Global & Disaster Medicine

Archive for the ‘Polio’ Category

Fifteen new cases of polio have been confirmed in Syria

Reuters

‘……“We are very worried, because obviously if there is already one case of polio of a kid that is paralyzed it’s already an outbreak. We know for example that for one kid that is paralyzed there are almost 200 asymptomatic so it means that virus circulating, so it is very serious,” Jasarevic [WHO spokesman] said…….’

Poliomyelitis

Fact sheet
Updated April 2017


Key facts

  • Polio (poliomyelitis) mainly affects children under 5 years of age.
  • 1 in 200 infections leads to irreversible paralysis. Among those paralyzed, 5% to 10% die when their breathing muscles become immobilized.
  • Polio cases have decreased by over 99% since 1988, from an estimated 350 000 cases then, to 37 reported cases in 2016. As a result of the global effort to eradicate the disease, more than 16 million people have been saved from paralysis.
  • As long as a single child remains infected, children in all countries are at risk of contracting polio. Failure to eradicate polio from these last remaining strongholds could result in as many as 200 000 new cases every year, within 10 years, all over the world.
  • In most countries, the global effort has expanded capacities to tackle other infectious diseases by building effective surveillance and immunization systems.

Polio and its symptoms

Polio is a highly infectious disease caused by a virus. It invades the nervous system, and can cause total paralysis in a matter of hours. The virus is transmitted by person-to-person spread mainly through the fecal-oral route or, less frequently, by a common vehicle (for example, contaminated water or food) and multiplies in the intestine. Initial symptoms are fever, fatigue, headache, vomiting, stiffness of the neck and pain in the limbs. 1 in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralyzed, 5% to 10% die when their breathing muscles become immobilized.

People most at risk

Polio mainly affects children under 5 years of age.

Prevention

There is no cure for polio, it can only be prevented. Polio vaccine, given multiple times, can protect a child for life.

Global caseload

Polio cases have decreased by over 99% since 1988, from an estimated 350 000 cases in more than 125 endemic countries then, to 37 reported cases in 2016.

Of the 3 strains of wild poliovirus (type 1, type 2, and type 3), wild poliovirus type 2 was eradicated in 1999 and no case of wild poliovirus type 3 has been found since the last reported case in Nigeria in November 2012.

WHO Response

Launch of the Global Polio Eradication Initiative

In 1988, the Forty-first World Health Assembly adopted a resolution for the worldwide eradication of polio. It marked the launch of the Global Polio Eradication Initiative (GPEI), spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, and supported by key partners including the Bill & Melinda Gates Foundation. This followed the certification of the eradication of smallpox in 1980, progress during the 1980s towards elimination of the poliovirus in the Americas, and Rotary International’s commitment to raise funds to protect all children from the disease.

Progress

Overall, since the GPEI was launched, the number of cases has fallen by over 99%.

In 1994, the WHO Region of the Americas was certified polio-free, followed by the WHO Western Pacific Region in 2000 and the WHO European Region in June 2002. On 27 March 2014, the WHO South-East Asia Region was certified polio-free, meaning that transmission of wild poliovirus has been interrupted in this bloc of 11 countries stretching from Indonesia to India. This achievement marks a significant leap forward in global eradication, with 80% of the world’s population now living in certified polio-free regions.

More than 16 million people are able to walk today, who would otherwise have been paralysed. An estimated 1.5 million childhood deaths have been prevented, through the systematic administration of vitamin A during polio immunization activities.

Opportunity and risks: an emergency approach

The strategies for polio eradication work when they are fully implemented. This is clearly demonstrated by India’s success in stopping polio in January 2011, in arguably the most technically-challenging place, and polio-free certification of the entire South-East Asia Region of WHO occurred in March 2014.

Failure to implement strategic approaches, however, leads to ongoing transmission of the virus. Endemic transmission is continuing in Afghanistan, Nigeria and Pakistan. Failure to stop polio in these last remaining areas could result in as many as 200 000 new cases every year, within 10 years, all over the world.

Recognizing both the epidemiological opportunity and the significant risks of potential failure, the “Polio Eradication and Endgame Strategic Plan 2013-2019” was developed, in consultation with polio-affected countries, stakeholders, donors, partners and national and international advisory bodies. The new Plan was presented at a Global Vaccine Summit in Abu Dhabi, United Arab Emirates, at the end of April 2013. It is the first plan to eradicate all types of polio disease simultaneously – both due to wild poliovirus and due to vaccine-derived polioviruses.

