Wüstenschiff

Burundi - Polio
02.11.2009

Nachdem in der nordwestlichen Provinz Cibitoke zwei Fälle von Polio diagnostiziert wurden, ist eine groß angelegte Impfkampagne für 1,5 Millionen Einwohner eingeleitet worden. Burundi war über 10 Jahre poliofrei, die aktuellen Erkrankungen wurden aus der benachbarten DR Kongo importiert. Impfschutz beachten. / crm

POLIOMYELITIS - WORLDWIDE
**************************
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In this update:
[1] Pakistan
[2] Global Case Counts
[3] Global Updates

******
[1] Pakistan
Date: 24 Jan 2010
Source: Individual.com [edited]
<http://www.individual.com/storyrss.php? ... 8697c178b5>


The 1st polio case of the country in the year 2010 has been confirmed
by the laboratory and is identified as a type-1 case from Bajaur
Agency in FATA. Sources associated with the Expanded Program on
Immunization (EPI), giving details of the case on Thursday [21 Jan
2010], said the 1st victim of the year was a 9-month-old child.

--
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******
[2] Global Case Counts
Date: 19 Jan 2010
Source: Polio Eradication.org [edited]
<http://www.polioeradication.org/casecount.asp>


Total cases: Year-to-date 2010 / Year-to-date 2009 / Total in 2009
Globally: 2 / 0 / 1588
- in endemic countries: 2 / 0 / 1239
- in non-endemic countries: 0 / 0 / 349

Country: Year-to-date 2010 / Year-to-date 2009 / Total in 2009 / Date
of onset of most recent case
Afghanistan: 1 / 0 / 38 / 6 Jan 2010
Pakistan: 1 / 0 / 89 / 1 Jan 2010
India: 0 / 0 / 724 / 30 Dec 2009
Mauritania: 0 / 0 / 11 / 22 Dec 2009
Chad: 0 / 0 / 66 / 6 Dec 2009
Sierra Leone: 0 / 0 / 12 / 28 Nov 2009
Nigeria: 0 / 0 / 388 / 20 Nov 2009
Mali: 0 / 0 / 2 / 12 Nov 2009
Guinea: 0 / 0 / 41 / 8 Nov 2009
Liberia : 0 / 0 / 11 / 26 Oct 2009
Burkina Faso: 0 / 0 / 15 / 25 Oct 2009
Cameroon: 0 / 0 / 3 / 15 Oct 2009
Benin: 0 / 0 / 21 / 9 Oct 2009
Angola: 0 / 0 / 29 / 15 Sep 2009
Burundi: 0 / 0 / 2 / 12 Sep 2009
CAR: 0 / 0 / 14 / 9 Aug 2009
Cote d'Ivoire: 0 / 0 / 27 / 6 Aug 2009
Kenya: 0 / 0 / 18 / 30 Jul 2009
Sudan: 0 / 0 / 45 / 27 Jun 2009
DRC: 0 / 0 / 3 / 24 Jun 2009
Niger: 0 / 0 / 15 / 28 May 2009
Uganda: 0 / 0 / 8 / 10 May 2009
Togo: 0 / 0 / 6 / 28 Mar 2009

--
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******
[3] Global Updates
Date: 19 Jan 2010
Source: Polio Eradication.org [edited]
<http://www.polioeradication.org/casecount.asp>


Headlines:
- In the last 6 months, in 3rd place for the total number of cases
and for the number of cases of wild poliovirus type 1 (WPV1) are 2
countries with outbreaks of imported WPV - Chad for the total number
(52) and Guinea for the number of WPV1 (25). India reported the
highest total number of cases (542) as well as the highest number of
wild poliovirus type 1 (49), followed by Pakistan (61 total, 44
WPV1). Data for 2009 is not yet final.
- Nigeria and Pakistan will be using bivalent oral polio vaccine
(bOPV) within the next 2 months, ([30 Jan 2010] for the former and
possibly [15 Feb 2010] for the latter). With this, all 4 endemic
countries will have deployed the new vaccine within 2 months of each other.

Endemic countries:

Afghanistan:
- Two new cases were reported in the last week (both WPV3), one with
onset in 2009 and one in 2010. The total number of cases for 2009 is
38 and for 2010 is now one. The most recent case had onset of
paralysis on [6 Jan 2010] in Hilmand.
- The December 2009 case is the 1st from Nangarhar Province in the
Eastern Region of Afghanistan since November 2008. While genetic
sequencing is awaited, it is likely that the virus is related to that
circulating in the bordering areas of Pakistan. A mop-up is planned
for the entire province, targeting 400 000 children with bOPV on
[24-26 Jan 2010].
- A major coordinated attack in Kabul this week has affected security
and planning.
- The next SIAs [Supplementary Immunization Activity] are
Sub-national Immunization Days (SNIDs) planned for [14-16 Feb 2010]
in coordination with Pakistan.

India:
- Five new cases were reported in the last week (all WPV3), bringing
the total number of cases for 2009 to 724. The most recent case had
onset of paralysis on [30 Dec 2009] in Bihar.
- A surveillance review for western Uttar Pradesh [UP] is taking
place this week.
- The next NIDs are scheduled for February [2010], with most of the
country using trivalent OPV and mOPV1, mOPV3 and bOPV being used in
different parts of UP and Bihar and adjoining states.

Nigeria:
- No new cases were reported in the last week, so the total number of
cases for 2009 remains 388. The most recent case had onset of
paralysis on [20 Nov 2009] (WPV1 from Kebbi).
- The Northern Traditional and Religious Leaders Forum for Primary
Healthcare and Polio Eradication held their 1st meeting of the year
on [14 Jan 2010], attended by the Federal Minister of Health and the
Executive Director of the National Primary Healthcare Development
Agency. Citing the pivotal role of the traditional leadership in
garnering local support and reaching children, the Minister of Health
said, "What I'm setting for 2010 is collaboration with you, looking
to your leadership. We shall drag polio from Nigeria this year."
- A national EPI/polio eradication review and planning meeting,
including communications, is taking place in Kaduna this week.
- Bivalent OPV is being distributed to states this week for use in
the [30 Jan 2010] nationwide Immunization Plus Days (IPDs). Northern
states will hold a vaccination campaign on [6 Mar 2010] to coordinate
with the 15-country west Africa SIAs.

Pakistan:
- One new case was reported in the last week (WPV1) for 2010, the 1st
case of the year with onset of paralysis on [1 Jan 2010] in North
West Frontier Province. Two new cases (WPV1 and WPV3) were reported
in the last week for 2009, bringing the total number of cases for 2009 to 89.
- The most recent case is a child from Bajour who has never received
OPV. Parts of Bajour have not been covered by a Supplementary
Immunization Activity (SIA) for nearly 2 years because of
inaccessibility due to insecurity.
- The Sub-national Immunization Days (SNIDs) were launched on [18 Jan
2010] with high-level participation including the President and the
Minister of Health as well as senior political leadership in Lahore.
- Two initiatives are being explored in meetings this week: the 1st
to pilot community-based polio eradication activities for
surveillance and social mobilization in select areas of NWFP; and the
2nd to improve the involvement of the Pathan community in Karachi.
- Instead of a high-level technical consultation, a planning meeting
is now scheduled in Islamabad on [8-9 Feb 2010] to focus on the 15
districts with persistent transmission, to be followed by an
inter-provincial advocacy meeting.
- The next NIDs are planned for [15-17 Feb 2010], possibly using bOPV
and coordinated with SNIDs in southern Afghanistan.

Importation countries:

Angola:
- No new cases were reported in the past week. The total number of
cases for 2009 remains 29. The most recent case had onset of
paralysis on [15 Sep 2009] (WPV1 from Benguela).
- SNIDs were held on [11-13 Dec 2009], using mOPV1, in Benguela,
Bengo, Cuanza Sul, Cuanza Norte and Luanda. The next SIAs in Angola
are planned to be nationwide in May [2010], using mOPV1.

Burundi:
- No new cases were reported this week. The total number of cases
remains 2. The most recent case (WPV1 from Cibitoke Province, 5 km
from the border of DR Congo) had onset of paralysis on [12 Sep 2009].
- The most recent campaign was held on [17 Nov 2009], with reports of
high-quality coverage.

Cameroon:
- No new cases were reported this week. The total number of cases in
2009 remains 3. The most recent case had onset of paralysis on [15
Oct 2009] (WPV3 from Extreme Nord province).
- NIDs with trivalent OPV were held on [4-6 Dec 2009]. The next SIAs
are tentatively planned for early March [2010].

