Polio elimination in Europe: Strategies to prevent re-emergence

Donato Greco

WHO EU Regional Polio Certification Commission

The Global Polio Eradication Initiative (GPEI)

• Began in 1988

• By 2006 Wild polio Virus trasmission in all but 4 countries (Afghanistan, India, Nigeria and Pakistan)

• The GPEI plan 2010-12 :

– End outbreaks of 2009 by mid 2010

– End outbreaks of 2010 by mid 2010

The Global Polio Eradication Initiative (GPEI) HOW

• high infant immunization coverage with four doses of oral poliovirus vaccine (OPV) in the first year of life;

• supplementary doses of OPV to all children under five years of age during SIAs;

• surveillance for wild poliovirus through reporting and laboratory testing of all acute flaccid paralysis (AFP) cases among children under fifteen years of age;

• targeted “mop-up” campaigns once wild poliovirus transmission is limited to a specific focal area.

The Global Polio Eradication Initiative (GPEI)

• More than five million people who would otherwise have been paralysed are walking today because they have been immunized against polio since the initiative began in 1988.

• By preventing a debilitating disease, the Global Polio Eradication Initiative is helping to reduce poverty, and is giving children and their families a greater chance of leading healthy and productive lives.

• By establishing the capacity to access children everywhere, more than two billion children worldwide have been immunized during SIAs, demonstrating that well-planned health interventions can reach even the most remote, conflict-affected or poorest areas

The last Euro Region polio case :Turkey 1998

First import-related polio outbreak in the European Region since declared

polio-free in 2002

Third region declared polio-free

To remain polio-free:– improve population immunity

– increase capacity to rapidly detectany remaining transmission or new importation of wild poliovirus

– implement polio importation preparedness plans if required

7

Groups involved in certification of polio eradication at

global, regional, and country levels

8

Roles of National Certification Committees (NCCs) and Regional Certification Commission (RCC)

9

NCCs submit an annual progress reportAttesting that they are polio-free,

and stating that they would be able to detect importations of wild poliovirus with an Action Plan for such events.

RCC reviews the statements from NCCs on why the NCC believes the country is polio free;

RCC evaluates countries as to their risk for transmission if a wild poliovirus was introduced (High, Intermediate, Low) using pre-agreed criteria.

It is the RCC that will decide when a country is free of polio, not a country.

Requirements for regional certificationAbsence of wild polioviruses isolated from cases of acute paralytic poliomyelitis for three years, demonstrated through the following surveillance methodologies:

Acute Flaccid Paralysis at 1/100,000 children below 15 years with compliance with virological investigation criteria;

Surveillance of representative numbers of samples of faecal or CSF specimens for enteroviruses without wild polioviruses being detected;

Environmental sampling that is sensitive, specific and from representative populations with an action plan for further investigations if wild polioviruses are detected.

Any samples containing wild polioviruses must be destroyed or contained securely.

10

Risk of transmission following importation of wild poliovirus: WHO European Region, 2009

11

1

3

2

4

1-Bosnia & Herzegovina

2-Turkey (Eastern)

3-Georgia

4-Tajikistan

RCC conclusions 2009: Tajikistan

SIAs in the border areas of Tajikistan will be very important for preventing the introduction of wild poliovirus into the Region.

Routine polio immunization coverage is below desired levels. Continued low coverage will result in the accumulation of a cohort of susceptible children that may eventually pose a risk for the entire Region.

12

po

Poliomilelitys in Tagikistan 2010

Donato Greco7 giugno 2010

Genetic relationship of 2010TJK35325 isolate to recent Indian SOAS PV1

strains

ERC

A new poliovirus entered the country

600 paralized children !

