Polio: Good news from India, but global concern

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Jan 12, 2012 (CIDRAP News) – For the first time in its history, India has gone for nearly a year with no new polio cases, the Global Polio Eradication Initiative (GPEI) announced today.

The country—one of four where polio is still considered endemic—will achieve the 1-year milestone on Jan 13, if no new wild polio virus (WPV) cases are reported before then and all pending samples test negative in the next few weeks, the GPEI said.

The announcement comes amid calls from global health experts for a major push to eradicate polio this year and worries that if that effort fails, the goal could remain elusive for years to come.

"If we fail to get over the finish line, we will need to continue expensive control measures for the indefinite future," Dr. Thomas Frieden, director of the US Centers for Disease Control and Prevention (CDC), said in a CDC polio update released Jan 6.

In mid December Frieden called on all CDC staffers to become active participants in an intensified effort to banish polio, the statement said. The CDC is the lead technical partner in the GPEI, which also includes the World Health Organization (WHO), Rotary International, the United Nations Children's Fund, and the Bill & Melinda Gates Foundation.

If India can go a full year with no new polio cases, it will be removed from the list of countries where the disease is classified as endemic, according to a Scientific American report published today. It may take until mid-February to certify that milestone, given the time it takes to test all patient samples, the story noted.

The other countries where polio continues to spread are Pakistan, Afghanistan, and Nigeria. Pakistan has had 189 cases confirmed so far for 2011, while Afghanistan has had 74 and Nigeria 40, according to the GPEI statement.

The global total of cases confirmed so far for 2011 is 620, which includes 315 in polio-endemic countries and 305 in non-endemic countries, the GPEI said. At this time last year, 920 cases had been confirmed for 2010, but the 2010 total reached 1,352 after all samples were tested.

Travelers in polio-endemic countries have carried the infection back to 39 other countries over the past several years, the CDC said.

"Three of these countries—Angola, Chad, and Democratic Republic of the Congo—have continued to have transmission of poliovirus for more than one year, raising concerns that a window of opportunity to eradicate this crippling and sometimes deadly disease may be closing," the CDC said. "It is therefore critical that we give this final push toward eradication our best effort."

Concern about the challenge of eradicating polio this year also surfaced in the Jan 6 issue of the WHO's Weekly Epidemiological Record (WER). At a November meeting, the WHO's Strategic Advisory Group of Experts on Immunization (SAGE) noted the GPEI Independent Monitoring Board's conclusion: that the GPEI was "not on track to interrupt polio transmission by the end of 2012, as proposed . . . unless fundamental problems can be addressed," the WER report said.

"SAGE stated unequivocally that the risk of failure to finish global polio eradication constitutes a programmatic emergency of global proportions for public health, and is not acceptable under any circumstances," the meeting summary said.

"Failure would not only lead to a major resurgence of the disease with thousands of children crippled for life or killed every year, but would also be seen as the most expensive public health failure in history," it said.

The experts noted that the global number of type 3 WPV cases was at an all-time low, but expressed concern that the number in 2011 had not declined "substantively" since 2010, according to the report.

The advisory group said there should be "consequences at all levels for individuals, institutions, and governments who fail to deliver on their mandates" to fight polio. In particular, the panel encouraged the WHO to assess how to use existing mechanisms to implement vaccination recommendations for travelers to polio-affected countries and to consider travel advisories for areas of uncontrolled transmission.

SAGE also said the GPEI should be careful to avoid "overstating the impact of incremental progress in some infected countries and where overall efforts to eradicate polio remain vulnerable, most notably Pakistan and northern Nigeria."

The GPEI was launched in 1988, when the disease was widespread in more than 125 countries and paralyzed an estimated 350,000 children annually, the CDC statement noted.

See also:

GPEI update

Jan 6 WHO WER

Jan 6 CDC statement on push for polio eradication

Jan 9 Scientific American story

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