Central African Republic (CAR):
- No new cases were reported in the past week. The total number of
cases for 2009 remains 14. The most recent case had onset of
paralysis on [9 Aug 2009] (WPV3 from RS3).
- A 2nd round of Child Health Day immunizations were held from [26-30
Dec 2009] with OPV for under 5-year-olds nationwide. An accelerated
routine immunization campaign is scheduled for the end of January
[2010]. The next polio SIAs are tentatively planned for early March [2010].

Chad:
- Two new cases were reported in the last week (both WPV3), bringing
the total number of cases for 2009 to 66. The most recent case had
onset of paralysis on [6 Dec 2009] (in Mandoul).
- Chad has not had an SIA since October 2009, as SNIDs planned for [4
Dec 2009] were cancelled at the last minute. The next SIAs are
nationwide on [5 Feb 2010]. They will be followed by a round in early
March [2010], in coordination with Cameroon, CAR, Nigeria and the 15
west African countries.

Democratic Republic of Congo (DRC):
- No new cases were reported in DR Congo in the past week. The total
number of cases for 2009 remains 3. The most recent case had onset of
paralysis on [24 Jun 2009] (WPV3 from Bas-Congo).
- The most recent SIAs took place on [17 Nov 2009] in South Kivu and
on [26 Nov 2009] in North Kivu. SNIDs are planned for May and June [2010].

Horn of Africa:
- No new cases were reported in the past week. The total number of
cases for Kenya, Sudan and Uganda in 2009 remains 71. The most recent
case had onset of paralysis on [30 Jul 2009] (WPV1 from Kenya).
- Sub-national surveillance gaps persist, particularly in southern
Sudan, and undetected circulation cannot be ruled out.
- The most recent SIAs in the region were held in southern Sudan on
[7 Dec 2009] and in northern Sudan from [14 Dec 2009], with both
areas using trivalent OPV. Southern Sudan is planning further
campaigns in February [2010] using mOPV1.

West Africa:
- Two new cases were reported in the past week (both WPV1 from
Mauritania), bringing the total number of cases in west Africa for
2009 to 161 from 10 countries. The most recent case had onset of
paralysis on [22 Dec 2009] (WPV1 in Mauritania).
- The outbreak is still active in Benin, Burkina Faso, Cote d'Ivoire,
Guinea, Liberia, Mali, Mauritania and Sierra Leone.
- A synchronized immunization response was held on [4 Dec 2009] in
Burkina Faso, Mali and Cote d'Ivoire, using mOPV1, followed by
Mauritania on [8 and 22 Dec 2009], Guinea on [12 Dec 2009] and
Liberia on [14 Dec 2009].
- Mauritania and Senegal are holding SIAs on [15 and 12 Feb 2010]
respectively, with mOPV1.
- The multi-country SIAs have been postponed to [6 Mar 2010]. The 15
countries participating are: Benin, Burkina Faso, Cape Verde, Cote
d'Ivoire, Gambia, Ghana, Guinea, Guinea Bissau, Liberia, Mali,
Mauritania, Niger, Senegal, Sierra Leone and Togo and. In
coordination, Chad and Nigeria, and possibly Cameroon and CAR, will
also hold SIAs. The total target population is 85.5 million children.

--
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ProMED-mail <promed@promedmail.org>

[From the update reports available on the polioeradication.org
website, it appears as though there has been significant progress
during 2009 vis a vis potential interruption of transmission of the
wild poliovirus (WPV) in Nigeria. As Nigeria has been a significant
exporter of the wild poliovirus in the African region, this should
have a major impact. As a reminder, pre-2004, most of the African
countries had interrupted WPV transmission. As a result of decreased
vaccination acceptance in Northern Nigeria, during the ensuing years,
there has been identification of WPV associated polio cases in many
of the countries that have been genetically linked the WPVs
circulating in Nigeria.

Of the 23 countries that have identified WPV associated polio cases
with dates of onset in 2009, 14 involved only WPV1, and 9 involved
WPV1 and WPV3 (there were 3 countries that identified WPV3 during
2008, but not during 2009). (see
<http://www.polioeradication.org/content ... ecount.pdf> for a
table of wild poliovirus isolates by country 2000 through 2010.).

The 4 countries that are endemic for polio are Afghanistan, India,
Pakistan and Nigeria. Three of these 4 countries continue to have
areas of civil strife that impact on vaccination activities. As the
above reports suggest, there are other countries with civil strife
ongoing where vaccination activities have been impacted, and where
WPV has been re-introduced.

For a map showing the distribution of polio cases worldwide, during
the period 20 Jul 2009 through 19 Jan 2010, see
<http://www.polioeradication.org/content ... emap.shtml>. - Mod.MPP]

Africa united in fight against polio outbreak
85 million children to be immunized across 19 countries
04.03.2010 - UNICEF

DAKAR/BRAZZAVILLE - More than 85 million children under five years old will be immunized against polio in 19 countries across West and Central Africa in a massive example of cross-border cooperation aimed at stopping a year-long polio epidemic. Nine countries in West and Central Africa – Burkina Faso, Cameroon, Chad, Guinea, Liberia, Mali, Mauritania, Senegal and Sierra Leone – are considered to have active outbreaks of polio (i.e. cases within the last six months) ... mehr

Gruß
Birgitt

POLIOMYELITIS - WORLDWIDE (02): SENEGAL
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In this update:
[1] Senegal
[2] Global case counts
[3] Global updates

******
[1] Senegal
Date: 5 Mar 2010
Source: Afrique en ligne [Trans. by Mod.MPP, edited]
<http://www.afriquejet.com/actualites/sa ... 45273.html>


Senegal reports 2 cases of polio
--------------------------------
The Senegalese Minister of Health and Prevention, Modou Diagne Fada,
announced in Dakar on Thursday [4 Mar 2010] that there were 2 cases
of poliomyelitis reported in his country, affirming that these were
the 1st such cases since 1998.

He announced the organization of a national vaccination campaign from
[6-9 Mar 2010], targetting children aged zero to 5 years.

Caused by the wild poliovirus, poliomyelitis is a very serious and
contagious infectious disease that can produce limb paralysis and can
result in death.

--
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[The date of onset of the most recent case in Senegal is listed as 12
Jan 2010 (see section [2] global case counts below) According to the
polio eradication website, on 4 Mar 2010, there was the announcement
of a planned vaccination campaign in 19 countries across West and
Central Africa, with the objective to vaccinate more than 85 million
children under 5 years old in order to interrupt a polio epidemic
that has been ongoing for more than a year.

The epidemic traces back to spread from polio endemic Nigeria to
polio free countries in 2008. A total of 9 countries have reported
cases of polio within the past 6 months: Burkina Faso, Cameroon,
Chad, Guinea, Liberia, Mali, Mauritania, Senegal and Sierra Leone. In
addition to these 9 countries, Nigeria, Ghana, Benin, Central African
Republic, Gambia, Cape Verde and Guinea Bissau will all launch their
campaigns on 6 Mar 2010. Niger, Togo and Cote d'Ivoire will launch
campaigns at a later date following political transitions or
elections. (see
<http://www.polioeradication.org/content ... 003.asp#01>
for full text of this announcement).

--
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<promed@promedmail.org>

******
[2] Global case counts
Date: 2 Mar 2010
Source: Polio eradication website [edited]
<http://www.polioeradication.org/casecount.asp>


Total cases: Year-to-date 2010 / Year-to-date 2009 / Total in 2009
Globally: 34 / 91 / 1606
- in endemic countries: 29 / 66 / 1256
- in non-endemic countries: 5 / 25 / 350

Country: Year-to-date 2010 / Year-to-date 2009 / Total in 2009 / Date
of onset of most recent case

Pakistan: 7 / 7 / 89 / 5 Feb 2010
India: 16 / 14 / 741 / 1 Feb 2010
Afghanistan: 5 / 3 / 38 / 24 Jan 2010
Senegal: 2 / 0 / 0 / 12 Jan 2010
Chad: 3 / 0 / 66 / 8 Jan 2010
Nigeria: 1 / 42 / 388 / 3 Jan 2010
Mauritania:* 0 / 0 / 13 / 22 Dec 2009
Sierra Leone: 0 / 0 / 11 / 28 Nov 2009
Mali: 0 / 1 / 2 / 12 Nov 2009
Guinea: 0 / 0 / 42 / 8 Nov 2009
Liberia: 0 / 0 / 11 / 26 Oct 2009
Burkina Faso: 0 / 2 / 15 / 25 Oct 2009
Cameroon: 0 / 0 / 3 / 15 Oct 2009
Angola: 0 / 1 / 29 / 15 Sep 2009
Burundi: 0 / 0 / 2 / 12 Sep 2009
CAR: 0 / 0 / 14 / 9 Aug 2009
Cote d'Ivoire: 0 / 0 / 26 / 6 Aug 2009
Kenya: 0 / 2 / 19 / 30 Jul 2009
Sudan: 0 / 11 / 45 / 27 Jun 2009
DRC: 0 / 0 / 3 / 24 Jun 2009
Niger: 0 / 3 / 15 / 28 May 2009
Uganda: 0 / 1 / 8 / 10 May 2009
Benin: 0 / 2 / 20 / 19 Apr 2009
Togo: 0 / 2 / 6 / 28 Mar 2009

