Number Of Polio Cases Research Articles

Progress Toward Poliomyelitis Eradication - Worldwide, January 2022-December 2023.

In 1988, poliomyelitis (polio) was targeted for eradication. Global efforts have led to the eradication of two of the three wild poliovirus (WPV) serotypes (types 2 and 3), with only WPV type 1 (WPV1) remaining endemic, and only in Afghanistan and Pakistan. This report describes global polio immunization, surveillance activities, and poliovirus epidemiology during January 2022-December 2023, using data current as of April 10, 2024. In 2023, Afghanistan and Pakistan identified 12 total WPV1 polio cases, compared with 22 in 2022. WPV1 transmission was detected through systematic testing for poliovirus in sewage samples (environmental surveillance) in 13 provinces in Afghanistan and Pakistan, compared with seven provinces in 2022. The number of polio cases caused by circulating vaccine-derived polioviruses (cVDPVs; circulating vaccine virus strains that have reverted to neurovirulence) decreased from 881 in 2022 to 524 in 2023; cVDPV outbreaks (defined as either a cVDPV case with evidence of circulation or at least two positive environmental surveillance isolates) occurred in 32 countries in 2023, including eight that did not experience a cVDPV outbreak in 2022. Despite reductions in paralytic polio cases from 2022, cVDPV cases and WPV1 cases (in countries with endemic transmission) were more geographically widespread in 2023. Renewed efforts to vaccinate persistently missed children in countries and territories where WPV1 transmission is endemic, strengthen routine immunization programs in countries at high risk for poliovirus transmission, and provide more effective cVDPV outbreak responses are necessary to further progress toward global polio eradication.

The association of online search interest with polio cases and vaccine coverage: an infodemiological and ecological study.

Achievement of universal eradication of paralytic poliomyelitis has remained a challenge. Despite the general decline in cases, multiple outbreaks attributed to poor vaccination still occur. Noncompliance from vaccination can be improved through education on various media platforms. In the internet age, online health-seeking behavior plays a significant role in this regard. Hence, our study investigated the association between global online search interest in polio with the number of polio cases and vaccination coverage. This infodemiological and ecological study utilized Google Trends' search volume index (SVI) for "polio" and the World Health Organization data on the number of polio cases (PC) and vaccine coverage rate (VCR) per country between 2006 and 2019. Associations between SVI for "polio" with PC and with VCR were evaluated. From the years 2006 to 2019, the global inquiry for this term was highest (i.e., SVI at 100) last October 2018. There was a direct correlation between the SVI for "polio" and PC while there was an inverse relationship between SVI and VCR per country per year. Both relationships have weak to moderate strength of associations. Based on our models, a one-unit increase in the SVI leads to a 3.8% increase in the number of polio cases. On the other hand, a one-unit increase in the SVI leads to a 0.01% decrease in the VCR.Conclusions: Dynamic changes in global SVIs for polio may reflect fluctuations in the number of polio cases and rates of vaccine coverage. Our study brings into light the largely untapped and potential use of online search behavior for polio to anticipate changes in PC and VCR in real-time. What is Known: •Parental vaccine hesitancy is a strong hindrance to the eradication of vaccine-preventable diseases. •The internet is a major source of information that modifies this attitude. What is New: •Internet health-seeking behavior can be measured using Google Trends' search volume index and can be used to correlate to certain aspects of public health determinants of a certain disease. •Google Trends' search volume index correlates with the number of polio cases/immunization rates, and this provides a basis for considering public health measures online.

Polio in Afghanistan: a systemic review on eradication interventions and challenges

After the Global Polio Eradication Initiative was established, the global incidence of polio decreased by 99 percent. However, from a global perspective, the number of polio cases in Afghanistan is still increasing, therefore more attention should be brought to the issue of polio eradication in Afghanistan. This article is set out to revisit and analyze the interventions and challenges of polio eradication in Afghanistan. Data in the article are obtained from various academic journals and official public health websites. After reviewing the research results of public health experts throughout the years, it is evident that despite using multiple intervention measures in the eradication process, more effort is needed to address the challenges that are specific to different areas of Afghanistan. In the recent future, more cases of polio are expected due to the COVID-19 pandemic. Therefore, public health workers must increase the intensity of polio surveillance in Afghanistan and ensure that there are sufficient vaccines in stock when house-to-house vaccination begins again.

