POLIOMYELITIS UPDATE (11): INDIA, VACCINE DERIVED POLIOVIRUS 2
**************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
[1]
Date: Sat 8 Jun 2013
From: Panduranga Rao <raopp@ellafoundation.org> [edited]
Polio (VDPV) paralysis in infant in Maharashtra, India
------------------------------------------------------
Some local news papers report a case of poliomyelitis from Maharashtra State suspected to be caused by vaccine derived poliovirus (VDPV). The virus involved in this case is reported to be vaccine derived poliovirus 2. There is some conflicting news about the vaccination status of the infant involved. An official from the ministry of health is reported to have said that this is an isolated case, hinting that the virus is not circulating. It is also reported that health teams are collecting samples from the local people to ascertain the immunity status of the population. India has been off the list of polio endemic countries for the last 2.5 years.
Following are some of the links for reports about this case in local newspapers:
http://www.thehindu.com/news/national/w ... 792320.ece,
http://indiatoday.intoday.in/story/poli ... 78908.html,
http://www.dnaindia.com/india/1845120/r ... olio-virus, and
http://timesofindia.indiatimes.com/indi ... 468765.cms
--
Panduranga Rao
Ella Foundation
<raopp@ellafoundation.org>
******
[2]
Date: Sat 8 Jun 2013
Source: The Hindu [edited]
http://www.thehindu.com/news/national/w ... 792320.ece
WHO investigating Maharashtra's polio case
------------------------------------------
A team from the World Health Organization is investigating how an 11 month old infant has been infected with poliovirus in Maharashtra's Beed district, in spite of stringent efforts by the Health Ministry to control its spread.
It is the 1st time since March 2012 that the state has registered a polio case. Health minister Suresh Shetty told The Hindu that he had ordered an investigation and would get the WHO report on Saturday morning [8 Jun 2013].
The infant, hailing from Kanhapur village in Dharur tehsil [county], has been found to have the vaccine derived poliovirus (VDPV) type 2, a rare strain which is genetically mutated from the strain contained in the oral polio vaccine [OPV].
The infant was initially admitted to the government medical college in Ambejogai, Beed, on [3 May 2013]. "The child had high fever and suffered paralysis in all 4 limbs," said AK Singare, residential medical officer of Swami Ramanand Teerth Hospital, Ambejogai. The child was then transferred to the Latur government medical college on [16 May 2013] and tested positive for VDPV on [1 Jun 2013].
VDPVs are further classified into circulating vaccine-derived poliovirus, immunodeficiency-related vaccine-derived poliovirus (iVDPV), and ambiguous vaccine-derived poliovirus. It is still unclear which form of the virus has infected the child.
Officials in charge of the case said the child having been ill for prolonged periods indicated the possibility of iVDPV, which could be further linked to lack of sanitation and health facilities.
Though the case has rung alarm bells, health experts say this does not threaten India's polio-free status. Detecting VDPV is part of the surveillance system but only infections caused by wild poliovirus [WPV] strains like P1 and P3 are taken into account when declaring a country polio-free, and not a P2 strain which is caused by the oral polio vaccine and hence causes VDPV infection.
India's last case of wild polio infection was reported on [13 Jan 2011] from West Bengal.
--
communicated by:
Panduranga Rao
<raopp@ellafoundation.org>
[ProMED-mail thanks Panduranga Rao for these communications.
The report of a case of polio due to infection with a vaccine-derived poliovirus (VDPV) in a country is always a concern as the possibility of circulating VDPVs (cVDPV) is there, an indication of pockets of low vaccination coverage that permit the circulation of these viruses.
In the newswire report above, there is mention of the possibility that this case may represent an immunodeficiency related VDPV infection, and not represent an infection with a cVDPV.
According to the latest information on the India National Polio Surveillance Project website:
Vaccine derived polioviruses
- A vaccine-derived poliovirus (VDPV) has been confirmed in a 10 month old boy in Dharur block of Beed district in [Maharashtra]. VDPVs are extremely rare and occur in children with immunodeficiency or in populations with low levels of immunization.
- This is the 3rd case of VDPV in 2013. Earlier, VDPV was reported in an 8 month old boy in a village in Jaipatna block of Kalahandi district of Odisha and a 5 month old girl in Kako block of Jehanabad district of Bihar. All 3 cases are of VDPV type 2.
- In 2012, VDPV was reported in an immunodeficient child in Murshidabad district of West Bengal. In 2011, 7 cases of VDPVs were reported -- 3 in children with immune deficiency in Dhamtari (Chhattisgarh), Barnala (Punjab), and Jajpur (Odisha) and 4 in areas with low routine immunization coverage in Udaipur (Rajasthan), Ghaziabad, and Badaun (Uttar Pradesh) and Vidisha (Madhya Pradesh).
- The Government of India and the States have been effectively responding to the VDPVs in the past. The response to VDPVs that are detected in areas with low routine immunization coverage involve conducting catch up routine vaccination campaigns. The response is consistent with the global strategy. As a result, none of the VDPVs detected in India during the past 3 years have shown any evidence of circulation.
- In the current situation of polio eradication, an importation of wild poliovirus remains the larger threat to the children in India. OPV has reduced the polio incidence globally by greater than 99 per cent and has helped India stop transmission of wild poliovirus. India has not reported any case of polio for over 2 years, the last case being in January 2011. (The full report is available at http://www.npspindia.org/VDPV.doc).
We await more information on the final classification of the type of VDPV in this case -- immunodeficiency related, circulating, or ambiguous. (This moderator was hoping there might be more specific information to report on this case prior to posting, but alas, not.)
For a map of locations within India where VDPVs have been identified see http://www.npspindia.org/Polio11.asp.
For a map of India showing states, see http://www.mapsofindia.com/maps/india/i ... al-map.htm. For the HealthMap/ProMED map of India, see http://healthmap.org/r/1*Oa. - Mod.MPP]
Kinderlähmung - Poliomyelitis
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Kinderlähmung - Poliomyelitis weltweit
POLIOMYELITIS UPDATE (12): KENYA, SOMALIA, REQUEST FOR INFORMATION, ISRAEL ENVIRONMENTAL SAMPLES
************************************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
In this update:
[1] Kenya, Somalia
[2] Israel: environmental samples
[3] Global update: Polio Eradication Initiative
******
[1] Kenya, Somalia
Date: Fri 14 Jun 2013
Source: Midnimo [edited]
http://www.midnimo.com/2013/06/14/somal ... s-release/
Somalia: polio outbreak confirmed in Mogadishu and Kenya
--------------------------------------------------------
The 1st confirmed case of the wild poliovirus (WPV1) in Somalia since 2007 has been reported in Mogadishu on [9 May 2013].
Since then, 14 WPV cases have been reported and also 2 WPV cases in Kenya [see comment following this newswire as the total number of cases reported in Somalia and Kenya combined is 14. - Mod.MPP] Experts have warned the outbreak could spread to neighbouring countries and a surveillance alert for polio has been issued to all countries across the Horn of Africa. There is a great risk that the disease can reach Somaliland. Globally, 3 countries remain polio endemic (Nigeria, Pakistan, and Afghanistan). As long as polio exists anywhere in the world, all children are at risk from polio if not vaccinated.
Poliomyelitis (polio) is a highly infectious disease caused by the poliovirus which invades the nervous system, and can cause irreversible paralysis (usually in the legs) or even death in a matter of hours. The poliovirus enters through the mouth, in water or food contaminated with faecal material from an infected person. The virus multiplies in the intestine and is excreted by the infected person in faeces, which can pass on the virus to others.
There is no cure for polio but it can be prevented through giving children several doses of the oral polio vaccine. The vaccine is essential protection for children and we urge all parents, mothers, and caregivers to make sure that their children under the age of 5 are vaccinated now. The vaccine is available at all health centres and will be made available during the National Immunization Days (NIDs) exercise also. The vaccinators will be coming to your house to immunize your children.
Dates for next the National immunization Days (NIDs) in Somaliland:
16-19 Jun 2013
1-4 Jul 2013
18-21 Aug 2013
16-19 Dec 2013
--
communicated by:
ProMED-mail
<promed@promedmail.org>
[According to the most recent figures from the Polio Eradication Initiative (see section [3] below), there have been a total of 14 cases of polio associated with the WPV1 circulating in Somalia and the Dadaab region of Kenya combined, with 9 cases reported in Somalia, and 5 cases reported in Kenya. Clarification of these numbers would be greatly appreciated, as it is always possible that additional cases have been reported since the preparation of the weekly update on the Polio Eradication Initiative website.
For the HealthMap/ProMED-mail interactive map of Somalia, see http://healthmap.org/r/1Ahv; and of Kenya, see http://healthmap.org/r/1r1D. - Mod.MPP]
******
[2] Israel: environmental samples
Date: Thu 13 Jun 2013
Source: Haaretz [edited]
http://www.haaretz.com/news/national/tr ... m-1.529466
Traces of poliovirus found in sewers in Ashdod and other locales in southern Israel
----------------------------------------------------------------------
Traces of poliovirus have been detected in the sewage systems of a number of locations in the south, including Kiryat Gat and Ashdod. This follows the discovery last week [3 Jun 2013] of poliovirus in the Be'er Sheva sewage system, a strain similar to one recently found in Egypt [see prior ProMED-mail posts referenced below].
The Health Ministry believes that all of the traces of poliovirus originate in the Bedouin town of Rahat, after the virus was found in the sewers there at the end of March [2013].
The ministry has not received any reports of individuals contracting polio as a result, but is continuing to pursue its polio vaccination campaign among children and adults in the Negev town of Rahat, in an effort to head off an outbreak.
The presence of poliovirus in Rahat's sewage system is evidence that one or more residents of the town have been excreting the virus at its infectious stage.
Polio has been virtually eradicated in most developed countries through vaccinations.
The disease, which can cause permanent paralysis, is still prevalent in some 3rd world countries. Booster shots are available for those who have been vaccinated but are at risk of exposure.
As part of a national program, babies are vaccinated against the disease at 2, 4, and 6 months of age, at one year, and then again at school in grades 2 and 8.
The type of poliovirus found in Rahat is similar to the polio discovered last year [2012] in Egypt and it was apparently brought to Rahat by someone who had been infected with the disease in Egypt.
Health clinics in the south are being urged to make sure babies are properly vaccinated.
"Hygiene rules should be scrupulously observed, particularly washing one's hands after using the bathroom, before having contact with food, and after changing babies' diapers to avoid contracting the virus," the Health Ministry said.
"There is no [polio] contamination of the water system and no need to boil water in those communities in which polio has been detected in the sewage, and there is no change in policy regarding the communities in the vicinity of Rahat."
This year's [2013] outbreak is not the 1st evidence of the persistence of polio in Israel. Traces of the virus were found in the Tel Aviv area's sewage system most recently in 2005, and led to a program to ensure that children were getting vaccinated.
[byline: Dan Even]
--
communicated by:
ProMED-mail
<promed@promedmail.org>
[Kiryat Gat and Ashdod are both located in the Southern District of Israel to the north and north west of Be'er Sheva and Rahat, where identification of WPV1 in sewage samples was reported earlier (see http://www.ezilon.com/maps/asia/israel-maps.html for a map of Israel showing locations of key cities around the country).
The identification of WPV1 in sewage samples in multiple locations without identification of clinical cases of polio most likely suggests that there is "silent" circulation of WPV1 ongoing in the Southern District of the country, with infection of more than one individual and in more than one location. Achievement of high vaccination levels in these areas should hopefully interrupt the transmission of this WPV and prevent clinical cases of polio.
For the HealthMap/ProMED-mail interactive map of Israel, see http://healthmap.org/r/7it-. - Mod.MPP]
******
[3] Global update: Polio Eradication Initiative
Date: Wed 12 Jun 2013
Source: Global Polio Eradication Initiative [edited]
http://polioeradication.org/Dataandmoni ... sweek.aspx
Global Polio Eradication Initiative update as of 12 Jun 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 55 / 73 / 223
- in endemic countries: 41 / 70 / 217
- in non-endemic countries: 14 / 3 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 14 / 0 / 0 / 14 // 19 / 2 / 1 / 22 / 58 // 19 May 2013
Afghanistan: 2 / 0 / 0 / 2 // 8 / 0 / 0 / 8 / 37 // 28 Mar 2013
Nigeria: 25 / 0 / 0 / 25 // 28 / 12 / 0 / 40 / 122 // 4 May 2013
Somalia: 9 / 0 / 0 / 9 // 0 / 0 / 0 / 0 / 0 // 16 May 2013
Kenya: 5 / 0 / 0 / 5 // 0 / 0 / 0 / 0 / 0 // 18 May 2013
Chad: 0 / 0 / 0 / 0 // 3 / 0 / 0 / 3 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 55 / 0 / 0 / 55 // 58 / 14 / 1 / 73 / 223
Total in endemic countries: 41 / 0 / 0 / 41 // 55 / 14 / 1 / 70 / 217
Total outbreak: 14 / 0 / 0 / 14 // 3 / 0 / 0 / 3 / 6
Data in WHO as of 12 Jun 2012 for 2012 data and 11 Jun 2013 for 2013 data.
Afghanistan
-----------
- No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains 2. The most recent WPV case had onset of paralysis on [28 Mar 2013] (WPV1 from Kunar, Eastern Region).
- No new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
Nigeria
-------
- One new WPV case was reported in the past week (WPV1 from Kano), bringing the total number of WPV cases for 2013 to 25. It is the most recent WPV case in the country and had onset of paralysis on [4 May 2013].
- No new cases of cVDPV2 were reported in the past week. The most recent cVDPV2 case had onset of paralysis on [24 Nov 2012] (from Kebbi).
Pakistan
--------
- 4 new WPV cases were reported in the past week (WPV1s from Federally Administered Tribal Areas - FATA, including 3 from Khyber Agency), bringing the total number of WPV cases for 2013 to 14. One of the newly-reported cases is the most recent WPV case in the country and had onset of paralysis on [19 May 2013].
- One new cVDPV2 case was reported in the past week (from Gadap town, greater Karachi, Sindh), bringing the total number of cVDPV2 cases for 2013 to 5. It is the most recent cVDPV2 case in the country and had onset of paralysis on [8 May 2013].
Chad
----
- No new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac).
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (onset of paralysis on [4 Feb 2013] from Salamat).
Horn of Africa
--------------
- 5 new WPV cases were reported in the past week (2 WPV1s from Somalia and 3 WPV1s from Kenya), bringing the total number of WPV1 cases in the region to 14 (9 WPV1s from Somalia and 5 WPV1s from Kenya). 2 of these new cases are the most recent and had onset of paralysis on [18 May 2013] (both from Kenya).
- Outbreak response activities are continuing across the Horn of Africa.
- In Somalia, 2 large-scale immunization campaigns have already been implemented, including in Banadir (which includes Mogadishu), including targeting children aged less than 10 years. Lessons from these campaigns are now being addressed in preparation of the next rounds starting on [12 Jun 2013]. In Banadir, all age groups are being targeted. Focus is on fine-tuning microplans to include schools, more clearly define vaccinator team daily workloads, improving supervision, and expanding the scope and content of monitoring activities.
- In Kenya, immunization activities began on [26 May 2013] to reach nearly 440 000 children aged less than 15 years across the Dadaab area. Preparations are ongoing for the next SNIDs, on [15 Jun 2013], covering broader areas including all age groups in the Dadaab area. Further campaigns planned for late June and mid-August [2013].
- Immunization campaigns are also planned and being conducted in other areas of the Horn of Africa, notably Ethiopia and Yemen, to urgently boost population immunity levels and minimize the risk of spread of the outbreak.
- In Ethiopia, in border areas with Kenya and Somalia, an immunization activity was held on [31 May 2013] (targeting children aged less than 15 years). Focus was particularly on reaching children in refugee camps. Broader activities are planned to start [16 Jun 2013] and in early July [2013].
- In Yemen, activities were held last week [2-5 Jun 2013] to reach 2.1 million children, with a 2nd round planned for late June [2013] to reach 3.5 million children and NIDs in August [2013].
West Africa
-----------
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
- Multi-country immunization campaigns were conducted on 24-27 May [2013], using trivalent OPV, across West Africa. The activity followed a multi-country campaign at end-April [2013] in Benin, Burkina Faso, Cote d'Ivoire, Guinea, Liberia, Mali, and Sierra Leone, to reach nearly 30 million children under the age of 5 years. Ghana and Togo conducted activities on [1-3 Jun 2013]. Niger will conduct subnational immunization activities on [15-18 Jun 2013] (with bivalent OPV).
[See more at http://www.polioeradication.org/Dataand ... UfDNO.dpuf]
--
communicated by:
ProMED-mail
<promed@promedmail.org>
[The outbreak in Somalia and Kenya has been ongoing since early May 2013. As the most recent dates of onset of paralysis of the confirmed cases to date were in mid-May (16 and 18 May 2013 in Somalia and Kenya respectively), it would not be surprising if there were additional cases identified before the transmission cycle is interrupted with the intensified vaccination activities begun in response to these outbreaks.
The concerns raised about potential spread to other countries in the Horn of Africa are valid, as vaccination levels have not been consistently high. Data from WHO and UNICEF estimates of vaccination coverages in Yemen (revised in 2011) show that during the period 2000 through 2011, OPV3 (3rd dose of oral polio vaccine) levels were about 80 per cent, ranging from a low of 66 per cent in 2003 to a high of 88 per cent in 2010 (see http://www.who.int/immunization_monitoring/data/yem.pdf). In Ethiopia, the OPV3 estimates during the period 2000 to 2011 ranged from a low of 44 per cent in 2003 to a high of 62 per cent in 2011 (see http://www.who.int/immunization_monitoring/data/eth.pdf).
For a map showing the locations of confirmed cases of polio as of 11 Jun 2013, see http://www.polioeradication.org/Dataandmonitoring.aspx. - Mod.MPP]
************************************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
In this update:
[1] Kenya, Somalia
[2] Israel: environmental samples
[3] Global update: Polio Eradication Initiative
******
[1] Kenya, Somalia
Date: Fri 14 Jun 2013
Source: Midnimo [edited]
http://www.midnimo.com/2013/06/14/somal ... s-release/
Somalia: polio outbreak confirmed in Mogadishu and Kenya
--------------------------------------------------------
The 1st confirmed case of the wild poliovirus (WPV1) in Somalia since 2007 has been reported in Mogadishu on [9 May 2013].
Since then, 14 WPV cases have been reported and also 2 WPV cases in Kenya [see comment following this newswire as the total number of cases reported in Somalia and Kenya combined is 14. - Mod.MPP] Experts have warned the outbreak could spread to neighbouring countries and a surveillance alert for polio has been issued to all countries across the Horn of Africa. There is a great risk that the disease can reach Somaliland. Globally, 3 countries remain polio endemic (Nigeria, Pakistan, and Afghanistan). As long as polio exists anywhere in the world, all children are at risk from polio if not vaccinated.
Poliomyelitis (polio) is a highly infectious disease caused by the poliovirus which invades the nervous system, and can cause irreversible paralysis (usually in the legs) or even death in a matter of hours. The poliovirus enters through the mouth, in water or food contaminated with faecal material from an infected person. The virus multiplies in the intestine and is excreted by the infected person in faeces, which can pass on the virus to others.
There is no cure for polio but it can be prevented through giving children several doses of the oral polio vaccine. The vaccine is essential protection for children and we urge all parents, mothers, and caregivers to make sure that their children under the age of 5 are vaccinated now. The vaccine is available at all health centres and will be made available during the National Immunization Days (NIDs) exercise also. The vaccinators will be coming to your house to immunize your children.
Dates for next the National immunization Days (NIDs) in Somaliland:
16-19 Jun 2013
1-4 Jul 2013
18-21 Aug 2013
16-19 Dec 2013
--
communicated by:
ProMED-mail
<promed@promedmail.org>
[According to the most recent figures from the Polio Eradication Initiative (see section [3] below), there have been a total of 14 cases of polio associated with the WPV1 circulating in Somalia and the Dadaab region of Kenya combined, with 9 cases reported in Somalia, and 5 cases reported in Kenya. Clarification of these numbers would be greatly appreciated, as it is always possible that additional cases have been reported since the preparation of the weekly update on the Polio Eradication Initiative website.
For the HealthMap/ProMED-mail interactive map of Somalia, see http://healthmap.org/r/1Ahv; and of Kenya, see http://healthmap.org/r/1r1D. - Mod.MPP]
******
[2] Israel: environmental samples
Date: Thu 13 Jun 2013
Source: Haaretz [edited]
http://www.haaretz.com/news/national/tr ... m-1.529466
Traces of poliovirus found in sewers in Ashdod and other locales in southern Israel
----------------------------------------------------------------------
Traces of poliovirus have been detected in the sewage systems of a number of locations in the south, including Kiryat Gat and Ashdod. This follows the discovery last week [3 Jun 2013] of poliovirus in the Be'er Sheva sewage system, a strain similar to one recently found in Egypt [see prior ProMED-mail posts referenced below].
The Health Ministry believes that all of the traces of poliovirus originate in the Bedouin town of Rahat, after the virus was found in the sewers there at the end of March [2013].
The ministry has not received any reports of individuals contracting polio as a result, but is continuing to pursue its polio vaccination campaign among children and adults in the Negev town of Rahat, in an effort to head off an outbreak.
The presence of poliovirus in Rahat's sewage system is evidence that one or more residents of the town have been excreting the virus at its infectious stage.
Polio has been virtually eradicated in most developed countries through vaccinations.
The disease, which can cause permanent paralysis, is still prevalent in some 3rd world countries. Booster shots are available for those who have been vaccinated but are at risk of exposure.
As part of a national program, babies are vaccinated against the disease at 2, 4, and 6 months of age, at one year, and then again at school in grades 2 and 8.
The type of poliovirus found in Rahat is similar to the polio discovered last year [2012] in Egypt and it was apparently brought to Rahat by someone who had been infected with the disease in Egypt.
Health clinics in the south are being urged to make sure babies are properly vaccinated.
"Hygiene rules should be scrupulously observed, particularly washing one's hands after using the bathroom, before having contact with food, and after changing babies' diapers to avoid contracting the virus," the Health Ministry said.
"There is no [polio] contamination of the water system and no need to boil water in those communities in which polio has been detected in the sewage, and there is no change in policy regarding the communities in the vicinity of Rahat."
This year's [2013] outbreak is not the 1st evidence of the persistence of polio in Israel. Traces of the virus were found in the Tel Aviv area's sewage system most recently in 2005, and led to a program to ensure that children were getting vaccinated.
[byline: Dan Even]
--
communicated by:
ProMED-mail
<promed@promedmail.org>
[Kiryat Gat and Ashdod are both located in the Southern District of Israel to the north and north west of Be'er Sheva and Rahat, where identification of WPV1 in sewage samples was reported earlier (see http://www.ezilon.com/maps/asia/israel-maps.html for a map of Israel showing locations of key cities around the country).
The identification of WPV1 in sewage samples in multiple locations without identification of clinical cases of polio most likely suggests that there is "silent" circulation of WPV1 ongoing in the Southern District of the country, with infection of more than one individual and in more than one location. Achievement of high vaccination levels in these areas should hopefully interrupt the transmission of this WPV and prevent clinical cases of polio.
For the HealthMap/ProMED-mail interactive map of Israel, see http://healthmap.org/r/7it-. - Mod.MPP]
******
[3] Global update: Polio Eradication Initiative
Date: Wed 12 Jun 2013
Source: Global Polio Eradication Initiative [edited]
http://polioeradication.org/Dataandmoni ... sweek.aspx
Global Polio Eradication Initiative update as of 12 Jun 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 55 / 73 / 223
- in endemic countries: 41 / 70 / 217
- in non-endemic countries: 14 / 3 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 14 / 0 / 0 / 14 // 19 / 2 / 1 / 22 / 58 // 19 May 2013
Afghanistan: 2 / 0 / 0 / 2 // 8 / 0 / 0 / 8 / 37 // 28 Mar 2013
Nigeria: 25 / 0 / 0 / 25 // 28 / 12 / 0 / 40 / 122 // 4 May 2013
Somalia: 9 / 0 / 0 / 9 // 0 / 0 / 0 / 0 / 0 // 16 May 2013
Kenya: 5 / 0 / 0 / 5 // 0 / 0 / 0 / 0 / 0 // 18 May 2013
Chad: 0 / 0 / 0 / 0 // 3 / 0 / 0 / 3 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 55 / 0 / 0 / 55 // 58 / 14 / 1 / 73 / 223
Total in endemic countries: 41 / 0 / 0 / 41 // 55 / 14 / 1 / 70 / 217
Total outbreak: 14 / 0 / 0 / 14 // 3 / 0 / 0 / 3 / 6
Data in WHO as of 12 Jun 2012 for 2012 data and 11 Jun 2013 for 2013 data.
Afghanistan
-----------
- No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains 2. The most recent WPV case had onset of paralysis on [28 Mar 2013] (WPV1 from Kunar, Eastern Region).
- No new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
Nigeria
-------
- One new WPV case was reported in the past week (WPV1 from Kano), bringing the total number of WPV cases for 2013 to 25. It is the most recent WPV case in the country and had onset of paralysis on [4 May 2013].
- No new cases of cVDPV2 were reported in the past week. The most recent cVDPV2 case had onset of paralysis on [24 Nov 2012] (from Kebbi).
Pakistan
--------
- 4 new WPV cases were reported in the past week (WPV1s from Federally Administered Tribal Areas - FATA, including 3 from Khyber Agency), bringing the total number of WPV cases for 2013 to 14. One of the newly-reported cases is the most recent WPV case in the country and had onset of paralysis on [19 May 2013].
- One new cVDPV2 case was reported in the past week (from Gadap town, greater Karachi, Sindh), bringing the total number of cVDPV2 cases for 2013 to 5. It is the most recent cVDPV2 case in the country and had onset of paralysis on [8 May 2013].
Chad
----
- No new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac).
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (onset of paralysis on [4 Feb 2013] from Salamat).
Horn of Africa
--------------
- 5 new WPV cases were reported in the past week (2 WPV1s from Somalia and 3 WPV1s from Kenya), bringing the total number of WPV1 cases in the region to 14 (9 WPV1s from Somalia and 5 WPV1s from Kenya). 2 of these new cases are the most recent and had onset of paralysis on [18 May 2013] (both from Kenya).
- Outbreak response activities are continuing across the Horn of Africa.
- In Somalia, 2 large-scale immunization campaigns have already been implemented, including in Banadir (which includes Mogadishu), including targeting children aged less than 10 years. Lessons from these campaigns are now being addressed in preparation of the next rounds starting on [12 Jun 2013]. In Banadir, all age groups are being targeted. Focus is on fine-tuning microplans to include schools, more clearly define vaccinator team daily workloads, improving supervision, and expanding the scope and content of monitoring activities.
- In Kenya, immunization activities began on [26 May 2013] to reach nearly 440 000 children aged less than 15 years across the Dadaab area. Preparations are ongoing for the next SNIDs, on [15 Jun 2013], covering broader areas including all age groups in the Dadaab area. Further campaigns planned for late June and mid-August [2013].
- Immunization campaigns are also planned and being conducted in other areas of the Horn of Africa, notably Ethiopia and Yemen, to urgently boost population immunity levels and minimize the risk of spread of the outbreak.
- In Ethiopia, in border areas with Kenya and Somalia, an immunization activity was held on [31 May 2013] (targeting children aged less than 15 years). Focus was particularly on reaching children in refugee camps. Broader activities are planned to start [16 Jun 2013] and in early July [2013].
- In Yemen, activities were held last week [2-5 Jun 2013] to reach 2.1 million children, with a 2nd round planned for late June [2013] to reach 3.5 million children and NIDs in August [2013].
West Africa
-----------
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
- Multi-country immunization campaigns were conducted on 24-27 May [2013], using trivalent OPV, across West Africa. The activity followed a multi-country campaign at end-April [2013] in Benin, Burkina Faso, Cote d'Ivoire, Guinea, Liberia, Mali, and Sierra Leone, to reach nearly 30 million children under the age of 5 years. Ghana and Togo conducted activities on [1-3 Jun 2013]. Niger will conduct subnational immunization activities on [15-18 Jun 2013] (with bivalent OPV).
[See more at http://www.polioeradication.org/Dataand ... UfDNO.dpuf]
--
communicated by:
ProMED-mail
<promed@promedmail.org>
[The outbreak in Somalia and Kenya has been ongoing since early May 2013. As the most recent dates of onset of paralysis of the confirmed cases to date were in mid-May (16 and 18 May 2013 in Somalia and Kenya respectively), it would not be surprising if there were additional cases identified before the transmission cycle is interrupted with the intensified vaccination activities begun in response to these outbreaks.
The concerns raised about potential spread to other countries in the Horn of Africa are valid, as vaccination levels have not been consistently high. Data from WHO and UNICEF estimates of vaccination coverages in Yemen (revised in 2011) show that during the period 2000 through 2011, OPV3 (3rd dose of oral polio vaccine) levels were about 80 per cent, ranging from a low of 66 per cent in 2003 to a high of 88 per cent in 2010 (see http://www.who.int/immunization_monitoring/data/yem.pdf). In Ethiopia, the OPV3 estimates during the period 2000 to 2011 ranged from a low of 44 per cent in 2003 to a high of 62 per cent in 2011 (see http://www.who.int/immunization_monitoring/data/eth.pdf).
For a map showing the locations of confirmed cases of polio as of 11 Jun 2013, see http://www.polioeradication.org/Dataandmonitoring.aspx. - Mod.MPP]
-
Birgitt
- Moderator
- Beiträge: 35230
- Registriert: Di 2. Aug 2005, 22:52
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- Kontaktdaten:
Kinderlähmung - Poliomyelitis weltweit
POLIOMYELITIS UPDATE (13): KENYA, SOMALIA, PAKISTAN, GLOBAL
***********************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
In this update:
[1] Somalia, Kenya: newswire blog
[2] Global update: Polio Eradication Initiative
******
[1] Somalia, Kenya: newswire blog
Date: Fri 28 Jun 2013
Source: National Public Radio [edited]
A big worry among people trying to wipe out polio is that the virus will regain a foothold, somewhere to launch a comeback -- someplace, perhaps, like Somalia.
Polio has paralyzed 25 children in Somalia and another 6 in a Kenyan refugee camp since early May [2013], the Global Polio Eradication Initiative reported Wednesday [26 Jun 2013]. Before this outbreak, Somalia hadn't had a polio case in more than 5 years.
There were only 223 polio cases around the world in 2012, the lowest ever recorded. Even in the remaining 3 endemic countries -- Afghanistan, Pakistan and Nigeria -- polio was only showing up isolated in a few remote areas.
This outbreak in Somalia could threaten that progress.
The recent cases are probably just the tip of the iceberg, says Sona Bari, from the World Health Organization (WHO). "The last time we saw an outbreak in this part of the world it involved Yemen, most of the countries in the Horn of Africa, Sudan, and led to about 700 cases," Bari says.
Somalia is a tough place to fight polio. It has very low rates of immunization for most diseases, including polio. Vaccination teams can't even enter parts of Somalia because of violence.
Just last week, Islamic extremists launched a suicide attack on the United Nations headquarters in Mogadishu. After a 90-minute gun battle, 22 people at the compound died.
Despite the security problems in Somalia, emergency responses to the polio cases are underway. Local health officials in Somalia have launched 3 massive vaccination drives, Bari says, and Kenya has already carried out 2 special immunization campaigns in the refugee camp.
When outbreaks like these occur, she says, the goal is to break the poliovirus's transmission cycle by trying to get more than 90 percent of the local population vaccinated.
"The virus is looking for children [susceptible individuals] in which it can circulate," Bari says. "The virus can't live out in the sewage or in the environment on its own. So it needs human beings. And it looks for people who are not immune, who are going to allow it to continue transmitting."
This outbreak is still in its early stages, she says. And WHO expects to see more polio cases reported from Somalia in the coming weeks. But, Bari says, polio workers are hopeful that the emergency vaccination campaigns are reaching enough children to slow the spread of the virus.
There have been 77 polio cases reported worldwide so far this year [2013], compared with 84 to this point in 2012. But almost half of this year's [2013] cases have occurred in Somalia and Kenya.
[Byline: Jason Beaubien]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[HealthMap/ProMED-mail maps can be accessed at http://healthmap.org/r/1zkN (Kenya) and http://healthmap.org/r/1Ahv (Somalia).]
******
[2] Global update: Polio Eradication Initiative
Date: Wed 26 Jun 2013
Source: Polio Eradication Initiative [edited]
http://polioeradication.org/Dataandmoni ... sweek.aspx
Global Polio Eradication Initiative update as of 26 Jun 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 77 / 84 / 223
- in endemic countries: 46 / 80 / 217
- in non-endemic countries: 31 / 4 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 17 / 0 / 0 / 17 // 19 / 2 / 1 / 22 / 58 // 6 Jun 2013
Afghanistan: 3 / 0 / 0 / 3 // 10 / 0 / 0 / 10 / 37 // 6 Jun 2013
Nigeria: 26 / 0 / 0 / 26 // 33 / 12 / 0 / 45 / 122 // 18 May 2013
Somalia: 25 / 0 / 0 / 25 // 0 / 0 / 0 / 0 / 0 // 25 May 2013
Kenya: 6 / 0 / 0 / 6 // 0 / 0 / 0 / 0 / 0 // 18 May 2013
Chad: 0 / 0 / 0 / 0 // 4 / 0 / 0 / 4 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 77 / 0 / 0 / 77 // 69 / 14 / 1 / 84 / 223
Total in endemic countries: 46 / 0 / 0 / 46 // 65 / 14 / 1 / 80 / 217
Total outbreak: 31 / 0 / 0 / 31 // 4 / 0 / 0 / 4 / 6
Data in WHO as of 26 Jun 2012 for 2012 data and 25 Jun 2013 for 2013 data.
Afghanistan
-----------
- One new WPV case was reported in the past week (WPV1 from Nangarhar), bringing the total number of WPV cases for 2013 to 3. It is the most recent WPV case in the country and had onset of paralysis on [6 Jun 2013].
- All 3 WPV cases this year [2013] were reported from the Eastern Region. In the traditional high-risk Southern Region, no WPV cases have been reported since November 2012.
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
Nigeria
-------
- No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains 26. The most recent WPV case had onset of paralysis on [18 May 2013] (WPV1 from Bauchi).
- No new cases of cVDPV2 were reported in the past week. The most recent cVDPV2 case had onset of paralysis on [24 Nov 2012] (from Kebbi).
Pakistan
--------
- One new WPV case was reported in the past week (WPV1 from Bara in Khyber Agency, Federally Administered Tribal Areas - FATA), bringing the total number of WPV cases for 2013 to 17. It is the most recent WPV case in the country and had onset of paralysis on [6 Jun 2013].
- Bara is affected by an outbreak of WPV1, with 7 cases now confirmed since end-April [2013]. This outbreak is the major WPV reservoir in all of Asia, and is threatening progress achieved elsewhere in the country and in neighbouring Afghanistan. It is an area where limited vaccination activities have been conducted since 2009, due to hampered access and insecurity.
- In 2011 and 2012, Bara was the epicentre of a major outbreak which also spread to other areas.
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 5. The most recent cVDPV2 case had onset of paralysis on [8 May 2013] (from Gadap town, greater Karachi, Sindh).
Central Africa: Chad and Cameroon
---------------------------------
- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac).
- One new cVDPV2 case was reported in the past week in Chad, bringing the total number of cVDPV2 cases for 2013 to 2. It is the most recent cVDPV2 case in the country and had onset of paralysis on [10 Apr 2013] (from N'Djamena).
- In Cameroon, a cVDPV2 case was also reported from Extreme-Nord (onset of paralysis on [9 May 2013]).
- Genetic sequencing is ongoing to determine the origin of these latest cases, but it is likely that they are linked to the ongoing cVDPV2 outbreak affecting Chad.
Horn of Africa
--------------
- A total of 6 new WPV cases were reported in the past week (WPV1s from Somalia), bringing the total number of WPV1 cases in the region to 31 (25 WPV1s from Somalia and 6 WPV1s from Kenya). The most recent WPV case in the region had onset of paralysis on [23 May 2013] (from Banadir, Somalia).
- The bulk of the newly reported cases are from Banadir, which remains the epicentre of the outbreak.
- Although newly reported cases are increasing, it is important to note that none of these cases represent breakthrough transmission since outbreak response activities began.
- However, of concern is that 2 cases have now been reported from districts in Lower Shabelle region in south-central Somalia where access for supplementary immunization activities (SIAs) has been compromised for the past 3 years. Surveillance in this area, however, remains functional. As many as 500 000 children in this area are at particular risk of polio at the moment. Efforts are ongoing to operate in this area, and vaccinations are continuing at entry and exit points to build up immunity levels.
- In Somalia, the 3rd round of outbreak response campaigns was conducted last week, including in Banadir (which includes Mogadishu), targeting all age groups.
- Anecdotal feedback from the field indicates overall good coverage is being achieved, with strong community participation. The 4th round will start on [1 Jul 2013], again aiming to reach all age groups in Banadir.
- The security situation continues to be evaluated, especially following the deadly attack on the UN compound in Mogadishu last week.
- In Kenya, the 2nd round of outbreak response campaigns was conducted last week. In the Dadaab area, all age groups were targeted. The 3rd round will start on [1 Jul 2013].
- Immunization campaigns are also planned and being conducted in other countries of the Horn of Africa, notably Ethiopia and Yemen, to urgently boost population immunity levels and minimize the risk of spread of the outbreak.
West Africa
-----------
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[There have been 22 new cases reported since the last ProMED-mail update on 14 Jun 2013, raising the global total of confirmed cases from 55 to 77. Sadly, the majority of newly confirmed cases are in countries that had been previously polio free -- Somalia and Kenya. Cases continue to occur in the 3 remaining endemic countries -- Afghanistan, Nigeria and Pakistan, but fortunately at a lower rate.
The concerns about the possibility of expanded outbreaks occurring in other countries where wild poliovirus (WPV) transmission has been interrupted are real concerns. The continued occurrence of circulating vaccine derived poliovirus (cVDPV) cases serves as an indicator of suboptimal vaccination coverage in the areas, and these areas serve as foci where transmission of the WPV can continue.
Unfortunately, the 3 remaining endemic countries for WPV circulation, and Somalia, are all areas with civil unrest and violence against international agency staff as well as local staff working as vaccinators; this definitely hinders vaccination activities and impedes the necessary activities to eliminate the pockets of susceptible individuals.
For a map showing the locations of confirmed WPV cases, see http://www.polioeradication.org/Dataand ... dwide.aspx. - Mod.MPP]
***********************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
In this update:
[1] Somalia, Kenya: newswire blog
[2] Global update: Polio Eradication Initiative
******
[1] Somalia, Kenya: newswire blog
Date: Fri 28 Jun 2013
Source: National Public Radio [edited]
A big worry among people trying to wipe out polio is that the virus will regain a foothold, somewhere to launch a comeback -- someplace, perhaps, like Somalia.
Polio has paralyzed 25 children in Somalia and another 6 in a Kenyan refugee camp since early May [2013], the Global Polio Eradication Initiative reported Wednesday [26 Jun 2013]. Before this outbreak, Somalia hadn't had a polio case in more than 5 years.
There were only 223 polio cases around the world in 2012, the lowest ever recorded. Even in the remaining 3 endemic countries -- Afghanistan, Pakistan and Nigeria -- polio was only showing up isolated in a few remote areas.
This outbreak in Somalia could threaten that progress.
The recent cases are probably just the tip of the iceberg, says Sona Bari, from the World Health Organization (WHO). "The last time we saw an outbreak in this part of the world it involved Yemen, most of the countries in the Horn of Africa, Sudan, and led to about 700 cases," Bari says.
