POLIOMYELITIS UPDATE (25): SYRIA (DEIR AL ZOUR) CONFIRMED, WHO
**************************************************************
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] WHO report
[2] News media report
******
[1] WHO report
WHO, Global Alert and Response
Date: Tue 29 Oct 2013
Source: WHO Global Alert and Response (GAR), Disease Outbreak News [edited]
http://www.who.int/csr/don/2013_10_29/en/index.html
Polio in the Syrian Arab Republic
---------------------------------
Following reports of a cluster of 22 acute flaccid paralysis (AFP) cases on [17 Oct 2013] in the Syrian Arab Republic, wild poliovirus type 1 (WPV1) has been isolated from 10 of the cases under investigation. Final genetic sequencing results are pending to determine the origin of the isolated viruses. Wild poliovirus had not been detected in the Syrian Arab Republic since 1999.
Most of the cases are very young (below 2 years of age), and were un- or under-immunized. Estimated immunization rates in the Syrian Arab Republic declined from 91 percent in 2010 to 68 percent in 2012.
Even before this laboratory confirmation, health authorities in the Syrian Arab Republic and neighbouring countries had begun the planning and implementation of a comprehensive outbreak response. On [24 Oct 2013], an already-planned large scale supplementary immunization activity (SIA) was launched in the Syrian Arab Republic to vaccinate 1.6 million children against polio, measles, mumps, and rubella, in both government-controlled and contested areas.
Implementation of an SIA in Deir Al Zour [Dayr az Zawr] province commenced promptly when the 1st 'hot cases' were reported. Larger-scale outbreak response across the Syrian Arab Republic and neighbouring countries is anticipated to begin in early November 2013, to last for at least 6 to 8 months depending on the area and based on evolving epidemiology.
Given the current situation in the Syrian Arab Republic, frequent population movements across the region and subnational immunity gaps in key areas, the risk of further international spread of wild poliovirus type 1 across the region is considered to be high. A surveillance alert has been issued for the region to actively search for additional potential cases.
WHO's International Travel and Health recommends that all travellers to and from polio-infected areas be fully vaccinated against polio.
--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp
******
[2] News media report
Date: Tue 29 Oct 2013
Source: The New York Times [edited]
http://www.nytimes.com/2013/10/30/world ... syria.html
United Nations officials confirmed an outbreak of polio among children in Syria on Tuesday [29 Oct 2013], lending urgency to plans for vaccination campaigns there and in nearby countries to try to halt the spread of the disease.
Tests confirmed polio in 10 out of 22 children in Deir al Zour Province in northeastern Syria who became ill this month [October 2013], Oliver Rosenbauer, a spokesman for the World Health Organization, said. Results of tests on the other 12 children are expected soon, he added.
"With population movements, it can travel to other areas, so the risk is high of spread across the region," Mr Rosenbauer said.
United Nations officials said last week [week of 21 Oct 2013] they were launching a campaign to immunize 2.4 million children in Syria against polio and other diseases. With thousands of refugees fleeing daily from Syria's civil war to neighboring countries, they are also intensifying immunization efforts in 6 countries, including Lebanon, Jordan, Iraq, and Turkey, which have taken in more than 2 million Syrian refugees, as well as Egypt and Israel.
Most of the affected children in Syria are under 2 years old, Mr Rosenbauer said, underscoring the impact of 31 months of conflict on Syria's health infrastructure. The United Nations says half a million Syrian children have not been inoculated against polio in a country where, before the conflict, 95 percent of the country's population was immunized.
Despite the difficulty of delivering vaccines in a country convulsed by war, the United Nations Children's Fund said it had vaccinated about a million Syrian children this year [2013], including 800 000 who were vaccinated against polio.
After confirming the presence of the disease, attention is turning to identifying the source, Mr Rosenbauer said. Public health officials have speculated that a possible source may have been jihadists traveling to Syria from Pakistan which, with Afghanistan and Nigeria, are the only countries where the disease is still endemic.
The outbreak of polio in Syria "shows you have to eradicate the disease in the endemic countries because from there it will spread no matter where you are," Mr Rosenbauer, who works with the World Health Organization's Polio Eradication Initiative, said in an interview.
The polio outbreak in Syria was "a setback" like any upsurge in the disease, but health officials were seeing significant progress in curbing the disease in endemic countries, Mr Rosenbauer said. In Pakistan and Nigeria, the disease is geographically more restricted and in southern Afghanistan, the area of the country where the disease is endemic, no new cases had been reported this year [2013]. "That's never happened before," he said.
[Byline: Nick Cumming-Bruce]
--
Communicated by:
Ryan McGinnis
<ryan@bigstormpicture.com>
[The reports above provide confirmation of the previously highly suspected cases of polio in Syria. At present 10 of the 22 suspected cases have been confirmed. The information provided to date suggests that the civil unrest has significantly impacted public health initiatives in Syria, where polio vaccination coverage had been 95 percent prior to the civil unrest. The observation that "most" of the cases in Syria are less than 2 years old and were unvaccinated, suggests that the 31 months of civil unrest have disrupted the routine vaccination activities of the country.
Information that is still pending includes the genetic studies on the WPV identified in this outbreak to know the probable source of the transmission. It is tempting to speculate the virus' origin, possibly the same virus as currently circulating in nearby Israel, Gaza strip, and Egypt, where viruses genetically related to those currently circulating in Pakistan have been identified in asymptomatic individuals as well as in sewage samples in these areas. That being said, the affected region is in the eastern part of Syria near the border with Iraq and one wonders if there might be 'silent' circulation of the WPV in neighboring Iraq as well.
Maps of Syria can be seen at http://www.ezilon.com/maps/images/asia/ ... -Syria.gif and http://healthmap.org/r/8S1u . - Mod.MPP]
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POLIOMYELITIS UPDATE (26): SYRIA WHO
************************************
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: WHO
[2] Global update: Polio Eradication Initiative
******
[1] Syria: WHO
Date: Mon 11 Nov 2013
Source: WHO Global Alert and Response (GAR), Disease Outbreak News [edited]
http://www.who.int/csr/don/2013_11_11po ... index.html
Polio in the Syrian Arab Republic - update [11 Nov 2013]
--------------------------------------------------------
To date 13 cases of wild poliovirus type 1 (WPV1) have been confirmed in the Syrian Arab Republic. Genetic sequencing indicates that the isolated viruses are most closely linked to virus detected in environmental samples in Egypt in December 2012 (which in turn had been linked to wild poliovirus [WPV] circulating in Pakistan). Closely related wild poliovirus strains have also been detected in environmental samples in Israel, West Bank and Gaza Strip since February 2013. Wild poliovirus had not been detected in the Syrian Arab Republic since 1999.
A comprehensive outbreak response continues to be implemented across the region. On [24 Oct 2013], an already-planned large-scale supplementary immunization activity was launched in the Syrian Arab Republic to vaccinate 1.6 million children against polio, measles, mumps, and rubella, in both government-controlled and contested areas. Implementation of a supplementary immunization campaign in Deir Al Zour province commenced promptly when the 1st 'hot' acute flaccid paralysis (AFP) cases were reported. Larger-scale outbreak response across the Syrian Arab Republic and neighbouring countries will continue for at least 6-8 months depending on the area and based on the evolving situation.
Given the current situation in the Syrian Arab Republic, frequent population movements across the region and the immunization level in key areas, the risk of further international spread of wild poliovirus type 1 across the region is considered to be high. A surveillance alert has been issued for the region to actively search for additional potential cases.
WHO's International Travel and Health recommends that all travellers to and from polio-infected areas be fully vaccinated against polio.
--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp
[For the HealthMap/ProMED-mail interactive map of Syria, see http://healthmap.org/r/3aLZ. - Mod.MPP]
******
[2] Global update: Polio Eradication Initiative
Date: Thu 14 Nov 2013
Source: Global Polio Eradication Initiative [edited]
http://polioeradication.org/Dataandmoni ... sweek.aspx
Global Polio Eradication Initiative update as of 13 Nov 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 334 / 187 / 223
- in endemic countries: 119 / 182 / 217
- in non-endemic countries: 215 / 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: 59 / 0 / 0 / 59 // 51 / 2 / 1 / 54 / 58 // 21 Oct 2013
Afghanistan: 9 / 0 / 0 / 9 // 27 / 0 / 0 / 27 / 37 // 27 Sep 2013
Nigeria: 51 / 0 / 0 / 51 // 83 / 18 / 0 / 101 / 122 // 8 Oct 2013
Somalia: 180 / 0 / 0 / 180 // 0 / 0 / 0 / 0 / 0 // 30 Sep 2013
Ethiopia: 6 / 0 / 0 / 6 // 0 / 0 / 0 / 0 / 0 // 19 Sep 2013
Cameroon: 2 / 0 / 0 / 2 // 0 / 0 / 0 / 0 / 0 // 19 Oct 2013
Syrian Arab Republic: 13 / 0 / 0 / 13 // 0 / 0 / 0 / 0 / 0 // 4 Oct 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: 334 / 0 / 0 / 334 // 166 / 20 / 1 / 187 / 223
Total in endemic countries: 119 / 0 / 0 / 119 // 161 / 20 / 1 / 182 / 217
Total outbreak: 215 / 0 / 0 / 215 // 5 / 0 / 0 / 5 / 6
Data in WHO as of 13 Nov 2012 for 2012 data and 12 Nov 2013 for 2013 data.
