POLIOMYELITIS - WORLDWIDE (09): PAKISTAN, AFGHANISTAN, GLOBAL VACCINE DERIVED POLIOVIRUS
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In this update:
[1] Pakistan, Afghanistan MMWR update
[2] Global update as of 3 Oct 2012 (including VDPV)
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[1] Pakistan, Afghanistan MMWR update
Date: 4 Oct 2012
Source: MMWR 5 Oct 2012 / 61(39);790-795 [edited]
http://www.cdc.gov/mmwr/preview/mmwrhtm ... mm6139a4_e
Progress Toward Poliomyelitis Eradication -- Afghanistan and Pakistan, January 2011-August 2012
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In 1988, the World Health Assembly resolved to eradicate polio, which led to the establishment of the Global Polio Eradication Initiative (GPEI). In 2012, however, the transmission of indigenous wild poliovirus (WPV) continued uninterrupted in Afghanistan, Pakistan, and Nigeria (1,2), leading the World Health Assembly to declare completion of polio eradication a programmatic emergency for global public health (3). This report updates previous reports (1,4,5) and describes polio eradication activities and progress in Afghanistan and Pakistan during January 2011-August 2012 as of [9 Sep 2012].
During 2011, 80 WPV cases were confirmed in Afghanistan, compared with 25 WPV cases in 2010; 17 WPV cases were confirmed during January-August 2012, compared with 34 WPV cases for the same period in 2011. In Pakistan, 198 WPV cases were confirmed in 2011, compared with 144 WPV cases in 2010; 30 WPV cases were confirmed during January-August 2012, compared with 88 WPV cases during the same period in 2011. During January 2011-August 2012, no WPV type 3 (WPV3) cases were confirmed in Afghanistan, and 4 confirmed WPV3 cases and one case with coinfection of WPV3 and WPV type 1 (WPV1) were reported in Pakistan. Violence targeting vaccinators has occurred previously in Afghanistan and recently in Pakistan. To progress further toward interruption of WPV transmission within their countries and across their shared border, the governments of Afghanistan and Pakistan might consider reviewing the implementation of their national emergency action plans (6,7) and determine how to enhance the safety of vaccination teams within conflict-affected areas of both countries.
Immunization Activities
Estimated national routine immunization coverage of infants with 3 doses of oral polio vaccine (OPV3) is 66 percent in Afghanistan and 75 percent in Pakistan, with subnational variation in both countries (8). A surrogate measure of routine OPV3 coverage based on parental recall and immunization cards of children aged 6-23 months with acute flaccid paralysis (AFP) not the result of polio (non-polio AFP)* was 61 percent nationally in Afghanistan; 15 percent in the conflict-affected South Region and Farah Province in the West Region combined; 71 percent in the West Region, excluding Farah Province; and 78 percent in the rest of the country. OPV3 coverage among children aged 6-23 months with non-polio AFP cases in Pakistan was 63 percent nationally, 26 percent in the conflict-affected Federally Administered Tribal Areas (FATA), 63 percent in Khyber Pakhtunkhwa (KP) Province, 52 percent in Sindh Province, 18 percent in Balochistan Province, and 77 percent in Punjab Province. Nationally, only 3.3 percent of children aged 6-23 months with non-polio AFP did not receive any oral polio vaccine (OPV) doses through routine or supplementary immunization activities (SIAs).**
During January 2011-August 2012, house-to-house SIAs generally targeted children aged less than or equal to 59 months using different OPV formulations, including bivalent types 1 and 3 and trivalent. During this period, 6 national immunization days and 10 subnational immunization days were conducted in Afghanistan in the East, Southeast, and South regions, and in Farah Province in the West Region. During a combined measles and OPV campaign, children aged less than or equal to 10 years were targeted. SIA planning and implementation in 2011 apparently worsened compared with previous years, as indicated by the proportion of children aged 6-23 months with non-polio AFP in high-risk districts having not received any doses of OPV vaccine, which rose from 9 percent in 2010 in the South Region to 21 percent in 2011. In Pakistan, 7 national immunization days were conducted, and 8 subnational immunization days were conducted in high-risk districts in the main WPV transmission areas of FATA, KP, Sindh, Balochistan, and southern Punjab. Several smaller SIAs targeting high-risk areas and migratory, internally displaced, and underserved or marginalized groups were conducted. Most campaigns targeted children aged less than 5 years; however, in Khyber Agency (Bara), FATA, a short interval additional dose (SIAD) strategy*** campaign in 2012 targeted children aged less than 15 years because much of this area had not been reached in 3 years. A significant population exodus, from Bara Tehsil of Khyber Agency to neighboring parts of KP (mainly Peshawar and Nowshera), occurred during April and May 2012. The displaced population was targeted with multiple SIA rounds using bivalent types 1 and 3 in the hosting communities (target age group: less than 5 years) and in a camp for displaced persons in Jalozai Nowshera (target age group: less than 15 years).
