WHO-EMRO, POLIO ERADICATION

24th meeting of the Regional Commission for Certification of Poliomyelitis Eradication,
Dubai, 12-14 April 2011

The WHO Regional Office for the Eastern Mediterranean is organizing the 24^th meeting of the Regional Commission for the Certification of Poliomyelitis Eradication from 12 to 14 April 2011 to take place in the Gloria Hotel, Dubai, United Arab Emirates.

Members of the Regional Certification Commission, chairpersons of national certification committees and managers of the Expanded Programme on Immunization from Bahrain, Egypt, Islamic Republic of Iran, Iraq, Jordan, Kuwait, Morocco, Oman, oPt, Qatar, Saudi Arabia, Sudan, Syrian Arab Republic, Tunisia, United Arab Emirates and Yemen will participate in the meeting. Representatives from ROTARY International, the Centers for Disease Control and Prevention, Atlanta, in addition to field staff and staff members from WHO headquarters, WHO Regional Offices for the Eastern Mediterranean, Africa, Europe and South-East Asia and UNICEF/South Sudan have been invited to attend.

H.E. Dr Hanif Hassan Ali, Minister of Health, United Arab Emirates and Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean, will address the meeting during its inaugural session on Tuesday, 12 April 2011.

The southern Sudan November National Immunization Day (NID)
1 November 2010

The southern Sudan November National Immunization Day (NID) started on 1 November in all 10 states in southern Sudan, after thorough planning, training of vaccinators, and provision of the necessary supplies and equipment. The launching ceremony started at 8:30 a.m. with a route march through the main street of Juba. It was attended by dignitaries from the Ministry of Health, Government of southern Sudan, State Minister of Health-Central Equatoria, World Health Organization (WHO), UNICEF, Rotary International, Pathfinder and nongovernmental organizations. In attendance also were the three different cultural groups, school children, disabled society, military band and other youth and social clubs.

The President of southern Sudan, H.E. Salvakir Mayandit, sent a message to the ceremony. In his message, the President pledged Government commitment and support to NIDs as a measure to eradicate polio from southern Sudan. He said polio vaccination was the right of every child and no child must be denied this right.

The keynote address was delivered by H.E. Dr Luka Tombekuna Monoja, the Minister of Health, Government of southern Sudan. He expressed the concern of the Government about the outbreak of 2008–2009 in which 64 children were permanently paralysed. His Excellency acknowledged the frantic efforts made by the Ministry of Health, in collaboration with WHO and other partners, which was successful in bringing the outbreak under control since June 2009. His Excellency said the gains must be sustained and cautioned against complacency. Referring to the recently reported case from Uganda, His Excellency described it as a wake-up call and said that all hands must be on deck until polio was completely eradicated.

After the speech, H.E. administered vaccine drops to a child to declare the campaign officially opened.
Inauguration ceremonies were also conducted in all the other nine states by the Governors and State Ministers of Health.

Crisis task force for polio eradication established in Federally Administered Tribal Areas, Pakistan
August 2010

In response to the increasing number of polio cases in FATA, Pakistan, and the WHO Regional Director Dr Hussein A. Gezairy’s letter to the Governor of Khyber Pakhtunkhwa, a crisis task force for polio eradication in FATA was established by the Governor under the chairmanship of the FATA additional Chief Secretary.

The task force will, among other issues, develop a strategy to address issues of inaccessibility, report to the Governor regularly on the results and solicit his guidance whenever required. They will also develop an “oversight plan” wherein political agents and health managers in agencies will develop a reporting mechanism for effective oversight by a FATA secretariat.

Members of this task force include the Secretary for Law and Order, the Secretary for Administration and Coordination, the Director General of the Disaster Management Authority, the Director General of Projects, together with representatives from the army and the scouts of FATA. The recent floods that have swept across the area have temporarily affected implementation of eradication efforts.

Tajikistan poliovirus outbreak, May 2010

As of 10 May 2010, 278 acute flaccid paralysis (AFP) cases have been reported, and 56 cases have been confirmed as wild poliovirus type 1 in Tajikistan. The number of confirmed cases is changing every day as there are over 200 cases pending classification. Genetic sequencing has determined that the origin of the poliovirus found in Tajikistan is most closely related to virus originating from Uttar Pradesh, India.

Afghanistan is the only country in the WHO Region that shares a border with Tajikistan. In response to the outbreak in Tajikistan, Afghanistan has enhanced surveillance activities in the four border provinces of Balkh, Kunduz, Takhar and Badakhshan. During the National Immunization Days from 2 to 4 May, special attention was given to border areas and all children transiting Afghanistan via the four border crossing points were vaccinated. Afghanistan will also synchronize mop-up activities using mOPV1 with Tajikistan and Uzbekistan in the four border provinces.

More information

Dr Hussein A. Gezairy meets H.E. the Prime Minister during his present visit to Pakistan; calls for greater support at the district level to interrupt the ongoing circulation of poliovirus.

P for polio or progress and peace–Afghanistan polio immunization campaign, February 2010

“We can do it and it must be done” stressed Mr Peter Graaff, World Health Organization (WHO) Representative, Afghanistan, at the launch of the first polio immunization campaign, 14 to 16 February 2010 in Afghanistan.

