplementary
Immunization Activities (SIAs) in which any type 1-containing vaccine
was used, coverage was insufficient. Chad is at high risk of further
spread of this current importation.
•The percentage of
missed children during SIAs has increased from a low of 8% in March
after the President's launch, to a high of 15% at the end of the year.
The proximity of Logone Oriental and Occidental (which have reported the
recent cases) to neighbouring Cameroon and Central African Republic
further increases the risk of this expanding outbreak.
•It is important to note
that this WPV1 outbreak represents a new outbreak, and is unrelated to
the re-established virus transmission chain (WPV3) affecting the country
since November 2007. No cases linked to that transmission chain have
been reported since May 2010.
•A high-level round
table for the media was held on 20 January, to ensure clear
communication on the urgency of the outbreak. The event was presided
over by the Secretary of State for Public Health with participation from
the country representatives of WHO and UNICEF, the President of the
N'Djamena Rotary Club and the Vice-President of the Chad Red Cross.
•NIDs will be conducted
on 10-12 February; it will be critical to increase the sensitivity of
independent monitoring, to assure a clear picture of the outbreak
response activities.
DEMOCRATIC REPUBLIC OF THE CONGO (DR CONGO)
•DR Congo is
experiencing a severe outbreak in Kasai Occidentale and Bandundu, the
result of polio transmission from across the Angolan border. At the same
time, separate outbreaks are ongoing in Bas-Congo (related to the
Republic of Congo outbreak) and in the east of the country (related to
2009 transmission).
•An emergency plan is
currently being finalized by the government. On an official visit to DR
Congo on 7-8 February, WHO Director-General Dr Margaret Chan met
President Laurent Kabila, who stated his intention to combat the current
poliovirus circulation "without mercy." Dr Chan also discussed the
agency's support to the government's response plan with the Prime
Minister and Minister of Health.
IMPORTATION COUNTRIES
REPUBLIC OF CONGO
•Many of the 540 cases
of acute flaccid paralysis (AFP) reported from Congo do not have stool
specimens but are clinically compatible with polio. Final classification
of these cases is expected by March.
•In the epicentre of the
outbreak in Pointe Noire and Kouilou, the large number of cases without
stool samples are now being reviewed and classified, many of which will
likely be confirmed as polio.
•The network Al-Jazeera
English broadcast a moving documentary on the obligation to complete
polio eradication, illustrating the tragedy of paralysis and death that
polio can cause through the stories of two young men affected by the
outbreak. The full 25-minute programme can be viewed on: http://www.youtube.com/watch?
HORN OF AFRICA
•An international
mission of technical experts is taking place in early February, to
finalize an SIA plan and review operational plans to strengthen disease
surveillance in both Kenya and Uganda. This is critical, as in some
areas of Kenya, upwards of 20% of children were missed during outbreak
response activities in 2010, and the outbreak from 2009 continued
undetected into 2010. Corrective actions, including the deployment of
additional STOP team members, have begun.
•Ethiopia is preparing
for a second phase of Child Health Days in February; the first was held
in October. In Somalia, preparations are also under way for NIDs in
late March and late April. Both countries continue to be at risk of
polio, given ongoing WPV transmission in the Uganda/Kenya border area,
and evidence of a cVDPV in Ethiopia in early 2010.
CENTRAL ASIA AND RUSSIA
•Six months have
passed since the most recent case in Tajikistan (4 July 2010), the first
site of the outbreak in Central Asia.
•The European Regional
Certification Commission met in January in St. Petersburg and discussed
further SIAs, surveillance and analysis of risks.
•Comprehensive outbreak response is continuing in all four countries, with a focus on the North Caucasus region of Russia.
NEPAL
•Mop-ups are
continuing in highest-risk border districts with India. All cases in
2010 were from the Central Development Region (CDR), in Rautahat and
Mahottari districts, bordering Bihar, India.
•NIDs will be conducted in Nepal in February and March 2011.