During 2011-2012, as in past years, SIA teams were unable to reach thousands of children living in areas that have been inaccessible**** to vaccination teams because of insecurity. In Afghanistan, the estimated proportion of targeted children living in inaccessible areas in the South Region was 6-21 percent (72 500-273 000 children) during SIAs conducted in 2010 and 2011, and 2-5 percent (28 400-65 000 children) in SIAs during January-June 2012. In Pakistan, the proportion of targeted children living in inaccessible areas of KP during SIAs decreased from less than 1-2 percent (less than 30 000-100 000 children) during January-March 2010 to less than 0.2 percent (less than 6000 children) during April 2010-December 2011. In FATA, however, the proportion of targeted children living in inaccessible areas was 20-31 percent during 2010 and 9-24 percent during 2011, leaving approximately 99 000-350 000 children un-reached during each SIA conducted during 2010 and 2011. During January-July 2012, 6-23 percent (64 000-257 500) of children in the target population in FATA were not accessible. Despite a gradual improvement in access to children in FATA, approximately 200 000 children were unreachable because of a ban on polio SIAs recently imposed by some local authorities in the tribal agencies of North and South Waziristan. All areas have been accessible in KP since September 2011.
WPV Surveillance:
AFP surveillance
Standard indicators are used to monitor AFP surveillance performance.***** In 2011, the annual national non-polio AFP rate (per 100 000 population aged less than 15 years) was 10.5 in Afghanistan (range among the 8 regions: 6.0-12.8), and 7.2 in Pakistan (range among the 7 provinces/regions: 2.3-9.7). The percentage of AFP cases for which adequate specimens were collected was 92 percent in Afghanistan (range: 80-98 percent) and 88 percent in Pakistan (range: 78-93 percent). Despite overall high AFP surveillance performance indicators, genomic sequencing data from WPVs obtained from confirmed polio cases and environmental surveillance samples continue to indicate surveillance gaps of WPV in certain areas of Pakistan and Afghanistan.
Environmental surveillance
In Pakistan, AFP surveillance is supplemented by environmental surveillance. During 2011-August 2012, 353 sewage samples from 21 sites in 11 cities from all major provinces of Pakistan were tested for polioviruses. The number of cities with sewage sampling increased from 8 in 2011 to 11 in 2012. WPVs frequently have been isolated from sewage samples collected in all major cities in Pakistan since testing began in mid-July 2009, including several large urban areas where there was absence of confirmed WPV in reported AFP cases: Lahore in Punjab (latest confirmed case: December 2011, latest positive sewage sample: August 2012), Rawalpindi (latest confirmed case: April 2010, latest positive sewage sample: May 2012), and Sukkur (latest confirmed case: September 2010, latest positive sewage sample: July 2012). WPV continues to be isolated from the majority of environmental samples at most sampling sites, although the frequency of WPV-positive environmental samples decreased in Quetta, Balochistan, which has had no WPV-positive environmental sample since February 2012. WPV3 has not been detected in sewage samples at any site since October 2010.
WPV Epidemiology
In Afghanistan, 80 WPV1 cases were reported during 2011, compared with 25 WPV cases (17 WPV1, 8 WPV3) in 2010, and 17 WPV1 cases were reported during January-August 2012, compared with 34 WPV1 cases during the same period in 2011 (see Table, Figures 1 and 2 at above given URL link) (4,5). The last WPV3 case reported in Afghanistan was in the South Region in April 2010. During January 2011-August 2012, 72 (74 percent) WPV cases were reported among children aged less than 36 months. Among the 72 children, 24 (33 percent) received no OPV doses, 23 (32 percent) received 1-3 OPV doses, and 25 (35 percent) received greater than or equal to 4 OPV doses. During this period, WPV cases were reported in 40 (12 percent) of 329 districts, including 13 high-risk districts****** in the southwestern provinces of Kandahar, Helmand, Urozgan, and Farah.
