Wüstenschiff

Confirmed international spread of wild poliovirus from Pakistan
20.09.2011 - WHO

Wild poliovirus type 1 (WPV1) genetically linked to virus currently circulating in Pakistan has been isolated in China. Pakistan is affected by nationwide transmission of WPV1, and is the location of the only wild poliovirus type 3 (WPV3) case in Asia in 2011 (a strain on the verge of elimination on the continent). As at 13 September 2011, Pakistan had reported 84 cases, compared to 48 cases for the same period in 2010.

In 2011, supplementary immunization activities (SIAs) in Pakistan have been inadequate in quality in key high-risk areas. In security-compromised parts of the Federally Administered Tribal Areas (FATA), and in particular in Khyber agency, upwards of 200,000 children have been regularly missed during SIAs conducted during the last two years. In addition to challenges relating to reaching children in insecure areas of Khyber Pakhtunkhwa and FATA, significant operational challenges continue to mar the quality of SIAs in accessible areas of Khyber and in other key transmission areas of the country, notably in the provinces of Balochistan and Sindh. At the same time, undetected circulation cannot be ruled out due to persistent subnational surveillance gaps. Given these factors, the widespread transmission of WPV1, documented spread internationally, and the detection of the only WPV3 in Asia in 2011, the World Health Organization (WHO) rates as 'high' the risk of further international spread of WPV from Pakistan, particularly given the expected large-scale population movements associated with Umrah and the upcoming Hajj (pilgrimage to Mecca, Kingdom of Saudi Arabia) in the coming months.

To urgently address the widespread transmission of wild poliovirus affecting the country, the Government of Pakistan has this year launched a National Polio Emergency Action Plan, under the auspices His Excellency the President. However, the impact of the Plan is not yet being seen at the critical programme implementation level. To rapidly build up population immunity levels to both serotypes, staggered subnational immunization days are planned for 19-21 September, to be closely followed by further activities in high-risk union councils in 54 districts of the country. However, key to success will be to overcome remaining operational challenges in fully-accessible areas and implemented special outreach strategies with full community participation to increase access to populations in security-compromised areas. To achieve this, full and consistent engagement and accountability at provincial, district and union-council level is urgently needed.

It is important that countries across Asia and the Eastern Mediterranean strengthen disease surveillance for acute flaccid paralysis (AFP), in order to rapidly detect any poliovirus importations and facilitate a rapid response should importation occur. Countries should also continue to boost routine immunization coverage against all strains of polio to minimize the consequences of any introduction.

As per recommendations outlined in WHO's International travel and health, travellers to and from Pakistan should be fully protected by vaccination. Travellers to Pakistan who have in the past received three or more doses of OPV should be offered another dose of polio vaccine before departure. Any unimmunized individuals intending to travel to Pakistan should complete a full course of vaccination. Travellers from Pakistan should have a full course of vaccination against polio before leaving Pakistan, with a minimum one dose of OPV before departure. Some polio-free countries may also require travellers from Pakistan to be immunized against polio in order to obtain an entry visa.

With Hajj and Umrah season already started, the Kingdom of Saudi Arabia has issued vaccination requirements for travellers (all ages) for Umrah and Hajj. These requirements are in line with recommendations outlined in WHO's International travel and health, with the addition that travellers of all ages from polio endemic countries are required to show proof of vaccination with OPV six weeks before travel to the Kingdom of Saudi Arabia, and will receive a further dose of OPV upon their arrival.

POLIOMYELITIS - WORLDWIDE (13): KENYA
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******
Kenya - Western Province
Date: 19 Sep 2011
Source: AlertNet / IRIN [edited]
<http://www.trust.org/alertnet/news/keny ... o-outbreak>


Thousands of children to be immunized amid polio outbreak
----------------
Health officials are on high alert after 3 cases of the Wild Polio
Virus Type 1 were recently recorded in western Kenya.

"Even if one case is detected, it is considered an outbreak as the
virus can spread really fast," Shahnaaz Sharif, the Director of Public
Health and Sanitation, told IRIN.

The virus, detected in 3 children in the Kamagambo area of Rongo
District, Western Province [according to multiple maps this moderator
has consulted, Kamagambo and Rongo District are located in Nyanza
Province - Mod.MPP], is similar to one found in Uganda's Bugiri
District in 2010, according to Sharif.

The virus is most commonly associated with paralysis, and on average,
one person in every 200 infected develops irreversible paralysis
usually of the lower limbs, said Sharif.

Though polio is targeted for eradication in Kenya, there have been
sporadic outbreaks, with cases reported in the northern Garissa and
Turkana districts in 2006 and 2009, respectively.

The outbreaks were linked to ongoing polio circulation in neighbouring
Somalia and Southern Sudan, according to the Ministry of Public Health
and Sanitation.

In 2009-2010, 23 previously polio-free countries were re-infected due
to imports of the virus, according to the UN World Health
Organization.

"Polio is big to fight against but the government and other
stakeholders will do all [they] can in a bid to eradicate this deadly
virus," said Sharif.

A massive immunization campaign is planned in Rongo and neighbouring
Homabay, Kisii, Kisumu, Nyamira, Migori and Transmara districts.

"We are targeting at least 1.8 million children aged below 5 years as
we do not want to take [the] chances of letting the virus spread even
further," he said. "There are 200 carriers in every one case
detected."

Epidemiologists have also been dispatched to the region to sensitize
health workers about the virus, with parents being urged to seek
medical care for children with symptoms such as fever, fatigue,
vomiting and stiffness in the neck.

Polio is preventable through a vaccine given multiple times.

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

[Of note in the above newswire is that the wild poliovirus type 1
(WPV1) identified in the current cases in Western Kenya are similar
genotypically to the WPV1 identified in a case in Bugiri Uganda in
October 2010 (see prior ProMED-mail post Poliomyelitis - worldwide
(23): Uganda 20101027.3900 for information on the WPV1 identified in
Bugiri Uganda in 2010).

At that time, the WPV1 identified was genotypically similar to the
WPV1 isolated in a case in Turkana in NorthWest Kenya (see prior
ProMED-EAFR post Poliomyelitis, wild type - Kenya (Turkana)
20090914.202049 for information on the WPV1 transmission in Turkana,
Kenya in 2009). At that time (2009 in Turkana Kenya), the WPV1
isolated was genotypically similar to WPV1 circulating in Southern
Sudan (see
<http://www.publichealth.go.ke/index2.ph ... &Itemid=94>
for the Minister of Public Health and Sanitation, Kenya statement on
the outbreak in Turkana in 2009).

Of note is that the Sudan had been polio free in 2002 and 2003. WPV
was re-introduced to Sudan from Nigeria in 2004, with extensive
transmission in 2004-2005, no cases in 2006, one case in 2007, and
since 2008 has had continuous transmission of WPV). (see prior
ProMED-mail post Poliomyelitis - Worldwide (02): Kenya, Uganda ex
Sudan 20090226.0808 for information on the WPV transmission in Sudan,
and data extracted from the Polio Eradication Initiative database
<http://apps.who.int/immunization_monito ... xtract.cfm>).

Hence, the events ongoing in Kenya, Uganda and the Sudan are a
reflection of the fragile situation faced by countries following
interruption of transmission of WPV when the WPV is still circulating
in other areas. The need to maintain high vaccination coverages to
prevent reintroduction of WPV transmission in an area is evident, but
a significant resource challenge for many areas. In the above
situation, the civil strife ongoing in the Sudan further complicated
the situation.

For a map of Kenya showing provinces, see
<http://www.nationsonline.org/oneworld/m ... a_map2.htm>. For the
interactive HealthMap/ProMED map showing the location of Kamagamba
Kenya, see <http://healthmap.org/r/1g0l>. - Mod.MPP]

POLIOMYELITIS - WORLDWIDE (14): AFGHANISTAN, PAKISTAN, NIGERIA, CHAD,
CHINA
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Date: Wed 28 Sep 2011
Source: Global Polio Eradication Initiative [edited]
<http://www.polioeradication.org/Dataand ... sweek.aspx>


Case count as of 27 Sep 2011:
Total cases: Year-to-date 2011 / Year-to-date 2010 / Total in 2010
Globally: 410 / 682 / 1249
- endemic countries: 153 / 120 / 232
- non-endemic countries: 257 / 562 / 1117

Countries reporting new cases during past week
----------------------------------------------

- Endemic countries

Afghanistan
One new case was reported in the past week (wild poliovirus type 1 -
WPV1, from Hilmand), bringing the total number of cases for 2011 to 28
(all WPV1). The most recent case had onset of paralysis on [4 Sep
2011], from Badghis province.

Nigeria
4 new cases were reported in the past week, 3 WPV1 and one wild
poliovirus type 3 (WPV3), bringing the total number of cases for 2011
to 33 (25 WPV1, 9 WPV3). The most recent case had onset of paralysis
on [26 Aug 2011] (WPV3 from Kano).

Pakistan
2 new cases were reported in the past week (WPV1s from Balochistan and
Khyber Pakhtunkhwa - KP), bringing the total number of cases for 2011
to 91 (90 WPV1 cases and one WPV3 case). The most recent case had
onset of paralysis on [10 Sep 2011] (WPV1 from KP).

