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Progress Towards Polio Eradication

in EMR

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• Status of global eradication

• Priority countries (except EMR)

• 2004-5: Intensification

• 2006-8: Certification, OPV cessation & mainstreaming of the infrastructure.

Presentation

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Polio Eradication Progress1988 - 2003

1988

350 000 cases

125 countries

2003

785 cases

6 countries

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Endemic countries

Wild virus type 1

Wild virus type 3

Importation

Changing Epidemiology 2003Importations > endemic areas

Nigeria virusexported to 8

countries.Western Uttar Pradeshexported to polio-free

states in India.

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Risks: Increasing VulnerabilityPolio Campaigns 2002 vs. 2004

2002: 100 countries2004: <20 countries

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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

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‘ 2004: a one time opportunity for a polio-

free world. ’Meeting of MinistersWorld Health

OrganizationGeneva, Switzerland15 January 2004

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Non polio AFP rate in EMR by province (Pakistan by district)

01/01/2003-31/12/2003

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

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

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Percent of AFP cases with adequate samples in EMR, 2003

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% AFP cases with adequate stool specimens EMR provinces, 2003

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

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18

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Non-polio AFP rate per 100,000 children under 15, EMR, 1993-2004

To date 21/03/04

AFP Surveillance

Polio Eradication Strategies

0.240.49

0.7 0.710.85 0.88

1.1

1.42

1.9

2.32.4

2.07

0

0.5

1

1.5

2

2.5

3

93 94 95 96 97 98 99 00 01 01 03 04EMR Mar 04

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Non polio AFP rate in EMR, 2003

05/02/04

AFP surveillanceNon-polio AFP rate/ 100,000 <15

EMR countries, 2003

EMR Mar 04

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Non polio AFP rate in EMR, 2003

05/02/04

AFP surveillanceNon-polio AFP rate/ 100,000 <15

EMR countries, 2004 (to date 21/03/04)

EMR Mar 04

22

43

53

6366 67

70

8388 90 89

0

10

2030

40

50

60

7080

90

100

95 96 97 98 99 00 01 02 03 04

AFP SurveillancePolio Eradication Strategies% of AFP cases with adequate stool specimens, 1995-2004

To date 21/03/04

EMR Mar 04

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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

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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

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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

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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

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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

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Endemic countries

Wild virus type 1

Wild virus type 3

Importation

Increasing VulnerabilityImportations > endemic areas, 2003

Nigeria virusexported to 7

countries.

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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