Distribution of laboratory-confirmed polio cases by district*, Tajikistan, Feb,2010

Distribution of laboratory-confirmed polio cases by district, Tajikistan, March,2010

Distribution of laboratory-confirmed polio cases by district*, Tajikistan, April,2010

Distribution of laboratory-confirmed polio cases by district*, Tajikistan, May,2010

Distribution of laboratory-confirmed polio cases by district*, Tajikistan, June,2010

Local movement to/from Tajikistan to neighbouring countries

Laboratory confirmed polio cases, AFP cases negative for poliovirus, and AFP cases pending results by date of paralysis

onset, Tajikistan, 2010

Data as of 21 October 2010

Source: Weekly AFP reporting to WHO European Region

Total 706 AFP Cases (including 458 confirmed wild poliovirus type1)

SIA

Round 1SIA

Round 2

SIA

Round 3

SIA

Round 4

Mop-up SIA

Round 613-17 Sep mOPV

34 districts(98-100%)

Accounts for

73% of all

global polio

cases

in 2010, to

date

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Cases of AFP in Tajikistan 2010 at 6 june 2010 by age group

more 6 less 6

Distribution of laboratory confirmed polio cases by week of paralysis onset, Tajikistan, 2010

Data as of 21 October 2010

Source: Weekly AFP reporting to WHO European Region

Total 458 confirmed wild poliovirus type1

1 2 2 4 5111213

2011 7 21 1 2 2 3 2 3

1417

373326

33

35

12

311

12

6 1012

1322

17

23 1

3 2 8

11 4

14

44

1 1 10

10

20

30

40

50

60

70

80

90

53 1 2 3 4 5 6 7 8 9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

27

28

29

30

31

32

33

34

Week of onset (ISO week number)

Nu

mb

er

of

ca

se

s

15+ years

6-14 years

1-5 years

Under 1

How susceptible the tajik ?

• Assuming 200 infected per case

• At least 150.000 individuals were infected

• In many districts paralitic polio incidence was bigger than 100/100.000

• 1child over 3 below 1 year was not protected

• 1 child over 5 below 6 years was not protected

• 1 adolescent (6-15) over 10 was not protected

How is in your country ??

• This suggests that poor immunization coverage is not a very recent issue. A proportion of Tajik children has not been vaccinated or has received incomplete vaccination systematically during the last 20 years, leading to a build-up of susceptible hosts that was conducive to the current outbreak.

• Summing susceptibles cohorts

• We can only conclude that for the last 20 or more years there has been a regular, systematic deficiency in the vaccination services in Tajikistan. This is not an issue that concerns only “pockets” nor rural/Hard to Reach communities, but that affects a large part of the “normal” children population.

Why polio outbreak in Tajikistan?

Immunization coverage (susceptibility)

• Constraints in delivery of immunization through health system

• Accuracy of administrative coverage data

• Supplemental activities postponed due to lack of funding

AFP Surveillance (detection)

• Timely detection and transparent reporting

• Appropriate response actions

• Delay on diagnostics

Commitment and resources

• Feeling of “done”

