Kinderlähmung - Poliomyelitis

[Birgitt]

POLIOMYELITIS - WORLDWIDE (02): KENYA, UGANDA ex SUDAN
******************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
[1] Kenya
[2] Kenya
[3] Uganda

******
[1] Kenya
Date: Wed 25 Feb 2009
Source: Reuters AlertNet [edited]
<http://www.alertnet.org/thenews/newsdesk/LP623578.htm>

Polio has infected a 4-year-old girl in northern Kenya in the
country's 1st case of the disease since 2006, the government said on
Wednesday [25 Feb 2009]. The girl is believed to have contracted the
virus from neighboring southern Sudan, which has struggled to improve
its health sector since a 2005 peace deal ended a 2-decade civil war.

Shahnaaz Sharif, Kenya's director of public health and sanitation,
said a vaccination campaign would begin in the area on 7 Mar 2009 and
would aim to immunize more than 95 000 children.

Youngsters under 3 are most at risk from the disease, which can cause
irreversible paralysis. Vaccines have eliminated the virus as a
public health threat in most parts of the world.

[Byline: Alison Bevege]

--
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[The HealthMap/ProMED-mail interactive map of Kenya showing the
extent of the border with Somalia is available at
<http://healthmap.org/promed/en?v=0.5,37.9,6>.
- Mod.CP]

******
[2] Kenya
Date: 25 Feb 2009
Source: The Associated Press/Google hosted [edited]
<http://www.google.com/hostednews/ap/art ... AD96IL8NG0>


Kenya announced its 1st polio infection in 20 years on Wednesday [25
Feb 2009], after a 4-year-old girl was diagnosed with the disease
along the country's remote border with Sudan.

"In a country free of polio, when you make a diagnosis of one case of
polio, the definition is an outbreak," said Dr. David Okello, country
representative of the World Health Organization. For every child
paralyzed by polio, there are about 200 other asymptomatic cases who
can spread the disease to others.

Okello said they were investigating a 2nd case in Lokichoggio, 900 km
(560 miles) north of the capital city of Nairobi, where an infant had
shown symptoms of the disease.

"Really we are not sure; there may be other cases," said Okello.

Polio is an infectious disease that mainly strikes children under 5.
It is spread primarily by the feces of an infected person getting
into the food chain [the main route of infection is considered
fecal-oral, but oral-oral infection can occur in the early stages of
infection, when the virus can be isolated from lymphatic tissue in
the oropharynx - Mod.MPP]. It causes paralysis and can be fatal.

In 2006, 2 refugees escaping the war in Somalia were diagnosed with
the disease at the Dadaab refugee camp at Kenya's eastern border with
Somalia. That outbreak was contained before it spread.

Okello said the disease may have spread from south Sudan, where a
polio outbreak occurred in early January [2009].

He said many Kenyan children were not immunized due to post election
violence in 2008, which left more than 1000 people dead and 600 000
people displaced from their homes. Many have still not returned home.

Okello said coverage of the immunization campaign was 100 percent
before the violence but has dropped to 60 percent.

He said in the next 10 days, health officials will conduct immediate
vaccination of Lokichoggio and surrounding areas to prevent the
spread of the disease and then a synchronized vaccination campaign
involving Sudan, Ethiopia and Uganda.

Global efforts to eradicate polio have decreased cases by 99 percent
since 1988. Last year [2008], it was only endemic in 4 countries:
Afghanistan, India, Nigeria and Pakistan. But those countries have
the potential to re-infect anywhere in the world.

[Byline: Tom Odula]

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

******
[3] Uganda
Date: 25 Feb 2009
Source: New Vision [edited]
<http://www.newvision.co.ug/D/8/12/672540>


A child is being treated for polio in Amuru district 12 years since
the last case was reported in Uganda.

No case had been reported in the country since 1996, and in 2006, the
WHO declared Uganda free of polio. A country is declared polio-free
if no case of the disease is found for 10 years.

But a sample from a 16-month-old baby boy admitted to Lacor Hospital
with weakness in the limbs has tested positive for the polio virus.
The child is said to have been living in Awer camp for the internally
displaced persons, and he was 1st treated for malaria.

Samples from 2 other suspected cases in the camp have been taken for
testing at the Centres for Disease Control in Entebbe.

Doctors in Amuru said the patients present with acute flaccid
paralysis, which is the weakness of limbs. The district health
officer, Dr. Patrick Odong yesterday [24 Feb 2009] said the
preliminary results from the sample tested positive. He said the
sample had been sent to South Africa for confirmatory tests.

A team from the Ministry of Health is expected in Amuru today [25 Feb
2009] to carry out verification and collect more samples, he said.

The assistant commissioner for epidemic surveillance, Dr. Issa
Makumbi, and Dr. Possy Mugyenyi of the Uganda National Expanded
Programme on Immunisation said the preliminary tests had showed
positive results. Makumbi said he had sent a team to the district to
check on the situation.

Due to the global sensitivity to polio, the health ministry reported
constant surveillance.

"We don't want any chances of polio re-entry into the country. We are
concerned that the disease may spread from our neighbours," Monica
Musenero, the principle epidemiologist, said.

Last year [2008], the ministry and the WHO issued a polio alert and
launched an immunisation programme after cases were reported in the
neighbouring DR Congo.

The districts that were feared to be under threat were Kanungu,
Kisoro, Rukungiri, Kabale and Kasese.

Others were Bundibugyo, Ntungamo, Mbarara and Bushenyi. This was
because of their closeness to the Congo border and the fact that
Congolese were fleeing into Uganda, escaping the armed conflict back
home.

The health ministry and the WHO launched a polio immunisation
campaign in Kanungu last year [2008], which targeted children below 5
years in the 9 districts bordering Congo.

In the 1st week of February [2009], about 1.4 million children in 23
districts were immunised against polio. The 2-day sub-national
immunisation targeted children below 5 years.

"Our target was to reach 80 percent of the children in the 25 risky
districts. So far, we have immunised 1.4 million children, which is
90 percent coverage," said Mugyenyi.

[Byline: Anne Mugisa and Raymond Baguma]

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

[The occurrence of cases of polio in Kenya and Uganda, both suspected
to be importations from Southern Sudan, serves as a further
illustration of the challenges faced by the polio eradication effort,
especially in Africa. Both countries have been polio free for many
years (Kenya for 20 years -- although there was a solitary imported
case from Somalia in 2006 -- and Uganda for 12 years). In contrast,
the Sudan has reported 5 confirmed cases of polio this year (2009),
with date of onset of the most recent confirmed case on 1 Feb 2009.
In addition, there were reports of 26 confirmed cases last year
(2008) in the Sudan as well (see polio eradication website, weekly
case count as of 24 Feb 2009, available at
<http://www.polioeradication.org/casecount.asp>).

According to WHO reports, wild poliovirus (WPV) has been circulating
in the Sudan for more than 12 months, with the original importation
related to the upsurge in WPV activity in Nigeria (see Poliomyelitis
- Worldwide: WHO report Nigeria, updates 20090106.0052). The current
cases are in both Uganda and Kenya. A disturbing bit of news is the
significant drop in vaccination coverages in Kenya related to the
recent civil unrest in 2008, setting up a situation of a large cohort
of susceptibles under 2 years of age that would facilitate WPV
circulation in the country in general (not just isolated to the
externally displaced persons due to conflicts in neighboring
countries). The challenges faced in Africa are multiple, both the
continued problems with vaccine coverages in Nigeria as well as
numerous countries with civil unrest and internally as well as
externally displaced persons.

The most recent information on reports of confirmed cases of polio by
country, available on the polio eradication website
<http://www.polioeradication.org/casecount.asp>
are presented in the following table and highlight the challenges
still faced in Africa related to the ongoing WPV circulation in
Nigeria, with 5 additional West African countries reporting WPV cases
with dates of onset in 2009 (Benin, Togo, Burkina Faso, and Niger,
Mali).

Country: Year-to-date 2009 / Year-to-date 2008 / Total in 2008 / Date
of onset of most recent case

India: 13 / 82 / 559 / 7 Feb 2009
Kenya: 1 / 0 / 0 / 7 Feb 2009
Sudan: 5 / 0 / 26 / 1 Feb 2009
Pakistan: 7 / 2 / 118 / 30 Jan 2009
Benin: 2 / 0 / 6 / 29 Jan 2009
Afghanistan: 2 / 2 / 31 / 27 Jan 2009
Nigeria: 30 / 19 / 799 / 26 Jan 2009
Togo: 2 / 0 / 3 / 26 Jan 2009
Burkina Faso: 2 / 0 / 6 / 15 Jan 2009
Niger: 3 / 2 / 13 / 6 Jan 2009
Mali: 1 / 0 / 1 / 4 Jan 2009
CAR: 0 / 0 / 3 / 30 Dec 2008
Chad: 0 / 1 / 37 / 26 Dec 2008
Angola: 0 / 1 / 29 / 26 Dec 2008
Cote d'Ivoire: 0 / 0 / 1 / 24 Dec 2008
Ghana: 0 / 0 / 8 / 8 Nov 2008
DRC: 0 / 0 / 5 / 18 Oct 2008
Nepal: 0 / 2 / 6 / 15 Oct 2008
Ethiopia: 0 / 0 / 3 / 27 Apr 2008

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

[Birgitt]

Indien - Poliomyelitis
02.03.2009

Trotz flächendeckender Impfkampagnen gehört Indien noch immer zu den vier Ländern mit endemischer Polio und steht mit den Fallzahlen weltweit nach Nigeria an zweiter Stelle. Bis Ende Februar wurden 13 Erkrankungen registriert. 2008 wurden 557 Erkrankungen gemeldet. Hygiene und Impfschutz beachten. / Quelle: crm

[Birgitt]

Polio in Sudan – high risk of international spread
02.09.2009 - WHO

The recent expansion of a prolonged outbreak of wild poliovirus type 1 (WPV1) in Sudan poses a very high risk of further international spread, requiring urgent and immediate outbreak response activities in the affected areas and heightened surveillance in countries at risk. Previously restricted to southern Sudan and western Ethiopia, the outbreak has now spread to Kenya and Uganda. Two WPV1 cases have also been confirmed in northern Sudan (in Khartoum and Port Sudan), reflecting either further spread of the southern Sudan epidemic, a new importation from outside the country, or undetected transmission of a previous importation of virus of northern Nigeria origin into this area in 2003-6. Epidemiologic and virologic investigations are ongoing to clarify the latter.

