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SASTM Newsflash - Poliomyelitis update: Kenya, Somalia, Pakistan, Global

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POLIOMYELITIS UPDATE:

 

KENYA, SOMALIA, PAKISTAN, GLOBAL

 

A big worry among people trying to wipe out polio is that the virus will regain a foothold, somewhere to launch a comeback -- someplace, perhaps, like Somalia.

 

Polio has paralyzed 25 children in Somalia and another 6 in a Kenyan refugee camp since early May [2013], the Global Polio Eradication Initiative reported Wednesday [26 Jun 2013]. Before this outbreak, Somalia hadn't had a polio case in more than 5 years.

 

There were only 223 polio cases around the world in 2012, the lowest ever recorded. Even in the remaining 3 endemic countries -- Afghanistan, Pakistan and Nigeria -- polio was only showing up isolated in a few remote areas.

 

This outbreak in Somalia could threaten that progress.

 

The recent cases are probably just the tip of the iceberg, says Sona Bari, from the World Health Organization (WHO). "The last time we saw an outbreak in this part of the world it involved Yemen, most of the countries in the Horn of Africa, Sudan, and led to about 700 cases," Bari says.

 

Somalia is a tough place to fight polio. It has very low rates of immunization for most diseases, including polio. Vaccination teams can't even enter parts of Somalia because of violence.

 

Just last week, Islamic extremists launched a suicide attack on the United Nations headquarters in Mogadishu. After a 90-minute gun battle, 22 people at the compound died.

 

Despite the security problems in Somalia, emergency responses to the polio cases are underway. Local health officials in Somalia have launched 3 massive vaccination drives, Bari says, and Kenya has already carried out 2 special immunization campaigns in the refugee camp.

 

When outbreaks like these occur, she says, the goal is to break the poliovirus's transmission cycle by trying to get more than 90 percent of the local population vaccinated.

 

"The virus is looking for children [susceptible individuals] in which it can circulate," Bari says. "The virus can't live out in the sewage or in the environment on its own. So it needs human beings. And it looks for people who are not immune, who are going to allow it to continue transmitting."

 

This outbreak is still in its early stages, she says. And WHO expects to see more polio cases reported from Somalia in the coming weeks. But, Bari says, polio workers are hopeful that the emergency vaccination campaigns are reaching enough children to slow the spread of the virus.

 

There have been 77 polio cases reported worldwide so far this year [2013], compared with 84 to this point in 2012. But almost half of this year's [2013] cases have occurred in Somalia and Kenya.

 

 

 

Global Polio Eradication Initiative update as of 26 Jun 2013

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Wild poliovirus (WPV) cases

Total cases: Year-to-date 2013 / Year-to-date 2012 / Total 2012

Globally: 77 / 84 / 223

- in endemic countries: 46 / 80 / 217

- in non-endemic countries: 31 / 4 / 6

 

Case breakdown by country

Countries: 2013 WPV1 / WPV3 / W1W3 / Total 2013 // 2012 WPV1 / WPV3 /

W1W3 / Total year-to-date 2012 / Total 2012 // Date most recent case

 

Pakistan: 17 / 0 / 0 / 17 // 19 / 2 / 1 / 22 / 58 // 6 Jun 2013

Afghanistan: 3 / 0 / 0 / 3 // 10 / 0 / 0 / 10 / 37 // 6 Jun 2013

Nigeria: 26 / 0 / 0 / 26 // 33 / 12 / 0 / 45 / 122 // 18 May 2013

Somalia: 25 / 0 / 0 / 25 // 0 / 0 / 0 / 0 / 0 // 25 May 2013

Kenya: 6 / 0 / 0 / 6 // 0 / 0 / 0 / 0 / 0 // 18 May 2013

Chad: 0 / 0 / 0 / 0 // 4 / 0 / 0 / 4 / 5 // 14 Jun 2012

Niger: 0 / 0 / 0 / 0 // 0 / 0 / 0 / 0 / 1 // 15 Nov 2012

Total: 77 / 0 / 0 / 77 // 69 / 14 / 1 / 84 / 223 Total in endemic countries: 46 / 0 / 0 / 46 // 65 / 14 / 1 / 80 / 217 Total outbreak: 31 / 0 / 0 / 31 // 4 / 0 / 0 / 4 / 6

 

Data in WHO as of 26 Jun 2012 for 2012 data and 25 Jun 2013 for 2013 data.

 

Afghanistan

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- One new WPV case was reported in the past week (WPV1 from Nangarhar), bringing the total number of WPV cases for 2013 to 3. It is the most recent WPV case in the country and had onset of paralysis on [6 Jun 2013].

- All 3 WPV cases this year [2013] were reported from the Eastern Region. In the traditional high-risk Southern Region, no WPV cases have been reported since November 2012.

- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases in 2013 remains 3. The most recent cVDPV2 case had onset of paralysis on [13 Mar 2013] (from Kandahar, Southern Region).