Somalia is a tough place to fight polio. It has very low rates of immunization for most diseases, including polio. Vaccination teams can't even enter parts of Somalia because of violence.
Just last week, Islamic extremists launched a suicide attack on the United Nations headquarters in Mogadishu. After a 90-minute gun battle, 22 people at the compound died.
Despite the security problems in Somalia, emergency responses to the polio cases are underway. Local health officials in Somalia have launched 3 massive vaccination drives, Bari says, and Kenya has already carried out 2 special immunization campaigns in the refugee camp.
When outbreaks like these occur, she says, the goal is to break the poliovirus's transmission cycle by trying to get more than 90 percent of the local population vaccinated.
"The virus is looking for children [susceptible individuals] in which it can circulate," Bari says. "The virus can't live out in the sewage or in the environment on its own. So it needs human beings. And it looks for people who are not immune, who are going to allow it to continue transmitting."
This outbreak is still in its early stages, she says. And WHO expects to see more polio cases reported from Somalia in the coming weeks. But, Bari says, polio workers are hopeful that the emergency vaccination campaigns are reaching enough children to slow the spread of the virus.
There have been 77 polio cases reported worldwide so far this year [2013], compared with 84 to this point in 2012. But almost half of this year's [2013] cases have occurred in Somalia and Kenya.
[Byline: Jason Beaubien]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[HealthMap/ProMED-mail maps can be accessed at http://healthmap.org/r/1zkN (Kenya) and http://healthmap.org/r/1Ahv (Somalia).]
******
[2] Global update: Polio Eradication Initiative
Date: Wed 26 Jun 2013
Source: Polio Eradication Initiative [edited]
http://polioeradication.org/Dataandmoni ... sweek.aspx
Global Polio Eradication Initiative update as of 26 Jun 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 77 / 84 / 223
- in endemic countries: 46 / 80 / 217
- in non-endemic countries: 31 / 4 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 17 / 0 / 0 / 17 // 19 / 2 / 1 / 22 / 58 // 6 Jun 2013
Afghanistan: 3 / 0 / 0 / 3 // 10 / 0 / 0 / 10 / 37 // 6 Jun 2013
Nigeria: 26 / 0 / 0 / 26 // 33 / 12 / 0 / 45 / 122 // 18 May 2013
Somalia: 25 / 0 / 0 / 25 // 0 / 0 / 0 / 0 / 0 // 25 May 2013
Kenya: 6 / 0 / 0 / 6 // 0 / 0 / 0 / 0 / 0 // 18 May 2013
Chad: 0 / 0 / 0 / 0 // 4 / 0 / 0 / 4 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 77 / 0 / 0 / 77 // 69 / 14 / 1 / 84 / 223
Total in endemic countries: 46 / 0 / 0 / 46 // 65 / 14 / 1 / 80 / 217
Total outbreak: 31 / 0 / 0 / 31 // 4 / 0 / 0 / 4 / 6
Data in WHO as of 26 Jun 2012 for 2012 data and 25 Jun 2013 for 2013 data.
Afghanistan
-----------
- One new WPV case was reported in the past week (WPV1 from Nangarhar), bringing the total number of WPV cases for 2013 to 3. It is the most recent WPV case in the country and had onset of paralysis on [6 Jun 2013].
- All 3 WPV cases this year [2013] were reported from the Eastern Region. In the traditional high-risk Southern Region, no WPV cases have been reported since November 2012.
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
Nigeria
-------
- No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains 26. The most recent WPV case had onset of paralysis on [18 May 2013] (WPV1 from Bauchi).
- No new cases of cVDPV2 were reported in the past week. The most recent cVDPV2 case had onset of paralysis on [24 Nov 2012] (from Kebbi).
Pakistan
--------
- One new WPV case was reported in the past week (WPV1 from Bara in Khyber Agency, Federally Administered Tribal Areas - FATA), bringing the total number of WPV cases for 2013 to 17. It is the most recent WPV case in the country and had onset of paralysis on [6 Jun 2013].
- Bara is affected by an outbreak of WPV1, with 7 cases now confirmed since end-April [2013]. This outbreak is the major WPV reservoir in all of Asia, and is threatening progress achieved elsewhere in the country and in neighbouring Afghanistan. It is an area where limited vaccination activities have been conducted since 2009, due to hampered access and insecurity.
- In 2011 and 2012, Bara was the epicentre of a major outbreak which also spread to other areas.
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 5. The most recent cVDPV2 case had onset of paralysis on [8 May 2013] (from Gadap town, greater Karachi, Sindh).
Central Africa: Chad and Cameroon
---------------------------------
- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac).
- One new cVDPV2 case was reported in the past week in Chad, bringing the total number of cVDPV2 cases for 2013 to 2. It is the most recent cVDPV2 case in the country and had onset of paralysis on [10 Apr 2013] (from N'Djamena).
- In Cameroon, a cVDPV2 case was also reported from Extreme-Nord (onset of paralysis on [9 May 2013]).
- Genetic sequencing is ongoing to determine the origin of these latest cases, but it is likely that they are linked to the ongoing cVDPV2 outbreak affecting Chad.
Horn of Africa
--------------
- A total of 6 new WPV cases were reported in the past week (WPV1s from Somalia), bringing the total number of WPV1 cases in the region to 31 (25 WPV1s from Somalia and 6 WPV1s from Kenya). The most recent WPV case in the region had onset of paralysis on [23 May 2013] (from Banadir, Somalia).
- The bulk of the newly reported cases are from Banadir, which remains the epicentre of the outbreak.
- Although newly reported cases are increasing, it is important to note that none of these cases represent breakthrough transmission since outbreak response activities began.
- However, of concern is that 2 cases have now been reported from districts in Lower Shabelle region in south-central Somalia where access for supplementary immunization activities (SIAs) has been compromised for the past 3 years. Surveillance in this area, however, remains functional. As many as 500 000 children in this area are at particular risk of polio at the moment. Efforts are ongoing to operate in this area, and vaccinations are continuing at entry and exit points to build up immunity levels.
- In Somalia, the 3rd round of outbreak response campaigns was conducted last week, including in Banadir (which includes Mogadishu), targeting all age groups.
- Anecdotal feedback from the field indicates overall good coverage is being achieved, with strong community participation. The 4th round will start on [1 Jul 2013], again aiming to reach all age groups in Banadir.
- The security situation continues to be evaluated, especially following the deadly attack on the UN compound in Mogadishu last week.
- In Kenya, the 2nd round of outbreak response campaigns was conducted last week. In the Dadaab area, all age groups were targeted. The 3rd round will start on [1 Jul 2013].
- Immunization campaigns are also planned and being conducted in other countries of the Horn of Africa, notably Ethiopia and Yemen, to urgently boost population immunity levels and minimize the risk of spread of the outbreak.
West Africa
-----------
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[There have been 22 new cases reported since the last ProMED-mail update on 14 Jun 2013, raising the global total of confirmed cases from 55 to 77. Sadly, the majority of newly confirmed cases are in countries that had been previously polio free -- Somalia and Kenya. Cases continue to occur in the 3 remaining endemic countries -- Afghanistan, Nigeria and Pakistan, but fortunately at a lower rate.
The concerns about the possibility of expanded outbreaks occurring in other countries where wild poliovirus (WPV) transmission has been interrupted are real concerns. The continued occurrence of circulating vaccine derived poliovirus (cVDPV) cases serves as an indicator of suboptimal vaccination coverage in the areas, and these areas serve as foci where transmission of the WPV can continue.
Unfortunately, the 3 remaining endemic countries for WPV circulation, and Somalia, are all areas with civil unrest and violence against international agency staff as well as local staff working as vaccinators; this definitely hinders vaccination activities and impedes the necessary activities to eliminate the pockets of susceptible individuals.
For a map showing the locations of confirmed WPV cases, see http://www.polioeradication.org/Dataand ... dwide.aspx. - Mod.MPP]
-
Birgitt
- Moderator
- Beiträge: 35230
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Kinderlähmung - Poliomyelitis weltweit
POLIOMYELITIS UPDATE (14): ISRAEL, ENVIRONMENTAL SAMPLES, GLOBAL
****************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
In this update:
[1] Israel, positive environmental samples: WHO
[2] Israel, positive environmental samples, locations
[3] Israel, positive environmental samples, locations
[4] Global update: Polio Eradication Initiative
******
[1] Israel, positive environmental samples: WHO
Date: Mon 15 Jul 2013
Source: WHO Global Alert and Response [edited]
http://www.who.int/csr/don/2013_07_15/en/index.html
Poliovirus detected from environmental samples in Israel - update 15 Jul 2013
---------------------------------------------------------------------------
Wild poliovirus type 1 (WPV1) has been isolated in 30 sewage samples from 10 sampling sites in Israel. The samples were collected from [3 Feb 2013 to 30 Jun 2013]. Most positive WPV1 samples were detected from southern Israel. All viruses have been detected in sewage only; no cases of paralytic polio have been reported.
Detection of viruses across the country indicates increased geographic extent of circulation for a prolonged period of time. WHO assesses the risk of further international spread of WPV from Israel as moderate to high.
Health authorities in Israel are continuing to conduct a full epidemiological and public health investigation to actively search for potential cases of paralytic polio and any un-immunized persons. Routine immunization coverage is estimated at 94 percent or above over the last 8 years. The frequency of environmental surveillance sampling has been increased. Environmental surveillance is frequently used by countries around the world, including in Israel, to support the detection of diseases of public health importance. Similar activities are being implemented by health authorities in Gaza and West Bank and no WPV has been detected to date from these areas.
The Government of Israel is planning supplementary immunization activities (SIA) with oral polio vaccine (OPV). The objectives of the SIAs with OPV are to boost mucosal immunity levels to rapidly interrupt virus circulation. These SIAs follow efforts initiated at the beginning of June 2013 to catch up with any un- or under-immunized children using inactivated polio vaccine (IPV).
It is important that all countries, in particular those with frequent travel and contacts with polio affected countries, strengthen surveillance for cases of acute flaccid paralysis (AFP), in order to rapidly detect any new poliovirus importations and facilitate a rapid response. Countries should also analyze routine immunization coverage data to identify any subnational gaps in population immunity to guide catch-up immunization activities and thereby minimize the consequences of any new virus introduction. Priority should be given to areas at high-risk of importations and where OPV3 or IPV3/DPT3 vaccine coverage is less than 80 percent.
WHO's International Travel and Health recommends that all travellers to and from polio affected areas be fully vaccinated against polio. Just 3 countries remain endemic for indigenous transmission of WPV: Nigeria, Pakistan and Afghanistan. Additionally, in 2013, the Horn of Africa is affected by an outbreak of WPV.
--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp
[The presence of WPV1 in sewage samples in more than one location over the course of 2 months is highly suggestive of circulation of the WPV1 in the southern region of Israel. The possibility is also there that it represents a traveller who has prolonged excretion of the virus.
For the HealthMap/ProMED map of Israel, see http://healthmap.org/r/1z-1. - Mod.MPP]
******
[2] Israel, positive environmental samples, locations
Date: Fri 12 Jul 2013
Source: Haaretz [edited]
http://www.haaretz.com/news/national/po ... m-1.535338
The poliovirus has continued to spread through sewer systems across Israel, based on widespread sample surveys of sewer systems recently ordered by the Health Ministry.
Still, no polio sufferers have been found, the Health Ministry said, stressing that the virus has been located in sewer systems only.
The survey found the virus in the Ayalon sewer system that handles sewage from the cities of Ramle, Lod and Modi'in and the communities located in the Gezer Regional Council; in the sewer system that handles sewage from the Lev Hasharon Regional Council, including the community of Kalansua; and in the sewage treatment plant that serves the communities of Jaljulia and Kafr Bara. The discovery of the poliovirus in these sewer systems follows the virus' discovery at sewage treatment plants serving Negev communities. The virus was 1st discovered in May [2013] in sewage from the Negev city of Rahat.
All the polioviruses found recently have a similar genetic structure to the strain of the virus found in December 2012 in Egypt, according to the director of Public Health Services in the Health Ministry, Prof. Itamar Grotto. According to Grotto, it is believed that the virus was brought to Israel by a carrier who was infected in Egypt, and has already been transmitted to additional people, although it is impossible to estimate the number of infected.
"It can be assumed that the virus has spread and infected people in the center of the country and the Sharon region," said Grotto. However, he added, it could not be ruled out that the virus was brought to the center of the country by people living in the south who work in the center.
The survey samples from sewer systems across the country have yet to find any polioviruses in Tel Aviv, Haifa, Jerusalem, Ashkelon or Eilat, or in the sewer systems of the central Dan region or of the north.
In recent days, the Health Ministry has increased preparations for a vaccination campaign that will provide an additional polio vaccine to children up to the age of 8 across the south. Currently children are vaccinated with an injection of a dead poliovirus at ages 2 months, 4 months, 6 months and one year, and then in the 2nd grade of school.
The new campaign would administer an additional polio vaccine that contains a weakened live virus in drop form to children up to age 8. Grotto said the final decision to carry out the vaccination campaign will be made based on the results of a fecal sample survey being conducted now by the Health Ministry in Negev communities.
World Health Organization figures show that the poliovirus is considered active in only 5 countries today. In Afghanistan, Pakistan and Nigeria the virus is considered to be "endemic"; in 1988, this description fit 125 countries. Isolated numbers of polio sufferers have also been found, according to the WHO, in Somalia and Kenya since the beginning of this year [2013].
Israel is likely to join these 2 countries should any individuals be diagnosed with polio. The WHO has a goal of eradicating polio worldwide by 2018.
To reduce the risk of contracting polio, the Health Ministry instructs individuals to be meticulous about personal hygiene, particularly washing hands after using the bathroom, before touching food and after changing infants' diapers. The ministry also called for parents to be meticulous about keeping up-to-date with routine vaccinations for their children up to age 6 at well-baby centers across the country.
[Byline: Dan Even]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[All of the new locales where WPV1 has been identified (Ramle, Lod and Modi'in and the communities located in the Gezer Regional Council, Lev Hasharon Regional Council, Jaljulia and Kafr Bara) are located in the Central District of Israel. The earlier report of WPV1 isolates were from environmental samples in the Negev District in the South of Israel (see prior ProMED-mail posts Poliomyelitis update (10): Israel, positive environmental samples, MOH 20130605.1756289, Poliomyelitis update (09): Israel, positive environmental samples, RFI 20130604.1754766, and Poliomyelitis update (08): Israel, environmental isolates, WHO, RFI 20130603.1753099 for more details).
The finding that the WPV1 isolates are similar genetically to those identified in Egypt in December 2012 (see Poliomyelitis - worldwide (01): Egypt ex Pakistan, Niger 20130122.1509210 for more details) is in keeping with continued circulation of the same virus as originally identified in May 2013 in Rahat and Beer Sheeba in the Southern District.
Israel is comprised of 6 main administrative districts: Jerusalem District, Northern District, Haifa District, Central District, Tel Aviv District, and the Southern District.
For more detailed information on the Central District of Israel, the Wikipedia entry provides links to information on the cities, local councils and regional councils http://en.wikipedia.org/wiki/Central_District_(Israel). -Mod.MPP]
******
[3] Israel, positive environmental samples
Date: Thu 11 Jul 2013
Source: Arutz Sheva [edited]
http://www.israelnationalnews.com/News/ ... eAFeTvOuq9
Traces of the poliomyelitis virus are continuing to appear in sewage treatment facilities in southern and central Israel, according to the Health Ministry.
The virus, which can cause paralysis, was once considered eradicated. But nearly one million doses of the "live attenuated" oral vaccine were ordered at a cost of several million shekels after the live virus was 1st detected in February [2013] in routine samples of sewage extracted from Rahat.
Israel is one of only 5 countries in the world that routinely tests stool samples, via 16 sewage treatment plants around the country.
Health Minister Yael German stressed there is "no reason to panic," saying that not even one case of clinical poliomyelitis has appeared thus far.
But the ministry is continuing to monitor and examine stool samples around the country, and traces are continuing to spread. The areas where the virus has been detected include the Lev Hasharon area, Modi'in, Ramle, the Negev Bedouin city of Rahat, Be'er Sheva, Ashdod and Tel Aviv.
According to some experts who testified before the Knesset Health Committee last month [June 2013], some 10 percent of Negev residents have not been inoculated against the virus.
An advanced form of the oral polio vaccine is to be administered to some 150 000 children in the south this month, following last month's visit to Israel by officials from the World Health Organization and the US Centers for Disease Control.
Some rabbis in Jerusalem have begun to announce their recommendation to vaccinate all children under the age of 6.
A total of 5 vaccination stations were opened in Jerusalem for the purpose of distributing polio vaccines to the hareidi-religious population [ultra orthodox], which includes families who choose not to immunize their children at all.
In an alarming development, Knesset member Yisrael Eichler (UTJ) recently charged that many of the well-baby clinics in hareidi-religious neighborhoods around the country have failed to keep up with the high birthrate and to monitor the children's health in these families.
As a result, he warned, thousands of children in the country could be at risk.
[Byline: Hana Levi Julian]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The initial positive environmental samples were in sewage serving Arab communities in the Southern District with the speculation that there was introduction of the virus from a traveler to or from Egypt, where a similar WPV1 was identified in December 2012. Vaccination activities in the Southern District have been increased to raise coverages there and interrupt the apparent "silent" transmission of the WPV1 (in this case the use of the word "silent" means that there have not been clinical cases of polio associated with this circulating virus identified).
While the 2012 reported vaccination coverage with polio vaccine in Israel was 95 percent (according to data available on the WHO website: http://apps.who.int/immunization_monito ... %5B%5D=ISR), concern re: pockets of unvaccinated individuals where the WPV1 could circulate is valid. The above newswire highlights the concerns raised about sub-optimal vaccination coverages in the ultra-orthodox community in Jerusalem. In the past few years, there have been outbreaks of measles and mumps in the ultra-orthodox communities in Israel, the UK and the US (see prior ProMED-mail postings listed below), which serve as evidence of lower coverages with MMR vaccine (measles, mumps and rubella), and possibly suggestive of lower coverages with other vaccines, including the polio vaccine. (This moderator attempted to find information on vaccination coverage by vaccine and administrative division in Israel but was unsuccessful).
In addition to the environmental sampling for WPV1 in sewage, the Ministry of Health of Israel has begun doing stool sampling at mother and infant care centers and HMOs in the Southern District (http://www.health.gov.il/English/News_a ... 013_1.aspx). Results of this sampling will be available in several weeks. It will be interesting to know if WPV1 is detected from individuals, and to learn the vaccination status of the positive individuals. Israel uses the inactivated poliovirus vaccine (IPV) and one wonders if the circulation of the WPV1 is occurring in individuals with a history of 3 or more doses of IPV (see Duintjer Tebbens RJ, Pallansch MA, Chumakov KM, Halsey NA, Hovi T, Minor PD, Modlin JF, Patriarca PA, Sutter RW, Wright PF, Wassilak SG, Cochi SL, Kim JH, Thompson KM. Review and assessment of poliovirus immunity and transmission: synthesis of knowledge gaps and identification of research needs. Risk Anal. 2013 Apr;33(4):606-46. doi: 10.1111/risa.12031. Epub 28 Mar 2013). - Mod.MPP]
******
[4] Global update: Polio Eradication Initiative
Date: Wed 10 Jul 2013
Source: Polio Eradication Initiative [edited]
http://polioeradication.org/Dataandmoni ... sweek.aspx
Global Polio Eradication Initiative update as of 10 Jul 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 108 / 91 / 223
- in endemic countries: 56 / 87 / 217
- in non-endemic countries: 52 / 4 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 18 / 0 / 0 / 18 // 19 / 2 / 1 / 22 / 58 // 6 Jun 2013
Afghanistan: 3 / 0 / 0 / 3 // 10 / 0 / 0 / 10 / 37 // 6 Jun 2013
Nigeria: 35 / 0 / 0 / 35 // 41 / 13 / 0 / 54 / 122 // 18 Jun 2013
Somalia: 45 / 0 / 0 / 45 // 0 / 0 / 0 / 0 / 0 // 8 Jun 2013
Kenya: 7 / 0 / 0 / 7 // 0 / 0 / 0 / 0 / 0 // 3 Jun 2013
Chad: 0 / 0 / 0 / 0 // 4 / 0 / 0 / 4 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 77 / 0 / 0 / 77 // 69 / 14 / 1 / 84 / 223
Total in endemic countries: 56 / 0 / 0 / 56 // 71 / 15 / 1 / 87 / 217
Total outbreak: 52 / 0 / 0 / 52 // 4 / 0 / 0 / 4 / 6
Data in WHO as of 10 Jul 2012 for 2012 data and 9 Jul 2013 for 2013 data.
- In the Horn of Africa, an outbreak of WPV1 is continuing, centred around Banadir, Somalia. The majority of cases associated with this outbreak developed paralysis before the start of the comprehensive emergency outbreak response activities.
- WPV3 continues to be at the lowest ever recorded levels. Globally, WPV3 has not been detected anywhere since November 2012, from Yobe state, Nigeria. In Asia, the strain has not been detected in over a year (since April 2012, from Khyber Agency in Pakistan). With the current historic low levels of WPV3, the world has a unique opportunity to rid itself of the 2nd strain of wild poliovirus (following the last case of WPV2 in 1999).
Afghanistan
-----------
- No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains 3. The most recent WPV case had onset of paralysis on [6 Jun 2013] (WPV1 from Nangarhar).
- All 3 WPV cases this year [2013] were reported from Eastern Region, with links to both WPV1 in 2013 from neighbouring areas of Pakistan and WPV1 in 2012 from Afghanistan. In the high-risk Southern Region, no WPV cases have been reported since November 2012.
- Particular focus will be on immunizing mobile populations and Afghan populations on both sides of the border.
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
Nigeria
-------
- A total of 9 new WPV cases were reported in the past week, bringing the total number of WPV cases for 2013 to 35. The most recent WPV case had onset of paralysis on [18 Jun 2013] (WPV1 from Bauchi).
- No new cases of cVDPV2 were reported in the past week. The most recent cVDPV2 case had onset of paralysis on [24 Nov 2012] (from Kebbi).
Pakistan
--------
- No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains 18. The most recent WPV case in the country had onset of paralysis on [6 Jun 2013] (WPV1 from Bara in Khyber Agency, Federally Administered Tribal Areas - FATA).
- No new cVDVP2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 5. The most recent cVDPV2 case had onset of paralysis on [8 May 2013] (from Gadap town, greater Karachi, Sindh).
- FATA is the major WPV1 reservoir in Pakistan at the moment. Of 18 WPV1 cases reported in the country in 2013, more than half are from FATA. Bara in Khyber Agency is particularly affected. This outbreak is threatening progress achieved elsewhere in the country and in neighbouring Afghanistan.
- In 2011 and 2012, Bara was the epicentre of a major outbreak which also spread to other areas.
Central Africa: Chad and Cameroon
---------------------------------
- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac).
- However, one new cVDPV2 case was reported in the country, with onset of paralysis on [3 May 2013](from Kanem), bringing the total number of cVDPV2 cases for 2013 to 4.
- In Cameroon, no new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (onset of paralysis on [9 May 2013] from Extreme-Nord).
Horn of Africa
--------------
- A total of 4 new WPV cases were reported in the past week (all from Banadir, Somalia), bringing the total number of WPV1 cases in the region to 52 (45 WPV1s from Somalia and 7 WPV1s from Kenya). The most recent case in the region had onset of paralysis on [8 Jun 2013] (from Banadir).
- Banadir remains the epicentre of the outbreak.
- Outbreak response across the Horn of Africa continues to be implemented. In Somalia, campaigns were held on [1-6 Jul 2013]. In Kenya, activities were conducted on [3-7 Jul 2013]. In Ethiopia on [5-8 Jul 2013], and in Yemen the next campaigns are planned for late August [2013].
West Africa
-----------
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[Since the last update (data from 26 Jun 2013), the total number of cases has increased by 31 cases -- from 77 to 108, with 20 additional cases reported in Somalia, 9 cases in Nigeria (all identified in the preceding week), and one case each in Pakistan and Kenya.
Using the reports of cVDPV cases (circulating vaccine derived poliovirus) in a country as an indicator of low vaccination coverages, the occurrence of these cases in Pakistan and Chad in recent months serves as a reminder that pockets of susceptibles still exist in these countries.
For the map of the world showing locations of polio cases, see http://www.polioeradication.org/Dataand ... dwide.aspx. - Mod.MPP]
****************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
In this update:
[1] Israel, positive environmental samples: WHO
[2] Israel, positive environmental samples, locations
[3] Israel, positive environmental samples, locations
[4] Global update: Polio Eradication Initiative
******
[1] Israel, positive environmental samples: WHO
Date: Mon 15 Jul 2013
Source: WHO Global Alert and Response [edited]
http://www.who.int/csr/don/2013_07_15/en/index.html
Poliovirus detected from environmental samples in Israel - update 15 Jul 2013
---------------------------------------------------------------------------
Wild poliovirus type 1 (WPV1) has been isolated in 30 sewage samples from 10 sampling sites in Israel. The samples were collected from [3 Feb 2013 to 30 Jun 2013]. Most positive WPV1 samples were detected from southern Israel. All viruses have been detected in sewage only; no cases of paralytic polio have been reported.
Detection of viruses across the country indicates increased geographic extent of circulation for a prolonged period of time. WHO assesses the risk of further international spread of WPV from Israel as moderate to high.
Health authorities in Israel are continuing to conduct a full epidemiological and public health investigation to actively search for potential cases of paralytic polio and any un-immunized persons. Routine immunization coverage is estimated at 94 percent or above over the last 8 years. The frequency of environmental surveillance sampling has been increased. Environmental surveillance is frequently used by countries around the world, including in Israel, to support the detection of diseases of public health importance. Similar activities are being implemented by health authorities in Gaza and West Bank and no WPV has been detected to date from these areas.
The Government of Israel is planning supplementary immunization activities (SIA) with oral polio vaccine (OPV). The objectives of the SIAs with OPV are to boost mucosal immunity levels to rapidly interrupt virus circulation. These SIAs follow efforts initiated at the beginning of June 2013 to catch up with any un- or under-immunized children using inactivated polio vaccine (IPV).
It is important that all countries, in particular those with frequent travel and contacts with polio affected countries, strengthen surveillance for cases of acute flaccid paralysis (AFP), in order to rapidly detect any new poliovirus importations and facilitate a rapid response. Countries should also analyze routine immunization coverage data to identify any subnational gaps in population immunity to guide catch-up immunization activities and thereby minimize the consequences of any new virus introduction. Priority should be given to areas at high-risk of importations and where OPV3 or IPV3/DPT3 vaccine coverage is less than 80 percent.
WHO's International Travel and Health recommends that all travellers to and from polio affected areas be fully vaccinated against polio. Just 3 countries remain endemic for indigenous transmission of WPV: Nigeria, Pakistan and Afghanistan. Additionally, in 2013, the Horn of Africa is affected by an outbreak of WPV.
--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp
[The presence of WPV1 in sewage samples in more than one location over the course of 2 months is highly suggestive of circulation of the WPV1 in the southern region of Israel. The possibility is also there that it represents a traveller who has prolonged excretion of the virus.
For the HealthMap/ProMED map of Israel, see http://healthmap.org/r/1z-1. - Mod.MPP]
******
[2] Israel, positive environmental samples, locations
Date: Fri 12 Jul 2013
Source: Haaretz [edited]
http://www.haaretz.com/news/national/po ... m-1.535338
The poliovirus has continued to spread through sewer systems across Israel, based on widespread sample surveys of sewer systems recently ordered by the Health Ministry.
Still, no polio sufferers have been found, the Health Ministry said, stressing that the virus has been located in sewer systems only.
The survey found the virus in the Ayalon sewer system that handles sewage from the cities of Ramle, Lod and Modi'in and the communities located in the Gezer Regional Council; in the sewer system that handles sewage from the Lev Hasharon Regional Council, including the community of Kalansua; and in the sewage treatment plant that serves the communities of Jaljulia and Kafr Bara. The discovery of the poliovirus in these sewer systems follows the virus' discovery at sewage treatment plants serving Negev communities. The virus was 1st discovered in May [2013] in sewage from the Negev city of Rahat.
All the polioviruses found recently have a similar genetic structure to the strain of the virus found in December 2012 in Egypt, according to the director of Public Health Services in the Health Ministry, Prof. Itamar Grotto. According to Grotto, it is believed that the virus was brought to Israel by a carrier who was infected in Egypt, and has already been transmitted to additional people, although it is impossible to estimate the number of infected.
"It can be assumed that the virus has spread and infected people in the center of the country and the Sharon region," said Grotto. However, he added, it could not be ruled out that the virus was brought to the center of the country by people living in the south who work in the center.
The survey samples from sewer systems across the country have yet to find any polioviruses in Tel Aviv, Haifa, Jerusalem, Ashkelon or Eilat, or in the sewer systems of the central Dan region or of the north.
In recent days, the Health Ministry has increased preparations for a vaccination campaign that will provide an additional polio vaccine to children up to the age of 8 across the south. Currently children are vaccinated with an injection of a dead poliovirus at ages 2 months, 4 months, 6 months and one year, and then in the 2nd grade of school.
The new campaign would administer an additional polio vaccine that contains a weakened live virus in drop form to children up to age 8. Grotto said the final decision to carry out the vaccination campaign will be made based on the results of a fecal sample survey being conducted now by the Health Ministry in Negev communities.
World Health Organization figures show that the poliovirus is considered active in only 5 countries today. In Afghanistan, Pakistan and Nigeria the virus is considered to be "endemic"; in 1988, this description fit 125 countries. Isolated numbers of polio sufferers have also been found, according to the WHO, in Somalia and Kenya since the beginning of this year [2013].
Israel is likely to join these 2 countries should any individuals be diagnosed with polio. The WHO has a goal of eradicating polio worldwide by 2018.
To reduce the risk of contracting polio, the Health Ministry instructs individuals to be meticulous about personal hygiene, particularly washing hands after using the bathroom, before touching food and after changing infants' diapers. The ministry also called for parents to be meticulous about keeping up-to-date with routine vaccinations for their children up to age 6 at well-baby centers across the country.
[Byline: Dan Even]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[All of the new locales where WPV1 has been identified (Ramle, Lod and Modi'in and the communities located in the Gezer Regional Council, Lev Hasharon Regional Council, Jaljulia and Kafr Bara) are located in the Central District of Israel. The earlier report of WPV1 isolates were from environmental samples in the Negev District in the South of Israel (see prior ProMED-mail posts Poliomyelitis update (10): Israel, positive environmental samples, MOH 20130605.1756289, Poliomyelitis update (09): Israel, positive environmental samples, RFI 20130604.1754766, and Poliomyelitis update (08): Israel, environmental isolates, WHO, RFI 20130603.1753099 for more details).
The finding that the WPV1 isolates are similar genetically to those identified in Egypt in December 2012 (see Poliomyelitis - worldwide (01): Egypt ex Pakistan, Niger 20130122.1509210 for more details) is in keeping with continued circulation of the same virus as originally identified in May 2013 in Rahat and Beer Sheeba in the Southern District.
Israel is comprised of 6 main administrative districts: Jerusalem District, Northern District, Haifa District, Central District, Tel Aviv District, and the Southern District.
For more detailed information on the Central District of Israel, the Wikipedia entry provides links to information on the cities, local councils and regional councils http://en.wikipedia.org/wiki/Central_District_(Israel). -Mod.MPP]
******
[3] Israel, positive environmental samples
Date: Thu 11 Jul 2013
Source: Arutz Sheva [edited]
http://www.israelnationalnews.com/News/ ... eAFeTvOuq9
Traces of the poliomyelitis virus are continuing to appear in sewage treatment facilities in southern and central Israel, according to the Health Ministry.
The virus, which can cause paralysis, was once considered eradicated. But nearly one million doses of the "live attenuated" oral vaccine were ordered at a cost of several million shekels after the live virus was 1st detected in February [2013] in routine samples of sewage extracted from Rahat.
Israel is one of only 5 countries in the world that routinely tests stool samples, via 16 sewage treatment plants around the country.
Health Minister Yael German stressed there is "no reason to panic," saying that not even one case of clinical poliomyelitis has appeared thus far.
But the ministry is continuing to monitor and examine stool samples around the country, and traces are continuing to spread. The areas where the virus has been detected include the Lev Hasharon area, Modi'in, Ramle, the Negev Bedouin city of Rahat, Be'er Sheva, Ashdod and Tel Aviv.
According to some experts who testified before the Knesset Health Committee last month [June 2013], some 10 percent of Negev residents have not been inoculated against the virus.
An advanced form of the oral polio vaccine is to be administered to some 150 000 children in the south this month, following last month's visit to Israel by officials from the World Health Organization and the US Centers for Disease Control.
Some rabbis in Jerusalem have begun to announce their recommendation to vaccinate all children under the age of 6.
A total of 5 vaccination stations were opened in Jerusalem for the purpose of distributing polio vaccines to the hareidi-religious population [ultra orthodox], which includes families who choose not to immunize their children at all.
In an alarming development, Knesset member Yisrael Eichler (UTJ) recently charged that many of the well-baby clinics in hareidi-religious neighborhoods around the country have failed to keep up with the high birthrate and to monitor the children's health in these families.
As a result, he warned, thousands of children in the country could be at risk.
[Byline: Hana Levi Julian]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The initial positive environmental samples were in sewage serving Arab communities in the Southern District with the speculation that there was introduction of the virus from a traveler to or from Egypt, where a similar WPV1 was identified in December 2012. Vaccination activities in the Southern District have been increased to raise coverages there and interrupt the apparent "silent" transmission of the WPV1 (in this case the use of the word "silent" means that there have not been clinical cases of polio associated with this circulating virus identified).
While the 2012 reported vaccination coverage with polio vaccine in Israel was 95 percent (according to data available on the WHO website: http://apps.who.int/immunization_monito ... %5B%5D=ISR), concern re: pockets of unvaccinated individuals where the WPV1 could circulate is valid. The above newswire highlights the concerns raised about sub-optimal vaccination coverages in the ultra-orthodox community in Jerusalem. In the past few years, there have been outbreaks of measles and mumps in the ultra-orthodox communities in Israel, the UK and the US (see prior ProMED-mail postings listed below), which serve as evidence of lower coverages with MMR vaccine (measles, mumps and rubella), and possibly suggestive of lower coverages with other vaccines, including the polio vaccine. (This moderator attempted to find information on vaccination coverage by vaccine and administrative division in Israel but was unsuccessful).
In addition to the environmental sampling for WPV1 in sewage, the Ministry of Health of Israel has begun doing stool sampling at mother and infant care centers and HMOs in the Southern District (http://www.health.gov.il/English/News_a ... 013_1.aspx). Results of this sampling will be available in several weeks. It will be interesting to know if WPV1 is detected from individuals, and to learn the vaccination status of the positive individuals. Israel uses the inactivated poliovirus vaccine (IPV) and one wonders if the circulation of the WPV1 is occurring in individuals with a history of 3 or more doses of IPV (see Duintjer Tebbens RJ, Pallansch MA, Chumakov KM, Halsey NA, Hovi T, Minor PD, Modlin JF, Patriarca PA, Sutter RW, Wright PF, Wassilak SG, Cochi SL, Kim JH, Thompson KM. Review and assessment of poliovirus immunity and transmission: synthesis of knowledge gaps and identification of research needs. Risk Anal. 2013 Apr;33(4):606-46. doi: 10.1111/risa.12031. Epub 28 Mar 2013). - Mod.MPP]
******
[4] Global update: Polio Eradication Initiative
Date: Wed 10 Jul 2013
Source: Polio Eradication Initiative [edited]
http://polioeradication.org/Dataandmoni ... sweek.aspx
Global Polio Eradication Initiative update as of 10 Jul 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 108 / 91 / 223
- in endemic countries: 56 / 87 / 217
- in non-endemic countries: 52 / 4 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 18 / 0 / 0 / 18 // 19 / 2 / 1 / 22 / 58 // 6 Jun 2013
Afghanistan: 3 / 0 / 0 / 3 // 10 / 0 / 0 / 10 / 37 // 6 Jun 2013
Nigeria: 35 / 0 / 0 / 35 // 41 / 13 / 0 / 54 / 122 // 18 Jun 2013
Somalia: 45 / 0 / 0 / 45 // 0 / 0 / 0 / 0 / 0 // 8 Jun 2013
Kenya: 7 / 0 / 0 / 7 // 0 / 0 / 0 / 0 / 0 // 3 Jun 2013
Chad: 0 / 0 / 0 / 0 // 4 / 0 / 0 / 4 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 77 / 0 / 0 / 77 // 69 / 14 / 1 / 84 / 223
Total in endemic countries: 56 / 0 / 0 / 56 // 71 / 15 / 1 / 87 / 217
Total outbreak: 52 / 0 / 0 / 52 // 4 / 0 / 0 / 4 / 6
Data in WHO as of 10 Jul 2012 for 2012 data and 9 Jul 2013 for 2013 data.
- In the Horn of Africa, an outbreak of WPV1 is continuing, centred around Banadir, Somalia. The majority of cases associated with this outbreak developed paralysis before the start of the comprehensive emergency outbreak response activities.
- WPV3 continues to be at the lowest ever recorded levels. Globally, WPV3 has not been detected anywhere since November 2012, from Yobe state, Nigeria. In Asia, the strain has not been detected in over a year (since April 2012, from Khyber Agency in Pakistan). With the current historic low levels of WPV3, the world has a unique opportunity to rid itself of the 2nd strain of wild poliovirus (following the last case of WPV2 in 1999).
Afghanistan
-----------
- No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains 3. The most recent WPV case had onset of paralysis on [6 Jun 2013] (WPV1 from Nangarhar).
- All 3 WPV cases this year [2013] were reported from Eastern Region, with links to both WPV1 in 2013 from neighbouring areas of Pakistan and WPV1 in 2012 from Afghanistan. In the high-risk Southern Region, no WPV cases have been reported since November 2012.
- Particular focus will be on immunizing mobile populations and Afghan populations on both sides of the border.
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
Nigeria
-------
- A total of 9 new WPV cases were reported in the past week, bringing the total number of WPV cases for 2013 to 35. The most recent WPV case had onset of paralysis on [18 Jun 2013] (WPV1 from Bauchi).
- No new cases of cVDPV2 were reported in the past week. The most recent cVDPV2 case had onset of paralysis on [24 Nov 2012] (from Kebbi).
Pakistan
--------
- No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains 18. The most recent WPV case in the country had onset of paralysis on [6 Jun 2013] (WPV1 from Bara in Khyber Agency, Federally Administered Tribal Areas - FATA).
- No new cVDVP2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 5. The most recent cVDPV2 case had onset of paralysis on [8 May 2013] (from Gadap town, greater Karachi, Sindh).
- FATA is the major WPV1 reservoir in Pakistan at the moment. Of 18 WPV1 cases reported in the country in 2013, more than half are from FATA. Bara in Khyber Agency is particularly affected. This outbreak is threatening progress achieved elsewhere in the country and in neighbouring Afghanistan.
- In 2011 and 2012, Bara was the epicentre of a major outbreak which also spread to other areas.
Central Africa: Chad and Cameroon
---------------------------------
- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac).
- However, one new cVDPV2 case was reported in the country, with onset of paralysis on [3 May 2013](from Kanem), bringing the total number of cVDPV2 cases for 2013 to 4.
- In Cameroon, no new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (onset of paralysis on [9 May 2013] from Extreme-Nord).
Horn of Africa
--------------
- A total of 4 new WPV cases were reported in the past week (all from Banadir, Somalia), bringing the total number of WPV1 cases in the region to 52 (45 WPV1s from Somalia and 7 WPV1s from Kenya). The most recent case in the region had onset of paralysis on [8 Jun 2013] (from Banadir).