WEST AFRICA
•The outbreak appears
to be slowing, as four months have passed since the most recent case. In
order to protect these gains, NIDs took place in Niger (14 January) and
Burkina Faso (4 February), and SNIDs in Guinea (17 January). Further
rounds across west Africa are planned for 25 March and 22 April
Monthly Situation Report - JANUARY 2011
All data as of 1 February 2011
For latest news and polio case data by country, updated every week: www.polioeradication.org
fACTS & fIGURES
There have
been 950 cases globally* in 2010 (864 type 1 and 86 type 3), compared
with 1,595 cases at the same time in 2009 (477 type 1 and 1,116 type 3
and 2 mixtures). 20 countries reported cases in 2010, compared with 23 in 2009.
HEADLINES
President of Pakistan kicks off emergency plan to stop polio:
President Asif Ali Zardari formally launched the emergency plan on 24
January. The only polio-endemic country with an increase in cases in
2010, Pakistan has struggled in the past six months to slow the
transmission of poliovirus. The number of children paralyzed by the
virus jumped by 60% (from 88 in 2009 to 144 in 2010, as of 1 February
2011). More
Renewed leadership commitment in Angola: President
Jose Eduardo dos Santos reaffirmed the Government´s and his personal
commitment to eliminating polio in a meeting with the UNICEF Executive
Director and senior leadership from the Bill & Melinda Gates
Foundation and WHO African Regional Office. The President agreed to
spearhead the country's 2011 vaccination campaigns; this pledge was
echoed by Vice Ministers, Vice Governors and civil society
organizations, who agreed they would work across the country to improve
vaccination coverage. More
Bill Gates call for a final push to end polio, joins UK Prime Minister David Cameron to announce contributions: New
funding from the United Kingdom and the Crown Prince of Abu Dhabi will
help reduce the US$720 million funding gap of the Global Polio
Eradication Initiative, but Mr Gates, co-chair of the Bill & Melinda
Gates Foundation, reminded readers of his annual letter
that eradicating polio requires "funding from a range of donors, to
support an aggressive program that will get the job done." Mr Cameron
also called on other donors to back polio eradication: noting the
question of international development assistance in the current
financial climate, Mr Cameron said, "There is never a wrong time to do
the right thing." More
*Many of the
540 cases of acute flaccid paralysis (AFP) reported from Congo do not
have stool specimens but are clinically compatible with polio. When
definitively classified, these cases will add to the yearly total.
ENDEMIC COUNTRIES
AFGHANISTAN
•In the past nine
months, no WPV3 has been recorded in Afghanistan. The recent WPV1
detected in December is a new importation from neighbouring Pakistan.
•The first Subnational
Immunization Days (SNIDs) of the year were held on 30 January to 2
February, in synchronization with Pakistan.
•Efforts were focused on
reaching all populations in the 13 high-risk districts of the Southern
Region. Access during supplementary immunization activities (SIAs) in
the latter half of 2010 had improved, and this trend needs to continue
in 2011. During the last three SIAs, less than 10% of the target
population was inaccessible, compared to more than 25% at the start of
2010.
INDIA
•India continues to
report record-low levels of both WPV1 and WPV3, particularly in the
traditional endemic reservoir areas. In Uttar Pradesh, no cases of WPV3
have been reported since April 2010; the most recent WPV1 is from
October 2009. In Bihar, no cases of WPV1 have been reported since 1
September 2010; it has been more than 12 months since Bihar reported a
WPV3.
•The outbreak in West
Bengal has persisted for nearly 12 months and is the longest running
outbreak in a previously polio-free area experiencing a WPV importation
in 2010. Confirmation was received in January of a WPV1 environmental
sample collected in November in Mumbai. For these reasons, urgent
efforts are under way to close any residual immunity gaps, especially in
high-risk areas of West Bengal, and with special strategies to reach
mobile population groups.
•In January, over 15,000
children were immunized during the Ganga Sagar festival in the South 24
Parganas district of West Bengal. As part of the renewed emphasis on
reaching migrant and nomadic populations, social mobilizers pointed
festival goers to the vaccination teams. The fair saw 620,000 people
coming in from other states and from neighbouring countries. A mop-up
is being held on 5 February in high-risk districts of West Bengal.