For three days, 19,000 health workers travelled from house to house in 14 provinces to reach 2.8 million children under-5 years of age in southern, south-eastern, western and eastern Afghanistan. The immunization drive is part of an ongoing effort to eradicate polio in Afghanistan, which is together with Pakistan, India and Nigeria the only country still affected by the disease.

3.5 million doses of bivalent oral polio vaccine were required for this campaign, which is supported by UNICEF, WHO and other long-term partners, such as Rotary International and the Centers for Disease Control (CDC), Atlanta. “The progress that has been achieved so far was possible only thanks to the strong partnership that we have built over the past years,” emphasized Ms Catherine Mbengue, UNICEF Representative.

In 2009, six rounds of national immunization days (NIDS) reaching almost 7.5 million children took place. Four rounds of subnational campaigns (SNID) were conducted in areas where polio cases have been recorded, in order to stop the virus and prevent the disease from spreading to other parts of the country and across the border to Pakistan. Six rounds of NID and four rounds of SNID are planned this year.

“The eradication of polio in Afghanistan is tantalizing close, and yet we are still so far away;” said Mr Graaff at the campaign’s launch in Jalalabad. “I hope that 2010 will be a major step towards a polio-free Afghanistan.”

Female caregivers are the cornerstone in the realization of this goal. Since 2009, UNICEF and WHO have set up ‘women’s courtyards’ throughout Nangarhar province to include women in the immunization drive. Once a woman has become a member of a women’s courtyard it is her responsibility to spread the word about polio prevention by discussing it with female household members in her neighbourhood. This initiative aims to widely disseminate information about polio and other vaccine preventable diseases. Today, an increasing number of polio vaccination agents are female, with easy access to households. “So much has changed over the past months. Female vaccination teams have become the cornerstone of our fight against polio in the east. The involved women are amazingly dynamic and well organized;” said Ms Mbengue, especially in rural Afghanistan where women are sometimes hampered by traditions. The women’s courtyards have opened up the path towards empowerment. As vaccination agents and community mobilizers women are taking an active role in the fight against the crippling disease.

Each polio immunization campaign is composed of three phases. First, female community mobilizers wander from door to door to sensitize families on the importance of vaccination; shortly afterwards they are followed by vaccination teams who visit the children at home. As many families live far from health facilities this mobile approach is essential in reaching a maximum of children in the target group. At the end of each campaign day the immunization teams meet to compile their statistics and discuss problems encountered. Remarkably, male and female vaccinators meet in the same room with equal rights of speech.

Yet, despite ongoing efforts, circulation of the polio virus continues. 38 cases have been reported in 2009, seven more than the year before. Lack of community awareness and inadequate health infrastructure are among the major concerns. Population movement from polio-free areas to polio-endemic locations and vice-versa are another concern, especially along the border between Afghanistan and Pakistan. With the support of Rotary International, vaccination checkpoints have been set up at both sides of the border to make sure that children crossing into the respective countries are being vaccinated.

The first and foremost concern is insecurity. As access of vaccination teams to children living in conflict-affected areas is limited, an average of 100 000 children cannot be reached through either vaccination campaigns or routine immunization efforts.

“We should not forget that health is neutral. The right to vaccination is not being denied by anybody. Please do not only allow the immunization campaign to take place, but facilitate access for the vaccinators to your children;” pleaded Mr Graaff.

Ms Mbengue concluded the launching event with words of hope: “We can eradicate polio, with partnership and peace. Our efforts mean progress for the children of Afghanistan, Pakistan and worldwide – today and tomorrow.”

Bivalent oral polio vaccine to be used for the first time in Pakistan
The next Pakistan nation-wide vaccination campaign is scheduled to take place from 15 to 17 February 2010 using bivalent oral polio vaccine (bOPV) in the high- and medium-risk areas (77 districts), covering 68% of the target population, and trivalent OPV elsewhere. bOPV is being used for the first time in Pakistan.”
Risk categorization of districts/agencies

Afghanistan: Thirteen southern districts critical for polio eradication - WHO
Kabul, 25 January 2010 (Integrated Regional Information Networks (IRIN)) - Successful anti-polio action depends on vaccinators being able to reach and immunize every child under-5 years of age in 13 volatile districts in the southern provinces of Kandahar, Helmand and Farah, according to the World Health Organization (WHO).

"These 13 districts are high priority areas and if we succeed in fighting the virus there, we will eradicate polio in the country," Tahir Pervaiz Mir, WHO's polio eradication officer in Afghanistan, told IRIN. "The virus is localized and we want to finish the job at the earliest [opportunity] and not allow it to spread beyond the southern region," he said.

About 84% of Afghanistan is polio-free but the disease remains virulent in the 13 districts, where health workers have little or no access. Most of the 38 polio cases in 2009 were reported in the south, though one case each was reported in the provinces of Kapisa, Ghor, Nangarhar and Nuristan. Polio is a highly infectious viral disease which affects mostly children under 5 through the oral-faecal route and in some cases causes permanent paralysis, according to WHO.