- Non-endemic countries

Chad
2 new cases were reported in the past week (WPV1s from Ouaddai and
Tandjile), bringing the total number of cases for 2011 to 114 (111
WPV1s and 3 WPV3s). The most recent case had onset of paralysis on [10
Aug 2011] (WPV1 from Ouaddai).

China
One new case (WPV1) was reported in the past week, leading to a total
of 10 cases reported by the country this year [2011]. All cases were
reported in Xinjiang Uygur autonomous region, however this latest case
is the 1st outside the originally-infected Hotan prefecture (in Bazhou
prefecture). The most recent case had onset of paralysis on [5 Sep
2011].

Countries with confirmed cases in 2011, no new cases in week ending 27
Sep 2011
----------------------------------------------------------------------
India
India has reported a single case this year [2011], a WPV1 with onset
of paralysis on [13 Jan 2011] in West Bengal.

Angola
No new cases were reported in the past week. The total number of cases
for 2011 remains 4. The most recent case (WPV1) had onset of paralysis
on [27 Mar 2011] in Kuando Kubango, in the country's south-east, 6
months ago.

Democratic Republic of the Congo (DRC)
No new cases were reported in the past week. The total number of cases
for 2011 remains 79 (all WPV1). The most recent case had onset of
paralysis on [27 Aug 2011] in Popokabaka, Bandundu.

Horn of Africa
No new cases were reported in the past week. The only case reported in
the Horn of Africa this year was due to WPV1 and had onset of
paralysis on [30 Jul 2011] in Nyanza Province, on Lake Victoria,
western Kenya.

West Africa
No new cases were reported from this region in the past week. The
total number of cases for 2011 in the West African region is still 47
(2 from Burkina Faso, 34 from Cote d'Ivoire, 2 from Guinea, 7 from
Mali, and 2 from Niger). The most recent case (WPV3) was reported in
Siguiri district of Kankan province, Guinea, with onset of paralysis
on [27 Jul 2011].

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

[For the map of the worldwide distribution of WPV associated cases in
2011, see <http://www.polioeradication.org/Dataandmonitoring.aspx>.

In the past week there have been a total of 10 new cases of WPV
associated disease, 7 of which came from 3 of the 4 endemic countries
(Afghanistan, Nigeria, and Pakistan reported cases whereas India has
not confirmed a WPV associated case since January 2011.

Of the 3 cases of WPV associated disease reported from non-endemic
countries, Chad has reported 2 cases and one from the Xingjiang Uygur
Autonomous Region in China. Of concern is that the latest reported
case in China represents spread to a previously non-affected
prefecture.

For those readers interested in the control measures ongoing in areas
having reported WPV associated disease in 2011, more detailed
information from the Global Polio Eradication Initiative is available
at
<http://www.polioeradication.org/Dataand ... sweek.aspx>.
- Mod.MPP]

China - Polio
04.10.2011

Nachdem China 11 Jahre lang poliofrei war, erkrankten seit Anfang Juli 10 Kinder in der autonomen Region Xinjiang (NW). Genetische Analysen haben einen Import des Virusstammes aus Pakistan bestätigt. Von einer weiteren Ausbreitung ist auszugehen. Impfschutz beachten. / Quelle: crm

Gruß
Birgitt

POLIOMYELITIS, VACCINE DERIVED - MADAGASCAR: (TOLIARA) REQUEST FOR
INFORMATION
******************************************************************************

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Date: Wed 19 Oct 2011
Source: Linfo Reunion [in French, trans., edited]
http://www.linfo.re/-Societe,402-/Madag ... reapparait


Madagascar: the epidemic of polio reappears
-------------------------------------------
While no cases of polio have been detected in Madagascar since the
late 1990s, the authorities announced that they had identified 6 new
cases in the south of the country, raising fears of a new resurgence
of the epidemic of polio. The low immunization rates combined with the
health problems and malnutrition may well contribute to a reoccurrence
of this disease.

While polio has virtually disappeared from the Big Island since 1997,
the Ministry of Health said it had identified 6 cases [of polio] in
unvaccinated children in the remote areas of Fort Dauphin and Tulear.
A study conducted by the Pasteur Institute has indicated that the
virus involved in these cases is derived from a vaccine virus and
therefore would be less virulent causing a slight paralysis, while the
wild-type virus usually causes severe paralysis. [This is not correct
as vaccine derived poliomyelitis cases do present with significant
paralytic disease. - Mod.MPP]

However, those cases associated with poliovirus vaccine derived from
making the eradication of polio more complex, according to scientists,
especially in the wild south of Madagascar, the location of the new
epidemic, where they are struggling with challenges related to the
health and sanitation including malnutrition. This compounds the
problem of low vaccination coverages.

A report released by the Ministry of Health in 2010 showed that only
70 per cent of Malagasy children were vaccinated against polio and
this nationwide rate includes areas in the south, the most vulnerable
zones on the large island.

An epidemiological investigation will permit identifying if there are
other cases [of circulating vaccine derived poliovirus (cVDPV)
paralytic disease] in other regions of the country. But in the
meantime, a mass vaccination campaign was launched beginning Monday,
[17 Oct 2011] in order to increase the immunity level [against
poliovirus infection] of the population, mainly in children.

--
communicated by:
ProMED-mail from HealthMap alerts


[Madagascar had identified circulating vaccine derived poliovirus
(cVDPV) associated paralytic disease in 2001-2002. At that time there
were 5 cases of type 2 cVDPV associated cases reported from the same
province -- Toliara -- where these current cases have been identified.
The 1st case had date of onset in 2001 and was a resident of Toliara
(Tulear). The other 4 cases with dates of onset in March and April
2002 were in a rural village about 400 km (250 mi) from Toliara. None
of those cases had a history of having completed a 3 dose series of
polio vaccination. According to genetic studies on the involved
viruses in the cases and contacts, the cases from the 2 different
areas represented 2 genetically distinct, independent cVDPV lineages.
At that time, the OPV (oral polio vaccine) coverage in Madagascar was
less than 50 per cent countrywide.

According to the Polio Eradication Initiative website, in 2005, there
were 3 additional type 2 VDPV (vaccine derived polioviruses) cases
identified in the same province (Toliara) as in the 2001-2002 cases
(see Table on cVDPV isolates by
country and VDPV type, 2000-2001
http://www.polioeradication.org/Dataand ... virus.aspx).
Of note, according to Rakoto-Andrianarivelo M et al (see ref 7 below),
in 2005 type 3 or type 2 VDPV was isolated from 5 paralytic cases and
from healthy contacts. The isolated strains were classified into 4
recombinant lineages that showed complex mosaic genomic structures
originating from different vaccine strain serotypes and probably from
human enterovirus C (HEV-C) species. Genetic relatedness could be
observed among these 4 lineages. At that time, the OPV coverage in the
affected province was less than 80 per cent.

Given the history of 2 prior outbreaks of paralytic disease associated
with cVDPVs in the same province (Toliara), it would be of interest to
see the phylogenetic trees of these current isolates compared with
those involved in the outbreaks in 2001/2002 and 2005 -- one wonders
if there has been continued circulation of the VDPV lineages
associated with the prior outbreaks or if repeated lapses in OPV
coverages have led to the emergence of different lineages of VDPVs in
the region.

Fort Dauphin is now known as Tolanaro or Tolagnaro. it is the capital
of the Anosy Region and the Tolanaro district, located in the extreme
south of the country in the province of Toliara. Tulear is now known
as Toliara and is the capital of the Atsimo-Andrefana region, in
province of Toliara (from Wikipedia information on administrative
divisions of Madagascar, http://en.wikipedia.org/wiki/Madagascar.)

For a map of Madagascar showing provinces, see
http://www.madbookings.com/madagascar/m ... al_map.jpg.
For the interactive HealthMap/ProMED-mail map of Toliara province, see
http://healthmap.org/r/1lUh. For a map of the location of the 2005
cVDPV cases in Madagascar, see ref 7 below, Figure 1, available at
http://jid.oxfordjournals.org/content/1 ... nsion.html.

