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PROGRESS TOWARDS POLIO ERADICATION WORLDWIDE 2013-2014
Discussion below; full text, with figures, is at http://www.who.int/wer/2014/wer8922.pdf?ua=1
Significant progress towards polio eradication has been made since 2012. No WPV3 case has been identified in any country since November 2012 in Nigeria, raising the possibility that WPV3 transmission may have been interrupted globally. In March 2014, the SEAR joined AMR, WPR and EUR as Regions certified free of indigenous wild poliovirus. With this achievement, 80% of the world’s population now lives in countries certified as polio-free. Indigenous WPV transmission in AFR and EMR is now restricted to fewer geographical areas within each of the 3 remaining endemic countries than at any time previously. Of note, the remarkable decrease in the number of reported WPV cases and of affected states and districts in Nigeria was accompanied by significantly improved SIA quality indicators during late 2012 and early 2013. WPV transmission in Nigeria appears to be restricted to Kano and Borno states although gaps in surveillance quality remain.
During 2010–2012, the conflict in Afghanistan prevented vaccinators from safely accessing children in many areas of the Southern Region of Afghanistan. However,
systematic negotiations greatly improved access to children in 2013, which, together with successful efforts to improve the quality of SIAs, virtually interrupted trans
-mission of endemic WPV in the Southern Region. Nevertheless, the success of global polio eradication is being challenged by major limitations in access and security
in other countries.
In Pakistan, targeted attacks against polio workers and police officers assigned to protect them have seriously compromised the implementation of SIAs in parts of
the Federally Administered Tribal Areas (FATA), of Khyber Pakhtunkhwa (KP) province, and in parts of Karachi city. The continued ban on polio vaccination in
North and South Waziristan, FATA, where local authorities have prevented vaccination of >350,000 children since June 2012, is largely responsible for the increase
in cases in 2013 and 2014 in Pakistan, and for recent WPV importations into Afghanistan and the Syrian Arabic Republic. However, as of end-April 2014, 12 consecutive SIAs have already been carried out in the KP region, demonstrating the importance of strong political commitment and engagement of local communities,
religious leaders, and humanitarian organizations to reach unvaccinated children in these areas.
Anti-government elements in Nigeria have prevented vaccinators from visiting some areas of Borno state since early 2013; however, vaccination access has improved gradually and 83.9% of children were accessible by March 2014.
Limitations in access and security have also greatly affected the ability to promptly control and terminate outbreaks. Outbreak control has also been compromised by suboptimal AFP surveillance performance and SIA implementation. The outbreak in the Horn of Africa has lasted >9 months after initial confirmation, partly
due to limitations in the quality of outbreak response in insecure parts of Somalia and difficult-to-reach areas in Ethiopia. The ongoing circulation of WPV1 in Cameroon and Equatorial Guinea poses a risk for wider spread, including into populations affected by civil unrest in the Central African Republic. An intensive
outbreak response is being planned to include neighbouring countries in order to limit further extension of transmission.
With further restriction of the geographic extent of WPV circulation in the endemic countries, and provided that outbreaks following importation into polio-
free countries can be prevented or promptly terminated, interruption of transmission could be achieved worldwide in the near future. The GPEI has developed the
Polio Eradication and Endgame Strategic Plan for 2013–2018to (1) interrupt all poliovirus transmission, (2)progressively withdraw OPV and introduce inactivated poliovirus vaccine, (3) certify polio eradication, and (4) transfer assets and infrastructure to routine immunization programmes as part of the GPEI legacy.
Greatly concerned by the renewed international spread of WPV in 2014, WHO declared the recent international spread of WPV a ‘Public Health Emergency of Interna
tional Concern (PHEIC)’ and issued Temporary Recommendations under the International Health Regulations (IHR 2005) to reduce international spread of WPV
through (1) ensuring that residents and long-term visitors traveling from States currently exporting WPV –Cameroon, Pakistan and the Syrian Arab Republic –
receive polio vaccination prior to international travel, and encouraging residents and long-term visitors traveling from States where WPV is present but not currently ex
ported – Afghanistan, Equatorial Guinea, Ethiopia, Iraq, Israel, Nigeria, and Somalia – to receive polio vaccination prior to international travel (http://www.who.int/media-centre/news/statements/2014/polio-20140505/en/) and (3) that the vaccination received is documented on an International vaccination certificate.
At this critical time for the GPEI, enhanced commitment by countries and GPEI partners is crucial for maintaining current gains and to complete the global eradication of polio.