- Banadir remains the epicentre of the outbreak.
- Outbreak response across the Horn of Africa continues to be implemented. In Somalia, campaigns were held on [1-6 Jul 2013]. In Kenya, activities were conducted on [3-7 Jul 2013]. In Ethiopia on [5-8 Jul 2013], and in Yemen the next campaigns are planned for late August [2013].
West Africa
-----------
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[Since the last update (data from 26 Jun 2013), the total number of cases has increased by 31 cases -- from 77 to 108, with 20 additional cases reported in Somalia, 9 cases in Nigeria (all identified in the preceding week), and one case each in Pakistan and Kenya.
Using the reports of cVDPV cases (circulating vaccine derived poliovirus) in a country as an indicator of low vaccination coverages, the occurrence of these cases in Pakistan and Chad in recent months serves as a reminder that pockets of susceptibles still exist in these countries.
For the map of the world showing locations of polio cases, see http://www.polioeradication.org/Dataand ... dwide.aspx. - Mod.MPP]
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Kinderlähmung - Poliomyelitis weltweit
POLIOMYELITIS UPDATE (15): SOMALIA, KENYA, GLOBAL
*************************************************
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In this update:
[1] Somalia, Kenya
[2] Global update - Polio Eradication Initiative
******
[1] Somalia
Date: 22 Jul 2013
Source: NPR (National Public Radio) [edited]
Somalia hadn't had a case of polio for nearly 6 years. But in the past few months, the virus has come back. Now the East African country has the worst polio outbreak anywhere in the world.
20 new cases of polio were reported this week in Somalia by the Global Polio Eradication Initiative. That brings the total number of cases in the Horn of Africa to 73. The rest of the world combined has tallied only 59 cases so far this year [2013].
Health workers are worried that the virus could gain a foothold in the Horn of Africa and jeopardize the multibillion-dollar effort to wipe out the virus worldwide. The last time polio struck Somalia, the virus spread across the Horn of Africa into Yemen and eventually over into Southeast Asia.
Until this recent outbreak, global efforts to eradicate polio appeared to be making remarkable progress. Last year [2012], the number of children paralyzed by polio hit a record low at 223. This year [2013], it was looking like there were going to be even fewer cases. The last significant pockets of the virus appeared to be isolated in Afghanistan, Pakistan and Nigeria. Then in May [2013], a 2 year old girl in Mogadishu became the 1st confirmed case of polio in Somalia in more than 6 years.
The number of polio cases in Somalia is increasing by the day, says Dr Nasir Yusuf, who leads UNICEF's immunization efforts in eastern and southern Africa. Part of the problem, he says, is that the majority of children in Somalia have never been immunized against polio. "We have an outbreak in a population that has been quite vulnerable for quite some time," Yusuf says. Somalia has the 2nd worst rate of polio vaccination in the world after Equatorial Guinea, according to the World Health Organization.
In response to the current outbreak, there have been 5 emergency polio immunization campaigns in Somalia since May [2013]. The Somali government directs the campaigns, but it doesn't control or have access to vast swaths of the country. Some of the most recent polio cases have occurred in areas that are considered off limits to vaccination teams.
Underscoring the lack of security in the region even for health workers, 2 health workers with Medecins Sans Frontieres [Doctors Without Borders] were freed this week after having been held hostage in Somalia for almost 2 years. The women had been working in the Dadaab refugee camp in Kenya, where 8 new polio cases were reported in May [2013].
The current outbreak is forcing governments throughout the region, including parts of the Middle East, to launch supplemental vaccination drives, Yusuf says, because polio is capable of spreading quickly. "A week after the virus was reported in south central Somalia, one of the viruses got into the Somali refugee camp in the most eastern part of Kenya," he says. "So that tells you how fast this virus made it."
Editor's note:
According to WHO, the 1st polio case in the outbreak actually occurred [30 Apr 2013], in Kenya. Then the 2nd case was confirmed [9 May 2013] in Somalia. Either way, the outbreak spanned a vast geographic area quickly.
The virus reproduces inside the human gut, and many people carry it but show no symptoms. This give the virus the opportunity to travel long distances inside people and then get shed into the environment through feces. WHO traced the poliovirus in Somalia to one in West Africa. Nigeria is the only place there where polio is still endemic.
Before these cases in the Horn of Africa, the end of the multibillion-dollar effort appeared to be in sight. The Somali outbreak is now forcing UNICEF, WHO and other international agencies to dedicate vast resources to boost polio vaccination coverage throughout East Africa and parts of the Middle East. Those are resources that can't be used to attack the virus in Afghanistan, Pakistan and Nigeria, which appeared, until now, to be the last few places where polio had a foothold.
[byline: Jason Beaubien]
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[2] Global update - Polio Eradication Initiative
Date: 18 Jul 2013
Source: Polio Eradication Initiative [edited]
http://www.polioeradication.org/Dataand ... sweek.aspx
Global Polio Eradication Initiative update as of 10 Jul 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 132 / 96 / 223
- in endemic countries: 59 / 91 / 217
- in non-endemic countries: 73 / 5 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 21 / 0 / 0 / 21 // 20 / 2 / 1 / 23 / 58 // 6 Jun 2013
Afghanistan: 3 / 0 / 0 / 3 // 13 / 0 / 0 / 13 / 37 // 6 Jun 2013
Nigeria: 35 / 0 / 0 / 35 // 42 / 13 / 0 / 55 / 122 // 18 Jun 2013
Somalia: 65 / 0 / 0 / 65 // 0 / 0 / 0 / 0 / 0 // 12 Jun 2013
Kenya: 8 / 0 / 0 / 8 // 0 / 0 / 0 / 0 / 0 // 14 Jun 2013
Chad: 0 / 0 / 0 / 0 // 5 / 0 / 0 / 5 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 132 / 0 / 0 / 132 // 80 / 15 / 1 / 96 / 223
Total in endemic countries: 59 / 0 / 0 / 59 // 75 / 15 / 1 / 91 / 217
Total outbreak: 73 / 0 / 0 / 73 // 5 / 0 / 0 / 5 / 6
Data in WHO as of 17 Jul 2012 for 2012 data and 16 Jul 2013 for 2013 data.
Highlights: Polio this week - As of 17 Jul 2013
- The outbreak in the Horn of Africa is expanding, with 21 newly-reported cases (one from Kenya, 20 from Somalia). In Somalia, 2 immunization campaigns have been conducted since the most recent case occurred. Outbreak response activities are continuing, and planning and approaches continue to be strengthened.
- Update on WPV in environmental samples in Israel: WPV1 has now been isolated in 30 sewage samples from 10 sampling sites in Israel. The samples were collected between February and June 2013. All viruses have been detected in sewage only; no cases of paralytic polio have been reported. Health authorities in Israel are continuing to conduct a full epidemiological and public health investigation. The Government of Israel is planning supplementary immunization activities (SIAs) with OPV to boost mucosal immunity levels to rapidly interrupt virus circulation.
Afghanistan
- No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains 3. The most recent WPV case had onset of paralysis on [6 Jun 2013] (WPV1 from Nangarhar).
- All 3 WPV cases this year [2013] were reported from the Eastern Region, with links to both WPV1 in 2013 from neighbouring areas of Pakistan and WPV1 in 2012 from Afghanistan. In the high-risk Southern Region, no WPV cases have been reported since November 2012.
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
Nigeria
- No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains 35. The most recent WPV case had onset of paralysis on [18 Jun 2013] (WPV1 from Bauchi).
- No new cases of cVDPV2 were reported in the past week. The most recent cVDPV2 case had onset of paralysis on [24 Nov 2012] (from Kebbi).
Pakistan
- Three new WPV cases were reported in the past week (WPV1s from Khyber Agency and North Waziristan, Federally Administered Tribal Areas - FATA, and in Peshawar, Khyber Pakhtunkhwa - KP), bringing the total number of WPV cases for 2013 to 21. The case from Peshawar is the most recent WPV in the country, and had onset of paralysis on [30 Jun 2013].
- No new cVDVP2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 5. The most recent cVDPV2 case had onset of paralysis on [8 May 2013] (from Gadap town, greater Karachi, Sindh).
- FATA is the major WPV1 reservoir in Pakistan at the moment. Bara in Khyber Agency is particularly affected. This outbreak is threatening progress achieved elsewhere in the country and in neighbouring Afghanistan.
- In 2011 and 2012, Bara was the epicentre of a major outbreak which also spread to other areas.
- The new case in North Waziristan is particularly concerning, as it is in an area where immunizations have been suspended by local leaders since last June [2012]. 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. North Waziristan is also affected by cVDPV2 cases.
- Confirmation of these latest cases underscores the risk ongoing polio transmission (be it due to WPV or cVDPV) in the country continues to pose to children everywhere, and in particular to children living in areas where access has not been possible for extended periods of time.
Central Africa: Chad and Cameroon
- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac). No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 4 (the most recent cVDPV2 case had onset of paralysis on [12 May 2013] from Ennedi).
- In Cameroon, one new cVDPV2 case was reported in the past week, bringing the total number of cVDPV2 cases for 2013 to 2. This latest case had onset of paralysis on [27 May 2013], from Extreme-Nord. The 1st case had onset of paralysis on [9 May 2013], also from Extreme-Nord.
Horn of Africa
- 21 new WPV1 cases were reported in the past week (one from Dadaab, Kenya, and 20 from Somalia), bringing the total number of WPV1 cases in the region to 73 (65 WPV1s from Somalia and 8 WPV1s from Kenya). The most recent case in the region had onset of paralysis on [14 Jun 2013] (the newly-reported case from Kenya).
- In Somalia, 2 immunization campaigns have been conducted since the most recent case occurred.
- Some of the new cases are from inaccessible areas of south-central Somalia. More than 600 000 children are particularly vulnerable to polio in this area. Vaccination posts are being set up in areas bordering inaccessible areas to immunize all populations entering/leaving such areas (including targeting older age groups). Assessments of high-risk areas and populations continue to be conducted, including mapping chronic conflict-areas and major population movement routes. Local-level access negotiations have intensified to increase access to populations in inaccessible areas.
- Outbreak response across the Horn of Africa continues to be implemented. In Somalia, campaigns were held on [1-6 Jul 2013]. Planning is underway for NIDs during Ramadan on [21-24 Jul 2013]. Specific radio messages are being developed with the involvement of the Ministry of Religious Affairs.
- In Kenya, activities were conducted on [1-10 Jul 2013], with the next campaigns planned for August [2013]. In Ethiopia, activities were held on [5-9 Jul 2013] to be followed by the next round in August [2013]. In Yemen, the next campaigns are planned for late August [2013].
West Africa
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
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[Since the last update (data from 10 Jul 2013), the total number of cases has increased by 24 cases, from 108 to 132, with 20 additional cases reported in Somalia, 3 cases in Afghanistan (all identified in the preceding week), and one case in Kenya. Of concern is the number of newly identified cases in Somalia, 20 in the past week, and 20 in the week preceding (see prior ProMED-mail post Poliomyelitis update (14): Israel, environmental samples, global 20130715.1826123). The fact that these cases have occurred in areas that are not accessible (due to security risks) is of significant concern, as it hinders effective control measures now as well as prevention of future outbreaks and ultimate interruption of WPV circulation in the area.
The continued occurrence of CVDPV cases (circulating vaccine derived poliovirus), most recently in Cameroon, is an indicator of low vaccination coverages, and highlights concerns regarding the risk of introduction of WPV into countries where there are cVDPV cases.
For a map of the world showing locations of polio cases, see http://www.polioeradication.org/Dataand ... dwide.aspx. - Mod.MPP]
*************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
In this update:
[1] Somalia, Kenya
[2] Global update - Polio Eradication Initiative
******
[1] Somalia
Date: 22 Jul 2013
Source: NPR (National Public Radio) [edited]
Somalia hadn't had a case of polio for nearly 6 years. But in the past few months, the virus has come back. Now the East African country has the worst polio outbreak anywhere in the world.
20 new cases of polio were reported this week in Somalia by the Global Polio Eradication Initiative. That brings the total number of cases in the Horn of Africa to 73. The rest of the world combined has tallied only 59 cases so far this year [2013].
Health workers are worried that the virus could gain a foothold in the Horn of Africa and jeopardize the multibillion-dollar effort to wipe out the virus worldwide. The last time polio struck Somalia, the virus spread across the Horn of Africa into Yemen and eventually over into Southeast Asia.
Until this recent outbreak, global efforts to eradicate polio appeared to be making remarkable progress. Last year [2012], the number of children paralyzed by polio hit a record low at 223. This year [2013], it was looking like there were going to be even fewer cases. The last significant pockets of the virus appeared to be isolated in Afghanistan, Pakistan and Nigeria. Then in May [2013], a 2 year old girl in Mogadishu became the 1st confirmed case of polio in Somalia in more than 6 years.
The number of polio cases in Somalia is increasing by the day, says Dr Nasir Yusuf, who leads UNICEF's immunization efforts in eastern and southern Africa. Part of the problem, he says, is that the majority of children in Somalia have never been immunized against polio. "We have an outbreak in a population that has been quite vulnerable for quite some time," Yusuf says. Somalia has the 2nd worst rate of polio vaccination in the world after Equatorial Guinea, according to the World Health Organization.
In response to the current outbreak, there have been 5 emergency polio immunization campaigns in Somalia since May [2013]. The Somali government directs the campaigns, but it doesn't control or have access to vast swaths of the country. Some of the most recent polio cases have occurred in areas that are considered off limits to vaccination teams.
Underscoring the lack of security in the region even for health workers, 2 health workers with Medecins Sans Frontieres [Doctors Without Borders] were freed this week after having been held hostage in Somalia for almost 2 years. The women had been working in the Dadaab refugee camp in Kenya, where 8 new polio cases were reported in May [2013].
The current outbreak is forcing governments throughout the region, including parts of the Middle East, to launch supplemental vaccination drives, Yusuf says, because polio is capable of spreading quickly. "A week after the virus was reported in south central Somalia, one of the viruses got into the Somali refugee camp in the most eastern part of Kenya," he says. "So that tells you how fast this virus made it."
Editor's note:
According to WHO, the 1st polio case in the outbreak actually occurred [30 Apr 2013], in Kenya. Then the 2nd case was confirmed [9 May 2013] in Somalia. Either way, the outbreak spanned a vast geographic area quickly.
The virus reproduces inside the human gut, and many people carry it but show no symptoms. This give the virus the opportunity to travel long distances inside people and then get shed into the environment through feces. WHO traced the poliovirus in Somalia to one in West Africa. Nigeria is the only place there where polio is still endemic.
Before these cases in the Horn of Africa, the end of the multibillion-dollar effort appeared to be in sight. The Somali outbreak is now forcing UNICEF, WHO and other international agencies to dedicate vast resources to boost polio vaccination coverage throughout East Africa and parts of the Middle East. Those are resources that can't be used to attack the virus in Afghanistan, Pakistan and Nigeria, which appeared, until now, to be the last few places where polio had a foothold.
[byline: Jason Beaubien]
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******
[2] Global update - Polio Eradication Initiative
Date: 18 Jul 2013
Source: Polio Eradication Initiative [edited]
http://www.polioeradication.org/Dataand ... sweek.aspx
Global Polio Eradication Initiative update as of 10 Jul 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 132 / 96 / 223
- in endemic countries: 59 / 91 / 217
- in non-endemic countries: 73 / 5 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 21 / 0 / 0 / 21 // 20 / 2 / 1 / 23 / 58 // 6 Jun 2013
Afghanistan: 3 / 0 / 0 / 3 // 13 / 0 / 0 / 13 / 37 // 6 Jun 2013
Nigeria: 35 / 0 / 0 / 35 // 42 / 13 / 0 / 55 / 122 // 18 Jun 2013
Somalia: 65 / 0 / 0 / 65 // 0 / 0 / 0 / 0 / 0 // 12 Jun 2013
Kenya: 8 / 0 / 0 / 8 // 0 / 0 / 0 / 0 / 0 // 14 Jun 2013
Chad: 0 / 0 / 0 / 0 // 5 / 0 / 0 / 5 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 132 / 0 / 0 / 132 // 80 / 15 / 1 / 96 / 223
Total in endemic countries: 59 / 0 / 0 / 59 // 75 / 15 / 1 / 91 / 217
Total outbreak: 73 / 0 / 0 / 73 // 5 / 0 / 0 / 5 / 6
Data in WHO as of 17 Jul 2012 for 2012 data and 16 Jul 2013 for 2013 data.
Highlights: Polio this week - As of 17 Jul 2013
- The outbreak in the Horn of Africa is expanding, with 21 newly-reported cases (one from Kenya, 20 from Somalia). In Somalia, 2 immunization campaigns have been conducted since the most recent case occurred. Outbreak response activities are continuing, and planning and approaches continue to be strengthened.
- Update on WPV in environmental samples in Israel: WPV1 has now been isolated in 30 sewage samples from 10 sampling sites in Israel. The samples were collected between February and June 2013. All viruses have been detected in sewage only; no cases of paralytic polio have been reported. Health authorities in Israel are continuing to conduct a full epidemiological and public health investigation. The Government of Israel is planning supplementary immunization activities (SIAs) with OPV to boost mucosal immunity levels to rapidly interrupt virus circulation.
Afghanistan
- No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains 3. The most recent WPV case had onset of paralysis on [6 Jun 2013] (WPV1 from Nangarhar).
- All 3 WPV cases this year [2013] were reported from the Eastern Region, with links to both WPV1 in 2013 from neighbouring areas of Pakistan and WPV1 in 2012 from Afghanistan. In the high-risk Southern Region, no WPV cases have been reported since November 2012.
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
Nigeria
- No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains 35. The most recent WPV case had onset of paralysis on [18 Jun 2013] (WPV1 from Bauchi).
- No new cases of cVDPV2 were reported in the past week. The most recent cVDPV2 case had onset of paralysis on [24 Nov 2012] (from Kebbi).
Pakistan
- Three new WPV cases were reported in the past week (WPV1s from Khyber Agency and North Waziristan, Federally Administered Tribal Areas - FATA, and in Peshawar, Khyber Pakhtunkhwa - KP), bringing the total number of WPV cases for 2013 to 21. The case from Peshawar is the most recent WPV in the country, and had onset of paralysis on [30 Jun 2013].
- No new cVDVP2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 5. The most recent cVDPV2 case had onset of paralysis on [8 May 2013] (from Gadap town, greater Karachi, Sindh).
- FATA is the major WPV1 reservoir in Pakistan at the moment. Bara in Khyber Agency is particularly affected. This outbreak is threatening progress achieved elsewhere in the country and in neighbouring Afghanistan.
- In 2011 and 2012, Bara was the epicentre of a major outbreak which also spread to other areas.
- The new case in North Waziristan is particularly concerning, as it is in an area where immunizations have been suspended by local leaders since last June [2012]. 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. North Waziristan is also affected by cVDPV2 cases.
- Confirmation of these latest cases underscores the risk ongoing polio transmission (be it due to WPV or cVDPV) in the country continues to pose to children everywhere, and in particular to children living in areas where access has not been possible for extended periods of time.
Central Africa: Chad and Cameroon
- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac). No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 4 (the most recent cVDPV2 case had onset of paralysis on [12 May 2013] from Ennedi).
- In Cameroon, one new cVDPV2 case was reported in the past week, bringing the total number of cVDPV2 cases for 2013 to 2. This latest case had onset of paralysis on [27 May 2013], from Extreme-Nord. The 1st case had onset of paralysis on [9 May 2013], also from Extreme-Nord.
Horn of Africa
- 21 new WPV1 cases were reported in the past week (one from Dadaab, Kenya, and 20 from Somalia), bringing the total number of WPV1 cases in the region to 73 (65 WPV1s from Somalia and 8 WPV1s from Kenya). The most recent case in the region had onset of paralysis on [14 Jun 2013] (the newly-reported case from Kenya).
- In Somalia, 2 immunization campaigns have been conducted since the most recent case occurred.
- Some of the new cases are from inaccessible areas of south-central Somalia. More than 600 000 children are particularly vulnerable to polio in this area. Vaccination posts are being set up in areas bordering inaccessible areas to immunize all populations entering/leaving such areas (including targeting older age groups). Assessments of high-risk areas and populations continue to be conducted, including mapping chronic conflict-areas and major population movement routes. Local-level access negotiations have intensified to increase access to populations in inaccessible areas.
- Outbreak response across the Horn of Africa continues to be implemented. In Somalia, campaigns were held on [1-6 Jul 2013]. Planning is underway for NIDs during Ramadan on [21-24 Jul 2013]. Specific radio messages are being developed with the involvement of the Ministry of Religious Affairs.
- In Kenya, activities were conducted on [1-10 Jul 2013], with the next campaigns planned for August [2013]. In Ethiopia, activities were held on [5-9 Jul 2013] to be followed by the next round in August [2013]. In Yemen, the next campaigns are planned for late August [2013].
West Africa
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
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[Since the last update (data from 10 Jul 2013), the total number of cases has increased by 24 cases, from 108 to 132, with 20 additional cases reported in Somalia, 3 cases in Afghanistan (all identified in the preceding week), and one case in Kenya. Of concern is the number of newly identified cases in Somalia, 20 in the past week, and 20 in the week preceding (see prior ProMED-mail post Poliomyelitis update (14): Israel, environmental samples, global 20130715.1826123). The fact that these cases have occurred in areas that are not accessible (due to security risks) is of significant concern, as it hinders effective control measures now as well as prevention of future outbreaks and ultimate interruption of WPV circulation in the area.
The continued occurrence of CVDPV cases (circulating vaccine derived poliovirus), most recently in Cameroon, is an indicator of low vaccination coverages, and highlights concerns regarding the risk of introduction of WPV into countries where there are cVDPV cases.
For a map of the world showing locations of polio cases, see http://www.polioeradication.org/Dataand ... dwide.aspx. - Mod.MPP]
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Birgitt
- Moderator
- Beiträge: 35230
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Kinderlähmung - Poliomyelitis weltweit
POLIOMYELITIS UPDATE (16): ISRAEL, SOMALIA, GLOBAL
**************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
In this update:
[1] Israel - asymptomatic carriers
[2] Israel - suspected cases, RFI
[3] Somalia
[4] India - 4th case of VDPV
[5] Global update - Polio Eradication Initiative
******
[1] Israel - asymptomatic carriers
Date: 31 Jul 2013
Source: Haaretz [edited]
http://www.haaretz.com/news/national/
The Health Ministry is preparing for a campaign to inoculate children in the south of Israel with a live attenuated vaccine against polio, in light of the continued spread of the disease through the region's sewage systems. However, a final decision will only be made this weekend and announced on Sunday [4 Aug 2013].
The new inoculations would be on top of the regular polio shots given to all children at 2 months, 4 months, 6 months and 12 months, and then again in 2nd grade. Those shots contain the dead polio virus.
As Haaretz reported 3 weeks ago, any decision to revaccinate children with a live-virus vaccine involves an ethical dilemma, since the goal isn't to protect the children themselves, as they are already protected by the dead-virus vaccine. Rather, the goal would be to protect those around them, and especially their parents and other relatives. The live attenuated virus will commonly spread to other people, and thus inoculate them as well.
Revaccination involves virtually no risk that the children themselves will contract polio, with only one known case of a child who contracted polio from a live-virus vaccine after previously being inoculated with the dead-virus version.
Until 2005, Israel regularly vaccinated children with the live attenuated virus, which is administered orally. But in exceptional cases, the live attenuated virus can cause polio in other people who contract it from the inoculated child, especially if they already have weakened immune systems, for instance because they are seriously ill.
This is why the Health Ministry ultimately stopped the practice, and one reason why it is still weighing the benefits of a new inoculation campaign.
To reduce the potential risks, the ministry has ordered drops containing only 2 strains of attenuated polio virus, rather than the 3 contained in the drops used until 2005.
The ministry said it is currently consulting with leading experts in the field, including senior pediatricians and family doctors, as well as public figures and officials from the affected municipalities, on whether to launch the campaign.
Meanwhile, it is continuing to collect stool samples from residents of the south in order to assess the spread of the disease. Thus far, it has collected 2300 samples, from which it has identified 7 Israelis who definitely carry the virus and 10 suspected carriers. However, none of them have come down with active polio.
Israel hasn't had an active polio case since 1988, when 15 people came down with the disease, mostly in Hadera and Or Akiva. All suffered some degree of paralysis.
The current polio outbreak began in late May [2013]. The virus was 1st detected in the sewers of the Bedouin town of Rahat in the Negev. It later spread to the sewage systems of several other southern towns, including Be'er Sheva and Ashdod.
Over the past month [July 2013], it has also spread to several towns in central Israel, including Ramle, Lod and Modi'in. The Health Ministry thinks the disease arrived from Egypt.
The ministry believes that the fact no active polio cases have yet occurred despite the spread of the disease is because such a high percentage of the population has been vaccinated against polio, an estimated 94 to 95 percent.
Worldwide, only 5 countries are known to have people with active polio. In 3 of them, Pakistan, Afghanistan and Nigeria, the disease is considered endemic, while in the other 2, Somalia and Kenya, only a few isolated cases have been identified since the start of 2013. Should anyone here come down with an active case of the disease, Israel would join this dubious list.
[Byline: Dan Even]
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[The dilemma posed by the re-introduction of the live attenuated vaccine is a significant issue, as the possibility of having vaccine derived poliovirus (VDPV) cases among inadequately vaccinated individuals is of real concern. As seen in other countries, there is also the risk of having circulating VDPV (cVDPV) cases, especially when the vaccine is used in areas with pockets of low vaccination coverages. It is interesting that, thus far, the wild poliovirus carriage rate is 0.3-0.4 percent (7-10 out of 2300 sampled), a very low rate, suggesting there is a significant "wall of immunes" preventing heightened circulation of the WPV in the community.
In the absence of paralytic cases, in an area with relatively high vaccination coverages, one can understand the challenges the MOH is having in deciding the best approach to take to interrupt transmission of the WPV.
Israel is comprised of 6 main administrative districts: Jerusalem District, Northern District, Haifa District, Central District, Tel Aviv District, and the Southern District. WPV1 isolates have been found in environmental samples of sewage in both the Southern and Central Districts earlier this year [2013] (see prior ProMED-mail posts: Poliomyelitis update (14): Israel, environmental samples, global 20130715.1826123; Poliomyelitis update (10): Israel, positive environmental samples, MOH 20130605.1756289; Poliomyelitis update (09): Israel, positive environmental samples, RFI 20130604.1754766; and Poliomyelitis update (08): Israel, environmental isolates, WHO, RFI 20130603.1753099 for more details on these isolates from sewage sampling). These isolates were found to be genetically similar to those circulating in Pakistan and the sewage isolate found in Egypt in December 2012 (see prior ProMED-mail post Poliomyelitis - worldwide (01): Egypt ex Pakistan, Niger 20130122.1509210).
For the HealthMap/ProMED map of Israel, see http://healthmap.org/r/1z-1. - Mod.MPP]
******
[2] Israel - suspected cases, RFI
Date: 23 Jul 2013
Source: Yeshiva World News [edited]
http://www.theyeshivaworld.com/news/Gen ... srael.html
According to a Channel 1 News report, 3 children from the Bedouin community of Tel Sheva and a 4th southern district child are feared to have contracted polio.
Health Ministry officials have been urging parents to have all children under 6 vaccinated after traces of polio were detected in Beersheva area sewers. In addition, traces of the virus were found recently in the Sharon Region sewage system. The system is connected to the Lev HaSharon, Kalansua, Jaljulia, Kfar Bara and Choreshim communities.
Health officials in the southern district in the past 2 weeks conducted tests on 1700 stool samples from adults and children from areas in which polio was detected in the sewage system. Additional testing is being conducted for those people whose stool samples tested positive. Health officials explain the children may be carrying the illness but remain asymptomatic.
Thousands of samples are being studied as well to determine how many children up the age of 8 carry the virus.
If these cases are confirmed, and if it is established that a large population carries the virus, the ministry is likely to give an additional vaccine to an estimated 150 000 children under the age of 8. A decision is expected within approximately 2 weeks.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[This moderator has attempted to find more information on these supposedly suspected cases of polio in the Southern district to no avail. From the wording of the article, this moderator suspects that the "alleged" cases refer to asymptomatic carriers of the WPV; the article mentions 3 or possibly 4 such cases out of 1700 stool samples tested for WPV, whereas the newswire in the 1st section ([1]) mentions 7-10 positive samples out of 2300 stool specimens processed. The article is being presented here requesting clarification from knowledgeable sources in Israel. - Mod.MPP]
******
[3] Somalia
Date: 30 Jul 2013
Source: Voice of America [edited]
http://www.voanews.com/content/somalia- ... 12895.html
Somalia's Ministry of Health confirms there are now 94 cases of polio in south-central Somalia, and the outbreak is showing no signs of slowing down. New cases of the disease near the border with Ethiopia have also put that country at risk.
The polio outbreak, 1st identified in May [2013], is spreading throughout Somalia, according to Dr. Yassin Nur, head of immunization at Somalia's Ministry of Health.
He said another case also has been confirmed in the autonomous region of Somaliland, close to Ethiopia, and could easily be transmitted across the border.
"The risk is there," Nur said. "Not to mention that Ethiopia has a very long and porous border with Somalia, and it would be very easy to have an outbreak in Ethiopia."
Another 10 cases of polio also have been confirmed across the border with Kenya, in the Dadaab refugee camps.
Before the new outbreak, polio had been nearly eradicated across the world, with active cases reported only in 3 countries: Afghanistan, Pakistan and Nigeria.
But the U.N. children's agency UNICEF said that in May [2013], a 2-year-old girl in Somalia was confirmed to have contracted polio, becoming the 1st case in the country since 2007.
According to Nur, the population of internally displaced people [IDPs], who number more than one million in Somalia, are most at risk of contracting the virus that causes polio. The constant movement of people raises the risk of spreading the disease.
"The problem is this movement between Somalia and Kenya, between Somalia and Ethiopia," Nur said. "Whether they are IDPs or not, the movement of the people is what worries us."
Nur is hopeful a vaccination campaign launched in coordination with U.N. agencies, as well as local and international organizations, will be able to "limit and control" the transmission of the disease.
According to the U.N., almost 4 million people have received a polio vaccination in Somalia since May [2013].
Children are most at risk of contracting the disease, which has no cure and can paralyze those who are infected.
[Byline: Gabe Joselow]
--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>
[According to the most recent global update on the Polio Eradication Initiative website, as of today [31 Jul 2013], there have been 95 cases of WPV in Somalia and 10 in Kenya in this ongoing outbreak. The challenges of interrupting transmission in a "floating" population as seen in Somalia and Kenya are expressed in the above newswire, as the denominator of numbers of individuals targeted for vaccination changes on a daily basis with the continued migration of the internally displaced persons (IDPs) in Somalia, and those who seek refuge in the camps in Kenya. The concerns of possible spread into Ethiopia are valid concerns, especially with the most recent case occurring in Somaliland, near the border with Ethiopia, where there is a similar population movement ongoing.
For the HealthMap/ProMED map of Somalia, see http://healthmap.org/r/1Ahv. For a map showing the region with borders between Somalia, Ethiopia and Kenya, see http://img.static.reliefweb.int/sites/r ... 97-map.png. - Mod.MPP]
******
[4] India - 4th case of VDPV
Date: 30 Jul 2013
Source: The Hindu [edited]
http://www.thehindu.com/news/national/o ... epage=true
A 9-month-old boy from Navi Mumbai has tested positive for vaccine- derived poliovirus (VDPV) type 2 and is now on a ventilator at BJ Wadia Hospital in Parel. This is the 4th such case recorded in the country this year [2013].
"When he arrived, he didn't have any power in all the 4 limbs. Now, he is showing signs of improvement. There is flickering and muscle contraction in his legs," said the director of the Directorate of Health Services, Dr. Satish Pawar.
[The boy], born in Muzaffarpur, Bihar, was brought to Mumbai by his mother when he was 2 months old. Since then, he has been orally vaccinated for polio 5 times. "There seems to be a problem with his immunity, which we are examining at the moment. In normal children, the polio virus in the intestines completely dies after about 200-300 rounds of replication. But in this child's case, due to low immunity, the virus seems to have become virulent, resulting in polio," said Dr. Pawar.
A Polio Surveillance Team visited the Ilthanpada area in Navi Mumbai where the child lives. The area has 95 per cent polio vaccination coverage, according to municipal records. The team has taken stool samples of all the family members, including [the boy's] older brother.
Meanwhile, the State Health Department has asked the Navi Mumbai Municipal Corporation to follow a protocol. "There are about 450 children in the Ilthanpada area, and they will be thoroughly examined. A polio drive will be undertaken in Navi Mumbai, and if there are homes that had not administered polio drops, they will be asked to do so," Dr. Pawar said. The sewage system and other sanitary conditions in the area would also be checked.
The earlier 3 cases were from Orissa, Pudicherry and Maharashtra. In 2012, a VDPV case was recorded from West Bengal. Going by the past records, circulating VDPVs have been rapidly stopped with 2-3 rounds of high-quality immunisation campaigns. Health experts said the solution lay in immunising a child several times with the oral vaccine to stop polio transmission, regardless of the origin of the virus.
"The time has come to shift to injected polio vaccine, as this does not cause the disease. Even as India has become polio-free, the need of the hour is for the government to come up with a comprehensive programme where even VDPVs don't occur," said Dr. Nitin Shah, paediatrician from PD Hinduja Hospital.
--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka
[The concerns re: VDPV infection in an immune compromised individual is that there is the chance the individual will become a chronic VDPV carrier and virus shedder over prolonged periods of time.
It is interesting that the discussion on switching to the inactivated vaccine has begun, especially given the occurrence of 4 VDPV cases this year (2013). It has been 2.5 years since the last case of WPV associated polio was identified in India (in January 2011). The cost and logistical implications of switching from an oral vaccine to an injectable vaccine in India are not minor. We await further discussions.
For a map of India showing states, see http://www.globalsherpa.org/wp-content/ ... states.png. For the HealthMap/ProMED map of India, see http://healthmap.org/r/1pSH. - Mod.MPP]
******
[5] Global - Polio Eradication Initiative
Date: 31 Jul 2013
Source: Polio Eradication Initiative [edited]
http://www.polioeradication.org/Dataand ... sweek.aspx
Global Polio Eradication Initiative update as of 31 Jul 2013
-----------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 170 / 103 / 223
- in endemic countries: 65 / 98 / 217
- in non-endemic countries: 85 / 5 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 22 / 0 / 0 / 22 // 20 / 2 / 1 / 23 / 58 // 3 Jul 2013
Afghanistan: 3 / 0 / 0 / 3 // 15 / 0 / 0 / 15 / 37 // 6 Jun 2013
Nigeria: 40 / 0 / 0 / 35 // 46 / 14 / 0 / 60 / 122 // 9 Jul 2013
Somalia: 95 / 0 / 0 / 65 // 0 / 0 / 0 / 0 / 0 // 10 Jul 2013
Kenya: 10 / 0 / 0 / 10 // 0 / 0 / 0 / 0 / 0 // 6 Jul 2013
Chad: 0 / 0 / 0 / 0 // 5 / 0 / 0 / 5 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 170 / 0 / 0 / 170 // 86 / 16 / 1 / 103 / 223
Total in endemic countries: 65 / 0 / 0 / 65 // 81 / 16 / 1 / 98 / 217
Total outbreak: 105 / 0 / 0 / 105 // 5 / 0 / 0 / 5 / 6
Data in WHO as of 31 Jul 2012 for 2012 data and 30 Jul 2013 for 2013 data.
Highlights of this week:
- In Nigeria, the Presidential Task Force has reviewed the latest epidemiology of poliovirus transmission and strategies to overcome remaining challenges. A new risk-classification system of low-performing areas aims to focus resources where they are most needed.
- In Pakistan, the outbreak in Federally Administered Tribal Areas (FATA) is continuing, with a new case reported from Khyber Agency. The current outbreak is threatening progress achieved elsewhere in the country, as well as efforts in neighbouring Afghanistan.
Afghanistan
- No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains 3. The most recent WPV case had onset of paralysis on [6 Jun 2013] (WPV1 from Nangarhar).
- All 3 WPV cases this year were reported from Eastern Region. In the high-risk Southern Region, no WPV cases have been reported since November 2012.
- No new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
- Subnational immunization days (SNIDs) were held on [1-3 Jul 2013], with resources focusing on Southern and Eastern Region. Planning is underway for nationwide activities in August [2013].
Nigeria
- Five new WPV cases were reported in the past week (4 WPV1s from Kano state and one WPV1 from Yobe state), bringing the total number of WPV1 cases for 2013 to 40. The most recent WPV1 case had onset of paralysis on [9 Jul 2013] (WPV1 from Kano).
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (with onset of paralysis on [6 Jun 2013] from Borno). Although this cVDPV2 case is linked to cVDPV2 currently circulating in Chad, which has also been detected in Cameroon, cVDPV2 linked to this transmission chain had previously been isolated from an environmental sample in Kano in March [2013] (indicating circulation in Nigeria).
- The latest epidemiology and strategies were discussed at last week's Presidential Task Force meeting on [23 Jul 2013] in Abuja. The meeting underscored that more than half of this year's [2013] cases are from 2 states: Borno and Yobe.
- Performance during Immunization Plus Days (IPDs) continues to improve in all high-risk states. However, vaccination coverage gaps persist in low-performing Local Government Areas (LGAs), particularly in Kano, Borno and Yobe.
- Although Borno and Yobe are affected by insecurity, polio eradication activities are continuing in most LGAs of Borno and all LGAs of Yobe. Special strategies are being evaluated for these areas, including conducting
"wall fencing" immunizations around insecure areas, use of permanent health teams and increased use of Short Interval Additional Dose (SIADs) campaigns, as and when opportunities arise. Social mobilization activities are being targeted to increase community demand for polio vaccination.
- Efforts must continue to improve micro planning, reaching "absent" children and further engaging communities and traditional leaders to address non-compliance.
- At the same time, more needs to be done to foster subnational political engagement [as] the involvement of LGA Chairpersons remains inconsistent across high-risk states. Engagement at the state-level is also inconsistent, as measured by the Abuja Commitments.
- A new risk classification system will improve the delivery of resources to areas where they are most needed. Across the high-risk states, 129 LGAs have now been classified as "very, very high risk," "very high risk," or "special situation" (security-affected LGAs in Borno and Yobe).
- The next subnational IPD in northern states is planned for early September [2013] using bivalent OPV. Measles vaccine will also be offered during this round.
Pakistan
- One new WPV1 case was reported in the past week (WPV1 from Khyber Agency, Federally Administered Tribal Area - FATA), bringing the total number of WPV1 cases for 2013 to 22. It is the most recent WPV1 case in the country and had onset of paralysis on [3 Jul 2013].
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 5. The most recent cVDPV2 case had onset of paralysis on [8 May 2013] (from Gadap town, greater Karachi, Sindh).
- Additionally, one new WPV1 environmental sample was isolated from Peshawar, Khyber Pakhtunkhwa (KP), collected in early July [2013]. In total, 22 environmental samples have tested positive for WPV1 in 2013 from various sites across Pakistan, the bulk from Peshawar (9) and Hyderabad, Sindh (5).
- Federally Administered Tribal Areas (FATA) is the major WPV1 reservoir in Pakistan at the moment, accounting for 13 of this year's [2013] 22 cases in the country. Khyber Agency is particularly affected, with 9 cases, and in particular Bara tehsil of Khyber. This outbreak is threatening progress achieved elsewhere in the country and in neighbouring Afghanistan. In 2011 and 2012, Bara was the epicentre of a major outbreak which also spread to other areas.
Chad, Cameroon and Central African Republic
- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac). No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 4 (the most recent cVDPV2 case had onset of paralysis on [12 May 2013] from Ennedi).