Future benefits of polio eradication

Once polio is eradicated, the world can celebrate the delivery of a major global public good that will benefit all people equally, no matter where they live. Economic modelling has found that the eradication of polio would save at least US$ 40–50 billion between 1988 and 2035, mostly in low-income countries. Most importantly, success will mean that no child will ever again suffer the terrible effects of lifelong polio-paralysis.

 

 


Circulating vaccine-derived poliovirus type 2 – Democratic Republic of the Congo

WHO

Disease outbreak news
13 June 2017

In the Democratic Republic of the Congo (DRC), two separate circulating vaccine-derived poliovirus type 2s (cVDPV2s) have been confirmed. The first cVDPV2 strain has been isolated from two acute flaccid paralysis (AFP) cases from two districts in Haut-Lomami province, with onset of paralysis on 20 February and 8 March 2017. The second cVDPV2 strain has been isolated from Maniema province, from two AFP cases (with onset of paralysis on 18 April and 8 May 2017) and a healthy contact in the community.

Public health response

The Ministry of Health, supported by WHO and partners of the Global Polio Eradication Initiative (GPEI), has completed a risk assessment, including evaluating population immunity and the risk of further spread.

Outbreak response plans are currently being finalized, consisting of strengthening surveillance, including active case searching for additional cases of AFP, and supplementary immunization activities (SIAs) with monovalent oral polio vaccine type 2 (mOPV2), in line with internationally-agreed outbreak response protocols.

Surveillance and immunization activities are being strengthened in neighbouring countries.

WHO risk assessment

WHO assesses the risk of further national spread of these strains to be high, and the risk of international spread to be medium.

The detection of cVDPV2s underscores the importance of maintaining high routine vaccination coverage everywhere, to minimize the risk and consequences of any poliovirus circulation. These events also underscore the risk posed by any low-level transmission of the virus. A robust outbreak response as initiated is needed to rapidly stop circulation and ensure sufficient vaccination coverage in the affected areas to prevent similar outbreaks in the future. WHO will continue to evaluate the epidemiological situation and outbreak response measures being implemented.

WHO advice

It is important that all countries, in particular those with frequent travel and contacts with polio-affected countries and areas, strengthen surveillance for AFP cases in order to rapidly detect any new virus importation and to facilitate a rapid response. Countries, territories and areas should also maintain uniformly high routine immunization coverage at the district level to minimize the consequences of any new virus introduction.

WHO’s International Travel and Health recommends that all travellers to polio-affected areas be fully vaccinated against polio. Residents (and visitors for more than four weeks) from infected areas should receive an additional dose of OPV or inactivated polio vaccine (IPV) within four weeks to 12 months of travel. As per the advice of the Emergency Committee convened under the International Health Regulations (2005), efforts to limit the international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC). Countries affected by poliovirus transmission are subject to Temporary Recommendations. To comply with the Temporary Recommendations issued under the PHEIC, any country infected by poliovirus should declare the outbreak as a national public health emergency and consider vaccination of all international travellers.


Circulating vaccine-derived poliovirus type 2 – Syrian Arab Republic

WHO

Disease outbreak news
13 June 2017

A circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak has been confirmed in the Deir Al Zour Governorate of the Syrian Arab Republic. There is evidence of genetic linkage among three isolates of type-2 vaccine-derived polioviruses (VDPV2) isolated in the stool specimens of two acute flaccid paralysis (AFP) cases with dates of onset of paralysis on 5 March and 6 May 2017, and the contact specimen of an AFP case collected on 17 April 2017. Al Mayadeen was also the epi-centre of the wild poliovirus type 1 (WPV1) outbreak in Syrian Arab Republic in 2013. Aggressive multi-country polio outbreak response effectively controlled the WPV1 outbreak and no WPV1 case has been reported in Syrian Arab Republic since 21 January 2014.

Public health response

Since the confirmation of the first VDPV2 during May 2017, AFP surveillance has been intensified in the Governorate, especially in the Al Mayadeen district. As of 6 June 2017, a total of 58 AFP cases have been reported from the Governorate this year. In addition to the two cases that have tested positive for VDPV2, a further 11 have tested negative for polioviruses, with the remaining samples being under process in the laboratories or being transported to the laboratories.

Subsequent to the confirmation of the cVDPV2 outbreak, outbreak response planning is underway, including planning for supplementary immunization activities (SIAs) with monovalent oral polio vaccine type 2 (mOPV2), in line with internationally-agreed outbreak response protocols.