• Funds for supplemental immunization

Geo-political context

28

29

Direct flight routes departing Tajikistan, February 2009-February 2010

N=499,514 air travellers

Source data: CDC Division of Global Migration and Quarantine

11,079

5,3

70

An infected healthy carrier can

shed poliovirus for 3-6 weeks

Reported laboratory-confirmed polio cases: Russian Federation in 2010

MayMay - JuneMay - JulyMay - AugustMay - September

31

TJK-10-002-064-1504-Gissa-35503

TJK-10-003-022-0704-Kabad-35349

TJK-10-002-031-0804-Gissa-35291

TJK-10-003-015-3103-Kabad-35335

TJK-10-002-013-1003-Gissa-35411

TJK-10-002-018-1303-Gissa-35265

TJK-10-002-041-0804-Shajr-35311

TKM-10-008-005-Koytendag-37362

TJK-10-003-019-0304-Kabad-35343

TJK-10-003-023-0904-Kabad-35351

TJK-10-003-011-3003-Kabad-35327

TJK-10-002-040-1004-Gissa-35309

TJK-10-002-029-0904-Vahda-35287

TJK-10-002-026-0404-Gissa-35281

TJK-10-001-006-1804-Dusha-35444

TJK-10-002-067-2404-Rudak-35507

RUS-10-058-010-011-Sverdlovsk-36710

TJK-10-002-058-1904-Vahda-35494

RUS-10-058-010-010-Sverdlovsk-36229

RUS-10-075-003-002-Irkutskaya-35673

TJK-10-002-004-0103-Rudak-35393

TJK-10-002-002-0102-Rudak-35389

TJK-10-002-054-0804-Gissa-35487

TJK-10-002-061-1904-Gissa-35499

TJK-10-002-068-1904-Faiza-35509

TJK-10-002-014-1803-Rudak-35257

TJK-10-002-003-1202-Rudak-35391

RUS-ARI-STPETERSBURG-36796

TJK-10-002-010-0503-Gissa-35405

TJK-10-001-007-1304-Dusha-35445

TJK-10-002-042-1204-Varzo-35313

TJK-10-001-015-2404-Dusha-35461

TJK-10-002-044-1404-Rudak-35467

TJK-10-003-020-0404-Shart-35345

TJK-10-001-005-1004-Dusha-35255

TJK-10-002-035-0804-Gissa-35299

TJK-10-003-007-1503-Shart-35319

TJK-10-001-004-0104-Dusha-35253

TJK-10-002-048-1404-Vahda-35475

TJK-10-002-012-1303-Gissa-35409

TJK-10-002-008-0303-Rudak-35401

TJK-10-002-043-0504-Rudak-35315

TJK-10-002-063-2004-Gissa-35501

TJK-10-003-014-3003-Shart-35359

TJK-10-003-014-3003-Shart-35333

TJK-10-003-017-0504-Kabad-35339

TJK-10-001-012-2404-Dusha-35455

TJK-10-002-057-1604-Rudak-35491

TJK-10-002-059-2204-Vahda-35495

TJK-10-002-016-2103-Rudak-35261

TJK-10-003-036-0304-Bokht-35365

TJK-10-002-060-2204-Rudak-35497

KAZ-10-014-016-38375

RUS-UZB-10-016-006-011-Moscow-36815

RUS-10-048-001-002-Chechen Re-37706

RUS-10-048-001-003-Chechen Re-37708

TJK-10-002-039-0804-Gissa-35307

RUS-10-058-010-010CONTACT-Sverdlovsk-36674

RUS-10-043-016-007-Dagestan-37449

RUS-10043005012-Dagestan-38492

RUSTJKMOSCOWHEALTHY-35671

TJK-10-003-010-2803-Shart-35325

RUS-10-083-001-003-Khabarovsk-37251

RUS-10-059-012-002-Chelyabins-36648

TJK-10-003-034-0304-Djili-35361

TKM-10-008-004-Koytendag-37184

RUS-10-059-008-001-Chelyabins-36716

RUS-10-059-008-002-Chelyabins-36682

TKM-10-008-006-Koytendag-37364

TJK-10-001-014-2604-Dusha-35459

TJK-10-003-035-1004-Bokht-35363

TJK-10-003-037-0404-Bokht-35367

TJK-10-002-003-1202-Rudak-35391 2

TJK-10-002-025-0404-Rudak-35279

TJK-10-001-011-2604-Dusha-35453

TJK-10-003-026-0704-Shart-35357

UPSHA09153I09

UPFKB09180I09

all viruses are closely related

to the WPV1 SOAS genotype

from Northern India

outbreak is the result of a

single importation of WPV1 in the

Region

WPV1 isolates in the Russian

Federation, Turkmenistan

and Kazakhstan are genetically

related to those from Tajikistan

European Region outbreak response plan

Stop current outbreak

Prevent spread to neighbouring countries

Strengthen acute flaccid paralysis (AFP) surveillance in high risk areas

Demonstrate polio-free status to the Regional Certification Commission (RCC) on Poliomyelitis Eradication

Ensure long-term sustainability

Ensure preparedness

Increase and maintain population immunity

Maintain certification standard surveillance

32

Then what to do

• Over a total population of 7 million , 15 million OPV vaccination in Tajikistan in 4 months

• Targetting 0 to 5 kids and 6 – to 15 , but many young adults were vaccinated

• 6 National immunization days (SIAs)

• Coverage well over 95%

• Somentimes bigger than 100 !!!! (denominator fallacies !!)