Of particular concern is the confirmation of the WPV1 in Port Sudan. It is from this area that, from 2004 to 2006, WPV1 spread to re-infect several countries, including Saudi Arabia, Somalia, Yemen and Indonesia, causing outbreaks that resulted in more than 1,200 cases and over US$150 million in international emergency outbreak response costs. Due to the historical international spread of polioviruses from Port Sudan, the new international spread from southern Sudan to Kenya and Uganda, and the suboptimal quality of outbreak response activities in southern Sudan and western Ethiopia (monitoring data indicates that upwards of 30% of children remain un- or under-immunized with ≤3 doses of oral poliovirus vaccine), WHO assesses the risk of further international spread from the Sudan as very high.

Stopping this outbreak requires the full implementation of the international polio outbreak response standards, adopted by the World Health Assembly in May 2006, until transmission has been confirmed to be interrupted.

In northern Sudan, a large-scale supplementary immunization activity (SIA) began on 15 February with additional campaigns planned for 23 March and again in late-April. In southern Sudan, SIAs were held on 13 January and 23 February, with further activities planned for 23 March and late April, following which the onset of the rainy season in May could complicate the logistics of reaching all populations in this already difficult-to-access terrain. Consequently, particular attention is being given to closing the persistent OPV coverage gaps during the upcoming SIAs.

In coordination with the polio campaigns in the Sudan, plans for rapid outbreak response campaigns are being finalized for late March, late April and possibly again in late May in the affected areas of Kenya and Uganda. Genetic sequencing data suggests that the importations into these countries have been rapidly detected, improving the prospects for interrupting transmission in the near term if the campaigns are of sufficiently high quality to reach >90% of children in the affected areas.

It is important that countries across central Africa, the Horn of Africa and the Gulf strengthen surveillance for cases of acute flaccid paralysis (AFP), in order to rapidly detect any new poliovirus importations and facilitate a rapid response. Countries should also analyze routine immunization coverage data to identify any subnational gaps in population immunity to guide catch-up immunization activities and thereby minimize the consequences of any new virus introduction. Priority should be given to areas at high-risk of importations and where OPV3/DPT3 coverage is <80%.

Quelle: WHO

[Birgitt]

Kenia - Poliomyelitis
10.03.2009

Im Norden des Landes wurde bei einem 4-jährigen Mädchen Polio Wildvirus Typ 1 nachgewiesen. Abgesehen von einem importierten Fall in einem Flüchtlingslager 2006, handelt es sich bei dem aktuellen Fall, um die erste Polioerkrankung in Kenia seit 20 Jahren. Während der Aufstände, in Folge der Präsidentschaftswahlen 2008 wurden zahlreiche Kinder nicht gegen Polio geimpft. Ursprung des Virus ist wahrscheinlich der südliche Sudan, wo es im Januar dieses Jahres einen Ausbruch gab. Hygiene und Impfschutz (Polio) beachten. / Quelle: crm

[Birgitt]

Süd-Sudan steht vor Polio-Epidemie
24.03.2009 - Reuters

Juba, Sudan (Reuters) - Dem Süd-Sudan droht eine Polio-Epidemie.

Bisher seien 40 Krankheitsfälle registriert worden, teilten Vertreter der Gesundheitsbehörde am Dienstag mit. "Dies ist ein nationaler Notstand", beschrieb ein hochrangiger Vertreter die Lage. Die Weltgesundheitsorganisation (WHO) bestätigte, dass 20 Experten in die Region entsandt worden seien, um die hochansteckende Krankheit zu bekämpfen. "Es sieht nicht so aus, dass sich die Lage bessert und wegen der bevorstehenden Regenzeit wird es eng", sagte der Chef des Polio-Programms der WHO. Starke Regenfälle behindern oft die Arbeit von Impfteams in abgelegenen Gebieten. Der Süd-Sudan galt bisher als poliofrei ... mehr

Gruß
Birgitt

[Birgitt]

POLIOMYELITIS - WORLDWIDE (04): IMPORTATIONS AFRICA
***************************************************
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] Africa, importations
[2] Worldwide case count through 15 Apr 2009

*****
[1] Africa, Importations
Date: 16 Apr 2009
Source: MMWR 17 Apr 2009 / 58(14);357-362 [edited]
<http://www.cdc.gov/mmwr/preview/mmwrhtm ... mm5814a1_e>


Wild Poliovirus Type 1 and Type 3 Importations --
15 Countries, Africa, 2008-2009
---------------------------------------------------------------------------------
The Global Polio Eradication Initiative began in
1988; by 2006, indigenous transmission of wild
poliovirus (WPV) type 2 infection had been
interrupted globally, and indigenous transmission
of type 1 and 3 (WPV1 and WPV3) infection had
been interrupted in all but 4 countries worldwide
(Afghanistan, India, Nigeria, and Pakistan) (1).
Despite this success in controlling indigenous
transmission, during 2002-2006, 20 previously
polio-free countries* in Africa and Asia had
importations of WPV1 originating from Nigeria
(2--4), and 3 polio-free countries in Africa had
WPV1 importations originating from India (1). By
the end of 2007, control efforts in all countries
except Angola, Chad, Democratic Republic of the
Congo (DRC), Niger, and Sudan had stopped
transmission of WPV1 caused by these
importations. However, during 2008-2009, multiple
importations of WPV from countries with ongoing
transmission resumed in Africa. This report
describes 32 WPV importations into 15 African
countries, resulting in 96 polio cases during
January 2008 - March 2009 and persistent WPV
transmission in 5 previously polio-free African
countries (5). As with the 2002-2006 resurgence,
all of the importations originated from Nigeria
or India, but more rapid WPV identification and
response resulted in substantially fewer polio
cases than reported during 2002-2006. Sensitive
surveillance and continued rapid response
supplemental immunization activities (SIAs)** are
key to limiting further WPV spread, interrupting
the outbreaks, and allowing the polio prevention
focus in Africa to return to eradicating polio in
countries with persistent WPV transmission.

WPV Importations, 2008-2009
---------------------------
Comprehensive genomic sequencing provided by the
global polio laboratory network (6) allows
tracing of the origins of virus importations and
estimation of the duration of circulation in a
chain of transmission.*** An importation event is
defined as detection of one or more polio cases
in a country resulting from WPV transmission that
genetic analysis shows to have 1st circulated in
another country. An outbreak associated with an
importation event is defined as 2 or more polio
cases caused by WPV genetically related to the
identified imported WPV case with earliest onset.

During January 2008 - March 2009, 32 importations
of WPV1 and WPV3 resulted in 96 polio cases in 15
African countries (Figure, Table 1). Of these, 29
WPV importations originated from Nigeria, with
WPVs either imported directly or after
transmission through another country, resulting
in 68 polio cases. 3 WPV importations originated
from India, either imported directly or after
transmission through another country, resulting
in 28 cases. As of [24 Mar 2009], multiple
outbreaks resulting from importations were
ongoing. 3 regions of Africa were affected by
importations during 2008-2009: West Central
Africa, the Horn of Africa, and South Central Africa.

West Central Africa. During 2008-2009, increased
circulation of WPV1 in Nigeria resulted in WPV1
importations into 8 countries. WPV1 was imported
directly from Nigeria or indirectly through
neighboring countries into Benin, Burkina Faso,
Chad, Cote d'Ivoire, Ghana, Mali, Niger, and Togo
(Figure, Table 1). The number of reported polio
cases to date resulting from a single importation
event in West Central Africa during 2008-2009
ranged from one to 7 (Table 1). Niger reported 5
WPV1 and 5 WPV3 importation events originating
from Nigeria; of these, subsequent spread within
Niger was identified for 3 events. One WPV1
importation into Chad from Nigeria occurred in
2008. In addition, persistent circulation of WPV
imported into Chad and Niger from Nigeria before
2008 was detected during 2008-2009 (Table 2).

The Horn of Africa. During 2008, 2 WPV3
importations into western Sudan occurred. The
WPV3 in both cases originated from Nigeria and
transmitted through Chad, and resulted in 2
isolated polio cases with no evidence of further
spread (Table 1). Other cases occurred in the
Horn of Africa during 2008 that were traceable to
previous importations. In 2003, a WPV1
importation event originating in Nigeria caused
an outbreak of 51 polio cases in Chad.
Transmission was then imported to Sudan in
mid-2004, resulting in 147 polio cases in that
country during 2004-2005.**** Subsequent related
transmission occurred in 7 other countries
(Eritrea, Ethiopia, Indonesia, Kenya, Saudi
Arabia, Somalia, and Yemen) (2-4). The Sudan
outbreak subsided, and no additional related WPV1
polio cases attributable to the 2004 importation
into Sudan were detected until April 2008, after
which 53 additional cases were detected: 3 cases
in Ethiopia, 2 in northern Kenya, 5 in Uganda
(Table 1), and 43 in Sudan itself (Table 2).
Since 2004, a total of 190 polio cases in Sudan
have resulted from the 2004 importation (Table 2), despite multiple SIAs.

South Central Africa. 2 WPV1 importation events
and one WPV3 event in Angola, all originating
from India, resulted in WPV transmission during
2008-2009. An outbreak in Angola that followed
WPV1 importation in 2005 ended in 2007 with 19
confirmed cases but led to 58 cases in DRC during
2006-2008***** and 3 cases in the Central African
Republic in 2008 (Table 1). A 2nd WPV1
importation into Angola originating from northern
India was associated with 15 polio cases in
Angola during April 2007 - February 2009 (Table
2). A WPV3 importation, also originating from
northern India, resulted in 24 polio cases in
Angola and one case in DRC in 2008 (Figure, Table 1).

Vaccination Coverage
--------------------
Vaccination histories of children aged 6-59
months with acute flaccid paralysis (AFP) for
which specimen testing has not indicated WPV
infection (i.e., nonpolio AFP [NPAFP]) have been
used as a surrogate estimate of oral polio
vaccine (OPV) coverage with greater than or equal
to 3 total OPV doses of the overall target
population. The median percentage of coverage for
children aged 6-59 months with NPAFP in countries
affected by importations was 74 percent in 2008
(range: 54 percent - 90 percent) (Table 1) (2).