References
----------
1. Kew OM, Wright PF, Agol VI, et al. Circulating vaccine-derived
polioviruses: current state of knowledge. Bull World Health Organ.
2004 Jan; 82(1):16-23. Epub 2004 Feb 26 (full article available at
http://www.scielosp.org/scielo.php?pid= ... xt&tlng=es).
2. Tebbens RJ, Pallansch MA, Kew OM, et al. Risks of paralytic disease
due to wild or vaccine-derived poliovirus after eradication. Risk
Anal. 2006 Dec; 26(6): 1471-505 (full article available at
http://www.kidrisk.org/images/riskanal26.6.1471.pdf).
3. Wringe A, Fine PE, Sutter RW, Kew OM. Estimating the extent of
vaccine-derived poliovirus infection. PLoS One. 2008; 3(10): e3433.
Epub 2008 Oct 29 (full article available at
http://www.plosone.org/article/info:doi ... ne.0003433).
4. Centers for Disease Control and Prevention (CDC). Update on
vaccine-derived polioviruses -- worldwide, January 2008-June 2009.
MMWR Morb Mortal Wkly Rep. 2009 Sep 18; 58(36): 1002-6 (full article
available at
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5836a3.htm).
5. CDC. Update on vaccine-derived polioviruses. MMWR Morb Mortal Wkly
Rep. 2006 Oct 13; 55(40); 1093-7 (full article available at
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5540a3.htm).
6. CDC. Update on vaccine-derived polioviruses -- worldwide, July
2009-March 2011. MMWR Morb Mortal Wkly Rep. 2011 Jul 1; 60(25): 846-50
(full article available at
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6025a3.htm).
7. Rakoto-Andrianarivelo M, Gumede N, Jegouic S, et al: Reemergence of
recombinant vaccine-derived poliovirus outbreak in Madagascar. J
Infect Dis. 2008 May 15; 197(10): 1427-35 (full article available at
http://jid.oxfordjournals.org/content/197/10/1427.long). - Mod.MPP]

POLIOMYELITIS, VACCINE DERIVED - MADAGASCAR (02): (TOLIARA),
CORRECTION
***********************************************************************

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Date: Wed 16 Nov 2011
From: Jean-Michel Heraud [edited]


[Re: ProMED-mail Poliomyelitis, vaccine derived - Madagascar: (TL) RFI
20111020.3128]
----------------------------------------------------------------------
[The posting dated 20 Oct 2011], suggested that new cases of
poliomyelitis occurred in Madagascar. In fact, to date, there is no
evidence of any case of acute [flaccid] paralysis (AFP) or
poliomyelitis in Madagascar in 2011. The information attributed by the
source (Linfo Reunion [in French, trans., edited]) to the Ministry of
Health of Madagascar is false.

Recently, in 2 districts of the Toliara province (South-West of
Madagascar), 8 polio vaccine viruses including 3 potentially
pathogenic vaccine-derived polioviruses (VDPVs) have been isolated
from asymptomatic children (less than 5 years old) who did not receive
any oral polio vaccine in the 30 days before the samples collection. 2
of these VDPVs had more than 30 mutations in the VP1 region and one
had 6 mutations. Although these 3 viruses present similar genetic
features, they however clearly differ (no genetic link) from those
isolated in 2001-2002 and in 2005 from patients with acute flaccid
paralysis (poliomyelitis cases). The neuro-pathogenicity of these new
VDPVs is under investigation. It is important to mention that these
results were obtained as part of a research project on human
enteroviruses and not from the national surveillance system of the
acute [flaccid] paralysis (AFP) and poliomyelitis. This research
program is carried out by the virology unit at the Institut Pasteur
from Madagascar in partnership with the enterovirus biology unit at
the Institut Pasteur in Paris.

Although no evidence of acute flaccid paralysis linked to these new
VDPVs have been demonstrated, their detection in 3 children and their
genetic characteristics strongly suggest that the vaccine coverage
against poliovirus in the region of Toliara (Atsimo Andrefana) is too
low, favoring the circulation and genetic drift of the polio vaccine
strain. In order to respond to the threat of the emergence of an
epidemic strain in the Malagasy population, it is necessary to ensure
high polio vaccine coverage and to continue the monitoring of the
circulation of these VDPVs within the community. To reach these
objectives, the Ministry of Health has planned a campaign of
vaccination in some districts (Atsimo Andrefana, Androy, Anosy, and
Antananarivo) in December [2011] and January 2012].

--
Dr. Jean-Michel HERAUD, Ph.D.
Chief of the Virology Unit,
Director of the NIC
Institut Pasteur de Madagascar
BP 1274
Antananarivo 101 - Madagascar


[ProMED-mail would like to thank Dr Heraud for the detailed
explanation above of the circumstances surrounding the identification
of circulating vaccine derived polioviruses (cVDPV) in Toliara
Madagascar. It is unfortunate that the media presented incorrect
information surrounding these isolates, albeit providing local
incentive to increase vaccination coverages might not be considered a
bad outcome of this error. It will be interesting to learn the results
of the neurovirulence studies on these isolates as this region
(Toliara) has had prior clinical paralytic poliomyelitis cases
associated with cVDPV (in 2001-2002 and 2005).

According to the Polio Eradication Initiative website, as of 6 Nov
2011 there have been cVDPV paralytic poliomyelitis associated cases
identified in Mozambique (2 cases of cVDPV type 1), Nigeria (13 cases
of cVDPV type 2), Yemen (4 cases of cVDPV type 2), Somalia (5 cases of
cVDPV type 2), and Afghanistan (1 case of cVDPV type 2). (See
http://www.polioeradication.org/Dataand ... virus.aspx).

For a map of Madagascar showing provinces, see
http://www.madbookings.com/madagascar/m ... al_map.jpg.
For the interactive HealthMap/ProMED-mail map of Toliara province, see
http://healthmap.org/r/1lUh. For a map of the location of the 2005
cVDPV cases in Madagascar, see
http://jid.oxfordjournals.org/content/1 ... .large.jpg. -
Mod.MPP]

POLIOMYELITIS - WORLDWIDE (16): NIGERIA, GLOBAL
************************************************

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In this update:
[1] Nigeria
[2] Global update as of 16 Nov 2011

******
[1] Nigeria
Date: Mon 21 Nov 2011
Source: BBC News Africa [edited]
http://www.bbc.co.uk/news/world-africa-15819797


A 4-fold increase in polio has been reported in Nigeria, with the
disease spreading to other countries, a World Health Organisation
official says.

Forty-three cases were reported in Nigeria this year [2011], compared
to 11 last year [2010], the official, Thomas Moran, said.

Curbing the polio virus in Nigeria is key to eradicating the crippling
disease in Africa, he said.

In 2003, northern Nigeria's Muslim leaders opposed vaccinations,
claiming they could cause infertility.

Nigeria is one of 4 countries in the world -- along with Pakistan,
India, and Afghanistan -- where polio is still a major health risk.

Mr Moran told the BBC the disease had also spread to neighbouring
Niger, Mali, and Ivory Coast.

"The success of polio eradication in Africa rests on Nigeria
interrupting the virus," he said.

Polio was affecting 8 northern Nigerian states -- 2 more than a few
months ago, the head of Nigeria's National Primary Healthcare
Development Agency (NPHDA), Dr Ado Muhammad, told the BBC.

Mr Moran said the Nigerian government had shown "strong leadership" in
the campaign to eradicate polio and the WHO had been carrying out
large scale vaccination programmes to prevent the disease from
spreading.

"The immunity profile of Nigerian children is far better [now], which
limits the risk of international spread of the virus," Mr Moran said.
He also stressed that the number of children affected remained low.

"You can call it a 4-fold increase but it is still very low
transmission in a country as large as Nigeria with almost 50 [million]
children under 5 [years old]," he said.

At the Commonwealth summit last month [October 2011], the leaders of
Nigeria, Canada, the UK, and Australia pledged millions of dollars
towards the global effort to eradicate polio.

In 2003, the northern Nigerian state of Kano backed Muslim religious
leaders in opposing an immunisation programme, claiming it was a
Western plot to make people infertile. Health experts say this led to
many people becoming infected by polio.

The clerics and the state government later dropped their opposition to
the immunisation programme.

In 2007, there was a rare outbreak of a vaccine-derived form of polio
in northern Nigeria.

It affected 69 children who had been vaccinated.

--
Communicated by:
ProMED-mail from HealthMap alerts


******
[2] Global update as of 16 Nov 2011
Date: Wed 16 Nov 2011
Source: Global Polio Eradication Initiative
http://www.polioeradication.org/Dataand ... sweek.aspx


Case count as of 16 Nov 2011:
Total cases: Year-to-date 2011 / Year-to-date 2010 / Total in 2010
Globally: 520 / 789 / 1352
- endemic countries: 241 / 184 / 232
- non-endemic countries: 279 / 605 / 1120

Countries reporting new cases during past week
----------------------------------------------
- Endemic countries
Afghanistan
Six cases were reported in the past week [week ending 16 Nov 2011],
all wild poliovirus type 1 [WPV1]. The total number of cases for 2011
is now 53. 3 of the cases reported this week are in districts which
had not previously reported a case this year -- Barmal district in
Paktika province, Shahidi Hassas district in Uruzgan province, and
Daychopan in Zabul province. The case reported in Paktika is the 1st
case in the entire province for 2011. Afghanistan's most recent case
had onset of paralysis on [22 Oct 2011] (in Maywand district, Kandahar
province).

Pakistan
Nine new cases were reported in the past week (all WPV1s), from
Balochistan, Federally Administered Tribal Areas (FATA), Khyber
Pakhtunkhwa (KP), and Sindh, bringing the total number of cases for
2011 to 145. The most recent case had onset of paralysis on [19 Oct
2011] (WPV1 from KP).

[No new cases reported for the week ending 16 Nov 2011 in Nigeria and
India]

- Non-endemic countries
No new cases reported from any of the countries with 2011 transmission
-- Angola, Chad, Central African Republic, China, Democratic Republic
of the Congo, Horn of Africa (Kenya), West Africa (Cote d'Ivoire,
Guinea, Mali, and Niger).