In Pakistan, 198 WPV cases (196 WPV1, 2 WPV3) were reported during 2011, compared with 144 WPV cases (120 WPV1, 24 WPV3) during 2010; 30 WPV cases (27 WPV1, 2 WPV3, and one case with isolation of both WPV1 and WPV3) were reported during January-August 2012, compared with 88 during the same period in 2011 (see Table, Figures 1 and 2 at above given URL link). All WPV3 cases reported in Pakistan since 2011 were from Khyber Agency, FATA; the most recent cases were reported in April 2012. During January 2011-August 2012, 192 (84 percent) of 228 WPV cases were among children aged less than 36 months. Among the 228 children aged less than 36 months, 68 (30 percent) received no OPV doses, 51 (22 percent) received 1-3 OPV doses, and 9 (4 percent) received greater than or equal to 4 OPV doses. WPV cases were reported in 60 (38 percent) of 157 districts in Pakistan during 2011, compared with 40 (30 percent) districts during 2010, and from 17 (11 percent) districts during January-August 2012. During 2010, 98 (68 percent) of 144 cases were from KP and FATA, and 39 (27 percent) were from Balochistan and Sindh; during 2011, 82 (41 percent) of 198 cases were from KP and FATA, and 105 (53 percent) were from Balochistan and Sindh; by comparison, 22 (73 percent) of 30 cases reported during January-August 2012 were from KP and FATA. Of the 13 polio cases reported from FATA in 2012, 9 (69 percent) were from Bara Tehsil of Khyber Agency, which has not been accessible for polio SIAs since September 2009.
Reported by:
World Health Organization (WHO) Country Office Kabul, Afghanistan. WHO Country Office Islamabad, Pakistan. WHO Eastern Mediterranean Regional Office, Cairo, Egypt. Regional Reference Laboratory for Poliovirus, Islamabad, Pakistan. Global Polio Laboratory Network. Polio Eradication Dept, WHO, Geneva, Switzerland. Div of Viral Diseases, National Center for Immunization and Respiratory Diseases; Global Immunization Div, Center for Global Health, CDC. Corresponding contributor: Jenna Webeck, Global Immunization Div, Center for Global Health, CDC, , 404-553-7617.
MMWR Editorial Note
In Afghanistan, more than 3 times as many WPV cases occurred in 2011 as in 2010; in Pakistan, WPV cases increased by 37 percent in 2011 compared with 2010. In 2012, WPV1 transmission continues in the known endemic areas of southwestern Afghanistan. WPV1 transmission is widespread in high-risk districts in Pakistan; however, the number of reported WPV cases in Pakistan in 2012 has decreased 66 percent compared with the same period in 2011. Only 5 WPV3-associated cases have been reported since January 2011, all from a limited area in Pakistan.
In the southwestern endemic zone of Afghanistan, SIA planning and implementation in 2011 worsened compared with previous years, even though access to children in high-risk areas continued to improve. The 2012 Afghanistan National Polio Eradication Emergency Action Plan defined major challenges and key activities to address these challenges (6). New strategic approaches include a major surge in human resources, particularly at district and provincial administrative levels, management training, and use of locally recruited permanent polio teams in high-risk districts for continuous house-to-house vaccination. Even with the new strategies to partly address the security concerns, the national emergency action plan highlights other key obstacles to interrupting transmission, such as low quality program management and lack of accountability (6).
In Pakistan, 73 percent of WPV cases reported in 2012 were in insecure areas of FATA and KP. One 3rd of these cases were reported from one tribal agency, Khyber, the only known remaining focus of WPV3 transmission in Asia. Recent bans on polio vaccination by some local authorities in North Waziristan and South Waziristan in FATA, and deadly attacks on polio workers in Gaddap, a high-risk area of Karachi in Sindh Province, have further increased the difficulties in reaching under-immunized children. To achieve polio eradication, both Pakistan and Afghanistan might consider how to enhance the safety of vaccination teams within conflict-affected areas.
Implementation of the Pakistan Polio Eradication National Emergency Action Plan, launched in early 2011, augmented in early 2012, and monitored at the highest political level, has made district commissioners and union council medical officers responsible for program implementation. Staffing also has increased substantially, particularly at the union council level (7). SIA preparations are being monitored systematically; if preparations in union councils or districts are not meeting quality benchmarks, SIAs are deferred.