Timeliness of Detection and Response
------------------------------------
In the 15 countries with 32 importation events
during 2008-2009, the median interval from onset
of paralysis in the 1st identified case to
laboratory confirmation of polio was 31.5 days
(range: 10-61 days) (Table 1), substantially
lower than the median of 51 days reported during
2002-2005 polio resurgence (2). Similarly, the
median interval from laboratory confirmation to
1st large-scale vaccination response was 27.5
days (range: 1-91), lower than the median of 37
days reported during 2002-2005 (2). Response SIAs
in Africa in 2008 were synchronized among 12
countries. After detection in 2009 of new polio
cases in Kenya and Uganda, synchronized SIAs for
these and neighboring countries were conducted in
March and are planned again for April and May.

Persistent Transmission After Importation
-----------------------------------------
A total of 5 previously polio-free countries
(Angola, Chad, DRC, Niger, and Sudan) had WPV
importation events before 2008 that resulted in
persistent transmission for greater than or equal
to 12 months, extending into the period 2008-2009
(Table 2). As an indicator of weaker routine and
SIA vaccination in these 5 countries, the median
proportion of children aged 6-59 months with
NPAFP and a vaccination history of greater than
or equal to 3 total OPV doses during 2008 was 64
percent, compared with 75 percent for all other
countries with cases following importation during
2008-2009. Among these 5 countries, Angola, Chad,
and Sudan have been the source of multiple WPV
importations to neighboring countries and also
have reported polio cases in their own countries
since November 2008. Deficiencies in AFP
surveillance****** and SIA implementation in
certain subnational areas noted in technical
reviews have not been corrected in the three
countries. Efforts are under way to strengthen
AFP surveillance and to enhance SIA
implementation in these countries through
examination of operations by technical advisory
committees, improved oversight by international
consultants, and strengthened planning and
supervision of SIA and routine vaccination delivery.

Reported by: Global Polio Laboratory Network,
Polio Eradication Dept, World Health
Organization, Geneva, Switzerland. Div of Viral
Diseases, Global Immunization Div, National
Center for Immunization and Respiratory Diseases, CDC.

Editorial Note:
---------------
During January 2008 to March 2009, 4 countries in
Africa (Angola, Chad, Nigeria, and Sudan) were
the source of repeated WPV importation into other
countries on the continent. In Angola, Chad, and
Sudan, indigenous WPV circulation appeared
interrupted before 2002, but ongoing transmission
was reestablished during 2004-2008 after WPV
importation (2). In Angola, Chad, Nigeria, and
Sudan, health infrastructure is weak, routine
vaccination coverage in certain areas is low, and
multiple SIAs have failed to reach a substantial
proportion of children in critical locales
because of inadequate planning and
implementation. Angola, Chad, and Sudan all have
experienced civil war in recent years; Chad and
Sudan continued to have civil unrest during 2008-2009.

Nigeria has been the major reservoir of both WPV1
and WPV3 circulation for further spread in Africa
during 2008-2009 and of WPV1 during 2002-2006
(2-4). Indigenous WPV transmission has never been
interrupted in Nigeria. Chronically weak routine
vaccination and SIA implementation were
compounded during 2003-2004 by a decrease in
vaccine acceptance and an increase in WPV
transmission; during that period, misconceptions
about the safety of OPV led to loss of public
confidence and suspension of SIAs in some
northern states (8). The continuing polio
prevention challenge in Nigeria is being
addressed through a reinvigorated federal
government effort to engage local community
leadership and enhanced state and local
government oversight of SIA implementation (8).

During 2005-2008, Angola received WPV
importations on 3 occasions from India and was
the source of polio cases in the DRC during
2006-2008, the Central African Republic in 2008,
and Namibia in 2006 (1,9). The exact modes of WPV
transmission from India to Angola have not yet
been identified, but studies are under way to
determine what travel factors might be
associated. Although WPV3 is less commonly
associated with importation events than WPV1
(which is more likely to cause paralytic disease
and have a wide geographic spread), both
long-distance importation of WPV3 and
transmission across country borders occurred in Africa during 2008-2009.

The outbreaks associated with WPV importations
during 2008-2009 have tended to be smaller than
those observed during 2002-2005, when 47
importation events originating from Nigeria
affected 16 countries in Africa and resulted in
1335 polio cases (2). The fewer number of polio
cases resulting from the more recent importations
likely can be attributed to more timely
laboratory confirmation (2), more rapid
initiation of SIAs, and improved coverage with
OPV in the targeted population. A surrogate
indicator of OPV coverage is the percentage of
children aged 6-59 months with NPAFP who have
received greater than or equal to 3 total doses
of OPV; in the 15 countries affected by WPV
importation during 2008-2009, the median was 74
percent, (range: 54 percent - 90 percent) in 2008
compared with 55 percent (range: 31 percent - 83
percent) for these same countries in 2004.
Critical to early recognition of WPV importation
and timely response is a sensitive AFP
surveillance system that meets WHO performance
criteria at the lowest subnational level.

Early recognition and response to WPV
transmission limit the size of affected areas
within a country, and enable more rapid control
of an outbreak (10). SIAs are planned to continue
in these affected countries and neighboring areas
in 2009. WPV importations from reservoir
countries into polio-free areas will continue to
occur until transmission is interrupted globally.
The risk for importation is greatest for
countries adjacent to those countries where WPV
transmission continues; however, globalized
transportation and international migration pose a
risk for WPV reintroduction for all countries.
Recent findings of WPV in sewage samples in
Switzerland and Egypt, where no polio cases have
been detected since 1984 and 2004, respectively,
confirm that long-distance importations can occur
and that high levels of vaccination coverage
limit local transmission (5,6). All polio-free
countries are advised to maintain sensitive,
efficient AFP surveillance systems in all areas
to detect importations rapidly and to maintain
sufficient levels of immunity against
polioviruses through routine vaccination programs
or, where necessary, SIAs. National authorities
should prepare and update plans for timely,
large-scale, high-quality response SIAs should importations occur (10).

References
----------
1. CDC. Progress toward interruption of wild
poliovirus transmission-worldwide, January
2007-April 2008. MMWR 2008;57:489-94. [available
at <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5718a4.htm>]
2. CDC. Resurgence of wild poliovirus type 1
transmission and consequences of importation-21
countries, 2002-2005. MMWR 2006; 55:145-50.
[available at <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5506a1.htm>]
3. World Health Organization. Outbreak news.
Poliomyelitis, Ethiopia and Somalia. Wkly
Epidemiol Rec 2006;81:350.[available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5506a1.htm>]
4. World Health Organization. Outbreak news.
Poliomyelitis, Kenya. Wkly Epidemiol Rec
2006;81:410. [available at <http://www.who.int/wer/2006/wer8143.pdf>
5. CDC. Progress toward interruption of wild
poliovirus transmission-worldwide,
January-December 2008. MMWR 2009;58:308-12.
[available at <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5718a4.htm>]
6. CDC. Laboratory surveillance for wild and
vaccine-derived polioviruses-worldwide, January
2007-June 2008. MMWR 2008;57:967-70. [available
at <http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5735a2.htm>
7. Liu HM, Zheng DP, Zhang LB, Oberste MS,
Pallansch MA, Kew OM. Molecular evolution of a
type 1 wild-vaccine poliovirus recombinant during
widespread circulation in China. J Virol
2000;74:11153-61. [full article available at
<http://jvi.asm.org/cgi/reprint/74/23/11153>]
8. CDC. Progress toward poliomyelitis
eradication-Nigeria, January 2007-August 12,
2008. MMWR 2008;57:942-6. [available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5734a4.htm>]
9. CDC. Outbreak of polio in adults-Namibia,
2006. MMWR 2006;55:1198-201. [available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5544a3.htm>]
10. World Health Organization. Advisory
Committee on Polio Eradication-standing
recommendations for responding to circulating
polioviruses in polio-free areas. Wkly Epidemiol
Rec 2005;80:330-1. [available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5544a3.htm>]

* Countries with no evidence of indigenous WPV
transmission for greater than or equal to 1 year
and subsequent cases determined to be of external
origin by genomic sequencing analysis.

** Mass campaigns conducted for a brief period
(days to weeks), during which 1 dose of oral
poliovirus vaccine is administered to all
children aged less than 5 years, regardless of vaccination history.

*** The sequence of the complete VP1 coding
region is determined by using automated
cycle-sequencing procedures described previously
(7) and by comparing the resulting sequences with
those in a database of all recent poliovirus
isolates. The origins of virus importation are
then derived via phylogenetic analysis.

**** In Sudan during 2004-2005, transmission of
another chain of WPV1 accounted for 5 additional
polio cases, and a previously undetected lineage
of WPV3 accounted for 3 other polio cases.

***** Eighteen polio cases resulted from 3
separate WPV1 importations into DRC from Angola
during 2006-2007. A fourth importation of WPV1
into DRC resulted in 40 cases during December 2006-August 2008 (Table 2).

****** AFP surveillance quality is monitored by
performance indicators that suggest the ease by
which any WPV transmission will be detected. The
current World Health Organization (WHO) targets
are a NPAFP detection rate of greater than 2
cases per 100 000 population aged less than 15
years and adequate stool specimen collection from
greater than 80 percent of AFP cases, in which 2
specimens are collected greater than 24 hours
apart, both within 14 days of paralysis onset,
and shipped on ice or frozen ice packs to a
WHO-accredited laboratory, arriving in good
condition. National data might mask surveillance
system weaknesses at subnational levels.

FIGURE. Wild poliovirus (WPV) cases and
importation routes* - worldwide, 2008-2009. [see
URL link to the MMWR article for these figures]

Wild poliovirus (WPV) cases and importation routes* - worldwide, 2008-2009

* Importation routes (not each importation
event) indicated by arrows. Width of arrow
corresponds to number of importation events.
Genomic sequencing analysis identified Nigeria as
the country of WPV origin in 29 importation
events, and India in 3 events. Importations
across the Pakistan-Afghanistan border are not
included. Data as of 24 Mar 2009.

&#134; Countries with no evidence of indigenous WPV
transmission for greater than or equal to 1 year,
subsequent cases determined to be of external
origin, and reestablished transmission of WPV for
greater than or equal to 12 months.