- The 4 cVDPV2 cases were reported from various parts of the country, indicating widespread transmission. In some areas, only one immunization round has been conducted in response. A more comprehensive outbreak response to these cVDPV2 cases must be planned and implemented. The risk of further spread within Chad and further international spread remains high (cVDPV2 circulating in Chad has also been detected in Cameroon and Nigeria).
- In Cameroon, no new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 2. The most recent cVDPV2 case had onset of paralysis on [27 May 2013] (from Extreme-Nord).
- Emergency outbreak response is ongoing in both countries.
- Central African Republic (CAR) continues to be at risk of re-infection due to proximity with Chad and, in some areas, insecurity. To minimize the risk and consequences of potential re-infection, 2 subnational immunization campaigns were conducted in border areas with Chad, in June and July [2013] using trivalent OPV.
Horn of Africa
- 24 new WPV1 cases were reported in the past week (23 from Somalia and one from Kenya), bringing the total number of WPV1 cases in the region to 105 (95 from Somalia and 10 from Kenya). The most recent case in the region had onset of paralysis on [10 Jul 2013] (from Somalia).
- Eleven of the newly-reported cases are from Banadir, which remains the epicentre of the outbreak, accounting for more than half of all cases associated with this outbreak.
- Four of the newly-reported cases are from Lower Shabelle, areas of which are inaccessible due to insecurity. Special strategies continue to be implemented for these areas, including increased local-level access negotiations, immunizing older age groups and setting up vaccination posts at entry/exit points of inaccessible areas.
- In Somalia, nationwide campaigns were conducted last week, targeting children under the age of 5 years. In Kenya, SIAs are currently ongoing ([27-30 Jul 2013]), aiming to reach host communities around the Dadaab camps.
- Immunization campaigns across the Horn of Africa, including in Ethiopia and Yemen, will continue throughout August [2013].
West Africa
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
- Multi-country immunization campaigns are planned in West Africa for mid-October [2013], as well as SNIDs in parts of Mali and Niger in July and September [2013], respectively.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[Since the last polio update, with information as of 10 Jul 2013, there have been 38 new cases reported, raising the global total of polio cases from 132 to 170. 32 of these cases have occurred in the ongoing outbreak in Somalia and Kenya, raising the total number of outbreak associated cases to 105 from 73. In Somalia, during this 3-week period (from 10-31 Jul 2013), there have been 30 newly identified cases, raising the total number of cases in Somalia to 95.
A disappointing observation is that the year-to-date total of confirmed cases of WPV associated polio for 2013 is now 170, whereas the year-to-date total for this same period in 2012 was 103.
For the map showing locations of all confirmed WPV cases in the world as of 30 Jul 2013, see http://www.polioeradication.org/Dataandmonitoring.aspx. - Mod.MPP]
**************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
In this update:
[1] Israel - asymptomatic carriers
[2] Israel - suspected cases, RFI
[3] Somalia
[4] India - 4th case of VDPV
[5] Global update - Polio Eradication Initiative
******
[1] Israel - asymptomatic carriers
Date: 31 Jul 2013
Source: Haaretz [edited]
http://www.haaretz.com/news/national/
The Health Ministry is preparing for a campaign to inoculate children in the south of Israel with a live attenuated vaccine against polio, in light of the continued spread of the disease through the region's sewage systems. However, a final decision will only be made this weekend and announced on Sunday [4 Aug 2013].
The new inoculations would be on top of the regular polio shots given to all children at 2 months, 4 months, 6 months and 12 months, and then again in 2nd grade. Those shots contain the dead polio virus.
As Haaretz reported 3 weeks ago, any decision to revaccinate children with a live-virus vaccine involves an ethical dilemma, since the goal isn't to protect the children themselves, as they are already protected by the dead-virus vaccine. Rather, the goal would be to protect those around them, and especially their parents and other relatives. The live attenuated virus will commonly spread to other people, and thus inoculate them as well.
Revaccination involves virtually no risk that the children themselves will contract polio, with only one known case of a child who contracted polio from a live-virus vaccine after previously being inoculated with the dead-virus version.
Until 2005, Israel regularly vaccinated children with the live attenuated virus, which is administered orally. But in exceptional cases, the live attenuated virus can cause polio in other people who contract it from the inoculated child, especially if they already have weakened immune systems, for instance because they are seriously ill.
This is why the Health Ministry ultimately stopped the practice, and one reason why it is still weighing the benefits of a new inoculation campaign.
To reduce the potential risks, the ministry has ordered drops containing only 2 strains of attenuated polio virus, rather than the 3 contained in the drops used until 2005.
The ministry said it is currently consulting with leading experts in the field, including senior pediatricians and family doctors, as well as public figures and officials from the affected municipalities, on whether to launch the campaign.
Meanwhile, it is continuing to collect stool samples from residents of the south in order to assess the spread of the disease. Thus far, it has collected 2300 samples, from which it has identified 7 Israelis who definitely carry the virus and 10 suspected carriers. However, none of them have come down with active polio.
Israel hasn't had an active polio case since 1988, when 15 people came down with the disease, mostly in Hadera and Or Akiva. All suffered some degree of paralysis.
The current polio outbreak began in late May [2013]. The virus was 1st detected in the sewers of the Bedouin town of Rahat in the Negev. It later spread to the sewage systems of several other southern towns, including Be'er Sheva and Ashdod.
Over the past month [July 2013], it has also spread to several towns in central Israel, including Ramle, Lod and Modi'in. The Health Ministry thinks the disease arrived from Egypt.
The ministry believes that the fact no active polio cases have yet occurred despite the spread of the disease is because such a high percentage of the population has been vaccinated against polio, an estimated 94 to 95 percent.
Worldwide, only 5 countries are known to have people with active polio. In 3 of them, Pakistan, Afghanistan and Nigeria, the disease is considered endemic, while in the other 2, Somalia and Kenya, only a few isolated cases have been identified since the start of 2013. Should anyone here come down with an active case of the disease, Israel would join this dubious list.
[Byline: Dan Even]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The dilemma posed by the re-introduction of the live attenuated vaccine is a significant issue, as the possibility of having vaccine derived poliovirus (VDPV) cases among inadequately vaccinated individuals is of real concern. As seen in other countries, there is also the risk of having circulating VDPV (cVDPV) cases, especially when the vaccine is used in areas with pockets of low vaccination coverages. It is interesting that, thus far, the wild poliovirus carriage rate is 0.3-0.4 percent (7-10 out of 2300 sampled), a very low rate, suggesting there is a significant "wall of immunes" preventing heightened circulation of the WPV in the community.
In the absence of paralytic cases, in an area with relatively high vaccination coverages, one can understand the challenges the MOH is having in deciding the best approach to take to interrupt transmission of the WPV.
Israel is comprised of 6 main administrative districts: Jerusalem District, Northern District, Haifa District, Central District, Tel Aviv District, and the Southern District. WPV1 isolates have been found in environmental samples of sewage in both the Southern and Central Districts earlier this year [2013] (see prior ProMED-mail posts: Poliomyelitis update (14): Israel, environmental samples, global 20130715.1826123; Poliomyelitis update (10): Israel, positive environmental samples, MOH 20130605.1756289; Poliomyelitis update (09): Israel, positive environmental samples, RFI 20130604.1754766; and Poliomyelitis update (08): Israel, environmental isolates, WHO, RFI 20130603.1753099 for more details on these isolates from sewage sampling). These isolates were found to be genetically similar to those circulating in Pakistan and the sewage isolate found in Egypt in December 2012 (see prior ProMED-mail post Poliomyelitis - worldwide (01): Egypt ex Pakistan, Niger 20130122.1509210).
For the HealthMap/ProMED map of Israel, see http://healthmap.org/r/1z-1. - Mod.MPP]
******
[2] Israel - suspected cases, RFI
Date: 23 Jul 2013
Source: Yeshiva World News [edited]
http://www.theyeshivaworld.com/news/Gen ... srael.html
According to a Channel 1 News report, 3 children from the Bedouin community of Tel Sheva and a 4th southern district child are feared to have contracted polio.
Health Ministry officials have been urging parents to have all children under 6 vaccinated after traces of polio were detected in Beersheva area sewers. In addition, traces of the virus were found recently in the Sharon Region sewage system. The system is connected to the Lev HaSharon, Kalansua, Jaljulia, Kfar Bara and Choreshim communities.
Health officials in the southern district in the past 2 weeks conducted tests on 1700 stool samples from adults and children from areas in which polio was detected in the sewage system. Additional testing is being conducted for those people whose stool samples tested positive. Health officials explain the children may be carrying the illness but remain asymptomatic.
Thousands of samples are being studied as well to determine how many children up the age of 8 carry the virus.
If these cases are confirmed, and if it is established that a large population carries the virus, the ministry is likely to give an additional vaccine to an estimated 150 000 children under the age of 8. A decision is expected within approximately 2 weeks.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[This moderator has attempted to find more information on these supposedly suspected cases of polio in the Southern district to no avail. From the wording of the article, this moderator suspects that the "alleged" cases refer to asymptomatic carriers of the WPV; the article mentions 3 or possibly 4 such cases out of 1700 stool samples tested for WPV, whereas the newswire in the 1st section ([1]) mentions 7-10 positive samples out of 2300 stool specimens processed. The article is being presented here requesting clarification from knowledgeable sources in Israel. - Mod.MPP]
******
[3] Somalia
Date: 30 Jul 2013
Source: Voice of America [edited]
http://www.voanews.com/content/somalia- ... 12895.html
Somalia's Ministry of Health confirms there are now 94 cases of polio in south-central Somalia, and the outbreak is showing no signs of slowing down. New cases of the disease near the border with Ethiopia have also put that country at risk.
The polio outbreak, 1st identified in May [2013], is spreading throughout Somalia, according to Dr. Yassin Nur, head of immunization at Somalia's Ministry of Health.
He said another case also has been confirmed in the autonomous region of Somaliland, close to Ethiopia, and could easily be transmitted across the border.
"The risk is there," Nur said. "Not to mention that Ethiopia has a very long and porous border with Somalia, and it would be very easy to have an outbreak in Ethiopia."
Another 10 cases of polio also have been confirmed across the border with Kenya, in the Dadaab refugee camps.
Before the new outbreak, polio had been nearly eradicated across the world, with active cases reported only in 3 countries: Afghanistan, Pakistan and Nigeria.
But the U.N. children's agency UNICEF said that in May [2013], a 2-year-old girl in Somalia was confirmed to have contracted polio, becoming the 1st case in the country since 2007.
According to Nur, the population of internally displaced people [IDPs], who number more than one million in Somalia, are most at risk of contracting the virus that causes polio. The constant movement of people raises the risk of spreading the disease.
"The problem is this movement between Somalia and Kenya, between Somalia and Ethiopia," Nur said. "Whether they are IDPs or not, the movement of the people is what worries us."
Nur is hopeful a vaccination campaign launched in coordination with U.N. agencies, as well as local and international organizations, will be able to "limit and control" the transmission of the disease.
According to the U.N., almost 4 million people have received a polio vaccination in Somalia since May [2013].
Children are most at risk of contracting the disease, which has no cure and can paralyze those who are infected.
[Byline: Gabe Joselow]
--
Communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>
[According to the most recent global update on the Polio Eradication Initiative website, as of today [31 Jul 2013], there have been 95 cases of WPV in Somalia and 10 in Kenya in this ongoing outbreak. The challenges of interrupting transmission in a "floating" population as seen in Somalia and Kenya are expressed in the above newswire, as the denominator of numbers of individuals targeted for vaccination changes on a daily basis with the continued migration of the internally displaced persons (IDPs) in Somalia, and those who seek refuge in the camps in Kenya. The concerns of possible spread into Ethiopia are valid concerns, especially with the most recent case occurring in Somaliland, near the border with Ethiopia, where there is a similar population movement ongoing.
For the HealthMap/ProMED map of Somalia, see http://healthmap.org/r/1Ahv. For a map showing the region with borders between Somalia, Ethiopia and Kenya, see http://img.static.reliefweb.int/sites/r ... 97-map.png. - Mod.MPP]
******
[4] India - 4th case of VDPV
Date: 30 Jul 2013
Source: The Hindu [edited]
http://www.thehindu.com/news/national/o ... epage=true
A 9-month-old boy from Navi Mumbai has tested positive for vaccine- derived poliovirus (VDPV) type 2 and is now on a ventilator at BJ Wadia Hospital in Parel. This is the 4th such case recorded in the country this year [2013].
"When he arrived, he didn't have any power in all the 4 limbs. Now, he is showing signs of improvement. There is flickering and muscle contraction in his legs," said the director of the Directorate of Health Services, Dr. Satish Pawar.
[The boy], born in Muzaffarpur, Bihar, was brought to Mumbai by his mother when he was 2 months old. Since then, he has been orally vaccinated for polio 5 times. "There seems to be a problem with his immunity, which we are examining at the moment. In normal children, the polio virus in the intestines completely dies after about 200-300 rounds of replication. But in this child's case, due to low immunity, the virus seems to have become virulent, resulting in polio," said Dr. Pawar.
A Polio Surveillance Team visited the Ilthanpada area in Navi Mumbai where the child lives. The area has 95 per cent polio vaccination coverage, according to municipal records. The team has taken stool samples of all the family members, including [the boy's] older brother.
Meanwhile, the State Health Department has asked the Navi Mumbai Municipal Corporation to follow a protocol. "There are about 450 children in the Ilthanpada area, and they will be thoroughly examined. A polio drive will be undertaken in Navi Mumbai, and if there are homes that had not administered polio drops, they will be asked to do so," Dr. Pawar said. The sewage system and other sanitary conditions in the area would also be checked.
The earlier 3 cases were from Orissa, Pudicherry and Maharashtra. In 2012, a VDPV case was recorded from West Bengal. Going by the past records, circulating VDPVs have been rapidly stopped with 2-3 rounds of high-quality immunisation campaigns. Health experts said the solution lay in immunising a child several times with the oral vaccine to stop polio transmission, regardless of the origin of the virus.
"The time has come to shift to injected polio vaccine, as this does not cause the disease. Even as India has become polio-free, the need of the hour is for the government to come up with a comprehensive programme where even VDPVs don't occur," said Dr. Nitin Shah, paediatrician from PD Hinduja Hospital.
--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka
[The concerns re: VDPV infection in an immune compromised individual is that there is the chance the individual will become a chronic VDPV carrier and virus shedder over prolonged periods of time.
It is interesting that the discussion on switching to the inactivated vaccine has begun, especially given the occurrence of 4 VDPV cases this year (2013). It has been 2.5 years since the last case of WPV associated polio was identified in India (in January 2011). The cost and logistical implications of switching from an oral vaccine to an injectable vaccine in India are not minor. We await further discussions.
For a map of India showing states, see http://www.globalsherpa.org/wp-content/ ... states.png. For the HealthMap/ProMED map of India, see http://healthmap.org/r/1pSH. - Mod.MPP]
******
[5] Global - Polio Eradication Initiative
Date: 31 Jul 2013
Source: Polio Eradication Initiative [edited]
http://www.polioeradication.org/Dataand ... sweek.aspx
Global Polio Eradication Initiative update as of 31 Jul 2013
-----------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 170 / 103 / 223
- in endemic countries: 65 / 98 / 217
- in non-endemic countries: 85 / 5 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 22 / 0 / 0 / 22 // 20 / 2 / 1 / 23 / 58 // 3 Jul 2013
Afghanistan: 3 / 0 / 0 / 3 // 15 / 0 / 0 / 15 / 37 // 6 Jun 2013
Nigeria: 40 / 0 / 0 / 35 // 46 / 14 / 0 / 60 / 122 // 9 Jul 2013
Somalia: 95 / 0 / 0 / 65 // 0 / 0 / 0 / 0 / 0 // 10 Jul 2013
Kenya: 10 / 0 / 0 / 10 // 0 / 0 / 0 / 0 / 0 // 6 Jul 2013
Chad: 0 / 0 / 0 / 0 // 5 / 0 / 0 / 5 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 170 / 0 / 0 / 170 // 86 / 16 / 1 / 103 / 223
Total in endemic countries: 65 / 0 / 0 / 65 // 81 / 16 / 1 / 98 / 217
Total outbreak: 105 / 0 / 0 / 105 // 5 / 0 / 0 / 5 / 6
Data in WHO as of 31 Jul 2012 for 2012 data and 30 Jul 2013 for 2013 data.
Highlights of this week:
- In Nigeria, the Presidential Task Force has reviewed the latest epidemiology of poliovirus transmission and strategies to overcome remaining challenges. A new risk-classification system of low-performing areas aims to focus resources where they are most needed.
- In Pakistan, the outbreak in Federally Administered Tribal Areas (FATA) is continuing, with a new case reported from Khyber Agency. The current outbreak is threatening progress achieved elsewhere in the country, as well as efforts in neighbouring Afghanistan.
Afghanistan
- No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains 3. The most recent WPV case had onset of paralysis on [6 Jun 2013] (WPV1 from Nangarhar).
- All 3 WPV cases this year were reported from Eastern Region. In the high-risk Southern Region, no WPV cases have been reported since November 2012.
- No new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
- Subnational immunization days (SNIDs) were held on [1-3 Jul 2013], with resources focusing on Southern and Eastern Region. Planning is underway for nationwide activities in August [2013].
Nigeria
- Five new WPV cases were reported in the past week (4 WPV1s from Kano state and one WPV1 from Yobe state), bringing the total number of WPV1 cases for 2013 to 40. The most recent WPV1 case had onset of paralysis on [9 Jul 2013] (WPV1 from Kano).
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (with onset of paralysis on [6 Jun 2013] from Borno). Although this cVDPV2 case is linked to cVDPV2 currently circulating in Chad, which has also been detected in Cameroon, cVDPV2 linked to this transmission chain had previously been isolated from an environmental sample in Kano in March [2013] (indicating circulation in Nigeria).
- The latest epidemiology and strategies were discussed at last week's Presidential Task Force meeting on [23 Jul 2013] in Abuja. The meeting underscored that more than half of this year's [2013] cases are from 2 states: Borno and Yobe.
- Performance during Immunization Plus Days (IPDs) continues to improve in all high-risk states. However, vaccination coverage gaps persist in low-performing Local Government Areas (LGAs), particularly in Kano, Borno and Yobe.
- Although Borno and Yobe are affected by insecurity, polio eradication activities are continuing in most LGAs of Borno and all LGAs of Yobe. Special strategies are being evaluated for these areas, including conducting
"wall fencing" immunizations around insecure areas, use of permanent health teams and increased use of Short Interval Additional Dose (SIADs) campaigns, as and when opportunities arise. Social mobilization activities are being targeted to increase community demand for polio vaccination.
- Efforts must continue to improve micro planning, reaching "absent" children and further engaging communities and traditional leaders to address non-compliance.
- At the same time, more needs to be done to foster subnational political engagement [as] the involvement of LGA Chairpersons remains inconsistent across high-risk states. Engagement at the state-level is also inconsistent, as measured by the Abuja Commitments.
- A new risk classification system will improve the delivery of resources to areas where they are most needed. Across the high-risk states, 129 LGAs have now been classified as "very, very high risk," "very high risk," or "special situation" (security-affected LGAs in Borno and Yobe).
- The next subnational IPD in northern states is planned for early September [2013] using bivalent OPV. Measles vaccine will also be offered during this round.
Pakistan
- One new WPV1 case was reported in the past week (WPV1 from Khyber Agency, Federally Administered Tribal Area - FATA), bringing the total number of WPV1 cases for 2013 to 22. It is the most recent WPV1 case in the country and had onset of paralysis on [3 Jul 2013].
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 5. The most recent cVDPV2 case had onset of paralysis on [8 May 2013] (from Gadap town, greater Karachi, Sindh).
- Additionally, one new WPV1 environmental sample was isolated from Peshawar, Khyber Pakhtunkhwa (KP), collected in early July [2013]. In total, 22 environmental samples have tested positive for WPV1 in 2013 from various sites across Pakistan, the bulk from Peshawar (9) and Hyderabad, Sindh (5).
- Federally Administered Tribal Areas (FATA) is the major WPV1 reservoir in Pakistan at the moment, accounting for 13 of this year's [2013] 22 cases in the country. Khyber Agency is particularly affected, with 9 cases, and in particular Bara tehsil of Khyber. This outbreak is threatening progress achieved elsewhere in the country and in neighbouring Afghanistan. In 2011 and 2012, Bara was the epicentre of a major outbreak which also spread to other areas.
Chad, Cameroon and Central African Republic
- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac). No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 4 (the most recent cVDPV2 case had onset of paralysis on [12 May 2013] from Ennedi).
- The 4 cVDPV2 cases were reported from various parts of the country, indicating widespread transmission. In some areas, only one immunization round has been conducted in response. A more comprehensive outbreak response to these cVDPV2 cases must be planned and implemented. The risk of further spread within Chad and further international spread remains high (cVDPV2 circulating in Chad has also been detected in Cameroon and Nigeria).
- In Cameroon, no new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 2. The most recent cVDPV2 case had onset of paralysis on [27 May 2013] (from Extreme-Nord).
- Emergency outbreak response is ongoing in both countries.
- Central African Republic (CAR) continues to be at risk of re-infection due to proximity with Chad and, in some areas, insecurity. To minimize the risk and consequences of potential re-infection, 2 subnational immunization campaigns were conducted in border areas with Chad, in June and July [2013] using trivalent OPV.
Horn of Africa
- 24 new WPV1 cases were reported in the past week (23 from Somalia and one from Kenya), bringing the total number of WPV1 cases in the region to 105 (95 from Somalia and 10 from Kenya). The most recent case in the region had onset of paralysis on [10 Jul 2013] (from Somalia).
- Eleven of the newly-reported cases are from Banadir, which remains the epicentre of the outbreak, accounting for more than half of all cases associated with this outbreak.
- Four of the newly-reported cases are from Lower Shabelle, areas of which are inaccessible due to insecurity. Special strategies continue to be implemented for these areas, including increased local-level access negotiations, immunizing older age groups and setting up vaccination posts at entry/exit points of inaccessible areas.
- In Somalia, nationwide campaigns were conducted last week, targeting children under the age of 5 years. In Kenya, SIAs are currently ongoing ([27-30 Jul 2013]), aiming to reach host communities around the Dadaab camps.
- Immunization campaigns across the Horn of Africa, including in Ethiopia and Yemen, will continue throughout August [2013].
West Africa
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
- Multi-country immunization campaigns are planned in West Africa for mid-October [2013], as well as SNIDs in parts of Mali and Niger in July and September [2013], respectively.
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[Since the last polio update, with information as of 10 Jul 2013, there have been 38 new cases reported, raising the global total of polio cases from 132 to 170. 32 of these cases have occurred in the ongoing outbreak in Somalia and Kenya, raising the total number of outbreak associated cases to 105 from 73. In Somalia, during this 3-week period (from 10-31 Jul 2013), there have been 30 newly identified cases, raising the total number of cases in Somalia to 95.
A disappointing observation is that the year-to-date total of confirmed cases of WPV associated polio for 2013 is now 170, whereas the year-to-date total for this same period in 2012 was 103.
For the map showing locations of all confirmed WPV cases in the world as of 30 Jul 2013, see http://www.polioeradication.org/Dataandmonitoring.aspx. - Mod.MPP]
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Kinderlähmung - Poliomyelitis in Indien
POLIOMYELITIS - UPDATE (17): INDIA, VACCINATION STRATEGY COMMENTARY
*******************************************************************
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Date: Sat 3 Aug 2013
From: TJ John <tjacobjohn@yahoo.co.in> [edited]
This is regarding the invitation for "further discussions" on VDPVs in India, and the "cost and logistical implications" of introducing IPV that are "not minor."
There have been 4 children with AFP from whom VDPV type 2 was isolated during 2013. The last 2 got wide media publicity. Possibly 2 children had immune deficiency and had immunodeficiency-associated VDPV, but the other 2 had community acquired VDPV. Naturally transmitted wild poliovirus type 2 (WPV-2) was last isolated in India in 1999. Since then, all vaccine-associated paralytic polio (VAPP) due to Sabin type 2 and most of the VDPV cases have been iatrogenic. The number of VAPP cases in India are not counted or, if counted, are not available in the public domain, but we assume about 100 per year and some 40 percent to be due to Sabin-2. VDPV cases are counted and data are available to the public [see http://www.npspindia.org/bulletin.pdf for the 27 Jul 2013 bulletin showing results of polio surveillance activities in India, including information on VDPVs identified by the national reference lab. - Mod.MPP].
Ethics and epidemiology demand that Sabin-2 should no longer be given; the new 2013-2018 Strategic Plan of WHO and GPEI has a new end game strategy, including the switch from trivalent OPV to bivalent OPV without type 2. For risk mitigation of consequences of immunity gaps to type 2, at least one dose of IPV will be required 6 months earlier. Thus, universal IPV introduction in all countries currently giving only OPV will be mandatory. India has a committee to advise the government on this policy shift. Availability and affordability are being explored, but no major problems are anticipated. A few Indian companies with tie ups with European IPV manufacturers have assured India of both supply and low cost, one US dollar or just a bit more than one dollar per dose. All of us are looking forward to the day when we can say polio is truly eradicated, when no child gets infected with polio virus, wild or vaccine.
--
Jacob John
Retired Professor, Clinical Virology,
Christian Medical College,
Vellore, Tamil Nadu,
India
<tjacobjohn@yahoo.co.in>
[ProMED-mail would like to thank Dr. T Jacob John for accepting the invitation to discuss this moderator's comment on the vaccine choice in India.
This moderator chose the provocative statement regarding the cost and logistical implications for introduction of IPV not being minor intentionally, as it has historically been the classic response to justify a continuation of the use of OPV and avoid the inevitable switch to IPV. This moderator agrees with Dr. John's statement that "Ethics and epidemiology demand that Sabin-2 should no longer be given." Since the wild poliovirus type 2 (WPV2) had worldwide transmission interrupted in 1999 and has not been responsible for clinical cases of poliomyelitis since 1999, the risk of infection with the virus is zero. In contrast, since 2000, there have been 576 cases of polio reported that are attributable to infection with circulating vaccine derived poliovirus type 2 (cVDPV2) in 14 countries. In 2009/2010, India reported 16 cases of polio due to infection with cVDPV2. (see http://www.polioeradication.org/Dataand ... virus.aspx).
The 2013 Strategic Plan of WHO and GPEI referred to by Dr. John, dated April 2013, can be found at http://www.polioeradication.org/Portals ... 09_ENG.pdf. A detailed analysis of the draft was conducted by the Strategic Advisory Group of Experts (SAGE) in November 2012. (for more information, see http://www.who.int/immunization/sage/me ... index.html). Links to all the background documents presented to the SAGE at the 6-8 Nov 2012 meeting can be found at http://www.who.int/immunization/sage/me ... index.html. - Mod.MPP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1pSH.]
*******************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Sat 3 Aug 2013
From: TJ John <tjacobjohn@yahoo.co.in> [edited]
This is regarding the invitation for "further discussions" on VDPVs in India, and the "cost and logistical implications" of introducing IPV that are "not minor."
There have been 4 children with AFP from whom VDPV type 2 was isolated during 2013. The last 2 got wide media publicity. Possibly 2 children had immune deficiency and had immunodeficiency-associated VDPV, but the other 2 had community acquired VDPV. Naturally transmitted wild poliovirus type 2 (WPV-2) was last isolated in India in 1999. Since then, all vaccine-associated paralytic polio (VAPP) due to Sabin type 2 and most of the VDPV cases have been iatrogenic. The number of VAPP cases in India are not counted or, if counted, are not available in the public domain, but we assume about 100 per year and some 40 percent to be due to Sabin-2. VDPV cases are counted and data are available to the public [see http://www.npspindia.org/bulletin.pdf for the 27 Jul 2013 bulletin showing results of polio surveillance activities in India, including information on VDPVs identified by the national reference lab. - Mod.MPP].
Ethics and epidemiology demand that Sabin-2 should no longer be given; the new 2013-2018 Strategic Plan of WHO and GPEI has a new end game strategy, including the switch from trivalent OPV to bivalent OPV without type 2. For risk mitigation of consequences of immunity gaps to type 2, at least one dose of IPV will be required 6 months earlier. Thus, universal IPV introduction in all countries currently giving only OPV will be mandatory. India has a committee to advise the government on this policy shift. Availability and affordability are being explored, but no major problems are anticipated. A few Indian companies with tie ups with European IPV manufacturers have assured India of both supply and low cost, one US dollar or just a bit more than one dollar per dose. All of us are looking forward to the day when we can say polio is truly eradicated, when no child gets infected with polio virus, wild or vaccine.
--
Jacob John
Retired Professor, Clinical Virology,
Christian Medical College,
Vellore, Tamil Nadu,
India
<tjacobjohn@yahoo.co.in>
[ProMED-mail would like to thank Dr. T Jacob John for accepting the invitation to discuss this moderator's comment on the vaccine choice in India.
This moderator chose the provocative statement regarding the cost and logistical implications for introduction of IPV not being minor intentionally, as it has historically been the classic response to justify a continuation of the use of OPV and avoid the inevitable switch to IPV. This moderator agrees with Dr. John's statement that "Ethics and epidemiology demand that Sabin-2 should no longer be given." Since the wild poliovirus type 2 (WPV2) had worldwide transmission interrupted in 1999 and has not been responsible for clinical cases of poliomyelitis since 1999, the risk of infection with the virus is zero. In contrast, since 2000, there have been 576 cases of polio reported that are attributable to infection with circulating vaccine derived poliovirus type 2 (cVDPV2) in 14 countries. In 2009/2010, India reported 16 cases of polio due to infection with cVDPV2. (see http://www.polioeradication.org/Dataand ... virus.aspx).
The 2013 Strategic Plan of WHO and GPEI referred to by Dr. John, dated April 2013, can be found at http://www.polioeradication.org/Portals ... 09_ENG.pdf. A detailed analysis of the draft was conducted by the Strategic Advisory Group of Experts (SAGE) in November 2012. (for more information, see http://www.who.int/immunization/sage/me ... index.html). Links to all the background documents presented to the SAGE at the 6-8 Nov 2012 meeting can be found at http://www.who.int/immunization/sage/me ... index.html. - Mod.MPP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1pSH.]
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Kinderlähmung - Poliomyelitis in Israel
POLIOMYELITIS UPDATE (18): ISRAEL
*********************************
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Date: 7 Aug 2013
From: Emilia Anis <emilia.anis@moh.health.gov.il> [edited]
In response to the ongoing circulation wild poliovirus type 1 (WPV1) in sewage samples in southern Israel, on [4 Aug 2013], the Israeli Ministry of Health officially launched a supplementary oral poliovirus vaccine campaign directed at 150 000 children ages 0-9 [years] in Israel's Southern District. Health officials emphasize that the campaign may in the near future be extended to cover Israel's entire 0-9 year population, based upon ongoing evaluation of the situation. No polio cases have been detected despite enhanced acute flaccid paralysis (AFP) surveillance and supplementary surveillance for aseptic meningitis.
Israel has maintained a routine environmental polio surveillance program since 1988. In June 2013, wild poliovirus type 1 (WPV1) was 1st detected in sewage samples in southern Israel. Reanalysis of earlier samples indicated that WPV1 had been circulating in Israel since February 2013, primarily in the Southern District. Upon confirmation of the presence of WPV1 in multiple sites, Israel undertook an inactivated polio vaccine (IPV) campaign aimed at bringing all children up-to-date on their routine polio vaccines, and offering a single IPV dose to adults in affected areas. In parallel, in order to inform pending policy decisions, environmental sampling was expanded and intensified, and stool sampling was initiated in the affected areas. These investigations confirmed that WPV1 was circulating predominantly in the south among children aged 0-9. WPV1 has been detected in sewage in several locations in Israel's Central District but in far lower concentrations. Based on these geographic and demographic characteristics, the Ministry of Health yesterday [6 Aug 2013] launched a supplementary immunization program of bivalent OPV (types 1 and 3) focused on children 0-9 [years] in the Southern District. In the 1st 3 days of the campaign, approximately 11 000 children have been vaccinated.
The Israeli polio response, led by the Minister of Health and the Director General of the ministry, has been fully coordinated with leading local epidemiology, infection disease, and pediatric experts, and with international organizations including the WHO and the United States CDC. A joint WHO/CDC mission visited Israel in June [2013], and its experts have been consulted at every stage of the outbreak response. Evaluation and consultations are ongoing regarding expansion of the campaign.
--
Eran Kopel
Ehud Kaliner
Shepherd Roee Singer
Itamar Grotto
Emilia Anis <emilia.anis@moh.health.gov.il>
[all of the Israeli Ministry of Health Public Health Services]
[ProMED-mail would like to thank Dr. Anis and colleagues for this concise update and clarification of the situation in Israel. Newswires had erroneously mentioned that there had been cases of polio.
The estimate that the wild poliovirus (WPV) has been circulating in the south of Israel since February 2013 raises questions as to how long WPV circulation can continue in populations with high coverages with the inactivated polio vaccine (IPV), and the ultimate implications vis a vis the endgame strategy for polio eradication.
In 1990, Israel began vaccination against polio using a combined vaccine program with 3 doses of IPV followed by 3 doses of OPV (oral polio vaccine). This schedule was used until 2005, when OPV was eliminated from the schedule to use 4 doses of IPV by the age of 15 months and an IPV booster dose in 1st grade (ages 5-6 years) (ref: Shulman LM, Manor Y, Sofer D, Handsher R, Swartz T, Delpeyroux F, Mendelson E. Neurovirulent vaccine-derived polioviruses in sewage from highly immune populations. PLoS One. 2006 Dec 20;1:e69). Having used IPV exclusively since 2005, information on the individuals found to be WPV carriers, such as age distribution and vaccination history, will be potentially helpful in furthering the policy discussions on the endgame strategy related to vaccination cessation.
This moderator has been a strong proponent of the use of IPV when the risk of exposure to WPV is significantly less than the risk of infection and illness from a vaccine-derived poliovirus (VDPV). The information that there has been circulation of WPV in a highly vaccinated population for 5 or more months is disconcerting. There are many questions that arise related to the timing of vaccine switch (OPV to IPV) and necessary monitoring to identify "silent" circulation of IPV at the global level, before vaccination can be ended.
We anxiously await results of investigations in Israel.
For the HealthMap/ProMED map of Israel, see http://healthmap.org/r/1z-1. - Mod.MPP]
*********************************
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http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: 7 Aug 2013
From: Emilia Anis <emilia.anis@moh.health.gov.il> [edited]
In response to the ongoing circulation wild poliovirus type 1 (WPV1) in sewage samples in southern Israel, on [4 Aug 2013], the Israeli Ministry of Health officially launched a supplementary oral poliovirus vaccine campaign directed at 150 000 children ages 0-9 [years] in Israel's Southern District. Health officials emphasize that the campaign may in the near future be extended to cover Israel's entire 0-9 year population, based upon ongoing evaluation of the situation. No polio cases have been detected despite enhanced acute flaccid paralysis (AFP) surveillance and supplementary surveillance for aseptic meningitis.
Israel has maintained a routine environmental polio surveillance program since 1988. In June 2013, wild poliovirus type 1 (WPV1) was 1st detected in sewage samples in southern Israel. Reanalysis of earlier samples indicated that WPV1 had been circulating in Israel since February 2013, primarily in the Southern District. Upon confirmation of the presence of WPV1 in multiple sites, Israel undertook an inactivated polio vaccine (IPV) campaign aimed at bringing all children up-to-date on their routine polio vaccines, and offering a single IPV dose to adults in affected areas. In parallel, in order to inform pending policy decisions, environmental sampling was expanded and intensified, and stool sampling was initiated in the affected areas. These investigations confirmed that WPV1 was circulating predominantly in the south among children aged 0-9. WPV1 has been detected in sewage in several locations in Israel's Central District but in far lower concentrations. Based on these geographic and demographic characteristics, the Ministry of Health yesterday [6 Aug 2013] launched a supplementary immunization program of bivalent OPV (types 1 and 3) focused on children 0-9 [years] in the Southern District. In the 1st 3 days of the campaign, approximately 11 000 children have been vaccinated.
The Israeli polio response, led by the Minister of Health and the Director General of the ministry, has been fully coordinated with leading local epidemiology, infection disease, and pediatric experts, and with international organizations including the WHO and the United States CDC. A joint WHO/CDC mission visited Israel in June [2013], and its experts have been consulted at every stage of the outbreak response. Evaluation and consultations are ongoing regarding expansion of the campaign.
--
Eran Kopel
Ehud Kaliner
Shepherd Roee Singer
Itamar Grotto
Emilia Anis <emilia.anis@moh.health.gov.il>
[all of the Israeli Ministry of Health Public Health Services]
[ProMED-mail would like to thank Dr. Anis and colleagues for this concise update and clarification of the situation in Israel. Newswires had erroneously mentioned that there had been cases of polio.
The estimate that the wild poliovirus (WPV) has been circulating in the south of Israel since February 2013 raises questions as to how long WPV circulation can continue in populations with high coverages with the inactivated polio vaccine (IPV), and the ultimate implications vis a vis the endgame strategy for polio eradication.
In 1990, Israel began vaccination against polio using a combined vaccine program with 3 doses of IPV followed by 3 doses of OPV (oral polio vaccine). This schedule was used until 2005, when OPV was eliminated from the schedule to use 4 doses of IPV by the age of 15 months and an IPV booster dose in 1st grade (ages 5-6 years) (ref: Shulman LM, Manor Y, Sofer D, Handsher R, Swartz T, Delpeyroux F, Mendelson E. Neurovirulent vaccine-derived polioviruses in sewage from highly immune populations. PLoS One. 2006 Dec 20;1:e69). Having used IPV exclusively since 2005, information on the individuals found to be WPV carriers, such as age distribution and vaccination history, will be potentially helpful in furthering the policy discussions on the endgame strategy related to vaccination cessation.
This moderator has been a strong proponent of the use of IPV when the risk of exposure to WPV is significantly less than the risk of infection and illness from a vaccine-derived poliovirus (VDPV). The information that there has been circulation of WPV in a highly vaccinated population for 5 or more months is disconcerting. There are many questions that arise related to the timing of vaccine switch (OPV to IPV) and necessary monitoring to identify "silent" circulation of IPV at the global level, before vaccination can be ended.
We anxiously await results of investigations in Israel.
For the HealthMap/ProMED map of Israel, see http://healthmap.org/r/1z-1. - Mod.MPP]
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Birgitt
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Kinderlähmung - Poliomyelitis weltweit
POLIOMYELITIS UPDATE (19): SOMALIA, ISRAEL, GLOBAL
**************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
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In this update:
[1] Somalia - increased cases, newswire
[2] Israel - update, WHO
[3] Global update - Polio Eradication Initiative
******
[1] Somalia - increased cases, newswire
Date: Fri 16 Aug 2013
Source: IOL News, South African Press Association/AFP report [edited]
http://www.iol.co.za/news/africa/somali ... g5SDNK-2So
Aid workers in war-torn Somalia are struggling to contain a dangerous outbreak of the crippling poliovirus, with rampant insecurity hampering efforts, the United Nations said on Friday [16 Aug 2013].
[In 2013], 6 years after the Horn of Africa nation was declared free of the virus, at least 105 cases have been confirmed in Somalia, the "worst outbreak in the world in a non-endemic country", the UN Office for the Coordination of Humanitarian Affairs (OCHA) said in a statement. "The polio outbreak plaguing Somalia has spread despite significant efforts to curb the disease," OCHA added.
While 4 million people have been vaccinated, getting drugs to more than 600 000 children in southern and central Somalia -- areas partly under control of the al-Qaeda linked Al-Shabaab, who block vaccination efforts -- is "extremely challenging", it added.