Although WPV transmission within Afghanistan and Pakistan still occurs separately, genetic sequencing of polioviruses detected during AFP surveillance and environmental sewage sampling indicate that population movement (cross-border and internal) contributes substantially to the spread of poliovirus in Afghanistan and Pakistan. The number of transit teams in Pakistan providing OPV to children passing through border crossings and bus stops has increased, and regular cross-border planning and coordination of SIAs and surveillance activities with Afghanistan is taking place.
GPEI's 2012-2013 Global Emergency Action Plan (9), together with the national emergency action plans, seeks to accelerate activities to put the remaining countries with WPV transmission back on track toward interruption of WPV transmission (1,6,7). Although GPEI activities in Afghanistan and Pakistan have been accelerated, ongoing WPV transmission in both countries remains a threat to achieving the GPEI goal (10).
References:
1. CDC. Progress toward interruption of wild poliovirus transmission--worldwide, January 2011-March 2012. MMWR 2012;61:353-7. [available at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6119a6.htm]
2. CDC. Progress toward poliomyelitis eradication--Africa, 2011. MMWR 2012;61:190-4. [available at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6111a4.htm]
3. World Health Assembly. Poliomyelitis: intensification of the global eradication initiative. Agenda item A65/20. Geneva, Switzerland: World Health Organization; 2012. Available at
http://apps.who.int/gb/ebwha/pdf_files/ ... _20-en.pdf. Accessed 14 Sep 2012.
4. CDC. Progress toward poliomyelitis eradication--Afghanistan and Pakistan, 2009. MMWR 2010;59:268-72. [available at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5909a4.htm]
5. CDC. Progress toward poliomyelitis eradication--Afghanistan and Pakistan, January 2010-September 2011. MMWR 2011;60:1523-7. [available at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6044a4.htm]
6. Global Polio Eradication Initiative. Afghanistan Emergency Action Plan for Polio Eradication 2012-2013. Geneva, Switzerland: World Health Organization; 2012. Available at
http://www.polioeradication.org/portals ... 4_6imb.pdf. Accessed 14 Sep 2012.
7. Government of Islamic Republic of Pakistan. Augmenting the National Emergency Action Plan for Polio Eradication in 2012. January 2012. Islamabad, Pakistan. Government of Islamic Republic of Pakistan; 2012. Available at
http://www.polioeradication.org/portals ... 5_6imb.pdf. Accessed 12 Sep 2012.
8. World Health Organization. WHO vaccine-preventable diseases monitoring system: 2011 global summary. Geneva, Switzerland: World Health Organization; 2011. Available at
http://www.who.int/vaccines/globalsumma ... select.cfm and
http://apps.who.int/immunization_monito ... select.cfm. Accessed 15 Aug 2012.
9. Global Polio Eradication Initiative. Global Polio Eradication Initiative Emergency Action Plan 2012-2013. Geneva, Switzerland: World Health Organization; 2012. Available at
http://www.polioeradication.org/resourc ... nplan.aspx. Accessed 1 Oct 2012.
10. Independent Monitoring Board of the Polio Eradication Initiative. Every missed child: report of the Independent Monitoring Board of the Global Polio Eradication Initiative. Geneva, Switzerland: World Health Organization; 2012. Available at
http://www.polioeradication.org/portals ... report.pdf. Accessed 15 Aug 2012.
* Vaccination histories of children aged 6-23 months with AFP who do not test WPV-positive are used to estimate OPV coverage of the overall target population and to corroborate national reported routine immunization coverage estimates.
** Mass campaigns conducted for a brief period (days to weeks) in which one dose of OPV is administered to all children aged less than 5 years, regardless of vaccination history. Campaigns can be conducted nationally or in sections of the country.
*** SIADs are used during negotiated periods of nonviolence in otherwise inaccessible areas to vaccinate children with a monovalent OPV or bivalent OPV dose, which is administered within 1-2 weeks of the prior dose.
**** Areas considered too dangerous by the World Health Organization (WHO) and the local government to conduct an SIA.
***** The quality of AFP surveillance is monitored by performance indicators that include 1) the detection rate of non-polio AFP cases and 2) the proportion of AFP cases with adequate stool specimens. WHO operational targets for countries with endemic polio transmission are a non-polio AFP detection rate of at least 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 at least 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.
****** High-risk districts include those persistently affected by WPV transmission and those in proximity to the persistently affected districts.