TABLE 1. Importations of wild poliovirus (WPV)
type 1 and type 3 into 15 previously polio-free* countries - Africa, 2008-2009

Region/Country: Importation event&#134; by WPV type /
Onset date of 1st polio case / Onset date most
recent polio case / Most recent country of WPV
circulation by genomic sequencing / Number of
polio cases to date / Interval from onset date of
1st case to date of confirmation (days) /
Interval from confirmation to 1st large-scale
vaccination response (days)§ / Estimated OPV3
coverage during 2007 (percent)¶ / Surrogate OPV
coverage of overall target population during 2008 (percent)**

West Central Africa
===================
Benin:
------
WPV1 / 19 Mar 2008 / - / Nigeria / 1 / 35 / 26 / 64 / 53
WPV1 / 30 Jun 2008 / - / Nigeria / 1 / 37 / 2 / - / -
WPV1 / 3 Nov 2008 / 2 Nov 2009 / Nigeria / 6 / 43 / 73 / - / -
WPV3 / 1 Dec 2008 / - / Nigeria / 1 / 30 / 58

Burkina Faso:
-------------
WPV1 / 6 Jun 2008 / - / Nigeria / 1 / 49 / 91 / 99 / 64
WPV1 / 4 Nov 2008 / 15 Jan 2009 / Togo / 4 / 42 / 45 / - / -
WPV1 / 16 Nov 2008 / 25 Jan 2009 / Benin / 6 / 31 / 44 / - / -

Chad:
-----
WPV1 / 18 Nov 2008 / - / Nigeria / 1 / 45 / 62 / 36 / 45

Cote d'Ivoire:
--------------
WPV1 / 24 Dec 2008 / 11 Feb 2009 / Ghana / 2 / 35 / 30 / 75 / 24

Ghana:
------
WPV1 / 15 Sep 2008 / - / Burkina Faso / 1 / 29 / 2 / 94 / 41
WPV1 / 20 Sep 2008 / 8 Nov 2008 / Nigeria / 7 / 25 / 1 / - / -

Mali:
-----
WPV1 / 30 Aug 2008 / 4 Jan 2009 / Burkina Faso / 2 / 61 / 28 / 62 / 53

Niger:
------
WPV1 / 23 Jan 2008 / - / Nigeria / 1 / 24 / 7 / 55 / 68
WPV1 / 5 Jan 2008 / - / Nigeria / 1 / 23 / 26 / - / -
WPV1 / 25 Feb 2008 / 12 Apr 2008 / Nigeria / 2 / 37 / 38 / - / -
WPV1 / 11 Apr 2008 / - / Nigeria / 1 / 35 / 28 / - / -
WPV1 / 20 May 2008 / - / Nigeria / 1 / 45 / 14 / - / -
WPV3 / 10 Oct 2008 / - / Nigeria / 1 / 20 / 27 / - / -
WPV3 / 6 Dec 2008 / 17 Feb 2009 / Nigeria / 3 / 53 / 30 / - / -
WPV3 / 10 Dec 2008 / 5 Jan 2009 / Nigeria / 3 / 30 / 49 / - / -
WPV3 / 3 Jan 2009 / - / Nigeria / 1 / 41 / 14 / - / -
WPV3 / 2 Feb 2009 / - / Chad / 1 / 30 / 23 / - / -

Togo:
-----
WPV1 / 16 Oct 2008 / 3 Feb 2009 / Burkina Faso / 6 / 24 / 34 / 78 / 47
WPV1 / 26 Jan 2009 / 3 Feb 2009 / Ghana / 2 / 22 / 10 / - / -

Horn of Africa
==============
Ethiopia:
---------
WPV1 / 4 Apr 2008 / 27 Apr 2008 / Sudan / 3 / 32 / 29 / 71 / 25

Kenya:
------
WPV1 / 7 Feb 2009 / 8 Feb 2009 / Sudan / 2 / 10 / 19 / 76 / 28

Sudan:
------
WPV3 / 6 Jul 2008 / - / Chad / 1 / 24 / 26 / 84 / 83&#134;&#134;
WPV3 / 16 Dec 2008 / - / Chad / 1 / 30 / 32 / - / -

Uganda:
-------
WPV1 / 28 Jan 2009 / 18 Feb 2009 / Sudan / 5 / 34 / 5 / 59 / 35

South Central Africa
====================
Angola:
-------
WPV3 / 19 Mar 2008 / 17 Nov 2008 / India / 24 / 26 / 32 / 83 / 31

Central African Republic:
-------------------------
WPV1 / 6 Apr 2008 / 30 Dec 2008 / Democratic
Republic of the Congo / 3 / 15 / 15 / 47 / 34

Democratic Republic of the Congo:
---------------------------------
WPV3 / 18 Oct 2008 / - / Angola / 1 / 41 / 20 / 87 / 39

* Countries with no evidence of indigenous WPV
transmission for greater than or equal to 1 year
and subsequent cases determined to be of external
origin by genomic sequencing analysis.

&#134; Detection of one or more polio cases resulting
from WPV determined to be of external origin. Data as of [24 Mar 2009].

§ Where greater than or equal to 25 percent of
children were targeted for vaccination.

¶ World Health Organization/UNICEF estimate of
vaccination coverage with 3 doses of live,
attenuated oral polio vaccine (OPV3) by age 12
months, on the basis of country reports and most recent survey data.

** The percentage of children aged 6-59 months
with nonpolio acute flaccid paralysis (specimen
testing does not indicate WPV infection) who have
received greater than or equal to 3 doses of OPV;
these national data might mask vaccination
coverage weaknesses at subnational levels.

&#134;&#134; For Southern Sudan, 74 percent.

TABLE 2. Pre-2008 importations of wild poliovirus
(WPV) type 1 and type 3 with persistent
transmission periods (greater than or equal to 12
months) - 5 previously polio-free* countries, Africa, 2008-2009

Region/Country: Importation event&#134; by WPV type /
Onset date of 1st polio case / Onset date of most
recent polio case / Most recent country of WPV
circulation by genomic sequencing / Number of
resulting polio cases to date (number during
2008-2009) / Nonpolio acute flaccid paralysis
(NFAFP) rate per 100 000 population aged less
than 15 years, 2008§ / percent adequate specimen
collection, 2008¶ / Longest period between
detected WPV cases (mos) / No. of SIAs** conducted since WPV confirmation

West Central Africa
===================
Chad:
-----
WPV1 / 18 May 2007 / 13 Aug 2008 / Nigeria / 6 (1) / 3.8 / 84 / 15 / 7
WPV3&#134;&#134; / 15 Nov 2007 / 26 Dec 2008 / Nigeria / 28 (26) / 3 / 5 /

Niger:
------
WPV1 / 5 Mar 2007 / 2 Apr 2008 / Nigeria / 8 (2) / 4.9 / 84 / 6 / 8

Horn of Africa
==============
Sudan:
------
WPV1 / 20 May 2004 / 25 Feb 2009 / Chad / 190
(43) / 2.8 / 94 / 36 / greater than 20

South Central Africa
====================
Angola:
-------
WPV1 / 25 Apr 2007 / 4 Feb 2009 / India / 15 (5) / 3.7 / 94 / 6 / 12

Democratic Republic of the Congo:
---------------------------------
WPV1 / 17 Dec 2006 / 5 Aug 2008 / Angola / 40 (4) / 6.0 / 88 / 3 / 10

* Countries with no evidence of indigenous WPV
transmission for ?1 year and subsequent cases
determined to be of external origin by genomic sequencing analysis.

&#134; Detection of one or more polio cases resulting
from WPV determined to be of external origin. Data as of [24 Mar 2009].

§ The current World Health Organization (WHO)
operational target rate is greater than 2 cases
per 100 000 population aged less than 15 years;
these national data might mask vaccination
coverage weaknesses at subnational levels.

¶ The WHO target is adequate stool specimen
collection from greater than 80 percent of NFAFP
cases, in which 2 specimens are collected greater
than 24 hours apart, both within 14 days of
paralysis onset, and shipped on ice or frozen ice
packs to a WHO-accredited laboratory, arriving in
good condition; these national data might mask
vaccination coverage weaknesses at subnational levels.

** Supplementary immunization activities. These
are mass campaigns conducted for a brief period
(days to weeks), during which 1 dose of oral
poliovirus vaccine is administered to all
children aged less than 5 years, regardless of vaccination history.

&#134;&#134; An additional WPV3 importation event occurred
in Chad with origin in Nigeria and transmission
of nearly 12 months, resulting in 11 polio cases,
with onset of the 1st case on [27 Nov 2007], and
onset of the most recent case on [18 Nov 2008].

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

******
[2] Worldwide case count through 15 Apr 2009
Date: 15 Apr 2009
Source: Polio Eradication Web site [edited]
<http://www.polioeradication.org/casecount.asp>


Total cases: Year-to-date 2009 / Year-to-date 2008 / Total in 2008
- globally: 289 / 313 / 1659
- in endemic countries: 213 / 300 / 1513
- in non-endemic countries: 76 / 13 / 146

Case breakdown by country
Country: Year-to-date 2009 / Year-to-date 2008 /
Total in 2008 / Date of onset of most recent case
India: 28 / 186 / 559 / 25 Mar 2009
Nigeria: 171 / 106 / 806 / 24 Mar 2009
Sudan: 25 / 1 / 26 / 15 Mar 2009
Afghanistan: 5 / 5 / 31 / 2 Mar 2009
Niger: 10 / 5 / 12 / 1 Mar 2009
Ghana: 1 / 0 / 8 / 28 Feb 2009
Pakistan: 9 / 3 / 117 / 25 Feb 2009
Benin: 11 / 0 / 6 / 24 Feb 2009
Uganda: 7 / 0 / 0 / 21 Feb 2009
Kenya: 5 / 0 / 0 / 18 Feb 2009
Togo: 4 / 0 / 3 / 18 Feb 2009
Angola: 4 / 1 / 29 / 18 Feb 2009
Cote d'Ivoire: 1 / 0 / 1 / 11 Feb 2009
Burkina Faso: 6 / 0 / 6 / 10 Feb 2009
Democratic Republic of the Congo: 1 / 1 / 5 / 10 Feb 2009
Mali: 1 / 0 / 1 / 4 Jan 2009
Central African Republic: 0 / 0 / 3 / 30 Dec 2008
Chad: 0 / 2 / 37 / 26 Dec 2008
Nepal: 0 / 3 / 6 / 15 Oct 2008
Ethiopia: 0 / 0 / 3 / 27 Apr 2008

For monthly situation reports by country, see
<http://www.polioeradication.org/content ... sitrep.asp>.