Highlights of the week
----------------------
- 13 cases of wild poliovirus type 1 (WPV1) have been confirmed in the Syrian Arab Republic. Genetic sequencing indicates that the isolated viruses are most closely linked to virus detected in environmental samples in Egypt in December 2012 (which in turn had been linked to wild poliovirus circulating in Pakistan). Closely related wild poliovirus strains have also been detected in environmental samples in Israel, and The West Bank and Gaza Strip since February 2013. A comprehensive outbreak response continues to be implemented across the sub-region.
- The number of WPV1 cases in Pakistan for 2013 (59) now exceeds the number of polio cases reported from Pakistan during the same time period in 2012 (54). Nigeria has reported half the cases (51/101) and Afghanistan one third (9/27) of cases compared to the same time period in 2012.
Afghanistan
-----------
- No new WPV1 cases were reported in the past week. The total number of WPV cases for 2013 remains 9 (all WPV1), of which all were reported from the Eastern Region, close to the Pakistan border. The most recent WPV1 case was reported from Chapa Dara district, Kunar province, with onset of paralysis on [27 Sep 2013].
- 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 this week. The total number of WPV cases for 2013 remains 51 (all WPV1). The most recent WPV1 case in the country had onset of paralysis on [8 Oct 2013] from Kumbotso, Kano state.
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (with onset of paralysis in the most recently reported case on [6 Jun 2013], from Borno).
- OPV was administered along with measles vaccine during Child Health Days (CHDs) in the north and the middle of the country on [5-9 Oct 2013] and in middle-band and southern states in [2-6 Nov 2013]. SNIDs [subnational immunization days] are planned for northern states starting mid-November [2013].
Pakistan
--------
- 3 new WPV1 cases were reported in the past week -- 2 from Toba Tek Singh district in Punjab and one from North Waziristan in the Federally Administered Tribal Areas (FATA).
- The total number of WPV1 cases for Pakistan in 2013 is now 59. The most recent WPV1 case had onset of paralysis on [21 Oct 2013] (from Toba Tek Singh district, Punjab). The majority of WPV1 cases in Pakistan this year [2013], 41 (69 percent), are from FATA, of which 16 are from Khyber Agency and 18 from North Waziristan.
- 3 new cVDPV2 cases were reported in the past week, all from North Waziristan. The total number of cVDPV2 cases for Pakistan is now 35. The most recent cVDPV2 case had onset of paralysis [15 Oct 2013] (from North Waziristan).
- The situation in North Waziristan is increasingly alarming. It is the area with the largest number of children being paralyzed by poliovirus in all of Asia (18 WPV1 and 28 cVDPV2 cases). 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.
- NIDs [national immunization days] were conducted on [30 Sep to 2 Oct 2013]. SNIDs were conducted on [14-16 Oct 2013] using bOPV [bivalent oral polio vaccine]. NIDs are planned for late November [2013]. Additional case response SIAs are also planned targeting the newly infected areas of Punjab.
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 nationwide immunization campaign was conducted [25-27 Oct 2013]. NIDs are planned for late November [2013].
- In Cameroon, a 2nd WPV1 case was reported in the past week from Foumbot, Ouest region, following the 1st WPV1 case reported from Ouest region with onset of paralysis on [19 Oct 2013]. Outbreak response is underway.
- No new cVDPV2 cases were reported in the past week from Cameroon. 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 Province.
- Central African Republic (CAR) continues to be at serious risk of re-infection due to proximity with Chad and Cameroon, ongoing insecurity and humanitarian crises, and destruction of the health infrastructure. To minimize the risk and consequences of potential re-infection, SNIDs were conducted on [30 Sep to 2 Oct 2013] and Child Health Days, including OPV vaccination, from [11-13 Nov 2013]. Further SNIDs are planned for December [2013] with dates and districts to be decided.
Horn of Africa
--------------
- No new WPV1 cases were reported from the Horn of Africa region in the past week.
- The total number of WPV cases (all WPV1) for 2013 in the Horn of Africa remains 201 (180 from Somalia, 14 from Kenya, and 6 from Ethiopia). The most recent WPV1 case in the region had onset of paralysis on [30 Sep 2013] (from Lower Shabelle, Somalia).
- Outbreak response activities continue across countries in the Horn of Africa. 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, the quality of SIA [supplementary immunization activity] operations is 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 Other areas of the Horn of Africa remain at risk of re-infection.
- NIDs were completed in Djibouti and Ethiopia alongside with SNIDs in Yemen in early October [2013]. In Somalia, nationwide immunization campaigns targeting all age groups were conducted [20-24 Oct 2013]. SNIDs in South Sudan targeting under 15 year olds were carried out [22-24 Oct 2013].
- NIDs are planned for mid-November [2013] in Ethiopia, Kenya, Sudan, Somalia, and South Sudan.
Israel and West Bank and Gaza
-----------------------------
- Although no case of paralytic polio has yet 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). The most recent lab results show the 1st WPV1-negative results from a southern sampling site (Beer Sheva), which has so far been persistently WPV1-positive.
- Since 2005, only inactivated polio vaccine (IPV) has been used for routine childhood immunization in Israel. To interrupt WPV1 transmission, a nationwide SIA with bivalent OPV targeting children less than 10 years of age has been conducted during August and September [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 November and December [2013].
Syrian Arab Republic
--------------------
- 3 new WPV1 cases were reported from Deir-Al-Zour governorate in the past week. The total number of WPV1 cases for Syria in 2013 is now 13, all from Deir-Al-Zour. Wild poliovirus was last reported in Syria in 1999.
- A comprehensive outbreak response continues to be implemented in Syria and across the sub-region. On [24 Oct 2013], an already-planned large-scale supplementary immunization activity was launched in the Syrian Arab Republic to vaccinate 1.6 million children against polio, measles, mumps and rubella, in both government-controlled and contested areas.
- Implementation of a supplementary immunization campaign in Deir-Al-Zour province commenced promptly when the first 'hot' acute flaccid paralysis (AFP) cases were reported.
- Larger-scale outbreak response SIAs across the Syrian Arab Republic and neighbouring countries will continue for at least 6-8 months depending on the area and based on the evolving epidemiological situation. The main aim is to rapidly reach children in the immediately-affected and other high-risk areas, followed by wider-scale immunization campaigns across the region targeting 22 million children over the next 6 months.
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 were conducted in West Africa [25-28 Oct 2013]. Additional subnational campaigns are planned in the region for late November [2013].
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[In an earlier ProMED-mail post (Poliomyelitis - update (22): South Sudan, global 20130930.1976296), there was mention of 3 cases of WPV confirmed in South Sudan. Since then, the information has been retracted due to "laboratory error" (see http://reliefweb.int/report/south-sudan ... e-n%C2%B01 and http://www.nathnac.org/pro/clinical_upd ... 051113.htm for more details.)
Since 23 Oct 2013, there has been an increase from 301 to 334 cases of which 16 occurred in endemic countries -- 13 of them in Pakistan -- and 17 occurred in non-endemic countries -- 13 of them in Syria. Of note is the information on the genetic sequencing of the WPV isolate associated with the ongoing outbreak in Syria -- closely related to the WPV isolated in Egypt, which in turn is related to a virus circulating in Pakistan.
For the global map showing the locations of all confirmed WPV associated 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] Syria: WHO
[2] Global update: Polio Eradication Initiative
******
[1] Syria: WHO
Date: Mon 11 Nov 2013
Source: WHO Global Alert and Response (GAR), Disease Outbreak News [edited]
http://www.who.int/csr/don/2013_11_11po ... index.html
Polio in the Syrian Arab Republic - update [11 Nov 2013]
--------------------------------------------------------
To date 13 cases of wild poliovirus type 1 (WPV1) have been confirmed in the Syrian Arab Republic. Genetic sequencing indicates that the isolated viruses are most closely linked to virus detected in environmental samples in Egypt in December 2012 (which in turn had been linked to wild poliovirus [WPV] circulating in Pakistan). Closely related wild poliovirus strains have also been detected in environmental samples in Israel, West Bank and Gaza Strip since February 2013. Wild poliovirus had not been detected in the Syrian Arab Republic since 1999.
A comprehensive outbreak response continues to be implemented across the region. On [24 Oct 2013], an already-planned large-scale supplementary immunization activity was launched in the Syrian Arab Republic to vaccinate 1.6 million children against polio, measles, mumps, and rubella, in both government-controlled and contested areas. Implementation of a supplementary immunization campaign in Deir Al Zour province commenced promptly when the 1st 'hot' acute flaccid paralysis (AFP) cases were reported. Larger-scale outbreak response across the Syrian Arab Republic and neighbouring countries will continue for at least 6-8 months depending on the area and based on the evolving situation.