Although access for vaccination is compromised due to prevailing insecurity in Deir Al Zour, the Governorate has been partially reached by several vaccination campaigns against polio and other vaccine-preventable diseases since the beginning of 2016. Most recently, two campaigns have been conducted in March and April 2017 using bivalent oral polio vaccine (bOPV). The most recent full trivalent oral polio vaccine (tOPV) round was conducted in October 2015; while tOPV rounds conducted in the first four months of 2016 only reached part of the target population of the Deir Al Zour Governorate. It is pertinent to mention that Syrian Arab Republic introduced two doses of inactivated polio vaccine (IPV) in the routine infant immunization schedule in 2008. Syrian Arab Republic switched from tOPV to bOPV for routine immunization on 1 May 2016.

A detailed risk analysis is currently being updated, including assessing overall population immunity levels and strengthening active searches for additional cases of AFP. Surveillance and immunization activities are being strengthened in neighbouring countries as well.

WHO risk assessment

The detection of cVDPV2 underscores the importance of maintaining high levels of routine vaccination coverage at all levels to minimize the risk and consequences of any poliovirus circulation. Such events also underscore the risk in areas or regions with continued substantial insecurity that hampers maintaining high population immunity through routine vaccination. A robust outbreak response is needed to rapidly stop the VDPV2 transmission. WHO will continue to evaluate the epidemiological situation and outbreak response measures being implemented.

WHO advice

It is important to complete the ongoing risk assessment as soon as possible to inform the vaccination response with mOPV2 and IPV. The geographical scale of the vaccination response will be in accordance with the findings of the risk assessment. It will be critical to achieve the highest possible coverage during the vaccination response. Given the difficult and challenging security situation in the area, appropriate strategies will be identified and utilized to implement the response. Intensified AFP surveillance should continue.

It is important that all countries, in particular those with frequent travel and contacts with polio-affected countries and areas, strengthen surveillance for AFP cases in order to rapidly detect any new virus importation and to facilitate a rapid response. Countries, territories, and areas should also maintain uniformly high routine immunization coverage at the district level to minimize the consequences of any new virus introduction.

WHO’s International Travel and Health recommends that all travellers to polio-affected areas be fully vaccinated against polio. Residents (and visitors for more than four weeks) from infected areas should receive an additional dose of OPV or IPV within four weeks to 12 months prior to the travel.

As per the advice of an Emergency Committee convened under the International Health Regulations (2005), efforts to limit the international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC). Countries affected by poliovirus transmission are subject to Temporary Recommendations. To comply with the Temporary Recommendations issued under the PHEIC, any country infected by poliovirus should declare the outbreak as a national public health emergency and consider vaccination of all international travellers.


Moving targets: A Pakistani vaccination strategy as agile and stubborn as the polio virus itself.

The Guardian

“….makeshift vaccination clinics set up at bus stops, border crossings, army posts, and police checkpoints across the country in an effort to reach children who are on the move…..

At hundreds of sites, teams of health workers verify that every child passing through receives the vaccine.

Another child, another family, another generation is protected, and Pakistan moves one step closer to having zero polio cases…..”

 


Yemen: UNICEF vaccination campaign reaches five million children

UN

“….In the first campaign of its kind this year, 40,000 vaccinators spread across Yemen to provide children with polio vaccine and vitamin A supplements. Mobile health teams have reached children wherever they are, including in places where access to health services has been cut off by the fighting. Health workers have shown heroic resolve in crossing frontlines, mountains and valleys to vaccinate children…..”

A little boy is vaccinated against polio in Sa’ada, Yemen. (file) Photo: UNICEF/UN026952/Madhok

 


Response to a Large Polio Outbreak in a Setting of Conflict — Middle East, 2013–2015

Chukwuma Mbaeyi, DDS1; Michael J. Ryan, MD2; Philip Smith, MD2; Abdirahman Mahamud, MD2; Noha Farag, MD, PhD1; Salah Haithami, MD2; Magdi Sharaf, MD2; Jaume C. Jorba, PhD3; Derek Ehrhardt, MPH, MSN1

Weekly / March 3, 2017 / 66(8);227–231

Summary

What is already known about this topic?Afghanistan, Nigeria, and Pakistan are the only three countries that have never interrupted endemic transmission of wild poliovirus (WPV). Continued WPV circulation in these countries poses a risk for polio outbreaks in polio-free regions of the world, especially in countries experiencing conflict and insecurity, with attendant disruption of health care and immunization services.

