Impact of the intensified eradication effort

The year 2006 began with confirmation that indigenous wild poliovirus transmission had been stopped in Egypt and Niger, reducing the number of endemic countries to a historic low of four. In the remaining countries - Afghanistan, India, Nigeria and Pakistan - intensification of immunization campaigns succeeded in geographically restricting virus transmission by the end of 2006. In response to rising number of cases in the early part of the year, by May Nigeria rolled out "Immunization Plus Days", adding other health interventions to polio vaccination campaigns and leading to improved coverage. An aggressive immunization response to a large outbreak in India made the outbreak far smaller than in previous years: analysis of the vaccination status of cases showed that children over two years of age were well-vaccinated, enabling a focus on the youngest children, to whom the 'immunity gap' is now limited. New epidemiological studies showed that unique demographic and sanitation conditions in northern India make trivalent oral polio vaccine less effective there than elsewhere, informing a decision to use the more efficacious monovalent vaccine on a larger scale. The sustained poliovirus circulation between Pakistan and Afghanistan, aided by the frequent movement of people across a porous border, sparked closer synchronization of vaccination campaigns and activities at crossing points. In Afghanistan, President Hamid Karzai kept close oversight of polio eradication activities, prompted in part by an outbreak in the Southern Region during the first part of the year which was exacerbated by deteriorating security. Only 10 of the 26 countries re-infected since 2003 were still reporting polio transmission in the second half of 2006, following rapid and intense immunization responses. An important success was the end of the Indonesia and Yemen outbreaks, the largest in case numbers. By the end of the year, high-risk outbreaks from imported virus were limited to central Africa, the Horn of Africa and Bangladesh. Based on the progress in 2006, the Advisory Committee on Poliomyelitis Eradication (ACPE), which provides independent technical counsel to the Global Polio Eradication Initiative, re-affirmed in October the technical and operational feasibility of polio eradication. The ACPE noted that success depended on the remaining four countries, which now have the best tools available to complete eradication: the more potent monovalent oral polio vaccine (mOPV) to boost immunity faster than before and laboratory procedures which halve the time needed to confirm poliovirus and allow for a rapid immunization response.1. Executive summary -- 2. Key events 2006 -- 3. Strategic objectives I: Interruption of poliovirus transmission -- 2. Surveillance and certification of global polio eradication -- 3. Development of products for potential global OPV cessation -- 4. Mainstreaming of the Global Polio Eradication Initiative -- 4. Financing -- 5. Glossary of terms"WHO/POLIO/07.02."On cover: logos for World Health Organization, Rotary International, CDC (U.S. Centers for Disease Control and Prevention), UNICEF.Available via the World Wide Web as an Acrobat .pdf file (1.62 MB, 43 p.)