Contributions of Volunteer Community Mobilizers to Polio Eradication in Nigeria: The Experiences of Non-governmental and Civil Society Organizations.

.The Northern states were the epicenter of the wild poliovirus outbreak in Nigeria in 2016. To raise immunization coverage, particularly of polio, the Polio Eradication Initiative (PEI) in Nigeria introduced the use of nongovernmental organizations and volunteer community mobilizers (VCMs) through the CORE Group Polio Project (CGPP). The CGPP has been contributing to Nigeria’s polio eradication efforts since 2013. This article explores the contributions of the 2,130 VCMs deployed in 31 participating local government areas in the five implementing CGPP states from 2014 to 2017 to increase awareness, understanding, and acceptance of polio immunization. Data for the study were collected from primary and secondary sources using five collection methods: a survey of VCM supervisors, focus group discussions with VCMs and their supervisors, key in-depth interviews with community stakeholders, case studies of specific best practices of VCMs, and a review of documents and records. A review of the data shows that the VCMs received comprehensive training on the importance of the PEI, routine immunization, Acute Flaccid Paralysis (AFP) surveillance, social mobilization and community engagement, use of behavior change communication tools, and interpersonal communication skills. According to the data collected, the VCMs used the following innovative strategies to ensure high vaccination coverage: house-to-house mobilization, community dialogues, compound meetings, community health camps, and tracking of non-compliant families, missed children, and dropouts. The involvement of VCMs in Nigeria’s PEI efforts has been a pivotal contribution to reductions in the number of households rejecting polio immunization, the proportion of families with missed children, the proportion of families that were non-compliant, and the number of polio cases.

Current Status and Underlying Problems of Eradication of Poliomyelitis in the Remaining Endemic Countries

In 1988, the World Health Assembly of the World Health Organization (WHO) launched the Global Polio Eradication Initiative (GPEI), with the resolve to interrupt transmission of wild poliovirus (WPV) worldwide by the year 2000. Eighteen years after the intended year of eradication, that target is yet to be achieved. To investigate the reasons behind this, a check of recent publications on poliomyelitis and polio virus was carried out. The databases and websites of institutions and organizations involved in the polio eradication programme were also checked. The findings showed that although the goal of interrupting polio transmission has not been meet, a lot of progress has been made. By 2006, transmission of WPV had been interrupted in all but four countries: Afghanistan, India, Nigeria and Pakistan. In February 2012, India was delisted from the list of polio-endemic countries leaving the remaining 3 countries as the only endemic countries in the world. Wild type 2 and 3 viruses have both been eliminated from circulations. The number of polio cases in the remaining endemic countries has reduced drastically. Nigeria is close to the target, but is yet to be certified polio-free, having experienced a setback in 2016. However, as long as transmission of WPV continues in these countries, the world cannot be free from the disease, as these countries serve as reservoirs of infection and sources of export of the virus to other countries. To be able to achieve the target of interrupting the transmission of WPV in the remaining endemic countries, the identified problems, particularly conflict in the countries concerned, will have to be factored into the programmes geared toward eradication of the disease.

How Drone Strikes and a Fake Vaccination Program Have Inhibited Polio Eradication in Pakistan: An Analysis of National Level Data.