What is added by this report?A WPV outbreak occurred in Syria and Iraq during 2013–2014 after importation of a poliovirus strain circulating in Pakistan. The outbreak represented the first occurrence of polio cases in both countries in approximately a decade, and resulted in 38 polio cases, including 36 in Syria and two in Iraq. Development and implementation of an integrated response plan for strengthening acute flaccid paralysis surveillance and synchronized mass vaccination campaigns by eight national governments in the Middle East facilitated interruption of the outbreak within 6 months of its identification.

What are the implications for public health practice?Countries experiencing active conflict and chronic insecurity are at increased risk for polio outbreaks because of political instability and population displacement hindering delivery of immunization services. Adoption of a concerted approach to planning and implementing response activities, with involvement of more stable neighboring countries, could serve as a useful model for polio outbreak response in areas affected by conflict, as exemplified by the Middle East polio outbreak response.

As the world advances toward the eradication of polio, outbreaks of wild poliovirus (WPV) in polio-free regions pose a substantial risk to the timeline for global eradication. Countries and regions experiencing active conflict, chronic insecurity, and large-scale displacement of persons are particularly vulnerable to outbreaks because of the disruption of health care and immunization services (1). A polio outbreak occurred in the Middle East, beginning in Syria in 2013 with subsequent spread to Iraq (2). The outbreak occurred 2 years after the onset of the Syrian civil war, resulted in 38 cases, and was the first time WPV was detected in Syria in approximately a decade (3,4). The national governments of eight countries designated the outbreak a public health emergency and collaborated with partners in the Global Polio Eradication Initiative (GPEI) to develop a multiphase outbreak response plan focused on improving the quality of acute flaccid paralysis (AFP) surveillance* and administering polio vaccines to >27 million children during multiple rounds of supplementary immunization activities (SIAs). Successful implementation of the response plan led to containment and interruption of the outbreak within 6 months of its identification. The concerted approach adopted in response to this outbreak could serve as a model for responding to polio outbreaks in settings of conflict and political instability.


Outbreak Detection and Epidemiology

Detection of the Middle East outbreak depended upon systems for AFP surveillance in the affected countries, including the World Health Organization’s (WHO’s) Early Warning, Alert and Response Network (EWARN)§, through which the outbreak was identified in October 2013. The nonpolio AFP (NPAFP) and stool adequacy rates served as indicators for assessing the ability of the affected countries to detect polio cases and also to determine when the outbreak had been interrupted.

Among countries that reported polio cases, the NPAFP rate in Syria in 2012 was 1.4 cases per 100,000 persons aged <15 years, below the recommended benchmark of ≥2. The NPAFP rate for Syria improved, increasing to 1.7 cases per 100,000 persons in 2013, the year the outbreak was detected, and to 4.0 and 3.0 in 2014 and 2015, respectively (Table). In Iraq, the NPAFP rate ranged from 3.1 to 4.0 during 2012–2015; estimates of NPAFP rates in Syria and Iraq might, however, be inaccurate because of the large-scale conflict-related displacement of persons and the attendant impact on target population estimates. Among countries at risk, NPAFP rates were suboptimal in Jordan at the onset, but improved over the course of the outbreak, increasing from 1.4 in 2013 to 3.2 in 2015. Despite incremental improvements, NPAFP rates remained <2 in Turkey over the course of the outbreak, and rates declined in Palestine from 2.2 in 2013 to 1.2 in 2014 before improving to 2.2 in 2015. All other countries involved in the response achieved recommended benchmarks.

Rates of stool specimen adequacy (i.e., receipt of two stool specimens collected at least 24 hours apart within 14 days of paralysis onset and properly shipped to the laboratory) in Syria increased from 68% in 2013 to 90% in 2015; in Iraq, rates of stool specimen adequacy exceeded the benchmark of ≥80% in each year during 2012–2015. Lebanon showed substantial gaps in stool specimen adequacy before and during the outbreak with rates ranging from 45% to 70% during 2012–2014, but the rate improved to 84% in 2015.

