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POLIO ERADICATION STATUS IN AFRICAN REGION.ppt

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					POLIO ERADICATION STATUS IN
      AFRICAN REGION


       As of 25th April 2007
      Outline Of Presentation

 WPV transmission in AFR in 2006
 Status of Polio Eradication Strategies
 Challenges
 2007 Priorities
               Reported DPT3 Coverage in AFR
                Jan-Nov 2005 & Jan-Nov 2006
               2005                                                   2006


    ND                                                  ND




         27%                67%                           59%                61%


                      72%                                         75%

                                             >= 80%
                50%                                             52%
                                             50 - 79%
                                             <50%
                                             EMRO
                                            >= 90%


                             ND: No data
                             Source: 2006 EPI Monthly report

3
            2006/07 WPV transmission
• As of 25th April 07, a total of 76 WPV cases have been
  confirmed in 3 countries Nigeria(61), DRC(12) and Niger
  (3)
• In 2006, a total of 1190 WPV cases confirmed in 9
  countries, (Angola, Cameroon, Chad, DRC, Ethiopia, Kenya,
  Namibia, Niger & Nigeria)
• Three epidemiological areas of WPV circulation in 2006
   – Nigeria-Niger-Cameroon-Chad. Multiple importation from Nigeria into Cameroon,
        Niger and Chad
   – Ethiopia-Kenya-Somalia. Original importation from Somalia into Ethiopia and
        Kenya
   – Angola-DRC-Namibia. Original importation from India into Angola in 2005.
        Subsequently multiple importation from Angola into DRC and Namibia
Distribution of Wild Polio Virus cases, WHO/AFRO: 2007




2007 wild poliovirus by country
      as of 18April 2007

  Country   W1   W3   W1+W3   Total
NIGERIA*    14   47     0      61
NIGER       1    2      0      3
DRC         12   0      0      12
TOTAL AFR   27   49     0      76
                                       Updated as of 25th April 2007
 Distribution of Wild Polio Virus cases, WHO/AFRO: 2005-2006




 2005                                         2006
                                         Country     W1       W3       W1+W3   Total
  Country   W1    W3    W1&W3   Total
                                        ANGOLA            2        0       0       2
ANGOLA      10    0       0      10
                                        ETHIOPIA      17           0       0      17
CAMEROON    1     0       0      1
                                        DRC           13           0       0      13
CHAD        2     0       0      2
                                        NIGER             9        2       0      11
ERITREA     1     0       0      1
                                        NIGERIA      844      278          2    1124
ETHIOPIA    22    0       0      22
                                        NAMIBIA       18           0       0      18
MALI        3     0       0      3
                                        KENYA             2        0       0       2
NIGER       9     1       0      10
                                        CAMEROON          1        1       0       2
NIGERIA     574   253     3     830
                                        CHAD              0        1       0       1
TOTAL       622   254     3     879
                                        TOTAL AFR    906      282          2    1190
                            Regional WPV cases trend
                            January-March 2005-2007
                      180
                                                                        163
Number of WPV cases




                      160

                      140                             131
                      120

                      100           91
                       80
                                                                   64
                       60
                                                 38
                       40
                             25             30              30
                       20                                                       9
                        0

                                  January         February              March

                                      2005        2006           2007
Nigeria, comparison of WPV cases
   (January-March 2006/2007)
  2006                      2007




         W1 (n=212)                W1 (n=14)
         W3 (n=25)                 W3 (n=47)

    # Infected States: 15     # Infected States: 15

                              Data as of 25th April 2007
Declining Immunity Gap in Highest Risk
    States that participated in IPDs
              OPV Status of non-Polio AFP cases, 6-59 months
100%




 80%




 60%




 40%




 20%




 0%
       Q1 Q2 Q3 Q4   Q1 Q2 Q3 Q4     Q1 Q2 Q3 Q4           Q1 Q2 Q3 Q4      Q1 Q2 Q3 Q4
           VH Risk        H Risk           MH Risk              M Risk         L Risk


                        0 Dose     1-2 Doses         3+ doses     Unknown
Impact of mOPV1 and IPD introduction on WPV
              in Nigeria, 2006
                                   Introduction of mOPV1
160                                    & IPDs in Nigeria

140

120
100

80
60

40
20
 0
      Jan   Feb   Mar    Apr   May      Jun   Jul   Aug    Sep   Oct   Nov   Dec


                        WPV1                         WPV3
                        Linear (WPV1)                Linear (WPV3)
  EMRO Experts supporting IPDs in Nigeria




