OVERVIEW OF POLIO ERADICATION INITIATIVE IN THE AFRICAN REGION COMMUNICATION MEETING MEETING DAKAR...

OVERVIEW OF POLIO ERADICATION INITIATIVE IN THE

AFRICAN REGION

COMMUNICATION MEETING MEETING

DAKAR – SENEGAL5TH TO 7TH APRIL 2008

2WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique

WPV transmission in AFR in 2006/7

Progress in Nigeria

Status in Polio importations countries 2006/7

SIA activities 2007/8

AFP Surveillance Status

Polio certification status

Regional routine Status

Regional Polio lab indicators

Challenges

2008 Priorities

Outline Of Presentation


Progress in African region 2006-2008

• In 2006, a total of 1192 WPV cases were confirmed in 9

countries in African region (1128 cases in Nigeria, 94%

of the total cases)

• Only 367 WPV cases with onset in 2007 have been

confirmed in 5 countries (Nigeria, DRC, Angola, Chad

and Niger) 70% of reduction in cases compared to 2006.

• As of 2nd of April 2008, 102 WPV cases were confirmed in

5 countries: Nigeria(95), Niger(3), Chad(2), DRC(1) and

Angola(1).


Wild Poliovirus Case Distribution 1 Jan - 31 Dec 2006 & 1 Jan – 31 Dec 2007

WPV Type 1

WPV Type 3

EMRO

2006

2007

Luanda

70% of Wild Poliovirus Case

Reduction

Country W1 W3 W1+W3 TotalNIGERIA 848 277 0 1125ANGOLA 2 0 0 2ETHIOPIA 17 0 0 17DRC 13 0 0 13NIGER 9 2 0 11NAMIBIA 19 0 0 19KENYA 2 0 0 2

CAMEROON 1 1 0 2CHAD 0 1 0 1TOTAL AFR 911 280 0 1192

Country W1 W3 W1+W3 TotalNIGERIA 111 175 0 286ANGOLA 8 0 0 8DRC 41 0 0 41NIGER 10 1 0 11CHAD 18 3 0 21TOTAL AFR 188 179 0 367


Wild Poliovirus Case Distribution (1 Jan – 5 March 2008)

Country W1 W3W1+W3 Total

NIGERIA 85 10 0 95

NIGER 3 0 0 3

ANGOLA 1 0 0 1

CHAD 0 2 0 2

DRC 1 0 0 1

TOTAL AFR 90 12 0 102


Strategies/Innovations Implemented in 2007

• Use of monovalent vaccine type 1 and type 3 in Nigeria and in importation countries

• Polio outbreak response activities within 4 weeks following importation

• Intensified activities in Nigeria through immunization Plus days (IPDs)– Focusing on Very High Risk LGAs

• Implementation of new Lab algorithm– Confirmation within 21 days vs 60 days


Wild poliovirus spread*, 2003-08

Wild virus type 1 Wild virus type 3 Wild virus type 1 & 3

*Excludes viruses detected from environmental surveillance and vaccine derived polio viruses

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO 2007. All rights reserved

Ongoing outbreak (due to imported wild poliovirus)

Endemic countries**

. Data in WHO HQ as of Feb 2008

Controlled outbreak (due to imported wild poliovirus)

Spread of the virus

93 events, 26 countries

Number of importations from Nigeria

Viral origin: 68 events (73%)

Number of importations from India

Viral origin: 25 events (27%)


AFRO-Importation Status• Active outbreak / importations

– Imported WPV, detected within the last 6 months • DRC (WPV since Feb 06) Latest 14/02/08• Angola (WPV since 2005) Latest 10/01/08• Chad (WPV since 2003) Latest 03/02/08• Niger (Repeated importations from Nigeria) Latest

23/01/08• Cameroon (recent importation from Chad details to be

communicated)

• Controlled outbreaks– Imported WPV, detected more than ONE YEAR ago

• Ethiopia (Last case 07/11/06)• Kenya (Last case 13/11/06)• Namibia (Last case 26/06/06)


Regional polio infected districts 2005-2007

2005

2006

Mali Niger

Nigeria

Namibia

DRC

Chad

Ethiopia

Angola

CameroonKenya

Mali Niger

Nigeria

Namibia

DRC

Chad

Ethiopia

Angola

CameroonKenya

Mali Niger

Nigeria

Namibia

DRC

Chad

Ethiopia

Angola

Cameroon

Kenya

2007

42% Reduction in Infected Districts(From 2005 to 2007)

173 Districts

266 Districts

297 Districts


Regional trends of WPV cases 2004-2007

0

20

40

60

80

100

120

140

160

180

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Nu

mb

er o

f W

PV

cas

es

2004 2005 2006 2007


Progress in Nigeria


Nigeria WPV cases trend(2002-2008*)

* 28 January 2008


2007 – 2008 Wild poliovirus Distribution Onset April 01, 2007/2008

* Onset of most recent case on 01-Mar-2008* Onset of most recent case on 01-Mar-2007

2008

# Infected States: 19

W1 (n=89)

W3 (n=12)

# Infected States: 15

W1 (n=12)

W3 (n=45)

2007


Current status in Polio importation countries

(Update as of 5th March 2008)


NIGERIA

Central Afr. Rep.