•National Immunization
Days (NIDs) were launched on 23 January by the President of India. In
response to the West Bengal outbreak, more than 1,140 NGO volunteers
were deployed to deliver focused community mobilization in the
highest-risk areas of Murshidabad and South 24 Parganas ahead of and
during the NIDs.
•A second NID is
scheduled for 27 February. These two nationwide rounds will be followed
by SNIDs in March, April, May and June.
NIGERIA
•Nigeria continues to
report record-low levels of both WPV1 and WPV3 transmission, with a 95%
decrease in cases in 2010 compared to 2009.
•However, transmission
of a circulating vaccine-derived poliovirus (cVDPV) continues.
Transmission of all types of virus, both vaccine-derived and wild,
particularly in the northeast of the country (Borno state, bordering
Chad), and in the northwest (Zamfara, Kebbi and Sokoto states) threaten
neighbouring countries. It is historically from these areas which
poliovirus spread internationally into west Africa and into Chad. The
progress in Nigeria is fragile until transmission in these areas is
stopped.
•The first nationwide
Immunization Plus Days (IPDs) in 2011 were conducted on 26 January (in
key northern states, the activity also included an integrated measles
campaign). The activity in Borno was delayed until 2 February; Borno
has not conducted any immunization activities since October 2010, due to
a health worker strike.
•The next nationwide
IPD is planned for 23 February using tOPV and will be followed by
subnational activities in March. These two campaigns will be critical,
as national elections will be held in April, and the rainy season will
commence in May, both factors which may compromise immunization
activities at that time.
•The next Expert Review
Committee on Polio Eradication and Routine Immunization (ERC) is
tentatively scheduled for 7-8 March. It is expected that the ERC will
review the latest risk assessments and agree on action plans to
interrupt all strains of transmission as rapidly as possible.
PAKISTAN
•Pakistan is the first
country to report cases in 2011 and the only endemic country to report
more cases in 2010 than in 2009. Over half the cases of 2010 are from
the Federally Administered Tribal Agencies (FATA). Five positive
environmental samples found in 2010 at sites as disparate as Lahore,
Quetta and Karachi provide further evidence that polio transmission is
widespread.
•NIDs were conducted on
28-30 December, using bivalent OPV. Access to all children in FATA was
again a hurdle, with 26% of the target population inaccessible.
•To urgently address the
increase in transmission in the country over the past 12 months, the
National Emergency Action Plan for polio eradication was presented to
the Prime Minister on 14 January and launched by President Asif Ali
Zardari on 24 January.
•Turning the plan into
action will depend on increased engagement and ownership at all levels,
and especially at the district-level (where the plan is ultimately
implemented). The plan is available at http://www.polioeradication.
•Coordination has
started with the Inter-religious Council for Health (IRCH) in 27
intervention districts on mother and child health issues, with special
emphasis on polio eradication and immunization.
•The first SNIDs of the year were launched on 31 January, in synchronization with Afghanistan.
RE-ESTABLISHED TRANSMISSION COUNTRIES
ANGOLA
•The outbreak in
Angola, which has this year spread to DR Congo and the Republic of
Congo, continues to pose a significant risk to Africa's eradication
effort, particularly given the strong progress achieved elsewhere on the
continent (in particular in Nigeria and west Africa). A mop-up was held
on 14-16 January in Cabinda in response to the Republic of Congo
outbreak.
•President Jose Eduardo
Dos Santos has stated his personal commitment to stopping polio in the
country and his intention to spearhead the 2011 SIA schedule. The
Executive Director of UNICEF and the President of the Global Health
Programme at the Bill and Melinda Gates Foundation, accompanied by the
WHO Assistant Regional Director for Africa, welcomed these commitments
and expressed the support of their organizations.
•Mop-ups will be held on
18-20 February in Luanda, Benguela, Bengo and Kuanza Norte: these are
the first campaigns to be conducted in response to the latest cases
Luanda and Benguela in November.
CHAD
•Chad is the first
country in Africa to report cases in 2011. Since September 2010, Chad is
experiencing an expanding WPV1 outbreak. During Supplementary
Immunization Activities (SIAs) in which any type 1-containing vaccine
was used, coverage was insufficient. Chad is at high risk of further
spread of this current importation.