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

******
[3] Global updates
Date: 2 Mar 2010
Source: Polio Eradication.org [edited]
<http://www.polioeradication.org/casecount.asp>


Headlines
---------
- A total of 16 African countries will immunize more than 70 million
children this weekend in a massive, synchronized cross-border
immunization campaign to stop the ongoing outbreak in West Africa in
its tracks. The 6 countries considered "highest risk" in this block
will hold a further campaign in 2 weeks and will be joined by another
3 countries which had to delay joining this weekend's activity for
political reasons.
- Internationally acclaimed actress and UNICEF Goodwill Ambassador
Mia Farrow is in Chad this week to draw attention to the upcoming
polio campaign. The President of Chad, the UNICEF Regional Director
and Ms Farrow will launch the campaign on Sunday [7 Mar 2010].
- Only one case of wild poliovirus has been reported globally this
week for 2010 -- a wild poliovirus type 3 (WPV3) case in Swat, Pakistan.
- The dramatic reduction in wild poliovirus type-1 (WPV1) cases
continues. In January and February last year [2009], there were 58
WPV1 cases worldwide -- this year [2010], there have been 7. The
long-time reservoirs of WPV1 in India -- Uttar Pradesh and Bihar --
have not reported WPV1 cases since [13 Nov 2009] and [29 Oct 2009],
respectively, while in Nigeria, the last WPV1 case in the country was
reported on 20 Nov 2009, after re-testing of the case reported in
Kwara in February [2010] returned negative for wild poliovirus.
- Nigeria's improved performance in immunization rounds continues to
return impressive results: the country often considered the key to
eradication in Africa has recorded one case of wild poliovirus in
2010 to date -- at the same time last year [2009], transmission was
widespread, with 42 cases recorded in 16 states across the country.

Endemic countries
-----------------
Afghanistan:
- No new cases were reported in the past week. The most recent case
had onset of paralysis on [24 Jan 2010] (WPV3 from Hilmand). The
total number of cases for 2010 is 5 (one WPV1, 4 WPV3).
- Sub-National Immunization Days (SNIDs) across the southern
districts were held from [14-16 Feb 2010], using bivalent oral polio
vaccine (bOPV). The Hilmand districts of Musa Qala and Sanguin were
the only districts unable to conduct the campaigns, due to active
conflict in the area, and those 2 districts are conducting the
campaign this week [1-6 Mar 2010].
- National Immunization Days (in conjunction with delivery of
de-worming tablets) will be held from [14-16 Mar 2010], using bOPV.

India:
- No new cases were reported in the past week. The most recent case
(WPV3 from Uttar Pradesh) had onset of paralysis on [1 Feb 2010]. The
total number of cases for 2010 is 16 (2 WPV1, 14 WPV3) compared to 14
at the same time last year [2009] (7 WPV1, 7 WPV3).
- The Operations Group Meeting was held in Delhi, chaired by
Secretary Rao of the Ministry of Health and Family Welfare and
attended by Joint Secretary Prasad and partners, with discussion
focusing on the upcoming Supplementary Immunization Activity plan and
the issue of vaccine availability. The 107 Block Plan was discussed
and is being implemented through the State Ministries of Health.
- The most recent rounds were the Nationwide Immunization Days held
on [10 Jan 2010 and 7 Feb 2010]. Sub-National Immunization Days
(SNIDs) are now planned for western Uttar Pradesh and parts of Bihar
on [21 Mar 2010], using mOPV1.

Nigeria:
- No new cases were reported in the past week. The most recent case
(WPV3 in Delta) had onset of paralysis on [3 Jan 2010] -- the only
case reported thus far in 2010. Since August 2009, Nigeria has
reported 13 cases of wild poliovirus in total.
- National Immunization Plus Days (NIPDs) from [30 Jan 2010 - 2 Feb
2010] used bOPV for the 1st time in Africa. The next planned activity
is a national round from [6 Mar 2010], using trivalent OPV (tOPV).

Pakistan:
- One new case was reported in the past week, a WPV3 from Swat, with
onset of paralysis on [5 Feb 2010]. This is the most recent case in
the country. The total number of cases for 2010 is 7 -- the same as
it was at this time last year [2009].
- Bivalent OPV was used for the 1st time in Pakistan in NIDs held
from [15-17 Feb 2010]. The next round will be held from [15-17 Mar
2010] in targeted districts considered high and medium-risk areas, using bOPV.

Importation countries
---------------------
Angola:
- No new cases were reported in the past week. The most recent case
had onset of paralysis on [15 Sep 2009] (WPV1 from Benguela). The
total number of cases for 2009 remains 29.
- SNIDs were held on [11-13 Dec 2009], using mOPV1, in Benguela,
Bengo, Cuanza Sul, Cuanza Norte and Luanda. The next SIAs in Angola
are planned to be nationwide in June, July and August [2010].
- The Technical Advisory Group for Angola and DR Congo is meeting in
Luanda this week.

Cameroon:
- No new cases were reported this week. The most recent case had
onset of paralysis on [15 Oct 2009] (WPV3 from Extreme Nord
province). The total number of cases in 2009 remains 3.
- NIDs with trivalent OPV were held on [4-6 Dec 2009]. The next
Supplementary Immunization Activities are planned for [6 Mar 2010]
(synchronized with 18 other countries in west and central Africa), using mOPV3.

Chad:
- No new cases for 2010 were reported in the past week. The most
recent case had onset of paralysis on [8 Jan 2010] in Wadi Fira. The
total number of cases for 2010 is 3.
- The last immunization activity in Chad took place in the 2nd week
of February [2010], using tOPV. Chad will take part in the 16-country
synchronized campaign being launched on Saturday [6 Mar 2010], using
mOPV3. Actress Mia Farrow is in-country to draw attention to the round.

Democratic Republic of Congo (DRC):
- No new cases were reported in DR Congo in the past week. The total
number of cases for 2009 remains 3. The most recent case had onset of
paralysis on [24 Jun 2009] (WPV3 from Bas-Congo).
* The most recent SIAs took place on [17 Nov 2009] in South Kivu
and on [26 Nov 2009] in North Kivu. Further SIAs are being planned
for May [2010].

Horn of Africa:
- No cases have been reported across the Horn for 2010; the most
recent case had onset of paralysis on [30 Jul 2009] (WPV1 from
Kenya). The total number of cases for Kenya, Sudan and Uganda in 2009 is 72.
- Northern Sudan conducted SIAs on [22 Feb 2010] using bOPV and
southern Sudan conducted rounds from [17 Feb 2010] using mOPV1. The
next rounds will be held from [26 Mar 2010] in southern Sudan, using bOPV.
- The Horn of Africa Coordination meeting is being held this week,
and will be followed by the Technical Advisory Group meeting next week.

West Africa:
- No new cases were reported in the past week for 2010. The most
recent case is a WPV1 from Senegal, with onset of paralysis on [12
Jan 2010]. The total number of cases for 2010 is 2, and for 2009 is 161.
- A large-scale outbreak response mop-up was held in Senegal on [12
Feb 2010], while a National Immunization Day was held in Mauritania
on [15 Feb 2010], with both countries using mOPV1.
- The next round will be the 16-country synchronized immunization
campaign across west and central Africa from [6 Mar 2010].
- Six countries will receive an additional dose on [26 Mar 2010]
(Burkina Faso, Guinea, Liberia, Mauritania, Senegal and Sierra
Leone), and will be joined by Cote d'Ivoire, Niger and Togo, who have
delayed this weekend's activity for political reasons, and southern
Sudan, before all 19 countries join together for another synchronized
round on [24 Apr 2010].

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[One hopes that this concerted effort in Africa will result in the
interruption of transmission of the wild poliovirus on the continent.
There are still areas of significant internal disruption and civil
unrest that remain somewhat below the radarscope where silent
transmission may be occurring.

According to the polio eradication website, there have been a total
of 33 wild polioviruses isolated (as of 2 Mar) in 2010 coming from 6
countries. Of these, 28 cases (85 percent) come from Pakistan (7),
India (16) and Afghanistan (5) -- suggesting that there have been
significant inroads in Africa. - Mod.MPP]

POLIOMYELITIS - WORLDWIDE (03): TAJIKISTAN, REQUEST FOR INFORMATION
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In this posting:
[1] Subscriber query
[2] Russian language newswire

******
[1] Subscriber query
Date: Thu 22 Apr 2010
From: Mick Mulders <mick.mulders@gmail.com>


Subject: Polio outbreak in Tajikistan
-------------------------------------
Any news about this outbreak? First time since 1998 in polio-free declared
WHO European Region.