V

a

c

c

i

n

a

t

i

o

n

SIAs – Tajikistan, May to November 2010

mOPV1

mOPV3

bOPV

tOPV

Round 1: 04-08 May

( 0-6 years / 99.4%)

Round 2: 18-22 May

( 0-6 years / 99.4%)

Round 3: 01-05 Jun

( 0-15 years / 98.8%)

Round 4: 15-05 Jun

( 0-15 years / 99.3%)

Round 5: 04-08 Oct

( 0-15 years)

Round 6: 08-12 Nov

( 0-15 years)

Mop-up Round 1 : 13-17 Sep

34 districts ( 0-15 years)

Planned

To be corrected

SIAs – Turkmenistan, July to Oct 2010

mOPV1

mOPV3

bOPV

tOPV

Round 1: 13-18 July

( 0-5 years / 98.9%) Round 2: 26 Aug – 05 Sep

( 0-15 years / 99.6%)

Round 3: 20-29 Sep

( 0-15 years / 99.6%)

Mop-up Round 1: 25 July - 06 Aug

( 0-15 years / 95.5%)

To be corrected

SIAs – Kyrgyzstan, May to Oct 2010

mOPV1

mOPV3

bOPV

tOPV

Round 1: 19-23 July

( 0-5 years / 95.2%)

Round 2: 23-27 Aug

( 0-5 years / 95%)

SIAs – Kazakhstan, May to Oct 2010

mOPV1

mOPV3

bOPV

tOPV

Round 1: 06-10 Sept

( 0-5 years / 98.9%)

SNID Round 2: 1-10 Nov

( 0-15 years / ------%)

Planned

Are we safe from the poliomielitis risk ?

Malta

1

2

3

4

5

6

7

8

Risk of transmission following importation of wild poliovirus: WHO European Region, 2010

High risk

Intermediate risk

Low risk

1-Bosnia & Herzegovina

2-Georgia

3-Montenegro

4-Malta

5-Turkey (Eastern)

6-Tajikistan

7-Ukraine

8-Uzbekistan

40Adding : Turkmenistan, Kirghistan, Afganistan, India, Nigeria,

Congo

23rd RCC conclusions 2010

The European Region has reached a critical juncture. The polio-free status for the entire Region is in jeopardy

The gravity of the situation requires that all Member States reinforce their polio surveillance so that any spread will be detected rapidly and effective control measures instituted at the earliest possible moment.

How many countries, represented in this room, have done this?

RCC will be monitoring the situation closely.

Failure to control polio within the European Region will jeopardize the global polio eradication initiative.

41

23rd RCC conclusions - 2010

Quality of polio surveillance is falling in many countries. Surveillance must be brought back to certification levels if the Region is to be certified as polio-free when global certification is considered.

The reports from many National Certification Committees are not convincing and would be inadequate for the purposes of final certification.

National Plans of Action must be completed and should be tested.

42

43

Status of preparedness plans in the European Region, 2010

• 37 Member States (MS) reported that preparedness plan or equivalent documents exist

• 33 MS submitted their plans to WHO

– 7/33 plans expired in 2008-2009

– 5/33 plans end in 2010

Data in WHO HQ as of 02

Nov 2010

Wild Poliovirus(1,2), 03 Nov 2009 – 02 Nov 2010

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 2010. All rights reserved

Case or outbreak following importation (0 - 6 months)

Endemic countries

Case or outbreak following importation (6 - 12 months)

Wild virus type 1

Wild virus type 3

Wild virus type 1/3

1Excludes viruses detected from environmental

surveillance and vaccine derived polioviruses. 1 WPV1

in Jammu and Kashmir, date of onset of 07 Feb 2010,

does not appear on the map. 2Of the poliovirus cases

reported from the Russian Federation, some may be

attributed to other countries following full investigation.

Data in WHO HQ as of 02

Nov 2010

Wild Poliovirus infected districts(1,2), 03 May – 02 Nov 2010

District infected with wild polio virus type 1

District infected with wild polio virus type 3

District infected with more than one type of wild poliovirus

1Excludes viruses detected from environmental

surveillance and vaccine derived polioviruses. 2Of

the poliovirus cases reported from the Russian

Federation, some may be attributed to other

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 2010 All rights reserved

Status CountryDate of most

recent type 1

Date of most

recent type 3

Endemic Pakistan 19-Oct-10 20-Sep-10

Afghanistan 11-Oct-10 NA

Nigeria 27-Sep-10 05-Oct-10

India 16-Sep-10 31-Aug-10

DRCongo 13-Sep-10 24-Jun-09

Angola 20-Aug-10 NA

Chad NA 10-May-10

Active outbreak Uganda 28-Sep-10 NA

Russian Federation 25-Sep-10 NA

Mali 01-May-10 17-Sep-10

Liberia 08-Sep-10 NA

Nepal 30-Aug-10 NA

Kazakistan 12-Aug-10 NA

Tajikistan 04-Jul-10 NA

Turkmenistan 28-Jun-10 NA

Re-established

transmission

Data in WHO HQ as of 02

Nov 2010 Data in WHO HQ

as of 02 Nov 2010

Wild Poliovirus 2000 - 2010

Country or territory 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2009 2006 2007 2008 2009 2010