A total of 38 WPV type 1 cases were reported during the outbreak, with dates of paralysis onset ranging from July 14, 2013 for the index case (Aleppo, Syria) to April 7, 2014 for the last confirmed case (Baghdad, Iraq). The outbreak was virologically confirmed in October 2013. Of the 38 cases reported, 36 occurred in Syria and two occurred in Iraq (Figure 1). Approximately two thirds (24 of 38) of reported cases occurred in male children and 74% of cases occurred in children aged <2 years. Fifty-eight percent of children with polio had never received oral poliovirus vaccine (OPV) either through routine or supplementary immunization (i.e., zero-dose children), and an additional 37% of children with polio had received ≤3 OPV doses. The remaining 5% of children with polio had received 3 OPV doses.

Thirty-five of the 36 polio cases in Syria were reported during 2013 and the last identified case had paralysis onset in January 2014. A breakdown of cases by governorate (Figure 2) indicates that 25 (69%) cases were reported from Deirez-Zour, five from Aleppo, three from Edleb, two from Hasakeh, and one from Hama. The two cases reported from Iraq occurred in February and April 2014; both were from Baghdad-Resafa Governorate. Both cases were related by genetic sequencing and were closely linked to WPV circulating in Syria. Genetic sequencing indicated virus circulation might have begun a year earlier somewhere in the Middle East, coincident with identification of WPV-positive environmental samples in Egypt in December 2012 (5). The implicated viral strain was genetically linked to strains circulating in Pakistan (6).

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Outbreak Response Plan Development

Eight countries in the region (Egypt, Iran, Iraq, Jordan, Lebanon, Palestine, Syria, and Turkey) developed a concerted Middle East polio outbreak response plan, which was updated during the course of the outbreak. Countries were grouped into two areas: 1) countries with poliovirus transmission (Syria and Iraq), and 2) countries at significant risk for poliovirus importation based on geographic proximity and influx of displaced persons from the outbreak zone (Egypt, Iran, Jordan, Lebanon, Palestine, and Turkey). The strategic response in these areas occurred in three phases. Phase I (October 2013–April 2014) focused on interrupting WPV transmission and halting spread of the virus beyond the affected countries. Phase II (May 2014–January 2015) identified areas at high risk for poliovirus importation and circulation based on stipulated criteria, including presence of refugees and mobile populations, security-compromised areas, districts with low vaccination coverage, and geographically hard-to-reach communities. These areas were prioritized for SIAs and intensified surveillance activities. Phase III (February–October 2015) was aimed at further boosting population immunity against polio through strengthened routine immunization systems and SIAs.

Immunization Coverage. Conflict in Syria and Iraq in the years preceding and following the outbreak led to steep declines in routine vaccination coverage among children in both countries, in contrast to most other countries in the Middle East where coverage remained high. Estimated national routine vaccination coverage of infants in Syria with 3 doses of oral poliovirus vaccine (OPV3) declined from preconflict levels of 83% in 2010 to 47%–52% during 2012–2014. Estimates of coverage in Iraq were ≤70% and coverage in Lebanon was 75% during 2012–2014. All other countries involved in the response had coverage levels of >90% during 2012–2014.

In response to the Middle East polio outbreak, >70 SIAs were conducted during October 2013–December 2015. SIAs targeted approximately 27 million children aged <5 years in eight countries and were conducted using trivalent (types 1, 2, and 3) and bivalent (types 1 and 3) OPV. Strategies used during the campaigns included fixed-post (health facility), house-to-house visits, transit-point vaccination, and deployment of mobile teams to vulnerable populations and geographically hard-to-reach areas. Strategies were tailored to the unique sociocultural context of each country involved in the response.

Implementation of outbreak response plan. Following identification of the outbreak, Syria conducted two rounds of national immunization days (NIDs) in November and December 2013, eight NIDs and one round of subnational immunization days (SNIDs) in 2014, and four NIDs and two SNIDs in 2015 (Table). Postcampaign monitoring coverage estimates improved from 79% in December 2013 to 93% in March 2014, with coverage levels ≥88% during a majority of the campaigns. Iraq held 14 NIDs and four SNIDs as part of the response, with postcampaign monitoring coverage levels ranging from 86% to 94% during 2014. Egypt, Iran, Jordan, Lebanon, Palestine, and Turkey conducted two to 11 vaccination campaigns.

Active conflict in many parts of Syria and some parts of Iraq limited access for vaccination activities during the course of the response. Negotiations with local authorities and engagement of community leaders enabled implementation of a limited number of vaccination campaigns in some conflict-affected areas, but it was difficult to monitor these campaigns, or generate reliable data on the quality of response activities. Egypt, Iraq, Jordan, Lebanon, and Turkey received large numbers of Syrian refugees (7), which placed significant strain on their health care resources and increased costs of implementing outbreak response activities. Refugees aged <15 years living in camps in Jordan were vaccinated against polio upon registration and entry, and during special vaccination campaigns held in camps.