2011 annual totals by county as of 16 Nov 2011:
Afghanistan - 53
India - 1
Pakistan - 145
Nigeria - 42
DR Congo - 86
Chad - 117
Angola - 5
Central African Republic - 2
China - 18
Guinea - 3
Kenya - 1
Cote d'Ivoire - 36
Niger - 2
Mali - 7
Congo - 1
Gabon - 1

--
Communicated by:
ProMED-mail


[The newswire discussion in [1] on the polio situation in Nigeria is a
deja vu for discussions back in 2004 through 2006 when Nigeria was the
leading exporter of wild poliovirus to other countries in Africa, and
subsequently outside of Africa (Indonesia) (see prior ProMED-mail
posts listed below). It is sad that the situation continues to the
present, with continued transmission of the WPV (types 1 and 3) and
re-seeding of countries that had interrupted WPV transmission for 2 or
more years.

Of note, the newswire on the situation in Nigeria mentions there had
been a significant outbreak of polio due to infection with circulating
vaccine derived poliovirus (cVDPV) in Nigeria in 2007 involving 69
children. In fact, cVDPV associated polio continues to be a problem in
Nigeria, with 71 cases reported in 2007, 66 cases reported in 2008,
154 cases reported in 2009, 27 cases reported in 2010, and 20 cases
reported in 2011 as of 15 Nov 2011
(http://www.polioeradication.org/Dataand ... virus.aspx).
As mentioned in prior ProMED-mail posts on reported cases of polio
associated with cVDPV, these cases tend to occur in areas with
inadequate vaccination coverages, further supporting the observation
that vaccination coverages in Nigeria are suboptimal. The continued
circulation of VDPVs contributes to rumors that the vaccine is
damaging children, continuing the cycle of vaccine refusal.

In terms of absolute numbers of cases of polio, the countries with the
most reported cases in decreasing order are: Pakistan (145 cases),
Chad (117), DR Congo (86), Afghanistan (53), Nigeria (42) and Cote
d'Ivoire (36). Pakistan has reported almost 1/3 of all cases reported
in 2011, with transmission documented throughout the country. (For
more details on the types of wild poliovirus identified in each
country, please go to the Polio Eradication Initiative weekly update
webpage at
http://www.polioeradication.org/Dataand ... sweek.aspx.

For a map showing locations of all WPV associated paralytic polio
cases reported worldwide as of 16 Nov 2011, see the map at
http://www.polioeradication.org/Dataand ... dwide.aspx.
- Mod.MPP]

POLIOMYELITIS - WORLDWIDE (17): INDIA
*************************************

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: Tue 22 Nov 2011
From: A Mark Joffe [edited]


[Re: ProMED-mail Poliomyelitis - worldwide (16): Nigeria, global
20111122.3421]
----------------------------------------------------------------------
Overlooked in this excellent update of worldwide poliomyelitis through
[16 Nov 2011] is that with only 6 weeks to go in the year, India has
had only one reported case of polio. This is an astonishing
achievement that many would have thought impossible a few years ago.
As one of the last countries in the world to have been unable to
interrupt polio transmission, India is coming very close to that
elusive goal. In fact, the article reported by ProMED describes
Nigeria as one of 4 countries in the world where polio is still a
major health risk, with 42 cases. Pakistan (145 cases) and Afghanistan
(53 cases) are 2 of the others. If the current success is sustained,
India, with one case this year, could soon be dropped from this list.

--
A Mark Joffe
Professor of Medicine, Division of Infectious Diseases, University of
Alberta
Senior Medical Director, Infection Prevention and Control
Alberta Health Services
#303 CSC, Royal Alexandra Hospital
10240 Kingsway
Edmonton, Alberta
Canada T5H 3V9


[ProMED-mail would like to thank Dr Joffe for highlighting the
successes seen in India. As he so correctly points out, of the 4
remaining polio endemic countries, India has reported only one case of
wild poliovirus (WPV) associated paralytic poliomyelitis during 2011,
with date of onset of this case 13 Jan 2011, in West Bengal (see
http://www.polioeradication.org/Dataand ... sweek.aspx).

For the map of reported WPV associated paralytic polio cases during
2011 (as of 16 Nov 2011), see
http://www.polioeradication.org/Dataand ... dwide.aspx.
- Mod.MPP]

POLIOMYELITIS - WORLDWIDE (18): PAKISTAN, GLOBAL
************************************************

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


In this update:
[1] Pakistan: newswire
[2] Global update: week ending 7 Dec 2011
[3] Global update: week ending 30 Nov 2011

******
[1] Pakistan: newswire
Date: Tue 6 Dec 2011
Source: Central Asia Online [edited]
http://centralasiaonline.com/en_GB/arti ... wsbrief-08


Pakistani polio cases reach 163
-------------------------------
Dr Altaf Bosan, head of Pakistan's polio programme said 2 more
children, one each from Khyber and Bajaur agencies, tested positive
for polio [6 Dec 2011], bringing the total number of infected children
to 163.

Of the 49 cases in FATA [Federally Administered Tribal Areas], 18 have
been in Khyber Pakhtunkhwa, with other cases in North and South
Waziristan, Frontier Region Lakki Marwat, and the Mohmand, Bajur,
Orakzai, and Kurram agencies.

"Half of these children weren't immunised due to the Taliban's
opposition to oral polio vaccine," Bosan said. The Taliban have said
polio vaccines are a Western plot.

[byline: Ashfaq Yusufzai]

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

[While the total number of cases reported in this newswire is
incorrect (according to the Global Polio Eradication Initiative data,
as of 7 Dec 2011 there have been a total of 167 cases reported in
Pakistan -- see [2] below for more information), the reason this
newswire was selected for this report was the last paragraph
mentioning the ongoing rumors that appear to be impeding vaccination
activities. This situation is very reminiscent of the situation in
Northern Nigeria in 2003/2004, where similar negative rumors led to a
disruption in effective vaccination activities which in turn led to an
increase in cases occurring in Northern Nigeria, which then led to
multiple country importations and re-infection of more than 15
countries that had interrupted wild poliovirus (WPV) transmission for
at least 2 years. To date in 2011, there has been an outbreak of WPV
in Western China (see prior ProMED-mail postings below) with 18 cases
attributable to a WPV1 genetically similar to those currently
circulating in Pakistan. Given the ongoing situation in Africa (see
sections [2] and [3] below, the situation in Pakistan mentioned above
(the increase in cases combined with the decreased vaccination
acceptance due to rumors) does not bode well for the region as the
chance of additional importations to other countries is ever present.

For the interactive HealthMap/ProMED map of Pakistan, see
http://healthmap.org/r/1iGJ. - Mod.MPP]

******
[2] Global update: week ending 7 Dec 2011
Date: Wed 7 Dec 2011
Source: Global Polio Eradication Initiative (GPEI) [edited]
http://www.polioeradication.org/Dataand ... sweek.aspx


Case count as of 7 Dec 2011:
Total cases: Year-to-date 2011 / Year-to-date 2010 / Total in 2010
Globally: 560 / 841 / 1352
- endemic countries: 272 / 201 / 232
- non-endemic countries: 288 / 640 / 1120

Afghanistan (1 new case)
One case was reported in the past week -- wild poliovirus type 1
(WPV1) from Nahri Sarraj district in Hilmand province -- bringing the
total number of cases for 2011 to 59. The most recent case had onset
of paralysis on [15 Nov 2011] (WPV1 from Kandahar).

There has been a significant increase in insecurity recently in the
southern endemic region, and in other parts of the country, with
multiple, parallel incidents reported.

India (0 new cases)
It has been 328 days since the onset of paralysis of India's 1st and
only case of WPV for the year [2011]. The case occurred in West Bengal
on [13 Jan 2011].

While great progress has been seen in the country, the Indian Ministry
of Health remains cautious. In order for WHO's South East Asia Region
to be certified as being 'polio-free', India will have to not report a
case and maintain adequate surveillance for a period of 3 years.
Dropping the guard now is not an option.

Nigeria (0 new cases -- Cameroon case reclassified as Nigerian)
No new cases were reported in the past week. The total number of cases
for 2011 remains 45. The most recent case in the country had onset of
paralysis on [29 Oct 2011] in Jigawa.

A case of WPV3 originally reported in Cameroon with onset of paralysis
on [6 Oct 2011] will be reassigned to Borno, Nigeria. Following a
joint country investigation, it was found that the case was a Nigerian
child who had crossed the border into Cameroon for treatment. The
virus is considered to be an 'orphan', as there is a significant
genetic difference between this new case and virus of the same genetic
cluster last seen in Nigeria in December 2010 in the Federal Capital
Territory. This indicates that the virus has been circulating
undetected for a substantial period of time, most possibly in
north-eastern Nigeria.

Lot Quality Assurance Sampling (LQAS) data from high risk local
government areas (LGAs) in Borno, Sokoto, and Kano indicates that
improvement in coverage is being made in these states compared to
earlier LQAS surveys. Kano state showed particularly strong results.
However, Wammako LGA in Sokoto state continues to be rejected at less
than 50 per cent coverage despite ongoing transmission in this LGA
since April [2011].

Rapid Surveillance Assessments are being conducted this week (5-9 Dec
2011) in 3 southern states that had previously reported suboptimal
surveillance indicators -- Osun, Edo, and Anambra. Further assessments
are planned for Kaduna, Taraba, Bauchi, and possibly other priority
areas in January 2012.