•The percentage of
missed children during SIAs has increased from a low of 8% in March
after the President's launch, to a high of 15% at the end of the year.
The proximity of Logone Oriental and Occidental (which have reported the
recent cases) to neighbouring Cameroon and Central African Republic
further increases the risk of this expanding outbreak.
•It is important to note
that this WPV1 outbreak represents a new outbreak, and is unrelated to
the re-established virus transmission chain (WPV3) affecting the country
since November 2007. No cases linked to that transmission chain have
been reported since May 2010.
•A high-level round
table for the media was held on 20 January, to ensure clear
communication on the urgency of the outbreak. The event was presided
over by the Secretary of State for Public Health with participation from
the country representatives of WHO and UNICEF, the President of the
N'Djamena Rotary Club and the Vice-President of the Chad Red Cross.
•NIDs will be conducted
on 10-12 February; it will be critical to increase the sensitivity of
independent monitoring, to assure a clear picture of the outbreak
response activities.
DEMOCRATIC REPUBLIC OF THE CONGO (DR CONGO)
•DR Congo is
experiencing a severe outbreak in Kasai Occidentale and Bandundu, the
result of polio transmission from across the Angolan border. At the same
time, separate outbreaks are ongoing in Bas-Congo (related to the
Republic of Congo outbreak) and in the east of the country (related to
2009 transmission).
•An emergency plan is
currently being finalized by the government. On an official visit to DR
Congo on 7-8 February, WHO Director-General Dr Margaret Chan met
President Laurent Kabila, who stated his intention to combat the current
poliovirus circulation "without mercy." Dr Chan also discussed the
agency's support to the government's response plan with the Prime
Minister and Minister of Health.
IMPORTATION COUNTRIES
REPUBLIC OF CONGO
•Many of the 540 cases
of acute flaccid paralysis (AFP) reported from Congo do not have stool
specimens but are clinically compatible with polio. Final classification
of these cases is expected by March.
•In the epicentre of the
outbreak in Pointe Noire and Kouilou, the large number of cases without
stool samples are now being reviewed and classified, many of which will
likely be confirmed as polio.
•The network Al-Jazeera
English broadcast a moving documentary on the obligation to complete
polio eradication, illustrating the tragedy of paralysis and death that
polio can cause through the stories of two young men affected by the
outbreak. The full 25-minute programme can be viewed on: http://www.youtube.com/watch?
HORN OF AFRICA
•An international
mission of technical experts is taking place in early February, to
finalize an SIA plan and review operational plans to strengthen disease
surveillance in both Kenya and Uganda. This is critical, as in some
areas of Kenya, upwards of 20% of children were missed during outbreak
response activities in 2010, and the outbreak from 2009 continued
undetected into 2010. Corrective actions, including the deployment of
additional STOP team members, have begun.
•Ethiopia is preparing
for a second phase of Child Health Days in February; the first was held
in October. In Somalia, preparations are also under way for NIDs in
late March and late April. Both countries continue to be at risk of
polio, given ongoing WPV transmission in the Uganda/Kenya border area,
and evidence of a cVDPV in Ethiopia in early 2010.
CENTRAL ASIA AND RUSSIA
•Six months have
passed since the most recent case in Tajikistan (4 July 2010), the first
site of the outbreak in Central Asia.
•The European Regional
Certification Commission met in January in St. Petersburg and discussed
further SIAs, surveillance and analysis of risks.
•Comprehensive outbreak response is continuing in all four countries, with a focus on the North Caucasus region of Russia.
NEPAL
•Mop-ups are
continuing in highest-risk border districts with India. All cases in
2010 were from the Central Development Region (CDR), in Rautahat and
Mahottari districts, bordering Bihar, India.
•NIDs will be conducted in Nepal in February and March 2011.
WEST AFRICA
•The outbreak appears
to be slowing, as four months have passed since the most recent case. In
order to protect these gains, NIDs took place in Niger (14 January) and
Burkina Faso (4 February), and SNIDs in Guinea (17 January). Further
rounds across west Africa are planned for 25 March and 22 April
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