Reviewing daily itinerary with teams

                                   Participating in Community Dialogues, Borno State, Feb 2007
     Nigeria WPV type1 clusters
             2004/05/06
• In 2004-05, 33 clusters were circulating in
  Nigeria
• I1C5 cluster exported to Horn of Africa in
  2004 continues circulating in HOA but not
  in Nigeria
• In Nigeria only 14/33 of 2004-05 clusters
  are still circulating in 2006
• 7/14 of the 2006 clusters in Nigeria have
  not been detected in the 2nd half 2006
120                                                         109          B4B1, I6C2B clusters in
100              Cluster B4B1
 80
                                                                         4 states in Nigeria,
 60                48
                                                                         2006
 40   32

 20
                                20                                       WPV type1 clusters B4B1 and I6C2B.
                                               9                  8
           2            1            2             3                     Are driving the epidemic in Nigeria
  0
      Jigawa       Kano         Katsina        Bauchi         Tot        Jigawa, Kano, Katsina and Bauchi
                                                                         account for 367 (84%) of I6C2B
                Jan-June 2006                Jul-Nov 2006

                                                                         And 117 (87%) of B4B1
350                                                         330

300
                   Cluster I6C2B
250

200
                  194                                                  Clusters Jan-June Jul-Nov Tot
150
                                                                       B4B1       124      11 135
100                             67
 50
      43
                        11           8
                                               26 16              37   I6C2B      379      44 423
           2
  0
      Jigawa        Kano        Katsina       Bauchi         Tot
                                                                       Other      159      129 288
               Jan-June 2006              July-Nov 2006                Total      662      184 846
      Nigeria WPV type3 clusters
              2004/05/06
• In 2004, 16 clusters were circulating in Nigeria
  and 18 clusters in 2005
• As at end of November 2006, 13 clusters were
  circulating in Nigeria
• D2A1 and D2A2 are the major WPV3 clusters
  circulating from 2004 to 2006
  – In 2006, they account for 87/176 (50% of WPV type 3)
    sequences as of end November
  – In 2006, the focus of D2A1 was predominant in Borno
    state (8/29)
  – In 2006, the focus of D2A2 was predominant in Kano
    (12/58) and Katsina (17/58)
         Wild poliovirus cases 2005/2007

                                              DR-Congo
                     Several
                     viruses
                    circulated
                   for up to 18
                     Months
                   undetected              Saurimo
                                  Lobito

                                           Angola




                                                     2007 WPV case
                                                     2006 WPV case
 Last WPV cases                    Namibia            Sequence links
14 November 2006
             WPV status in DRC
• In 2006, a total of 13 wild polioviruses have been
  confirmed in 04 provinces
   –   3 in Bas-Congo
   –   5 in Kasai Occidental
   –   4 in Bandundu (North)
   –   1 in Equateur (South)
• Majority of these have been reported in the last 4 months
  of the year
• In 2007, 11 WPV cases were reported in 2 provinces
  [Bandundu (north) and Equateur (South)]
• Recent focus of transmission is Inongo district, with
  spread into surrounding districts
2006, DR-Congo wild poliovirus spread

                               onset 17 Dec 06
                               Active!
                             Mbandaka

First case onset 2 Oct 06
Last case onset 14 Dec 06
                               Inongo district
        Active!


                    Kinshasa
                                         Kasai Oc.
          Bas-Congo
                                                     First case onset 5 May 06
                                                     Last case onset 13 Aug 06
First case onset 27 Feb 06                               Under control
Last case onset 19 Jun 06
    Under control


          ANGOLA
2006 AFP surveillance indicators
 Supplemental Immunization Activities

   Implemented SIAs 2006                   Planned SIAs 2007




                                No SIAs
                                1-2 NIDs/SNIDs
                                3-4 NIDs/SNIDs
                                >4 NIDs/SNIDs
77 million children immunised   Under discussion
In 2006 [Target 80 million]     Non-AFRO
Status of certification as at 31st Dec 2006




                                  Seychelles


   Pending
   Reports Accepted (15)
                                  Mauritius
   Reports Deferred (2)
   Presenting 2007 (6)
   EMRO countries
                          Challenges
• Interrupting WPV transmission in Nigeria
• Responding to importations into low population immunity areas.
• Mobilizing additional funds from within countries to fill persistent gap
• Achieving/sustaining certification level AFP surveillance at sub-national
   level.
• Overcoming specimen shipment difficulties due to tightening IATA
   regulations
• Introduction of the new accelerated testing algorithm with out
   interrupting lab support to program.
• Weak Health Systems
• Sustaining Political commitment in evolving environment


  24
           Priorities for 2007
•   Interrupt WPV transmission in Nigeria
•   Ensuring high quality SIAs in importation & high
    risk countries
•   Mobilization of funds for timely and adequate
    outbreak response particularly at country level
•   Achieving and/or sustaining certification level
    AFP surveillance at sub-national level
•   Implementation of accelerated diagnostic
    algorithm in all 16 labs
•   Supporting ongoing health systems
    strengthening using polio infrastructure
THANK YOU

				
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