Pakistan (6 new cases)
6 new cases were reported in the past week (all WPV1s), bringing the
total number of cases for 2011 to 167. The most recent cases were both
reported in Khyber Pakhtunkhwa on [17 Nov 2011] -- one in Tank
district and one in Kohat. The case reported in Tank is the district's
1st case for the year [2011]. Similarly, a case reported in Bahawalpur
district in Punjab province is that district's 1st case for the year
[2011].

Angola (0 new cases)
No new cases were reported in the past week. It has been 5 months
since Angola's most recent case -- a WPV1 with onset of paralysis on
[7 Jul 2011] in Uige in the country's north. The country has reported
a total of 5 cases in 2011.

The country's most recent case is in a province close to the border
with the Democratic Republic of the Congo. Genetic sequencing found
the virus to be most closely related to the Democratic Republic of the
Congo's Bandundu/Bas Congo transmission chain rather than to Angola's
re-established WPV1 -- it therefore represents a new
importation-related outbreak. The case was picked up during an active
case search in Angola. Another case, officially reported in the
Democratic Republic of the Congo with onset of paralysis on [28 Jul
2011], was found to be an Angolan child from a nearby village who had
sought treatment across the border in the Democratic Republic of the
Congo. It is therefore possible that this case will be reassigned to
Angola.

Chad and Central African Republic (CAR) (0 new cases)
No new cases were reported in Chad this week. The total number of
cases reported in Chad in 2011 is 125 (122 WPV1s and 3 WPV3s). The
most recent case had onset of paralysis on [26 Oct 2011] (WPV1 from
Logone Oriental).

LQAS identified a number of under-performing districts (Kelo,
Am-Timan, N'Djamena Sud, N'Djamena Nord, Guereda, and Goz Beida),
showing significant discrepancies from independent monitoring data. 7
districts were verified through LQAS as having greater than 90 per
cent coverage.

No new cases were reported from the CAR in the past week. The total
number of cases for 2011 remains 2 (both WPV1s), the most recent of
which had onset of paralysis on [6 Oct 2011] in Region Sanitaire 3
(RS3), in the country's north.

Cameroon (1 new case)
A case of WPV3 reported just inside Cameroon's border will be
reassigned to Nigeria as it was found to have been a Nigerian child
who contracted the virus in Nigeria (in Borno state).

China (0 new cases)
No new cases were reported in the past week. The total number of cases
for 2011 is 18 (all WPV1) and the most recent case had onset of
paralysis on [18 Sep 2011] (from Kashgar, in Xinjiang Uygur autonomous
region).

Democratic Republic of the Congo (DRC) (0 new cases)
No new cases were reported in the past week, therefore the total
number of cases for 2011 remains 87 (all WPV1s). The most recent case
had onset of paralysis on [29 Sep 2011] in the outbreak district of
Popokabaka in Bandundu in the country's west.

Horn of Africa (0 new cases)
There were no cases reported in the Horn of Africa this week. A case
of WPV1 with onset of paralysis on [30 Jul 2011] in Nyanza province,
western Kenya, is the only case to be reported in the Horn of Africa
this year [2011]. While there has only been a single case reported
this year, the fact that transmission has been continually missed
somewhere in Kenya and/or Uganda over the last few years means that
the Horn of Africa will continue to be an area of concern.

West Africa (0 new cases -- 1 new case pending Niger)
No cases were officially reported in west Africa in the past week,
however the GPEI has been given 'advance notice' of a case of WPV3 in
Niger. The total number of cases for 2011 in the west African region
remains 48 (36 from Cote d'Ivoire, 3 from Guinea, 7 from Mali, and 2
from Niger). All cases are WPV3, except for one WPV1 case from Niger.
Mali, Cote d'Ivoire and Guinea have not reported any cases in more
than 4 months. The most recent officially reported case in west Africa
had onset of paralysis on [3 Aug 2011] in Guinea.

Diffa, the province in which Niger's advance notice case has been
reported, was covered 6 times this year [2011] with type 3 containing
vaccine, yet almost 30 per cent of non-polio acute flaccid paralysis
cases reported in the province in 2011 were reported to have received
zero doses of vaccine. The area is relatively remote (and on the
opposite side of the country from the nation's capital) with low
population density, once again highlighting that every child, even
those in the farthest villages, must be reached with polio vaccine.
There has been a history of cases spreading from Nigeria across the
border to Niger, with several instances over the last 3 years. Niger
meets the acceptable standard for surveillance at the national level
but there are problems with surveillance at the sub-national level,
including in Diffa. One consultant has already agreed to be deployed
to Niger and the search is now on for a 2nd consultant to be sent to
the area to assist in the outbreak response. A STOP-team member
already present in the country will be re-tasked to the infected
area.

2011 annual totals by county as of 7 Dec 2011:
Afghanistan - 59
India - 1
Pakistan - 167
Nigeria - 45
DR Congo - 87
Chad - 125
Angola - 5
Central African Republic - 2
China - 18
Guinea - 3
Kenya - 1
Cote d'Ivoire - 36
Niger - 2
Mali - 7
Congo - 1
Gabon - 1

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

[In the past week (1-7 Dec 2011], new cases have been officially
confirmed in 2 countries: Afghanistan (1) and Pakistan (6). In
addition there was an "unofficial" report from Niger (1 case pending).
There was also a re-classification of a case from Cameroon to Nigeria,
as the location of the WPV transmission was found to be in Nigeria,
with medical care/treatment (and confirmation) sought in Cameroon.

For the global map showing the geographic locations of all confirmed
WPV associated paralytic poliomyelitis, see
http://www.polioeradication.org/Dataandmonitoring.aspx. - Mod.MPP]

******
[3] Global update: week ending 30 Nov 2011
Date: Wed 30 Nov 2011
Source: Global Polio Eradication Initiative (GPEI) [edited]
http://www.polioeradication.org/Polioandprevention.aspx


Case count as of 30 Nov 2011:
Total cases: Year-to-date 2011 / Year-to-date 2010 / Total in 2010
Globally: 553 / 821 / 1352
- endemic countries: 265 / 196 / 232
- non-endemic countries: 288 / 625 / 1120

Afghanistan (3 new cases)
3 new cases were reported in the past week (wild poliovirus type 1 --
WPV1; from Kapisa and Kandahar), bringing the total number of cases
for 2011 to 58. The most recent case had onset of paralysis on [15 Nov
2011] (WPV1 from Kandahar).

India (0 new cases)
India has not reported WPV in more than 10 months. The country's only
case for the year was reported in West Bengal on [13 Jan 2011].

Keeping up immunity and sensitive surveillance in India will be the
top priority in the coming months.

Surveillance reviews continue to be conducted in high-risk areas, to
further sensitize surveillance activities.

The field work for the mucosal immunity study in Moradabad, western
Uttar Pradesh, has now been completed. The trial began on 11 Oct 2011,
with the enrolment of 989 study infants over the course of just 6
days. The trial aims to evaluate the potential role of inactivated
polio vaccine (IPV), in combination with OPV [oral polio vaccine], in
helping close residual immunity gaps in key reservoir areas.

Nigeria (1 new case)
One new case was reported in the past week (WPV1 from Jigawa),
bringing the total number of cases for 2011 to 45. It is the most
recent case in the country, and had onset of paralysis on [29 Oct
2011].

Pakistan (7 new cases)
7 new cases were reported in the past week (all WPV1s, from
Balochistan, KP, FATA, and Sindh), bringing the total number of cases
for 2011 to 161. The most recent cases had onset of paralysis on [11
Nov 2011] (WPV1s from KP and FATA).

In addition, 6 positive environmental samples were reported,
underscoring that virus transmission is continuing across the
country.

Angola (0 new cases)
No new cases were reported in the past week. The total number of cases
for 2011 remains 5. The most recent case had onset of paralysis on [7
Jul 2011] (WPV1 from Uige).

Chad and CAR (6 new cases in Chad, 0 new cases in CAR)
In Chad, 6 new cases were reported in the past week (all WPV1s),
bringing the total number of cases for 2011 to 125 (122 WPV1s and 3
WPV3s). The most recent case had onset of paralysis on [26 Oct 2011]
(WPV1 from Logone Oriental). 5 of the new cases are reported from
Logone Oriental. In total, nearly half of the country's cases are from
this province (55 of 125).

No new cases were reported from the Central African Republic (CAR) in
the past week. The total number of cases for 2011 remains 2 (both
WPV1s), the most recent of which had onset of paralysis on [6 Oct
2011] in Region Sanitaire 3 (RS3), in the country's north.

A case of WPV3 reported just inside Cameroon's border has been found
to have been a Nigerian child who contracted the virus in Nigeria,
just across the border in Borno state. As such, it looks highly likely
that the case will be reassigned to Nigeria.

China (0 new cases)
No new cases were reported in the past week -- the total number of
cases for 2011 remains 18 (all WPV1). The most recent case had onset
of paralysis on [18 Sep 2011] (from Kashgar, in Xinjiang Uygur
autonomous region).

Democratic Republic of the Congo (DRC) (0 new cases)
No new cases were reported in the past week. The total number of cases
for 2011 remains 87 (all WPV1s). The most recent case had onset of
paralysis on [29 Sep 2011] (from the outbreak district of Popokabaka
in Bandundu).

