1. 1 Progress Towards Polio Eradication in EMR

2. 2 Status of global eradication Priority countries (except EMR) 2004-5: Intensification 2006-8: Certification, OPV cessation & mainstreaming of the infrastructure. Presentation

3. 3 Polio Eradication Progress Endemic Countries, 1988-2003 Last case in China Last case in Indonesia Last case in Somalia Last case in Bangladesh, DR Congo, Ethiopia & Angola Last case in Americas

4. 4 Polio Eradication Progress 1988 - 2003 1988 350 000 cases 125 countries 2003 785 cases 6 countries

5. Polio Eradication Progress Polio Cases, 1988-2003 1988: WHA Resolution to Eradicate Polio 1999 - 2003 5 Global Polio Eradication Initiative February 2004

6. 6 Changing Epidemiology, 2003 Endemic Cases Imports

7. 7 Endemic countries Wild virus type 1 Wild virus type 3 Importation Changing Epidemiology 2003 Importations > endemic areas Nigeria virus exported to 8 countries. Western Uttar Pradesh exported to polio-free states in India.

8. 8 Risks: Increasing Vulnerability Polio Campaigns 2002 vs. 2004 2004: <20 countries

9. 9 Stool Specimen Collection Rates, Sept 02- Oct 03 < 60% 60% -80% > 80% No AFP Risks: Surveillance Gaps Risks: performance gaps in reinfected & high risk areas

10. 10 ‘ 2004: a one time opportunity for a polio- free world. ’ Meeting of Ministers World Health Organization Geneva, Switzerland 15 January 2004

11. 11 Non polio AFP rate in EMR by province (Pakistan by district) 01/01/2003-31/12/2003

12. 12 Non polio AFP rate in EMR by province (Pakistan by district), 2003

13. 13 Non-polio AFP rate in EMR by province, 2004 (to date 22/06/04)

14. 14 Percent of AFP cases with adequate samples in EMR, 2003

15. 15 % AFP cases with adequate stool specimens EMR provinces, 2003

16. 16 % AFP cases with adequate stool specimens EMR provinces, 2004 (to date 22/06/04)

17. 17

18. 18

19. 19 Non-polio AFP rate per 100,000 children under 15, EMR, 1993-2004 To date 21/03/04 AFP Surveillance Polio Eradication Strategies EMR Mar 04

20. 20 Non polio AFP rate in EMR, 2003 05/02/04 AFP surveillance Non-polio AFP rate/ 100,000 <15 EMR countries, 2003 EMR Mar 04

21. 21 Non polio AFP rate in EMR, 2003 05/02/04 AFP surveillance Non-polio AFP rate/ 100,000 <15 EMR countries, 2004 (to date 21/03/04) EMR Mar 04

22. 22 AFP Surveillance Polio Eradication Strategies % of AFP cases with adequate stool specimens, 1995-2004 To date 21/03/04 EMR Mar 04

23. 23 Percent of AFP cases with adequate samples in EMR, 2003 05/02/04 AFP surveillance % AFP cases with adequate stool specimens EMR countries, 2003 EMR Mar 04

24. 24 Percent of AFP cases with adequate samples in EMR, 2003 05/02/04 AFP surveillance % AFP cases with adequate stool specimens EMR countries, 2004 EMR Mar 04

25. 25 P1 P3 Poliovirus Isolates 2004*

26. 26 Issues Areas of concern, NWFP, Quetta: tribal areas  Conservative/ less females/youngest children  high %unimmunized Local political leadership Need better SIA quality Fatigue/discouragement Action District analysis to identify HRD 3 rounds during LT season + 1 SNID + 3 Fall NIDs (quality) Advocacy plan District level Continue HL advocacy Plans for tribal areas District teams

27. 27 Issues Evidence of indigenous transmission in South/West Security situation (surveillance and SIAs) Population movements Action Focus on area of transmission (Dec-Jan) SNIDs + Mar- Apr NIDs + 2 fall NIDs (national monitors) Different modality for surveillance national staff National surveillance reviews in areas of concern

28. 28 Issues More than 300,000 missed in each round (100,000 in Cairo/Giza) Variable implementation between districts Slipping Surveillance quality in some areas (GC) Action Task force Identify and focus on poorly performing districts Continue/Increase technical support esp GC and Menia Feb: SNID + Spring NIDs+Fall NIDs + Mop- up plan Surveillance review

29. 29 Endemic countries Wild virus type 1 Wild virus type 3 Importation Increasing Vulnerability Importations > endemic areas, 2003 Nigeria virus exported to 7 countries.

30. 30 Regional strategic plan for poliomyelitis eradication 2004–2008 Prepared in consultation with nationals, UN agencies and other partners Covers the main elements of: –Intensifying supplemental immunization –Enhancing surveillance and maintaining the laboratory network –Laboratory containment –Certification –Strengthening EPI Essential to maintain trained personnel (national and international) and utilize them to support priority health programmes