The "Challenge to End Polio" update.

Wild poliovirus (WPV) cases

Data in WHO as of 6 Dec 2010 for 2010 data and 5 Dec 2011 for 2011 data.
*Not shown in the table is 1 confirmed WPV3 case reported in Cameroon which is pending country assignment following results of case investigation.**The 2010 total for Congo includes cases with inadequate specimens that have been exceptionally classified as confirmed polio based on their association with the WPV1 outbreak.

• One case was reported in the past week - wild poliovirus type 1 (WPV1) from Nahri Sarraj district in Hilmand province - bringing the total number of cases for 2011 to 59. The most recent case had onset of paralysis on 15 November (WPV1 from Kandahar).
• Sub-national Immunization Days (SNIDs) using bivalent oral polio vaccine (bOPV) took place from 4-6 December, covering the south, south-east and east of the country. In 28 districts of Southern Region and five districts in the country's west, the SNIDs formed the second of two Short Interval Additional Dose (SIAD) rounds. The first SIAD round, conducted from 27-29 November, was reported to have gone well overall.
• There has been a significant increase in insecurity recently in the southern endemic region, and in other parts of the country, with multiple, parallel incidents reported.

• It has been 328 days since the onset of paralysis of India's first and only case of WPV for the year. The case occurred in West Bengal on 13 January.
• While great progress has been seen in the country, the Indian Ministry of Health remains cautious. In order for WHO's South East Asia Region to be certified as being 'polio-free', India will have to not report a case and maintain adequate surveillance for a period of three years. Dropping the guard now is not an option.
• India is planning a series of vaccination rounds for 2011, ensuring that the nation's children continue to be protected against polio. A vaccination round using bOPV has been tentatively planned for January, but the extent of the round is still under consideration as the country is suffering from a short-term vaccine shortage. The country's last vaccination round for 2011 was a sub-national campaign which began on 13 November, vaccinating children in key high-risks areas (parts of West Bengal, Bihar, Uttar Pradesh, Punjab, Gujarat and Maharashtra) with bOPV.
• Preliminary feedback from a surveillance assessment recently conducted in Bihar was generally positive. Similar surveillance assessments are currently under way in Maharashtra.

• Six new cases were reported in the past week (all WPV1s), bringing the total number of cases for 2011 to 167. The most recent cases were both reported in Khyber Pakhtunkhwa on 17 November - one in Tank district and one in Kohat. The case reported in Tank is the district's first case for the year. Similarly, a case reported in Bahawalpur district in Punjab province is that district's first case for the year.
• Small-scale, staggered case-response supplementary immunization activities (SIAs) have been taking place since 16 November in areas outside the known transmission areas which have recently experienced cases including Rahim Yar Khan and Vehari districts in South Punjab (targeting 1.2 million children under five), and Nowshera and Lakki Marwat districts in Khyber Pahtunkhwa (targeting 0.4 million). Two SIAD rounds are being conducted in previously inaccessible parts of Khyber agency (Landi Kotal and Tirrah), seizing the opportunity to rapidly boost immunity.
• SNIDs using bOPV are planned for 19-21 December. A series of meetings concentrating on building a high-quality round in Sindh were held in Karachi on 2 and 3 December. The Karachi Polio Eradication Committee was chaired by the provincial Secretary of Health and was attended by the Pakistan WHO and UNICEF country representatives, and health and administrative leaders of Karachi and Sindh province. To assure multi-sectoral support, and the quality of the vaccination round, the WHO and UNICEF representatives, with a representative of the Bill & Melinda Gates Foundation, also met with Sindh's provincial Governor, Health Minister and Speaker of the Assembly, along with Shanaz Wazir Ali, the newly appointed Prime Minister's Focal Point for Polio. The Governor of Sindh took note of the grave situation and stressed the need to overcome the existing short-falls in vaccination campaign quality, calling for regular monitoring of SIAs.
  
  

• No new cases were reported in the past week. It has been five months since Angola's most recent case - a WPV1 with onset of paralysis on 7 July in Uige in the country's north. The country has reported a total of five cases in 2011.
• The country's most recent SIAs were SNIDs using monovalent oral polio vaccine type 1 (mOPV) conducted on 25-27 November. The round covered most of the north and the southwest of the country (in Luanda, Lunda Norte, Lunda Sul, Cabinda, Zaire, Uige, Cuando Cabango and northern Malange), vaccinating more than 3 million children under five.
• The country's most recent case is in a province close to the border with the Democratic Republic of the Congo. Genetic sequencing found the virus to be most closely related to the Democratic Republic of the Congo's Bandundu/Bas Congo transmission chain rather than to Angola's re-established WPV1 - it therefore represents a new importation-related outbreak. The case was picked up during an active case search in Angola. Another case, officially reported in the Democratic Republic of the Congo with onset of paralysis on 28 July, was found to be an Angolan child from a nearby village who had sought treatment across the border in the Democratic Republic of the Congo. It is therefore possible that this case will be reassigned to Angola.