Given the current situation in the Syrian Arab Republic, frequent population movements across the region and the immunization level in key areas, the risk of further international spread of wild poliovirus type 1 across the region is considered to be high. A surveillance alert has been issued for the region to actively search for additional potential cases.
WHO's International Travel and Health recommends that all travellers to and from polio-infected areas be fully vaccinated against polio.
--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp
[For the HealthMap/ProMED-mail interactive map of Syria, see http://healthmap.org/r/3aLZ. - Mod.MPP]
******
[2] Global update: Polio Eradication Initiative
Date: Thu 14 Nov 2013
Source: Global Polio Eradication Initiative [edited]
http://polioeradication.org/Dataandmoni ... sweek.aspx
Global Polio Eradication Initiative update as of 13 Nov 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 334 / 187 / 223
- in endemic countries: 119 / 182 / 217
- in non-endemic countries: 215 / 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: 59 / 0 / 0 / 59 // 51 / 2 / 1 / 54 / 58 // 21 Oct 2013
Afghanistan: 9 / 0 / 0 / 9 // 27 / 0 / 0 / 27 / 37 // 27 Sep 2013
Nigeria: 51 / 0 / 0 / 51 // 83 / 18 / 0 / 101 / 122 // 8 Oct 2013
Somalia: 180 / 0 / 0 / 180 // 0 / 0 / 0 / 0 / 0 // 30 Sep 2013
Ethiopia: 6 / 0 / 0 / 6 // 0 / 0 / 0 / 0 / 0 // 19 Sep 2013
Cameroon: 2 / 0 / 0 / 2 // 0 / 0 / 0 / 0 / 0 // 19 Oct 2013
Syrian Arab Republic: 13 / 0 / 0 / 13 // 0 / 0 / 0 / 0 / 0 // 4 Oct 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: 334 / 0 / 0 / 334 // 166 / 20 / 1 / 187 / 223
Total in endemic countries: 119 / 0 / 0 / 119 // 161 / 20 / 1 / 182 / 217
Total outbreak: 215 / 0 / 0 / 215 // 5 / 0 / 0 / 5 / 6
Data in WHO as of 13 Nov 2012 for 2012 data and 12 Nov 2013 for 2013 data.
Highlights of the week
----------------------
- 13 cases of wild poliovirus type 1 (WPV1) have been confirmed in the Syrian Arab Republic. Genetic sequencing indicates that the isolated viruses are most closely linked to virus detected in environmental samples in Egypt in December 2012 (which in turn had been linked to wild poliovirus circulating in Pakistan). Closely related wild poliovirus strains have also been detected in environmental samples in Israel, and The West Bank and Gaza Strip since February 2013. A comprehensive outbreak response continues to be implemented across the sub-region.
- The number of WPV1 cases in Pakistan for 2013 (59) now exceeds the number of polio cases reported from Pakistan during the same time period in 2012 (54). Nigeria has reported half the cases (51/101) and Afghanistan one third (9/27) of cases compared to the same time period in 2012.
Afghanistan
-----------
- No new WPV1 cases were reported in the past week. The total number of WPV cases for 2013 remains 9 (all WPV1), of which all were reported from the Eastern Region, close to the Pakistan border. The most recent WPV1 case was reported from Chapa Dara district, Kunar province, with onset of paralysis on [27 Sep 2013].
- 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 this week. The total number of WPV cases for 2013 remains 51 (all WPV1). The most recent WPV1 case in the country had onset of paralysis on [8 Oct 2013] from Kumbotso, Kano state.
- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains one (with onset of paralysis in the most recently reported case on [6 Jun 2013], from Borno).
- OPV was administered along with measles vaccine during Child Health Days (CHDs) in the north and the middle of the country on [5-9 Oct 2013] and in middle-band and southern states in [2-6 Nov 2013]. SNIDs [subnational immunization days] are planned for northern states starting mid-November [2013].
Pakistan
--------
- 3 new WPV1 cases were reported in the past week -- 2 from Toba Tek Singh district in Punjab and one from North Waziristan in the Federally Administered Tribal Areas (FATA).
- The total number of WPV1 cases for Pakistan in 2013 is now 59. The most recent WPV1 case had onset of paralysis on [21 Oct 2013] (from Toba Tek Singh district, Punjab). The majority of WPV1 cases in Pakistan this year [2013], 41 (69 percent), are from FATA, of which 16 are from Khyber Agency and 18 from North Waziristan.
- 3 new cVDPV2 cases were reported in the past week, all from North Waziristan. The total number of cVDPV2 cases for Pakistan is now 35. The most recent cVDPV2 case had onset of paralysis [15 Oct 2013] (from North Waziristan).
- The situation in North Waziristan is increasingly alarming. It is the area with the largest number of children being paralyzed by poliovirus in all of Asia (18 WPV1 and 28 cVDPV2 cases). 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.
- NIDs [national immunization days] were conducted on [30 Sep to 2 Oct 2013]. SNIDs were conducted on [14-16 Oct 2013] using bOPV [bivalent oral polio vaccine]. NIDs are planned for late November [2013]. Additional case response SIAs are also planned targeting the newly infected areas of Punjab.
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 nationwide immunization campaign was conducted [25-27 Oct 2013]. NIDs are planned for late November [2013].
- In Cameroon, a 2nd WPV1 case was reported in the past week from Foumbot, Ouest region, following the 1st WPV1 case reported from Ouest region with onset of paralysis on [19 Oct 2013]. Outbreak response is underway.
- No new cVDPV2 cases were reported in the past week from Cameroon. 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 Province.
- Central African Republic (CAR) continues to be at serious risk of re-infection due to proximity with Chad and Cameroon, ongoing insecurity and humanitarian crises, and destruction of the health infrastructure. To minimize the risk and consequences of potential re-infection, SNIDs were conducted on [30 Sep to 2 Oct 2013] and Child Health Days, including OPV vaccination, from [11-13 Nov 2013]. Further SNIDs are planned for December [2013] with dates and districts to be decided.
Horn of Africa
--------------
- No new WPV1 cases were reported from the Horn of Africa region in the past week.
- The total number of WPV cases (all WPV1) for 2013 in the Horn of Africa remains 201 (180 from Somalia, 14 from Kenya, and 6 from Ethiopia). The most recent WPV1 case in the region had onset of paralysis on [30 Sep 2013] (from Lower Shabelle, Somalia).
- Outbreak response activities continue across countries in the Horn of Africa. 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, the quality of SIA [supplementary immunization activity] operations is 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 Other areas of the Horn of Africa remain at risk of re-infection.
- NIDs were completed in Djibouti and Ethiopia alongside with SNIDs in Yemen in early October [2013]. In Somalia, nationwide immunization campaigns targeting all age groups were conducted [20-24 Oct 2013]. SNIDs in South Sudan targeting under 15 year olds were carried out [22-24 Oct 2013].
- NIDs are planned for mid-November [2013] in Ethiopia, Kenya, Sudan, Somalia, and South Sudan.
Israel and West Bank and Gaza
-----------------------------
- Although no case of paralytic polio has yet 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). The most recent lab results show the 1st WPV1-negative results from a southern sampling site (Beer Sheva), which has so far been persistently WPV1-positive.
- Since 2005, only inactivated polio vaccine (IPV) has been used for routine childhood immunization in Israel. To interrupt WPV1 transmission, a nationwide SIA with bivalent OPV targeting children less than 10 years of age has been conducted during August and September [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 November and December [2013].
Syrian Arab Republic
--------------------
- 3 new WPV1 cases were reported from Deir-Al-Zour governorate in the past week. The total number of WPV1 cases for Syria in 2013 is now 13, all from Deir-Al-Zour. Wild poliovirus was last reported in Syria in 1999.
- A comprehensive outbreak response continues to be implemented in Syria and across the sub-region. On [24 Oct 2013], an already-planned large-scale supplementary immunization activity was launched in the Syrian Arab Republic to vaccinate 1.6 million children against polio, measles, mumps and rubella, in both government-controlled and contested areas.
- Implementation of a supplementary immunization campaign in Deir-Al-Zour province commenced promptly when the first 'hot' acute flaccid paralysis (AFP) cases were reported.
- Larger-scale outbreak response SIAs across the Syrian Arab Republic and neighbouring countries will continue for at least 6-8 months depending on the area and based on the evolving epidemiological situation. The main aim is to rapidly reach children in the immediately-affected and other high-risk areas, followed by wider-scale immunization campaigns across the region targeting 22 million children over the next 6 months.
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 were conducted in West Africa [25-28 Oct 2013]. Additional subnational campaigns are planned in the region for late November [2013].
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[In an earlier ProMED-mail post (Poliomyelitis - update (22): South Sudan, global 20130930.1976296), there was mention of 3 cases of WPV confirmed in South Sudan. Since then, the information has been retracted due to "laboratory error" (see http://reliefweb.int/report/south-sudan ... e-n%C2%B01 and http://www.nathnac.org/pro/clinical_upd ... 051113.htm for more details.)