In assessing the effect of outbreak response activities, the vaccination status of nonpolio AFP cases in children aged 6–59 months in Syria and Iraq was reviewed. The proportion of NPAFP cases among children aged 6–59 months who were reported to have received ≥3 doses of OPV in Syria rose from 82% in 2013 to 94% in 2015, but remained at 93% among Iraqi children of the same age group during 2013–2015. The proportion of children aged 6–59 months with NPAFP who had never received OPV, or any other form of polio vaccination, decreased from 9% in 2013 to 2% in 2015 in Syria, but increased slightly from 1% to 3% in Iraq during the same period.

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Discussion

The Middle East polio outbreak occurred within an extremely challenging setting, given the ongoing civil war in Syria and conflict in several parts of Iraq. The near collapse of the health care system in conflict-affected parts of Syria resulted in plummeting levels of routine vaccination coverage that left many children born after the start of the civil war unimmunized or underimmunized against polio, and set the stage for the spread of poliovirus following importation within this age group and beyond.

Actions were taken to mitigate the risk for a polio outbreak in Syria when WPV-positive environmental isolates were identified in Egypt late in 2012. AFP surveillance activities in Syria, including in opposition-controlled areas, were intensified through WHO’s EWARN system, and polio vaccination campaigns were conducted in all of Syria’s governorates by January 2013 (6). However, the cohort of children born during the conflict remained vulnerable to a polio outbreak because of steep declines in routine polio vaccination coverage.

After a cluster of WPV cases was detected in Deirez-Zour Governorate, the government of Syria immediately declared the outbreak a public health emergency. A multicountry response plan was developed to contain and interrupt the outbreak, which was effectively contained within 6 months from the time of its identification. Improvements in AFP surveillance performance indicators in the outbreak-affected countries provided a basis for WHO to declare the outbreak over in 2015. In addition to intensified surveillance and immunization activities, the response owed its success in large part to the level of collaboration and concerted approach adopted by eight national governments in the region. Another factor contributing to the success of the response was that high routine immunization coverage in many countries in the region, coupled with high prewar vaccination coverage in Syria, limited the population of vulnerable persons to mostly children born after the onset of the civil war.

With the attention of GPEI focused on the final push to interrupt indigenous WPV transmission in the remaining three polio-endemic countries (810), vigilance must be maintained in the Middle East and other conflict-affected areas to forestall the risk for new WPV outbreaks. In the event of a new outbreak, the Middle East polio outbreak response provides a model for an effective response within challenging settings.



 

* The quality of acute flaccid paralysis (AFP) surveillance is monitored by performance indicators that include 1) the detection rate of nonpolio AFP (NPAFP) cases, and 2) the proportion of AFP cases with adequate stool specimens. World Health Organization (WHO) operational targets for countries with endemic poliovirus transmission are an NPAFP detection rate of ≥2 cases per 100,000 population aged <15 years, and adequate stool specimen collection from ≥80% of AFP cases, in which two specimens are collected ≥24 hours apart, both within 14 days of paralysis onset, and shipped on ice or frozen packs to a WHO-accredited laboratory, arriving in good condition (without leakage or desiccation).

Mass campaigns conducted for a brief period (days to weeks) in which 1 dose of oral poliovirus vaccine is administered to all children aged <5 years, regardless of vaccination history. Campaigns are conducted nationally or subnationally (i.e., in portions of the country).

§ http://apps.who.int/iris/bitstream/10665/70812/1/WHO_HSE_GAR_DCE_2012_1_eng.pdf.

http://apps.who.int/immunization_monitoring/globalsummary.