--
Dr Mick Mulders
<mick.mulders@gmail.com>

******
[2] Russian language newswire
Date: Thu 22 Apr 2010
Source: RIA (Russian News & Information Agency) Novosti [in Russian,
machine trans., edited]
<http://www.rian.ru/society/20100422/225589803.html>


Russia is ready to help Tajikistan in the fight against the polio outbreak
--------------------------------------------------------------------------
In response to an outbreak of polio reported in Tajikistan, Russia is ready
to help neighbors in the CIS and, if necessary, take protective measures,
the state chief sanitary inspector Dr Gennady Onishchenko told RIA Novosti
on Thursday [22 Apr 2010].

"Today we learned from the World Health Organization (WHO), that there were
more than 100 cases of polio in Tajikistan, including one death. In
addition, they are not localized to one place, but have occurred in several
cities -- for example, in Dushanbe and Leninskiye -- Onishchenko said.

According to Onishchenko, the 1st cases were registered in Tajikistan in
December 2009, and the Russian Polio Institute helped process specimens
taken from patients. Recently, however, the outbreak has become more
dynamic. [The laboratory testing] has confirmed that the cases are due to
wild poliovirus, not the same strain contained in the polio vaccine, said
Onishchenko.

"The [occurrence of an] outbreak suggests that the collective ["herd"]
immunity is faltering. Most likely, there were shortcomings in vaccination
[decreases in vaccination coverage]. We now make the [offer of assistance]
directly to Tajikistan and the CIS and, depending on the outcome, we will
take possible measures to help," he said. According to Onishchenko, Russian
scientists who had experience with outbreaks of polio in India, have
already traveled to Tajikistan.

"Let us understand what to do in our country. Some quarantine measures
introduced do not have much meaning, but, depending on how events will
unfold, we will take action on its territory," said Onishchenko. "We will
give guidance to our services on the ground that they [should be]
particularly careful when handling citizens of Tajikistan, especially
children," he added.

The head of Rospotrebnadzor [Federal Service for Consumer Affairs and Human
Welfare] was concerned about the situation of poliomyelitis in Tajikistan.
"There has been a breach in the defense, which has practically been formed.
There have been polio outbreaks associated with African countries and
Afghanistan. Now Tajikistan has been added to the list," said Onishchenko.

Poliomyelitis -- an acute infectious disease, children's spinal paralysis,
caused by a lesion of the gray matter of the spinal cord is characterized
mainly by disorders of the nervous system. Introduction of vaccines that
prevent polio, led to rapid reductions in morbidity, and in many areas, the
complete elimination of the disease. For example, Russia since 2002, is a
country free of the virus.

[byline: Alexei Nikolsky]

--
communicated by:
ProMED-mail
<promed@promedmail.org>

[As of Tue 20 Apr 2010, the above mentioned outbreak of polio has not been
reported on the polio eradication website (see
<http://www.polioeradication.org/casecount.asp>). In 2010 to date a total
of 71 cases of polio have been confirmed in the world of which 42 were in
endemic countries [India (19), Pakistan (13), Afghanistan (8 ), and Nigeria
(2)] and 29 were in non-endemic countries [Senegal (13), Chad (7),
Mauritania (4), Liberia (1), Sierra Leone (1), Angola (1), and Nepal (1)].

From the newswire above, it appears as though there has been significant
wild poliovirus (WPV) transmission in Tajikistan since sometime in December
2009, with the stated "more than 100 cases". (For every paralytic case
identified, there are between 50 and 1000 infected individuals without
paralytic disease, which allows for a somewhat "silent" transmission of the
virus over significant geographic areas).

If the report above is true and not exaggerated, this represents a
significant setback for polio eradication activities in Asia. According to
the WHO website, the last confirmed case of polio in Tajikistan was in
1997, but it was apparently due to a vaccine virus, as there have been no
WPVs confirmed in Tajikistan since 1996 (see
<http://www.who.int/immunization_monitor ... xtract.cfm>).

For a the interactive HealthMap/ProMED map of Tajikistan, see
<http://healthmap.org/r/01dJ>. Tajikistan shares a southern border with
Afghanistan, of which one area is a very narrow strip that separates
Tajikistan from Pakistan -- 2 of the 4 remaining polio endemic countries in
the world. (see <http://www.polioeradication.org>).

ProMED-mail would greatly appreciate more information from knowledgeable
sources on the number of confirmed and probable cases of polio in
Tajikistan, results of genetic testing of the virus identified (wild vs
vaccine derived, type 1, 2, or 3), and genetically confirmed geographic
origin of the virus. - Mod.MPP]

Polio in Tajikistan, first importation since Europe certified polio-free
23.04.2010 - WHO

Poliovirus type 1 has been detected in diagnostic samples from cases of Acute Flaccid Paralysis (AFP) from Tajikistan. This represents the first importation of poliovirus in the WHO European Region since it was certified polio-free in 2002.

As of 21 April 2010, 120 cases of acute flaccid paralysis had been reported from Tajikistan. The majority of these have onset of paralysis within the past 2 weeks, prompting the Government to notify WHO of an outbreak. Ten of the children have died. The vast majority of the cases are children < five years of age. Preliminary data suggests >45% had four or more doses of oral polio vaccine.

To date, poliovirus type 1 has been isolated in diagnostic specimens from 7 of these cases. All cases are in the south-west of the country, in an area bordering Afghanistan and Uzbekistan. Afghanistan is one of the four remaining polio-endemic countries. No cases have been reported in the areas of Afghanistan bordering Tajikistan.

The Government of Tajikistan has requested technical guidance and support from WHO. Vaccine for three outbreak response rounds is being pre-positioned by UNICEF Supply Division for Tajikistan.

Tajikistan's last case of clinically confirmed polio was in 1997; the last case of polio confirmed by virological testing was in 1991. Reported OPV3 coverage nationwide was 87% in 2008, the last year for which complete data are available under the WHO/UNICEF joint reporting process. AFP surveillance indicators in Tajikistan meet certification standards at the national level. In 2009, Tajikistan reported 35 cases of acute flaccid paralysis, of which none were caused by wild poliovirus. Globally, more than 90,000 cases of acute flaccid paralysis were reported in 2009, of which 1606 were caused by wild poliovirus.

Three cases of acute flaccid paralysis have been reported in Uzbekistan on the Tajikistan border; poliovirus has not been isolated yet in laboratory testing. In addition, a child from Tajikistan travelled from Dushanbe to Tashkent for medical treatment shortly after onset of paralysis. The Government of Uzbekistan is planning one nationwide round of vaccination; the Government of Kyrgyzstan, is immunizing children <5 years over the course of European Immunization Week (26-30 April).

WHO is communicating with countries in the Region about the outbreak. It is important that neighboring countries strengthen surveillance for cases of acute flaccid paralysis, in order to rapidly detect any new poliovirus importations and facilitate a rapid response. Countries should also analyze routine immunization coverage data to identify any sub-national gaps in population immunity to guide catch-up immunization activities and thereby minimize the consequences of any new virus introduction. Priority should be given to areas at high-risk of importations and where OPV3/DPT3 coverage is <80%.

This outbreak demonstrates the need to maintain high population immunity until transmission of polio has been interrupted worldwide.

Public health measures such as enhanced surveillance and immunization may be put in place at the borders by Tajik health authorities and their counterparts. It is important that international travellers to and from polio affected areas are adequately immunized against polio as recommended in Chapter 6 of International Travel and Health (see link below).

WHO does not recommend the imposition of restrictions to the international movement of persons as a control measure at this time.

POLIOMYELITIS - WORLDWIDE (04): TAJIKISTAN, UZBEKISTAN SUSPECTED
****************************************************************
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<http://www.isid.org>

******
Report from Tajikistan via ProMED-RUS
Date: Fri 23 Apr 2010
From: Nilufar Rakhmanova <promed-rus@promedmail.org> [edited]


[re: Poliomyelitis - Worldwide (03): Tajikistan, RFI 20100423.1314]
-------------------------------------------------------------------
The following information has been sent by our health specialists from
Tajikistan:

"That is true. 120 cases [have been] detected in Khatlon, Dushanbe, and the
[Region] of Republican Subordination. 7 confirmed [cases] with the "wild"
PV1 virus. 11 deaths (including 2 adults). WHO is conducting the
investigation of the outbreak and one CDC representative is also coming for
this reason soon.

There is a WHO plan to vaccinate children under 5 starting from May [2010].