"The inability to fully access these areas constitutes a major threat to the control of the outbreak," the statement read, warning that "Somalia remains one of the most difficult and dangerous environments in the world for aid workers".
While over 100 cases of children have been recorded, "the fact that this number of children show symptoms of paralysis means that there are probably thousands more with the virus, who do not have symptoms, but are capable of spreading it", OCHA added. [In studies done in earlier years of high poliovirus circulation, for every paralytic case of polio identified there were between 50 and 1000, with an average of 200 individuals, who were infected with the poliovirus without paralytic disease. - Mod.MPP]
Around 10 cases have also been reported in north eastern Kenya, which hosts almost half a million Somali refugees in sprawling camps.
In Somalia, while the bulk of cases are in the southern and central regions, the outbreak has also spread to self-declared independent Somaliland in the north-west.
Polio is spread by person-to-person contact, exacerbated by poor sanitation and a lack of clean water.
Multiple armies are fighting for control of southern Somalia, including rival warlords, Islamist extremists and a rag-tag national army backed by a 17 700 strong AU [African Union] force.
Aid workers report growing attacks on their staff. On Thursday [15 Aug 2013], the medical aid agency Medecins sans Frontieres (MSF; Doctors Without Borders) closed all its operations in Somalia after 22 years of working in the Horn of Africa troublespot, warning of growing insecurity and "extreme attacks".
The withdrawal by MSF, an aid agency that has earned a reputation for working in the toughest of conditions, will cut health care for hundreds of thousands of Somalis. MSF blamed "armed groups and civilian leaders" who it said "increasingly support, tolerate, or condone the killing, assaulting, and abducting of humanitarian aid workers".
--
communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>
[This newswire was included in this update to highlight the challenges existing in Somalia vis a vis security concerns for polio eradication efforts -- both in terms of vaccination activities and surveillance activities. Hence, while it appears as though this area has fewer cases, it is possible there is underreporting due to security concerns as well. The withdrawal of MSF from the area is a significant setback for delivery of services in the area.
For the HealthMap/ProMED map of Somalia, see http://healthmap.org/r/1Ahv. - Mod.MPP]
******
[2] Israel - update, WHO
Date: Thu 15 Aug 2013
Source: WHO Global Alert and Response [edited]
http://www.who.int/csr/don/2013_08_15/en/index.html
Poliovirus detected from environmental samples in Israel -- update -- 15 Aug 2013
---------------------------------------------------------------------------
The World Health Organization (WHO) estimates the risk of further international spread of wild poliovirus type 1 (WPV1) from Israel to remain moderate to high. This risk assessment reflects evidence of increasing geographic extent of circulation over a prolonged period of time.
WPV1 has been detected in 67 sewage samples from 24 sampling sites in Israel, collected from [3 Feb 2013 to 4 Aug 2013]. Initially restricted to southern Israel, WPV1 has now also been detected in the central district as well. WPV1 has also been isolated in stool samples from 27 healthy children (all under the age of 9 years) and one adult, who had been fully immunized for their age as part of ongoing stool sample survey activities. No case of paralytic polio has been reported. In addition to routine acute flaccid paralysis, public health authorities have expanded the surveillance to all age groups, have increased enterovirus surveillance, and are screening aseptic meningitis cases for polio.
A supplementary immunization activity (SIA) with bivalent oral polio vaccine (OPV) [bOPV] started in parts of southern Israel during the week of [5 Aug 2013], and a nationwide campaign is planned for [18 Aug 2013] for children up to the age of 9 years. The objective of these SIAs with OPV is to boost mucosal immunity levels in cohorts of children naive to OPV to rapidly interrupt virus circulation.
It is important that all countries, in particular those with frequent travel and contacts with polio affected countries, strengthen surveillance for cases of acute flaccid paralysis (AFP), in order to rapidly detect any new poliovirus importations and facilitate a rapid response. Countries should also analyze routine immunization coverage data to identify any subnational gaps in population immunity to guide catch-up immunization activities and thereby minimize the consequences of any new virus introduction. Priority should be given to areas at high risk of importations and where OPV3/DPT3 vaccine coverage is less than 80 per cent.
WHO's International Travel and Health recommends that all travellers to and from poliovirus-affected areas be fully vaccinated against polio. A total of 3 countries remain endemic for indigenous transmission of WPV: Nigeria, Pakistan and Afghanistan. In addition, in 2013, the Horn of Africa has been affected by an outbreak of WPV1.
--
communicated by:
ProMED-mail rapporteur Marianne Hopp
[While IPV (inactivated poliovirus vaccine) is an excellent and safe vaccine against polio that protects the individual vaccinated, the production of local immunity [in the gastrointestinal tract] to prevent excretion of the wild poliovirus (WPV) after a vaccinated individual is exposed and infected with the WPV is less than optimal. Hence, the decision to use OPV in the Israeli setting makes sense to assist in interruption of circulation of the WPV. The fact that WPV has been identified in 27 fully vaccinated children further supports the decision to use OPV in Israel.
For the HealthMap/ProMED map of Israel, see http://healthmap.org/r/1z-1. - Mod.MPP]
******
[3] Global update - Polio Eradication Initiative
Date: Tue 13 Aug 2013
Source: Global Polio Eradication Initiative [edited]
http://www.polioeradication.org/Dataand ... sweek.aspx
Global Polio Eradication Initiative update as of 13 Aug 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 181 / 121 / 223
- in endemic countries: 71 / 116 / 217
- in non-endemic countries: 110 / 5 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 24 / 0 / 0 / 24 // 26 / 2 / 1 / 29 / 58 // 13 Jul 2013
Afghanistan: 4 / 0 / 0 / 4 // 17 / 0 / 0 / 17 / 37 // 23 Jul 2013
Nigeria: 43 / 0 / 0 / 43 // 55 / 15 / 0 / 70 / 122 // 23 Jul 2013
Somalia: 100 / 0 / 0 / 100 // 0 / 0 / 0 / 0 / 0 // 10 Jul 2013
Kenya: 10 / 0 / 0 / 10 // 0 / 0 / 0 / 0 / 0 // 6 Jul 2013
Chad: 0 / 0 / 0 / 0 // 5 / 0 / 0 / 5 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 181 / 0 / 0 / 181 // 103 / 17 / 1 / 121 / 223
Total in endemic countries: 71 / 0 / 0 / 71 // 98 / 17 / 1 / 116 / 217
Total outbreak: 110 / 0 / 0 / 110 // 5 / 0 / 0 / 5 / 6
Data in WHO as of 14 Aug 2012 for 2012 data and 13 Aug 2013 for 2013 data.
Highlights of this week:
Afghanistan
-----------
- No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains 3. The most recent WPV case had onset of paralysis on [6 Jun 2013] (WPV1 from Nangarhar).
- All 3 WPV cases this year [2013] were reported from Eastern Region. In the high-risk Southern Region, no WPV cases have been reported since November 2012.
- No new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
- Subnational immunization days (SNIDs) were held on [1-3 Jul 2013], with resources focusing on Southern and Eastern Regions. Planning is under way for nationwide activities in late August [2013].
Nigeria
-------
- One new WPV1 case was reported in the past week, bringing the total of WPV1 cases for 2013 to 43. It is the most recent WPV1 case in the country and had onset of paralysis on [23 Jul 2013] (from Borno).
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (with onset of paralysis on [6 Jun 2013] from Borno). Although this cVDPV2 case is linked to cVDPV2 currently circulating in Chad which has also been detected in Cameroon, cVDPV2 linked to this transmission chain had previously been isolated from an environmental sample in Kano in March [2013] (indicating circulation in Nigeria).
- Nearly half of all WPV1 cases in the country this year [2013] are from Borno and Yobe state. As many as 35 per cent of children in these states remain under-immunized. This compares to other high-risk states of northern Nigeria (such as Kano, Jigawa, Katsina and Kaduna), where fewer than 20 per cent of children remain under-immunized.
- Targeted approaches are being implemented in those Local Government Areas (LGAs) of Borno and Yobe where access is hampered due to insecurity. However, the majority of LGAs in both states continue to participate during campaigns.
- Tailored approaches are also focusing on LGAs where performance has stalled, and those where performance has decreased.
- Across all areas, strengthened efforts are being made to track the direct engagement and oversight of eradication activities by LGA chairpersons.
- The engagement of communities, and traditional and religious leaders is continuing to be fostered.
- The Volunteer Community Mobilizer Network continues to be expanded, and social data analysis is expected to provide further understanding of why children are missed repeatedly. Innovative social mobilization activities being rolled out are: working with polio survivors' networks as advocates, use of smart phones for data collection and analysis, distribution of pro-OPV messages on CD ROM and DVD, and supporting social mobilization for measles SIAs.
- The next subnational Immunization Plus Days (IPDs) are planned across northern states in September [2013].
Pakistan
--------
- Two new WPV1 cases were reported in the past week (from North Waziristan, Federally Administered Tribal Areas - FATA; and, Gadap, Sindh), bringing the total number of WPV1 cases for 2013 to 24. The case from North Waziristan is the most recent WPV1 case in the country, and had onset of paralysis on [13 Jul 2013].
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 6. The most recent cVDPV2 case had onset of paralysis on [30 Jun 2013] (from North Waziristan).
- The case from Gadap is the 1st in greater Karachi since January [2013]. However, in 2013, 5 positive environmental samples (WPV1) were confirmed from Gadap, the most recent from [8 Jul 2013].
- FATA remains the major poliovirus reservoir in Pakistan, both due to WPV1 and cVDPV2. Khyber Agency is particularly affected, accounting for 14 of this year's 24 WPV1 cases in the country (9 of which from Khyber Agency); FATA also accounts for 3 of this year's 6 cVDPV2 cases (all from North Waziristan). North Waziristan is an area where immunization campaigns have been suspended by local leaders since June 2012.
- To minimize the risk of a major WPV1 and/or cVDPV2 outbreak in this area, it is critical that access to children is granted as quickly as possible. Immunization campaigns in neighbouring high-risk areas are being intensified, to further boost population immunity levels in those areas and minimize the risk of further spread.
Chad, Cameroon and Central African Republic
-------------------------------------------
- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac).
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 4 (the most recent cVDPV2 case had onset of paralysis on [12 May 2013] from Ennedi).
- The 4 cVDPV2 cases were reported from various parts of the country, indicating widespread transmission. In some areas, only one immunization round has been conducted in response. A more comprehensive outbreak response to these cVDPV2 cases must be planned and implemented. The risk of further spread within Chad and further international spread remains high (cVDPV2 circulating in Chad has also been detected in Cameroon and Nigeria).
- In Cameroon, no new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 2. The most recent cVDPV2 case had onset of paralysis on [27 May 2013] (from Extreme-Nord).
- Central African Republic (CAR) continues to be at risk of re-infection, due to proximity with Chad and in some areas insecurity. To minimize the risk and consequences of potential re-infection, 2 subnational immunization campaigns were conducted in border areas with Chad (in June and July [2013]). Further activities are planned in September [2013].
Horn of Africa
--------------
- No new WPV1 cases were reported in the past week. The total number of WPV1 cases for 2013 remains 110 (100 from Somalia and 10 from Kenya). The most recent WPV1 case in the region had onset of paralysis on [10 Jul 2013] (from Somalia).
- Access in some areas of south-central Somalia remains a significant challenge. Analysis shows that as many as 70 per cent of children in inaccessible areas are under-immunized. This compares to 20 per cent in accessible areas of the country. Of the 100 cases reported from Somalia, 16 are from inaccessible or only partially-accessible areas (10 districts in total, primarily from Lower Shabelle region).
- Special strategies continue to be implemented in particular in the Lower Shabelle region of Somalia, to improve operations in inaccessible areas. Local-level access negotiations are continuing, as are immunizing older age groups and setting up vaccination posts at entry/exit points of inaccessible areas. Community engagement activities continue to foster engagement of all communities in polio eradication activities. Activities include dissemination of public service announcements (PSAs), partnership with organized religious, youth and women's groups, vaccinator training, media workshops and bulk SMS distribution. The Somali National Women's Association continues to disseminate key messages about the dangers of polio and the benefits of OPV.
- In Kenya, the priority remains on increasing immunity levels in the Dadaab area of North Eastern province. Nearly 50 per cent of children in this area remain under-immunized (compared with less than 5 per cent in Kenya in general).
- The overriding objective remains stopping the outbreak in the affected areas. In addition, the comprehensive outbreak response plan is focusing on protecting populations at high risk, increasing operations in inaccessible areas, and protecting remaining areas across the Horn of Africa. Human resource capacity continues to be scaled up to support outbreak response activities.
- Within this strategic emergency outbreak response context, immunization campaigns across the Horn of Africa, including in Ethiopia and Yemen, are continuing in the 2nd half of August [2013].
West Africa
-----------
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
- Multi-country immunization campaigns are planned in West Africa for mid-October and mid-November [2013], as well as subnational campaigns in Niger in September [2013].
--
communicated by:
ProMED-mail
<promed@promedmail.org>
[According to the most recent data available on the Global Polio Eradication Initiative website, there has been an increase of 11 newly identified WPV cases globally since our last global update data from 31 Jul 2013 (Poliomyelitis update (16): Israel, Somalia, Global 20130801.1854632) from 170 cases to 181 cases.
Of concern is the persistent transmission of WPV in the 3 remaining endemic countries, where, in addition to the known circulation of the WPV, there has been circulating vaccine derived polioviruses as well (cVDPV), and persistent foci of insecurity hampering vaccination and surveillance activities.
In addition, the continued circulation of the WPV in Somalia with a similar situation of areas of insecurity where there are challenges to vaccination and surveillance activities.
For a map of the world showing the locations of WPV confirmed associated cases, see http://www.polioeradication.org/Dataandmonitoring.aspx. - Mod.MPP]
**************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
In this update:
[1] Somalia - increased cases, newswire
[2] Israel - update, WHO
[3] Global update - Polio Eradication Initiative
******
[1] Somalia - increased cases, newswire
Date: Fri 16 Aug 2013
Source: IOL News, South African Press Association/AFP report [edited]
http://www.iol.co.za/news/africa/somali ... g5SDNK-2So
Aid workers in war-torn Somalia are struggling to contain a dangerous outbreak of the crippling poliovirus, with rampant insecurity hampering efforts, the United Nations said on Friday [16 Aug 2013].
[In 2013], 6 years after the Horn of Africa nation was declared free of the virus, at least 105 cases have been confirmed in Somalia, the "worst outbreak in the world in a non-endemic country", the UN Office for the Coordination of Humanitarian Affairs (OCHA) said in a statement. "The polio outbreak plaguing Somalia has spread despite significant efforts to curb the disease," OCHA added.
While 4 million people have been vaccinated, getting drugs to more than 600 000 children in southern and central Somalia -- areas partly under control of the al-Qaeda linked Al-Shabaab, who block vaccination efforts -- is "extremely challenging", it added.
"The inability to fully access these areas constitutes a major threat to the control of the outbreak," the statement read, warning that "Somalia remains one of the most difficult and dangerous environments in the world for aid workers".
While over 100 cases of children have been recorded, "the fact that this number of children show symptoms of paralysis means that there are probably thousands more with the virus, who do not have symptoms, but are capable of spreading it", OCHA added. [In studies done in earlier years of high poliovirus circulation, for every paralytic case of polio identified there were between 50 and 1000, with an average of 200 individuals, who were infected with the poliovirus without paralytic disease. - Mod.MPP]
Around 10 cases have also been reported in north eastern Kenya, which hosts almost half a million Somali refugees in sprawling camps.
In Somalia, while the bulk of cases are in the southern and central regions, the outbreak has also spread to self-declared independent Somaliland in the north-west.
Polio is spread by person-to-person contact, exacerbated by poor sanitation and a lack of clean water.
Multiple armies are fighting for control of southern Somalia, including rival warlords, Islamist extremists and a rag-tag national army backed by a 17 700 strong AU [African Union] force.
Aid workers report growing attacks on their staff. On Thursday [15 Aug 2013], the medical aid agency Medecins sans Frontieres (MSF; Doctors Without Borders) closed all its operations in Somalia after 22 years of working in the Horn of Africa troublespot, warning of growing insecurity and "extreme attacks".
The withdrawal by MSF, an aid agency that has earned a reputation for working in the toughest of conditions, will cut health care for hundreds of thousands of Somalis. MSF blamed "armed groups and civilian leaders" who it said "increasingly support, tolerate, or condone the killing, assaulting, and abducting of humanitarian aid workers".
--
communicated by:
ProMED-mail from HealthMap Alerts
<promed@promedmail.org>
[This newswire was included in this update to highlight the challenges existing in Somalia vis a vis security concerns for polio eradication efforts -- both in terms of vaccination activities and surveillance activities. Hence, while it appears as though this area has fewer cases, it is possible there is underreporting due to security concerns as well. The withdrawal of MSF from the area is a significant setback for delivery of services in the area.
For the HealthMap/ProMED map of Somalia, see http://healthmap.org/r/1Ahv. - Mod.MPP]
******
[2] Israel - update, WHO
Date: Thu 15 Aug 2013
Source: WHO Global Alert and Response [edited]
http://www.who.int/csr/don/2013_08_15/en/index.html
Poliovirus detected from environmental samples in Israel -- update -- 15 Aug 2013
---------------------------------------------------------------------------
The World Health Organization (WHO) estimates the risk of further international spread of wild poliovirus type 1 (WPV1) from Israel to remain moderate to high. This risk assessment reflects evidence of increasing geographic extent of circulation over a prolonged period of time.
WPV1 has been detected in 67 sewage samples from 24 sampling sites in Israel, collected from [3 Feb 2013 to 4 Aug 2013]. Initially restricted to southern Israel, WPV1 has now also been detected in the central district as well. WPV1 has also been isolated in stool samples from 27 healthy children (all under the age of 9 years) and one adult, who had been fully immunized for their age as part of ongoing stool sample survey activities. No case of paralytic polio has been reported. In addition to routine acute flaccid paralysis, public health authorities have expanded the surveillance to all age groups, have increased enterovirus surveillance, and are screening aseptic meningitis cases for polio.
A supplementary immunization activity (SIA) with bivalent oral polio vaccine (OPV) [bOPV] started in parts of southern Israel during the week of [5 Aug 2013], and a nationwide campaign is planned for [18 Aug 2013] for children up to the age of 9 years. The objective of these SIAs with OPV is to boost mucosal immunity levels in cohorts of children naive to OPV to rapidly interrupt virus circulation.
It is important that all countries, in particular those with frequent travel and contacts with polio affected countries, strengthen surveillance for cases of acute flaccid paralysis (AFP), in order to rapidly detect any new poliovirus importations and facilitate a rapid response. Countries should also analyze routine immunization coverage data to identify any subnational gaps in population immunity to guide catch-up immunization activities and thereby minimize the consequences of any new virus introduction. Priority should be given to areas at high risk of importations and where OPV3/DPT3 vaccine coverage is less than 80 per cent.
WHO's International Travel and Health recommends that all travellers to and from poliovirus-affected areas be fully vaccinated against polio. A total of 3 countries remain endemic for indigenous transmission of WPV: Nigeria, Pakistan and Afghanistan. In addition, in 2013, the Horn of Africa has been affected by an outbreak of WPV1.
--
communicated by:
ProMED-mail rapporteur Marianne Hopp
[While IPV (inactivated poliovirus vaccine) is an excellent and safe vaccine against polio that protects the individual vaccinated, the production of local immunity [in the gastrointestinal tract] to prevent excretion of the wild poliovirus (WPV) after a vaccinated individual is exposed and infected with the WPV is less than optimal. Hence, the decision to use OPV in the Israeli setting makes sense to assist in interruption of circulation of the WPV. The fact that WPV has been identified in 27 fully vaccinated children further supports the decision to use OPV in Israel.
For the HealthMap/ProMED map of Israel, see http://healthmap.org/r/1z-1. - Mod.MPP]
******
[3] Global update - Polio Eradication Initiative
Date: Tue 13 Aug 2013
Source: Global Polio Eradication Initiative [edited]
http://www.polioeradication.org/Dataand ... sweek.aspx
Global Polio Eradication Initiative update as of 13 Aug 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 181 / 121 / 223
- in endemic countries: 71 / 116 / 217
- in non-endemic countries: 110 / 5 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 24 / 0 / 0 / 24 // 26 / 2 / 1 / 29 / 58 // 13 Jul 2013
Afghanistan: 4 / 0 / 0 / 4 // 17 / 0 / 0 / 17 / 37 // 23 Jul 2013
Nigeria: 43 / 0 / 0 / 43 // 55 / 15 / 0 / 70 / 122 // 23 Jul 2013
Somalia: 100 / 0 / 0 / 100 // 0 / 0 / 0 / 0 / 0 // 10 Jul 2013
Kenya: 10 / 0 / 0 / 10 // 0 / 0 / 0 / 0 / 0 // 6 Jul 2013
Chad: 0 / 0 / 0 / 0 // 5 / 0 / 0 / 5 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 181 / 0 / 0 / 181 // 103 / 17 / 1 / 121 / 223
Total in endemic countries: 71 / 0 / 0 / 71 // 98 / 17 / 1 / 116 / 217
Total outbreak: 110 / 0 / 0 / 110 // 5 / 0 / 0 / 5 / 6
Data in WHO as of 14 Aug 2012 for 2012 data and 13 Aug 2013 for 2013 data.
Highlights of this week:
Afghanistan
-----------
- No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains 3. The most recent WPV case had onset of paralysis on [6 Jun 2013] (WPV1 from Nangarhar).
- All 3 WPV cases this year [2013] were reported from Eastern Region. In the high-risk Southern Region, no WPV cases have been reported since November 2012.
- No new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
- Subnational immunization days (SNIDs) were held on [1-3 Jul 2013], with resources focusing on Southern and Eastern Regions. Planning is under way for nationwide activities in late August [2013].
Nigeria
-------
- One new WPV1 case was reported in the past week, bringing the total of WPV1 cases for 2013 to 43. It is the most recent WPV1 case in the country and had onset of paralysis on [23 Jul 2013] (from Borno).
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (with onset of paralysis on [6 Jun 2013] from Borno). Although this cVDPV2 case is linked to cVDPV2 currently circulating in Chad which has also been detected in Cameroon, cVDPV2 linked to this transmission chain had previously been isolated from an environmental sample in Kano in March [2013] (indicating circulation in Nigeria).
- Nearly half of all WPV1 cases in the country this year [2013] are from Borno and Yobe state. As many as 35 per cent of children in these states remain under-immunized. This compares to other high-risk states of northern Nigeria (such as Kano, Jigawa, Katsina and Kaduna), where fewer than 20 per cent of children remain under-immunized.
- Targeted approaches are being implemented in those Local Government Areas (LGAs) of Borno and Yobe where access is hampered due to insecurity. However, the majority of LGAs in both states continue to participate during campaigns.
- Tailored approaches are also focusing on LGAs where performance has stalled, and those where performance has decreased.
- Across all areas, strengthened efforts are being made to track the direct engagement and oversight of eradication activities by LGA chairpersons.
- The engagement of communities, and traditional and religious leaders is continuing to be fostered.
- The Volunteer Community Mobilizer Network continues to be expanded, and social data analysis is expected to provide further understanding of why children are missed repeatedly. Innovative social mobilization activities being rolled out are: working with polio survivors' networks as advocates, use of smart phones for data collection and analysis, distribution of pro-OPV messages on CD ROM and DVD, and supporting social mobilization for measles SIAs.
- The next subnational Immunization Plus Days (IPDs) are planned across northern states in September [2013].
Pakistan
--------
- Two new WPV1 cases were reported in the past week (from North Waziristan, Federally Administered Tribal Areas - FATA; and, Gadap, Sindh), bringing the total number of WPV1 cases for 2013 to 24. The case from North Waziristan is the most recent WPV1 case in the country, and had onset of paralysis on [13 Jul 2013].
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 6. The most recent cVDPV2 case had onset of paralysis on [30 Jun 2013] (from North Waziristan).
- The case from Gadap is the 1st in greater Karachi since January [2013]. However, in 2013, 5 positive environmental samples (WPV1) were confirmed from Gadap, the most recent from [8 Jul 2013].
- FATA remains the major poliovirus reservoir in Pakistan, both due to WPV1 and cVDPV2. Khyber Agency is particularly affected, accounting for 14 of this year's 24 WPV1 cases in the country (9 of which from Khyber Agency); FATA also accounts for 3 of this year's 6 cVDPV2 cases (all from North Waziristan). North Waziristan is an area where immunization campaigns have been suspended by local leaders since June 2012.
- To minimize the risk of a major WPV1 and/or cVDPV2 outbreak in this area, it is critical that access to children is granted as quickly as possible. Immunization campaigns in neighbouring high-risk areas are being intensified, to further boost population immunity levels in those areas and minimize the risk of further spread.
Chad, Cameroon and Central African Republic
-------------------------------------------
- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac).
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 4 (the most recent cVDPV2 case had onset of paralysis on [12 May 2013] from Ennedi).
- The 4 cVDPV2 cases were reported from various parts of the country, indicating widespread transmission. In some areas, only one immunization round has been conducted in response. A more comprehensive outbreak response to these cVDPV2 cases must be planned and implemented. The risk of further spread within Chad and further international spread remains high (cVDPV2 circulating in Chad has also been detected in Cameroon and Nigeria).
- In Cameroon, no new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 2. The most recent cVDPV2 case had onset of paralysis on [27 May 2013] (from Extreme-Nord).
- Central African Republic (CAR) continues to be at risk of re-infection, due to proximity with Chad and in some areas insecurity. To minimize the risk and consequences of potential re-infection, 2 subnational immunization campaigns were conducted in border areas with Chad (in June and July [2013]). Further activities are planned in September [2013].
Horn of Africa
--------------
- No new WPV1 cases were reported in the past week. The total number of WPV1 cases for 2013 remains 110 (100 from Somalia and 10 from Kenya). The most recent WPV1 case in the region had onset of paralysis on [10 Jul 2013] (from Somalia).
- Access in some areas of south-central Somalia remains a significant challenge. Analysis shows that as many as 70 per cent of children in inaccessible areas are under-immunized. This compares to 20 per cent in accessible areas of the country. Of the 100 cases reported from Somalia, 16 are from inaccessible or only partially-accessible areas (10 districts in total, primarily from Lower Shabelle region).
- Special strategies continue to be implemented in particular in the Lower Shabelle region of Somalia, to improve operations in inaccessible areas. Local-level access negotiations are continuing, as are immunizing older age groups and setting up vaccination posts at entry/exit points of inaccessible areas. Community engagement activities continue to foster engagement of all communities in polio eradication activities. Activities include dissemination of public service announcements (PSAs), partnership with organized religious, youth and women's groups, vaccinator training, media workshops and bulk SMS distribution. The Somali National Women's Association continues to disseminate key messages about the dangers of polio and the benefits of OPV.
- In Kenya, the priority remains on increasing immunity levels in the Dadaab area of North Eastern province. Nearly 50 per cent of children in this area remain under-immunized (compared with less than 5 per cent in Kenya in general).
- The overriding objective remains stopping the outbreak in the affected areas. In addition, the comprehensive outbreak response plan is focusing on protecting populations at high risk, increasing operations in inaccessible areas, and protecting remaining areas across the Horn of Africa. Human resource capacity continues to be scaled up to support outbreak response activities.
- Within this strategic emergency outbreak response context, immunization campaigns across the Horn of Africa, including in Ethiopia and Yemen, are continuing in the 2nd half of August [2013].
West Africa
-----------
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
- Multi-country immunization campaigns are planned in West Africa for mid-October and mid-November [2013], as well as subnational campaigns in Niger in September [2013].
--
communicated by:
ProMED-mail
<promed@promedmail.org>
[According to the most recent data available on the Global Polio Eradication Initiative website, there has been an increase of 11 newly identified WPV cases globally since our last global update data from 31 Jul 2013 (Poliomyelitis update (16): Israel, Somalia, Global 20130801.1854632) from 170 cases to 181 cases.
Of concern is the persistent transmission of WPV in the 3 remaining endemic countries, where, in addition to the known circulation of the WPV, there has been circulating vaccine derived polioviruses as well (cVDPV), and persistent foci of insecurity hampering vaccination and surveillance activities.
In addition, the continued circulation of the WPV in Somalia with a similar situation of areas of insecurity where there are challenges to vaccination and surveillance activities.
For a map of the world showing the locations of WPV confirmed associated cases, see http://www.polioeradication.org/Dataandmonitoring.aspx. - Mod.MPP]
-
Birgitt
- Moderator
- Beiträge: 35230
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Kinderlähmung - Poliomyelitis in Somalia
Somalia - Poliomyelitis
20.08.2013
Im April ist erneut Wildvirus Typ 1 aufgetreten. Insgesamt sind seit dem Ausbruch 105 Kinder erkrankt. Polio war zuvor nach Reimport von Wildvirus Typ 1 im Juli 2005 in Zirkulation gegangen. Trotz schwieriger Umstände gelang zunächst eine Eradikation im ganzen Land; die letzten Fälle datierten aus dem 1. Quartal 2007. Somalia galt von April 2008 bis April 2013 als poliofrei. Hygiene und Impfschutz beachten. / Quelle: crm
Gruß
Birgitt
20.08.2013
Im April ist erneut Wildvirus Typ 1 aufgetreten. Insgesamt sind seit dem Ausbruch 105 Kinder erkrankt. Polio war zuvor nach Reimport von Wildvirus Typ 1 im Juli 2005 in Zirkulation gegangen. Trotz schwieriger Umstände gelang zunächst eine Eradikation im ganzen Land; die letzten Fälle datierten aus dem 1. Quartal 2007. Somalia galt von April 2008 bis April 2013 als poliofrei. Hygiene und Impfschutz beachten. / Quelle: crm
Gruß
Birgitt
-
Birgitt
- Moderator
- Beiträge: 35230
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Kinderlähmung - Poliomyelitis weltweit
POLIOMYELITIS UPDATE (20): ETHIOPIA, GLOBAL
*******************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
In this update:
[1] Ethiopia
[2] Africa, Asia - eradication challenges
[3] Global update - Polio Eradication Initiative
******
[1] Ethiopia
Date: Thu 22 Aug 2013
Source: Voice of America [edited]
http://www.voanews.com/content/polio-sp ... 35218.html
A polio outbreak on the Horn of Africa has spread to Ethiopia.
An 18-month-old child in the Warder district [in Somali state] of Ethiopia is the country's 1st polio case since 2008.
Warder district is just across the border from Somalia, where 108 polio cases have been reported this year [2013].
Carol Pandak heads Rotary International's polio eradication program.
"It's not surprising that the virus is spreading. This area has been considered high risk because of its proximity to Somalia," said Pandak.
A Somali refugee camp in Kenya has also seen 12 cases of the paralyzing disease this year [2013].
The outbreak began in Somalia in May [2013], when a 2-year-old girl came down with the disease, the country's 1st since 2007 [see prior ProMED-mail posts below].
But this strain of the virus did not originate there, Pandak says.
"That virus comes from West Africa. And so, we need to deal with the remaining endemic countries because that's where the virus originates. And so, you have to deal with both at the same time," she said.
Nigeria, Pakistan and Afghanistan are the last 3 countries where the poliovirus is still endemic.
[Byline: Steve Baragona]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[Unfortunately, the concerns that the ongoing outbreak of polio in Somalia and the Dadaab region of Kenya (where there are Somali refugees) would potentially spread to Ethiopia were valid, as the 1st case of wild poliovirus (WPV) associated disease has been confirmed in a child in Ethiopia living in a district on the border with Somalia. The population movement in the Horn of Africa has seen prior WPV outbreaks involving Somalia, Ethiopia, Kenya and extension to Yemen; hence the major concerns about continued spread and transmission of the WPV.
As mentioned in the global polio update from the Polio Eradication Initiative website (see [3] below), the involved areas have a high percentage of incompletely vaccinated children, thereby leading to pools of susceptibles where the WPV can be easily transmitted.
For the map of Ethiopia showing the districts, see http://www.mapsofworld.com/ethiopia/eth ... l-map.html. For the HealthMap/ProMED map of Ethiopia, see http://healthmap.org/r/1Ahu. - Mod.MPP]
******
[2] Africa, Asia - eradication challenges
Date: Thu 22 Aug 2013
Source: The New York Times [edited]
http://www.nytimes.com/2013/08/23/healt ... nents.html
The global effort to eradicate polio, a disease that has been on the brink of extinction for years, is facing serious setbacks on 2 continents. The virus is surging in Somalia and the Horn of Africa, which had been largely free of cases for several years. And a new outbreak has begun in a part of Pakistan that a warlord declared off limits to vaccinators 14 months ago.
The African outbreak began in May [2013] with just 2 cases of polio paralysis: one in Mogadishu, Somalia's capital, and another in the huge Dadaab refugee camp in Kenya, where thousands of Somalis have fled fighting between Islamic militants, clan militias, government troops and African peacekeepers.
Now there are 121 cases in the region; last year [2012], there were only 223 in the world.
The new Pakistan outbreak is in North Waziristan, near the frontier with Afghanistan. It is in an area where a warlord banned polio vaccinations after it was disclosed that the CIA [Central Intelligence Agency] had staged a hepatitis vaccination campaign in its hunt for Osama bin Laden. The warlord, Hafiz Gul Bahadur, banned all efforts until American drone strikes ended.
Although only 3 North Waziristan children have suffered polio paralysis since then, even one case shows that the virus is in the area and could spread.
The new outbreaks may delay a recently announced USD 5.5 billion plan to eradicate polio by 2018. Nonetheless, public health officials still believe that, with enough local political will and donor money, they can prevail by using techniques that have worked before.
To prevent the disease from reaching Mecca during next month's hajj, Saudi Arabia has tightened its rules. Pilgrims from any country with polio cases must be vaccinated at home and again on arrival. Last year [2012], nearly 500 000 pilgrims were vaccinated on arrival, Dr. Ziad A. Memish, the Saudi deputy health minister, said recently.
The Pakistan outbreak is particularly frustrating because eradication had been going steadily forward despite the killings in December [2012] of 9 vaccinators.
Public health officials had counted themselves lucky that despite simultaneous vaccination bans in North and South Waziristan, no polio virus was known to be circulating in the 250 000 children in those areas. Vaccination posts were set up on nearby highways and on buses and trains. Urban hospitals packed the vaccine on ice for families willing to smuggle it back to neighbors. But it was not enough.
"The equation is simple," said Dr. Elias Durry, emergency coordinator for polio eradication in Pakistan for the World Health Organization [WHO]. "Where you can immunize, the virus goes away. Where you can't, the virus gets in, and it will paralyze these poor kids."
Dr. Durry said he hoped that parents whose children were paralyzed would speak up at local decision-making councils, called shuras, that are common in tribal areas, and possibly put pressure on warlords to rescind the ban.
Before the Waziristan outbreak, Pakistan had seen only 24 cases this year [2013], about as many as it had at the same point in 2012. Most were around Karachi and Peshawar, where last year's [2012] killings of the vaccinators took place and where resistance to vaccines is highest.
The Somali outbreak is different. There is little opposition to the vaccine itself, said Dr. Bruce Aylward, the WHO assistant director general for polio. In several Muslim countries, including Pakistan, the drive has been hurt by rumors that the vaccine sterilizes girls or contains the virus that causes AIDS or pork products.
But, he said, many cases are in areas south of Mogadishu where the Shabab, a militant group, operate. The group opposes mass campaigns because it believes the sight of thousands of vaccinators going house to house would undercut its claim to rule those areas.
"It's all about control," Dr. Aylward said.
Instead, the campaign negotiates with local chiefs and midlevel Shabab members to hold small drives.
Other tactics have changed, too: children of any age, and sometimes adults, get the drops, and drives are held twice a month instead of every 3 months.
Refugee camps face other obstacles. Large ones often have lawless areas on their fringes where vaccinators may fear to work because of predatory criminals.
"When this started, I said, 'Brace yourself for hundreds of cases,'" Dr. Aylward said, because he knew that few children born in the last 5 years had been immunized.
Still, he said he believed this outbreak could be beaten because it echoed the one that plagued the region from 2005 to 2007. It also began in Mogadishu, and it spread as far as Yemen and Eritrea and paralyzed about 700 children before multiple mass vaccination rounds snuffed it out. Kenya, Yemen and Ethiopia are already planning those with help from Geneva.
Somalia is so dangerous for health workers that Doctors Without Borders pulled out of the country this month [August 2013] after 22 years there. But polio officials hope their campaign will not be targeted, largely because it creates thousands of temporary paying jobs for "volunteer" vaccinators.
In Mogadishu in July [2013], President Hassan Sheik Mohamud publicly took polio drops at an event encouraging parents to vaccinate.
[A 38-year-old] mother of 4 changed her attitude. "I was thinking the vaccine might sicken our children," she said. "I realized later that it was good."
[A 26-year-old woman] said she accepted it "because I don't want this serious disease to cripple my children."
But [another woman], in a different Mogadishu neighborhood, said her husband had forbidden vaccination, believing it causes "a mysterious disease."
[Byline: Donald G. McNeil Jr.; Mohammed Ibrahim contributed reporting from Mogadishu, Somalia.]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The common themes in this article are the challenges faced by the polio eradication initiative related to areas of insecurity for vaccination efforts to reach the target population for vaccinations, and the politicization of the vaccination efforts. While the rumors that are circulating in the various areas are different, the outcome of these rumors is the same -- suspicion on the part of the population that the vaccines are being used to harm the children rather than to help the children; and the fact that this type of rumor mongering activities has been ongoing in the endemic countries on 2 different continents -- Africa (Nigeria) and Asia (Afghanistan and Pakistan). This moderator remembers the days when both sides of warring factions would lay down their arms to permit national vaccination efforts to occur, and would help out in making sure the vaccinators could reach their target populations. Today's environment is the opposite, where warring factions spread rumors to disrupt activities, and threaten the safety of individuals in the area, both the safety of the healthcare workers and that of the population that might choose to get vaccinated -- a very sad and sorry state of affairs that is difficult to understand.
For a map showing the locations of all confirmed WPV cases globally, see the Polio Eradication Initiative website: http://www.polioeradication.org/Dataandmonitoring.aspx - Mod.MPP
******
[3] Global update - Polio Eradication Initiative
Date: Wed 21 Aug 2013
Source: Global Polio Eradication Initiative [edited]
http://www.polioeradication.org/Dataand ... sweek.aspx
Global Polio Eradication Initiative update as of 21 Aug 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 192 / 123 / 223
- in endemic countries: 71 / 118 / 217
- in non-endemic countries: 121 / 5 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 24 / 0 / 0 / 24 // 26 / 2 / 1 / 29 / 58 // 13 Jul 2013
Afghanistan: 4 / 0 / 0 / 4 // 17 / 0 / 0 / 17 / 37 // 23 Jul 2013
Nigeria: 43 / 0 / 0 / 43 // 57 / 15 / 0 / 72 / 122 // 23 Jul 2013
Somalia: 108 / 0 / 0 / 108 // 0 / 0 / 0 / 0 / 0 // 10 Jul 2013
Ethiopia: 1 / 0 / 0 / 1 // 0 / 0 / 0 / 0 / 0 // 10 Jul 2013
Kenya: 12 / 0 / 0 / 12 // 0 / 0 / 0 / 0 / 0 // 14 Jul 2013
Chad: 0 / 0 / 0 / 0 // 5 / 0 / 0 / 5 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 192 / 0 / 0 / 192 // 105 / 17 / 1 / 123 / 223
Total in endemic countries: 71 / 0 / 0 / 71 // 100 / 17 / 1 / 118 / 217
Total outbreak: 121 / 0 / 0 / 121 // 5 / 0 / 0 / 5 / 6
Data in WHO as of 21 Aug 2012 for 2012 data and 20 Aug 2013 for 2013 data.