Pakistan 199 119 90 103 53 28 40 32 117 89 75 101 20-Sep-10 19-Oct-10 18 48 12-Oct-10

Afghanistan 27 11 10 8 4 9 31 17 31 38 24 19 11-Apr-10 11-Oct-10 1 2 27-Jul-09

Nigeria 28 56 202 355 782 830 1122 285 798 388 382 10 05-Oct-10 27-Sep-10

Uganda* 0 0 0 0 0 0 0 0 0 8 8 1 NA 28-Sep-10

Russian Federation∞ 0 0 0 0 0 0 0 0 0 0 0 14 NA 25-Sep-10

Mali*3

0 0 0 0 19 3 0 0 1 2 5 4 17-Sep-10 01-May-10

India 265 268 1600 225 134 66 676 874 559 741 528 39 31-Aug-10 16-Sep-10 2 13 33 2 18 12-Aug-10

DRC** 28 0 0 0 0 0 13 41 5 3 3 30 24-Jun-09 13-Sep-10

Liberia* 0 0 0 0 0 0 0 0 0 11 10 2 NA 08-Sep-10

Nepal** 4 0 0 0 0 4 5 5 6 0 0 6 15-Oct-08 30-Aug-10 1 12-Jul-10

Angola** 55 1 0 0 0 10 2 8 29 29 27 25 17-Nov-08 20-Aug-10

Kazakhstan* 0 0 0 0 0 0 0 0 0 0 0 1 NA 12-Aug-10

Tajikistan* 0 0 0 0 0 0 0 0 0 0 0 458 NA 04-Jul-10

Turkmenistan* 0 0 0 0 0 0 0 0 0 0 0 3 NA 28-Jun-10

Chad** 4 0 0 25 24 2 1 22 37 64 24 14 10-May-10 18-Nov-08

Senegal* 0 0 0 0 0 0 0 0 0 0 0 18 NA 30-Apr-10

Mauritania§

0 1 0 0 0 0 0 0 0 13 0 5 NA 28-Apr-10

Niger *** 2 6 3 40 25 10 11 11 12 15 15 2 01-Apr-10 28-May-09

Sierra Leone* 0 0 0 0 0 0 0 0 0 11 2 1 NA 28-Feb-10

Guinea* 0 0 0 0 7 0 0 0 0 42 32 0 NA 03-Nov-09

Burkina Faso* 0 0 1 11 9 0 0 0 6 15 13 0 NA 25-Oct-09

Cameroon* 0 0 0 2 13 1 2 0 0 3 2 0 15-Oct-09 06-Dec-06

Burundi* 0 0 0 0 0 0 0 0 0 2 2 0 NA 12-Sep-09

CAR** 3 0 0 1 30 0 0 0 3 14 14 0 09-Aug-09 30-Dec-08

Côte d'Ivoire**3

1 0 0 1 17 0 0 0 1 26 27 0 NA 06-Aug-09

Kenya* 0 0 0 0 0 0 2 0 0 19 18 0 NA 30-Jul-09

Sudan** 4 1 0 0 128 27 0 1 26 45 45 0 16-Dec-08 27-Jun-09 1 1 09-Jan-09

Benin** 1 0 0 2 6 0 0 0 6 20 20 0 01-Dec-08 19-Apr-09

Togo* 0 0 0 1 0 0 0 0 3 6 6 0 NA 28-Mar-09

Ghana** 1 0 0 8 0 0 0 0 8 0 0 0 NA 08-Nov-08

Ethiopia** 3 1 0 0 1 22 17 0 3 0 0 0 NA 27-Apr-08

Myanmar** 2 0 0 0 0 0 0 11 0 0 0 0 NA 28-May-07

Somalia** 46 7 3 0 0 185 35 8 0 0 0 0 06-Oct-02 25-Mar-07

Bangladesh** 1 0 0 0 0 0 18 0 0 0 0 0 23-Oct-99 22-Nov-06

Namibia* 0 0 0 0 0 0 19 0 0 0 0 0 NA 26-Jun-06

Indonesia* 0 0 0 0 0 303 2 0 0 0 0 0 NA 20-Feb-06

Yemen* 0 0 0 0 0 478 1 0 0 0 0 0 NA 02-Feb-06

Eritrea* 0 0 0 0 0 1 0 0 0 0 0 0 NA 23-Apr-05