Cases have also been detected in Uzbekistan and Afghanistan."

--
Nilufar Rakhmanova
ProMED-RUS moderator
<promed-rus@promedmail.org>

[Our thanks to our ProMED-RUS colleagues for this rapid confirmation and
additional information. - Mod.MPP]

******
--
Ralph O'Connor
CAPT, USPHS
Health Scientist
Division of Emergency Operations
OPHPR, CDC
USA
<ROConnor@cdc.gov>

[ProMED-mail gratefully acknowledges CAPT O'Connor's contribution.

The close geographic proximity of the outbreak to the border with
Afghanistan and the fact that polio is endemic in that country, do serve as
circumstantial evidence suggestive that the virus may well have originated
in Afghanistan, albeit no poliovirus transmission has been documented in
the border area in Afghanistan. Unfortunately there has also been probable
spread of poliovirus transmission to Uzbekistan with 3 reported suspected
cases. But that being said, we await genetic studies on the virus involved
in this outbreak as well as laboratory confirmation on the suspected cases
in Uzbekistan.

It is curious that this outbreak has apparently been ongoing since December
2009, somewhat beneath the surveillance radarscope. It will be interesting
to see the results of the epidemiologic investigation of the outbreak when
available. From the information given above one can speculate that there
were "sporadic cases" during the period December 2009 through the end of
March 2010, that may well have been missed and attributed to "AFP" in a
country where no polio cases had been seen in 13 years -- until there was
significant increase in AFP cases to flag an outbreak of something unusual.

While there is mention that more than 45 per cent of the cases have a
history of 4 or more doses of OPV, one wonders what the actual vaccine
efficacy is -- when there are higher levels of vaccination coverage, one
expects to find a higher proportion of cases among vaccinated individuals.
One of the many questions to be addressed here is whether this represents a
failure of the vaccine, or a failure to vaccinate (low vaccine efficacy vs
pockets of low vaccination coverage).

The provinces of Tajikistan can be seen on the map at
<http://en.wikipedia.org/wiki/Provinces_of_Tajikistan>. For the interactive
HealthMap/ProMED-mail map of Tajikistan, see
<http://healthmap.org/r/00Fa."http://hea ... org/r/00Fa>. - Mod.MPP]

Tadschikistan - Polio
27.04.2010

Die Weltgesundheitsorganisation (WHO) berichtet von 120 Polio-Fällen, einschließlich 10 Todesfällen. Bei Reisen sollte dringend der Impfschutz überprüft und ggf. aufgefrischt werden. / Quelle: crm

POLIOMYELITIS - WORLDWIDE (05): TAJIKISTAN, REQUEST FOR INFORMATION
***********************************************
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<http://www.isid.org>

[1] Clarification
[2] Eurosurveillance report - virus origin Uttar Pradesh, India
[3] Outbreak response

******
[1] Clarification
Date: 29 Apr 2010
From: Sona Bari <baris@who.int> [edited]


I wish to refer to [the report from ProMED-RUS
in] your posting [Poliomyelitis - Worldwide (04):
Tajikistan, Uzbekistan susp 20100424.1319] in
which it is stated, in the context of the polio
outbreak in Tajikistan, that "Cases have also
been detected in Uzbekistan and Afghanistan."

Please allow me to clarify that no cases of polio
have been confirmed in Uzbekistan to date and
that polio cases reported this year [2010] in
Afghanistan (10 to date) are not related to the
outbreak in Tajikistan. No cases have been
detected in the areas of Afghanistan bordering Tajikistan.

--
Sona Bari
External Relations
Polio Eradication Initiative
World Health Organization
20 Avenue Appia,
CH-1211 Geneva 27, Switzerland
<baris@who.int>
<http://www.polioeradication.org>

******
[2] Eurosurveillance report - virus origin Uttar Pradesh, India
Date: 29 Apr 2010
Source: Eurosurveillance 15(17), 29 Apr 2010 [edited]
<http://www.eurosurveillance.org/ViewArt ... leId=19558>


On 23 Apr 2010, the World Health Organisation
announced the confirmation of wild poliovirus
serotype 1 (WPV1) in 7 samples from children with
Acute Flaccid Paralysis (AFP) in Tajikistan, in
the context of a multi-district cluster starting in December 2009.

Poliomyelitis (polio) was eliminated in the WHO
European Region and the Region was certified
polio-free in 2002. Since then, considerable
efforts of national authorities and of the
international public health community have
sustained the polio-free status for the 880
million population of the Region. The last
indigenous case of wild poliovirus infection in
the WHO European Region was reported in Turkey in
1998 [1]. However, poliovirus imported from polio
endemic countries remains a threat. In 1996,
following migration resulting from the opening of
borders in 1992, Albania reported 138 laboratory
confirmed cases of WPV1 infection, including 16
deaths, with 24 confirmed polio cases detected in
the bordering United Nations administered
Province of Kosovo [2]. The main age group
affected was the group of 10 to 34 years-old
which accounted for 79 percent of cases and the
lowest incidence was reported among children aged
one to 9 years. Among those with known
vaccination status, 93 percent had received at
least 3 doses of oral polio vaccine (OPV). The
last outbreak in the EU, due to imported WPV3,
occurred in the Netherlands in 1992 and 1993 in a
community objecting to vaccination [3]. A total
of 71 individuals were paralysed and 2 deaths
were reported. The last cases of imported wild
poliovirus in the WHO European Region were
reported in 2001. These occurrences were
associated with WPV1 originating from India, with
3 Roma children in Bulgaria and one non-paralytic
case in Georgia [4]. These cases related to
importation did not result in indigenous
transmission, defined by the WHO as uninterrupted
transmission occurring for more than 12 months.

Tajikistan, with a 6.6 million population, is one
of the 5 Central Asian Republics and borders
Uzbekistan, Kyrgyzstan, China and Afghanistan.
Two outbreaks of polio were registered in
Tajikistan in the 1990s, with 111 and 26 cases of
poliomyelitis reported to the WHO in 1991 and
1994, respectively [5]. The last clinically
confirmed case of poliomyelitis observed in Tajikistan was in 1997 [1,6].

The reported vaccine coverage with 3 doses of OPV
in Tajikistan in 2008 was 87 percent [7], which
is below the WHO target of over 90 percent [8].
In 2007, the national health authorities in
Tajikistan conducted an immunisation campaign
against polio, targeting children less than 3
years old in the areas bordering Afghanistan.

At the beginning of April 2010, the WHO Country
Office in Tajikistan was informed of an increase
in AFP cases in multiple contiguous districts. On
average, Tajikistan reports 35-40 AFP cases
annually with peaks in July and October. As of
[28 Apr 2010], the Ministry of Health of
Tajikistan reported 171 AFP cases to WHO, with a
sharp increase in the past 2 weeks, including 12
deaths and 32 cases of laboratory confirmed WPV1
infection; the tests were conducted at the WHO
regional reference laboratory for polio, based at
the Chumakov Institute of Poliomyelitis and Viral
Encephalitis, Moscow, Russian Federation [9].
Genetic sequencing has determined that the
poliovirus is most closely related to virus from
Uttar Pradesh, India. One-hundred and thirty-six
(80 percent) of the AFP cases were in children
aged under 5 years (age range 0-17 years). Cases
were mainly reported from districts bordering
Afghanistan and Uzbekistan. The Uzbek national
authorities are investigating 3 cases of AFP.

Following the confirmation of WPV1 in Tajikistan,
3 rounds of nationwide immunisation with
monovalent OPV type 1 are planned for all
children aged 5 years or younger (1.1 million
children) with a 2 week interval between each
round, starting the 1st round on [4 May 2010]. In
addition, there are ongoing efforts to strengthen
AFP surveillance. Upon the request of the
Ministry of Health of Tajikistan, WHO deployed a
multi-disciplinary team of clinical,
epidemiological, and virological experts, to
investigate the event and assist national
authorities in planning and implementing the
necessary public health measures. WPV1 and WPV3
activity is currently recorded in Afghanistan. As
of [20 Apr 2010], Afghanistan reported 8 cases of
poliomyelitis (one WPV1 and seven WPV3) for the
year 2010. The onset of disease in the most
recent case was on [8 Apr 2010]. Since 2002, no
cases of wild poliovirus infection have been
detected in northern Afghanistan, areas with
recognised high quality AFP surveillance.
Pakistan reported 13 cases of polio due to WPV1
and WPV3 so far in 2010 [8]. Polio is still
endemic in 4 countries worldwide; besides
Afghanistan and Pakistan these are India and Nigeria [8].

