overview of polio eradication initiative in the african region communication meeting meeting dakar...
TRANSCRIPT
OVERVIEW OF POLIO ERADICATION INITIATIVE IN THE
AFRICAN REGION
COMMUNICATION MEETING MEETING
DAKAR – SENEGAL5TH TO 7TH APRIL 2008
2WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
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
3WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
Progress in African region 2006-2008
• 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 2006.
• As of 2nd of April 2008, 102 WPV cases were confirmed in
5 countries: Nigeria(95), Niger(3), Chad(2), DRC(1) and
Angola(1).
4WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
Wild Poliovirus Case Distribution 1 Jan - 31 Dec 2006 & 1 Jan – 31 Dec 2007
WPV Type 1
WPV Type 3
EMRO
2006
2007
Luanda
70% of Wild Poliovirus Case
Reduction
Country W1 W3 W1+W3 TotalNIGERIA 848 277 0 1125ANGOLA 2 0 0 2ETHIOPIA 17 0 0 17DRC 13 0 0 13NIGER 9 2 0 11NAMIBIA 19 0 0 19KENYA 2 0 0 2
CAMEROON 1 1 0 2CHAD 0 1 0 1TOTAL AFR 911 280 0 1192
Country W1 W3 W1+W3 TotalNIGERIA 111 175 0 286ANGOLA 8 0 0 8DRC 41 0 0 41NIGER 10 1 0 11CHAD 18 3 0 21TOTAL AFR 188 179 0 367
5WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
Wild Poliovirus Case Distribution (1 Jan – 5 March 2008)
Country W1 W3W1+W3 Total
NIGERIA 85 10 0 95
NIGER 3 0 0 3
ANGOLA 1 0 0 1
CHAD 0 2 0 2
DRC 1 0 0 1
TOTAL AFR 90 12 0 102
6WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
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
7WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
Wild poliovirus spread*, 2003-08
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 2007. 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%)
8WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
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)
9WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
Regional polio infected districts 2005-2007
2005
2006
Mali Niger
Nigeria
Namibia
DRC
Chad
Ethiopia
Angola
CameroonKenya
Mali Niger
Nigeria
Namibia
DRC
Chad
Ethiopia
Angola
CameroonKenya
Mali Niger
Nigeria
Namibia
DRC
Chad
Ethiopia
Angola
Cameroon
Kenya
2007
42% Reduction in Infected Districts(From 2005 to 2007)
173 Districts
266 Districts
297 Districts
10WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
Regional trends of WPV cases 2004-2007
0
20
40
60
80
100
120
140
160
180
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Nu
mb
er o
f W
PV
cas
es
2004 2005 2006 2007
11WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
Progress in Nigeria
12WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
Nigeria WPV cases trend(2002-2008*)
* 28 January 2008
13WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
2007 – 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-2007
2008
# Infected States: 19
W1 (n=89)
W3 (n=12)
# Infected States: 15
W1 (n=12)
W3 (n=45)
2007
14WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
Current status in Polio importation countries
(Update as of 5th March 2008)
15WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
NIGERIA
Central Afr. Rep.