Since 23 Oct 2013, there has been an increase from 301 to 334 cases of which 16 occurred in endemic countries -- 13 of them in Pakistan -- and 17 occurred in non-endemic countries -- 13 of them in Syria. Of note is the information on the genetic sequencing of the WPV isolate associated with the ongoing outbreak in Syria -- closely related to the WPV isolated in Egypt, which in turn is related to a virus circulating in Pakistan.
For the global map showing the locations of all confirmed WPV associated polio 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 (28): SYRIA, GLOBAL, WHO
*********************************************
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: WHO
[2] Global update: Polio Eradication Initiative
******
[1] Syria: WHO
Date: Tue 26 Nov 2013
Source: WHO Global Alert and Response (GAR), Disease Outbreak News [edited]
http://www.who.int/csr/don/2013_11_26po ... index.html
Polio in the Syrian Arab Republic - update [26 Nov 2013]
--------------------------------------------------------
A total of 17 cases due to wild poliovirus type 1 (WPV1) have been confirmed in the Syrian Arab Republic. In addition to 15 cases confirmed in Deir Al Zour province, 2 additional cases have been confirmed, one each in rural Damascus and Aleppo, confirming widespread circulation of the virus. The case with most recent onset developed paralysis on [8 Oct 2013].
A comprehensive outbreak response continues to be implemented across the region. 7 countries and territories are holding mass polio vaccination campaigns targeting 22 million children under the age of 5 years. In a joint resolution, all countries of the WHO Eastern Mediterranean Region have declared polio eradication to be an emergency, calling for support in negotiating and establishing access to those children who are currently unreached with polio vaccination. WHO and UNICEF are committed to work with all organizations and agencies providing humanitarian assistance to Syrians affected by the conflict to ensure all Syrian children are vaccinated no matter where they live.
It is anticipated that outbreak response will need to continue for at least 6 to 8 months, depending on the area and based on evolving epidemiology.
Given the current situation in the Syrian Arab Republic, frequent population movements across the region and subnational immunity gaps in key areas, the risk of further spread of wild poliovirus across the region is considered to be high. A surveillance alert has been issued for the region to actively search for additional potential cases in addition to implementing the recommended supplementary immunization activities with oral polio vaccine.
--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp
******
[2] Global update: Polio Eradication Initiative
Date: Wed 27 Nov 2013
Source: Global Polio Eradication Initiative [edited]
http://polioeradication.org/Dataandmoni ... sweek.aspx
Global Polio Eradication Initiative update as of 27 Nov 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 347 / 202 / 223
- in endemic countries: 123 / 197 / 217
- in non-endemic countries: 224 / 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: 64 / 0 / 0 / 64 // 53 / 2 / 1 / 56 / 58 // 4 Nov 2013
Afghanistan: 9 / 0 / 0 / 9 // 31 / 0 / 0 / 31 / 37 // 27 Sep 2013
Nigeria: 51 / 0 / 0 / 51 // 86 / 18 / 0 / 104 / 122 // 8 Oct 2013
Somalia: 183 / 0 / 0 / 183 // 0 / 0 / 0 / 0 / 0 // 9 Oct 2013
Ethiopia: 6 / 0 / 0 / 6 // 0 / 0 / 0 / 0 / 0 // 19 Sep 2013
Cameroon: 4 / 0 / 0 / 4 // 0 / 0 / 0 / 0 / 0 // 30 Oct 2013
Syrian Arab Republic: 17 / 0 / 0 / 17 // 0 / 0 / 0 / 0 / 0 // 8 Oct 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: 347 / 0 / 0 / 347 // 181 / 20 / 1 / 202 / 223
Total in endemic countries: 123 / 0 / 0 / 123 // 176 / 20 / 1 / 197 / 217
Total outbreak: 224 / 0 / 0 / 224 // 5 / 0 / 0 / 5 / 6
Data in WHO as of 27 Nov 2012 for 2012 data and 26 Nov 2013 for 2013 data.
Highlights of the week
----------------------
- In Syria, 4 new wild polio virus type 1 (WPV1) cases were reported in the past week. New cases in Aleppo and Douma (rural Damascus) indicate that polio is spreading within the country and reaffirm the urgent need to vaccinate all children in Syria, regardless of who controls the area where they are.
- In Kenya, the government declared polio a public health emergency on [22 Nov 2013] and directed the Ministry of Health to fast-track the immunization activities and to ensure the entire country is covered.
Afghanistan
-----------
- No new WPV1 cases were reported in the past week. The total number of WPV cases for 2013 remains 9 (all WPV1). All WPV1 cases in 2013 are reported from Eastern Region, close to the Pakistan border. The most recent WPV1 case had onset of paralysis on [27 Sep 2013] from Chapa Dara district, 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).
- Subnational immunization days (SNIDs) were conducted [23-25 Nov 2013] with further SNIDs planned for mid-December [2013].
Nigeria
-------
- No new WPV cases were reported this week. The total number of WPV cases for Nigeria 2013 remains 50 (all WPV1). The most recent WPV1 case in the country had onset of paralysis on [8 Oct 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).
- SNIDs are planned for early and mid-December [2013].
Pakistan
--------
- One new WPV1 case was reported in the past week from FR Bannu, Federally Administered Tribal Areas (FATA). The total number of WPV1 cases for Pakistan in 2013 is now 64. The most recent WPV1 case had onset of paralysis on [4 Nov 2013] (from FATA).
- 2 new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 is now 43. The most recent cVDPV2 case had onset of paralysis [27 Oct 2013] (from North Waziristan, FATA).
- The situation in North Waziristan is alarming. It is the area with the largest number of children being paralyzed by poliovirus in all of Asia. 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). A nationwide immunization campaign was conducted [25-27 Oct 2013]. NIDs were conducted in Chad [22-24 Nov 2013].
- In Cameroon, 2 new WPV1 cases were reported in the past week, both from Malentouen in Ouest region. The total number of WPV1 cases is now 4. The most recent case in Cameroon had onset of paralysis on [30 Oct 2013] (WPV1 from Ouest).
- An outbreak response to the Cameroon cases is currently underway. In 2013, 5 large-scale supplementary immunization activities (SIAs) have already been conducted in Cameroon (in April, May, July, August, and October [2013]), as the country was considered at high-risk of re-infection due to its proximity with Nigeria. SNIDs are planned for early December [2013] followed by NIDs in mid-January and February 2014.
- 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 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 and Cameroon, ongoing 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 child health days (CHD) [11-13 Nov 2013]. Further SNIDs are planned for December [2013] with dates and districts to be decided.
Horn of Africa
--------------
- No new WPV1 cases were reported in the past week (from Somalia). The total number of WPV1 cases in the Horn of Africa remains 203 (183 from Somalia, 14 from Kenya, and 6 from Ethiopia). The most recent WPV1 case in the region had onset of paralysis on [9 Oct 2013] (from Lower Shabelle, Somalia).
- 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. All efforts continue to be made to reach all children everywhere.
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 was conducted in August to October [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 were conducted in early November [2013], with a 2nd round planned for early December [2013].
Middle East
-----------
- In Syria, 4 new WPV1 cases were reported in the past week, 2 from previously infected district Mayadeen in Deir-Al-Zour and one from Douma, rural Damascus and Fardous, Aleppo, respectively. The total number of WPV1 cases is now 17. The new cases in Aleppo and rural Damascus signal that polio is spreading in the country, but are also a sign that workers are actively looking for cases of polio. Prior to the outbreak wild poliovirus was last reported in Syria in 1999.
- In the Middle East, a comprehensive outbreak response continues to be implemented across the region. The large-scale supplementary immunization activity which started in Syria on [24 Oct 2013] to vaccinate 1.6 million children against polio, measles, mumps and rubella, in both government-controlled and contested areas, has been completed.
- 7 countries and territories are holding mass polio vaccination campaigns repeatedly targeting 22 million children under the age of 5 years over the next 6-8 months. In a joint resolution, all countries of the WHO Eastern Mediterranean Region have declared polio eradication to be an emergency, calling for support in negotiating and establishing access to those children who are currently unreached with polio vaccination.
- WHO and UNICEF are committed to working with all organizations and agencies providing humanitarian assistance to Syrians affected by the conflict. This includes vaccinating all Syrian children no matter where they are, whether in government or contested areas, or outside Syria.
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 were conducted in West Africa [25-28 Oct 2013]. Additional national campaigns were conducted [22-25 Nov 2013].
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[There is a "rumor" circulating in the press that there are several cases of polio in a Syrian refugee camp in Austria. This may be related to a report allegedly coming from WHO EURO (European Regional Office): "In parts of Europe where vaccine coverage is low, including Bosnia and Herzegovina, Ukraine, and Austria, immunisation levels may not be high enough to prevent sustained transmission of the polio virus, they stress." (See http://www.dailymail.co.uk/news/article ... ramme.html).
Since the last polio update (20 Nov 2017), as of 27 Nov 2013 there have been 7 newly confirmed cases of WPV infection worldwide -- 4 in Syria, 2 in Cameroon, and 1 in Pakistan. (According to the global tally chart presented above, there are only 6 newly confirmed cases included in the total... the case in Pakistan has not been added to the global tally as yet). Of the 4 cases in Syria, 2 are from the previously identified outbreak region, and 2 are from outside the outbreak site, suggesting there is further geographic spread of the virus throughout the country.