The movement of Tajik nationals in the European
Union (EU) is limited as less than 2200 Schengen
visas were issued in 2009. Considering these
small numbers of Tajik nationals coming to the
Schengen area, the risk of spread of WPV1
associated with the ongoing outbreak in
Tajikistan within the EU is considered to be
limited. However, importation of cases cannot be
excluded, and high levels of vaccine coverage
with 3 doses of polio vaccine are needed to
ensure that importation into the EU will not
occur. Pockets of susceptible populations do
exist in the EU and the risk of disease in these
groups is high if the virus is introduced in
these communities. Avoiding complacency and
maintaining good AFP and/or enterovirus
surveillance in the EU to comply with WHO targets
is of utmost importance to prevent WPV
importation and further spread, particularly
considering that 90% of cases associated with WPV
infection do not have clinical symptoms. The need
to maintain vigilance, implement adequate
measures to detect and prevent re-importation of
polio into polio-free regions is also stressed in
a paper by H Nokleby et al. in this issue of Eurosurveillance [10].

While AFP surveillance is considered the gold
standard for certification purposes, other
surveillance strategies and sources of data have
been accepted by the WHO European Regional
Certification Commission of the Eradication of
Poliomyelitis that enable the detection, rapid
reporting, and investigation of any paralytic
polio cases. This applies to countries that have
been non-endemic for a long time, with high
levels of sanitation and strong health systems.
Accepted alternative surveillance strategies
include enterovirus surveillance and/or
environmental surveillance for polioviruses.
Member states of the WHO European Region conduct
a combination of AFP, enterovirus, and/or
environmental surveillance. Forty-three of the 53
member states in the WHO European Region conduct
AFP surveillance, including 23 of the 29 EU/EEA
countries (Liechtenstein is not reporting to
WHO), 41 have implemented enhanced enterovirus
surveillance while 7 are doing environmental
surveillance through sewage systems.

A region is certified as polio-free if no
indigenous poliomyelitis cases are identified for
a period of more than 3 years in the presence of
high quality, certification-standard
surveillance. The current outbreak in Tajikistan
represents the 1st introduction of wild
poliovirus in the WHO European Region since it
has been certified polio-free in 2002. Therefore,
strong measures are needed to protect the status.
The present situation calls for strong political
and financial commitment from all member states
to ensure the WHO European Region sustains its
polio-free status and that global eradication of polio will be reached by 2012.

Although the region is considered at high-risk
for importation of wild poliovirus due to ongoing
global travel, trade, and migration, especially
with the 4 polio endemic countries, the current
poliomyelitis outbreak in Tajikistan does not
substantially affect the risk for further spread
to the EU Member States at this time. It is
important to note that WHO does not recommend
restrictions on international travel and trade in
case of the detection of wild poliovirus but
emphasizes that standard recommendations
regarding vaccination of travellers to and from a
polio-affected country apply until a polio outbreak is interrupted.

Acknowledgements
The authors acknowledge the Ministry of Health of
Tajikistan for actions taken in response to the
ongoing polio outbreak and for cooperation with
the Global Polio Eradication Initiative.

References

1. Certification of Poliomyelitis Eradication:
European Region declared &#145;polio-free&#146;. Fifteenth
meeting of the European Regional Certification
Commission. Copenhagen, 19-21 June 2002, p 103.
Available from: <http://www.euro.who.int/document/E88105.pdf>
2. Ciofi degli Atti M, Prevots R, Sallabanda A,
Malfait P, Diamanti E, Aylward B, et al. Polio
outbreak in Albania 1996. Euro Surveill.
1997;2(5). pii=162. Available from:
<http://www.eurosurveillance.org/ViewArt ... icleId=162>
3. Oostvogel PM, van Wijngaarden JK, van der
Avoort HG, Mulders MN, Conyn-van Spaendonck MA,
Rümke HC, et al. Poliomyelitis outbreak in an
unvaccinated community in the Netherlands,
1992-3. Lancet. 1994;344(8923):665-70.
4. Noah N, Ramsay M, Twisselmann B. Imported
cases of polio in Bulgaria ­ vaccination campaign
postponed. Euro Surveill. 2001;5(21). pii=1747.
Available from:
<http://www.eurosurveillance.org/ViewArt ... cleId=1747>
5. World Health Organization Regional Office
for Europe. The centralized information system
for infectious diseases (CISID). Available from:
<http://data.euro.who.int/cisid/?TabID=239415>
6. Poliomyelitis. Fact sheet 04/02. Copenhagen,
21 June 2002. WHO, Rotary International, CDC,
Unicef. Available from:
<http://www.euro.who.int/document/mediac ... eeeuro.pdf>
7. World Health Organization. Tajikistan
reported immunization coverage, 1980-2008.
Available from:
<http://www.who.int/immunization_monitor ... .cfm?C=TJK>
8. Global polio eradication initiative.
Programme of Work 2009 and financial resource
requirements 2009-2013, as of May 2009. WHO,
Rotary International, CDC, Unicef. Available
from:
<http://www.polioeradication.org/content ... rk2009.pdf>
9. Global polio eradication initiative . Polio
in Tajikistan, first importation since Europe
certified polio-free. WHO, Rotary International,
CDC, Unicef. 22 April 2010. Available from:
<http://www.polioeradication.org/content ... 004.asp#03>
10. Nokleby H, de Carvalho Gomes H, Johansen K,
Kreidl P. Protection against poliomyelitis in
Europe. Euro Surveill. 2010;15(17). pii=19556.
Available from:
<http://www.eurosurveillance.org/ViewArt ... leId=19556>

[Reported by: World Health Organization Country
Office Tajikistan /1, WHO Regional Office for
Europe /2, European Centre for Disease Prevention
and Control /3 1. World Health Organization
Country Office Tajikistan, Dushanbe, Tajikistan
2. World Health Organization Regional Office for
Europe, Copenhagen, Denmark 3. Europe and
European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

******
[3] Outbreak response
Date: 29 Apr 2010
Source: Polio Eradication Initiative [edited]
<http://www.polioeradication.org/content ... 004.asp#04>


Tajikistan is launching an outbreak response
vaccination activity on [1 May 2010] in the
capital Dushanbe and 6 surrounding districts, as
lab testing confirms that 32 children in the
country have been paralysed by polio. This
response is to be followed by 3 nation-wide
vaccination campaigns, the 1st of which is due to
start on [4 May]. Four million doses of vaccine have arrived in the country.

Genetic sequencing has now determined that the
poliovirus is most closely related to virus from
Uttar Pradesh, India. Countries neighbouring
Tajikistan have lined up protective measures:
Uzbekistan is planning to vaccinate its children
under 5 years of age starting in the last week of
May [2010]; Kyrgyzstan is conducting polio
vaccinations as part of European Immunization
Week; Afghanistan has stepped up surveillance
along its border with Tajikistan and is focusing
staff resources on border provinces during its [2
May 2010] nationwide immunization activity.

WHO and UNICEF are urgently seeking emergency
funding to support the costs of the field
operations and vaccination campaigns. Rotary
International, the US Centers for Disease Control
and Prevention and the UK Department for
International Development have already pledged emergency funding.

The Ministries of Health in Tajikistan and
Uzbekistan are supported in their planning and
implementation by WHO, the US Centers for Disease
Control and Prevention, the United Nations
Children&#146;s Fund (UNICEF), the International
Federation of Red Cross and Red Crescent
Societies and other partners in the Global Polio Eradication Initiative.

WHO recommendations for travel to Tajikistan are
the same as for any other polio-infected country
­ immunization or boosting of past immunization.
No further actions or travel restrictions are recommended.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[In the above report (see [2] Eurosurveillance
report], as of 27 Apr 2010, there have been 171
cases of AFP with 12 deaths reported of which 32
had WPV1 isolated. This represents an increase of
51 AFP cases and 2 deaths, with 25 addition
isolates of WPV1 since the 1st report of this
outbreak (see prior ProMED-mail posting
Poliomyelitis - Worldwide (04): Tajikistan,
Uzbekistan susp 20100424.1319). Additional
information since the 1st report on this outbreak
includes genetic sequencing of the WPV1 isolated
from cases as most closely resembling viruses
from Uttar Pradesh India. It has been pointed out
that while Afghanistan is still a polio endemic
country not having interrupted transmission and
sustained the interruption for 3 years, the
northern part of Afghanistan has not had recent
poliovirus transmission, with 7 out of the 8
confirmed cases with onset in 2010 having WPV3
isolated, whereas the virus identified in the
current outbreak in Tajiskistan is WPV1. The
identification of the probable origin of the
virus in Uttar Pradesh, a key endemic area in
India further highlights the ease of travel of
microorganisms (and their hosts), crossing borders silently.

We still await word on the findings of the
investigations on the 3 identified AFP cases in
Uzbekistan, as well as more information on
results of the investigation of the outbreak in
Tajikistan, with possible information on the
silent or not so silent spread of the WPV since December 2009.