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

[The MMWR report on the importations of wild
poliovirus (WPV) into the 15 African countries
that had previously interrupted transmission of
WPV is very sobering and serves as a reminder of
the continued risk of WPV transmission. While
there have clearly been signs of improvements in
programmatic activities surrounding polio
eradication (decreased mean time for laboratory
confirmation of suspected cases, and decreased
mean time from diagnosis of case to
implementation of vaccination activities), the
fact remains that there is continued circulation
of the WPV, and many of the countries, once
transmission of the WPV has been interrupted, do
not have the resources to sustain vaccination
coverages at the recommended 80 percent or greater.

From the most recent case count by country, one
sees that there have been 7 confirmed cases in
Uganda resulting from the importation from the
Sudan after 12 years without WPV transmission;
and there have been 5 confirmed cases in Kenya,
resulting from the importation from the Sudan,
following 20 years without WPV transmission in
the country (there were 2 imported cases from
Somalia in 2006) -- both incidents serving as a
reminder that there were pockets of susceptibles in each of the countries.

For a map of countries with wild poliovirus (WPV)
cases during the period 15 October 2008 through 14 Apr 2009, see
<http://www.polioeradication.org/content ... emap.shtml>. - Mod.MPP]

[Birgitt]

Indien - Poliomyelitis
11.05.2009

Trotz flächendeckender Impfkampagnen gehört Indien noch immer zu den vier Ländern mit endemischer Polio und steht mit den Fallzahlen weltweit nach Nigeria an zweiter Stelle. Bis Ende März wurden 40 Erkrankungen registriert. 2008 wurden 557 Erkrankungen gemeldet. Hygiene und Impfschutz beachten. / Quelle: crm

[Birgitt]

POLIOMYELITIS - WORLDWIDE (05)
*******************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

In this update:
[1] Kenya
[2] Worldwide update
[3] Religious objection to vaccination

******
[1] Kenya
Date: 20 May 2009
Source: The Standard [edited]
<http://www.eastandard.net/news/InsidePa ... 34&cid=159&>


Health experts have warned that the country is not safe from a fresh
outbreak of the debilitating disease. They also revealed that about
300 000 children are not vaccinated during routine immunisation.

UNICEF Chief of Health Sanjiv Kumar said yesterday [19 May 2009] that
in spite of rapid response and 2 rounds of anti-polio campaigns, the
virus was still circulating.

"The latest was detected on [19 Apr 2009], raising doubts on the
quality and coverage during the campaigns," said Dr Kumar.

Reported polio cases have risen from 2 in February [2008], to 8 in
March [2009] and now 13.

Speaking during the launch of the 3rd round of the polio immunisation
campaign at a city hotel yesterday [19 May 2009], Kumar expressed
concern that there was a downward trend in immunisation coverage.

He said 10 of 13 children diagnosed with the wild polio virus in
Turkana District had not been immunised. In February [2009], a polio
outbreak reported in the district left 13 children paralyzed.

UNICEF challenged the country to overcome the obstacles of
immunisation in the hard-to-reach areas, which are mainly susceptible
to disease importation.

Public Health and Sanitation Director Shahnaaz Sharif announced plans
to boost coverage of immunisation campaigns against polio.

Dr Sharif said vaccination sites would stay open on weekends and
public holidays. "The government is to blame for low immunisation
coverage, but when we ask people to bring their children they do not.
Everybody has a role to play to lock out polio," said Sharif.

He said the polio outbreak was due to low immunisation in Turkana
District and cross-border movement. The World Health Organization
(WHO) Head of Expanded Programme on Immunisation, Mohammed Duale,
urged the government to address the issue of vaccine stock.

WHO has reported that the wild polio virus in Kenya was exported from Sudan.

The government has identified 42 high-risk districts in Rift Valley,
Central and Nairobi provinces.

Health experts have expressed concern that the polio outbreak
threatens to undo the gains made since 1984.

The 1st polio cases reported early this year [2009] were of 2
children aged 2 and 4 respectively.

Three emergency campaigns a month after the other have been conducted
in Kenya, Uganda and Ethiopia to stem the spread.

Kenya faces increased risk of polio importation from its northern
neighbors, where new cases of polio resurgence have been reported.

[Byline: Elizabeth Mwai]

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

******
[2] Worldwide update
Date: 19 May 2009
Source: Polio Eradication Web site [edited]
<http://www.polioeradication.org/casecount.asp>


Total cases: Year-to-date 2009 / Year-to-date 2008 / Total in 2008
- globally: 436 / 453 / 1652
- in endemic countries: 318 / 432 / 1506
- in non-endemic countries: 118 / 21 / 146

Case breakdown by country
Country: Year-to-date 2009 / Year-to-date 2008 / Total in 2008 / Date
of onset of most recent case

Central African Republic: 2 / 1 / 3 / 3 May 2009
India: 43 / 229 / 559 / 29 Apr 2009
Nigeria: 256 / 187 / 799 / 24 Apr 2009
Pakistan: 12 / 9 / 117 / 21 Apr 2009
Afghanistan: 7 / 7 / 31 / 19 Apr 2009
Kenya: 11 / 0 / 0 / 12 Apr 2009
Angola: 6 / 5 / 29 / 11 Apr 2009
Guinea: 1 / 0 / 0 / 9 Apr 2009
Cote d'Ivoire: 10 / 0 / 1 / 6 Apr 2009
Sudan: 33 / 1 / 26 / 4 Apr 2009
Chad: 1 / 2 / 37 / 1 Apr 2009
Togo: 6 / 0 / 3 / 28 Mar 2009
Benin: 17 / 0 / 6 / 25 Mar 2009
Niger: 13 / 6 / 12 / 23 Mar 2009
Burkina Faso: 9 / 0 / 6 / 16 Mar 2009
Uganda: 7 / 0 / 0 / 21 Feb 2009
Democratic Republic of the Congo: 1 / 2 / 5 / 10 Feb 2009
Mali: 1 / 0 / 1 / 4 Jan 2009
Ghana: 0 / 0 / 8 / 8 Nov 2008
Nepal: 0 / 3 / 6 / 15 Oct 2008
Ethiopia: 0 / 1 / 3 / 27 Apr 2008

For monthly situation reports by country, see
<http://www.polioeradication.org/content ... sitrep.asp>.

Weekly summaries as of 19 May 2009

Endemic countries
------------
Afghanistan
* No new cases were reported this week. Afghanistan has reported 7
cases in 2009, all of them wild poliovirus type 1 (WPV1). The most
recent case, from Kandahar province, had onset of paralysis on [19 Apr 2009].
* The next National Immunization Days (NIDs) are planned for [23-25
May 2009], using trivalent oral polio vaccine (tOPV). Further
sub-national immunization days are planned for [21-23 Jun 2009] in
selected southern districts, using monovalent oral polio vaccine type
1 (mOPV1).

India
* Three new cases were reported in the past week: one WPV1 (in
Bihar's Saharsa district, with onset of paralysis on [20 Apr 2009])
and 2 WPV3 cases, in the Badaun and Rampur districts of Uttar
Pradesh. The most recent case (WPV3 case in Badaun, UP) had onset of
paralysis on [29 Apr 2009].
* The next large-scale SNIDs across UP, Bihar and key high-risk and
re-infected areas are proposed for [24-29 May 2009], using mOPV1.
* The total number of cases for 2009 is now 43, compared to 229 at
this time last year [2008].

Nigeria
* 13 new cases were reported in the past week: One WPV1 case in
Talata-mafara, Zamfara, with onset of paralysis on [20 Apr 2009], and
12 WPV3 cases, 4 of which were from Bauchi state.
* The total number of cases for 2009 is now 256, of which 190 cases
are WPV3, 65 of which are type 1, and one is a type 1/3 mixture. The
most recent case had onset of paralysis on [24 Apr 2009] (WPV3 in
Zaria in Kaduna state).
* The next nationwide Immunization Plus Days (IPDs) will be held
from [30 May 200 -2 Jun 2009], using trivalent OPV (tOPV).

Pakistan
* Up to 1 million people are now internally displaced (IDPs) in
Pakistan due to the ongoing military conflict in North West Frontier
Province (NWFP), and the polio program is responding in earnest. Nine
transit teams have now immunized more than 17 850 children aged under
5 on the 3 main transit routes out of the conflict zone. More than 87
000 people are currently living in the 26 IDP camps now established
in NWFP, and mobile immunization teams have immunized more than 6890
children by going tent to tent in the camps. With 868 936 IDPs, or 91
percent of the total displaced population registered as currently
living with host families such as friends or family, it is critical
that the upcoming NIDs planned for [28-30 May 2009], targeting 33
million children using trivalent OPV (tOPV), is of exceptional
quality. Special training is being given to the teams covering
communities hosting IDPs to ensure that as many IDP children as
possible, many of whom have not been immunized against polio since
August 2008 due to the poor security situation, are reached.
* No new cases were reported in the past week. The total number of
cases for 2009 remains 12. The most recent case (WPV1 case in Multan
in Punjab) had onset of paralysis on [21 Apr 2009].
* NIDs will be held from [28-30 May 2009], distributing tOPV and
Vitamin A. A sub-national immunization round (SNID) is subsequently
planned in selected districts from [22-24 Jun 2009] using mOPV1.

Importation countries
-----------
Angola
* Two new cases were reported in the past week, both WPV1, one each
in Benguela and Luanda provinces. The Luanda case is the most recent,
with onset of paralysis on [11 Apr 2009]. The total number of cases
for 2009 is now 6 (all WPV1).
* While no cases of WPV3 have been reported, the detection of 2
WPV3 cases in October 2008 and February 2009 in the southern
Democratic Republic of Congo (DRC), closely related to the Angolan
outbreak (last case in Namibe Province in November 2008) suggests
that transmission of this serotype continues in Angola.
* The Benguela case has been covered by one Sub-National
Immunization Day (SNID). The Luanda case will be covered by NIDs
planned for June [2009] (in conjunction with a measles campaign),
July and August [2009], with tOPV.

Central African Republic (CAR)
* One new case was reported in the past week, a WPV3 case from
Ouham, RS3, with onset of paralysis on [3 May 2009]. The total number
of cases for 2009 is now 2.
* No WPV1 has been reported in the country since [30 Dec 2008].
* National Child Health Days will be held from [23-29 May 2009],
with tOPV administered. An NID is planned for the end of June [2009].