As long as there continue to be endemic foci of WPV transmission, areas that have previously interrupted WPV transmission are at risk of re-introduction of WPV transmission within their countries as evidenced by the past 10+ years worth of polio eradication efforts. A recent disturbing observation was the occurrence of continued circulation of WPV in an area using IPV (inactivated polio vaccine). The absence of clinical cases of paralytic disease is a testimony to the efficacy of the IPV vaccine, yet the continued circulation of the WPV in spite of high overall coverages (albeit with small pockets of low vaccination coverage) is disturbing.
For a map showing the geographic locations of all confirmed WPV cases worldwide for 2013 and 2012, see http://www.polioeradication.org/Dataand ... dwide.aspx.
On this map, one can see the geographic spread of the WPV in Syria, from the eastern portion of the country to the western portion. - Mod.MPP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3aLZ.]
*********************************************
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: WHO
[2] Global update: Polio Eradication Initiative
******
[1] Syria: WHO
Date: Tue 26 Nov 2013
Source: WHO Global Alert and Response (GAR), Disease Outbreak News [edited]
http://www.who.int/csr/don/2013_11_26po ... index.html
Polio in the Syrian Arab Republic - update [26 Nov 2013]
--------------------------------------------------------
A total of 17 cases due to wild poliovirus type 1 (WPV1) have been confirmed in the Syrian Arab Republic. In addition to 15 cases confirmed in Deir Al Zour province, 2 additional cases have been confirmed, one each in rural Damascus and Aleppo, confirming widespread circulation of the virus. The case with most recent onset developed paralysis on [8 Oct 2013].
A comprehensive outbreak response continues to be implemented across the region. 7 countries and territories are holding mass polio vaccination campaigns targeting 22 million children under the age of 5 years. In a joint resolution, all countries of the WHO Eastern Mediterranean Region have declared polio eradication to be an emergency, calling for support in negotiating and establishing access to those children who are currently unreached with polio vaccination. WHO and UNICEF are committed to work with all organizations and agencies providing humanitarian assistance to Syrians affected by the conflict to ensure all Syrian children are vaccinated no matter where they live.
It is anticipated that outbreak response will need to continue for at least 6 to 8 months, depending on the area and based on evolving epidemiology.
Given the current situation in the Syrian Arab Republic, frequent population movements across the region and subnational immunity gaps in key areas, the risk of further spread of wild poliovirus across the region is considered to be high. A surveillance alert has been issued for the region to actively search for additional potential cases in addition to implementing the recommended supplementary immunization activities with oral polio vaccine.
--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp
******
[2] Global update: Polio Eradication Initiative
Date: Wed 27 Nov 2013
Source: Global Polio Eradication Initiative [edited]
http://polioeradication.org/Dataandmoni ... sweek.aspx
Global Polio Eradication Initiative update as of 27 Nov 2013
------------------------------------------------------------
Wild poliovirus (WPV) cases
Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012
Globally: 347 / 202 / 223
- in endemic countries: 123 / 197 / 217
- in non-endemic countries: 224 / 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: 64 / 0 / 0 / 64 // 53 / 2 / 1 / 56 / 58 // 4 Nov 2013
Afghanistan: 9 / 0 / 0 / 9 // 31 / 0 / 0 / 31 / 37 // 27 Sep 2013
Nigeria: 51 / 0 / 0 / 51 // 86 / 18 / 0 / 104 / 122 // 8 Oct 2013
Somalia: 183 / 0 / 0 / 183 // 0 / 0 / 0 / 0 / 0 // 9 Oct 2013
Ethiopia: 6 / 0 / 0 / 6 // 0 / 0 / 0 / 0 / 0 // 19 Sep 2013
Cameroon: 4 / 0 / 0 / 4 // 0 / 0 / 0 / 0 / 0 // 30 Oct 2013
Syrian Arab Republic: 17 / 0 / 0 / 17 // 0 / 0 / 0 / 0 / 0 // 8 Oct 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: 347 / 0 / 0 / 347 // 181 / 20 / 1 / 202 / 223
Total in endemic countries: 123 / 0 / 0 / 123 // 176 / 20 / 1 / 197 / 217
Total outbreak: 224 / 0 / 0 / 224 // 5 / 0 / 0 / 5 / 6
Data in WHO as of 27 Nov 2012 for 2012 data and 26 Nov 2013 for 2013 data.
Highlights of the week
----------------------
- In Syria, 4 new wild polio virus type 1 (WPV1) cases were reported in the past week. New cases in Aleppo and Douma (rural Damascus) indicate that polio is spreading within the country and reaffirm the urgent need to vaccinate all children in Syria, regardless of who controls the area where they are.
- In Kenya, the government declared polio a public health emergency on [22 Nov 2013] and directed the Ministry of Health to fast-track the immunization activities and to ensure the entire country is covered.
Afghanistan
-----------
- No new WPV1 cases were reported in the past week. The total number of WPV cases for 2013 remains 9 (all WPV1). All WPV1 cases in 2013 are reported from Eastern Region, close to the Pakistan border. The most recent WPV1 case had onset of paralysis on [27 Sep 2013] from Chapa Dara district, 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).
- Subnational immunization days (SNIDs) were conducted [23-25 Nov 2013] with further SNIDs planned for mid-December [2013].
Nigeria
-------
- No new WPV cases were reported this week. The total number of WPV cases for Nigeria 2013 remains 50 (all WPV1). The most recent WPV1 case in the country had onset of paralysis on [8 Oct 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).
- SNIDs are planned for early and mid-December [2013].
Pakistan
--------
- One new WPV1 case was reported in the past week from FR Bannu, Federally Administered Tribal Areas (FATA). The total number of WPV1 cases for Pakistan in 2013 is now 64. The most recent WPV1 case had onset of paralysis on [4 Nov 2013] (from FATA).
- 2 new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 is now 43. The most recent cVDPV2 case had onset of paralysis [27 Oct 2013] (from North Waziristan, FATA).
- The situation in North Waziristan is alarming. It is the area with the largest number of children being paralyzed by poliovirus in all of Asia. 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). A nationwide immunization campaign was conducted [25-27 Oct 2013]. NIDs were conducted in Chad [22-24 Nov 2013].
- In Cameroon, 2 new WPV1 cases were reported in the past week, both from Malentouen in Ouest region. The total number of WPV1 cases is now 4. The most recent case in Cameroon had onset of paralysis on [30 Oct 2013] (WPV1 from Ouest).
- An outbreak response to the Cameroon cases is currently underway. In 2013, 5 large-scale supplementary immunization activities (SIAs) have already been conducted in Cameroon (in April, May, July, August, and October [2013]), as the country was considered at high-risk of re-infection due to its proximity with Nigeria. SNIDs are planned for early December [2013] followed by NIDs in mid-January and February 2014.
- 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 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 and Cameroon, ongoing 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 child health days (CHD) [11-13 Nov 2013]. Further SNIDs are planned for December [2013] with dates and districts to be decided.
Horn of Africa
--------------
- No new WPV1 cases were reported in the past week (from Somalia). The total number of WPV1 cases in the Horn of Africa remains 203 (183 from Somalia, 14 from Kenya, and 6 from Ethiopia). The most recent WPV1 case in the region had onset of paralysis on [9 Oct 2013] (from Lower Shabelle, Somalia).
- 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. All efforts continue to be made to reach all children everywhere.
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 was conducted in August to October [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 were conducted in early November [2013], with a 2nd round planned for early December [2013].
Middle East
-----------
- In Syria, 4 new WPV1 cases were reported in the past week, 2 from previously infected district Mayadeen in Deir-Al-Zour and one from Douma, rural Damascus and Fardous, Aleppo, respectively. The total number of WPV1 cases is now 17. The new cases in Aleppo and rural Damascus signal that polio is spreading in the country, but are also a sign that workers are actively looking for cases of polio. Prior to the outbreak wild poliovirus was last reported in Syria in 1999.
- In the Middle East, a comprehensive outbreak response continues to be implemented across the region. The large-scale supplementary immunization activity which started in Syria on [24 Oct 2013] to vaccinate 1.6 million children against polio, measles, mumps and rubella, in both government-controlled and contested areas, has been completed.
- 7 countries and territories are holding mass polio vaccination campaigns repeatedly targeting 22 million children under the age of 5 years over the next 6-8 months. In a joint resolution, all countries of the WHO Eastern Mediterranean Region have declared polio eradication to be an emergency, calling for support in negotiating and establishing access to those children who are currently unreached with polio vaccination.
- WHO and UNICEF are committed to working with all organizations and agencies providing humanitarian assistance to Syrians affected by the conflict. This includes vaccinating all Syrian children no matter where they are, whether in government or contested areas, or outside Syria.
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 were conducted in West Africa [25-28 Oct 2013]. Additional national campaigns were conducted [22-25 Nov 2013].