Horn of Africa (0 new cases)
There were no cases reported in the Horn of Africa this week. There
has only been one case reported in the Horn of Africa this year [2011]
-- a WPV1 with onset of paralysis on [30 Jul 2011] in Nyanza Province,
on Lake Victoria in western Kenya.

West Africa (0 new cases)
No cases were reported in west Africa in the past week. The total
number of cases for 2011 in the west African region remains 48 (36
from Cote d'Ivoire, 3 from Guinea, 7 from Mali, and 2 from Niger). All
cases are WPV3, except for one WPV1 case from Niger.

West Africa continues to be the global epicentre for WPV3
transmission, a strain on the verge of elimination. 5 different WPV3
transmission chains are affecting the region, with 3 of these
circulating in Nigeria (most recent case: [17 Sep 2011]). 2 other
strains are associated with the outbreak in Cote d'Ivoire (most recent
case: [24 Jul 2011]) and Guinea (most recent case: [3 Aug 2011]).

2011 annual totals by country as of 30 Nov 2011:
Afghanistan - 58
India - 1
Pakistan - 161
Nigeria - 45
DR Congo - 87
Chad - 125
Angola - 5
Central African Republic - 2
China - 18
Guinea - 3
Kenya - 1
Cote d'Ivoire - 36
Niger - 2
Mali - 7
Congo - 1
Gabon - 1

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

[During the week 24-30 Nov 2011, there were new cases officially
confirmed in 4 countries: Afghanistan (3), Nigeria (1), Pakistan (7),
and Chad (6).

It is interesting to observe the time interval between the date of
onset and date/week of confirmation of WPV cases. In Afghanistan, the
interval appears to be approximately 2 weeks for the most recent case,
in Nigeria 4 weeks, in Pakistan 2 weeks, in Chad 4 weeks -- markedly
improved from earlier days when these intervals were in months. -
Mod.MPP]

POLIOMYELITIS - WORLDWIDE (19): CHINA, PAKISTAN, GLOBAL
*******************************************************

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org


In this update:
[1] China - Newswire
[2] Pakistan - Newswire
[3] Global update: week ending 14 Dec 2011

******
[1] China - Newswire
Date: 14 Dec 2011
Source: Shanghai Daily / Xinhua [edited]
http://www.shanghaidaily.com/article/ar ... p?id=38947


Polio cases reach 20 in Xinjiang
--------------------
The number of polio cases recorded in northwest China's Xinjiang Uygur
Autonomous Region since an outbreak was confirmed in August [2011] has
reached 20, local health officials said Wednesday [14 Dec 2011].

The Chinese Center for Disease Control and Prevention had been testing
samples taken from patients in the region diagnosed with Acute Flaccid
Paralysis (AFP), a common indicator of polio, to check for the
disease. On [5 Dec 2011], the tests uncovered 2 new polio cases, said
the officials.

One of the samples was taken from a 53-year-old patient from Aksu
prefecture who died on [23 Oct 2011], taking the confirmed number of
deaths from polio in the Xinjiang outbreak to 2.

Poliomyelitis, or polio, is a viral disease of the brain and spinal
cord that mainly affects children under five years of age. One in 200
infections leads to irreversible paralysis, usually in the legs.

AFP is a sudden onset of weakness or paralysis, as is commonly found
with polio.

Local health officials said the 1st 3 cases of this year's [2011]
polio outbreak came from abroad [The virus was identified as
genetically similar to those currently circulating in neighboring
Pakistan. See prior ProMED-mail post Poliomyelitis - worldwide (11):
China 20110827.2625 for more information. - Mod.MPP]

Xinjiang neighbors 3 of the 4 polio-endemic countries in the world:
Afghanistan, India, Nigeria and Pakistan (for a map showing the
proximity of Afghanistan, India and Pakistan to Xinjian, see
http://www.sacu.org/maps/provmap.png. - Mod.MPP]

The local government has conducted large-scale vaccinations in
response to the region's polio epidemic that started in August, when
the 1st cases of the disease in China since 2000 were discovered.

Health authorities said 4 regions in Xinjiang -- the prefectures of
Hotan, Kashgar, Bayingolin and Aksu -- were classified as epidemic
zones.

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

[See below official note from the Polio Eradication Initiative (in
section [3]) on these newly confirmed cases. The most recent date of
onset of these cases is 9 Oct 2011. Prior to these new cases, the
most recent date of onset of confirmed cases was on 18 Sep 2011. It
appears as though there is a delay in confirmation of cases so it may
be too early to conclude that transmission of the Wild poliovirus
(WPV) has been interrupted.

For the interactive HealthMap/ProMED map of Xinjiang Uygur Autonomous
Region, see http://healthmap.org/r/1aQE. - Mod.MPP]

******
[2] Pakistan - Newswire
Date: 15 Dec 2011
Source: Central Asia Online [edited]
http:
//centralasiaonline.com/en_GB/articles/caii/newsbriefs/2011/12/15/newsbrief-11

Health workers have recorded 6 new polio cases in Pakistan, bringing
the number of polio-infected children to 173 so far this year [2011],
officials said [15 Dec 2011].

Doctors found 4 new cases in Balochistan and one each in Khyber
Pakhtunkhwa and Frontier Region Kohat, Dr. Altaf Bosan, head of the
prime minister’s Polio Eradication Cell, told Central Asia Online.

Pakistan is the biggest contributor to the world’s 565 polio cases
reported so far in 2011, he said.

Media reports have linked the number of polio cases to a campaign by
the Taliban to prevent parents from getting immunisations for their
children. The Taliban claim that polio vaccines are a conspiracy by
the West to sterilise Muslims, thus reducing the Muslim population.

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

[As mentioned in a prior ProMED-mail post (Poliomyelitis - worldwide
(18): Pakistan, global 20111208.3552), the mention of a smear campaign
on the part of fundamentalists in Pakistan is a deju vu of what
happened in northern Nigeria in 2003/2004 which was responsible for
reintroduction of wild poliovirus (WPV) into many countries which had
previously interrupted transmission of WPV.

For the interactive HealthMap/ProMED map of Pakistan, see
http://healthmap.org/r/1iGJ - Mod.MPP]

******
[3] Global update: week ending 14 Dec 2011
Date: 14 Dec 2011 [posted after 16 Dec 2011]
Source: Polio Eradication Initiative [edited]
http://www.polioeradication.org/Dataand ... sweek.aspx


Case count as of 14 Dec 2011:
Total cases: Year-to-date 2011 / Year-to-date 2010 / Total in 2010
Globally: 571 / 874 / 1352
- endemic countries: 281 / 211 / 232
- non-endemic countries: 290 / 663 / 1120

Nigeria
One new case was officially reported this week - a case of WPV3
reassigned from Cameroon (onset of paralysis on [6 Oct 2011]) to a
district of Borno (Bama) which had not previously reported a case of
WPV this year. The total number of cases for 2011 is now 46. The
country's most recent case, a WPV1, had onset of paralysis on [29 Oct
2011] in Jigawa. ...Genetic sequencing of the case reassigned from
Cameroon indicated that the virus had been circulating, undetected,
for over a year.

Pakistan
Six new cases were reported in the past week (all WPV1s), bringing the
total number of cases for 2011 to 173. The most recent case was
reported in Killa Abdullah, Balochistan, with onset of paralysis on
[27 Nov 2011]. A case reported this week in the Harnai district of
Balochistan is that district's 1st case for the year [2011].

Angola
No new cases were reported in the past week. The country has reported
a total of 5 cases in 2011, the most recent of which had onset of
paralysis on [7 Jul 2011] in Uige in the country's north.

Chad and CAR
No new cases were reported in Chad this week. The total number of
cases reported in Chad in 2011 remains 125 (122 WPV1s and 3 WPV3s).
The most recent case had onset of paralysis on [26 Oct 2011] (WPV1
from Logone Oriental).

No new cases were reported from the Central African Republic (CAR) in
the past week - the total number of cases for 2011 therefore remains 2
(both WPV1s). CAR's most recent case had onset of paralysis on [6 Oct
2011] in Region Sanitaire 3 (RS3), in the country's north.

China
Although not yet included in official data, 2 new adult cases have
been reported by the China Centre for Disease Control, both from the
outbreak area in southern Xinjian Uygurh Autnomous Region. The cases
are an 18-year old man from Hetian prefecture (which has reported the
majority of cases to date) and a 53 year-old man who is the 1st case
reported from Aksu prefecture; the latter tragically died in late
October [2011]. While the officially reported total case count for
2011 remains 18 (all WPV1), it will go up to 20 once both cases have
been formally reported, with the Aksu case the most recent case (onset
of paralysis [9 Oct 2011]).

While the scale and speed of China's initial outbreak response was
impressive, the country continues to be at risk of continued
circulation of wild poliovirus. All residents of southern Xinjiang up
to the age of 39 are being targeted with OPV during a measles
vaccination campaign currently being conducted. However, so far no
other vaccination rounds have been confirmed between now and early
March 2012.

Democratic Republic of the Congo (DRC)
One new case was reported in the past week - a case of WPV1 with onset
of paralysis on [3 Nov 2011] in Nyunzu district in Katanga province
(this is the country's most recent case). The total number of cases
for 2011 therefore rises to 88 (all WPV1s).