Highlights of this week:
- In Ethiopia, a case of WPV1 has been detected in an 18-month-old child from the Somali Region (Warder district).
- In Israel, WPV1 has been detected in 68 sewage samples collected from [3 Feb 2013] to [16 Aug 2013] from 24 sampling sites.
- In Somalia, 8 new WPV1 cases have been reported this week from previously infected districts.
Afghanistan
-----------
- No new WPV case was reported in the past week.
- All 4 WPV cases this year [2013] were reported from Eastern Region. The most recent WPV1 case had onset of paralysis on [23 Jul 2013] from Kunar province. In the high-risk Southern Region, no WPV cases have been reported since November 2012.
- No WPV3 has been detected in Afghanistan since April 2010.
- No new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
- Subnational immunization days (SNIDs) were held on [1-3 Jul 2013], with resources focusing on Southern and Eastern Regions. Planning is underway for nationwide SIAs in late August [2013].
Nigeria
-------
- No new WPV case was reported in the past week. The total of WPV1 cases for 2013 remains 43. The most recent WPV1 case in the country had onset of paralysis on [23 Jul 2013] (from Borno).
- The most recent WPV3 detected in Nigeria was in November 2012.
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (with onset of paralysis on [6 Jun 2013] from Borno).
- Nearly half of all WPV1 cases in the country this year are from Borno and Yobe state. As many as 35 percent of children in these states remain under-immunized. In comparison, in other high-risk states of northern Nigeria (such as Kano, Jigawa, Katsina and Kaduna), fewer than 20 percent of children remain under-immunized.
- Targeted approaches are being implemented in those LGAs of Borno and Yobe where access is hampered due to insecurity.
- Across all areas, strengthened efforts are being made to track the direct engagement and oversight of eradication activities by LGA Chairpersons, and traditional and religious leaders.
- The next subnational Immunization Plus Days (IPDs) are planned across northern states in September [2013].
Pakistan
--------
- No new WPV cases have been reported in the past week. The total number of WPV1 cases for 2013 is 24. The most recent WPV1 case in the country case is from North Waziristan, and had onset of paralysis on [13 Jul 2013].
- No new WPV3 has been detected in the country since April 2012.
- 1 new cVDPV2 case was reported in the past week from a new district, Mohmand, in FATA [Federally Administered Tribal Areas] with the onset of paralysis on [13 Jul 2013]. The total number of cVDPV2 cases for 2013 is 12.
- FATA remains the major poliovirus reservoir in Pakistan and in Asia, both due to WPV1 and cVDPV2.
Chad, Cameroon and Central African Republic
-------------------------------------------
- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac).
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 4 (the most recent cVDPV2 case had onset of paralysis on [12 May 2013] from Ennedi).
- The 4 cVDPV2 cases were reported from various parts of the country, indicating widespread transmission. In some areas, only one immunization round has been conducted in response. A more comprehensive outbreak response to these cVDPV2 cases must be planned and implemented. The risk of further spread within Chad and further international spread remains high (cVDPV2 circulating in Chad has also been detected in Cameroon and Nigeria).
- In Cameroon, no new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 2. The most recent cVDPV2 case had onset of paralysis on [27 May 2013] (from Extreme-Nord).
- Central African Republic (CAR) continues to be at serious risk of re-infection due to proximity with Chad, ongoing insecurity and humanitarian crises, and destruction of health infrastructure. To minimize the risk and consequences of potential re-infection, 2 subnational immunization campaigns were conducted in June and July [2013]. A SNID is planned for September [2013] and a NID for October [2013].
Horn of Africa
--------------
- 11 new WPV1 cases were reported in the past week -- in previously infected districts in Kenya and Somalia, and in a previously unaffected country, Ethiopia. The total number of WPV1 cases for 2013 is 121 (108 from Somalia, 12 from Kenya, 1 from Ethiopia). The most recent WPV1 case in the region had onset of paralysis on [14 Jul 2013] (from Kenya).
- On [14 Aug 2013], a case of WPV1 was reported in a child living in Ethiopia with date of onset of paralysis of [10 Jul 2013]. The case is an 18-month old child from the Somali Region (Warder district) of Ethiopia who had never been vaccinated with oral polio vaccine (OPV).
- Because of the known routes of poliovirus spread in previous outbreaks in the Horn of Africa, the Somali region of Ethiopia had been considered at 'high risk', and since June [2013], 2 large-scale supplementary immunization activities (SIAs) had already been conducted as part of the broader Horn of Africa outbreak response.
- In Ethiopia, an immediate local immunization campaign is being conducted in the vicinity of the case, with a larger-scale SIA planned targeting 950 000 children under the age of 5 years. Additional SIAs are planned from September to November [2013]. Confirmation of the case in Ethiopia underscores the risk this outbreak continues to pose to countries across the region.
- Access in some areas of south-central Somalia remains a significant challenge. Analysis shows that as many as 70 percent of children in inaccessible areas are under-immunized. This compares to 20 percent in accessible areas of the country. Of the 108 cases reported from Somalia so far, 33 are from inaccessible or only partially-accessible areas; 75 cases are from accessible areas or accessible areas with security challenges.
- In Kenya, the priority remains on increasing immunity levels in the Dadaab area of North Eastern province. Nearly 50 percent of children in this area remain under-immunized (compared to less than 5 percent in Kenya on the whole).
Israel
------
- WPV1 has been detected in 67 sewage samples from 24 sampling sites in Israel, collected from [3 Feb 2013 to 4 Aug 2013]. Initially restricted to southern Israel, WPV1 has now also been detected in environmental sampling sites elsewhere in Israel, indicating widespread transmission throughout the country. No case of paralytic polio has been reported.
- To interrupt WPV1 transmission, a supplementary immunization activity (SIA) with bivalent oral polio vaccine (OPV) targeting children up to the age of 9 years was initiated in the southern district of Israel during the week of [5 Aug 2013]; since [18 Aug 2013], the SIA was expanded to the entire country. The objective of the SIA with OPV is to boost intestinal immunity in children vaccinated with IPV only in order to rapidly interrupt wild poliovirus transmission.
West Africa
-----------
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
- Multi-country immunization campaigns are planned in West Africa for mid-October [2013] and mid-November [2013], as well as subnational campaigns in Niger in September [2013].
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[In the past week since the last global update (13 Aug 2013), the number of cases of confirmed WPV associated disease has increased from 181 to 192 (see Poliomyelitis update (19): Somalia, Israel, global 20130817.1884992). Unfortunately, all of the newly confirmed cases have been outbreak associated, with no new cases confirmed from the 3 endemic countries (Afghanistan, Nigeria, Pakistan).
The number of WPV cases associated with the ongoing outbreak in the Horn of Africa (Somalia, Kenya and now Ethiopia) has increased from 110 to 121 in the past week, with 8 newly confirmed cases in Somalia, 2 in Kenya and one in Ethiopia. The report mentions that as many as 70 percent of children in inaccessible areas are underimmunized. But only 33 of the 108 cases (30.6 percent) have been from these areas. The question that arises is if these areas are inaccessible, could there be more cases occurring in these areas that are not coming to the attention of the health sector. (The same question applies to the inaccessible areas in Afghanistan and Pakistan and other countries with ongoing civil unrest and difficult-to-access locations).
Another worrisome occurrence is the continued spread of WPV northward in Israel. On Tuesday (20 Aug 2013) there was an announcement that WPV had been isolated from sewage sampling in the north -- Baka al-Garbiyeh in the Haifa district (see http://www.haaretz.com/news/national/.premium-1.542639). For a map of Israel showing districts, see http://www.emapsworld.com/images/israel ... ts-map.gif.
For the map showing the geographic locations of all WPV confirmed cases in the world, see http://www.polioeradication.org/Dataandmonitoring.aspx. - Mod.MPP]
*******************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
In this update:
[1] Ethiopia
[2] Africa, Asia - eradication challenges
[3] Global update - Polio Eradication Initiative
******
[1] Ethiopia
Date: Thu 22 Aug 2013
Source: Voice of America [edited]
http://www.voanews.com/content/polio-sp ... 35218.html
A polio outbreak on the Horn of Africa has spread to Ethiopia.
An 18-month-old child in the Warder district [in Somali state] of Ethiopia is the country's 1st polio case since 2008.
Warder district is just across the border from Somalia, where 108 polio cases have been reported this year [2013].
Carol Pandak heads Rotary International's polio eradication program.
"It's not surprising that the virus is spreading. This area has been considered high risk because of its proximity to Somalia," said Pandak.
A Somali refugee camp in Kenya has also seen 12 cases of the paralyzing disease this year [2013].
The outbreak began in Somalia in May [2013], when a 2-year-old girl came down with the disease, the country's 1st since 2007 [see prior ProMED-mail posts below].
But this strain of the virus did not originate there, Pandak says.
"That virus comes from West Africa. And so, we need to deal with the remaining endemic countries because that's where the virus originates. And so, you have to deal with both at the same time," she said.
Nigeria, Pakistan and Afghanistan are the last 3 countries where the poliovirus is still endemic.
[Byline: Steve Baragona]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[Unfortunately, the concerns that the ongoing outbreak of polio in Somalia and the Dadaab region of Kenya (where there are Somali refugees) would potentially spread to Ethiopia were valid, as the 1st case of wild poliovirus (WPV) associated disease has been confirmed in a child in Ethiopia living in a district on the border with Somalia. The population movement in the Horn of Africa has seen prior WPV outbreaks involving Somalia, Ethiopia, Kenya and extension to Yemen; hence the major concerns about continued spread and transmission of the WPV.
As mentioned in the global polio update from the Polio Eradication Initiative website (see [3] below), the involved areas have a high percentage of incompletely vaccinated children, thereby leading to pools of susceptibles where the WPV can be easily transmitted.
For the map of Ethiopia showing the districts, see http://www.mapsofworld.com/ethiopia/eth ... l-map.html. For the HealthMap/ProMED map of Ethiopia, see http://healthmap.org/r/1Ahu. - Mod.MPP]
******
[2] Africa, Asia - eradication challenges
Date: Thu 22 Aug 2013
Source: The New York Times [edited]
http://www.nytimes.com/2013/08/23/healt ... nents.html
The global effort to eradicate polio, a disease that has been on the brink of extinction for years, is facing serious setbacks on 2 continents. The virus is surging in Somalia and the Horn of Africa, which had been largely free of cases for several years. And a new outbreak has begun in a part of Pakistan that a warlord declared off limits to vaccinators 14 months ago.
The African outbreak began in May [2013] with just 2 cases of polio paralysis: one in Mogadishu, Somalia's capital, and another in the huge Dadaab refugee camp in Kenya, where thousands of Somalis have fled fighting between Islamic militants, clan militias, government troops and African peacekeepers.
Now there are 121 cases in the region; last year [2012], there were only 223 in the world.
The new Pakistan outbreak is in North Waziristan, near the frontier with Afghanistan. It is in an area where a warlord banned polio vaccinations after it was disclosed that the CIA [Central Intelligence Agency] had staged a hepatitis vaccination campaign in its hunt for Osama bin Laden. The warlord, Hafiz Gul Bahadur, banned all efforts until American drone strikes ended.
Although only 3 North Waziristan children have suffered polio paralysis since then, even one case shows that the virus is in the area and could spread.
The new outbreaks may delay a recently announced USD 5.5 billion plan to eradicate polio by 2018. Nonetheless, public health officials still believe that, with enough local political will and donor money, they can prevail by using techniques that have worked before.
To prevent the disease from reaching Mecca during next month's hajj, Saudi Arabia has tightened its rules. Pilgrims from any country with polio cases must be vaccinated at home and again on arrival. Last year [2012], nearly 500 000 pilgrims were vaccinated on arrival, Dr. Ziad A. Memish, the Saudi deputy health minister, said recently.
The Pakistan outbreak is particularly frustrating because eradication had been going steadily forward despite the killings in December [2012] of 9 vaccinators.
Public health officials had counted themselves lucky that despite simultaneous vaccination bans in North and South Waziristan, no polio virus was known to be circulating in the 250 000 children in those areas. Vaccination posts were set up on nearby highways and on buses and trains. Urban hospitals packed the vaccine on ice for families willing to smuggle it back to neighbors. But it was not enough.
"The equation is simple," said Dr. Elias Durry, emergency coordinator for polio eradication in Pakistan for the World Health Organization [WHO]. "Where you can immunize, the virus goes away. Where you can't, the virus gets in, and it will paralyze these poor kids."
Dr. Durry said he hoped that parents whose children were paralyzed would speak up at local decision-making councils, called shuras, that are common in tribal areas, and possibly put pressure on warlords to rescind the ban.
Before the Waziristan outbreak, Pakistan had seen only 24 cases this year [2013], about as many as it had at the same point in 2012. Most were around Karachi and Peshawar, where last year's [2012] killings of the vaccinators took place and where resistance to vaccines is highest.
The Somali outbreak is different. There is little opposition to the vaccine itself, said Dr. Bruce Aylward, the WHO assistant director general for polio. In several Muslim countries, including Pakistan, the drive has been hurt by rumors that the vaccine sterilizes girls or contains the virus that causes AIDS or pork products.
But, he said, many cases are in areas south of Mogadishu where the Shabab, a militant group, operate. The group opposes mass campaigns because it believes the sight of thousands of vaccinators going house to house would undercut its claim to rule those areas.
"It's all about control," Dr. Aylward said.
Instead, the campaign negotiates with local chiefs and midlevel Shabab members to hold small drives.
Other tactics have changed, too: children of any age, and sometimes adults, get the drops, and drives are held twice a month instead of every 3 months.
Refugee camps face other obstacles. Large ones often have lawless areas on their fringes where vaccinators may fear to work because of predatory criminals.
"When this started, I said, 'Brace yourself for hundreds of cases,'" Dr. Aylward said, because he knew that few children born in the last 5 years had been immunized.
Still, he said he believed this outbreak could be beaten because it echoed the one that plagued the region from 2005 to 2007. It also began in Mogadishu, and it spread as far as Yemen and Eritrea and paralyzed about 700 children before multiple mass vaccination rounds snuffed it out. Kenya, Yemen and Ethiopia are already planning those with help from Geneva.
Somalia is so dangerous for health workers that Doctors Without Borders pulled out of the country this month [August 2013] after 22 years there. But polio officials hope their campaign will not be targeted, largely because it creates thousands of temporary paying jobs for "volunteer" vaccinators.
In Mogadishu in July [2013], President Hassan Sheik Mohamud publicly took polio drops at an event encouraging parents to vaccinate.
[A 38-year-old] mother of 4 changed her attitude. "I was thinking the vaccine might sicken our children," she said. "I realized later that it was good."
[A 26-year-old woman] said she accepted it "because I don't want this serious disease to cripple my children."
But [another woman], in a different Mogadishu neighborhood, said her husband had forbidden vaccination, believing it causes "a mysterious disease."
[Byline: Donald G. McNeil Jr.; Mohammed Ibrahim contributed reporting from Mogadishu, Somalia.]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[The common themes in this article are the challenges faced by the polio eradication initiative related to areas of insecurity for vaccination efforts to reach the target population for vaccinations, and the politicization of the vaccination efforts. While the rumors that are circulating in the various areas are different, the outcome of these rumors is the same -- suspicion on the part of the population that the vaccines are being used to harm the children rather than to help the children; and the fact that this type of rumor mongering activities has been ongoing in the endemic countries on 2 different continents -- Africa (Nigeria) and Asia (Afghanistan and Pakistan). This moderator remembers the days when both sides of warring factions would lay down their arms to permit national vaccination efforts to occur, and would help out in making sure the vaccinators could reach their target populations. Today's environment is the opposite, where warring factions spread rumors to disrupt activities, and threaten the safety of individuals in the area, both the safety of the healthcare workers and that of the population that might choose to get vaccinated -- a very sad and sorry state of affairs that is difficult to understand.
For a map showing the locations of all confirmed WPV cases globally, see the Polio Eradication Initiative website: http://www.polioeradication.org/Dataandmonitoring.aspx - Mod.MPP
******
[3] Global update - Polio Eradication Initiative
Date: Wed 21 Aug 2013
Source: Global Polio Eradication Initiative [edited]
http://www.polioeradication.org/Dataand ... sweek.aspx
Global Polio Eradication Initiative update as of 21 Aug 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 192 / 123 / 223
- in endemic countries: 71 / 118 / 217
- in non-endemic countries: 121 / 5 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 24 / 0 / 0 / 24 // 26 / 2 / 1 / 29 / 58 // 13 Jul 2013
Afghanistan: 4 / 0 / 0 / 4 // 17 / 0 / 0 / 17 / 37 // 23 Jul 2013
Nigeria: 43 / 0 / 0 / 43 // 57 / 15 / 0 / 72 / 122 // 23 Jul 2013
Somalia: 108 / 0 / 0 / 108 // 0 / 0 / 0 / 0 / 0 // 10 Jul 2013
Ethiopia: 1 / 0 / 0 / 1 // 0 / 0 / 0 / 0 / 0 // 10 Jul 2013
Kenya: 12 / 0 / 0 / 12 // 0 / 0 / 0 / 0 / 0 // 14 Jul 2013
Chad: 0 / 0 / 0 / 0 // 5 / 0 / 0 / 5 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 192 / 0 / 0 / 192 // 105 / 17 / 1 / 123 / 223
Total in endemic countries: 71 / 0 / 0 / 71 // 100 / 17 / 1 / 118 / 217
Total outbreak: 121 / 0 / 0 / 121 // 5 / 0 / 0 / 5 / 6
Data in WHO as of 21 Aug 2012 for 2012 data and 20 Aug 2013 for 2013 data.
Highlights of this week:
- In Ethiopia, a case of WPV1 has been detected in an 18-month-old child from the Somali Region (Warder district).
- In Israel, WPV1 has been detected in 68 sewage samples collected from [3 Feb 2013] to [16 Aug 2013] from 24 sampling sites.
- In Somalia, 8 new WPV1 cases have been reported this week from previously infected districts.
Afghanistan
-----------
- No new WPV case was reported in the past week.
- All 4 WPV cases this year [2013] were reported from Eastern Region. The most recent WPV1 case had onset of paralysis on [23 Jul 2013] from Kunar province. In the high-risk Southern Region, no WPV cases have been reported since November 2012.
- No WPV3 has been detected in Afghanistan since April 2010.
- No new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
- Subnational immunization days (SNIDs) were held on [1-3 Jul 2013], with resources focusing on Southern and Eastern Regions. Planning is underway for nationwide SIAs in late August [2013].
Nigeria
-------
- No new WPV case was reported in the past week. The total of WPV1 cases for 2013 remains 43. The most recent WPV1 case in the country had onset of paralysis on [23 Jul 2013] (from Borno).
- The most recent WPV3 detected in Nigeria was in November 2012.
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (with onset of paralysis on [6 Jun 2013] from Borno).
- Nearly half of all WPV1 cases in the country this year are from Borno and Yobe state. As many as 35 percent of children in these states remain under-immunized. In comparison, in other high-risk states of northern Nigeria (such as Kano, Jigawa, Katsina and Kaduna), fewer than 20 percent of children remain under-immunized.
- Targeted approaches are being implemented in those LGAs of Borno and Yobe where access is hampered due to insecurity.
- Across all areas, strengthened efforts are being made to track the direct engagement and oversight of eradication activities by LGA Chairpersons, and traditional and religious leaders.
- The next subnational Immunization Plus Days (IPDs) are planned across northern states in September [2013].
Pakistan
--------
- No new WPV cases have been reported in the past week. The total number of WPV1 cases for 2013 is 24. The most recent WPV1 case in the country case is from North Waziristan, and had onset of paralysis on [13 Jul 2013].
- No new WPV3 has been detected in the country since April 2012.
- 1 new cVDPV2 case was reported in the past week from a new district, Mohmand, in FATA [Federally Administered Tribal Areas] with the onset of paralysis on [13 Jul 2013]. The total number of cVDPV2 cases for 2013 is 12.
- FATA remains the major poliovirus reservoir in Pakistan and in Asia, both due to WPV1 and cVDPV2.
Chad, Cameroon and Central African Republic
-------------------------------------------
- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac).
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 4 (the most recent cVDPV2 case had onset of paralysis on [12 May 2013] from Ennedi).
- The 4 cVDPV2 cases were reported from various parts of the country, indicating widespread transmission. In some areas, only one immunization round has been conducted in response. A more comprehensive outbreak response to these cVDPV2 cases must be planned and implemented. The risk of further spread within Chad and further international spread remains high (cVDPV2 circulating in Chad has also been detected in Cameroon and Nigeria).
- In Cameroon, no new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 2. The most recent cVDPV2 case had onset of paralysis on [27 May 2013] (from Extreme-Nord).
- Central African Republic (CAR) continues to be at serious risk of re-infection due to proximity with Chad, ongoing insecurity and humanitarian crises, and destruction of health infrastructure. To minimize the risk and consequences of potential re-infection, 2 subnational immunization campaigns were conducted in June and July [2013]. A SNID is planned for September [2013] and a NID for October [2013].
Horn of Africa
--------------
- 11 new WPV1 cases were reported in the past week -- in previously infected districts in Kenya and Somalia, and in a previously unaffected country, Ethiopia. The total number of WPV1 cases for 2013 is 121 (108 from Somalia, 12 from Kenya, 1 from Ethiopia). The most recent WPV1 case in the region had onset of paralysis on [14 Jul 2013] (from Kenya).
- On [14 Aug 2013], a case of WPV1 was reported in a child living in Ethiopia with date of onset of paralysis of [10 Jul 2013]. The case is an 18-month old child from the Somali Region (Warder district) of Ethiopia who had never been vaccinated with oral polio vaccine (OPV).
- Because of the known routes of poliovirus spread in previous outbreaks in the Horn of Africa, the Somali region of Ethiopia had been considered at 'high risk', and since June [2013], 2 large-scale supplementary immunization activities (SIAs) had already been conducted as part of the broader Horn of Africa outbreak response.
- In Ethiopia, an immediate local immunization campaign is being conducted in the vicinity of the case, with a larger-scale SIA planned targeting 950 000 children under the age of 5 years. Additional SIAs are planned from September to November [2013]. Confirmation of the case in Ethiopia underscores the risk this outbreak continues to pose to countries across the region.
- Access in some areas of south-central Somalia remains a significant challenge. Analysis shows that as many as 70 percent of children in inaccessible areas are under-immunized. This compares to 20 percent in accessible areas of the country. Of the 108 cases reported from Somalia so far, 33 are from inaccessible or only partially-accessible areas; 75 cases are from accessible areas or accessible areas with security challenges.
- In Kenya, the priority remains on increasing immunity levels in the Dadaab area of North Eastern province. Nearly 50 percent of children in this area remain under-immunized (compared to less than 5 percent in Kenya on the whole).
Israel
------
- WPV1 has been detected in 67 sewage samples from 24 sampling sites in Israel, collected from [3 Feb 2013 to 4 Aug 2013]. Initially restricted to southern Israel, WPV1 has now also been detected in environmental sampling sites elsewhere in Israel, indicating widespread transmission throughout the country. No case of paralytic polio has been reported.
- To interrupt WPV1 transmission, a supplementary immunization activity (SIA) with bivalent oral polio vaccine (OPV) targeting children up to the age of 9 years was initiated in the southern district of Israel during the week of [5 Aug 2013]; since [18 Aug 2013], the SIA was expanded to the entire country. The objective of the SIA with OPV is to boost intestinal immunity in children vaccinated with IPV only in order to rapidly interrupt wild poliovirus transmission.
West Africa
-----------
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
- Multi-country immunization campaigns are planned in West Africa for mid-October [2013] and mid-November [2013], as well as subnational campaigns in Niger in September [2013].
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[In the past week since the last global update (13 Aug 2013), the number of cases of confirmed WPV associated disease has increased from 181 to 192 (see Poliomyelitis update (19): Somalia, Israel, global 20130817.1884992). Unfortunately, all of the newly confirmed cases have been outbreak associated, with no new cases confirmed from the 3 endemic countries (Afghanistan, Nigeria, Pakistan).
The number of WPV cases associated with the ongoing outbreak in the Horn of Africa (Somalia, Kenya and now Ethiopia) has increased from 110 to 121 in the past week, with 8 newly confirmed cases in Somalia, 2 in Kenya and one in Ethiopia. The report mentions that as many as 70 percent of children in inaccessible areas are underimmunized. But only 33 of the 108 cases (30.6 percent) have been from these areas. The question that arises is if these areas are inaccessible, could there be more cases occurring in these areas that are not coming to the attention of the health sector. (The same question applies to the inaccessible areas in Afghanistan and Pakistan and other countries with ongoing civil unrest and difficult-to-access locations).
Another worrisome occurrence is the continued spread of WPV northward in Israel. On Tuesday (20 Aug 2013) there was an announcement that WPV had been isolated from sewage sampling in the north -- Baka al-Garbiyeh in the Haifa district (see http://www.haaretz.com/news/national/.premium-1.542639). For a map of Israel showing districts, see http://www.emapsworld.com/images/israel ... ts-map.gif.
For the map showing the geographic locations of all WPV confirmed cases in the world, see http://www.polioeradication.org/Dataandmonitoring.aspx. - Mod.MPP]
-
Birgitt
- Moderator
- Beiträge: 35230
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Kinderlähmung - Poliomyelitis weltweit
POLIOMYELITIS UPDATE (21): GLOBAL
*********************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Wed 28 Aug 2013
Source: Global Polio Eradication Initiative [edited]
http://www.polioeradication.org/Dataand ... sweek.aspx
Global Polio Eradication Initiative update as of 28 Aug 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 214 / 128 / 223
- in endemic countries: 72 / 123 / 217
- in non-endemic countries: 142 / 5 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 25 / 0 / 0 / 25 // 26 / 2 / 1 / 29 / 58 // 27 Jul 2013
Afghanistan: 4 / 0 / 0 / 4 // 17 / 0 / 0 / 17 / 37 // 23 Jul 2013
Nigeria: 43 / 0 / 0 / 43 // 61 / 16 / 0 / 77 / 122 // 23 Jul 2013
Somalia: 128 / 0 / 0 / 128 // 0 / 0 / 0 / 0 / 0 // 30 Jul 2013
Ethiopia: 1 / 0 / 0 / 1 // 0 / 0 / 0 / 0 / 0 // 10 Jul 2013
Kenya: 13 / 0 / 0 / 13 // 0 / 0 / 0 / 0 / 0 // 14 Jul 2013
Chad: 0 / 0 / 0 / 0 // 5 / 0 / 0 / 5 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 214 / 0 / 0 / 214 // 109 / 18 / 1 / 128 / 223
Total in endemic countries: 72 / 0 / 0 / 72 // 104 / 18 / 1 / 123 / 217
Total outbreak: 142 / 0 / 0 / 142 // 5 / 0 / 0 / 5 / 6
Data in WHO as of 28 Aug 2012 for 2012 data and 27 Aug 2013 for 2013 data.
Highlights of this week:
- The outbreak of wild poliovirus type 1 (WPV1) in the Horn of Africa, which affects Somalia, Kenya and Ethiopia, has spread into 2 new states of Somalia.
- In Israel, the number of sewage samples which have tested positive for WPV1 has reached 85; one sewage sample collected in West Bank and Gaza has tested positive for WPV1.
Afghanistan
-----------
- No new WPV case was reported in the past week.
- All 4 WPV cases this year [2013] were reported from Eastern Region. The most recent WPV1 case had onset of paralysis on [23 Jul 2013], from Kunar province.
- No WPV3 has been detected in Afghanistan since April 2010.
- No new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
- Subnational immunization days (SNIDs) were held on [1-3 Jul 2013], with resources focusing on strengthening campaign quality in Southern and Eastern Regions.
Nigeria
-------
- No new WPV case was reported in the past week. The total of WPV1 cases for 2013 remains 43. The most recent WPV1 case in the country had onset of paralysis on [23 Jul 2013] (from Borno).
- The most recent WPV3 detected in Nigeria was reported in November 2012.
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (with onset of paralysis on [6 Jun 2013], from Borno).
- The next subnational Immunization Plus Days (IPDs) are planned across northern states in September [2013].
Pakistan
--------
- One new case of WPV was reported in the past week, a WPV1 from FR Bannu in the Federally Administered Tribal Areas [FATA], with onset of paralysis on [27 Jul 2013]. This is the most recent case in the country and brings the total number of WPV1 cases for 2013 to 25.
- The total number of cVDPV2 cases for 2013 remains 12.
- FATA remains the major poliovirus reservoir in Pakistan and in Asia, both due to WPV1 and cVDPV2.
Chad, Cameroon and Central African Republic
-------------------------------------------
- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac).
- In Chad, no new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 4 (the most recent cVDPV2 case had onset of paralysis on [12 May 2013] from Ennedi).
- In Cameroon, one new cVDPV2 case was reported in the past week, bringing the total number of cVDPV2 cases for 2013 to 3. This new case had onset of paralysis on [19 Jul 2013] (from Extreme-Nord).
- Central African Republic (CAR) continues to be at serious risk of re-infection due to proximity with Chad, ongoing insecurity and humanitarian crises, and destruction of health infrastructure. To minimize the risk and consequences of potential re-infection, 2 subnational immunization campaigns were conducted in June and July [2013]. A SNID is planned for September [2013] and a NID for October [2013].
Horn of Africa
--------------
- 20 new WPV1 cases were reported in the past week in Somalia and one in Kenya. The total number of WPV1 cases for 2013 is 142 (128 from Somalia, 13 from Kenya, 1 from Ethiopia). The most recent WPV1 case in the region had onset of paralysis on [30 Jul 2013] (from Somalia).
- The outbreak is spreading geographically in Somalia, with 2 new states reporting cases: Galgadud and Gedo. Anticipation of this spread has driven intense vaccination activities across the country, in an effort to raise immunity.
Israel and West Bank and Gaza
-----------------------------
- WPV1 has been detected in 85 sewage samples from 27 sampling sites in Israel, collected from [3 Feb to 18 Aug 2013]. Initially restricted to southern Israel, WPV1 has now also been detected in environmental sampling sites elsewhere in Israel, indicating transmission throughout the country. A sampling site in Tulkarem in the West Bank has also reported a positive sample, collected on [30 Jun 2013]. No case of paralytic polio has been reported in either Israel or the West Bank and Gaza.
- To interrupt WPV1 transmission, a supplementary immunization activity (SIA) with bivalent oral polio vaccine (OPV) targeting children up to the age of 9 years was initiated in the southern district of Israel during the week of [5 Aug 2013]; since [18 Aug 2013], the SIA was expanded to all of Israel. The objective of the SIA with OPV is to boost intestinal immunity in children vaccinated with IPV only in order to rapidly interrupt wild poliovirus transmission.
- Following the positive sample from Tulkarem, subsequent samples in the West Bank and Gaza have all tested negative. Discussions have begun for a vaccination response to the positive sample in the West Bank.
West Africa
-----------
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
- One new cVDPV2 was reported in the past week from Niger's Diffa province, with onset of paralysis on [11 Jul 2013]. Niger has not reported a case of cVDPV since 2011. Genetic sequencing has shown that the virus is related to those seen in Cameroon, Chad and (Borno) Nigeria.
- Multi-country immunization campaigns are planned in West Africa for mid-October [2013] and mid-November, as well as subnational campaigns in Niger in September [2013].
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[In the past week since the last global update (20 Aug 2013), the number of cases of confirmed WPV associated disease has increased from 192 to 214 (see Poliomyelitis update (20): Ethiopia, global 20130823.1897833). All but one of the newly confirmed cases have been outbreak associated, with the only new case confirmed from one of the 3 endemic countries (Afghanistan, Nigeria, Pakistan), occurring in Pakistan.
The number of wild poliovirus (WPV) cases associated with the ongoing outbreak in the Horn of Africa (Somalia, Kenya, and now Ethiopia) has increased from 121 to 142 in the past week, with 20 newly confirmed cases in Somalia and one in Kenya.
Another worrisome occurrence is the continued spread of WPV northward in Israel and now to the West Bank. Fortunately to date there have not been any cases of paralytic polio resulting from the transmission of WPV in the region.
The occurrence of cases of polio associated with infection with circulating vaccine derived polioviruses (cVDPVs) in Cameroon and Niger reflects the high risk of recurrent WPV associated disease should the WPV be introduced into these areas, as cVDPV cases occur in areas with suboptimal vaccination coverages.
For the map showing the geographic locations of all WPV confirmed cases in the world, see http://www.polioeradication.org/Dataandmonitoring.aspx. - Mod.MPP]
*********************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Wed 28 Aug 2013
Source: Global Polio Eradication Initiative [edited]
http://www.polioeradication.org/Dataand ... sweek.aspx
Global Polio Eradication Initiative update as of 28 Aug 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 214 / 128 / 223
- in endemic countries: 72 / 123 / 217
- in non-endemic countries: 142 / 5 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 25 / 0 / 0 / 25 // 26 / 2 / 1 / 29 / 58 // 27 Jul 2013
Afghanistan: 4 / 0 / 0 / 4 // 17 / 0 / 0 / 17 / 37 // 23 Jul 2013
Nigeria: 43 / 0 / 0 / 43 // 61 / 16 / 0 / 77 / 122 // 23 Jul 2013
Somalia: 128 / 0 / 0 / 128 // 0 / 0 / 0 / 0 / 0 // 30 Jul 2013
Ethiopia: 1 / 0 / 0 / 1 // 0 / 0 / 0 / 0 / 0 // 10 Jul 2013
Kenya: 13 / 0 / 0 / 13 // 0 / 0 / 0 / 0 / 0 // 14 Jul 2013
Chad: 0 / 0 / 0 / 0 // 5 / 0 / 0 / 5 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 214 / 0 / 0 / 214 // 109 / 18 / 1 / 128 / 223
Total in endemic countries: 72 / 0 / 0 / 72 // 104 / 18 / 1 / 123 / 217
Total outbreak: 142 / 0 / 0 / 142 // 5 / 0 / 0 / 5 / 6
Data in WHO as of 28 Aug 2012 for 2012 data and 27 Aug 2013 for 2013 data.
Highlights of this week:
- The outbreak of wild poliovirus type 1 (WPV1) in the Horn of Africa, which affects Somalia, Kenya and Ethiopia, has spread into 2 new states of Somalia.
- In Israel, the number of sewage samples which have tested positive for WPV1 has reached 85; one sewage sample collected in West Bank and Gaza has tested positive for WPV1.
Afghanistan
-----------
- No new WPV case was reported in the past week.
- All 4 WPV cases this year [2013] were reported from Eastern Region. The most recent WPV1 case had onset of paralysis on [23 Jul 2013], from Kunar province.
- No WPV3 has been detected in Afghanistan since April 2010.
- No new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
- Subnational immunization days (SNIDs) were held on [1-3 Jul 2013], with resources focusing on strengthening campaign quality in Southern and Eastern Regions.
Nigeria
-------
- No new WPV case was reported in the past week. The total of WPV1 cases for 2013 remains 43. The most recent WPV1 case in the country had onset of paralysis on [23 Jul 2013] (from Borno).
- The most recent WPV3 detected in Nigeria was reported in November 2012.
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (with onset of paralysis on [6 Jun 2013], from Borno).
- The next subnational Immunization Plus Days (IPDs) are planned across northern states in September [2013].
Pakistan
--------
- One new case of WPV was reported in the past week, a WPV1 from FR Bannu in the Federally Administered Tribal Areas [FATA], with onset of paralysis on [27 Jul 2013]. This is the most recent case in the country and brings the total number of WPV1 cases for 2013 to 25.
- The total number of cVDPV2 cases for 2013 remains 12.
- FATA remains the major poliovirus reservoir in Pakistan and in Asia, both due to WPV1 and cVDPV2.
Chad, Cameroon and Central African Republic
-------------------------------------------
- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac).
- In Chad, no new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 4 (the most recent cVDPV2 case had onset of paralysis on [12 May 2013] from Ennedi).
- In Cameroon, one new cVDPV2 case was reported in the past week, bringing the total number of cVDPV2 cases for 2013 to 3. This new case had onset of paralysis on [19 Jul 2013] (from Extreme-Nord).
- Central African Republic (CAR) continues to be at serious risk of re-infection due to proximity with Chad, ongoing insecurity and humanitarian crises, and destruction of health infrastructure. To minimize the risk and consequences of potential re-infection, 2 subnational immunization campaigns were conducted in June and July [2013]. A SNID is planned for September [2013] and a NID for October [2013].
Horn of Africa
--------------
- 20 new WPV1 cases were reported in the past week in Somalia and one in Kenya. The total number of WPV1 cases for 2013 is 142 (128 from Somalia, 13 from Kenya, 1 from Ethiopia). The most recent WPV1 case in the region had onset of paralysis on [30 Jul 2013] (from Somalia).
- The outbreak is spreading geographically in Somalia, with 2 new states reporting cases: Galgadud and Gedo. Anticipation of this spread has driven intense vaccination activities across the country, in an effort to raise immunity.
Israel and West Bank and Gaza
-----------------------------
- WPV1 has been detected in 85 sewage samples from 27 sampling sites in Israel, collected from [3 Feb to 18 Aug 2013]. Initially restricted to southern Israel, WPV1 has now also been detected in environmental sampling sites elsewhere in Israel, indicating transmission throughout the country. A sampling site in Tulkarem in the West Bank has also reported a positive sample, collected on [30 Jun 2013]. No case of paralytic polio has been reported in either Israel or the West Bank and Gaza.
- To interrupt WPV1 transmission, a supplementary immunization activity (SIA) with bivalent oral polio vaccine (OPV) targeting children up to the age of 9 years was initiated in the southern district of Israel during the week of [5 Aug 2013]; since [18 Aug 2013], the SIA was expanded to all of Israel. The objective of the SIA with OPV is to boost intestinal immunity in children vaccinated with IPV only in order to rapidly interrupt wild poliovirus transmission.
- Following the positive sample from Tulkarem, subsequent samples in the West Bank and Gaza have all tested negative. Discussions have begun for a vaccination response to the positive sample in the West Bank.
West Africa
-----------
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
- One new cVDPV2 was reported in the past week from Niger's Diffa province, with onset of paralysis on [11 Jul 2013]. Niger has not reported a case of cVDPV since 2011. Genetic sequencing has shown that the virus is related to those seen in Cameroon, Chad and (Borno) Nigeria.
- Multi-country immunization campaigns are planned in West Africa for mid-October [2013] and mid-November, as well as subnational campaigns in Niger in September [2013].
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[In the past week since the last global update (20 Aug 2013), the number of cases of confirmed WPV associated disease has increased from 192 to 214 (see Poliomyelitis update (20): Ethiopia, global 20130823.1897833). All but one of the newly confirmed cases have been outbreak associated, with the only new case confirmed from one of the 3 endemic countries (Afghanistan, Nigeria, Pakistan), occurring in Pakistan.
The number of wild poliovirus (WPV) cases associated with the ongoing outbreak in the Horn of Africa (Somalia, Kenya, and now Ethiopia) has increased from 121 to 142 in the past week, with 20 newly confirmed cases in Somalia and one in Kenya.
Another worrisome occurrence is the continued spread of WPV northward in Israel and now to the West Bank. Fortunately to date there have not been any cases of paralytic polio resulting from the transmission of WPV in the region.
The occurrence of cases of polio associated with infection with circulating vaccine derived polioviruses (cVDPVs) in Cameroon and Niger reflects the high risk of recurrent WPV associated disease should the WPV be introduced into these areas, as cVDPV cases occur in areas with suboptimal vaccination coverages.