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[There is a "rumor" circulating in the press that there are several cases of polio in a Syrian refugee camp in Austria. This may be related to a report allegedly coming from WHO EURO (European Regional Office): "In parts of Europe where vaccine coverage is low, including Bosnia and Herzegovina, Ukraine, and Austria, immunisation levels may not be high enough to prevent sustained transmission of the polio virus, they stress." (See http://www.dailymail.co.uk/news/article ... ramme.html).
Since the last polio update (20 Nov 2017), as of 27 Nov 2013 there have been 7 newly confirmed cases of WPV infection worldwide -- 4 in Syria, 2 in Cameroon, and 1 in Pakistan. (According to the global tally chart presented above, there are only 6 newly confirmed cases included in the total... the case in Pakistan has not been added to the global tally as yet). Of the 4 cases in Syria, 2 are from the previously identified outbreak region, and 2 are from outside the outbreak site, suggesting there is further geographic spread of the virus throughout the country.
As long as there continue to be endemic foci of WPV transmission, areas that have previously interrupted WPV transmission are at risk of re-introduction of WPV transmission within their countries as evidenced by the past 10+ years worth of polio eradication efforts. A recent disturbing observation was the occurrence of continued circulation of WPV in an area using IPV (inactivated polio vaccine). The absence of clinical cases of paralytic disease is a testimony to the efficacy of the IPV vaccine, yet the continued circulation of the WPV in spite of high overall coverages (albeit with small pockets of low vaccination coverage) is disturbing.
For a map showing the geographic locations of all confirmed WPV cases worldwide for 2013 and 2012, see http://www.polioeradication.org/Dataand ... dwide.aspx.
On this map, one can see the geographic spread of the WPV in Syria, from the eastern portion of the country to the western portion. - Mod.MPP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/3aLZ.]
-
Birgitt
- Moderator
- Beiträge: 35230
- Registriert: Di 2. Aug 2005, 22:52
- Wohnort: NRW / Südl. Rheinland
- Kontaktdaten:
Kinderlähmung - Poliomyelitis weltweit - Impfungen
POLIOMYELITIS - UPDATE (30): COMMENT, VACCINATION
*************************************************
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 30 Nov 2013
From: Antoine Flahault <antoine.flahault@parisdescartes.fr>
and Ted H Tulchinsky <tulchinskyted@hotmail.com> [edited]
[Re: ProMED-mail Poliomyelitis update (29): comment 20131129.2082683]
---------------------------------------------------------------------
Prof John's comments on polio policy in ProMED [29 Nov 2013] do not address the key point of the recent 2013 experience of WPV1 infection in the sewage in Israel and in the adjacent Palestinian territories of the West Bank and Gaza. Israel had no polio cases despite the widespread presence of WPV1 in the environment, which is attributed to the high level of IPV immunization and sanitation, but lack of OPV [oral polio vaccine] for prevention of viral seeding in the sewage system. In contrast, the Palestinian territories have used a combined OPV/IPV [inactivated polio vaccine] policy in effect since 1978 also with very high coverage and had less than 10 percent of the WPV sewage finding that Israel had in 2013 and also had no polio cases. The use of OPV gave a protective effect in preventing entry of the WPV to the West Bank and Gaza.
WHO and CDC are seemingly committed to an IPV only policy not only for the industrialized countries but also for medium and low income countries. We consider this inappropriate and potentially dangerous especially in countries such as India with low immunization coverage and poor sanitary conditions. Indeed it is also dangerous for the wealthy countries now practicing IPV-only policies. Despite high immunization coverage and standards of sanitation, WPV can easily be imported and spread via travelers, refugees from Africa and the Middle East.
We urge the WHO, CDC, GAVI and other policy makers on polio eradication to reconsider their IPV-only policies and accept the safer and less expensive OPV/IPV combined policy as the way forward learning from the experience we reported in the Lancet of [16 Nov 2013]. One or 2 doses of IPV in the routine immunization program (together with DPT [diphtheria, pertussis (whooping cough), and tetanus], polio, and Hib [_Haemophilus influenzae_ type b]) in combined vaccine followed by 3 doses of OPV in the 1st year and a booster dose of OPV at age 6 would be suitable. This would provide the individual and community protection as seen in the "natural experiment" in the Palestinian and Israeli situation.
--
Antoine Flahault MD PhD,
Professor of Public Health, Centre Virchow-Villerme, School of Medicine Descartes, Sorbonne Paris Cite, France; Co-Director of the Virchow-Villerme Centre for Public Health, Paris & Berlin; Co-Chair of the European Academic Global Health Alliance (EAGHA), Brussels, Belgium, Former Dean of EHESP French School of Public Health, Sorbonne Paris Cite, France, Membre Correspondant de l'Academie Nationale de Medecine, Paris, France
TH Tulchinsky MD MPH
Emeritus Associate Professor, Braun School Public Health, Hebrew University-Hadassah, Ein Karem, Jerusalem, Israel
[In deciding vaccination recommendations, one of the key analyses facing policy makers involves an assessment of the risk-benefit equation surrounding the recommendation. The switch to a pure IPV policy in the USA took approximately 20 years of discussion and assessment following the transition in the epidemiology of the disease in the USA so that after 1979, with the exception of imported cases of WPV associated paralysis, the only cases of locally acquired paralytic disease seen were associated with infection with the vaccine virus (VAPP -- vaccine associated paralytic polio)(ref 1). The USA transitioned to a mixed IPV followed by OPV schedule to a pure IPV vaccination policy by 2000 (refs 2 and 3). The Advisory Committee on Immunization Practices (ACIP) concluded in June 1999 that to eliminate the risk of VAPP the recommended polio vaccination schedule should be an all-IPV schedule for routine childhood immunizations (refs 3, 4, 5). OPV was to be used for:
"1. Mass vaccination campaigns to control outbreaks of paralytic polio.
2. Unvaccinated children who will be traveling in less than 4 weeks to areas where polio is endemic.
3. Children of parents who do not accept the recommended number of vaccine injections. These children may receive OPV only for the 3rd or 4th dose or both; in this situation, healthcare providers should administer OPV only after discussing the risk for VAPP with parents or caregivers."
Since changing to an all-IPV immunization schedule in 2000, there have been only 2 cases of VAPP reported in the USA, one was an imported case and one was in a genetically immunocompromised person who was most likely exposed to OPV before its use was discontinued in 2000 (ref 6).
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 7). The continued transmission of the WPV over the period of 6-8 months in a population that was highly vaccinated in the absence of actual cases of paralytic disease demonstrated the strengths of the IPV policy, vis a vis protection of the vaccinated individuals, although at the same time, demonstrated the weaknesses of the IPV vaccination policy through the continued circulation of the WPV as found in sewage samples throughout Israel. The identification of genetically similar WPVs from sewage samples in Egypt, Israel, the West Bank, Gaza (with no AFP cases associated with infection with these WPVs), and those circulating in Syria associated with paralytic disease suggests that an appropriate strategy to interrupt the transmission of the WPV in the region would be to have vaccination campaigns based on the use of the OPV in the region.
That being said, as stated in previous ProMED-mail posts, 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). There are many questions that arise related to the timing of vaccine switch (OPV to IPV) and necessary monitoring to identify "silent" circulation of WPV at the global level, before vaccination can be ended.
References
----------
1. Strebel PM, Sutter RW, Cochi SL, et al: Epidemiology of poliomyelitis in the United States one decade after the last reported case of indigenous wild virus-associated disease. Clin Infect Dis 1992; 14(2): 568-79; abstract available at http://cid.oxfordjournals.org/content/14/2/568.abstract.
2. CDC. Poliomyelitis prevention in the United States: Introduction of a sequential vaccination schedule of inactivated poliovirus vaccine followed by oral poliovirus vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997; 46(RR-3): 1-25; available at http://www.cdc.gov/mmwr/PDF/rr/rr4603.pdf.
3. CDC. Notice to Readers: Recommendations of the Advisory Committee on Immunization Practices: Revised Recommendations for Routine Poliomyelitis Vaccination. MMWR 1999; 48(27); 590; available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4827a4.htm.
4. CDC. Poliomyelitis prevention in the United States: updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2000; 49(No. RR-5): 1-22; available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4905a1.htm.
5. American Academy of Pediatrics Committee on Infectious Diseases. Prevention of poliomyelitis: recommendations for use of only inactivated poliovirus vaccine for routine immunization. Pediatrics 1999; 104(6): 1404-6; available at http://pediatrics.aappublications.org/c ... l.pdf+html.
6. CDC. Manual for the Surveillance of Vaccine-Preventable Diseases (5th Edition, 2012). Chapter 12: Poliomyelitis; available at http://www.cdc.gov/vaccines/pubs/surv-m ... polio.html.
7. Shulman LM, Manor Y, Sofer D, et al: Neurovirulent vaccine-derived polioviruses in sewage from highly immune populations. PLoS One. 2006; 20; 1: e69; available at http://www.plosone.org/article/info%3Ad ... ne.0000069.
