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OVERVIEW OF POLIO ERADICATION INITIATIVE IN THE AFRICAN REGION

OVERVIEW OF POLIO ERADICATION INITIATIVE IN THE AFRICAN REGION. COMMUNICATION MEETING MEETING DAKAR – SENEGAL 5 TH TO 7 TH APRIL 2008. Outline Of Presentation. WPV transmission in AFR in 2006/7 Progress in Nigeria Status in Polio importations countries 2006/7 SIA activities 2007/8

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OVERVIEW OF POLIO ERADICATION INITIATIVE IN THE AFRICAN REGION

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  1. OVERVIEW OF POLIO ERADICATION INITIATIVE IN THE AFRICAN REGION COMMUNICATION MEETING MEETING DAKAR – SENEGAL 5TH TO 7TH APRIL 2008

  2. Outline Of Presentation • 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

  3. 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).

  4. Wild Poliovirus Case Distribution 1 Jan - 31 Dec 2006 & 1 Jan – 31 Dec 2007 Luanda WPV Type 1 EMRO WPV Type 3 2007 2006 70% of Wild Poliovirus Case Reduction

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

  6. 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

  7. Wild poliovirus spread*, 2003-08 93 events, 26 countries Number of importations from Nigeria Viral origin: 68 events (73%) Number of importations from India Viral origin: 25 events (27%) Wild virus type 1 Wild virus type 3 Wild virus type 1 & 3 Endemic countries** Ongoing outbreak (due to imported wild poliovirus) Controlled outbreak (due to imported wild poliovirus) Spread of the virus 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 *Excludes viruses detected from environmental surveillance and vaccine derived polio viruses . Data in WHO HQ as of Feb 2008

  8. 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)

  9. Regional polio infected districts 2005-2007 Niger Mali Chad Nigeria Ethiopia Cameroon 42% Reduction in Infected Districts (From 2005 to 2007) Kenya DRC 2007 Angola Mali Chad Niger Namibia Ethiopia Nigeria Cameroon Kenya DRC 2006 Angola Namibia Mali Chad Niger Nigeria Ethiopia Cameroon Kenya DRC 2005 Angola Namibia 173 Districts 266 Districts 297 Districts

  10. Regional trends of WPV cases 2004-2007

  11. Progress in Nigeria

  12. Nigeria WPV cases trend(2002-2008*) * 28 January 2008

  13. 2007 – 2008 Wild poliovirus DistributionOnset April 01, 2007/2008 W1 (n=89) W1 (n=12) W3 (n=12) W3 (n=45) # Infected States: 15 2007 2008 # Infected States: 19 * Onset of most recent case on 01-Mar-2007 * Onset of most recent case on 01-Mar-2008

  14. Current status in Polio importation countries (Update as of 5th March 2008)

  15. Cameroon WPV Type1 (Date of onset: 18/11/2007) Last case reported 6/12/2006 CHAD CAMEROON Central Afr. Rep. NIGERIA Douala CONGO

  16. Angola, Wild Poliovirus case Distribution (2007-2008)

  17. NIGER, Wild poliovirus Case Distribution2007-2008 2007 N=11 2008 N=3 Most recent WPV case Onset 23/1/2008 WPV type 3 WPV type 1

  18. Low Risk Medium High Risk DRC, Risk Analysis Status (As of 22 February 2008)

  19. No SIAs 1-2 NIDs/SNIDs >4 NIDs/SNIDs Non-AFRO Polio SIAs in AFR in 2007 • 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.

  20. NID SNID Planned 2008 Polio SIAs (Tentative dates) Note: Last quarter dates to be completed

  21. Regional Operational AFP Surveillance Indicators (2005-2007) 2007 The 2 AFP operational indicators: - NP-AFP rate>=2/100,000 - Stool adeq. rate >=80% 2006 2005 Met the 2 AFP surveillance indicators Met only one AFP surveillance indicator Have not met both AFP surveillance indicators

  22. 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

  23. Number of AFP cases reported increased External review Example of Impact – Angola AFP cases by Month 2006-2007

  24. Regional Polio Certification Standards 2005-2007 2007 2006 2005 Met certification standards Have not met certification standards

  25. Status of certification in AFRO - 2007 Seychelles Pending Reports Accepted (21) Presenting 2008 (8) Mauritius EMRO countries

  26. 66% 72% 84% 58% EMRO >= 80% >= 90% 50 - 79% <50% Routine DPT3 Coverage in AFR (Jan-Aug 2006 & Jan-Aug 2007) 2006 2007 ND 59% 74% 75% 52% ND=No Data Source: Country/EPI Monthly Report 28

  27. WHO/AFRO Polio Laboratory Network Performance-2001-2007 ** as of 03/10/2007 * Maidiguri/CDC double testing

  28. Timeline – Target Dates 2008 Interruption of type 1 polio 2009 Interruption of type 3 polio • Certification of all WHO Regions • Cessation of all routine OPV use

  29. 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 32

  30. 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 • Monitorthe 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

  31. THANK YOU

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