For the interactive HealthMap/ProMED map of
Tajikistan, showing borders with neighboring
countries (including Uzbekistan and Afghanistan)
see <http://healthmap.org/r/01f4>. For the
interactive HealthMap/ProMED map of Uttar
Pradesh, India, see
<http://healthmap.org/r/00Hk>. Moving the map
around, one can see that Uttar Pradesh is a
significant distance to the southeast from Tajikistan. - Mod.MPP]

Polio in Tajikistan - Update
29.04.2010 - WHO

171 cases of acute flaccid paralysis (AFP) have been reported by the Ministry of Health of the Republic of Tajikistan from January to present. 32 of these cases are confirmed wild poliovirus type 1, results are pending for the remaining cases. The majority of these cases have an onset of paralysis within the past 3 weeks. There have been 12 deaths.

Of the 32 confirmed wild poliovirus cases, 17 are under the age of two years, 14 are between the ages of two and five years, and one is between the ages of six and 15 years. Sixty-six percent are male. To date, 15 of the confirmed polio cases had paralysis onset during March and 17 have had paralysis onset during April. Information on vaccination history is available for 21 of the 32 confirmed cases. Of these cases, 2 (10%) have reported to have received less than three doses of OPV and 19 (90%) received three or more doses of OPV.

All cases are reported from the south-west of the country, including the capital city Dushanbe. This region borders Afghanistan and Uzbekistan,. Genetic sequencing has now determined that the poliovirus is most closely related to virus from Uttar Pradesh, India.

In response to the outbreak, the government of Tajikistan confirmed they are planning three supplementary rounds of immunization targeting every child <5 years (approx. 1.1 million children). Monovalent oral poliovirus type 1 vaccine will be used to quickly build immunity levels among children in the country. The first round will begin in the capital Dushanbe and six surrounding districts on May 1 with other regions to begin vaccination of children <5 years on May 4. Two additional national rounds have been tentatively scheduled for 18-22 May and 1-5 June.

Neighbouring countries are responding to the outbreak by heightening surveillance at all health care facilities and reporting sites while reviewing immunization status of children. Uzbekistan (target population 2.89 million children <5 years) is planning two national rounds of supplementary immunization with efforts to synchronize these rounds with Tajikistan in May and June. A campaign in Kyrgyzstan to boost the immunity of children against vaccine preventable disease including polio, which was planned by the government as part of European Immunization Week, will end tomorrow. Kyrgyzstan is planning to conduct additional sub-national immunization days in defined geographic areas.

WHO maintains its recommendation not to impose restrictions to the international movement of persons as a control measure at this time. It is important that international travellers to and from polio affected areas are adequately immunized against polio as recommended in Chapter 6 of International Travel and Health.

Tadschikistan - Polio
03.05.2010

Seit Januar diesen Jahres wurden von den Gesundheitsbehörden 171 Fälle akuter schlaffer Lähmungen gemeldet. Bei 32 Patienten konnte ein Poliovirus als Krankheitsursache identifiziert werden, für die restlichen Fälle stehen die Untersuchungsergebnisse noch aus. Bisher gab es 12 Todesfälle. Dringend Impfschutz gegen Polio überprüfen und ggf. auffrischen. / Quelle: crm

POLIOMYELITIS - WORLDWIDE (08 ): NIGERIA (SOKOTO)
************************************************
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<http://www.promedmail.org>
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Date: Tue 11 May 2010
Source: AllAfrica, Daily Trust (Nigeria) report [edited]
<http://allafrica.com/stories/201005110237.html>


A confirmed case of wild poliovirus [infection] has been discovered
in Dange/Shuni local government Area of Sokoto State, paralyzing a
9-month-old baby. The type 1 wild poliovirus is the most dangerous
and feared case which is capable of paralyzing children.

Though the country has yet to record any type 1 wild poliovirus cases
this year (2010), this is however the 1st in 6 months bringing the
number to 3 cases of polio in 2010, compared with 240 for the same
period in 2009.

The Daily Trust [newspaper] had reported that the remaining 2 cases
of type 3 wild poliovirus were discovered in Anka local government
area (LGA) of Zamfara and Bomadi LGA of Delta State, on 9 Apr and 3
Jan 2010 respectively. Speaking on the issue, Dr Mohammed Ali Pate,
executive director National Primary Health Care Development Agency
(NPHCDA), said that drastic and immediate measures have already been
put in place to interrupt the spread of the deadly virus.

He said the NPHCDA is working closely with states and local
authorities, traditional leaders, and other partners to fully
investigate and determine the risks to children in the Dange/Shuni
LGA and adjoining areas. The NPHCDA has placed Kebbi and Zamfara
states on increased alert for polio cases, with a polio vaccination
campaign planned across 20 Northern states from 5-8 Jun 2010.

Meanwhile the 9-month-old boy in Dange/Shuni LGA experienced
paralysis in his left leg following a fever on 18 Apr 2010.

[Byline: Ruby Leo]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[According to the Global Polio Eradication Initiative (18 Apr 2010)
cases of poliovirus infection have plummeted in Nigeria. As countries
across west and central Africa prepare for cross-border synchronized
campaigns to vaccinate some 85 million children under the age of 5
against polio, cases in Nigeria continue to plummet. As of 13 Apr
2010, Nigeria had reported one case of polio in 2010, compared to 171
at the same time last year [2009]. In order to capitalize on this
progress, during 4 days last month [April 2010], Nigeria immunized
over 45.5 million children. Maintaining the gains in Nigeria is
crucial to finally kick polio out of the African continent (see
<http://www.polioeradication.org/content ... 004.asp#01>).

A map of the states of Nigeria, showing Sokoto in the far north, can
be accessed at
<http://www.un.org/Depts/Cartographic/ma ... igeria.pdf>.
The HealthMap/ProMED-mail interactive map of Nigeria is available at
<http://healthmap.org/r/007*>. - Mod.CP]

POLIOMYELITIS - WORLDWIDE (09): RUSSIA ex TAJIKISTAN
****************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

*****
[1]
Date: Fri 14 May 2010
Source: Reuters [edited]
<http://www.reuters.com/article/idUSTRE64D26A20100514>


Russia has confirmed its 1st polio case in 13 years in an infant
visiting from Tajikistan, but there is no immediate threat of a wider
outbreak, the country's main public health body said Friday [14 May
2010]. The 9-month-old girl was diagnosed with the disease after
arriving in the Siberian region of Irkutsk from the Central Asian
state, where at least 12 people have died from a polio outbreak, said
Rospotrebnadzor spokeswoman Lyubov Voropayeva.

"All the necessary epidemiological measures have been taken. There is
not currently any threat the disease will spread," Voropayeva said.

Tests in a Moscow hospital found that a 2nd girl from Tajikistan,
also 9 months old, was carrying the polio virus but had not developed
the disease, Voropayeva said. The last case of polio was confirmed in
Russia in 1997.

Polio, which spreads in areas with poor sanitation, attacks the
nervous system and can cause irreversible paralysis within hours of
infection. Children under the age of 3 are most vulnerable. The
disease was practically eliminated as a public health problem in
industrialized countries in the 1960s, but remains endemic in 7
countries, including India, Nigeria, and Pakistan, according to the
World Health Organization (WHO).

At least 12 people have died of polio since January [2010] in
Tajikistan, WHO figures show. "It is a huge outbreak," WHO
spokeswoman Sona Bari told Reuters in Geneva. She said at least 83
cases of polio had been registered in Tajikistan. Apart from Russia,
no other ex-Soviet country has reported infections from the outbreak, she said.

UNICEF, the UN children's fund, Friday [14 May 2010] said it was
starting a 2nd round of polio vaccination in Tajikistan, aiming to
reach 1.1 million children under the age of 6 and was planning
additional vaccinations in Uzbekistan and Turkmenistan.

The WHO, a UN agency, will present its strategy for eradicating polio
by 2013 at its annual ministerial meeting of 193 member states in
Geneva next week [17-21 May 2010].

[Byline: Conor Humphries; additional reporting by Stephanie Nebehay in Geneva]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

******
[2]
Date: 13 May 2010
Source: Prime Time Russia [edited]
<http://rt.com/prime-time/2010-05-13/pol ... sures.html>


The 2nd case of poliomyelitis in 2 days was registered in Russia,
this time in the capital. In both cases, the virus was imported.
Today [13 May 2010] doctors have confirmed the diagnosis for a
9-month-old daughter of immigrants who came to Moscow from Tajikistan
in search for work. On [12 May 2010], the same diagnosis was
confirmed for a 9-month-old girl in Irkutsk, Siberia -- also a
daughter of recently arrived Tajik workers.