• No new cases were reported in Chad this week. The total number of cases reported in Chad in 2011 is 125 (122 WPV1s and three WPV3s). The most recent case had onset of paralysis on 26 October (WPV1 from Logone Oriental).
• Chad held NIDs using bOPV on 25-27 November. LQAS identified a number of under-performing districts (Kelo, Am-Timan, N'Djamena Sud, N'Djamena Nord, Guereda and Goz Beida), showing significant discrepancies from independent monitoring data. Seven districts were verified through LQAS as having greater than 90% coverage.
• No new cases were reported from the Central African Republic (CAR) in the past week. The total number of cases for 2011 remains two (both WPV1s), the most recent of which had onset of paralysis on 6 October in Region Sanitaire 3 (RS3), in the country's north. CAR held NIDs on 25-27 November. In RS3, children up to the age of 15 were targeted, while in the rest of the country the round targeted children under five. Anecdotal reports from the round suggest that there are many improvements that need to be made to improve campaign quality. A further round is planned for 13-15 January in RS3, again vaccinating children under 15 years of age.
• A case of WPV3 reported just inside Cameroon's border will be reassigned to Nigeria as it was found to have been a Nigerian child who contracted the virus in Nigeria (in Borno state). Cameroon has decided to maintain its heightened SIA schedule, protecting its children against the virus circulating in neighbouring countries. SNIDs using bOPV were conducted in the three northern-most regions on 28 October and 18 November, to be followed by a similar round planned to begin on 10 December.

• No new cases were reported in the past week. The total number of cases for 2011 is 18 (all WPV1) and the most recent case had onset of paralysis on 18 September (from Kashgar, in Xinjiang Uygur autonomous region).
• SNIDs using mOPV1 took place on 12-16 November. In five prefectures around the outbreak people up to the age of 39 were vaccinated, while children up to five years of age received the vaccine in the rest of Xianjiang Uygur Autonomous Region.
• To date, the plan to conduct an additional OPV round in the outbreak area, together with a measles campaign in December, has not been confirmed. The next large SIA is planned for early March 2012.

• No new cases were reported in the past week - therefore the total number of cases for 2011 remains 87 (all WPV1s). The most recent case had onset of paralysis on 29 September in the outbreak district of Popokabaka in Bandundu in the country's west.
• While the country's presidential election results are due this week, it is hoped that any disruption will have a minimal affect on polio eradication activities. SNIDs using bOPV are currently planned for 10-12 December, aiming to reach more than 1.3 million children under the age of five in parts of Bandundu, Bas Congo, Kasai Oriental, Katanga, Maniema and Sud Kivu. On 13 December, tOPV will be given alongside measles vaccine in Nord Kivu, Kinshasa and the districts of Bas Congo and Bandundu that weren't covered in the SNIDs. The country's most recent SIAs were SNIDs from 10-12 November.

• There were no cases reported in the Horn of Africa this week. A case of WPV1 with onset of paralysis on 30 July in Nyanza province, western Kenya, is the only case to be reported in the Horn of Africa this year. While there has only been a single case reported this year, the fact that transmission has been continually missed somewhere in Kenya and/or Uganda over the last few years means that the Horn of Africa will continue to be an area of concern.
• SNIDS using bOPV are currently finishing up (3-7 December) in several Ugandan districts bordering the infected area. Kenya will carry out SNIDs from 10 December. Reports from Kenya's SNIDs held on 12-16 November were 'guardedly optimistic'.
• Somalia is also finishing up a vaccination round - NIDs using tOPV from 4-8 December. While insecurity is an ongoing problem in Somalia, the vaccination teams are hoping to reach as many children as possible.

• No cases were officially reported in west Africa in the past week, however the GPEI has been given 'advance notice' of a case of WPV3 in Niger. The total number of cases for 2011 in the west African region remains 48 (36 from Côte d'Ivoire, three from Guinea, seven from Mali and two from Niger). All cases are WPV3, except for one WPV1 case from Niger. Mali, Côte d'Ivoire and Guinea have not reported any cases in more than four months. The most recent officially reported case in west Africa had onset of paralysis on 3 August in Guinea.
• Diffa, the province in which Niger's advance notice case has been reported, was covered six times this year with type 3 containing vaccine, yet almost 30% of non-polio acute flaccid paralysis cases reported in the province in 2011 were reported to have received zero doses of vaccine. The area is relatively remote (and on the opposite side of the country from the nation's capital) with low population density - once again highligh ting that every child, even those in the farthest villages, must be reached with polio vaccine. There has been a history of cases spreading from Nigeria across the border to Niger, with several instances over the last three years. Niger's last vaccination round took place on 28 October (NIDs) and the country's next round (SNIDs), planned for 23 December, has been built into the outbreak response. A further round of SNIDs is being planned for 12 January. Niger meets the acceptable standard for surveillance at the national level but there are problems with surveillance at the sub-national level, including in Diffa. One consultant has already agreed to be deployed to Niger and the search is now on for a second consultant to be sent to the area to assist in the outbreak response. A STOP-team member already present in the country will be re-tasked to the infected area.
• A multi-country round was launched on 24 November, covering all of Mali and Côte d'Ivoire along with parts of Guinea and Liberia.