22 October 2008
Data as at 21 October 2008


Map of polio cases worldwide
Map of infected districts (pdf)
Wild poliovirus list 2000-2008 (pdf)
Circulating vaccine-derived poliovirus (pdf)
For monthly case distribution, infected districts and surveillance indicators (pdf), click here
Monthly situation reports     

Information by country

 

Total cases	Year-to-date 2008	Year-to-date 2007	Total in 2007
Globally	1406	635	1315
- in endemic countries:	1317	564	1208
- in non-endemic countries:	89	71	107

Case breakdown by country

• In Ghana, two polio cases (WPV1s) were reported, the first in the country since 2003. Countries across west Africa continue to be at risk of international spread of polio from the current WPV1 outbreak in northern Nigeria. WPV1 from northern Nigeria has this year previously spread to Benin, Burkina Faso and Niger. See 'importation countries' below, for further details.
• In India, an aggressive response to the WPV1 outbreak in western Uttar Pradesh is continuing. In total, six large-scale immunization campaigns will have been conducted with monovalent oral polio vaccine type 1 (mOPV1) in this area, in the second half of 2008. Free of endemic WPV1 for more than 12 months, the core highest-risk districts of western Uttar Pradesh have recently experienced local spread of WPV1 originally imported from Bihar. See 'India' section below, for further details.
• On 16 October, two important new studies on polio eradication were published in the New England Journal of Medicine, evaluating the efficacy of mOPV1 compared with trivalent OPV in northern Nigeria, as well as among newborn children in Egypt. Both studies found mOPV1 to be significantly more effective than trivalent OPV, at protecting children against WPV1.
• The programmatic implications of these studies are significant, as they show that mOPV1 has the capacity to rapidly stop this year's WPV1 outbreak in northern Nigeria, if the quality of vaccination campaign operations is improved. At the same time, the results indicate that in key endemic areas – such as northern India – the remaining immunity gap against WPV1 in the youngest children (who are most vulnerable to polio) can be bridged more rapidly by mOPV1. For more information on these studies, please visit www.polioeradication.org.

Endemic countries

• Two new cases were reported in the past week (WPV1s), bringing the total number of cases for 2008 to 22. The most recent case had onset of paralysis on 25 September (WPV1 from Kandahar).
• National Immunization Days (NIDs) were held last week, from 19-21 October. Officially launching the activity, Dr S Moh Amin Fatimie, Minister of Public Health of Afghanistan, commended the efforts of more than 52,000 staff and volunteers, who aimed to immunize more than 7.5 million children under the age of five years. "This is a huge operation which covers all villages of Afghanistan and provides a unique opportunity for all Afghan families to get their children vaccinated against polio and be in contact with the health workers," he said. "We request all Afghans, health workers and health partners to provide any kind of help and support to this process, so that all Afghan children could get vaccinated in the coming three days."
• Efforts during these latest NIDs focused on increasing access to all populations, particularly in security-compromised areas of the country's Southern Region. Despite efforts, large areas of the Southern Region remained inaccessible due to insecurity. In Afghanistan, polio is largely restricted to the Southern Region (20 of this year's 22 cases occurring here).
• The next Sub-national Immunization Days (SNIDs) will be held on 23-25 November using mOPV1, and possibly with monovalent OPV type 3 (mOPV3) in some areas.

• 14 new cases were reported in the past week (two WPV1s and 12 WPV3s), bringing the total number of cases for 2008 to 486. The most recent case had onset of paralysis on 27 September (WPV3 from Uttar Pradesh).
• A proposed supplementary immunization activities (SIA) schedule has been finalized for the rest of the year. In western Uttar Pradesh, large-scale campaigns with mOPV1 are currently under-way (18-24 October), with further activities to be held on 16 November and again on 14 December. In total, this area will have been covered with six large-scale campaigns using mOPV1 in the second half of 2008.
• In Bihar, a similar SIA schedule as in western Uttar Pradesh has also been finalized, with campaigns being conducted in October, November and December.
• Rapidly stopping WPV1 in India remains an overriding strategic priority of the Global Polio Eradication Initiative. Key to success is sustaining the political momentum which has brought India so close to interrupting WPV1 transmission. Further testimony to the achieved progress is the geographic restriction of WPV1; in 2008, 18 districts are infected with WPV1, compared to 40 districts in 2007 (representing a 55% decrease in WPV1-infected districts).
• To further refine eradication strategies and finalize plans for 2009, it is being explored to move forward the India Expert Advisory Group on Polio Eradication (IEAG), from December to 11-12 November.

• Ten new cases were reported in the past week (eight WPV1s and two WPV3s), bringing the total number of cases for 2008 to 728. The most recent case had onset of paralysis on 27 September (WPV1 from Kano).
• Emergency mop-ups in key re-infected areas (in the centre and south of the country) were held on 18-21 October.
• All high-risk states are continuing strategic planning for upcoming rounds, focusing in the first instance on strengthening local microplans.
• The next Expert Review Committee for Polio Eradication and Routine Immunization (ERC) will meet next week, on 27-28 October, in Abuja, to review the current epidemiology and finalize plans for the next months.
• The current plans are to add mOPV1 to an integrated measles campaign at end-November (in the north) and December (in the south), with separate Immunization Plus Days (IPDs) to be held in high-risk areas in the north in December.