For the map showing the geographic locations of all WPV confirmed cases in the world, see http://www.polioeradication.org/Dataandmonitoring.aspx. - Mod.MPP]
-
Birgitt
- Moderator
- Beiträge: 35230
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Kinderlähmung - Poliomyelitis weltweit
POLIOMYELITIS UPDATE (22): SOUTH SUDAN, GLOBAL
**********************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
In this update:
[1] South Sudan: MOH press release
[2] Global update: Polio Eradication Initiative
******
[1] South Sudan: MOH press release
Date: Mon 30 Sep 2013
From: Samson Paul Baba <Samson_baba@yahoo.co.uk> [edited]
The Government of South Sudan is treating as an utmost priority an outbreak of polio in South Sudan. 3 children have been confirmed with the infection, 2 in Northern Bahr el Ghazal State and another in Eastern Equatoria State.
"We consider this a national health emergency," the Honourable Dr Riek Gai, Minister of Health, said on Monday [30 Sep 2013] morning. We are mobilizing from the highest level of Government to every community in the country in order to stop this disease.
"We are also working closely with WHO, UNICEF, and other key partners around the world and here in South Sudan to ensure the most effective response. Together, we will stop the spread of polio in South Sudan," the Minister added.
Two girls, aged 2 and 8, living in Aweil South County, Northern Bahr el Ghazal State and a 2-year-old girl in Ikotos county, Eastern Equatoria State, were confirmed on 26 Sep 2013 as having polio. The status of the 3 girls is being followed closely. The cases were confirmed by the Kenya Medical Research Institute in Nairobi.
South Sudan had been polio-free since June 2009.
Since the polio outbreak in Somalia was confirmed in May [2013], quickly followed by its spread to Kenya and Ethiopia, medical authorities across South Sudan have been on high alert to look for any possible cases in this country. The Ministry of Health and its partners conducted additional polio vaccination campaigns in August [2013] in the States considered most at risk from the outbreak in the affected countries on its borders. Those States were Upper Nile, Jonglei, Eastern Equatoria, and Central Equatoria. Pariang County in Unity State was also included in that vaccination campaign.
Immediately following the confirmation of the 3 polio cases, the Government and partners responded with emergency vaccinations in the areas where the virus was detected. The emergency "mop-up" campaign, in Aweil South County in Northern Bahr el Ghazal State, and Gogrial West county in Warrap State and Ikotos and Budi counties in Eastern Equatoria State will continue through 4 Oct [2013]. This "mop-up" campaign is designed to stop the spread of the virus quickly.
Additional campaigns will be held in every State in the country in October, November, and December [2013]. This will be an ongoing process to ensure children in South Sudan are protected from polio. The Government of South Sudan is also continuing to coordinate with neighboring countries in polio eradication efforts.
"We are organizing intensive vaccination campaigns throughout the country to protect our children against this devastating disease. We are determined to stop the spread of polio," the Minister said, "And we need everyone in the country to help us. We appeal to all parents to make sure their children are vaccinated. Protect your children through routine immunization and by making sure they receive additional polio vaccinations. We are working together for the eradication of polio. As long as polio exists anywhere in the world, every unimmunized child is at risk.
--
Dr Samson Paul Baba
Director General Community and Public Health
Ministry of Health
Republic of South Sudan
<Samson_baba@yahoo.co.uk>
via
ProMED-EAFR
<promed-eafr@promedmail.org>
[This press release from the South Sudan National Ministry of Health confirms a new outbreak of wild poliovirus (WPV, serotype not specified) in Northern Bahr el Ghazal and Eastern Equatoria states in South Sudan. Emergency response including polio vaccinations, intensified surveillance, and community education in affected and at-risk areas is already underway and will continue until December 2013. Further information on the WPV serotype and its country of origin will be appreciated.
Maps of the Republic of South Sudan can be seen at http://healthmap.org/r/1Oyp and http://en.wikipedia.org/wiki/South_Suda ... d_counties. - Mod.JFW]
******
[2] Global update: Polio Eradication Initiative
Date: Wed 25 Sep 2013
Source: Global Polio Eradication Initiative [edited]
http://polioeradication.org/Dataandmoni ... sweek.aspx
Global Polio Eradication Initiative update as of 25 Sep 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 270 / 150 / 223
- in endemic countries: 79 / 145 / 217
- in non-endemic countries: 191 / 5 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 28 / 0 / 0 / 28 // 34 / 2 / 1 / 37 / 58 // 19 Aug 2013
Afghanistan: 4 / 0 / 0 / 4 // 18 / 0 / 0 / 18 / 37 // 23 Jul 2013
Nigeria: 47 / 0 / 0 / 47 // 73 / 17 / 0 / 90 / 122 // 17 Aug 2013
Somalia: 174 / 0 / 0 / 174 // 0 / 0 / 0 / 0 / 0 // 27 Aug 2013
Ethiopia: 3 / 0 / 0 / 3 // 0 / 0 / 0 / 0 / 0 // 30 Aug 2013
Kenya: 14 / 0 / 0 / 14 // 0 / 0 / 0 / 0 / 0 // 14 Jul 2013
Chad: 0 / 0 / 0 / 0 // 5 / 0 / 0 / 5 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 270 / 0 / 0 / 270 // 130 / 19 / 1 / 150 / 223
Total in endemic countries: 79 / 0 / 0 / 79 // 125 / 19 / 1 / 145 / 217
Total outbreak: 191 / 0 / 0 / 191 // 5 / 0 / 0 / 5 / 6
Data in WHO as of 25 Sep 2012 for 2012 data and 24 Sep 2013 for 2013 data.
Highlights of week
------------------
- In the Horn of Africa, intensive outbreak response is continuing. The impact of the response is beginning to be seen, as the number of newly-reported cases from Banadir, Somalia (the epicentre of the outbreak) has declined. At the same time, operations are improving as more children are being reached, including in some inaccessible areas of south-central Somalia. The risk this outbreak poses for the entire region was again underscored this week, however, as 2 further cases from Ethiopia have been confirmed.
- In Pakistan, 12 new cVDPV2 cases are reported this week, the bulk in North Waziristan, FATA.
Afghanistan
-----------
- No new WPV cases were reported in the past week.
- All 4 WPV cases this year were reported from Eastern Region. The most recent WPV1 case had onset of paralysis on [23 Jul 2013], from Kunar province.
- No WPV3 has been detected in Afghanistan since April 2010.
- No new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
- In Southern Region, in the highest-risk areas, an analysis of the immunization status of non-polio acute flaccid paralysis (AFP) cases indicates overall immunity levels continue to improve. As many as 85 percent of children aged less than 3 years have received at least 3 doses of OPV [oral polio vaccine], an increase from 60 percent at the same time last year.
- Subnational immunization days (SNIDs) were held last week [15-17 Sep 2013], in low performing districts of Southern Region and Eastern Region. Preparations are ongoing for nationwide campaigns in early October [2013].
Nigeria
-------
- No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains 47 (all WPV1s). The most recent WPV1 case in the country had onset of paralysis on [17 Aug 2013] (from Taraba).
- No WPV3 has been detected in Nigeria since November 2012.
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (with onset of paralysis on [6 Jun 2013], from Borno).
- The primary challenge remains accessing all children in Borno state and further improve operational challenges in Kano state.
- Subnational immunization plus days (IPDs) across northern states were conducted on [7-10 Sep 2013]. Preparations for these latest campaigns had focused on identified highest-risk areas. In advance of that round, immunizations had taken place in wards of very high-risk LGAs.
- OPV will be administered along with measles vaccine during Child Health Days in north and middle-band states in early October [2013].
Pakistan
--------
- No new WPV cases were reported in the past week. The total number of WPV1 cases for 2013 remains 28. The most recent WPV1 case in the country had onset of paralysis on [19 Aug 2013] (from Khyber Pakhtunkhwa-KP).
- 12 new cVDPV2 cases were reported in the past week, 11 from North Waziristan, Federally Administered Tribal Areas (FATA) and one from Gadap, greater Karachi, Sindh. Onsets of paralysis of the new cases are from [3 Jul to 21 Aug 2013]. This brings the total number of cVDPV2 cases for 2013 to 24.
- The cases in North Waziristan are particularly concerning, as it is in an area where immunizations have been suspended by local leaders since last June [?2013 vs 2012]. 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. North Waziristan is also affected by WPV1 transmission.
- Additionally, 4 new environmental samples tested positive for WPV1, from Peshawar, FATA; Gadap, Sindh; Rawalpindi, Punjab; and, Multan, Punjab. Detection of the sample in Multan is particularly concerning, as WPV1 had not been detected in this area since early 2012.
- Confirmation of these latest cases in FATA underscores the risk ongoing polio transmission (be it due to WPV or cVDPV) in this area continues to pose to children everywhere, and in particular to children living in areas where access has not been possible for extended periods of time. FATA is the major poliovirus reservoir in Pakistan and in Asia, with confirmed circulation of both WPV1 and cVDPV2. More than 350 000 children in this area are regularly missed in inaccessible areas, during immunization activities. Efforts are ongoing to curb transmission in this area, including through vaccination at transit points and conducting short interval additional dose (SIADs) campaigns in areas that have recently become accessible.
Chad, Cameroon, and Central African Republic
--------------------------------------------
- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac). No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 4 (the most recent cVDPV2 case had onset of paralysis on [12 May 2013] from Ennedi). A small-scale supplementary immunization activity took place on [30 Aug 2013-1 Sep 2013], with staggered, larger-scale SNIDs currently ongoing. Nationwide activities are planned for late October [2013].
- In Cameroon, no new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 3. The most recent case had onset of paralysis on [19 Jul 2013] (from Extreme-Nord). NIDs are planned for [11-13 Oct 2013].
- Central African Republic (CAR) continues to be at serious risk of re-infection due to proximity with Chad, ongoing insecurity and humanitarian crises, and destruction of health infrastructure. To minimize the risk and consequences of potential re-infection, 2 subnational immunization campaigns were conducted in some areas in June and July [2013]. Discussions are ongoing for further activities, potentially in October and November [2013].
Horn of Africa
--------------
- 7 new WPV1 cases were reported in the past week, 5 from Somalia and 2 from Ethiopia. The total number of WPV1 cases for 2013 in the Horn of Africa is 191 (174 from Somalia, 14 from Kenya, and 3 from Ethiopia. The most recent WPV1 case in the region had onset of paralysis on [30 Aug 2013] (from Ethiopia).
- The 2 new cases from Ethiopia are both from Somali region, bordering Somalia. It is from this region that the 1st case from the country had been reported. Active case searches for any additional potential cases is continuing.
- Because of routes of poliovirus spread in previous Horn of Africa outbreaks, this area of Ethiopia had been considered at 'high risk', and since June [2013] had been conducting large-scale immunization campaigns. The response continues to be further strengthened. For example, World Food Programme (WFP) field monitors have been sensitized on AFP surveillance, and a proposal is being evaluated to use community volunteers to further intensify surveillance.
- 28 Permanent Vaccination Posts have now been established along the Ethiopia-Somalia border areas and at large transit points.
- Social mobilization and mass media activities continue to be scaled up in the country, including jingles on TV and radio and banner productions for local levels.
- The next campaign in Ethiopia will be NIDs, on [26-28 Sep 2013].
- Outbreak response in Somalia and Kenya is also continuing, as well as other areas of the Horn of Africa, notably Yemen. As a result of concerted outbreak response efforts, the impact of the response is beginning to be seen, as the number of newly-reported cases from Banadir, Somalia (the epicentre of the outbreak) has declined. At the same time, operations are improving as more children are being reached, including in some inaccessible areas of south-central Somalia. However, more needs to be done, for as many as 500 000 children remain inaccessible in parts of south-central Somalia.
Israel and West Bank and Gaza
-----------------------------
- Although no case of paralytic polio has been reported, WPV1 has been detected in 96 sewage samples from 27 sampling sites in Israel, collected from [3 Feb to 25 Aug 2013], indicating widespread transmission throughout the country. 3 positive samples have also been collected from the West Bank and Gaza (the most recent on [20 Aug 2013]).
- To interrupt WPV1 transmission, a supplementary immunization activity (SIA) with bivalent OPV targeting children up to the age of 9 years has been ongoing since August [2013] in Israel.
- SIAs for West Bank and Gaza have been tentatively scheduled for October and November [2013].
West Africa
-----------
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
- No new cVDPV2 cases were reported in the past week from Niger. The country has reported a single case of cVDPV2 in 2013, with onset of paralysis on [11 Jul 2013]. Genetic sequencing has shown that the virus is related to that seen in Cameroon, Chad and Nigeria (Borno).
- Multi-country synchronized immunization campaigns are planned in West Africa for late October [2013]. Additional subnational campaigns were conducted [7-9 Sep 2013] in Niger, and additional rounds are planned in the region for early November [2013].
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[Since the last ProMED-mail Poliomyelitis update on 27 Aug 2013 (Poliomyelitis update (21): global 20130829.1911713), there have been an increase in total numbers of confirmed WPV cases from 214 to 270 as of 24 Sep 2013. The overwhelming majority of these newly confirmed cases are from the ongoing outbreak in the Horn of Africa where there have been 49 new cases confirmed in the past month according to the Polio Eradication Initiative website. This does not include the newly confirmed cases (3) in South Sudan.
The spread of the outbreak to South Sudan is disconcerting and disappointing. There are other countries in the surrounding areas where there is known population movement that have not confirmed cases of WPV associated polio as yet, but where the risk is high, given substantial pockets of inadequately immunized children. Reported polio vaccination coverages are available on the WHO website and show suboptimal coverages in the Sudan, Yemen, Djbouti to name a few (http://apps.who.int/immunization_monito ... epol3.html).
In Pakistan, while there were only 3 newly confirmed WPV cases in the past month, the notification of 12 newly confirmed cVDPV2 cases in the hard to access area where there have been difficulties in vaccine acceptance does not bode well for interrupting transmission of the WPV in Pakistan. In addition, the continued circulation of the WPV in Pakistan has been associated with exportation of the WPV to Egypt, Israel and the West Bank and Gaza as seen by WPV isolates taken from sewage samples in these locations that have been genetically linked to the WPV currently circulating in Pakistan.
The continued circulation of the WPV in Israel, Gaza, and the West Bank is also disconcerting, even in the absence of clinical cases thus far. A 1 Sep 2013 press release from the Israeli MOH highlighted the challenges in the area:
"The Ministry of Health appeals to parents in Beer Sheba and Qiryat Gat to have their children promptly vaccinated: "In tests performed this week [week of 1 Sep 2013] at wastewater treatment plants in the southern region, the wild poliovirus was found to be still present in the sewerage of Beer Sheba and Qiryat Gat. The immunization level in Beer Sheba is only 56 percent (approximately 12 000 children have not yet been vaccinated), and in Qiryat Gat it is only 62 percent (approximately 3000 children have not yet been vaccinated)." (http://www.health.gov.il/English/News_a ... 013_1.aspx).
For a map showing the location of WPV cases this year (2013), see http://www.polioeradication.org/Dataand ... dwide.aspx. - Mod.MPP]
**********************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
In this update:
[1] South Sudan: MOH press release
[2] Global update: Polio Eradication Initiative
******
[1] South Sudan: MOH press release
Date: Mon 30 Sep 2013
From: Samson Paul Baba <Samson_baba@yahoo.co.uk> [edited]
The Government of South Sudan is treating as an utmost priority an outbreak of polio in South Sudan. 3 children have been confirmed with the infection, 2 in Northern Bahr el Ghazal State and another in Eastern Equatoria State.
"We consider this a national health emergency," the Honourable Dr Riek Gai, Minister of Health, said on Monday [30 Sep 2013] morning. We are mobilizing from the highest level of Government to every community in the country in order to stop this disease.
"We are also working closely with WHO, UNICEF, and other key partners around the world and here in South Sudan to ensure the most effective response. Together, we will stop the spread of polio in South Sudan," the Minister added.
Two girls, aged 2 and 8, living in Aweil South County, Northern Bahr el Ghazal State and a 2-year-old girl in Ikotos county, Eastern Equatoria State, were confirmed on 26 Sep 2013 as having polio. The status of the 3 girls is being followed closely. The cases were confirmed by the Kenya Medical Research Institute in Nairobi.
South Sudan had been polio-free since June 2009.
Since the polio outbreak in Somalia was confirmed in May [2013], quickly followed by its spread to Kenya and Ethiopia, medical authorities across South Sudan have been on high alert to look for any possible cases in this country. The Ministry of Health and its partners conducted additional polio vaccination campaigns in August [2013] in the States considered most at risk from the outbreak in the affected countries on its borders. Those States were Upper Nile, Jonglei, Eastern Equatoria, and Central Equatoria. Pariang County in Unity State was also included in that vaccination campaign.
Immediately following the confirmation of the 3 polio cases, the Government and partners responded with emergency vaccinations in the areas where the virus was detected. The emergency "mop-up" campaign, in Aweil South County in Northern Bahr el Ghazal State, and Gogrial West county in Warrap State and Ikotos and Budi counties in Eastern Equatoria State will continue through 4 Oct [2013]. This "mop-up" campaign is designed to stop the spread of the virus quickly.
Additional campaigns will be held in every State in the country in October, November, and December [2013]. This will be an ongoing process to ensure children in South Sudan are protected from polio. The Government of South Sudan is also continuing to coordinate with neighboring countries in polio eradication efforts.
"We are organizing intensive vaccination campaigns throughout the country to protect our children against this devastating disease. We are determined to stop the spread of polio," the Minister said, "And we need everyone in the country to help us. We appeal to all parents to make sure their children are vaccinated. Protect your children through routine immunization and by making sure they receive additional polio vaccinations. We are working together for the eradication of polio. As long as polio exists anywhere in the world, every unimmunized child is at risk.
--
Dr Samson Paul Baba
Director General Community and Public Health
Ministry of Health
Republic of South Sudan
<Samson_baba@yahoo.co.uk>
via
ProMED-EAFR
<promed-eafr@promedmail.org>
[This press release from the South Sudan National Ministry of Health confirms a new outbreak of wild poliovirus (WPV, serotype not specified) in Northern Bahr el Ghazal and Eastern Equatoria states in South Sudan. Emergency response including polio vaccinations, intensified surveillance, and community education in affected and at-risk areas is already underway and will continue until December 2013. Further information on the WPV serotype and its country of origin will be appreciated.
Maps of the Republic of South Sudan can be seen at http://healthmap.org/r/1Oyp and http://en.wikipedia.org/wiki/South_Suda ... d_counties. - Mod.JFW]
******
[2] Global update: Polio Eradication Initiative
Date: Wed 25 Sep 2013
Source: Global Polio Eradication Initiative [edited]
http://polioeradication.org/Dataandmoni ... sweek.aspx
Global Polio Eradication Initiative update as of 25 Sep 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 270 / 150 / 223
- in endemic countries: 79 / 145 / 217
- in non-endemic countries: 191 / 5 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 28 / 0 / 0 / 28 // 34 / 2 / 1 / 37 / 58 // 19 Aug 2013
Afghanistan: 4 / 0 / 0 / 4 // 18 / 0 / 0 / 18 / 37 // 23 Jul 2013
Nigeria: 47 / 0 / 0 / 47 // 73 / 17 / 0 / 90 / 122 // 17 Aug 2013
Somalia: 174 / 0 / 0 / 174 // 0 / 0 / 0 / 0 / 0 // 27 Aug 2013
Ethiopia: 3 / 0 / 0 / 3 // 0 / 0 / 0 / 0 / 0 // 30 Aug 2013
Kenya: 14 / 0 / 0 / 14 // 0 / 0 / 0 / 0 / 0 // 14 Jul 2013
Chad: 0 / 0 / 0 / 0 // 5 / 0 / 0 / 5 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 270 / 0 / 0 / 270 // 130 / 19 / 1 / 150 / 223
Total in endemic countries: 79 / 0 / 0 / 79 // 125 / 19 / 1 / 145 / 217
Total outbreak: 191 / 0 / 0 / 191 // 5 / 0 / 0 / 5 / 6
Data in WHO as of 25 Sep 2012 for 2012 data and 24 Sep 2013 for 2013 data.
Highlights of week
------------------
- In the Horn of Africa, intensive outbreak response is continuing. The impact of the response is beginning to be seen, as the number of newly-reported cases from Banadir, Somalia (the epicentre of the outbreak) has declined. At the same time, operations are improving as more children are being reached, including in some inaccessible areas of south-central Somalia. The risk this outbreak poses for the entire region was again underscored this week, however, as 2 further cases from Ethiopia have been confirmed.
- In Pakistan, 12 new cVDPV2 cases are reported this week, the bulk in North Waziristan, FATA.
Afghanistan
-----------
- No new WPV cases were reported in the past week.
- All 4 WPV cases this year were reported from Eastern Region. The most recent WPV1 case had onset of paralysis on [23 Jul 2013], from Kunar province.
- No WPV3 has been detected in Afghanistan since April 2010.
- No new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
- In Southern Region, in the highest-risk areas, an analysis of the immunization status of non-polio acute flaccid paralysis (AFP) cases indicates overall immunity levels continue to improve. As many as 85 percent of children aged less than 3 years have received at least 3 doses of OPV [oral polio vaccine], an increase from 60 percent at the same time last year.
- Subnational immunization days (SNIDs) were held last week [15-17 Sep 2013], in low performing districts of Southern Region and Eastern Region. Preparations are ongoing for nationwide campaigns in early October [2013].
Nigeria
-------
- No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains 47 (all WPV1s). The most recent WPV1 case in the country had onset of paralysis on [17 Aug 2013] (from Taraba).
- No WPV3 has been detected in Nigeria since November 2012.
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (with onset of paralysis on [6 Jun 2013], from Borno).
- The primary challenge remains accessing all children in Borno state and further improve operational challenges in Kano state.
- Subnational immunization plus days (IPDs) across northern states were conducted on [7-10 Sep 2013]. Preparations for these latest campaigns had focused on identified highest-risk areas. In advance of that round, immunizations had taken place in wards of very high-risk LGAs.
- OPV will be administered along with measles vaccine during Child Health Days in north and middle-band states in early October [2013].
Pakistan
--------
- No new WPV cases were reported in the past week. The total number of WPV1 cases for 2013 remains 28. The most recent WPV1 case in the country had onset of paralysis on [19 Aug 2013] (from Khyber Pakhtunkhwa-KP).
- 12 new cVDPV2 cases were reported in the past week, 11 from North Waziristan, Federally Administered Tribal Areas (FATA) and one from Gadap, greater Karachi, Sindh. Onsets of paralysis of the new cases are from [3 Jul to 21 Aug 2013]. This brings the total number of cVDPV2 cases for 2013 to 24.
- The cases in North Waziristan are particularly concerning, as it is in an area where immunizations have been suspended by local leaders since last June [?2013 vs 2012]. 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. North Waziristan is also affected by WPV1 transmission.
- Additionally, 4 new environmental samples tested positive for WPV1, from Peshawar, FATA; Gadap, Sindh; Rawalpindi, Punjab; and, Multan, Punjab. Detection of the sample in Multan is particularly concerning, as WPV1 had not been detected in this area since early 2012.
- Confirmation of these latest cases in FATA underscores the risk ongoing polio transmission (be it due to WPV or cVDPV) in this area continues to pose to children everywhere, and in particular to children living in areas where access has not been possible for extended periods of time. FATA is the major poliovirus reservoir in Pakistan and in Asia, with confirmed circulation of both WPV1 and cVDPV2. More than 350 000 children in this area are regularly missed in inaccessible areas, during immunization activities. Efforts are ongoing to curb transmission in this area, including through vaccination at transit points and conducting short interval additional dose (SIADs) campaigns in areas that have recently become accessible.
Chad, Cameroon, and Central African Republic
--------------------------------------------
- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac). No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 4 (the most recent cVDPV2 case had onset of paralysis on [12 May 2013] from Ennedi). A small-scale supplementary immunization activity took place on [30 Aug 2013-1 Sep 2013], with staggered, larger-scale SNIDs currently ongoing. Nationwide activities are planned for late October [2013].
- In Cameroon, no new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 3. The most recent case had onset of paralysis on [19 Jul 2013] (from Extreme-Nord). NIDs are planned for [11-13 Oct 2013].
- Central African Republic (CAR) continues to be at serious risk of re-infection due to proximity with Chad, ongoing insecurity and humanitarian crises, and destruction of health infrastructure. To minimize the risk and consequences of potential re-infection, 2 subnational immunization campaigns were conducted in some areas in June and July [2013]. Discussions are ongoing for further activities, potentially in October and November [2013].
Horn of Africa
--------------
- 7 new WPV1 cases were reported in the past week, 5 from Somalia and 2 from Ethiopia. The total number of WPV1 cases for 2013 in the Horn of Africa is 191 (174 from Somalia, 14 from Kenya, and 3 from Ethiopia. The most recent WPV1 case in the region had onset of paralysis on [30 Aug 2013] (from Ethiopia).
- The 2 new cases from Ethiopia are both from Somali region, bordering Somalia. It is from this region that the 1st case from the country had been reported. Active case searches for any additional potential cases is continuing.
- Because of routes of poliovirus spread in previous Horn of Africa outbreaks, this area of Ethiopia had been considered at 'high risk', and since June [2013] had been conducting large-scale immunization campaigns. The response continues to be further strengthened. For example, World Food Programme (WFP) field monitors have been sensitized on AFP surveillance, and a proposal is being evaluated to use community volunteers to further intensify surveillance.
- 28 Permanent Vaccination Posts have now been established along the Ethiopia-Somalia border areas and at large transit points.
- Social mobilization and mass media activities continue to be scaled up in the country, including jingles on TV and radio and banner productions for local levels.
- The next campaign in Ethiopia will be NIDs, on [26-28 Sep 2013].
- Outbreak response in Somalia and Kenya is also continuing, as well as other areas of the Horn of Africa, notably Yemen. As a result of concerted outbreak response efforts, the impact of the response is beginning to be seen, as the number of newly-reported cases from Banadir, Somalia (the epicentre of the outbreak) has declined. At the same time, operations are improving as more children are being reached, including in some inaccessible areas of south-central Somalia. However, more needs to be done, for as many as 500 000 children remain inaccessible in parts of south-central Somalia.
Israel and West Bank and Gaza
-----------------------------
- Although no case of paralytic polio has been reported, WPV1 has been detected in 96 sewage samples from 27 sampling sites in Israel, collected from [3 Feb to 25 Aug 2013], indicating widespread transmission throughout the country. 3 positive samples have also been collected from the West Bank and Gaza (the most recent on [20 Aug 2013]).
- To interrupt WPV1 transmission, a supplementary immunization activity (SIA) with bivalent OPV targeting children up to the age of 9 years has been ongoing since August [2013] in Israel.
- SIAs for West Bank and Gaza have been tentatively scheduled for October and November [2013].
West Africa
-----------
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
- No new cVDPV2 cases were reported in the past week from Niger. The country has reported a single case of cVDPV2 in 2013, with onset of paralysis on [11 Jul 2013]. Genetic sequencing has shown that the virus is related to that seen in Cameroon, Chad and Nigeria (Borno).
- Multi-country synchronized immunization campaigns are planned in West Africa for late October [2013]. Additional subnational campaigns were conducted [7-9 Sep 2013] in Niger, and additional rounds are planned in the region for early November [2013].
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[Since the last ProMED-mail Poliomyelitis update on 27 Aug 2013 (Poliomyelitis update (21): global 20130829.1911713), there have been an increase in total numbers of confirmed WPV cases from 214 to 270 as of 24 Sep 2013. The overwhelming majority of these newly confirmed cases are from the ongoing outbreak in the Horn of Africa where there have been 49 new cases confirmed in the past month according to the Polio Eradication Initiative website. This does not include the newly confirmed cases (3) in South Sudan.
The spread of the outbreak to South Sudan is disconcerting and disappointing. There are other countries in the surrounding areas where there is known population movement that have not confirmed cases of WPV associated polio as yet, but where the risk is high, given substantial pockets of inadequately immunized children. Reported polio vaccination coverages are available on the WHO website and show suboptimal coverages in the Sudan, Yemen, Djbouti to name a few (http://apps.who.int/immunization_monito ... epol3.html).
In Pakistan, while there were only 3 newly confirmed WPV cases in the past month, the notification of 12 newly confirmed cVDPV2 cases in the hard to access area where there have been difficulties in vaccine acceptance does not bode well for interrupting transmission of the WPV in Pakistan. In addition, the continued circulation of the WPV in Pakistan has been associated with exportation of the WPV to Egypt, Israel and the West Bank and Gaza as seen by WPV isolates taken from sewage samples in these locations that have been genetically linked to the WPV currently circulating in Pakistan.
The continued circulation of the WPV in Israel, Gaza, and the West Bank is also disconcerting, even in the absence of clinical cases thus far. A 1 Sep 2013 press release from the Israeli MOH highlighted the challenges in the area:
"The Ministry of Health appeals to parents in Beer Sheba and Qiryat Gat to have their children promptly vaccinated: "In tests performed this week [week of 1 Sep 2013] at wastewater treatment plants in the southern region, the wild poliovirus was found to be still present in the sewerage of Beer Sheba and Qiryat Gat. The immunization level in Beer Sheba is only 56 percent (approximately 12 000 children have not yet been vaccinated), and in Qiryat Gat it is only 62 percent (approximately 3000 children have not yet been vaccinated)." (http://www.health.gov.il/English/News_a ... 013_1.aspx).
For a map showing the location of WPV cases this year (2013), see http://www.polioeradication.org/Dataand ... dwide.aspx. - Mod.MPP]
-
Birgitt
- Moderator
- Beiträge: 35230
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Kinderlähmung - Poliomyelitis weltweit
POLIOMYELITIS UPDATE (23): SYRIA SUSPECTED, GLOBAL, REQUEST FOR INFORMATION
***************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
In this update:
[1] Syria (Deir Al Zour): suspected, WHO
[2] Global update: Polio Eradication Initiative
******
[1] Syria (Deir Al Zour): suspected, WHO
Date: Sat 19 Oct 2013
Source: WHO Global Alert and Response (GAR), Disease Outbreak News [edited]
http://www.who.int/csr/don/don_updates/en/index.html
Report of suspected polio cases in the Syrian Arab Republic - [19 Oct 2013]
----------------------------------------------------------------------
On [17 Oct 2013], the World Health Organization (WHO) received reports of a cluster of acute flaccid paralysis (AFP) cases in the Syrian Arab Republic. This cluster of 'hot' AFP was detected in early October 2013 in Deir Al Zour province and is currently being investigated. Initial results from the national polio laboratory in Damascus indicate that 2 of the cases could be positive for polio -- final results are awaited from the regional reference laboratory of the Eastern Mediterranean Region of WHO. Wild poliovirus was last reported in Syria in 1999.
The Ministry of Health of the Syrian Arab Republic confirms that it is treating this event as a cluster of 'hot' AFP cases, pending final laboratory confirmation, and an urgent response is currently being planned across the country. Syria is considered at high-risk for polio and other vaccine-preventable diseases due to the current situation.
A surveillance alert has been issued for the region to actively search for additional potential cases. Supplementary immunization activities in neighbouring countries are currently being planned.
WHO's International Travel and Health recommends that all travelers to and from polio-infected areas be fully vaccinated against polio.
--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp
[As mentioned in the report above, if confirmed, these will be the 1st cases of polio confirmed in Syria since 1999. According to a newswire report on this event, a cluster of "10 paralysis cases" has been identified in Syria (see Helen Branswell's article in the Canadian Press at http://globalnews.ca/news/912945/polio- ... -outbreak/). Still pending is confirmation that a poliovirus has been identified from one or more of these AFP cases, and if so, what type of poliovirus (wild poliovirus -- WPV -- vs possible vaccine derived poliovirus -- VDPV). And, if WPV is identified, the genetic profile of the virus to determine the possible origin of the virus. WPV genetically related to WPV in Pakistan has been circulating in nearby Israel and the West Bank and the Gaza Strip. Additional information of interest is the age of the cases and their vaccination histories.
Unfortunately it appears as though civil unrest is a significant factor impeding the polio eradication efforts. The disruption of the public health infrastructures in countries with civil unrest, combined with security concerns where vaccinators have been targets for violence, is a major obstacle.
The province (governorate) of Deir al Zour (Dayr az Zawr) can be seen on the map at http://www.ephotopix.com/syria_province_map.html. It is located in the northeast of the country, bordering with Iraq. If WPV is confirmed, given the civil unrest in Iraq, one wonders if there might be WPV circulating across the border in Iraq as well.
For the HealthMap/ProMED-mail interactive map of Syria, see http://healthmap.org/r/8S1u. - Mod.MPP]
******
[2] Global update: Polio Eradication Initiative
Date: Wed 16 Oct 2013
Source: Global Polio Eradication Initiative [edited]
http://polioeradication.org/Dataandmoni ... sweek.aspx
Global Polio Eradication Initiative update as of 16 Oct 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 296 / 171 / 223
- in endemic countries: 99 / 166 / 217
- in non-endemic countries: 197 / 5 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 43 / 0 / 0 / 43 // 41 / 2 / 1 / 44 / 58 // 26 Sep 2013
Afghanistan: 7 / 0 / 0 / 7 // 25 / 0 / 0 / 25 / 37 // 15 Sep 2013
Nigeria: 49 / 0 / 0 / 49 // 80 / 17 / 0 / 97 / 122 // 10 Sep 2013
Somalia: 174 / 0 / 0 / 174 // 0 / 0 / 0 / 0 / 0 // 14 Sep 2013
Ethiopia: 6 / 0 / 0 / 6 // 0 / 0 / 0 / 0 / 0 // 19 Sep 2013
South Sudan: 3 / 0 / 0 / 3 // 0 / 0 / 0 / 0 / 0 // 24 Aug [2013]
Kenya: 14 / 0 / 0 / 14 // 0 / 0 / 0 / 0 / 0 // 14 Jul 2013
Chad: 0 / 0 / 0 / 0 // 5 / 0 / 0 / 5 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 296 / 0 / 0 / 296 // 151 / 19 / 1 / 171 / 223
Total in endemic countries: 99 / 0 / 0 / 99 // 146 / 19 / 1 / 166 / 217
Total outbreak: 197 / 0 / 0 / 197 // 5 / 0 / 0 / 5 / 6
Data in WHO as of 16 Oct 2012 for 2012 data and 15 Oct 2013 for 2013 data.
Highlights of the week
----------------------
- 11 new wild poliovirus (WPV) cases were reported in the past week (one from Afghanistan, 2 from Ethiopia, 4 from Pakistan, and 4 from Somalia).
- Although the total WPV count is now higher than the same period 2012, the quantity of cases from the 3 endemic countries is 60 percent of the same time period 2012. Afghanistan has one third and Nigeria half the amount of cases when compared to 2012. Pakistan, with the majority of cases from Federally Administered Tribal Areas (FATA), has almost identical numbers to this time 2012. The situation in North Waziristan, FATA [Federally Administered Tribal Areas], is becoming increasingly severe, as it is the area with the largest number of children being paralyzed by poliovirus in all of Asia.
Afghanistan
-----------
- One new WPV1 case was reported in the past week. The total number of WPV cases for 2013 is now 7 (all WPV1), all of which were reported from Eastern Region, close to the Pakistan border. The most recent WPV1 case had onset of paralysis on [15 Sep 2013], from Kunar province.
- No new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
Nigeria
-------
- No new WPV cases were reported this week. The total number of WPV cases for 2013 remains 49 (all WPV1s). The most recent WPV1 case in the country had onset of paralysis on [10 Sep 2013] (from Kano).
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (with onset of paralysis on [6 Jun 2013], from Borno).
- The primary challenges remain to access all children in Borno state, including in areas currently inaccessible during supplementary immunization activities (SIAs) due to insecurity, and to further improve the quality of SIA implementation in Kano state.
Pakistan
--------
- 4 new WPV1 cases were reported in the past week. All were reported from FATA (2 from Khyber Agency and 2 from North Waziristan). The total number of WPV1 cases for Pakistan in 2013 is now 43. The most recent WPV1 case had onset of paralysis on [26 Sep 2013] (from Khyber Agency). The majority of WPV1 cases in Pakistan this year [2013], 31 (72 percent), are from FATA, of which 14 are from Khyber Agency and 13 from North Waziristan.
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for Pakistan remains 29. The most recent cVDPV2 case had onset of paralysis [12 Sep 2013] (from North Waziristan).
- The situation in North Waziristan is becoming increasingly severe, as it is the area with the largest number of children being paralyzed by wild poliovirus (13 cases) and cVDPV2s (22) in all of Asia. It is in an area where immunization activities have been suspended by local leaders since June 2012. It is critical that children in these areas are vaccinated and protected from poliovirus. Immunizations in neighboring high-risk areas are being intensified, to further boost population immunity levels in those areas and prevent further spread of this outbreak.
Chad, Cameroon, and Central African Republic
--------------------------------------------
- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac). No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 4 (the most recent cVDPV2 case had onset of paralysis on [12 May 2013] from Ennedi).
- In Cameroon, no new cVDPV2 case was reported in the past week. The total number of cVDPV2 cases for 2013 remains 4. The most recent case had onset of paralysis on [12 Aug 2013] (from Kolfata, Extreme-Nord).
- Central African Republic (CAR) continues to be at serious risk of re-infection due to proximity with Chad, ongoing insecurity and humanitarian crises, and destruction of health infrastructure.
Horn of Africa
--------------
- 6 new WPV1 cases were reported in the past week (4 from Somalia and 2 from Ethiopia). The total number of WPV cases (all WPV1) for 2013 in the Horn of Africa is now 197 (174 from Somalia, 14 from Kenya, 6 from Ethiopia, and 3 from South Sudan). The most recent WPV1 case in the region had onset of paralysis on [19 Sep 2014] (from Somali region, Ethiopia).
- Outbreak response across the Horn of Africa is continuing. As a result of concerted outbreak response efforts, the impact of the response is beginning to be seen, as the number of newly reported cases from Banadir, Somalia (the epicentre of the outbreak) has declined. At the same time, operations are improving as more children are being reached, including in some inaccessible areas of south-central Somalia. However, more needs to be done, because as many as 500 000 children still remain inaccessible in parts of south-central Somalia and other areas of the Horn of Africa remain at risk of re-infection.
Israel and West Bank and Gaza
-----------------------------
- Although no case of paralytic polio has been reported, environmental surveillance suggests that WPV1 transmission, first detected in February 2013, continues in southern and parts of central Israel. WPV1-positive samples were detected also in West Bank (2 sites) and the Gaza Strip (1 site).
- Since 2005, only inactivated polio vaccine (IPV) has been used for routine childhood immunization in Israel. To interrupt WPV1 transmission, a nationwide supplementary immunization activity (SIA) with bivalent OPV targeting children less than 10 years of age has been ongoing since August [2013].
- Following a consultation with the country's immunization advisory group, the Israeli Ministry of Health has recently decided to re-introduce OPV into the national immunization schedule.
West Africa
-----------
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
- No new cVDPV2 cases were reported in the past week from Niger. The country has reported a single case of cVDPV in 2013, with onset of paralysis on [11 Jul 2013]. Genetic sequencing has shown that the virus is related to that seen in Cameroon, Chad and Nigeria (Borno).
- Multi-country synchronized immunization campaigns are planned in West Africa for late October [2013]. Additional subnational campaigns were conducted [7-9 Sep 2013] in Niger, and additional rounds are planned in the region for early November [2013].
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[Since the last ProMED-mail update on polio in late September 2013, there have been 26 new confirmed cases of WPV -- from 270 to 296 cases (Poliomyelitis - update (22): South Sudan, global 20130930.1976296). Of these 26 newly confirmed cases, 20 have been in the 3 endemic countries (15 in Pakistan, 3 in Afghanistan, and 2 in Nigeria) and 6 have been identified in the ongoing outbreak in the Horn of Africa (3 in Ethiopia and 3 in South Sudan). According to the above report from the Polio Eradication Initiative, it states that there have been 6 new cases reported from the Horn of Africa - 2 from Ethiopia and 4 from Somalia. The table included with this report states there are 174 cases reported from Somalia, 3 in South Sudan and 6 cases reported from Ethiopia as of 16 Oct 2013. According to the similar table contained in the prior ProMED-mail post Poliomyelitis - update (22): South Sudan, global 20130930.1976296, as of 24 Sep 2013, there had been 174 cases in Somalia, 3 in Ethiopia, and no cases had been officially confirmed in South Sudan.