Chad
* No new cases were reported in the past week, meaning the WPV3
case from Chari-Baguirmi remains the only recorded case of 2009, with
onset of paralysis on [1 Apr 2009].
* A staggered, nationwide campaign using tOPV concluded on [17 May 2009].
* A further sub-national round is planned for the southwest from
[19-21 Jun 2009], using mOPV3, with NIDs using tOPV planned for
October and November [2009].

Democratic Republic of the Congo (DRC)
* No new cases were reported in the past week. The total number of
cases for 2009 remains one (WPV3 from Kasai Occidental in February 2009).
* DRC held a SNID on [7 May 2009], with further SNIDs planned for
[4 Jun 2009] and [9 Jul 2009], using a mix of mOPV1, mOPV3 and
trivalent OPV, depending on the risk and circumstances.
* DRC has not had a WPV1 case since August 2008.

Horn of Africa
* No new cases were reported in the past week, meaning the total
number of cases in the Horn of Africa for 2009 remains 51. The most
recent case had onset of paralysis on [12 Apr 2009] (WPV1 from
Turkana South, Rift Valley, Kenya).
* The major risks associated with this outbreak are ongoing
transmission and further geographic spread within the affected
countries into the high transmission season; spread from southern
Sudan or northern Uganda further westward into northeastern DRC or
CAR, and further spread eastward, particularly to Somalia and Yemen.
* To minimize these risks, outbreak response activities were
conducted in Sudan (using mOPV1 in southern Sudan and tOPV/mOPV1 in
the north) on [27-29 Apr 2009], with further activities planned for
[25 May 2009]. In Uganda, a NID (in conjunction with a measles
campaign) using tOPV is to be held from [6-8 Jun 2009]. Kenya has
planned SNIDs from [23 May 2009]. Both Uganda and Kenya also have
plans for the addition of OPV to nationwide measles activities during
the course of 2009. Ethiopia has plans for SIAs in high-risk areas
for [22-25 May 2009] and [28 Jun 2009-1 Jul 2009]. Yemen is currently
preparing plans for at least one NID in June 2009. Eritrea held an
SIA on [6 May 2009], its 1st since December 2005, using tOPV. Somalia
held an NID on [11 May 2009], while Djibouti is planning an SIA for
June [2009].

West Africa
* One new case was reported in Guinea, the 1st case in that country
since 2004, a WPV1 case in Beyla district, Nzerekore, with onset of
paralysis on [9 Apr 2009].
* The total number of cases in west Africa for 2009 is now 57 from
7 countries (Benin, Burkina Faso, Cote d'Ivoire, Mali, Niger, Togo
and Guinea). The most recent is the Guinea case.
* A coordinated 11-country immunization activity will be held from
[29 May-2 Jun 2009] encompassing 8 infected countries (Nigeria,
Benin, Burkina Faso, Cote d'Ivoire, Ghana, Mali, Niger and Togo) and
2 at-risk countries (Liberia and Sierra Leone) using mOPV1, tOPV or
mOPV3, depending on the risk and circumstances.
* Following these rounds, any transmission in west Africa will be
responded to by large-scale mop-ups with monovalent OPV.

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

******
[3] Religious objection to vaccination
Date: 21 May 2009
Source: Emerging Infectious Diseases [edited]
<http://www.cdc.gov/eid/content/15/6/978a.htm>


Religious Opposition to Polio Vaccination. Author: Haider J.
Warraich, Aga Khan University Medical College, Karachi, Pakistan
Warraich HJ. Religious opposition to polio vaccination [letter].
Emerg Infect Dis. 2009 Jun. Available from
<http://www.cdc.gov/EID/content/15/6/978a.htm>.

To the Editor: In 1988, the Global Polio Eradication Initiative was
formed, with the aim of reducing infection with poliomyelitis virus.
Two decades later in 2008, a total of 1625 children contracted acute
flaccid paralysis caused by poliovirus infection (1). This finding
represented a 150 percent increase over the number of cases in 2007
(1) and resulted in the reemergence of polio as one of the world's
deadliest infections. As of 2009, polio remains endemic to 4
countries (India, Nigeria, Pakistan, and Afghanistan); in 2008, cases
were also detected in 14 other countries.

Religious opposition by Muslim fundamentalists is a major factor in
the failure of immunization programs against polio in Nigeria (2),
Pakistan (3) and Afghanistan (4). This religious conflict in the
tribal areas of Pakistan is one of the biggest hindrances to
effective polio vaccination. Epidemiologists have detected
transmission of wild poliovirus from polio-endemic districts in
Afghanistan, most of which are located in the southern region of this
country bordering Pakistan, to tribal areas of Pakistan (4). This
transmission has resulted in new cases of polio in previously
polio-free districts. The local Taliban have issued fatwas denouncing
vaccination as an American ploy to sterilize Muslim populations.
Another common superstition spread by extremists is that vaccination
is an attempt to avert the will of Allah. The Taliban have
assassinated vaccination officials, including Abdul Ghani Marwat, who
was the head of the government's vaccination campaign in Bajaur
Agency in the Pakistani tribal areas, on his way back from meeting a
religious cleric (5). Over the past year, several kidnappings and
beatings of vaccinators have been reported. Vaccination campaigns in
Nigeria and Afghanistan have also been hampered by Islamic
extremists, especially in the Nigerian province of Kano in 2003,
which has resulted in the infection returning to 8 previously
polio-free countries in Africa (2).

Before the Global Polio Eradication Initiative in 1988, a total of
1000 persons/day were infected with a virus that would cripple them
for the rest of their lives (6). To eradicate the disease, one major
factor will be to gain support of those susceptible to fundamentalist
propaganda. Islam is a progressive religion, and religious leaders
should be asked to support polio eradication programs. The Imam of
the Ka'aba and other influential religious figures should be asked to
highlight the plight of children with polio. Vaccinators operating in
conflict-ridden areas should be provided protection so that they are
better able to perform their duties. Not only will children in these
areas be safer, but the disease will not be exported to areas where
wild polio transmission has been interrupted by vaccination. Further
study of the attitudes of Muslim populations toward vaccination is needed.

References
1. World Health Organization. Wild poliovirus weekly update. 2009 Jan
14 [cited 2009 Jan 17]. Available from
<http://www.polioeradication.org/casecount.asp>.
2. Kapp C. Surge in polio spreads alarm in northern Nigeria. Rumours
about vaccine safety in Muslim-run states threaten WHO's eradication
programme. Lancet. 2003;362:1631-2.
3. Ahmad K. Pakistan struggles to eradicate polio. Lancet Infect Dis.
2007;7:247.
4. Centers for Disease Control and Prevention. Resurgence of wild
poliovirus type 1 transmission and consequences of importation 21
countries, 2002-2005. MMWR Morb Mortal Wkly Rep. 2006;55:145-50, available at
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5516a5.htm>.
5. Daily Times. Health workers boycott polio vaccination in Bajaur
Agency. 2007 Feb 20 [cited 2009 Jan 17]. Available from
<http://www.dailytimes.com.pk/default.as ... 007_pg7_29>.
6. Cochi SL, Kew O. Polio today: are we on the verge of global
eradication? JAMA. 2008;300:839-41, available at
<http://jama.ama-assn.org/cgi/content/full/300/7/839>.

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

[Since the last polio update on 17 Apr 2009 (see ProMED-mail prior
posting Poliomyelitis - Worldwide (04): Importations Africa
20090417.1454), cases have continued to occur in both West Africa and
the Horn of Africa, with countries newly reporting cases, including
Chad, Central African Republic and Guinea. For Guinea, it reported
its 1st WPV-associated disease since 2004, and according to
newswires, Kenya has confirmed 2 additional cases in the past few
days (since the closure of this week's official report on 19 May 2009).

The letter to the editor of the Emerging Infectious Disease Journal
discussing the challenges facing the polio eradication effort is
timely. The challenges related to vaccination acceptance in Northern
Nigeria have gone on since 2004, and countries are continuing to be
re-infected after having successfully interrupted wild poliovirus
circulation. If one reviews the current status of the eradication
efforts, of the 4 countries with uninterrupted circulation of WPV
(endemic countries), 3 of the 4 countries are those very areas to
which the letter to the editor refers, a challenge facing the
eradication effort. - Mod.MPP]

[Birgitt]

POLIOMYELITIS - WORLDWIDE (06): UGANDA
**************************************
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] Uganda - Moyo district
[2] Uganda - Pader district
[3] Worldwide update

******
[1] Uganda - Moyo district
Date: 29 May 2009
Source: New Vision [edited]
<http://www.newvision.co.ug/D/8/13/683002>


A new case of the polio virus has been confirmed in a 2-year-old child
in Moyo district.

The district disease surveillance officer, Simon Amudra, said the case
was confirmed on Thursday [28 May 2009] after tests in Entebbe.

Amudra said the victim's mother used to commute from Moyo to Nimule
[Sudan] for trade, where the child was suspected to have contracted
the deadly virus.

"Two other suspected cases have been registered in Moyo and Itula
sub-counties, though not yet confirmed," he said.

The 1st case, that was confirmed in Amuru district after the declaring
of Uganda free of polio, was also suspected to have been contracted
from Sudan.

Since then, the ministry of health has carried a sub-national massive
immunisation against a further spread of the disease in Uganda.

Dufile and Moyo sub-counties share the international boundaries of
Uganda and Sudan.

[Byline: Dradenya Amazia]

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

******
[2] Uganda - Pader district
Date: 31 May 2009
Source: New Vision [edited]
<http://www.newvision.co.ug/D/8/16/683186>


A case of polio has been confirmed in Pader district ahead of the 2nd
round of the national polio immunisation this month [May 2009].

The disease surveillance officer, Alfred Okidi, said the case was
found at Atanga sub-county in Aruu county. "A 2-and-a-half-year old
child at Lacekocot is infected with the wild polio virus type one," he
said. "We are still investigating another case in the same
sub-county," Okidi told journalists in Pader on Thursday [28 May
2009]. Okidi said the disease outbreak could have been due to the low
polio immunisation coverage when it was last carried out in the
district. He urged residents in the district to safeguard against the
spread of the disease by practicing good hygiene.

Pader resident district commissioner Santo Okot Lapolo asked parents
to take their children aged below 5 for the next immunisation exercise
scheduled for [6 to 9 Jun 2009].

"We want to eradicate polio from our area so that in the next few
years, we don't have representatives of people with disabilities in
the district councils and Parliament due to polio," Lapolo said.