Horn of Africa
A case of WPV1 with onset of paralysis on [30 Jul 2011] in Nyanza
province, western Kenya, remains the only case to be reported in the
Horn of Africa this year [2011].

West Africa
One case was reported in Niger this week - a WPV3 with onset of
paralysis on [30 Oct 2011] in Diffa district, Diffa province, near to
the border with Nigeria. This is the most recent case in west Africa.
The total number of cases for 2011 in the west African region is now
49 (36 from Cote d'Ivoire, 3 from Guinea, 7 from Mali and 3 from
Niger). All cases are WPV3, except for one WPV1 case from Niger.
Genetic sequencing found the case in Diffa, Niger to be most closely
related to WPV3 most recently seen in Borno, Nigeria on [17 Sep 2011].


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

[From the above information, unfortunately it appears as though there
is continued transmission of WPV in both countries classified as
endemic for polio as well as countries classified as non-endemic for
polio. The disconcerting bits of information in the newswires and
Polio Eradication Initiative weekly summaries relate to the false
rumors surrounding vaccination in Pakistan and the observation that
there continue to be areas with "silent" transmission of WPV. In the
former case, the false rumors surrounding effects of the vaccine in
Pakistan are leading to reduced acceptance of vaccination which in
turn is paving the way for continued increased transmission and
increased numbers of cases due to WPV infection in Pakistan, and now
in neighboring countries (China). In the latter case, the "silent"
transmission of WPV has led to a false sense of security in areas such
as the Horn of Africa, where WPV was circulating for more than one
year before a clinical case was detected and confirmed. This false
sense of security applies to both the official public health sector as
well as the population who may "forget" the importance of vaccination
against polio in the absence of active cases in the area.

For the map showing the geographic location of all confirmed WPV
associated polio cases during 2011, see the 2011 map link on the Polio
Eradication Initiative website at:
http://www.polioeradication.org/Dataand ... dwide.aspx.
- Mod.MPP]

POLIOMYELITIS - WORLDWIDE: 2011 NEW CASES
*****************************************
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 report:
[1] Worldwide - 2011 data as of 5 Jan 2011
[2] Pakistan - New 2011 cases since official report in [1]
[3] Nigeria - 22 states WPV free 3 years

******

[1] Worldwide - 2011 data as of 5 Jan 2011

Date: 5 Jan 2012
Source: Polio eradication initiative website
http://www.polioeradication.org/Dataand ... sweek.aspx


2011 case count as of 5 Jan 2012:
Total cases: Year-to-date 2011 / Year-to-date 2010 / Total in 2010*
Globally: 620 / 920 / 1352
- endemic countries: 315 / 223 / 232
- non-endemic countries: 305 / 697 / 1120

The above represents data in WHO as of 4 Jan 2011 for 2010 data and 3 Jan 2012 for 2011 data.
*The 2010 total for Congo includes cases with inadequate specimens that have been exceptionally classified as confirmed polio based on their association with the WPV1 outbreak.


Afghanistan
Three new cases, all WPV1, were reported in the past week, bringing the total number of cases for 2011 to 74. The most recent case had onset of paralysis on [12 Dec 2011] in Maywand district in Kandahar province.

India
In the coming week, India will pass 12 months since the onset of paralysis of its most recent case. The case, which is the only case reported in India in 2011, had onset of paralysis on [13 Jan 2011] in West Bengal.

Nigeria
One new case was reported this week - the total number of cases for 2011 is now 51. The most recent case is a WPV1 with onset of paralysis on [27 Nov 2011] in Niger state.

Pakistan
Eight new cases were reported this week. The total number of cases in Pakistan is now 189. The most recent case (WPV1) had onset of paralysis on [16 Dec 2011], in Khyber, Federally Administered Tribal Areas.

Lot Quality Assurance Sampling methodology applied to the December [2011] Sub-national immunization days indicate that coverage was likely to be less than 80 percent in key transmission areas, such as northern Balochistan, and less than 90 percent in parts of southern Sindh. Of the 61 Union Councils surveyed, however, 39 were found likely to have coverage not less than 95 percent.

Angola
No new cases were reported in the past week. The country has reported a total of 5 cases in 2011, the most recent of which had onset of paralysis on 7 July in Uige in the country's north.

Chad and CAR
No new cases were reported in Chad this week, and the total number of cases is 130 (127 WPV1s and three WPV3s). The most recent case had onset of paralysis on [18 Nov 2011] (WPV1 from Logone Oriental).

One new case was reported from the Central African Republic (CAR) in the past week - the total number of cases for 2011 is now 4 (all WPV1s). CAR's most recent case had onset of paralysis on [8 Dec 2011] in Region Sanitaire 3 (RS3), in the country's north.

China
No new cases were reported in the past week. China has a total of 21 cases, all WPV1. The most recent had onset of paralysis on [9 Oct 2011] from Akesu prefecture.
China is at continued risk of circulation of wild poliovirus.

Democratic Republic of the Congo (DRC)
Three new cases were reported in the past week, bringing the total number of cases for 2011 to 92 (all WPV1). The most recent case had onset of paralysis on [28 Nov 2011] in Maniema province.

Horn of Africa
A case of WPV1 with onset of paralysis on [30 Jul 2011] in Nyanza province, western Kenya, remains the only case to be reported in the Horn of Africa in 2011.

West Africa
No new cases were reported in this region in the last week. The most recent case in west Africa is from Niger, with onset of paralysis on [17 Nov 2011] in Tahoua district, Birni Nkonni province, near the border with Nigeria. The total number of cases for 2011 in the west African region is 50 (36 from Cote d'Ivoire, 3 from Guinea, 7 from Mali and 4 from Niger). All cases are WPV3, except for 2 WPV1 cases from Niger.

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

[Because of time lags associated with collection and testing of laboratory specimens submitted for confirmation of wild poliovirus (WPV infection), and in some cases, delays in identifying suspected cases in areas with reduced access to health services, one expects to continue to have reports of cases of WPV associated disease from 2011 during the early weeks of 2012. The above information includes information from the official report of the status of 2011 WPV associated disease as of Thurs. 5 Jan 2012.

A map of the geographic locations of WPV confirmed cases in 2011 can be found at: http://www.polioeradication.org/Dataandmonitoring.aspx. Looking at the map one can see a band of "heavy" transmission in Asia, most notably in Pakistan and Afghanistan with the spill over (via importation followed by local transmission) into western China. There are also bands of WPV1 transmission in Chad, the Democratic Republic of the Congo and Nigeria, and bands of WPV3 transmission in Cote d'Ivoire and Nigeria.

While it is very noteworthy that India is on the verge of completing a full year without reports of WPV associated disease (the most recent date of onset was 13 Jan 2011 in West Bengal), the continued transmission of WPV in neighboring Pakistan is a reminder of the continued risk of re-introduction of WPV.

The findings of the Lot Quality Assessment performed in Pakistan following the last rounds of immunization activities in December 2011 are disheartening, as vaccination coverages in known areas of WPV transmission are suboptimal (less than 80 percent), translating into continued pockets of inadequate vaccination coverages where WPV will most likely continue to circulate. - Mod.MPP]

******
[2] Pakistan - New 2011 cases since official report in [1]
Date: 6 Jan 2012
Source: Express Tribune
http://tribune.com.pk/story/317814/poli ... -k-p-fata/


Two more polio cases have been reported in Khyber-Pakhtunkhwa (K-P) and Federally Administered Tribal Areas (Fata), pushing the toll in Pakistan to 191 cases as of [5 Jan 2012].

According to a Polio Monitoring and Coordination Cell report, one case each was reported in K-P and Fata last December [2011].

In Khyber Agency, [a one-and-a-half-year old male], who belongs to Sama Gari village in Bara, felt the 1st signs of paralysis on [23 Dec 2012]. According to his parents, [he] could not receive any oral polio vaccine dose in supplementary immunisation or vaccination campaigns, as the area is inaccessible due to security reasons since September 2009.

It is for this reason that 22 cases were reported from Khyber Agency alone last year. According to the report, 14 cases appeared in Bara and 4 each in Tirah and Landi Kotal. This, however, is the 7th polio case from Milaward in Sama Gari village. The claim is verified by the report, according to which over 40 per cent of the children remained inaccessible in the agency for most of 2011, except July [2011].

Similarly, in Tank district, [a] 23-month-old [male]from Gul Imam, suffered paralysis on [18 Dec 2011]. The report says the boy’s family refused to have him vaccinated on religious grounds and he only received polio drops twice as an infant. This is the 3rd polio case reported from Tank, the report added.

Of the total cases confirmed in Pakistan up till [5 Jan 2011], 72 cases were reported from Balochistan, 56 from Fata, 32 from Sindh, 22 from K-P, 8 from Punjab and one from Gilgit-Baltistan.

Pakistan is currently among 4 countries where the endemic is prevalent and ranks 1st with the highest number of cases in the world. It has also been reported that the country will face travel restrictions if it is unable to eradicate the disease by the end of this year [2012]. [This should probably read "unable to interrupt transmission of the WPV by the end of this year", as eradication of WPV in a country is defined as 3 years with zero reports of WPV associated disease. - Mod.MPP]

In November 2011, Prime Minister Yousaf Raza Gilani appointed Begum Shahnaz Wazir Ali as the focal person for coordination and monitoring of polio eradication in Pakistan. The government is planning to completely eradicate the crippling disease from the country this year [2012]. However, with a host of new cases emerging in K-P and Fata, polio eradication seems to be a far-fetched goal.