- 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: Sat 30 Nov 2013
From: Antoine Flahault <antoine.flahault@parisdescartes.fr>
and Ted H Tulchinsky <tulchinskyted@hotmail.com> [edited]
[Re: ProMED-mail Poliomyelitis update (29): comment 20131129.2082683]
---------------------------------------------------------------------
Prof John's comments on polio policy in ProMED [29 Nov 2013] do not address the key point of the recent 2013 experience of WPV1 infection in the sewage in Israel and in the adjacent Palestinian territories of the West Bank and Gaza. Israel had no polio cases despite the widespread presence of WPV1 in the environment, which is attributed to the high level of IPV immunization and sanitation, but lack of OPV [oral polio vaccine] for prevention of viral seeding in the sewage system. In contrast, the Palestinian territories have used a combined OPV/IPV [inactivated polio vaccine] policy in effect since 1978 also with very high coverage and had less than 10 percent of the WPV sewage finding that Israel had in 2013 and also had no polio cases. The use of OPV gave a protective effect in preventing entry of the WPV to the West Bank and Gaza.
WHO and CDC are seemingly committed to an IPV only policy not only for the industrialized countries but also for medium and low income countries. We consider this inappropriate and potentially dangerous especially in countries such as India with low immunization coverage and poor sanitary conditions. Indeed it is also dangerous for the wealthy countries now practicing IPV-only policies. Despite high immunization coverage and standards of sanitation, WPV can easily be imported and spread via travelers, refugees from Africa and the Middle East.
We urge the WHO, CDC, GAVI and other policy makers on polio eradication to reconsider their IPV-only policies and accept the safer and less expensive OPV/IPV combined policy as the way forward learning from the experience we reported in the Lancet of [16 Nov 2013]. One or 2 doses of IPV in the routine immunization program (together with DPT [diphtheria, pertussis (whooping cough), and tetanus], polio, and Hib [_Haemophilus influenzae_ type b]) in combined vaccine followed by 3 doses of OPV in the 1st year and a booster dose of OPV at age 6 would be suitable. This would provide the individual and community protection as seen in the "natural experiment" in the Palestinian and Israeli situation.
--
Antoine Flahault MD PhD,
Professor of Public Health, Centre Virchow-Villerme, School of Medicine Descartes, Sorbonne Paris Cite, France; Co-Director of the Virchow-Villerme Centre for Public Health, Paris & Berlin; Co-Chair of the European Academic Global Health Alliance (EAGHA), Brussels, Belgium, Former Dean of EHESP French School of Public Health, Sorbonne Paris Cite, France, Membre Correspondant de l'Academie Nationale de Medecine, Paris, France
TH Tulchinsky MD MPH
Emeritus Associate Professor, Braun School Public Health, Hebrew University-Hadassah, Ein Karem, Jerusalem, Israel
[In deciding vaccination recommendations, one of the key analyses facing policy makers involves an assessment of the risk-benefit equation surrounding the recommendation. The switch to a pure IPV policy in the USA took approximately 20 years of discussion and assessment following the transition in the epidemiology of the disease in the USA so that after 1979, with the exception of imported cases of WPV associated paralysis, the only cases of locally acquired paralytic disease seen were associated with infection with the vaccine virus (VAPP -- vaccine associated paralytic polio)(ref 1). The USA transitioned to a mixed IPV followed by OPV schedule to a pure IPV vaccination policy by 2000 (refs 2 and 3). The Advisory Committee on Immunization Practices (ACIP) concluded in June 1999 that to eliminate the risk of VAPP the recommended polio vaccination schedule should be an all-IPV schedule for routine childhood immunizations (refs 3, 4, 5). OPV was to be used for:
"1. Mass vaccination campaigns to control outbreaks of paralytic polio.
2. Unvaccinated children who will be traveling in less than 4 weeks to areas where polio is endemic.
3. Children of parents who do not accept the recommended number of vaccine injections. These children may receive OPV only for the 3rd or 4th dose or both; in this situation, healthcare providers should administer OPV only after discussing the risk for VAPP with parents or caregivers."
Since changing to an all-IPV immunization schedule in 2000, there have been only 2 cases of VAPP reported in the USA, one was an imported case and one was in a genetically immunocompromised person who was most likely exposed to OPV before its use was discontinued in 2000 (ref 6).
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 7). The continued transmission of the WPV over the period of 6-8 months in a population that was highly vaccinated in the absence of actual cases of paralytic disease demonstrated the strengths of the IPV policy, vis a vis protection of the vaccinated individuals, although at the same time, demonstrated the weaknesses of the IPV vaccination policy through the continued circulation of the WPV as found in sewage samples throughout Israel. The identification of genetically similar WPVs from sewage samples in Egypt, Israel, the West Bank, Gaza (with no AFP cases associated with infection with these WPVs), and those circulating in Syria associated with paralytic disease suggests that an appropriate strategy to interrupt the transmission of the WPV in the region would be to have vaccination campaigns based on the use of the OPV in the region.
That being said, as stated in previous ProMED-mail posts, 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). There are many questions that arise related to the timing of vaccine switch (OPV to IPV) and necessary monitoring to identify "silent" circulation of WPV at the global level, before vaccination can be ended.
References
----------
1. Strebel PM, Sutter RW, Cochi SL, et al: Epidemiology of poliomyelitis in the United States one decade after the last reported case of indigenous wild virus-associated disease. Clin Infect Dis 1992; 14(2): 568-79; abstract available at http://cid.oxfordjournals.org/content/14/2/568.abstract.
2. CDC. Poliomyelitis prevention in the United States: Introduction of a sequential vaccination schedule of inactivated poliovirus vaccine followed by oral poliovirus vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 1997; 46(RR-3): 1-25; available at http://www.cdc.gov/mmwr/PDF/rr/rr4603.pdf.
3. CDC. Notice to Readers: Recommendations of the Advisory Committee on Immunization Practices: Revised Recommendations for Routine Poliomyelitis Vaccination. MMWR 1999; 48(27); 590; available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4827a4.htm.
4. CDC. Poliomyelitis prevention in the United States: updated recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2000; 49(No. RR-5): 1-22; available at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4905a1.htm.
5. American Academy of Pediatrics Committee on Infectious Diseases. Prevention of poliomyelitis: recommendations for use of only inactivated poliovirus vaccine for routine immunization. Pediatrics 1999; 104(6): 1404-6; available at http://pediatrics.aappublications.org/c ... l.pdf+html.
6. CDC. Manual for the Surveillance of Vaccine-Preventable Diseases (5th Edition, 2012). Chapter 12: Poliomyelitis; available at http://www.cdc.gov/vaccines/pubs/surv-m ... polio.html.
7. Shulman LM, Manor Y, Sofer D, et al: Neurovirulent vaccine-derived polioviruses in sewage from highly immune populations. PLoS One. 2006; 20; 1: e69; available at http://www.plosone.org/article/info%3Ad ... ne.0000069.
- Mod.MPP]
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Pakistan - Militante verhindern Polio-Impfungen
Militants preventing polio vaccination in PakistanArmed militants are killing health workers in Pakistan, tasked with protecting children against polio, because of suspicion over western made vaccines. The World Health Organisation says that it is vital that young children are vaccinated as concern grows over a possible resurgence of the disease.
19.12.2013 - BBC Video
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Kinderlähmung - Poliomyelitis in Pakistan
In Pakistan finden Fachleute Typ-2-Polioviren in der Kanalisation - gegen diesen Erreger sind nicht mehr alle geimpften Menschen immun ...
04.01.2017 - spektrum
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Besiegt geglaubtes Poliovirus in Pakistan aufgetauchtSpuren eines seit zehn Jahren in freier Wildbahn ausgerotteten Poliovirus sind in der Kanalisation der pakistanischen Stadt Quetta gefunden worden. Die Entdeckung macht Seuchenfachleuten Sorgen, denn vor diesem Poliovirus Typ 2 schützt die verbreitete Schluckimpfung nicht mehr. Die pakistanische Regierung hat jetzt eine Impfkampagne für etwa 400 000 Kinder in der Region um Quetta gestartet, um einem Ausbruch des Erregers bei Menschen vorzubeugen.
04.01.2017 - spektrum
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Re: Kinderlähmung - Poliomyelitis
Seit Ende Januar sind wir dabei, unseren Impfschutz für die Reise nach Südamerika zu komplettieren. Polioimpfstoff ist nicht zu bekommen.
Mit freundlichen Grüßen
Rolf
Rolf
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Kinderlähmung | Rückschlag im Kampf gegen Polio
Der jüngste Polioausbruch in der Demokratischen Republik Kongo macht deutlich, mit welchen Hindernissen die Ausrottungsinitiative der WHO zu kämpfen hat. Lässt sich das Ziel, eine Welt ohne Polio, mit den verfügbaren Mitteln erreichen?
16.08.2018 - spektrum
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Rückschlag im Kampf gegen PolioDie Sorge wächst, ob sich das Virus von der Demokratischen Republik Kongo aus weiter über den Kontinent ausbreiten wird. Im Kongo spiele sich der zurzeit beunruhigendste Polioausbruch ab, sagt Michel Zaffran, der die GPEI leitet. Dieser Ausbruch wird nicht durch Wildviren verursacht; die gibt es seit 18 Jahren im Kongo nicht mehr – und auch sonst auf der Welt nur noch in Afghanistan, Pakistan und Nigeria. Auslöser sind vielmehr Impfviren (die Experten nenne sie cVDPVs von »circulating vaccine-derived polio virus«), die durch eine Ansammlung von Mutationen wieder gefährlich wurden und dadurch schwere Infektionen auslösen können.