[Byline: Cornes Lubangakene]

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

******
[3] Worldwide update
Date: 27 May 2009
Source: Polio Eradication Website [edited]
<http://www.polioeradication.org/casecount.asp>


Total cases: Year-to-date 2009 / Year-to-date 2008 / Total in 2008
Globally: 474 / 493 / 1652
- in endemic countries: 349 / 469 / 1506
- in non-endemic countries: 125 / 24 / 146

Case breakdown by country
Country: Year-to-date 2009 / Year-to-date 2008 / Total in 2008 / Date
of onset most recent case
India: 49 / 240 / 559 / 7 May 2009
Pakistan: 17 / 9 / 117 / 6 May 2009
Central African Republic (CAR): 4 / 1 / 3 / 3 May 2009
Nigeria: 276 / 213 / 799 / 24 Apr 2009
Sudan: 34 / 1 / 26 / 20 Apr 2009
Afghanistan: 7 / 7 / 31 / 19 Apr 2009
Kenya: 10 / 0 / 0 / 12 Apr 2009
Cote d'Ivoire: 12 / 0 / 1 / 12 Apr 2009
Angola: 6 / 5 / 29 / 11 Apr 2009
Guinea: 1 / 0 / 0 / 9 Apr 2009
Benin: 19 / 0 / 6 / 9 Apr 2009
Burkina Faso: 10 / 0 / 6 / 2 Apr 2009
Chad: 1/ 2 / 37 / 1 Apr 2009
Togo: 6 / 0 / 3 / 28 Mar 2009
Niger: 13 / 9 / 12 / 23 Mar 2009
Uganda: 7 / 0 / 0 / 21 Feb 2009
Democratic Republic of Congo (DRC): 1 / 2 / 5 / 10 Feb 2009
Mali: 1 / 0 / 1 / 4 Jan 2009
Ghana: 0 / 0 / 8 / 8 Nov 2008
Nepal: 0 / 3 / 6 / 15 Oct 2008
Ethiopia: 0 / 1 / 3 / 27 Apr 2008

Headlines
* From 29-31 May [2009], 11 countries across west Africa will
conduct a synchronized cross-border immunization campaign, comprising
Benin, Burkina Faso, Cote d'Ivoire, Ghana, Guinea, Liberia, Mali,
Niger, Sierra Leone, Togo, as well as Nigeria (the only endemic
country in the region). More than 400 000 volunteers and health
workers will aim to deliver nearly 90 million doses of oral polio
vaccine (OPV) to more than 74 million children under the age of 5
years. This is the 3rd such activity in 2009, following similar
campaigns in February and March [2009].
* Pakistan continues to vaccinate all available children in the
growing IDP [internally displaced persons] emergency. For details, see
Pakistan section.
* The Organisation of the Islamic Conference (OIC) Council of
Foreign Ministers' meeting in Damascus last week has urged the OIC to
work more closely with and provide further assistance to the GPEI
[Global Polio Eradication Initiative] in the last remaining
polio-endemic countries.

Endemic countries:
Afghanistan
* No new cases were reported this week. Afghanistan has reported 7
cases in 2009, all of them wild poliovirus type 1 (WPV1). The most
recent case, from Kandahar province, had onset of paralysis on [19 Apr
2009].
* National Immunization Days (NIDs) were held from [23-25 May 2009]
using trivalent oral polio vaccine (tOPV); however, initial monitoring
reports suggest immunization teams continued to be obstructed by
anti-government forces in some key southern areas, with 196 000
children missed as a result.
* Further sub-national immunization days are planned for [21-23 Jun
2009] in selected southern districts using monovalent oral polio
vaccine type 1 (mOPV1).

India
* Six new cases were reported in the past week, one WPV1, in JP
Nagar, Uttar Pradesh (UP) and 5 WPV3s (in the UP districts of Badaun,
Aligarh, Moradabad and Shahjahanpur). The most recent case (WPV3 from
Badaun, UP) had onset of paralysis on [7 May 2009].
* Large-scale SNIDs [SubNational Immunization Days] across UP, Bihar
and key high-risk and re-infected areas are currently being held using
mOPV1. The next SIA, to be held from [28 Jun 2009], is currently being
planned.
* The total number of cases for 2009 is now 49, compared to 240 at
this time last year [2008].

Nigeria
* 20 new cases were reported in the past week: one WPV1 case in
Asari Toru, Rivers state, with onset of paralysis on [29 Mar 2009],
and 19 WPV3 cases, of which 9 were from Kano state and 4 from Yobe.
* The total number of cases for 2009 is now 276, of which 209 cases
are WPV3, 66 of which are type 1, and one is a type 1/3 mixture. The
most recent case had onset of paralysis on [24 Apr 2009] (WPV3 in
Zaria in Kaduna state).
* The next nationwide Immunization Plus Days (IPDs) will be held
from [30 May-2 Jun 2009] using trivalent OPV (tOPV). In conjunction
with the new IPD [Immunization Preventible Diseases] Guidelines,
extensive preparations by all partners have been made for this
upcoming immunization round. For the 1st time, independent monitors
trained by WHO will be in place to verify micro-plans, while in most
high-risk states, governors are committed to ensuring a high-quality
campaign.

Pakistan
* With more than 2.38 million people now internally displaced (IDPs)
in Pakistan due to the ongoing military conflict in North West
Frontier Province (NWFP); this is now the largest IDP crisis
worldwide. The polio program has been immunizing children on main
transit routes or in IDP camps; as of [26 May 2009], 71 671 children
under 5 years of age had been vaccinated. Currently, more than 200 000
people are living in the 26 IDP camps established in NWFP, meaning
more than 90 percent of IDPs, or 2.1 million, are housed with host
families or, increasingly, schools and other public buildings. As a
result, emergency outreach immunization sessions are currently being
planned to vaccinate and register these children.
* Five new cases were reported in the past week: 4 WPV1, one each in
NWFP, Balochistan, Punjab and Sindh, and one WPV3, in Bajour, NWFP.
This WPV3 case is the most recent, with onset of paralysis on [6 May
2009]. The total number of cases for 2009 is now 17.
* NIDs will be held from [28-30 May 2009] distributing tOPV and
Vitamin A. A sub-national immunization round (SNID) is subsequently
planned in selected districts from [22-24 Jun 2009] using mOPV1.

Importation countries:
Angola
* No new cases were reported in the past week. The most recent case
(WPV1 from Luanda province had onset of paralysis on [11 Apr 2009]).
The total number of cases for 2009 is 6 (all WPV1).
* While no cases of WPV3 have been reported, the detection of 2 WPV3
cases in October 2008 and February 2009 in the southern Democratic
Republic of Congo (DRC) closely related to the Angolan outbreak (last
case in Namibe Province in November 2008) suggests that transmission
of this serotype continues in Angola.
* The Benguela cases have been covered by one Sub-National
Immunization Day (SNID). The Luanda case will be covered by NIDs
planned for [15-28 Jun 2009] (in conjunction with a measles campaign),
July and August [2009] with tOPV.

Central African Republic (CAR)
* Two new cases were reported in the past week, both WPV3 cases from
Ouham Pende, RS3, the same state that reported a case last week. Last
week's case remains the most recent, with onset of paralysis on [3 May
2009]. The total number of cases for 2009 is now 4.
* No WPV1 has been reported in the country since [30 Dec 2008].
* National Child Health Days were held from [23-25 May 2009]
administering tOPV. An NID is planned for the end of June [2009], most
likely using mOPV3.

Chad
* No new cases were reported in the past week, meaning the WPV3 case
from Chari-Baguirmi remains the only recorded case of 2009, with onset
of paralysis on [1 Apr 2009].
* A staggered, nationwide campaign using tOPV and mOPV1 was
completed on [15-17 May 2009].
* A further sub-national round is planned for the southwest from
[19-21 Jun 2009], immunizing 1.27 million children with mOPV3, with
NIDs using tOPV planned for October and November [2009].

Democratic Republic of the Congo (DRC)
* No new cases were reported in the past week. The total number of
cases for 2009 remains one (WPV3 from Kasai Occidental in February
[2009]).
* DRC held a SNID on [7 May 2009], with further SNIDs planned for [4
Jun 2009] and [9 Jul 2009] using a mix of mOPV1, mOPV3 and trivalent
OPV, depending on the risk and circumstances.
* DRC has not had a WPV1 case since August 2008.

Horn of Africa
* One new case was reported in Sudan this week, a WPV1 in Magwi,
Eastern Equatoria. This is the most recent case on the Horn of Africa,
with onset of paralysis on [20 Apr 2009]. The total number of cases in
the Horn of Africa for 2009 is now 51.
* The major risks associated with this outbreak are ongoing
transmission and further geographic spread within the affected
countries into the high transmission season; spread from southern
Sudan or northern Uganda further westward into northeastern DRC or
CAR, and further spread eastward, particularly to Somalia and Yemen.
* To minimize these risks, outbreak response activities were
conducted in Sudan (using mOPV1 in southern Sudan and tOPV/mOPV1 in
the north) on [27-29 Apr 2009], with further activities held in
southern Sudan on [26 May 2009] and a further round potentially to be
held in late June [2009].
* In Uganda, a NID (in conjunction with a measles campaign) using
tOPV is to be held from [6-8 Jun 2009]. Kenya held SNIDs from [23-27
May 2009] in key districts along the Rift Valley using mOPV1, with
another round planned for the end of June [2009]. Both Uganda and
Kenya also have plans for the addition of OPV to nationwide measles
activities during the course of 2009.
* Ethiopia held an SIA [supplementary immunization activity] in
high-risk areas from [22-25 May 2009] using mOPV1 and tOPV, with
another round planned in the Somali Region from [15 Jun 2009 and
mid-July 2009]. Eritrea held an SIA on [6 May 2009], its 1st since
December 2005, using tOPV; Somalia held an NID on [25 May 2009], while
Djibouti is planning an SIA for June [2009].
* Yemen is currently preparing plans for at least one NID in June 2009.