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References

  1. Akil L, Ahmad HA. The recent outbreaks and reemergence of poliovirus in war- and conflict-affected areas. Int J Infect Dis 2016;49:40–6. CrossRef PubMed
  2. Arie S. Polio virus spreads from Syria to Iraq. BMJ 2014;348:g2481. CrossRef PubMed
  3. Ahmad B, Bhattacharya S. Polio eradication in Syria. Lancet Infect Dis 2014;14:547–8. CrossRef PubMed
  4. Aylward B. An ancient scourge triggers a modern emergency. East Mediterr Health J 2013;19:903–4. PubMed
  5. World Health Organization. Outbreak news. Poliovirus isolation, Egypt. Wkly Epidemiol Rec 2013;88:74–5. PubMed
  6. Aylward RB, Alwan A. Polio in syria. Lancet 2014;383:489–91. CrossRef PubMed
  7. United Nations High Commissioner for Refugees. Syria regional refugee response: inter-agency information sharing portal. Geneva, Switzerland: United Nations High Commissioner for Refugees; 2017. http://data.unhcr.org/syrianrefugees/regional.php
  8. Morales M, Tangermann RH, Wassilak SG. Progress toward polio eradication—worldwide, 2015–2016. MMWR Morb Mortal Wkly Rep 2016;65:470–3. CrossRef PubMed
  9. Hampton LM, Farrell M, Ramirez-Gonzalez A, et al. ; Immunization Systems Management Group of the Global Polio Eradication Initiative. Cessation of trivalent oral poliovirus vaccine and introduction of inactivated poliovirus vaccine—worldwide 2016. MMWR Morb Mortal Wkly Rep 2016;65:934–8. CrossRef PubMed
  10. Mbaeyi C, Shukla H, Smith P, et al. Progress toward poliomyelitis eradication—Afghanistan, January 2015‒August 2016. MMWR Morb Mortal Wkly Rep 2016;65:1195–9. CrossRef PubMed

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TABLE. Acute flaccid paralysis (AFP) surveillance indicators and outbreak response activities by country and year — eight countries in the Middle East, 2012–2015
Year/Activity Country
Egypt Iran Iraq Jordan Lebanon Palestine Syria Turkey
2012
Nonpolio AFP rate* 3.9 3.5 3.8 1.5 2.2 1.3 1.4 0.9
AFP cases with adequate specimens (%) 92 92 90 84 50 95 84 80
2013
Nonpolio AFP rate* 3 4 3.1 1.4 2.2 2.2 1.7 1.2
AFP cases with adequate specimens (%) 92 96 84 91 45 95 68 76
SIAs 2 NIDs 2 NIDs 2 NIDs 2 NIDs 1 NID 2 NIDs 2 SNIDs
1 SNID
2014
Nonpolio AFP rate* 2.9 4.2 4 2.5 2.7 1.2 4 1.5
AFP cases with adequate specimens (%) 93 96 89 97 70 90 84 77
SIAs 2 NIDs 2 SNIDs 7 NIDs 3 NIDs 4 NIDs 1 NID 8 NIDs 5 SNIDs
1 SNID 3 SNIDs 2 SNIDs 3 SNIDs 1 SNID
2015
Nonpolio AFP rate* 3 4.3 3.6 3.2 5.2 2.2 3 1.7
AFP cases with adequate specimens (%) 94 97 82 97 84 92 90 82
SIAs 1 NID 2 SNIDs 5 NIDs 1 SNID 2 SNIDs 4 NIDs 2 SNIDs
2 SNIDs 2 SNIDs

Abbreviations: NIDs = national immunization days; SIAs = supplemental immunization activities; SNIDs = subnational immunization days.
* Cases per 100,000 children aged <15 years (target: ≥2 per 100,000).
No NIDs or SNIDs conducted for the year.

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Return to your place in the textFIGURE 1. Number of cases of wild poliovirus type 1 (WPV1), by month and year of paralysis onset — Syria and Iraq, 2013–2014

 The figure above is a bar chart showing the number of cases of wild poliovirus type 1, by month and year of paralysis onset in Syria and Iraq, during 2013–2014.

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Return to your place in the textFIGURE 2. Cases of wild poliovirus type 1 (WPV1) — Syria and Iraq, 2013–2014*

 The figure above is a map showing cases of wild poliovirus type 1 in Syria and Iraq during 2013–2014.

* Each dot represents one case. Dots are randomly placed within second administrative units.


Suggested citation for this article: Mbaeyi C, Ryan MJ, Smith P, et al. Response to a Large Polio Outbreak in a Setting of Conflict — Middle East, 2013–2015. MMWR Morb Mortal Wkly Rep 2017;66:227–231. DOI: http://dx.doi.org/10.15585/mmwr.mm6608a6.


Continued Endemic Wild Poliovirus Transmission in Nigeria, 2016

CDC

Nnadi C, Damisa E, Esapa L, et al. Continued Endemic Wild Poliovirus Transmission in Security-Compromised Areas — Nigeria, 2016. MMWR Morb Mortal Wkly Rep 2017;66:190–193. DOI: http://dx.doi.org/10.15585/mmwr.mm6607a2.