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[According to the above report, a key constraint to eradication of WPV transmission in both Pakistan and Afghanistan involves the inaccessibility of areas due to civil unrest, with areas considered too dangerous for personnel to enter and conduct vaccination activities. In today's [4 Oct 2012] press, there was a newswire on the kidnapping (and safe release) of 4 polio vaccinators in South Waziristan Agency earlier this week (
http://www.thenews.com.pk/Todays-News-1 ... eed-in-SWA). Until a truce for public health interventions can be reached, this remains a significant obstacle to achieve eradication goals. Other obstacles to the eradication efforts are the continued circulation of rumors about the vaccine safety and plots on the part of the west (most recent newswire on this can be found at
http://www.pakistantoday.com.pk/2012/10 ... nst-polio/).
Another important issue raised in the above report is the results of environmental sampling, identifying WPV in environmental samples from urban areas where WPV has not been confirmed in reported AFP cases, suggesting there continues to be WPV circulation in the areas either in missed AFP cases or related to non-AFP associated infections. Specifics given in the above article include Lahore in Punjab -- latest confirmed case: December 2011, latest positive sewage sample: August 2012; Rawalpindi -- latest confirmed case: April 2010, latest positive sewage sample: May 2012; and Sukkur -- latest confirmed case: September 2010, latest positive sewage sample: July 2012. As a Reminder there have been isolated WPV cases in Uganda and Kenya over the past several years with the WPV identified as genetically related to each other, suggesting "silent" circulation of the WPV in the area such as identified in Pakistan.
For a good map of the locations of the WPV cases identified in Pakistan and Afghanistan, see the maps included in part [2], available at
http://www.polioeradication.org/Dataand ... dwide.aspx. - Mod.MPP]
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[2] Global update as of 3 Oct 2012 (including VDPV)
Date: Wed 3 Oct 2012
Source: Global Polio Eradication Initiative (GPEI) [edited]
http://polioeradication.org/Dataandmoni ... sweek.aspx
Global Polio Eradication Initiative update as of 3 Oct 2012
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Total cases
Year-to-date 2012 / Year-to-date 2011 / Total in 2011*
Globally: 154 / 429 / 650
- in endemic countries: 149 / 170 / 341
- in non-endemic countries: 5 / 256 / 309
Case breakdown by country
Country: Year-to-date 2012 WPV1 / WPV3 / W1W3 / Total // Year-to-date 2011 WPV1 / WPV3 / W1W3 / Total // Total in 2011* / Date of most recent case
Pakistan: 37 / 2 / 1 / 40 // 99 / 1 / 0 / 100 // 198 / 13 Sep 2012
Nigeria: 73 / 17 / 0 / 90 // 25 / 8 / 0 / 33 // 62 / 1 Sep 2012
Afghanistan: 19 / 0 / 0 / 19 // 36 / 0 / 0 / 36 // 80 / 31 Aug 2012
India: 0 / 0 / 0 / 0 // 1 / 0 / 0 / 1 // 1 / 13 Jan 2011
Chad: 5 / 0 / 0 / 5 // 111 / 3 / 0 / 114 // 132 / 14 Jun 2012
DR Congo: 0 / 0/ 0 / 0 // 80 / 0 / 0 / 80 // 93 / 20 Dec 2011
Angola: 0 / 0 / 0 / 0 // 4 / 0 / 0 / 4 // 5 / 7 Jul 2011
Niger: 0 / 0 / 0 / 0 // 1 / 1 / 0 / 2 // 5 / 22 Dec 2011
CAR: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 // 4 / 8 Dec 2011
China: 0 / 0 / 0 / 0 // 10 / 0 / 0 / 10 // 21 / 9 Oct 2011
Guinea: 0 / 0/ 0 / 0 // 0 / 3 / 0 / 3 // 3 / 3 Aug 2011
Kenya: 0 / 0 / 0 / 0 // 1 / 0 / 0 / 1 // 1 / 30 Jul 2011
Cote d'Ivoire: 0 / 0 / 0 / 0 // 0 / 35 / 0 / 35 // 36 / 24 Jul 2011
Mali: 0 / 0 / 0 / 0 // 0 / 7 / 0 / 7 // 7 / 23 Jun 2011
Congo: 0 / 0 / 0 / 0 // 1 / 0 / 0 / 1 // 1 / 22 Jan 2011
Gabon: 0 / 0 / 0 / 0 // 1 / 0 / 0 / 1 // 1 / 15 Jan 2011
Total: 134 / 19 / 1 / 154 // 370 / 50 / 0 / 429 // 650
Total in endemic countries: 129 / 19 / 1 / 149 // 161 / 9 / 0 / 170 // 341
Total outbreak: 5 / 0 / 0 / 5 // 209 / 50 / 0 / 259 // 309
*Data in WHO as of 4 Oct 2011 for 2011 data and as of 2 Oct 2012 for 2012 data.