• Six new cases were reported in the past week (four WPV1s and two WPV3s), bringing the total number of cases for 2008 to 81. The most recent case had onset of paralysis on 3 October (WPV3 from North West Frontier Province - NWFP).
• The most recent NIDs were completed last week (13-15 October). In total, more than 33 million children under the age of five years were targeted with a mix of mOPV1 and trivalent OPV.
• In addition to more than 86,000 vaccination teams going 'house-to-house' across the country, special initiatives had been put in place to increase access to mobile populations, as well as those living in areas of insecurity. Polio vaccination points were established at highway and motorway toll plazas, airports, bus stops, railway stations and district borders. Additionally, posts were also established at 16 key border crossings with neighbouring Afghanistan, and special outreach was conducted in camps of Internally Displaced Persons (IDPs).
• Despite these efforts, however, large parts of the Federally Administered Tribal Areas (FATA) in NWFP were again inaccessible due to insecurity. This year, Pakistan has experienced spread of polio into previously polio-free areas (notably Punjab and Islamabad), in part due to a deteriorating security situation in known endemic areas resulting in increased population movements. Efforts are ongoing to rapidly raise population immunity levels across the country, including in polio-free and recently re-infected areas.
• The next NIDs will be held on 24-26 November, using trivalent OPV.

Importation countries

• No new cases were reported in the past week. The total number of cases for 2008 remains 25. The most recent case had onset of paralysis on 14 July (WPV3 from Benguela province).
• The next NIDs will be conducted with mOPV1 on 24-26 October.

• No new cases were reported in the past week. The total number of cases for 2008 remains two. The most recent case had onset of paralysis on 08 August (WPV1 from RS3 province).
• Two nationwide campaigns have been conducted this year, and two further nationwide campaigns are being planned before the end of the year.

• Two new cases were reported in the past week (WPV3s), bringing the total number of cases for 2008 to 26. The most recent case had onset of paralysis on 21 August (WPV3 from Mayo-Kebbi).
• These latest cases are in the west of the country, and in the south (close to the border with CAR). Chad is affected by ongoing and geographically dispersed circulation of both WPV1 and WPV3. With suboptimal outbreak response activities implemented in 2008 (both in quality, scope and timeliness), the risk of further spread of polio within Chad and internationally is high.
• The Technical Advisory Group on Polio Eradication (TAG) met last week in N'Djamena, to urgently review the situation. The group put forward key recommendations, including: addressing the operational challenges through improved microplans; aggressive interspersed utilization of mOPV1, mOPV3 and trivalent OPV; conducting outbreak response within 30 days of confirmation of any further polio cases; and systematically re-vaccinating any area where more than 5% of the population has been missed during previous campaigns.
• The group also identified the need for stronger high-level political ownership and engagement, beginning with the President's office downward. It is strong political ownership at every level which will ensure that the significant operational challenges which have marred the quality of polio campaigns in 2008 (as upwards of 40% of children were regularly missed) are addressed. The TAG recommendations were presented to the Prime Minister, who expressed concern and promised to mobilize Chad's government behind polio eradication.
• The next SNIDs will be held on 14-16 November in the east of the country, using mOPV1 and on 24-26 November in the west of the country, using mOPV3. The next NIDs are scheduled for December using trivalent OPV.

• No new cases were reported in the past week. The total number of cases for 2008 remains four. The most recent case had onset of paralysis on 5 August (WPV1 from Sud-Kivu).
• The next activities are planned for 4 November, when OPV will be added to a planned measles SIA (mOPV1 in highest-risk provinces and trivalent OPV in other areas).

• One new case was reported in the past week (WPV1 from southern Sudan), bringing the total number of cases for 2008 to nine (one WPV3 from West Darfur, Sudan; and eight WPV1s from the southern Sudan/western Ethiopia cross-border area). The most recent case had onset of paralysis on 12 September (WPV1 from Unity state, southern Sudan).
• Outbreak response activities will be held across Sudan on 27 October and 24 November (with mOPV1 in southern Sudan; and trivalent OPV in northern Sudan).
• In Ethiopia, activities will be held on 17 October (using a combination of mOPV1 and trivalent OPV), and again on 14 November (using mOPV1).

• No new cases were reported in the past week. The total number of cases for 2008 remains five. The most recent case had onset of paralysis on 27 July (WPV3 from Mid-West Development Region).
• The next SIA will be a mOPV3 mop-up starting 26 October.

• Two new cases were reported in the past week, bringing the total number of cases for this region to 18 (two in Benin, one in Burkina Faso, two in Ghana and 13 in Niger). The most recent case had onset of paralysis on 20 September (WPV1 from Ghana).
• These most recent cases are both from Ghana, the first polio in the country since 2003. While genetic sequencing of these cases is pending, west Africa continues to be at risk of international spread of polio from northern Nigeria. This year, WPV1 originating from northern Nigeria has been confirmed in Benin, Burkina Faso and Niger. In 2003-2004, WPV1 originating from northern Nigeria spread to re-infect eight countries across west Africa (Benin, Burkina Faso, Côte d'Ivoire, Ghana, Guinea, Mali, Niger and Togo).
• Ghana conducted already-planned NIDs with trivalent OPV on 15-17 October, and SNIDs in high-risk areas will be held with mOPV1 on 6-8 November and again on 27-29 November.
• Elsewhere in west Africa, following two synchronized SIAs in the border areas of Benin, Burkina Faso, Mali and Niger in June and July, a third round will be conducted on 24 October, with additional activities in November.

The Global Eradication of Polio