 

 


3-Day Polio Immunzation Program: WHO, UNICEF and health authorities keeping Yemen polio-free.

WHO

National polio immunization campaign launched in Yemen

WHO is working closely with UNICEF and health authorities to keep Yemen polio-free

WHO is working closely with UNICEF and health authorities to keep Yemen polio-freeSANA’A, 20 February 2017—A nationwide polio immunization campaign was launched today in Yemen by national health authorities with support from WHO and UNICEF, aiming to immunize 5 019 648 children under the age of 5.

More than 40 000 health workers are taking part in the 3-day campaign. In addition, religious and local council’s officials, as well as health educators are also mobilizing support for the campaign. High-risk groups, such as internally displaced persons (IDPs) and refugees, will also be reached.

“WHO is working closely with UNICEF and health authorities to keep Yemen polio-free. The threat of virus importation is serious and this campaign aims to curb any possible return of the virus to Yemen,” said Dr Nevio Zagaria, WHO Acting Representative in Yemen.

“WHO and its partners will continue to support the health authorities in increasing the vaccination coverage across Yemen.”

This is the first polio immunization campaign since April 2016. The security situation in Yemen has limited accessibility of many parts of the country, leaving many children at risk of vaccine preventable diseases.

As the nearly 2-year-old armed conflict in Yemen has been posing threats to the Expanded Programme on Immunization (EPI), WHO has supported the programme to keep polio vaccines safe through providing fuel, generators and solar-powered refrigerators to ensure the functionality of vaccine storage as well as cold chain transferring them from the war-torn areas into safer places.

“Despite huge security challenges, WHO is committed to supporting polio immunization campaigns and all activities of the EPI to maintain the polio-free status achieved by the country in 2006” said Dr Zagaria.


Afghanistan: Over 5.6 million children to be vaccinated against polio during large-scale vaccination campaign

WHO

Kabul 30 January 2017 – The Ministry of Public Health, WHO and UNICEF launched today the first polio subnational immunization days campaign of 2017. Over 5.6 million children will be vaccinated against polio in all provinces in the southern and south-eastern regions, most districts in the eastern region, as well as selected high-risk districts across the country, including Kabul city.

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“The campaign will build on strong progress seen in 2016. Last year Afghanistan had only 13 cases of polio nationwide, down from 20 in 2015. This was made possible through hard work by thousands of frontline health workers and a renewed emphasis on monitoring and oversight,” said Dr Maiwand Ahmadzai, Director of the National Emergency Operations Centre for Polio Eradication at the Ministry of Public Health, speaking at a joint press conference held in Kabul.

This week’s campaign is carried out by over 31 000 trained polio workers and it runs until 3 February when vaccinators revisit children who were missed when the vaccinators first visited. These vaccinators and other polio workers are trusted members of the community and they have been chosen because they care about children.

“We have seen significant progress in our polio eradication efforts over the past year. Most of Afghanistan is now polio-free, the circulation of the poliovirus is restricted to small areas in the eastern, southern and southeastern parts of the country and we have seen huge improvements in vaccination campaign quality,” said Dr Hemant Shukla, director of the polio programme at WHO. “Our focus is now on reaching every single child during every vaccination campaign to stop the transmission of polio.”

“With our collective efforts, we will be able to eradicate polio from the world. Vaccines are the right of every child and no child should be missed during polio campaigns,” said Ms Melissa Corkum, UNICEF Polio director in Afghanistan. “Thousands of frontline workers visit every house in the country during campaigns. That’s not an easy task. Due to the hard work of these dedicated frontline workers, we are closer to polio eradication than ever.”

In 2016, new initiatives have been implemented to strengthen the polio eradication programme in Afghanistan. All polio eradication activities have been brought under one leadership as Emergency Operations Centres have been established at the national and subnational level. The surveillance system has been strengthened and the circulation of wild poliovirus is unlikely to be missed in Afghanistan. The quality of campaigns, routine immunization and rapid response to polio cases have improved tremendously over the past year.

In 2016, 13 polio cases were registered: 7 cases in Paktika, 4 cases in Kunar, one case in Kandahar and one in Helmand province. Afghanistan remains one of 3 polio-endemic countries together with Pakistan and Nigeria.

 


Over 5.6 million children to be vaccinated against polio across Afghanistan

WHO

AFGHANISTAN

 


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