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Presentation from the European Scientific Conference on Applied Infectious Disease Epidemiology (ESCAIDE), published by the European Centre for Disease Prevention and Control (ECDC)
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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
-2
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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
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