Saudi Arabia* 0 0 0 0 1 0 0 0 0 0 0 0 NA 17-Dec-04

Egypt 4 5 7 1 1 0 0 0 0 0 0 0 07-Dec-00 03-May-04 2 30-Dec-08

Botswana* 0 0 0 0 1 0 0 0 0 0 0 0 NA 08-Feb-04

Lebanon* 0 0 0 1 0 0 0 0 0 0 0 0 NA 23-Jan-03

Zambia* 0 3 2 0 0 0 0 0 0 0 0 0 NA 27-Feb-02

Algeria* 0 1 0 0 0 0 0 0 0 0 0 0 NA 13-Oct-01

Georgia* 0 1 0 0 0 0 0 0 0 0 0 0 NA 02-Sep-01

Bulgaria* 0 2 0 0 0 0 0 0 0 0 0 0 NA 24-Apr-01

Iran* 3 0 0 0 0 0 0 0 0 0 0 0 NA 18-Dec-00

Cape Verde* 12 0 0 0 0 0 0 0 0 0 0 0 NA 13-Dec-00

Congo 22 0 0 0 0 0 0 0 0 0 0 0 29-Sep-00 28-Nov-00

Iraq 4 0 0 0 0 0 0 0 0 0 0 0 NA 28-Jan-00

Total 719 483 1918 784 1255 1979 1997 1315 1651 1604 1282 753 3 14 35 23 67

Total wild virus type 13

--- 349 1744 555 1045 1716 1666 321 976 482 425 679

Total wild virus type 3 --- 134 174 229 210 263 331 994 675 1122 857 74

Tot. in endemic countries 702 475 1915 732 999 934 1869 1208 1505 1256 1009 169

Tot. in non-end countries 17 8 3 52 256 1045 128 107 146 348 273 584

No. of countries 23 15 9 15 18 16 17 12 18 23 22 19

No. of endemic countries 20 10 7 6 6 6§§

4 4 4 4

Countries highlighted in pale yellow are considered to have active transmission (i.e. within the previous 6 months) of an imported poliovirus.1Data in WHO HQ on 03 Nov 2009 for 2009 data and 02 Nov 2010 for 2010 data.

2Wild viruses from environmental samples, contacts and other non-AFP sources.

3 In 2009: 1 case in Cote d'Ivoire was subsequently found to be sabin; 3 cases in Mali were subsequently reallocated to Guinea.

4Includes 2 cases in 2008 and 2006, 3 in 2009, 2007, 2005, 2004 and 2002, and 4 in 2001 with a mixture of W1W3 virus. *All cases are importation related. NA. Most recent case had date of onset prior to 1999.

§2001 wild virus of unknown origin; 2009 viruses are importation related. **All cases from 2003 onward are importation related. ∞Some cases may be attributed to other countries following full investigation.

***All cases from 2005 onward are importation related. §§

In 2005, no endemic circulation occurred in Egypt or Niger but their status remained endemic. --- Data not available.

Countries highlighted in yellow are endemic.