New vaccine

Owing to its "professional and dedicated anti-polio activities" Afghanistan in December was the first country globally to use a new polio vaccine which is believed to be 30% more effective, WHO's Mir said.

The new bivalent vaccine is specifically made for poliovirus types 1 and 3 which are circulating in the country. Type 2 has not been reported globally since 1999, according to health officials.

"With this new vaccine we feel more confident and will be able to defeat polio here," Abdul Qayum Pokhla, director of the health department in Kandahar, told IRIN, adding that about 2.8 million children received the bivalent vaccine in the southern provinces from 15 to 17 December 2009.

In order to ensure polio eradication and immunize newborn children, the trivalent vaccine will also be used in the four nationwide and four subnational immunization campaigns in 2010, WHO said.

"Letters of support"

The new and more efficient vaccine has strengthened health workers' technical capacity to wipe out poliomyelitis from Afghanistan.

"We need mouths [into which] to drop the OPV (oral polio vaccine)," said Mir.

He said "letters of support" from the insurgents' leadership have enabled vaccinators to access children in areas controlled or influenced by the Taliban. Donors have also been generous and there is no dearth of resources, health officials acknowledge. However, there are still several major challenges ahead, including parents' poor awareness about immunization, recurrent armed hostilities in polio-prone areas, population movement and cultural factors. Most of the vaccinators are male and when they knock on doors during immunization campaigns only the men bring small children for vaccination, but if men are not at home women do not take the very young to vaccinators due to social traditions, and these are the children we are failing to vaccinate," said Mir, adding that communities must help vaccinators reach every child under the age of 5.

A new polio vaccine was used for the first time yesterday in polio immunization campaigns in Afghanistan. The bivalent oral polio vaccine (bOPV) was recommended by the Advisory Committee on Poliomyelitis Eradication, the global technical advisory body of the Global Polio Eradication Initiative, as a critical tool to eradicate polio. It can provide the optimal concurrent protection needed by young children against both surviving serotypes (types 1 and 3) of the paralysing virus. This will vastly simplify the logistics of vaccination in conflict-affected parts of this country. This subnational immunization campaign, being conducted from 15 to 17 December, will deliver bOPV to 2.8 million children under-5 years of age in the southern, south-eastern and eastern Regions of Afghanistan.

GPEI salutes Dr Wahdan
“The father of polio eradication in the Eastern Mediterranean Region, Dr Mohamed Helmy Wahdan, has retired after three decades of superb service to the eradication effort.

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Dr Hussein A. Gezairy, WHO Regional Director for the Eastern Mediterranean, will participate in a meeting requested by Dr M. Chan, WHO Director-General, to review the key findings and recommendations of the independent evaluation of the major barriers to interrupting poliovirus transmission, which will take place in Geneva, on Tuesday, 3 November at 18.00 hrs.

The evaluation was requested by the WHO Executive Board during its January 2009 session. At this point in the Polio Eradication Programme, it is critical that the fresh perspectives, that the evaluation team have been able to bring to effectively overcome the remaining barriers to interruption of poliovirus transmission, are given full and due consideration. This meeting will provide an opportunity to agree on actions that can be taken to ensure the rapid implementation of recommendations.
Global Polio Eradication Initiative

(NIDs) National Immunization Days, (SNIDs) Sub-National Immunization Days, (AFP) Acute Flaccid Paralysis

Current situation in south Sudan

South Sudan is experiencing an outbreak of type 1 poliomyelitis since June 2008. A total of 63 cases has been confirmed so. Nine out of the ten states have reported confirmed cases. A recent surveillance review in early February 2009 has confirmed the high sensitivity of the system despite the issues with accessibility particularly during the wet season. Since February 2009, NIDS are monitored by international observers to provide an independent evaluation of the performance and coverage of the NIDs.
South Sudan Current Weekly Update (04 October 2009)

Another positive environmental samples in Egypt
One wild virus type 1 was isolated from an environmental sample in Cairo, Egypt on 28 December 2008. The genomic sequencing showed that the virus is related to the recent circulation in India. It should be noted that one mop-up has been already implemented 25-27 January 2009 after the isolation of the wild environmental sample. Another mop-up with mOPV1 will be done on 15-17 March 2009. the mop-up will cover 2.7 million under five children in greater Cairo.

Regional Director Visit to Afghanistan and Pakistan
Regional Director (RD) for the WHO Regional Office for the Eastern Mediterranean (EMRO) Dr Hussein A Gezairy traveled to Afghanistan and Pakistan, on a high-level visit for polio eradication. Dr Gezairy met with senior political leadership in both countries, including HE Afghanistan President Hamid Karzai and HE Pakistan Prime Minister Mr Syed Yusuf Raza Gilani in addition to the Federal Health Ministers in both countries, Dr Sayed Mohammad Amin Fatimi (Afghanistan) Mir Aijaz Hussain Jakhrani (Pakistan). Dr Gezairy commended the visible political will, determination and commitment to polio eradication in both countries and underscored that they have the capacity to achieve this target.