According to Russia's chief medical officer of health, Gennady
Onishchenko, now there is no danger for the lives of both children,
who have been given proper and timely medical help. However, there is
a risk that imported cases of poliomyelitis will affect the
epidemiological situation in the country.

"There is no need to worry, because we have taken all the necessary
measures to prevent an epidemic," Onishchenko underlined.

In order to fight the threat, Russian authorities have organized
additional vaccination of children in both countries and boosted
borderline quarantine control for passengers coming from Tajikistan
by all means of transport. All Tajik citizens currently in Russia
will be subjected to medical examination and vaccination.

The authorities have also introduced a temporary ban on Tajik
children under 6 entering the country until the end of the mass
immunization, which took off on [1 May 2010]. The measure does not
apply to Russian children temporarily residing in Tajikistan.
Moreover, Russian citizens are strongly recommended to leave the
country. Now more than 1000 Russian children -- mainly from officers'
families -- remain in the infected area.

On [5 May 2010], Russia banned the import of Tajik nuts and dried
fruits, which can contain the wild type of virus. The products
already in sale will be confiscated.

For their part, Tajik authorities prohibited children under 6 from
leaving the country. Only those immunized will be able to board
long-distance trains.

All in all, there have been 300 officially recognized cases of
poliomyelitis in Tajikistan. A total of 13 people have died. 90
percent of those infected are children under the age of 5.

Poliomyelitis is an acute viral infectious disease spread from person
to person. Around 90 percent of polio infections cause no symptoms at
all. However, in about 1 percent of cases the virus enters the
central nervous system, infecting and destroying motor neurons,
leading to muscle weakness and acute flaccid paralysis [the range of
paralytic vs non paralytic infections varies from 1 per 1000
infections to 1 per 200 infections - Mod.MPP].

There have been no cases of poliomyelitis in Russia for more than 14 years.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The above newswire reports of 2 separate imported cases of polio
from Tajikistan admitted to hospitals in Russia for treatment serves
as a further reminder that we live in a global village and microbial
agents travel widely and rapidly. According to data available on the
WHO website, the Russian Federation reported that 98 percent of the
population less than one year of age had received 3 or more doses of
polio vaccine in 2008 (see Table on Russian Federation reported
immunization coverage available at
<http://www.who.int/immunization_monitor ... .cfm?C=RUS>).


Hence, unless the wild poliovirus (WPV) enters a geographic pocket of
unvaccinated individuals, the statement that the risk of a polio
outbreak in the Russian Federation is very low, is theoretically an
accurate statement. A qualification to this statement would be if
there had been as yet unrecognized problems in vaccine potency of the
vaccines distributed for routine vaccination activities. Of note,
according to data available on the WHO website, Tajikistan reported
that 87 percent of the population less than one year of age had
received 3 or more doses of polio vaccine in 2008 (see table on
Tajistan reported immuniation coverages
<http://www.who.int/immunization_monitor ... .cfm?C=TJK>.

The 2nd newswire above has information on a series of somewhat
Draconian measures that have questionable value in the interruption
of WPV transmission. First, a ban on importation of Tajik nuts and
dried fruits because they can "can contain the wild type of virus".
This moderator has not seen any publications in the scientific
literature that would support a claim that polio is transmitted
through contaminated dried fruits and nuts.

Second, banning the entry of Tajik children less than 6 years of age
until the vaccination campaigns have been completed, but permitting
the entry of Russian children less than 6 years of age coming from
Tajikistan during this period. This moderator has not seen any
publications in the scientific literature that would support a claim
that polio has a predilection for infecting one nationality more than
another nationality in the former Soviet bloc of countries.

One suspects that in the immediate "panic" phase of identification of
WPV infected individuals from Tajikistan in Russia, where there have
not been WPV infections identified in 14 years, the media is having a
"feeding frenzy" and perhaps putting words into Russian officials'
mouths leading to published declarations of measures that have
questionable impact.

Of note, according to the polio eradication website statistics, as of
Tue 11 May 2010, Tajikistan has confirmed 56 cases of polio since the
beginning of 2010 (see
<http://www.polioeradication.org/casecount.asp>), the highest number
of cases reported from any country this year to date.

For a map of the Russian Federation showing Irkutsk, Siberia in
relation to other Asian countries, see
<http://www.worldatlas.com/webimage/coun ... aps/ru.htm> and
<http://healthmap.org/r/01hF>. Irkutsk is near to the border with
Mongolia. While the article above does not mention the method of
transportation of these imported WPV infected individuals -- overland
vs by plane -- there is the suggestion from the 2nd article that the
means of transport may well have been by train. It would be of
interest to know what the overland route was to see which geographic
areas might have been at risk of WPV introduction along the way. - Mod.MPP]

Tadschikistan - Polio
17.05.2010

Bei dem Ausbruch sind gegenwärtig ca. 278 Erkrankungfälle an Kinderlähmung gemeldet, 13 endeten tödlich. Die Leitung der tadschikischen Eisenbahn verkauft keine Reisetickets an ausreisende Passagiere mit Kindern unter 6 Jahren. Nur Reisende mit geimpften Kindern über 6 Jahre werden zugelassen. Dringend Impfschutz gegen Polio überprüfen und ggf. auffrischen. / Quelle: crm

POLIOMYELITIS - WORLDWIDE (10): TAJIKISTAN, RUSSIA ex TAJIKISTAN
****************************************************************
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] Tajikistan
[2] Russia ex Tajikistan

****
[1] Tajikistan
Date: 19 May 2010
Source: Baltinfo.ru [Trans. by Corr.ATS, edited]
<http://www.baltinfo.ru/news/Bolee-400-c ... ane-144412>


According to Shamsidin Jabirov, the head of the National Immunization
Centre, the number of hospitalized people with suspected
poliomyelitis increased by 10 percent in a week and reached to 409 in
Tajikistan. During last week [10-14 May 2010], a World Health
Organization (WHO) representative reported to Interfax about 360
hospitalizations, 84 confirmed cases and 2 fatal outcomes. The number
of confirmed cases remains the same. Additionally, 3 children who
arrived to Podmoskovye region from Tajikistan were diagnosed with
poliomyelitis.

--
Communicated by:
ProMED-RUS
<promed@promedmail.org>

******
[2] Russia ex Tajikistan
Date: 19 May 2010
Source: News agency "Finance" [Trans. by Corr.ATS, edited]
<http://www.finansmag.ru/news/70919>


Vladimir Semenov, the Minister of Heath of Moscow region, reported
about confirmation of 3 poliomyelitis cases in children in the oblast
who came from Tajikistan. He said that these children were
hospitalized after the national head sanitary doctor required
universal referral of all under 6-year-old children ex Tajikistan.
According to him, 12 children up to 6 years old have been
hospitalized in hospitals of Moscow oblast as of 17 May 2010.
Meanwhile, about 400 cases of poliomyelitis had been registered in
Tajikistan so far, including 15 fatalities.

Rospotrebnadzor [Russian Federal Agency for Protection of Customer
Rights and Human Welfare] is controlling arrivals of airplanes and
trains since the end of April [2010] and at the beginning of May
[2010] it introduced ban on imported dried fruits from Tajikistan.
Beginning [6 May 2010] the entry of children up to 6 years old from
Tajikistan is prohibited. This restriction will be in effect until
the situation is under control or complete immunization of all
children under 6 in Tajikistan is accomplished. According to the
World Health Organization (WHO) about 1.5 million people or 1 percent
of the total population in Russia are not immunized against
poliomyelitis. 20 000 Tajik nationals currently reside in Moscow
oblast including 124 under 15-year-old children.

--
Communicated by:
ProMED-RUS
<promed-rus@promedmail.org>

[According to the polio eradication website, as of 18 May 2010, there
have been 108 cases of polio confirmed in Tajikistan, with the date
of onset of last confirmed case on 18 Apr 2010 (see
<http://www.polioeradication.org/casecount.asp> for global and by
country case counts). This is in contrast with the 89 confirmed cases
reported in the above newswire. This represents an almost doubling of
confirmed cases in the past week, when 56 confirmed cases were
reported (see Poliomyelitis - worldwide (09): Russia ex Tajikistan
20100514.1575).

While the newswires are now reporting 3 confirmed cases of polio in
Tajik nationals hospitalized in Russian hospitals, as of 18 May 2010,
there have not been any confirmed cases of polio in Russia that have
been reported officially (see
<http://www.polioeradication.org/casecount.asp> for officially confirmed cases.

For a map of Tajikistan, see
<http://www.lonelyplanet.com/maps/asia/tajikistan/>. For the
interactive HealthMap/ProMED map of Tajikistan, see
<http://healthmap.org/r/00Fa>. - Mod.MPP]