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Progress Towards Polio Eradication
in EMR
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• Status of global eradication
• Priority countries (except EMR)
• 2004-5: Intensification
• 2006-8: Certification, OPV cessation & mainstreaming of the infrastructure.
Presentation
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Polio Eradication Progress1988 - 2003
1988
350 000 cases
125 countries
2003
785 cases
6 countries
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Endemic countries
Wild virus type 1
Wild virus type 3
Importation
Changing Epidemiology 2003Importations > endemic areas
Nigeria virusexported to 8
countries.Western Uttar Pradeshexported to polio-free
states in India.
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Risks: Increasing VulnerabilityPolio Campaigns 2002 vs. 2004
2002: 100 countries2004: <20 countries
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Stool Specimen Collection Rates, Sept 02-Oct 03
< 60%
60% -80%
> 80%
No AFP
Risks: Surveillance Gaps
Risks: performance gaps in reinfected & high risk areas
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‘ 2004: a one time opportunity for a polio-
free world. ’Meeting of MinistersWorld Health
OrganizationGeneva, Switzerland15 January 2004
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Non polio AFP rate in EMR by province (Pakistan by district)
01/01/2003-31/12/2003
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Non polio AFP rate in EMR by province (Pakistan by district), 2003
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Non-polio AFP rate in EMR by province, 2004 (to date 22/06/04)
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Percent of AFP cases with adequate samples in EMR, 2003
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% AFP cases with adequate stool specimens EMR provinces, 2003
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% AFP cases with adequate stool specimens EMR provinces, 2004 (to date 22/06/04)
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18
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Non-polio AFP rate per 100,000 children under 15, EMR, 1993-2004
To date 21/03/04
AFP Surveillance
Polio Eradication Strategies
0.240.49
0.7 0.710.85 0.88
1.1
1.42
1.9
2.32.4
2.07
0
0.5
1
1.5
2
2.5
3
93 94 95 96 97 98 99 00 01 01 03 04EMR Mar 04
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Non polio AFP rate in EMR, 2003
05/02/04
AFP surveillanceNon-polio AFP rate/ 100,000 <15
EMR countries, 2003
EMR Mar 04
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Non polio AFP rate in EMR, 2003
05/02/04
AFP surveillanceNon-polio AFP rate/ 100,000 <15
EMR countries, 2004 (to date 21/03/04)
EMR Mar 04
22
43
53
6366 67
70
8388 90 89
0
10
2030
40
50
60
7080
90
100
95 96 97 98 99 00 01 02 03 04
AFP SurveillancePolio Eradication Strategies% of AFP cases with adequate stool specimens, 1995-2004
To date 21/03/04
EMR Mar 04
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Percent of AFP cases with adequate samples in EMR, 2003
05/02/04
AFP surveillance% AFP cases with adequate stool specimens
EMR countries, 2003
EMR Mar 04
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Percent of AFP cases with adequate samples in EMR, 2003
05/02/04
AFP surveillance% AFP cases with adequate stool specimens
EMR countries, 2004
EMR Mar 04
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Issues•Areas of concern, NWFP, Quetta: tribal areas
Conservative/ less females/youngest children
high %unimmunized
•Local political leadership
•Need better SIA quality
•Fatigue/discouragement
Action•District analysis to identify HRD
•3 rounds during LT season + 1 SNID + 3 Fall NIDs (quality)
•Advocacy plan
•District level
•Continue HL advocacy
•Plans for tribal areas
•District teams
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Issues•Evidence of indigenous transmission in South/West
•Security situation (surveillance and SIAs)
•Population movements
Action•Focus on area of transmission
•(Dec-Jan) SNIDs + Mar-Apr NIDs + 2 fall NIDs (national monitors)
• Different modality for surveillance national staff
•National surveillance reviews in areas of concern
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Issues•More than 300,000 missed in each round (100,000 in Cairo/Giza)
•Variable implementation between districts
•Slipping Surveillance quality in some areas (GC)
Action•Task force•Identify and focus on poorly performing districts•Continue/Increase technical support esp GC and Menia•Feb: SNID + Spring NIDs+Fall NIDs + Mop-up plan•Surveillance review
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Endemic countries
Wild virus type 1
Wild virus type 3
Importation
Increasing VulnerabilityImportations > endemic areas, 2003
Nigeria virusexported to 7
countries.
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Regional strategic plan for poliomyelitis eradication
2004–2008• Prepared in consultation with nationals, UN agencies and
other partners• Covers the main elements of:
– Intensifying supplemental immunization– Enhancing surveillance and maintaining the laboratory network– Laboratory containment– Certification– Strengthening EPI
• Essential to maintain trained personnel (national and international) and utilize them to support priority health programmes