16.08.2018 - spektrum
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Erfolg bei Seuchenbekämpfung | Polio in Afrika ausgerottet
Als letztes afrikanisches Land hat Nigeria den Kampf gegen Kinderlähmung gewonnen. Dort war der Weg bis zur Auslöschung besonders zäh ...
Erfolg bei Seuchenbekämpfung: Polio in Afrika ausgerottet
25.08.2020 - taz
Africa declared free of wild polio in 'milestone'
25.08.2020 - BBC
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Erfolg bei Seuchenbekämpfung: Polio in Afrika ausgerottet
25.08.2020 - taz
Africa declared free of wild polio in 'milestone'
25.08.2020 - BBC
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Kinderlähmung in Afrika | Polio ist wieder da
Im August 2020 erklärte die Weltgesundheitsorganisation WHO Polio in Afrika für ausgerottet – nun ist die gefürchtete Kinderlähmung wieder da. Nach Malawi verzeichnet nun auch das benachbarte Mosambik seinen ersten Fall einer Erkrankung mit dem Polio-Wildvirus seit über dreißig Jahren. Ein Kind in der zentralmosambikanischen Provinz Tete sei daran erkrankt, meldeten die Gesundheitsbehörden diese Woche. Die WHO bestätigte am Donnerstag den Fall ...
Kinderlähmung in Afrika: Polio ist wieder da
19.05.2022 - taz
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Kinderlähmung in Afrika: Polio ist wieder da
19.05.2022 - taz
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Kinderlähmung - Poliomyelitis | Fälle in Israel und Mosambik
Israel - Poliomyelitis:
Seit Anfang März 2022 hat das Gesundheitsministerium 7 Infektionen mit Impfstoff-abgeleitetem Poliovirus Typ 3 (cVDPV3) bestätigt. Es sind die ersten Erkrankungen seit 1989. Seit September letzten Jahres wurde das Virus in mehreren Abwasserproben in Israel und in den palästinensischen Gebieten gefunden. Durch das Auftreten der Erkrankung wird Israel zu einem Land mit potentiellem Risiko der internationalen Verbreitung des Erregers. Alle Personen (Einheimische und Touristen), die sich länger als 4 Wochen im Land aufgehalten haben, müssen bei der Ausreise eine Impfung gegen Polio vorweisen können. Die Impfung muss zwischen 4 Wochen und einem Jahr vor der Abreise erfolgen und in einem international gültigen Impfausweis dokumentiert sein. Impfschutz beachten. Quelle: crm / 29.04.2022
Mosambik - Poliomyelitis:
Mitte Mai 2022 wurde in der Provinz Tête eine Infektion mit Polio-Wildvirus (WPV1) bestätigt. Der Fall steht vermutlich in Zusammenhang mit einem Fall im Nachbarland Malawi, dieser wurde im Februar aus Pakistan importiert. Im Mai wurden außerdem in der Provinz Nampula 3 Infektionen und in der Provinz Manica eine Infektion mit Impfstoff-abgeleitetem Poliovirus Typ 2 (cVDPV2) gemeldet. Im Februar wurden 2 Fälle in den Provinzen Nampula und Cabo Delgado nachgewiesen, diese stammen noch aus dem Vorjahr. Durch das Auftreten des cVDPV2 gehört das Land formal zu den Ländern mit potentiellem Risiko der internationalen Verbreitung des Erregers. Die offizielle Bestätigung der WHO steht noch aus. Alle Personen (Einheimische und Touristen), die sich länger als 4 Wochen im Land aufgehalten haben, sollten bei der Ausreise eine Impfung gegen Polio vorweisen können. Die Impfung muss zwischen 4 Wochen und einem Jahr vor der Abreise erfolgen und in einem international gültigen Impfausweis dokumentiert sein. Impfschutz beachten. Quelle: crm / 20.05.2022
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Seit Anfang März 2022 hat das Gesundheitsministerium 7 Infektionen mit Impfstoff-abgeleitetem Poliovirus Typ 3 (cVDPV3) bestätigt. Es sind die ersten Erkrankungen seit 1989. Seit September letzten Jahres wurde das Virus in mehreren Abwasserproben in Israel und in den palästinensischen Gebieten gefunden. Durch das Auftreten der Erkrankung wird Israel zu einem Land mit potentiellem Risiko der internationalen Verbreitung des Erregers. Alle Personen (Einheimische und Touristen), die sich länger als 4 Wochen im Land aufgehalten haben, müssen bei der Ausreise eine Impfung gegen Polio vorweisen können. Die Impfung muss zwischen 4 Wochen und einem Jahr vor der Abreise erfolgen und in einem international gültigen Impfausweis dokumentiert sein. Impfschutz beachten. Quelle: crm / 29.04.2022
Mosambik - Poliomyelitis:
Mitte Mai 2022 wurde in der Provinz Tête eine Infektion mit Polio-Wildvirus (WPV1) bestätigt. Der Fall steht vermutlich in Zusammenhang mit einem Fall im Nachbarland Malawi, dieser wurde im Februar aus Pakistan importiert. Im Mai wurden außerdem in der Provinz Nampula 3 Infektionen und in der Provinz Manica eine Infektion mit Impfstoff-abgeleitetem Poliovirus Typ 2 (cVDPV2) gemeldet. Im Februar wurden 2 Fälle in den Provinzen Nampula und Cabo Delgado nachgewiesen, diese stammen noch aus dem Vorjahr. Durch das Auftreten des cVDPV2 gehört das Land formal zu den Ländern mit potentiellem Risiko der internationalen Verbreitung des Erregers. Die offizielle Bestätigung der WHO steht noch aus. Alle Personen (Einheimische und Touristen), die sich länger als 4 Wochen im Land aufgehalten haben, sollten bei der Ausreise eine Impfung gegen Polio vorweisen können. Die Impfung muss zwischen 4 Wochen und einem Jahr vor der Abreise erfolgen und in einem international gültigen Impfausweis dokumentiert sein. Impfschutz beachten. Quelle: crm / 20.05.2022
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Kinderlähmung - Poliomyelitis | Risiko neuer Fälle steigt
Mit unermüdlichen Impfkampagnen bis in entlegenste Gegenden hat die Weltgemeinschaft die endgültige Ausrottung von Polio fast geschafft. Doch jetzt gibt es Rückschläge, vor allem durch die Corona-Pandemie ...
14.06.2022 - Spektrum
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20 Jahre ist Europa nun poliofrei, doch das Risiko neuer Fälle steigtWenige Jahre später, am 21. Juni 2002, erklärte die WHO ihre Europaregion mit mehr als 50 Ländern für poliofrei. Der 20. Jahrestag ist ein Meilenstein, aber es sieht nicht in aller Welt rosig aus. Das Ziel, nach der Ausrottung der Pocken 1980 auch Polio zur Geschichte zu machen, wurde bislang verfehlt. Immer neue Konflikte, die Vertreibung von Bevölkerungen, Migration und die Corona-Pandemie dürften es in weitere Ferne gerückt haben. Routine-Impfungen, zu denen auch Polio gehört, seien in den Jahren der Pandemie in vielen Ländern unterbrochen worden, sagt Oliver Rosenbauer von der Polio-Ausrottungsinitiative der WHO in Genf. »In einigen Regionen sind Kinder nun einem höheren Risiko durch Infektionen wie Polio ausgesetzt«, sagt er. »Dadurch steigt auch das Risiko, dass sich die Krankheit international wieder ausbreitet.«
14.06.2022 - Spektrum
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Kinderlähmung - Poliomyelitis | Viren im Abwasser
In vielen Ländern dieser Welt gelten Polioviren dank einer erfolgreichen Impfkampagne als ausgerottet. In London wurde der Erreger nun im Abwasser nachgewiesen. Droht ein neuer Ausbruch der Kinderlähmung?
28.06.2022 - Spektrum
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BIrgitt
Was die Polioviren im Londoner Abwasser bedeutenDer Eindruck, dass nun die gefürchtete Kinderlähmung wieder großflächig ausbricht, täuscht aber. Es ist nicht ungewöhnlich, dass immer mal wieder irgendwo auf der Welt Polioviren auftauchen – und das nicht trotz der globalen Ausrottungskampagne, sondern wegen ihr. Es ist auch nicht der erste derartige Fall in Europa. Die weltweite Impfkampagne, die das wilde Poliovirus in fast allen Staaten der Erde ausgerottet hat, basiert auf einem Impfstoff mit vermehrungsfähigen Polioviren – die berühmte Schluckimpfung. Dieser Lebendimpfstoff enthält abgeschwächte Erreger, die sich jedoch noch fortpflanzen und sogar andere Menschen anstecken können. Etwa zwei bis sechs Wochen lang scheiden Geimpfte das Virus aus.
28.06.2022 - Spektrum
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BIrgitt
