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

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 2 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

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 3 Progress in African region 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 As of 2 nd of April 2008, 102 WPV cases were confirmed in 5 countries: Nigeria(95), Niger(3), Chad(2), DRC(1) and Angola(1).

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 4 Wild Poliovirus Case Distribution 1 Jan - 31 Dec 2006 & 1 Jan – 31 Dec 2007 WPV Type 1 WPV Type 3 EMRO Luanda 70% of Wild Poliovirus Case Reduction

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 5 Wild Poliovirus Case Distribution (1 Jan – 5 March 2008) Country W1W3 W1+ W3Total NIGE RIA NIGE R 3003 ANG OLA 1001 CHA D 0202 DRC 1001 TOTAL AFR

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 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

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 7 Wild poliovirus spread*, 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 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%)

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 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)

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 9 Regional polio infected districts Mali Niger Nigeria Namibia DRC Chad Ethiopia Angola Cameroon Kenya Mali Niger Nigeria Namibia DRC Chad Ethiopia Angola Cameroon Kenya Mali Niger Nigeria Namibia DRC Chad Ethiopia Angola Cameroon Kenya % Reduction in Infected Districts (From 2005 to 2007) 173 Districts 266 Districts 297 Districts

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 10 Regional trends of WPV cases

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 11 Progress in Nigeria

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 12 Nigeria WPV cases trend ( *) * 28 January 2008

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique – 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 # Infected States: 19 W1 (n=89) W3 (n=12) # Infected States: 15 W1 (n=12) W3 (n=45) 2007

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 14 Current status in Polio importation countries (Update as of 5 th March 2008)

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 15 NIGERIA Central Afr. Rep. CHAD CAMEROON Cameroon WPV Type1 (Date of onset: 18/11/2007) Last case reported 6/12/2006 CONGO Douala

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 16 Angola, Wild Poliovirus case Distribution ( )

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 17 Most recent WPV case Onset 23/1/ N= N=3 WPV type 3 WPV type 1 NIGER, Wild poliovirus Case Distribution

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 18

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 19 DRC, Risk Analysis Status (As of 22 February 2008) Low Risk Medium High Risk

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 20

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 21 Polio SIAs in AFR in 2007 No SIAs 1-2 NIDs/SNIDs >4 NIDs/SNIDs Non-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.

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 22 NID SNID Planned 2008 Polio SIAs (Tentative dates) Note: Last quarter dates to be completed

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 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 ( )

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 24 Surveillance review Status 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

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 25 Example of Impact – Angola AFP cases by Month External review Number of AFP cases reported increased

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 26 Regional Polio Certification Standards Met certification standards Have not met certification standards 2006

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 27 Status of certification in AFRO Mauritius Seychelles Reports Accepted (21) Presenting 2008 (8) EMRO countries Pending

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique Routine DPT3 Coverage in AFR (Jan-Aug 2006 & Jan-Aug 2007) 2007 ND=No Data Source: Country/EPI Monthly Report ND <50% % >= 80% EMRO >= 90% 59% 74% 75% 52% 84% 72 % 58% 66%

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique AFR Immunization Status of NP-AFP cases

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 30 WHO/AFRO Polio Laboratory Network Performance ** as of 03/10/2007 Year AFP cases SpecimenTotal Polio Isolated WPV cases ITD in 14 days (%) Results in 28 days(%) NPEV rate (%) 20019,12818,6621, ,23418,2171, ,44316,8931, ,00920,2842, ,97323,9263, ,04625, * ** * Maidiguri/CDC double testing

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 31 Timeline – Target Dates 2008Interruption of type 1 polio 2009Interruption of type 3 polio 2012 Certification of all WHO Regions 2013 Cessation of all routine OPV use

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 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

WHO Regional Office for Africa / Bureau Régional de lOMS pour lAfrique 33 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

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