CHAD

CAMEROON

CameroonWPV Type1

(Date of onset: 18/11/2007)

Last case reported 6/12/2006

CONGO

Douala


ANGOLA

LUANDA

1 WPV case in 2008

8 WPV cases in 2007

Most recent WPV case, Onset 21/1/2008

Last case reported was 8/7/2007

ANGOLA

LUANDA

1 WPV case in 2008

8 WPV cases in 2007

1 WPV case in 2008

8 WPV cases in 2007

Most recent WPV case, Onset 21/1/2008

Last case reported was 8/7/2007

Angola, Wild Poliovirus case Distribution (2007-2008)


Most recent WPV caseOnset 23/1/2008

2007N=11

2008N=3

WPV type 3

WPV type 1

NIGER, Wild poliovirus Case Distribution2007-2008


Orientale Equateur

Bandundu

ANGOLA

Most recent WPV case Onset, 20/11/2007

DRC, Wild poliovirus case distribution, 2007

N=41

PVS Type1

Orientale Equateur

Bandundu

ANGOLA

Most recent WPV case Onset, 20/11/2007

DRC, Wild poliovirus case distribution, 2007

N=41

PVS Type1


DRC, Risk Analysis Status (As of 22 February 2008)

Low RiskMediumHigh Risk


WPV Type 1WPV Type 3

Chad, Wild Poliovirus Case Distribution(2007-2008)


2007 = 21 cases2008 = 1 case

WPV Type 1WPV Type 3

Chad, Wild Poliovirus Case Distribution(2007-2008)


2007 = 21 cases2008 = 1 case


Polio SIAs in AFR in 2007

No SIAs1-2 NIDs/SNIDs>4 NIDs/SNIDsNon-AFRO

• Infected countries implemented at least 4 rounds of SIAs (NIDs/SNIDs)

• Over 70 million children under 5 years reached from an overall target of 75 million

• Independent monitoring data ranged from 87 to 97% in most countries.

• Despite good monitoring data significant numbers of children (5-23%) are still missed.


NID

SNID

Planned 2008 Polio SIAs(Tentative dates)

Note: Last quarter dates to be completed

NID 26-29 Jan NID 23-26 FebSNID 5-8 Apr SNID 10-13 MaySNID 19-25 NovSNID 23-26 FebSNID 5-8 Apr SNID 24-26 Jan SNID 17-19 AprSNID May (dates to be confirmed)SNID 26-28 Jan NID 23-25 Feb (cancelled)NID Avr (under discussion)

BENIN NID 5-7 Apr

CAMEROONSNID 1st week Apr (dates to be confirmed)SNID 4-6 Apr SNID 9-11 MaySNID 14-16 Mar (mop up Luanda)SNID 18-20 Apr (mop up Luanda)NID 16-18 MayNID 20-22 June

ETHIOPIASNID Somali region (dates to be confrimed)

CHAD

Central Afr. Rep.

ANGOLA

PROPOSED POLIO SIAs DATES 2008

NIGERIA

NIGER

DRC


2005

2006

2007

Met the 2 AFP surveillance indicators

Have not met both AFP surveillance indicators

The 2 AFP operational indicators:- NP-AFP rate>=2/100,000- Stool adeq. rate >=80%

Met only one AFP surveillance indicator

Regional Operational AFP Surveillance Indicators (2005-2007)


Surveillance review Status - 2007

External review

Desk review

Deferred

Not planned

• 17 of the 20 surveillance reviews planned for 2007 were conducted- 4 comprehensive reviews (Angola, Namibia, Tanzania and Ghana)- 13 desk reviews

• Involvement of key partners


Example of Impact – Angola AFP cases by Month 2006-2007

0

5

10

15

20

25

30

35

40

45

50

Nu

mb

er o

f AF

P c

ases

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov

2006

2007

External review

Number of AFP cases reported increased


Regional Polio Certification Standards2005-2007

2007

2005

Met certification standards

Have not met certification standards

2006


Status of certification in AFRO - 2007

Mauritius

Seychelles

Reports Accepted (21)Presenting 2008 (8)

EMRO countries

Pending


28

2006

Routine DPT3 Coverage in AFR(Jan-Aug 2006 & Jan-Aug 2007)

2007

ND=No Data

Source: Country/EPI Monthly Report

ND

<50%

50 - 79%

>= 80%

EMRO

>= 90%

59% 74%

75%

52%

84%

72%

58%

66%


WHO/AFRO Polio Laboratory Network Performance-2001-2007

** as of 03/10/2007

Year AFP cases

Specimen Total PolioIsolated

WPV cases

ITD in 14 days (%)

Results in 28 days(%)

NPEV rate(%)

2001 9,128 18,662 1,251 65 93 88 13.5

2002 9,234 18,217 1,369 206 98 94 15.5

2003 8,443 16,893 1,933 446 99 98 12.4

2004 10,009 20,284 2,922 934 96 95 13.2

2005 11,973 23,926 3,984 884 85 98 11.8

2006 13,046 25,918 4536 1190 66* 98 14

2007** 9177 18489 2420 246 83 97 14

* Maidiguri/CDC double testing


Timeline – Target Dates

2008 Interruption of type 1 polio

2009 Interruption of type 3 polio

2012 Certification of all WHO Regions

2013 Cessation of all routine OPV use


32

Challenges

• Interrupting WPV transmission in Nigeria and other infected countries.

• Responding adequately to importations in countries with low population immunity

• Achieving and maintaining 2/100,000 non-polio AFP rate at sub-national level

• Consolidating the new accelerated laboratory testing algorithm

• Sustaining Political commitment for polio eradication


Priorities for 2008• Improve population immunity through supporting

routine immunization delivery.• Implement high quality SIA rounds in all infected

countries until interruption is achieved• Respond timely and adequately to any wild

poliovirus importations• Monitor the Operational NP-AFP target of

>2/100,000 at sub national level and address gaps.

• Consolidate implementation of the new polio lab algorithm to support timely response.

• Continue certification activities as planned

THANK YOU

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