[Byline: Mahwish Qayyum]

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

[The above newswire mentions 2 additional cases that do not appear to be included in the official data reported as of 5 Jan 2012 (see [1]Worldwide - 2011 data as of 5 Jan 2011) as the date of onset of most recent case in the official report is listed as 16 Jan 2012, whereas the case in Khyber Agency had a date of onset of 23 Dec 2012, and the case in FATA had a date of onset of 18 Dec 2012. These 2 cases highlight the challenges confronting the goal of interruption of WPV transmission in Pakistan. In one case, the child was not adequately vaccinated because of civil strife leading to interruptions in service delivery. In the other case, the child was not vaccinated because of religious objection to vaccination -- most likely due to the rumors circulating in Pakistan that the vaccine is a western plot to induce sterility in vaccine recipients, as the predominant religion in the FATA region Islam, is not a religion that bans the use of childhood vaccines.

For a map of Pakistan showing administrative divisions, see http://www.mapsofworld.com/pakistan/pak ... l-map.html. The Kyber-Pakhtunkhwa area borders with the FATA (Federally Administered Tribal Areas), which borders with Afghanistan, where there is also continued transmission of WPV (see official data below). - Mod.MPP]

******
[3] Nigeria - 22 states WPV free 3 years
Date: 7 Jan 2012
Source: All Africa
http://allafrica.com/stories/201201061165.html


Nigeria: 22 States in Nigeria Are Polio Free - NPHCDA
----------------
The Executive Director of the National Primary Health Care Development Agency, NPHCDA, Dr Ado Mohammed, has disclosed that 22 States in Nigeria have remained polio free for 3 years even as the country is among the 4 most endemic polio countries in the world.

Ado, who spoke in an interview in Minna, yesterday, said that as at the end of January 2011, the country has recorded as low as 51 cases of wild polio virus [WPV] in only 8 States.

According to him, the statistics represent 90 per cent of reduction in wild polio virus spread in the country as the country set 80 percent vaccine coverage in order to prevent further spread of the virus.

The Executive Director, who was in Minna for a one day sensitisation meeting of stakeholders on polio eradication and routine immunisation, disclosed that a national task team has been constituted to stop transmission of the diseases in the country by the end of this year [2012].

He said, "An immediate outcome of the task team's work is the accountability frame work to hold the federal, states, local government and our partners accountable for polio eradication".

[Byline: Abu Nmodu]

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

[[For a map of Nigeria showing states, see http://allafrica.com/stories/201201061165.html. There are presently 36 states and a Federal Capital Territory (Abuja). Hence, the above report that 22 states are now WPV free for 3 or more years means that 59 percent of the states and Federal Capital Territory have been WPV long enough to be considered as having eradicated WPV in these states. Unfortunately, there are still 8 states with active transmission of WPV, some of which include states that had the vaccination activities seriously interrupted back in 2003/2004 due to rumors similar to those affecting Pakistan today (see above report [2] Pakistan - New 2011 cases since official report in [1]). One hopes that the current transmission is not related to persist pockets of population that refuse vaccination based on the old rumors.

For the interactive HealthMap/ProMED map of Nigeria, see http://healthmap.org/r/1qGF - Mod.MPP]]

Hallo Gemeinde ,,

ich kann nur jeden eindinglich bitten sich Impfen zu lassen . Ich selber habe nun schon 53 Jahre Polio .
Es sind zwar wenige Behinderungen geblieben ABER bei fast 80 % der Polio Patienten stellt sich das Post Polio Syndrom ein .
Dieses PPS Syndrom stellt sich erst nach ca 30 - 40 nach der " durchlebten " Polio ein .
Ich als nicht Mediziner sage immer " die Polio holt sich ihren Nachschlag " eine genaue Erklärung würde hier zu weit führen .
( wer Infos haben möchte kann mir mailen ).
Nur so viel , die Muskeln bauen sich weiter ab und das arbeiten und reisen wir immer schwieriger .

Nochmals geht zur Impfung !!!!!!!!
Aber Vorsicht nur die Injektionsimpfung ist sicher keine Schluckimpfung

Euch allen ein gutes und gesundes 2012 und vieleicht trift man sich mal auf irgendeiner Piste
achte einfach auf die " Wüstenmaus "
LG
Bernd

Lieber Berndt,

danke für deine Offenheit und deine ehrliche und nachdrückliche Aufforderung zur Impfung.

Dir alles Gute, und weiterhin viele tolle Reisen!
Birgitt

Indien - Poliomyelitis
19.01.2012

Trotz flächendeckender Impfkampagnen gehört Indien noch immer zu den Ländern mit endemischer Polio. Im vergangenen Jahr wurde allerdings nur ein Fall im Januar bei einem 18 Monate alten Mädchen aus Panchla bei Kalkutta gemeldet, d.h. in den vergangenen 12 Monaten ist landesweit keine Erkrankung registriert worden. 2010 traten noch 42 Fälle, im Jahr 2009 noch 741 auf. Hygiene und Impfschutz weiterhin beachten. / Quelle: crm

Gruß
Birgitt

POLIOMYELITIS - WORLDWIDE (02): ETHIOPIA ex SOMALIA, SUSPECTED, REQUEST FOR INFORMATION
***************************************************************************************
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ProMED-mail is a program of the
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Date: Tue 24 Jan 2012
Source: UN News Centre [edited]
http://www.un.org/apps/news/story.asp?NewsID=41020


UN refugee agency warns of potential polio cases in Ethiopian camps
-------------------------------------------------------------------
The United Nations refugee agency [UNHCR] today [24 Jan 2012] voiced its concern over reports of 2 suspected polio cases this week among Somali refugees living in camps in Ethiopia and 3 cases in the surrounding community.

"The immediate priority is to confirm the outbreak, and samples have been collected and sent to Addis Ababa for laboratory confirmation," said spokesperson for the Office of the High Commissioner for Refugees (UNHCR) Melissa Fleming at a press briefing in Geneva.

Ms Fleming said UNHCR is working closely with the Ethiopian ministry of health, the World Health Organization (WHO), the UN Children's Fund (UNICEF), and other health partners to coordinate the response in the 5 refugee camps in Dollo Ado, where the cases were reported. The immediate priority is to confirm the outbreak, and samples have been collected and sent to Addis Ababa for laboratory confirmation.

"Once the strain of virus is identified, the appropriate vaccine will be dispatched to Dollo Ado for a mass vaccination campaign in the camps and surrounding communities," she said.

In addition, a nationwide anti-polio campaign is scheduled to start on [27 Jan 2012] and will be expanded to include all refugee camps.

A highly infectious disease caused by a virus, polio invades the nervous system and leads to irreversible paralysis in one out of 200 cases. Only 3 countries -- Afghanistan, Nigeria, and Pakistan -- remain polio-endemic today, and the number of cases has declined drastically in the past 25 years.

Ms Fleming stressed that UNHCR and other agencies have strengthened its surveillance to identify other potential polio cases. "At community level, mobilization and sensitization efforts have been stepped up to increase awareness of the signs and symptoms of polio and ways to prevent transmission.

"As the polio virus is transmitted through contaminated food and water, our partners providing water and sanitation are being engaged to ensure delivery of adequate services," she added.

According to UNHCR, some 143 000 Somalis are currently sheltered in 5 Ethiopian camps in Dollo Ado, which is now the 2nd largest refugee settlement in the Horn of Africa. Almost one million Somalis live as refugees in the region while another 1.36 million are internally displaced.

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

[The suspected cases of polio mentioned above, if confirmed, are the 1st identified polio cases reported in 2012. Of note, during 2011, there were no cases of polio associated with wild poliovirus (WPV) infection reported from either Somalia or Ethiopia (see summary table of 2011 cases available from the Global Polio Eradication Initiative webiste at http://www.polioeradication.org/Dataand ... sweek.aspx).

If confirmed, it will be important to see the results of genetic testing to determine the most likely origin of the WPV(s) involved. The only confirmed case of WPV associated paralysis in the Horn of Africa during 2011 was a single case with date of onset 30 Jul 2011, in Kenya. As the WPV involved in that case in Kenya was closely related to a virus that had been circulating in Uganda's Bugiri District in 2010 (see prior ProMED-mail post Poliomyelitis - worldwide (13): Kenya, China, Pakistan 20110920.2860), concern re: silent transmission in the region was raised. Of note is the location of Dolo Ado (?alternative spelling from that in the newswire above)-- in the south of Ethiopia just by the border with Kenya. It can be seen on a map of Ethiopia showing the location of refugee camps, at http://www.unhcr.org/cgi-bin/texis/vtx/ ... =49e483986.

While the newswire above does not include India as an endemic country for polio, the official information available on the Polio Eradication Initiative website states: "India has not had a case of wild poliovirus nor detected the virus in sewage sampling since [13 Jan 2011]. When all pending samples have cleared laboratory testing, India will be considered to have interrupted transmission of indigenous wild poliovirus."

More information on results of further investigations into the suspected cases of polio would be greatly appreciated. - Mod.MPP

A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1Ahu.]