 

Nigeria

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- No new WPV cases were reported in the past week. The total number of WPV cases for 2013 remains 26. The most recent WPV case had onset of paralysis on [18 May 2013] (WPV1 from Bauchi).

- No new cases of cVDPV2 were reported in the past week. The most recent cVDPV2 case had onset of paralysis on [24 Nov 2012] (from Kebbi).

 

Pakistan

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- One new WPV case was reported in the past week (WPV1 from Bara in Khyber Agency, Federally Administered Tribal Areas - FATA), bringing the total number of WPV cases for 2013 to 17. It is the most recent WPV case in the country and had onset of paralysis on [6 Jun 2013].

- Bara is affected by an outbreak of WPV1, with 7 cases now confirmed since end-April [2013]. This outbreak is the major WPV reservoir in all of Asia, and is threatening progress achieved elsewhere in the country and in neighbouring Afghanistan. It is an area where limited vaccination activities have been conducted since 2009, due to hampered access and insecurity.

- In 2011 and 2012, Bara was the epicentre of a major outbreak which also spread to other areas.

- No new cVDPV2 cases were reported in the past week. The total number of cVDPV2 cases for 2013 remains 5. The most recent cVDPV2 case had onset of paralysis on [8 May 2013] (from Gadap town, greater Karachi, Sindh).

 

Central Africa: Chad and Cameroon

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- In Chad, no new WPV cases were reported in the past week. The most recent WPV case had onset of paralysis on [14 Jun 2012] (WPV1 from Lac).

- One new cVDPV2 case was reported in the past week in Chad, bringing the total number of cVDPV2 cases for 2013 to 2. It is the most recent

cVDPV2 case in the country and had onset of paralysis on [10 Apr 2013] (from N'Djamena).

- In Cameroon, a cVDPV2 case was also reported from Extreme-Nord (onset of paralysis on [9 May 2013]).

- Genetic sequencing is ongoing to determine the origin of these latest cases, but it is likely that they are linked to the ongoing

cVDPV2 outbreak affecting Chad.

 

Horn of Africa

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- A total of 6 new WPV cases were reported in the past week (WPV1s from Somalia), bringing the total number of WPV1 cases in the region to 31 (25 WPV1s from Somalia and 6 WPV1s from Kenya). The most recent WPV case in the region had onset of paralysis on [23 May 2013] (from Banadir, Somalia).

- The bulk of the newly reported cases are from Banadir, which remains the epicentre of the outbreak.

- Although newly reported cases are increasing, it is important to note that none of these cases represent breakthrough transmission since outbreak response activities began.

- However, of concern is that 2 cases have now been reported from districts in Lower Shabelle region in south-central Somalia where access for supplementary immunization activities (SIAs) has been compromised for the past 3 years. Surveillance in this area, however, remains functional. As many as 500 000 children in this area are at particular risk of polio at the moment. Efforts are ongoing to operate in this area, and vaccinations are continuing at entry and exit points to build up immunity levels.

- In Somalia, the 3rd round of outbreak response campaigns was conducted last week, including in Banadir (which includes Mogadishu), targeting all age groups.

- Anecdotal feedback from the field indicates overall good coverage is being achieved, with strong community participation. The 4th round will start on [1 Jul 2013], again aiming to reach all age groups in Banadir.

- The security situation continues to be evaluated, especially following the deadly attack on the UN compound in Mogadishu last week.

- In Kenya, the 2nd round of outbreak response campaigns was conducted last week. In the Dadaab area, all age groups were targeted. The 3rd round will start on [1 Jul 2013].

- Immunization campaigns are also planned and being conducted in other countries of the Horn of Africa, notably Ethiopia and Yemen, to urgently boost population immunity levels and minimize the risk of spread of the outbreak.

 

West Africa

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- No new WPV cases were reported in the past week. The most recent case in the region was a WPV1 from Tahoua province in Niger with onset of paralysis on [15 Nov 2012].

 

Communicated by: ProMED-mail

 

There have been 22 new cases reported since the last ProMED-mail update on 14 Jun 2013, raising the global total of confirmed cases from 55 to 77. Sadly, the majority of newly confirmed cases are in countries that had been previously polio free -- Somalia and Kenya. Cases continue to occur in the 3 remaining endemic countries -- Afghanistan, Nigeria and Pakistan, but fortunately at a lower rate.

 

The concerns about the possibility of expanded outbreaks occurring in other countries where wild poliovirus (WPV) transmission has been interrupted are real concerns. The continued occurrence of circulating vaccine derived poliovirus (cVDPV) cases serves as an indicator of suboptimal vaccination coverage in the areas, and these areas serve as foci where transmission of the WPV can continue.

 

Unfortunately, the 3 remaining endemic countries for WPV circulation, and Somalia, are all areas with civil unrest and violence against international agency staff as well as local staff working as vaccinators; this definitely hinders vaccination activities and impedes the necessary activities to eliminate the pockets of susceptible individuals.

 

 

 


 

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