Of note, given the same number of confirmed cases reported from Somalia, as of 24 Sep 2013, the most recent confirmed case had onset on 27 Aug 2013, whereas in this past week's report, the most recent confirmed case in Somalia was recorded as having date of onset on 14 Sep 2013. Clarification of this information would be greatly appreciated.
In the year to date comparisons with 2012, there are now more cases confirmed with WPV in 2013 than at this time in 2012 -- 296 cases confirmed in 2013 compared with 223 cases confirmed in 2012. While the good news is that there appears to be a decrease in the numbers of confirmed cases of WPV in the 3 endemic countries, the bad news is that there has been a large outbreak in the Horn of Africa involving Somalia, Kenya, Ethiopia and South Sudan, and there is an outbreak presently suspected in Syria.
For a map showing the geographic locations of cases of confirmed WPV associated polio in the world in 2013, see http://www.polioeradication.org/Dataand ... dwide.aspx. - Mod.MPP]
***************************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
In this update:
[1] Syria (Deir Al Zour): suspected, WHO
[2] Global update: Polio Eradication Initiative
******
[1] Syria (Deir Al Zour): suspected, WHO
Date: Sat 19 Oct 2013
Source: WHO Global Alert and Response (GAR), Disease Outbreak News [edited]
http://www.who.int/csr/don/don_updates/en/index.html
Report of suspected polio cases in the Syrian Arab Republic - [19 Oct 2013]
----------------------------------------------------------------------
On [17 Oct 2013], the World Health Organization (WHO) received reports of a cluster of acute flaccid paralysis (AFP) cases in the Syrian Arab Republic. This cluster of 'hot' AFP was detected in early October 2013 in Deir Al Zour province and is currently being investigated. Initial results from the national polio laboratory in Damascus indicate that 2 of the cases could be positive for polio -- final results are awaited from the regional reference laboratory of the Eastern Mediterranean Region of WHO. Wild poliovirus was last reported in Syria in 1999.
The Ministry of Health of the Syrian Arab Republic confirms that it is treating this event as a cluster of 'hot' AFP cases, pending final laboratory confirmation, and an urgent response is currently being planned across the country. Syria is considered at high-risk for polio and other vaccine-preventable diseases due to the current situation.
A surveillance alert has been issued for the region to actively search for additional potential cases. Supplementary immunization activities in neighbouring countries are currently being planned.
WHO's International Travel and Health recommends that all travelers to and from polio-infected areas be fully vaccinated against polio.
--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp
[As mentioned in the report above, if confirmed, these will be the 1st cases of polio confirmed in Syria since 1999. According to a newswire report on this event, a cluster of "10 paralysis cases" has been identified in Syria (see Helen Branswell's article in the Canadian Press at http://globalnews.ca/news/912945/polio- ... -outbreak/). Still pending is confirmation that a poliovirus has been identified from one or more of these AFP cases, and if so, what type of poliovirus (wild poliovirus -- WPV -- vs possible vaccine derived poliovirus -- VDPV). And, if WPV is identified, the genetic profile of the virus to determine the possible origin of the virus. WPV genetically related to WPV in Pakistan has been circulating in nearby Israel and the West Bank and the Gaza Strip. Additional information of interest is the age of the cases and their vaccination histories.
Unfortunately it appears as though civil unrest is a significant factor impeding the polio eradication efforts. The disruption of the public health infrastructures in countries with civil unrest, combined with security concerns where vaccinators have been targets for violence, is a major obstacle.
The province (governorate) of Deir al Zour (Dayr az Zawr) can be seen on the map at http://www.ephotopix.com/syria_province_map.html. It is located in the northeast of the country, bordering with Iraq. If WPV is confirmed, given the civil unrest in Iraq, one wonders if there might be WPV circulating across the border in Iraq as well.
For the HealthMap/ProMED-mail interactive map of Syria, see http://healthmap.org/r/8S1u. - Mod.MPP]
******
[2] Global update: Polio Eradication Initiative
Date: Wed 16 Oct 2013
Source: Global Polio Eradication Initiative [edited]
http://polioeradication.org/Dataandmoni ... sweek.aspx
Global Polio Eradication Initiative update as of 16 Oct 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 296 / 171 / 223
- in endemic countries: 99 / 166 / 217
- in non-endemic countries: 197 / 5 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 43 / 0 / 0 / 43 // 41 / 2 / 1 / 44 / 58 // 26 Sep 2013
Afghanistan: 7 / 0 / 0 / 7 // 25 / 0 / 0 / 25 / 37 // 15 Sep 2013
Nigeria: 49 / 0 / 0 / 49 // 80 / 17 / 0 / 97 / 122 // 10 Sep 2013
Somalia: 174 / 0 / 0 / 174 // 0 / 0 / 0 / 0 / 0 // 14 Sep 2013
Ethiopia: 6 / 0 / 0 / 6 // 0 / 0 / 0 / 0 / 0 // 19 Sep 2013
South Sudan: 3 / 0 / 0 / 3 // 0 / 0 / 0 / 0 / 0 // 24 Aug [2013]
Kenya: 14 / 0 / 0 / 14 // 0 / 0 / 0 / 0 / 0 // 14 Jul 2013
Chad: 0 / 0 / 0 / 0 // 5 / 0 / 0 / 5 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 296 / 0 / 0 / 296 // 151 / 19 / 1 / 171 / 223
Total in endemic countries: 99 / 0 / 0 / 99 // 146 / 19 / 1 / 166 / 217
Total outbreak: 197 / 0 / 0 / 197 // 5 / 0 / 0 / 5 / 6
Data in WHO as of 16 Oct 2012 for 2012 data and 15 Oct 2013 for 2013 data.
Highlights of the week
----------------------
- 11 new wild poliovirus (WPV) cases were reported in the past week (one from Afghanistan, 2 from Ethiopia, 4 from Pakistan, and 4 from Somalia).
- Although the total WPV count is now higher than the same period 2012, the quantity of cases from the 3 endemic countries is 60 percent of the same time period 2012. Afghanistan has one third and Nigeria half the amount of cases when compared to 2012. Pakistan, with the majority of cases from Federally Administered Tribal Areas (FATA), has almost identical numbers to this time 2012. The situation in North Waziristan, FATA [Federally Administered Tribal Areas], is becoming increasingly severe, as it is the area with the largest number of children being paralyzed by poliovirus in all of Asia.
Afghanistan
-----------
- One new WPV1 case was reported in the past week. The total number of WPV cases for 2013 is now 7 (all WPV1), all of which were reported from Eastern Region, close to the Pakistan border. The most recent WPV1 case had onset of paralysis on [15 Sep 2013], from Kunar province.
- No new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
Nigeria
-------
- No new WPV cases were reported this week. The total number of WPV cases for 2013 remains 49 (all WPV1s). The most recent WPV1 case in the country had onset of paralysis on [10 Sep 2013] (from Kano).
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (with onset of paralysis on [6 Jun 2013], from Borno).
- The primary challenges remain to access all children in Borno state, including in areas currently inaccessible during supplementary immunization activities (SIAs) due to insecurity, and to further improve the quality of SIA implementation in Kano state.
Pakistan
--------
- 4 new WPV1 cases were reported in the past week. All were reported from FATA (2 from Khyber Agency and 2 from North Waziristan). The total number of WPV1 cases for Pakistan in 2013 is now 43. The most recent WPV1 case had onset of paralysis on [26 Sep 2013] (from Khyber Agency). The majority of WPV1 cases in Pakistan this year [2013], 31 (72 percent), are from FATA, of which 14 are from Khyber Agency and 13 from North Waziristan.
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for Pakistan remains 29. The most recent cVDPV2 case had onset of paralysis [12 Sep 2013] (from North Waziristan).
- The situation in North Waziristan is becoming increasingly severe, as it is the area with the largest number of children being paralyzed by wild poliovirus (13 cases) and cVDPV2s (22) in all of Asia. It is in an area where immunization activities have been suspended by local leaders since June 2012. It is critical that children in these areas are vaccinated and protected from poliovirus. Immunizations in neighboring high-risk areas are being intensified, to further boost population immunity levels in those areas and prevent further spread of this outbreak.
Chad, Cameroon, and Central African Republic
--------------------------------------------
- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac). No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 4 (the most recent cVDPV2 case had onset of paralysis on [12 May 2013] from Ennedi).
- In Cameroon, no new cVDPV2 case was reported in the past week. The total number of cVDPV2 cases for 2013 remains 4. The most recent case had onset of paralysis on [12 Aug 2013] (from Kolfata, Extreme-Nord).
- Central African Republic (CAR) continues to be at serious risk of re-infection due to proximity with Chad, ongoing insecurity and humanitarian crises, and destruction of health infrastructure.
Horn of Africa
--------------
- 6 new WPV1 cases were reported in the past week (4 from Somalia and 2 from Ethiopia). The total number of WPV cases (all WPV1) for 2013 in the Horn of Africa is now 197 (174 from Somalia, 14 from Kenya, 6 from Ethiopia, and 3 from South Sudan). The most recent WPV1 case in the region had onset of paralysis on [19 Sep 2014] (from Somali region, Ethiopia).
- Outbreak response across the Horn of Africa is continuing. As a result of concerted outbreak response efforts, the impact of the response is beginning to be seen, as the number of newly reported cases from Banadir, Somalia (the epicentre of the outbreak) has declined. At the same time, operations are improving as more children are being reached, including in some inaccessible areas of south-central Somalia. However, more needs to be done, because as many as 500 000 children still remain inaccessible in parts of south-central Somalia and other areas of the Horn of Africa remain at risk of re-infection.
Israel and West Bank and Gaza
-----------------------------
- Although no case of paralytic polio has been reported, environmental surveillance suggests that WPV1 transmission, first detected in February 2013, continues in southern and parts of central Israel. WPV1-positive samples were detected also in West Bank (2 sites) and the Gaza Strip (1 site).
- Since 2005, only inactivated polio vaccine (IPV) has been used for routine childhood immunization in Israel. To interrupt WPV1 transmission, a nationwide supplementary immunization activity (SIA) with bivalent OPV targeting children less than 10 years of age has been ongoing since August [2013].
- Following a consultation with the country's immunization advisory group, the Israeli Ministry of Health has recently decided to re-introduce OPV into the national immunization schedule.
West Africa
-----------
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
- No new cVDPV2 cases were reported in the past week from Niger. The country has reported a single case of cVDPV in 2013, with onset of paralysis on [11 Jul 2013]. Genetic sequencing has shown that the virus is related to that seen in Cameroon, Chad and Nigeria (Borno).
- Multi-country synchronized immunization campaigns are planned in West Africa for late October [2013]. Additional subnational campaigns were conducted [7-9 Sep 2013] in Niger, and additional rounds are planned in the region for early November [2013].
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[Since the last ProMED-mail update on polio in late September 2013, there have been 26 new confirmed cases of WPV -- from 270 to 296 cases (Poliomyelitis - update (22): South Sudan, global 20130930.1976296). Of these 26 newly confirmed cases, 20 have been in the 3 endemic countries (15 in Pakistan, 3 in Afghanistan, and 2 in Nigeria) and 6 have been identified in the ongoing outbreak in the Horn of Africa (3 in Ethiopia and 3 in South Sudan). According to the above report from the Polio Eradication Initiative, it states that there have been 6 new cases reported from the Horn of Africa - 2 from Ethiopia and 4 from Somalia. The table included with this report states there are 174 cases reported from Somalia, 3 in South Sudan and 6 cases reported from Ethiopia as of 16 Oct 2013. According to the similar table contained in the prior ProMED-mail post Poliomyelitis - update (22): South Sudan, global 20130930.1976296, as of 24 Sep 2013, there had been 174 cases in Somalia, 3 in Ethiopia, and no cases had been officially confirmed in South Sudan.
Of note, given the same number of confirmed cases reported from Somalia, as of 24 Sep 2013, the most recent confirmed case had onset on 27 Aug 2013, whereas in this past week's report, the most recent confirmed case in Somalia was recorded as having date of onset on 14 Sep 2013. Clarification of this information would be greatly appreciated.
In the year to date comparisons with 2012, there are now more cases confirmed with WPV in 2013 than at this time in 2012 -- 296 cases confirmed in 2013 compared with 223 cases confirmed in 2012. While the good news is that there appears to be a decrease in the numbers of confirmed cases of WPV in the 3 endemic countries, the bad news is that there has been a large outbreak in the Horn of Africa involving Somalia, Kenya, Ethiopia and South Sudan, and there is an outbreak presently suspected in Syria.
For a map showing the geographic locations of cases of confirmed WPV associated polio in the world in 2013, see http://www.polioeradication.org/Dataand ... dwide.aspx. - Mod.MPP]
-
Birgitt
- Moderator
- Beiträge: 35230
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Kinderlähmung - Poliomyelitis weltweit
POLIOMYELITIS UPDATE (24): SYRIA SUSPECTED, CAMEROON, GLOBAL
************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
In this update:
[1] Syria - suspected cases
[2] Global update - Polio Eradication Initiative
******
[1] Syria - suspected cases
Date: Thu 24 Oct 2013
Source: Reuters [edited]
http://www.reuters.com/article/2013/10/ ... LF20131024
Suspected polio outbreak in Syrian province spreads - WHO
---------------------------------------------------------
At least 22 people are now suspected of having polio in Syria, where health officials are scrambling to respond to the 1st outbreak of the crippling viral disease in 14 years, the World Health Organization (WHO) said on Thursday [24 Oct 2013].
Most of those stricken with acute flaccid paralysis -- a symptom of diseases including polio -- in the eastern province of Deir al-Zor [Dayr az Zawr] are children under the age of 2 [years], WHO spokesman Oliver Rosenbauer said.
"There is a cluster of 22 acute flaccid paralysis cases that is being investigated in that area," Rosenbauer told Reuters. "Everybody is treating this as an outbreak (of polio) and is in outbreak response mode."
The WHO, a UN agency, announced on Saturday [19 Oct 2013] that 2 suspected cases of polio had been detected, the 1st appearance of the disease in Syria since 1999.
Initial tests came back positive for polio in 2 of the 22 cases and final laboratory results due next week from a WHO reference laboratory in Tunis are "very, very likely" to confirm presence of the virus, Rosenbauer said.
There is no cure for the highly infectious disease; it can only be prevented through immunization, usually 3 doses.
More than 100 000 children under age 5 [years] are deemed at risk of polio in Deir al-Zor province, he said. Most of the countryside is in opposition hands but the city of Deir al-Zor itself is still partially controlled by government forces.
"The main concern right now is to quickly launch an immunization response," Rosenbauer said. Vaccination campaigns are being planned across Syria from November [2013] but logistics in a civil war are still being discussed.
With some 4000 Syrian refugees leaving the country daily, immunization campaigns are also planned in neighboring countries, where there may be gaps in coverage, he said.
Most of the 22 victims are believed never to have been vaccinated or to have received only a single dose of the oral polio vaccine, Rosenbauer said.
Polio invades the nervous system and can cause irreversible paralysis within hours. It is endemic in just 3 countries, Nigeria, Pakistan and Afghanistan, but sporadic cases also occur in other countries.
Rosenbauer, asked whether the virus may have been imported into Syria by a foreign combatant fighting in the civil war, replied: "The 1st step is virological verification that it is the polio virus.
"The next step is that every isolated virus gets looked at genetically to see where is the parent. Hopefully that will provide some clarity on where it would have come from," he said.
The outbreak is the latest setback to international efforts to eradicate polio -- as well adding another dimension to Syria's worsening humanitarian crisis as the war forces people from their homes and destroys health systems.
Polio cases worldwide decreased from an estimated 350 000 cases when the campaign began in 1988 to 223 reported cases in 2012, according to WHO. So far this year [2013] -- not including the 22 unconfirmed cases in Syria -- there have been 296 cases of wild poliovirus worldwide.
[byline: Stephanie Nebehay]
--
communicated by:
ProMED-mail rapporteur Mary Marshall
******
[2] Global update - Polio Eradication Initiative
Date: Thu 24 Oct 2013
Source: Global Polio Eradication Initiative [edited]
http://polioeradication.org/Dataandmoni ... sweek.aspx
Global Polio Eradication Initiative update as of 23 Oct 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 301 / 174 / 223
- in endemic countries: 103 / 170 / 217
- in non-endemic countries: 198 / 5 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 46 / 0 / 0 / 46 // 44 / 2 / 1 / 47 / 58 // 1 Oct 2013
Afghanistan: 8 / 0 / 0 / 8 // 25 / 0 / 0 / 25 / 37 // 19 Sep 2013
Nigeria: 49 / 0 / 0 / 49 // 80 / 17 / 0 / 97 / 122 // 10 Sep 2013
Somalia: 174 / 0 / 0 / 174 // 0 / 0 / 0 / 0 / 0 // 14 Sep 2013
Ethiopia: 6 / 0 / 0 / 6 // 0 / 0 / 0 / 0 / 0 // 19 Sep 2013
Cameroon: 1 / 0 / 0 / 1 // 0 / 0 / 0 / 0 / 0 // 1 Oct 2013
South Sudan: 3 / 0 / 0 / 3 // 0 / 0 / 0 / 0 / 0 // 24 Aug 2013
Kenya: 14 / 0 / 0 / 14 // 0 / 0 / 0 / 0 / 0 // 14 Jul 2013
Chad: 0 / 0 / 0 / 0 // 5 / 0 / 0 / 5 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 301 / 0 / 0 / 301 // 155 / 19 / 1 / 175 / 223
Total in endemic countries: 103 / 0 / 0 / 103 // 150 / 19 / 1 / 170 / 217
Total outbreak: 198 / 0 / 0 / 198 // 5 / 0 / 0 / 5 / 6
Data in WHO as of 23 Oct 2012 for 2012 data and 22 Oct 2013 for 2013 data.
Highlights of this week:
- World Polio Day - [24 Oct 2013]. Partners, governments, civil society and communities worldwide are today marking World Polio Day, as efforts to eradicate this disease once and for all are being intensified.
- In Syria, reports of suspected polio cases have emerged. A cluster of hot cases is currently being investigated, and has prompted planning for a comprehensive outbreak response across the region.
- One wild poliovirus type 1 (WPV1) case has been confirmed in Cameroon. This is the 1st WPV in the country since 2009. WPV1 was isolated from an acute flaccid paralysis (AFP) case from Ouest province, with onset of paralysis on [1 Oct 2013]. Genetic sequencing is on-going to determine origin of the isolated virus.
Afghanistan
-----------
- One new WPV1 case was reported in the past week. The total number of WPV cases for 2013 is now 8 (all WPV1), all of which were reported from Eastern Region, close to the Pakistan border. The most recent WPV1 case had onset of paralysis on [19 Sep 2013], from Kunar province.
- No new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
- National immunization days (NIDs) were conducted on [6-8 Oct 2013]. A 2nd NIDs is planned for late October [2013], followed by subnational immunization days (SNIDs) mid and late November [2013].
Nigeria
-------
- No new WPV cases were reported this week. The total number of WPV cases for 2013 remains 49 (all WPV1s). The most recent WPV1 case in the country had onset of paralysis on [10 Sep 2013] (from Kano).
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (with onset of paralysis on [6 Jun 2013], from Borno).
- The primary challenges remain to access all children in Borno state, including in areas currently inaccessible during supplementary immunization activities (SIAs) due to insecurity, and to further improve the quality of SIA implementation in Kano state.
- OPV was administered along with measles vaccine during Child Health Days (CHDs) in north and middle-band states on [5-9 Oct 2013]. Additional CHDs are planned for early November [2013] in middle-band and southern states. SNIDs are planned for northern states [14-19 Nov 2013].
Pakistan
--------
- Three new WPV1 cases were reported in the past week. All were reported from Federally Administered Tribal Areas (FATA -- 2 from FR Bannu and one from North Waziristan). The total number of WPV1 cases for Pakistan in 2013 is now 46. The most recent WPV1 case had onset of paralysis on [1 Oct 2013] (from FR Bannu). The majority of WPV1 cases in Pakistan this year, 34 (74 per cent), are from FATA, of which 14 from Khyber Agency and 14 from North Waziristan.
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for Pakistan remains 29. The most recent cVDPV2 case had onset of paralysis [12 Sep 2013] (from North Waziristan).
- The situation in North Waziristan is becoming increasingly severe, as it is the area with the largest number of children being paralysed by wild poliovirus (14 cases) and cVDPV2s (22) in all of Asia. It is in an area where immunization activities have been suspended by local leaders since June 2012. It is critical that children in these 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.
- NIDs were conducted on [30 Sep to 2 Oct 2013]. SNIDs were conducted [14-16 Oct 2013] using bOPV. Further NIDs are planned for November [2013] with dates to be confirmed using bOPV.
Chad, Cameroon and Central African Republic
-------------------------------------------
- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac). No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 4 (the most recent cVDPV2 case had onset of paralysis on [12 May 2013] from Ennedi). Nationwide immunization campaigns are planned for late October and November [2013].
- In Cameroon, one WPV1 was reported this week from Ouest province. This is the 1st WPV in Cameroon since 2009 and had onset of paralysis on [1 Oct 2013].
- An outbreak response is now being planned. In 2013, 5 large-scale supplementary immunization activities (SIAs) have already been conducted in Cameroon (in April, May, August, September and October [2013]), as the country was considered at high-risk of re-infection due to its proximity with Nigeria. The latest NIDs were conducted [11-13 Oct 2013].
- No new cVDPV2 cases were reported in the past week in Cameroon. The total number of cVDPV2 cases for 2013 remains 4. The most recent VPDV had onset of paralysis on [12 Aug 2013] (from Kolfata, Extreme-Nord).
- Central African Republic (CAR) continues to be at serious risk of re-infection due to proximity with Chad, on-going insecurity and humanitarian crises, and destruction of health infrastructure. To minimize the risk and consequences of potential re-infection, SNIDs were conducted on [30 Sep to 2 Oct 2013] and CHDs are planned for [11-13 Nov 2013].
Horn of Africa
--------------
- No new WPV1 cases were reported in the past week. The total number of WPV cases (all WPV1) for 2013 in the Horn of Africa remains 197 (174 from Somalia, 14 from Kenya, 6 from Ethiopia and 3 from South Sudan). The most recent WPV1 case in the region had onset of paralysis on [19 Sep 2013] (from Somali region, Ethiopia).
- Outbreak response across the Horn of Africa is continuing. As a result of concerted outbreak response efforts, the impact of the response is beginning to be seen, as the number of newly-reported cases from Banadir, Somalia (the epicentre of the outbreak) has declined. At the same time, operations are improving as more children are being reached, including in some inaccessible areas of south-central Somalia. However, more needs to be done, because as many as 500 000 children still remain inaccessible in parts of south-central Somalia and other areas of the Horn of Africa remain at risk of re-infection.
Israel and West Bank and Gaza
-----------------------------
- Although no case of paralytic polio has been reported, environmental surveillance suggests that WPV1 transmission, 1st detected in February 2013, continues in southern and parts of central Israel. WPV1-positive samples were detected also in West Bank (2 sites) and the Gaza Strip (1 site).
- Since 2005, only inactivated polio vaccine (IPV) has been used for routine childhood immunization in Israel. To interrupt WPV1 transmission, a nationwide supplementary immunization activity (SIA) with bivalent OPV targeting children less than 10 years of age has been on-going since August [2013].
- Following a consultation with the country's immunization advisory group, the Israeli Ministry of Health has recently decided to re-introduce OPV into the national immunization schedule.
- SIAs in West Bank and Gaza Strip have been tentatively scheduled for October and November [2013].
Syrian Arab Republic
--------------------
- In Syria, reports of suspected polio cases have emerged.
- On [17 Oct 2013], the World Health Organization (WHO) received reports of a cluster of acute flaccid paralysis (AFP) cases in the Syrian Arab Republic. This cluster of 'hot' AFP cases was detected in early October [2013] in Deir Al-Zour province and is currently being investigated. Wild poliovirus was last reported in Syria in 1999.
- A comprehensive outbreak response plan is urgently being finalized. The main aim is to rapidly conduct an immunization activity in the immediately-affected area (by end-October) and high-risk areas. Multiple large-scale SIAs are needed over the next 6 months (beginning in early November [2013]) across Syria and across the region.
West Africa
-----------
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
- No new cVDPV2 cases were reported in the past week from Niger. The country has reported a single case of cVDPV in 2013, with onset of paralysis on [11 Jul 2013]. Genetic sequencing has shown that the virus is related to that seen in Cameroon, Chad and Nigeria (Borno).
- Multi-country synchronized immunization campaigns are planned in West Africa for late October [2013]. Additional subnational campaigns were conducted [7-9 Sep 2013] in Niger, and additional rounds are planned in the region for early November [2013].
--
communicated by:
ProMED-mail
<promed@promedmail.org>
[Since the last ProMED-mail update on polio earlier this week (Poliomyelitis - update (23): Syria susp., global, RFI 20131020.2010654), the number of suspected cases of polio in Syria has increased from 10 to 22, suggesting that there has been significant circulation of poliovirus in the affected area. Confirmation of wild poliovirus (WPV) by the regional polio reference laboratory is still pending.
Another significant occurrence during this past week is the confirmation of WPV infection in Cameroon. Genetic studies on this isolate are still pending but most likely will be similar to those WPVs circulating in Nigeria, one of the 3 remaining polio endemic countries in the world.
As discussed in the above Global Polio Eradication Initiative update, the common denominator that seems to be impeding eradication efforts worldwide is the presence of civil unrest in a number of countries that had led to serious gaps in immunization coverages of the susceptible population.
For a map showing the location of confirmed WPV cases in 2013, see http://www.polioeradication.org/Dataand ... dwide.aspx.
The province (governorate) of Deir al-Zor (Dayr az Zawr) can be seen on the map at http://www.ephotopix.com/syria_province_map.html. It is located in the northeast of the country, bordering with Iraq. If WPV is confirmed, given the civil unrest in Iraq, one wonders if there might be WPV circulating across the border in Iraq as well.
For the HealthMap/ProMED-mail interactive map of Syria, see http://healthmap.org/r/8S1u. - Mod.MPP]
************************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
In this update:
[1] Syria - suspected cases
[2] Global update - Polio Eradication Initiative
******
[1] Syria - suspected cases
Date: Thu 24 Oct 2013
Source: Reuters [edited]
http://www.reuters.com/article/2013/10/ ... LF20131024
Suspected polio outbreak in Syrian province spreads - WHO
---------------------------------------------------------
At least 22 people are now suspected of having polio in Syria, where health officials are scrambling to respond to the 1st outbreak of the crippling viral disease in 14 years, the World Health Organization (WHO) said on Thursday [24 Oct 2013].
Most of those stricken with acute flaccid paralysis -- a symptom of diseases including polio -- in the eastern province of Deir al-Zor [Dayr az Zawr] are children under the age of 2 [years], WHO spokesman Oliver Rosenbauer said.
"There is a cluster of 22 acute flaccid paralysis cases that is being investigated in that area," Rosenbauer told Reuters. "Everybody is treating this as an outbreak (of polio) and is in outbreak response mode."
The WHO, a UN agency, announced on Saturday [19 Oct 2013] that 2 suspected cases of polio had been detected, the 1st appearance of the disease in Syria since 1999.
Initial tests came back positive for polio in 2 of the 22 cases and final laboratory results due next week from a WHO reference laboratory in Tunis are "very, very likely" to confirm presence of the virus, Rosenbauer said.
There is no cure for the highly infectious disease; it can only be prevented through immunization, usually 3 doses.
More than 100 000 children under age 5 [years] are deemed at risk of polio in Deir al-Zor province, he said. Most of the countryside is in opposition hands but the city of Deir al-Zor itself is still partially controlled by government forces.
"The main concern right now is to quickly launch an immunization response," Rosenbauer said. Vaccination campaigns are being planned across Syria from November [2013] but logistics in a civil war are still being discussed.
With some 4000 Syrian refugees leaving the country daily, immunization campaigns are also planned in neighboring countries, where there may be gaps in coverage, he said.
Most of the 22 victims are believed never to have been vaccinated or to have received only a single dose of the oral polio vaccine, Rosenbauer said.
Polio invades the nervous system and can cause irreversible paralysis within hours. It is endemic in just 3 countries, Nigeria, Pakistan and Afghanistan, but sporadic cases also occur in other countries.
Rosenbauer, asked whether the virus may have been imported into Syria by a foreign combatant fighting in the civil war, replied: "The 1st step is virological verification that it is the polio virus.
"The next step is that every isolated virus gets looked at genetically to see where is the parent. Hopefully that will provide some clarity on where it would have come from," he said.
The outbreak is the latest setback to international efforts to eradicate polio -- as well adding another dimension to Syria's worsening humanitarian crisis as the war forces people from their homes and destroys health systems.
Polio cases worldwide decreased from an estimated 350 000 cases when the campaign began in 1988 to 223 reported cases in 2012, according to WHO. So far this year [2013] -- not including the 22 unconfirmed cases in Syria -- there have been 296 cases of wild poliovirus worldwide.
[byline: Stephanie Nebehay]
--
communicated by:
ProMED-mail rapporteur Mary Marshall
******
[2] Global update - Polio Eradication Initiative
Date: Thu 24 Oct 2013
Source: Global Polio Eradication Initiative [edited]
http://polioeradication.org/Dataandmoni ... sweek.aspx
Global Polio Eradication Initiative update as of 23 Oct 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 301 / 174 / 223
- in endemic countries: 103 / 170 / 217
- in non-endemic countries: 198 / 5 / 6
Case breakdown by country
Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 / W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case
Pakistan: 46 / 0 / 0 / 46 // 44 / 2 / 1 / 47 / 58 // 1 Oct 2013
Afghanistan: 8 / 0 / 0 / 8 // 25 / 0 / 0 / 25 / 37 // 19 Sep 2013
Nigeria: 49 / 0 / 0 / 49 // 80 / 17 / 0 / 97 / 122 // 10 Sep 2013
Somalia: 174 / 0 / 0 / 174 // 0 / 0 / 0 / 0 / 0 // 14 Sep 2013
Ethiopia: 6 / 0 / 0 / 6 // 0 / 0 / 0 / 0 / 0 // 19 Sep 2013
Cameroon: 1 / 0 / 0 / 1 // 0 / 0 / 0 / 0 / 0 // 1 Oct 2013
South Sudan: 3 / 0 / 0 / 3 // 0 / 0 / 0 / 0 / 0 // 24 Aug 2013
Kenya: 14 / 0 / 0 / 14 // 0 / 0 / 0 / 0 / 0 // 14 Jul 2013
Chad: 0 / 0 / 0 / 0 // 5 / 0 / 0 / 5 / 5 // 14 Jun 2012
Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012
Total: 301 / 0 / 0 / 301 // 155 / 19 / 1 / 175 / 223
Total in endemic countries: 103 / 0 / 0 / 103 // 150 / 19 / 1 / 170 / 217
Total outbreak: 198 / 0 / 0 / 198 // 5 / 0 / 0 / 5 / 6
Data in WHO as of 23 Oct 2012 for 2012 data and 22 Oct 2013 for 2013 data.
Highlights of this week:
- World Polio Day - [24 Oct 2013]. Partners, governments, civil society and communities worldwide are today marking World Polio Day, as efforts to eradicate this disease once and for all are being intensified.
- In Syria, reports of suspected polio cases have emerged. A cluster of hot cases is currently being investigated, and has prompted planning for a comprehensive outbreak response across the region.
- One wild poliovirus type 1 (WPV1) case has been confirmed in Cameroon. This is the 1st WPV in the country since 2009. WPV1 was isolated from an acute flaccid paralysis (AFP) case from Ouest province, with onset of paralysis on [1 Oct 2013]. Genetic sequencing is on-going to determine origin of the isolated virus.
Afghanistan
-----------
- One new WPV1 case was reported in the past week. The total number of WPV cases for 2013 is now 8 (all WPV1), all of which were reported from Eastern Region, close to the Pakistan border. The most recent WPV1 case had onset of paralysis on [19 Sep 2013], from Kunar province.
- No new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).
- National immunization days (NIDs) were conducted on [6-8 Oct 2013]. A 2nd NIDs is planned for late October [2013], followed by subnational immunization days (SNIDs) mid and late November [2013].
Nigeria
-------
- No new WPV cases were reported this week. The total number of WPV cases for 2013 remains 49 (all WPV1s). The most recent WPV1 case in the country had onset of paralysis on [10 Sep 2013] (from Kano).
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (with onset of paralysis on [6 Jun 2013], from Borno).
- The primary challenges remain to access all children in Borno state, including in areas currently inaccessible during supplementary immunization activities (SIAs) due to insecurity, and to further improve the quality of SIA implementation in Kano state.
- OPV was administered along with measles vaccine during Child Health Days (CHDs) in north and middle-band states on [5-9 Oct 2013]. Additional CHDs are planned for early November [2013] in middle-band and southern states. SNIDs are planned for northern states [14-19 Nov 2013].
Pakistan
--------
- Three new WPV1 cases were reported in the past week. All were reported from Federally Administered Tribal Areas (FATA -- 2 from FR Bannu and one from North Waziristan). The total number of WPV1 cases for Pakistan in 2013 is now 46. The most recent WPV1 case had onset of paralysis on [1 Oct 2013] (from FR Bannu). The majority of WPV1 cases in Pakistan this year, 34 (74 per cent), are from FATA, of which 14 from Khyber Agency and 14 from North Waziristan.
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for Pakistan remains 29. The most recent cVDPV2 case had onset of paralysis [12 Sep 2013] (from North Waziristan).
- The situation in North Waziristan is becoming increasingly severe, as it is the area with the largest number of children being paralysed by wild poliovirus (14 cases) and cVDPV2s (22) in all of Asia. It is in an area where immunization activities have been suspended by local leaders since June 2012. It is critical that children in these 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.
- NIDs were conducted on [30 Sep to 2 Oct 2013]. SNIDs were conducted [14-16 Oct 2013] using bOPV. Further NIDs are planned for November [2013] with dates to be confirmed using bOPV.
Chad, Cameroon and Central African Republic
-------------------------------------------
- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac). No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 4 (the most recent cVDPV2 case had onset of paralysis on [12 May 2013] from Ennedi). Nationwide immunization campaigns are planned for late October and November [2013].
- In Cameroon, one WPV1 was reported this week from Ouest province. This is the 1st WPV in Cameroon since 2009 and had onset of paralysis on [1 Oct 2013].
- An outbreak response is now being planned. In 2013, 5 large-scale supplementary immunization activities (SIAs) have already been conducted in Cameroon (in April, May, August, September and October [2013]), as the country was considered at high-risk of re-infection due to its proximity with Nigeria. The latest NIDs were conducted [11-13 Oct 2013].
- No new cVDPV2 cases were reported in the past week in Cameroon. The total number of cVDPV2 cases for 2013 remains 4. The most recent VPDV had onset of paralysis on [12 Aug 2013] (from Kolfata, Extreme-Nord).
- Central African Republic (CAR) continues to be at serious risk of re-infection due to proximity with Chad, on-going insecurity and humanitarian crises, and destruction of health infrastructure. To minimize the risk and consequences of potential re-infection, SNIDs were conducted on [30 Sep to 2 Oct 2013] and CHDs are planned for [11-13 Nov 2013].
Horn of Africa
--------------
- No new WPV1 cases were reported in the past week. The total number of WPV cases (all WPV1) for 2013 in the Horn of Africa remains 197 (174 from Somalia, 14 from Kenya, 6 from Ethiopia and 3 from South Sudan). The most recent WPV1 case in the region had onset of paralysis on [19 Sep 2013] (from Somali region, Ethiopia).
- Outbreak response across the Horn of Africa is continuing. As a result of concerted outbreak response efforts, the impact of the response is beginning to be seen, as the number of newly-reported cases from Banadir, Somalia (the epicentre of the outbreak) has declined. At the same time, operations are improving as more children are being reached, including in some inaccessible areas of south-central Somalia. However, more needs to be done, because as many as 500 000 children still remain inaccessible in parts of south-central Somalia and other areas of the Horn of Africa remain at risk of re-infection.
Israel and West Bank and Gaza
-----------------------------
- Although no case of paralytic polio has been reported, environmental surveillance suggests that WPV1 transmission, 1st detected in February 2013, continues in southern and parts of central Israel. WPV1-positive samples were detected also in West Bank (2 sites) and the Gaza Strip (1 site).
- Since 2005, only inactivated polio vaccine (IPV) has been used for routine childhood immunization in Israel. To interrupt WPV1 transmission, a nationwide supplementary immunization activity (SIA) with bivalent OPV targeting children less than 10 years of age has been on-going since August [2013].
- Following a consultation with the country's immunization advisory group, the Israeli Ministry of Health has recently decided to re-introduce OPV into the national immunization schedule.
- SIAs in West Bank and Gaza Strip have been tentatively scheduled for October and November [2013].
Syrian Arab Republic
--------------------
- In Syria, reports of suspected polio cases have emerged.
- On [17 Oct 2013], the World Health Organization (WHO) received reports of a cluster of acute flaccid paralysis (AFP) cases in the Syrian Arab Republic. This cluster of 'hot' AFP cases was detected in early October [2013] in Deir Al-Zour province and is currently being investigated. Wild poliovirus was last reported in Syria in 1999.
- A comprehensive outbreak response plan is urgently being finalized. The main aim is to rapidly conduct an immunization activity in the immediately-affected area (by end-October) and high-risk areas. Multiple large-scale SIAs are needed over the next 6 months (beginning in early November [2013]) across Syria and across the region.
West Africa
-----------
- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].
- No new cVDPV2 cases were reported in the past week from Niger. The country has reported a single case of cVDPV in 2013, with onset of paralysis on [11 Jul 2013]. Genetic sequencing has shown that the virus is related to that seen in Cameroon, Chad and Nigeria (Borno).
- Multi-country synchronized immunization campaigns are planned in West Africa for late October [2013]. Additional subnational campaigns were conducted [7-9 Sep 2013] in Niger, and additional rounds are planned in the region for early November [2013].
--
communicated by:
ProMED-mail
<promed@promedmail.org>
[Since the last ProMED-mail update on polio earlier this week (Poliomyelitis - update (23): Syria susp., global, RFI 20131020.2010654), the number of suspected cases of polio in Syria has increased from 10 to 22, suggesting that there has been significant circulation of poliovirus in the affected area. Confirmation of wild poliovirus (WPV) by the regional polio reference laboratory is still pending.
Another significant occurrence during this past week is the confirmation of WPV infection in Cameroon. Genetic studies on this isolate are still pending but most likely will be similar to those WPVs circulating in Nigeria, one of the 3 remaining polio endemic countries in the world.
As discussed in the above Global Polio Eradication Initiative update, the common denominator that seems to be impeding eradication efforts worldwide is the presence of civil unrest in a number of countries that had led to serious gaps in immunization coverages of the susceptible population.
For a map showing the location of confirmed WPV cases in 2013, see http://www.polioeradication.org/Dataand ... dwide.aspx.
The province (governorate) of Deir al-Zor (Dayr az Zawr) can be seen on the map at http://www.ephotopix.com/syria_province_map.html. It is located in the northeast of the country, bordering with Iraq. If WPV is confirmed, given the civil unrest in Iraq, one wonders if there might be WPV circulating across the border in Iraq as well.
For the HealthMap/ProMED-mail interactive map of Syria, see http://healthmap.org/r/8S1u. - Mod.MPP]