Afghanistan:
- One new case was reported in the past week (WPV1 from the previously-uninfected province of Ghor), bringing the total number of cases for 2012 to 19. It was the most recent case, with onset of paralysis on [31 Aug 2012].
Nigeria
- No new cases of WPV were reported in the past week. The total number of cases for 2012 remains 90. The most recent case was WPV1 with onset of paralysis on [1 Sep 2012] in Kaduna province.
- One new case of circulating vaccine-derived poliovirus type 2 (cVDPVD2) was reported in the past week, from Sokoto state, bringing the total for this year [2012] to 4.
Pakistan
- Three new cases were reported in the past week (2 WPV1 from Khyber Pakhtunkhwa and one from Gilgit Baltistan), bringing the total number of cases for 2012 to 40. The most recent case was a WPV1 from Khyber Pakhtunkhwa with onset of paralysis on [13 Sep 2012].
Angola
- No new cases were reported in the past week; no cases have been reported in 2012. The country reported a total of 5 cases in 2011, and the last case had onset of paralysis on [7 Jul 2011] in Uige in the country's north.
Chad
- No new cases of WPV were reported in the past week. The most recently reported case occurred in the Lac region (WPV1) with onset of paralysis on [14 Jun 2012]. The total number of cases for 2012 remains 5.
- Five cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) have been reported (4 in N'djamena, one in Abeche), with the most recent date of onset of paralysis on [28 Aug 2012]. The cases are related to a single transmission chain.
Democratic Republic of the Congo (DRC)
- No new cases were reported in the past week. No wild poliovirus cases have been reported in 2012. The total number of WPV cases for 2011 is 93 (all WPV1). The most recent case had onset of paralysis on [20 Dec 2011] in Maniema province.
- Although the country has not reported a WPV case since December 2011, it has been affected by a circulating vaccine-derived poliovirus type 2 (cVDPV2) in Katanga province in 2012, with 17 cases reported (most recent case: [4 Apr 2012]). Efforts are focused on ensuring the cVDPV2 is fully stopped.
Horn of Africa
Following recent confirmation of 4 circulating vaccine-derived poliovirus type 2 (cVDPV2) cases in a Somali refugee camp in Dadaab, Kenya (3) and Kismayo, south-central Somalia (1), linked to last year's [2011] cVDPV2 in south-central Somalia, an immunization response is currently being planned. More than 800 000 children in eastern Kenya will be targeted, including in the Dadaab refugee camps (target age groups in the camps will be less than 15 years).
- While Kismayo is not accessible for mass vaccination campaigns due to insecurity, a round of Child Health Days will be conducted on [14-18 Oct 2012] in 2 recently accessible districts (Badade and Afmadow, which border Kismayo) with trivalent OPV. Two rounds of National Immunization Days using tOPV are scheduled for November and December 2012.
West Africa
- No new cases were reported in the past week. No cases have been reported in 2012. The total number of cases for 2011 in West Africa remains 51 (36 from Cote d'Ivoire, 3 from Guinea, 7 from Mali, and 5 from Niger). The most recent case from the region (WPV1 from Niger) had onset of paralysis on [22 Dec 2011].
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[For maps of locations of confirmed wild poliovirus (WPV) associated cases for 2011 and 2012, see
http://www.polioeradication.org/Dataand ... dwide.aspx. A ProMED HealthMap for Africa can be found at
http://healthmap.org/r/2r-O.
The absence of cases in non-endemic countries since the outbreak in Chad in the 1st 6 months of this year (2012) is cautiously heartening. The disheartening information in the above report is the occurrence of VDPV cases in Nigeria, Chad, Kenya (ex Somalia) and Somalia. The occurrence of VDPV cases serve as reminders that there are areas with low vaccination coverages that are potentially pre-disposed for circulation of VDPVs. - Mod.MPP]