Date of most

recent virus2010

Wild virus confirmed cases

Total

Wild virus reported from other sources2

01 Jan - 02 Nov1 Date of most

recent type 3

Date of most

recent type 1

Total

Data in WHO HQ as of 02 Nov

2010

Wild Poliovirus Cases by Type 2009 & 2010 - Year to Date Comparison

W1 W3 W1W3 W1 W3 W1W3 W1 W3 W1W3

Pakistan 60 28 1 51 23 1 80 21 19-Oct-10

Afghanistan 15 22 1 15 9 11 8 11-Oct-10

Nigeria* 75 313 0 73 307 2 5 5 05-Oct-10

India 79 661 1 66 461 1 16 23 16-Sep-10

Total 229 1024 3 205 800 4 112 57

DRCongo 0 3 0 0 3 30 0 13-Sep-10

Angola 29 0 0 27 0 25 0 20-Aug-10

Chad 0 64 0 0 24 0 14 10-May-10

Sudan 45 0 0 45 0 0 0 27-Jun-09

Total 74 67 72 27 55 14

Uganda 8 0 0 8 0 1 0 28-Sep-10

Russian Federation** 0 0 0 0 0 14 0 25-Sep-10

Mali*** 2 0 0 5 0 3 1 17-Sep-10

Liberia 11 0 0 10 0 2 0 08-Sep-10

Nepal 0 0 0 0 0 6 0 30-Aug-10

Kazakhstan 0 0 0 0 0 1 0 12-Aug-10

Tajikistan 0 0 0 0 0 458 0 04-Jul-10

Turkmenistan 0 0 0 0 0 3 0 28-Jun-10

Senegal 0 0 0 0 0 18 0 30-Apr-10

Mauritania 13 0 0 0 0 5 0 28-Apr-10

Niger 1 14 0 1 14 0 2 01-Apr-10

Sierra Leone 11 0 0 2 0 1 0 28-Feb-10

Guinea 42 0 0 32 0 0 0 03-Nov-09

Burkina Faso 15 0 0 13 0 0 0 25-Oct-09

Cameroon 0 3 0 0 2 0 0 15-Oct-09

Burundi 2 0 0 2 0 0 0 12-Sep-09

CAR 0 14 0 0 14 0 0 09-Aug-09

Côte d'Ivoire*** 26 0 0 27 0 0 0 06-Aug-09

Kenya 19 0 18 30-Jul-09

Benin 20 0 20 19-Apr-09

Togo 6 0 6 28-Mar-09

Total 176 31 144 30 0 512 3 0

Global total 479 1122 3 421 857 4 679 74 01Data in WHO/HQ as of 03 Nov 2009 for 2009 data and as of 02 Nov 2010 for 2010 data. *Nigeria later reclassified 2 W1W3 cases as W1 in 2009.

**Some cases may be attributed to other countries following full investigation.

***In 2009 data: 3 cases reported from Mali were subsequently reallocated to Guinea; 1 case reported in Côte d'Ivoire was subsequently found to be sabin.

Outbreak

Endemic

Re-established transmission

Country

classification

Total 2009 Date of most

recent case

01 Jan - 02 Nov1

2009 2010

Data in WHO HQ as of 02

Nov 2010

Comparison of 2009 and 2010 DataYear to Date (01 Jan to 02 Nov)

Data for 2009 as of 03 Nov 2009 and for 2010 as of 02

Nov 2010.

>90

days

2009 2010 2009 2010 2009 2010 2009 2010 2010

African 12196 12342 610 112 93 96 1626 1756 670as of 02 Nov

wild virus as of 27 Oct

Central 2487 2497 72 74 21 38 343 238 22

South/East 3195 3058 26 1 19 26 494 611 203

West 6514 6787 512 37 53 32 789 907 445

American 1270 1310 0 0 2 0 334 493 288 as of 29 Oct

Eastern Mediterranean 8687 8996 144 120 8 5 604 688 48 as of 01 Nov

European 1051 1794 0 476 0 8 391 380 140 as of 01 Nov

South East Asian 43854 48658 528 45 91 96 5066 5217 1726 as of 01 Nov

Western Pacific 4320 4720 0 0 3 3 356 437 300 as of 02 Nov

Global 71378 77820 1282 753 197 208 8377 8971 3172

Data received

in HQTotal

Pending Final

Classification

WHO region

AFP Cases Wild Virus

Polio

Compatible

A medical student with

the last texbook on

Communicable

diseases !

Where there is no

chapter on

Poliomielitis !!!

case of Polio ?

• How many of You know what polio is ?

• How many of you have ever seen a case of polio ?

• How safe are you on the good protection against polio of your district, town, region, country ??

NO More POLIO deaths on our Globe !!

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