Polio eradication

Poliomyelitis is a highly infectious disease caused by wild poliovirus types 1, 2 and 3. The virus is transmitted from person-to-person through ingestion of infected fecal matter. Following infection, the virus is shed intermittently in excrement for several weeks with little or no symptoms in majority of cases. The initial symptoms of poliomyelitis include fever, fatigue, headache, vomiting, neck stiffness and pain in the limbs. Less than 1% of the infected persons develop irreversible paralysis. Poliomyelitis mainly affects children less than five years. 5%-10% of those paralyzed by the virus die as a result of breathing complications.

Oral poliovirus vaccine (OPV) is used as the primary vaccine in interrupting wild polio virus (WPV) transmission, administered through routine immunization or during supplementary immunization activities (SIA). When given multiple times this vaccine almost always protects a child for life. However, in a number of importation countries, significant numbers of susceptible population accumulate because children below one year old are missed during routine immunization and more or less the same children are persistently missed during supplementary immunization campaigns due to sub-optimal quality of immunization activities targeting below 5 year old children. In 2008, of the estimated 5 million un-immunized children under 1 year old, 3 million [65%] reside in countries with circulating WPV or bordering a polio infected country. This in part has facilitated continued Poliovirus importations in the region.

The Role of Immunization and Vaccine Development Department

The role of IVD in Africa is aligned to that of the Global Polio Eradication Initiative (GPEI), which provides technical assistance and guidance to countries in order to ensure polio eradication in the region within a set timeline. AFRO IVD's responsibilities also include:

• Advocating/engaging with national Governments and partners to arrive at mutually agreed targets
• Providing technical support to member states in planning implementing monitoring and evaluating immunization activities in general
• Specifically for Polio Eradication implement the following strategies:
  - Achieving/maintaining high (At least 90%) oral polio vaccine (OPV) routine immunization coverage in all countries
  - Conducting quality SIA with OPV whenever implemented especially in countries reporting WPV
  - Supporting and maintaining Regional polio laboratory network
  - Monitoring and evaluating activities including providing regular feedback
  - Supporting the National Certification Committees (NCC) for Polio Eradication
  - Assisting and supporting resource mobilization efforts

Challenges

Access: The persistently un-reached children, particularly in countries with wild poliovirus (WPV) transmission.
Optimizing surveillance: Maintaining high quality and effective surveillance for polio.
Inadequate infrastructure: Difficulty in reaching remote areas for immunization.
Ineffective communication: Lack of accurate relay of information and community mobilization.
Motivated/skilled staff: Inadequate numbers of motivated and/or adequately trained staff.
Funding: Securing adequate funding to implement planned and outbreak activities.

What is WHO/AFRO is doing to combat Polio

• Improving population immunity, through the implementation of the RED strategy.
• Improving quality of SIA's through optimal micro-planning, selection of vaccinators and supervisors, training, supervision, independent monitoring and evaluation of campaigns in implementing countries.
• Responding timely and adequately to any importation of WPV using the appropriate oral polio vaccine.
• Sustaining quality of surveillance of at least 2/100,000 non-polio AFP rate and at least 80% stool adequacy rate at sub national level.
• Consolidating the implementation of the new polio laboratory algorithm to support timely response.

Progress

Since 1988, Polio cases worldwide have decreased by over 99%, from an estimated 350,000 cases in more than 125 endemic countries, to 1997 reported cases in 2006. Globally, only four countries remain polio endemic, namely Afghanistan, India, Nigeria and Pakistan. In the African Region, Nigeria presents the biggest challenge to polio eradication.

Our Goals

• To sustain political commitment for polio eradication.
• To interrupt circulation of WPV and circulating derived polioviruses (cVDPV) through: Intensified and high quality supplementary immunization activities including timely response to outbreaks and high quality routine immunization.
• To achieve and maintain high quality surveillance at sub-national level.
• To consolidate and scale up the new accelerated laboratory testing algorithm.
• Achieve regional certification.
• Mainstream the Polio Eradication initiative infrastructure.

Our Accomplishments

• Since 1999, Polio type 2 has been eradicated in AFRO and globally.
• The number of Polio endemic countries in the African region has been reduced from 30 in 1988, to only 1 (Nigeria) in 2008
• All AFRO countries have established functional and effective AFP surveillance systems.
• Laboratory turnaround time for stool specimen processing has been reduced from 60 days to only 21 days following the introduction of new laboratory approaches.
• Implementation of new outbreak response guidelines devised by the Advisory Committee on Polio Eradication and adopted at the WHO assembly in May 2006 resulted in timely response and improved quality of SIAs.
• 25 out of 46 AFRO countries have successfully presented their complete country documentation for certification of polio eradication to the African Regional Certification Commission (ARCC).

Our Partners

The Global Polio Eradication Initiative partners include: WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and the United Nations Children's Fund (UNICEF). Others include: United Nations Foundation, Bill & Melinda Gates Foundation, development banks (e.g. the World Bank); bilateral donor governments; European Commission; USAID, humanitarian and non- governmental organizations (e.g. the International Red Cross and Red Crescent societies) and corporate partners (e.g. De Beers & Wyeth). Volunteers during mass immunization campaigns in developing countries have played a key role in immunizing over 20 million people. The backbone of the initiative is the national government and established country infrastructure.