West Africa
* Two new cases were reported in Cote d'Ivoire in the past week,
both WPV1, from Bas Sassandra and Lagunes 2, with onset of paralysis
on [11 and 12 Apr 2009], respectively.
* Two new cases were reported in Benin this past week, both WPV1,
one each in Borgou and Zou, both with onset of paralysis in early
April [2009].
* And one new case was reported in Burkina Faso, a WPV1 in
Tenkodogo, with onset of paralysis on [2 Apr 2009].
* The total number of cases in west Africa for 2009 is now 62 from 7
countries (Benin, Burkina Faso, Cote d'Ivoire, Mali, Niger, Togo and
Guinea).
* A coordinated 11-country immunization activity will be held from
[29 May-2 Jun 2009], encompassing 9 infected countries (Nigeria,
Benin, Burkina Faso, Cote d'Ivoire, Ghana, Mali, Niger, Togo and
Guinea) and 2 at-risk countries (Liberia and Sierra Leone), using
mOPV1, tOPV or mOPV3, depending on the risk and circumstances. A
further immunization activity will be held in Guinea -- probably in
conjunction with several neighboring countries -- in late June [2008].
* Following these rounds, any transmission in west Africa will be
responded to by large-scale mop-ups with monovalent OPV.

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

[To further highlight the challenges faced by the polio eradication
initiative, the multicountry West African initiative scheduled for 29
May through 2 Jun 2009 was cancelled in Benin, due to a strike of the
health sector (see
<http://www.reliefweb.int/rw/rwb.nsf/db9 ... enDocument>
for details).

In the previous ProMED-mail polio update (Poliomyelitis - worldwide
(05) 20090521.1905), there was a newswire report of 13 cases in Kenya.
From the above information in the global polio case count from the
Polio Eradication Initiative website, the total number of cases
reported from Kenya is 10. It is unclear whether there is just a
reporting lag or the newswire in the earlier posting was erroneous.

The above newswire reports of 2 confirmed polio cases in different
districts in Uganda are disturbing, especially in the face of having
completed one NID and on the cusp of a 2nd NID, suggesting there
remain pockets of susceptibles in the country.

For a map of Uganda with districts, see
<http://www.lib.utexas.edu/maps/africa/u ... l_2005.jpg>. Moyo
district borders Sudan, and Pader district is to the west of Moyo
district, but one district to the south of the border with Sudan, and
one district to the west of the border with Kenya.

For the interactive HealthMap/ProMED-mail map, see
<http://healthmap.org/r/0089>.
- Mod.MPP]

[Birgitt]

Polio in Nigeria
17.07.2009 - WHO

In 2009, the northern states of Nigeria have experienced a large polio outbreak due to wild poliovirus type 3 (WPV3) with 258 cases, compared to 32 cases for the same period in 2008. WPV3 from northern Nigeria has this year spread internationally to Niger. Since February 2009, there has also been an increasing number of polio cases due to a type 2 circulating vaccine-derived poliovirus (cVDPV2) in northern Nigeria (103 cases to date in 2009 compared to 31 cases for the same period in 2008). Both serotypes are at continued, and in the case of the cVDPV2 increasing, risk of international spread. While the number of cVDPV2 cases is lower than WPV3 cases, circulation of this serotype is of particular international concern as the last case of polio due to a circulating wild poliovirus type 2 (WPV2) was in 1999.

In response to these risks, Nigeria has conducted nationwide polio supplementary immunization activities (SIAs) with monovalent OPV type 3 (mOPV3) in late January 2009 and with trivalent OPV from 30 May to 2 June. Additional SIAs are planned for later in the year, including an SIA with trivalent OPV for August.

To minimize the risk and consequences of international spread of these polioviruses, countries across west and central Africa, particularly those bordering the affected states of northern Nigeria, should enhance surveillance for acute flaccid paralysis (AFP), identify subnational population immunity gaps, and strengthen routine immunization with trivalent OPV. Countries affected by poliovirus importations should continue to supplement routine immunization with large-scale outbreak response activities with the relevant OPV, as per the WHA Resolution WHA59.1.

[Alexander]

Ausrottung der Kinderlähmung

Warum die Ausrottung der Kinderlähmung in Afrika scheitert

Der globale Kampf gegen Infektionskrankheiten ist keineswegs nur die Domäne von Mikrobiologen und Pharmakologen. Wichtiger als potente Impfstoffe und Antibiotika sind mitunter diplomatisches Feingefühl und der Wille, ein Projekt optimal anzugehen. In dieser Hinsicht hapert es bei einem der weltweit größten Impfprogramme – dem Versuch, die Kinderlähmung (Polio) endlich auszurotten. mehr...

Grüsse
Alexander

[Birgitt]

Indien - Poliomyelitis
07.09.2009

Trotz flächendeckender Impfkampagnen gehört Indien noch immer zu den vier Ländern mit endemischer Polio und steht mit den Fallzahlen weltweit nach Nigeria an zweiter Stelle. Bis Ende August wurden 260 Erkrankungen registriert. 2008 wurden 557 Erkrankungen gemeldet. Hygiene und Impfschutz beachten. / Quelle: crm
_________________________

Nigeria - Poliomyelitis
07.09.2009

Nachdem die Fallzahlen 2007 im Vergleich zu 2006 zurückgegangen waren, stiegen die Neuerkrankungen 2008 auf 798 an. In diesem Jahr wurden bisher 372 Fälle registriert. Damit steht Nigeria weltweit weiterhin an der Spitze. Nach neueren Untersuchungen gibt es in den nördlichen Bundesstaaten noch immer Schlüsselregionen mit hohem Risiko, in denen 20% der Kinder nicht geimpft sind. Impfschutz bei Reisen weiterhin beachten. / Quelle: crm

[Birgitt]

Indien - Poliomyelitis
19.10.2009

Trotz flächendeckender Impfkampagnen gehört Indien noch immer zu den vier Ländern mit endemischer Polio und steht mit den Fallzahlen weltweit nach Nigeria an zweiter Stelle. Bis Ende September wurden 431 Erkrankungen registriert. 2008 wurden 559 Erkrankungen gemeldet. Hygiene und Impfschutz beachten. / Quelle: crm

[Birgitt]

Fatale Angst vor der Polio-Impfung
28.10.2009 - Deutsche Welle

Die unheilbare Viruserkrankung Polio, die Kinderlähmung, sollte längst ausgerottet sein. In einigen Ländern wie Nigeria erkranken jährlich aber immer noch hunderte Kinder. Viele haben Angst vor einer Impfung. Zu Recht? ... mehr

Gruß
Birgitt

[Birgitt]

POLIOMYELITIS - WORLDWIDE (07): BURUNDI, PAKISTAN
*************************************************
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] Burundi
Date: Wed 28 Oct 2009
Source: IRIN [edited]
<http://www.irinnews.org/Report.aspx?ReportId=86780>


Burundi health officials act to check polio
-------------------------------------------
Following 2 reported cases of polio in Burundi's northwestern province
of Cibitoke, the Health Ministry and the World Health Organization
(WHO) have begun a 3-day immunization campaign, targeting at least 1.5
million children under 5, officials said. "By Tue 27 Oct 2009, initial
estimates indicated that at least 75 percent of the children targeted
were immunized in the 1st 2 days," Olivier Kagabo, head of the
national immunization department, said. "But we expect [to immunize]
more children on [28 Oct 2009] as parents generally come on the last
day."

Kagabo said local administration officials were assisting health
officials to mobilize parents to take their children for immunization.
Kagabo stressed that even vaccinated children should get the new
vaccine since "it is different from the routine vaccine they were
getting."

Burundi had eradicated polio for 10 years but 2 children caught the
disease in September [2009] following [importation] from neighbouring
Democratic Republic of Congo [DR Congo]. "The virus, wild poliovirus
type 1, originated from India and was imported into Angola and DR
Congo and reached Burundi last month," Kagabo said. A 2nd immunization
campaign will be held in November.

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

[The Republic of Burundi lies in the Great Lakes region of Eastern
Africa bordered by Rwanda to the north, Tanzania to the east and
south, and the Democratic Republic of the Congo to the west. Its size
is just under 28 000 square kilometers with an estimated population of
almost 8 700 000. It is to be hoped that the prompt response of the
authorities in Burundi will prevent spread of the imported infection
and return the country to its disease-free status.

The HealthMap/ProMED-mail interactive map of Burundi can be accessed at:
<http://healthmap.org/r/00YA>. - Mod.CP]

******
[2] Pakistan
Date: Tue 13 Oct 2009
Source: IRIN [edited]
<http://www.irinnews.org/Report.aspx?ReportId=86560>


Polio outbreak in Swat
----------------------
Health officials say 13 cases of polio have been confirmed in
Pakistan's volatile Swat District over the past 4 months, mainly
because vaccinators have been unable to access children there for more
than a year. Fierce fighting between government troops and Taliban
militants, which began in May [2009], has displaced hundreds of
thousands of people from Swat. Before the army campaign in the area
which ended in July [2009], militants had prevented access for
anti-polio teams.

"The Swat District currently has a polio outbreak. However, the good
news is that we were able to immunize children who had left these
areas. Upon their return we were able to immunize a significant
proportion of children during a campaign in September [2009]," Melissa
Corkum, polio programme coordination specialist with the UN Children's
Fund (UNICEF) in Islamabad, told IRIN.

She said a 3-day anti-polio campaign in Swat had begun on Mon 12 Oct
2009. "This time I will get my one-year-old daughter protected against
polio. My son, who is 5, has had drops several times before. Once I
took him to a hospital in Peshawar to get them, because the Taliban in
control here at that time said anyone vaccinating children would be
punished," Imran Gul, a Swat resident, told IRIN.

A total of 62 cases of polio have been confirmed so far this year in
Pakistan, with 35 in North West Frontier Province and the Federally
Administered Tribal Areas. "These include 12 cases in the
militancy-hit Bajuar Agency and 13 in Swat District," NWFP Health
Director-General Fazal Mahmood said. "The good thing is that most
people are conscious they have missed out on vaccinations and are keen
to get them now," said Hassan Khan, a Mingora-based physician.

According to the World Health Organization, Pakistan and Afghanistan
are among 4 countries in the world where polio is still considered
endemic.

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

[Together with Afghanistan, India and Nigeria, Pakistan remains one of
the 4 countries where polio is considered to be endemic. Up to one
million people are now internally displaced in Pakistan due to recent
conflict in the Swat Valley and the current military campaign in
Waziristan. The prospects for the polio eradication programme remain
challenging, but the cessation of fighting in the Swat Valley together
with the return of some of the population may facilitate the
resumption of routine immunisation.

The HealthMap/ProMED-mail interactive map of Pakistan, showing the
Swat District in North West Frontier Province, can be accessed at:
<http://healthmap.org/r/00YB>. - Mod.CP]