CHAD
CAMEROON
CameroonWPV Type1
(Date of onset: 18/11/2007)
Last case reported 6/12/2006
CONGO
Douala
16WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
ANGOLA
LUANDA
1 WPV case in 2008
8 WPV cases in 2007
Most recent WPV case, Onset 21/1/2008
Last case reported was 8/7/2007
ANGOLA
LUANDA
1 WPV case in 2008
8 WPV cases in 2007
1 WPV case in 2008
8 WPV cases in 2007
Most recent WPV case, Onset 21/1/2008
Last case reported was 8/7/2007
Angola, Wild Poliovirus case Distribution (2007-2008)
17WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
Most recent WPV caseOnset 23/1/2008
2007N=11
2008N=3
WPV type 3
WPV type 1
NIGER, Wild poliovirus Case Distribution2007-2008
18WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
Orientale Equateur
Bandundu
ANGOLA
Most recent WPV case Onset, 20/11/2007
DRC, Wild poliovirus case distribution, 2007
N=41
PVS Type1
Orientale Equateur
Bandundu
ANGOLA
Most recent WPV case Onset, 20/11/2007
DRC, Wild poliovirus case distribution, 2007
N=41
PVS Type1
19WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
DRC, Risk Analysis Status (As of 22 February 2008)
Low RiskMediumHigh Risk
20WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
WPV Type 1WPV Type 3
Chad, Wild Poliovirus Case Distribution(2007-2008)
Most recent WPV caseOnset 3/1/2008
2007 = 21 cases2008 = 1 case
WPV Type 1WPV Type 3
Chad, Wild Poliovirus Case Distribution(2007-2008)
Most recent WPV caseOnset 3/1/2008
2007 = 21 cases2008 = 1 case
21WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
Polio SIAs in AFR in 2007
No SIAs1-2 NIDs/SNIDs>4 NIDs/SNIDsNon-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.
22WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
NID
SNID
Planned 2008 Polio SIAs(Tentative dates)
Note: Last quarter dates to be completed
NID 26-29 Jan NID 23-26 FebSNID 5-8 Apr SNID 10-13 MaySNID 19-25 NovSNID 23-26 FebSNID 5-8 Apr SNID 24-26 Jan SNID 17-19 AprSNID May (dates to be confirmed)SNID 26-28 Jan NID 23-25 Feb (cancelled)NID Avr (under discussion)
BENIN NID 5-7 Apr
CAMEROONSNID 1st week Apr (dates to be confirmed)SNID 4-6 Apr SNID 9-11 MaySNID 14-16 Mar (mop up Luanda)SNID 18-20 Apr (mop up Luanda)NID 16-18 MayNID 20-22 June
ETHIOPIASNID Somali region (dates to be confrimed)
CHAD
Central Afr. Rep.
ANGOLA
PROPOSED POLIO SIAs DATES 2008
NIGERIA
NIGER
DRC
23WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
2005
2006
2007
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 (2005-2007)
24WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
Surveillance review Status - 2007
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
25WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
Example of Impact – Angola AFP cases by Month 2006-2007
0
5
10
15
20
25
30
35
40
45
50
Nu
mb
er o
f AF
P c
ases
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov
2006
2007
External review
Number of AFP cases reported increased
26WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
Regional Polio Certification Standards2005-2007
2007
2005
Met certification standards
Have not met certification standards
2006
27WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
Status of certification in AFRO - 2007
Mauritius
Seychelles
Reports Accepted (21)Presenting 2008 (8)
EMRO countries
Pending
28WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
28
2006
Routine DPT3 Coverage in AFR(Jan-Aug 2006 & Jan-Aug 2007)
2007
ND=No Data
Source: Country/EPI Monthly Report
ND
<50%
50 - 79%
>= 80%
EMRO
>= 90%
59% 74%
75%
52%
84%
72%
58%
66%
30WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
WHO/AFRO Polio Laboratory Network Performance-2001-2007
** as of 03/10/2007
Year AFP cases
Specimen Total PolioIsolated
WPV cases
ITD in 14 days (%)
Results in 28 days(%)
NPEV rate(%)
2001 9,128 18,662 1,251 65 93 88 13.5
2002 9,234 18,217 1,369 206 98 94 15.5
2003 8,443 16,893 1,933 446 99 98 12.4
2004 10,009 20,284 2,922 934 96 95 13.2
2005 11,973 23,926 3,984 884 85 98 11.8
2006 13,046 25,918 4536 1190 66* 98 14
2007** 9177 18489 2420 246 83 97 14
* Maidiguri/CDC double testing
31WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
Timeline – Target Dates
2008 Interruption of type 1 polio
2009 Interruption of type 3 polio
2012 Certification of all WHO Regions
2013 Cessation of all routine OPV use
32WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
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
33WHO Regional Office for Africa / Bureau Régional de l’OMS pour l’Afrique
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
THANK YOU