This article investigates whether the United States' counterinsurgency operations have inhibited polio eradication efforts in northwestern Pakistan, the world's last major reservoir of polio. Anecdotal evidence suggests that militants disrupt polio vaccination programs because of suspicions that campaigns are a cover for gathering intelligence on Central Intelligence Agency (CIA) drone targets. This paper analyzes national-level quantitative data to test this argument. Between 2004 and 2012, the number of polio cases in Pakistan closely mirrored the number of drone strikes. But from 2013 onward, polio cases increased while drone strikes fell. This can be explained by the CIA's use of a fake immunization campaign in a failed attempt to obtain the DNA of Osama bin Laden's relatives prior to his assassination in 2011. This seemingly vindicated militants' suspicions that vaccination programs were a cover for espionage. Militants consequently intensified their disruption of immunization campaigns, resulting in an increase in polio cases in Pakistan, as well as in Afghanistan, Syria, and Iraq. For politicians and military planners, drones are attractive because they are said to harm fewer civilians than conventional methods of warfare. However, this paper demonstrates that drone strikes had negative effects on the well-being of civilians in Pakistan and further afield because they undermined global efforts to eradicate polio.

Recommended Strategies to Move Closer Toward the Global Eradication of Polio: International Health Regulations.

DEAR EDITOR, Polio was once considered a fearsome disease with a tendency to strike suddenly and paralyze millions of children for their entire lifetime.[1] However, in response to the Global Polio Eradication Initiative, assistance from the World Health Organization, and support from various stakeholders (viz., policy makers, health personnel, nongovernmental organizations, etc.), the number of polio cases have been reduced by more than 99% when compared with 1998 estimates.[2] However, there is a definitive potential risk of spread of polio from these nations to other nations that have less than adequate vaccination.[1,2,3] Unlike most other infectious diseases, polio can be completely eradicated as none of the three strains of wild poliovirus can survive outside the human body for longer durations and will die, if they cannot infect a susceptible individual.[4] Further, type 2 wild poliovirus has already been eradicated in the year 1999 while very few cases attributed to type 3 wild poliovirus have been reported in the recent years.[1,4] In fact, other than Nigeria (in which last wild polio case was detected 1 year back), only two countries—Pakistan and Afghanistan—are remaining where polio transmission has never been interrupted.[2,3] Most of these improvements and reduction in the incidence of polio cases on the global platform has been observed following the declaration of polio as a Public Health Emergency of International Concern.[1,2] Even though in 2015, less than a third of the number of cases have been reported in Pakistan (in contrast to the number of cases in the similar interval in 2014) with no exportation of wild poliovirus cases since October 2014 and a significant decline in the number of unimmunized children, still Pakistan alone accounts for almost 85% of all global wild poliovirus cases in the current year.[2] On the contrary, Afghanistan has reported international spread of wild poliovirus even in 2015 (viz., two cases to Quetta and Sindh regions of Pakistan).[2] This is mainly because of the weak public health systems, noncompliance with the International Health Regulations (IHR) recommendations for the international air travelers (viz., measures not implemented uniformly for all ages, no tracking of the vaccination status of travellers, no exit screening or restriction on unvaccinated travellers, etc.), sharing of a common zone of poliovirus transmission between the two nations, suspension of mass vaccination campaigns in the Kandahar region, and poor sanitation facilities.[1,2] In an attempt to expedite the process of global eradication of polio and to address the existing deficient mechanisms, a wide range of recommendations has been proposed by the IHR emergency committee.[2] These recommendations have been broadly divided into three major categories, namely states currently exporting wild poliovirus (Pakistan and Afghanistan); states infected with wild poliovirus, but not currently exporting (Nigeria and Somalia); and states no longer infected by wild poliovirus, but which remain vulnerable to international spread (Ethiopia, Syria, etc.).[2] For the first two categories of nations, it has been advocated that these should declare interruption of poliovirus transmission as a national public health emergency; administer to all residents or long-term visitors (more than 4 weeks), a dose of oral poliovirus vaccine (OPV) or inactivated poliovirus vaccine (IPV) between 4 weeks and 1 year prior to international travel; ensure receiving of OPV/IPV to even urgent travelers; provision of an international certificate of vaccination or prophylaxis to the travelers; restrict departure of travelers who lack the necessary documents at the point of departure; improve level of coordination at various levels to strengthen cross-border efforts; sustain these measures until at least 6 months have passed without new exportations; and provide monthly (currently exporting) or once in a year (not currently exporting) report to IHR about the implementation of recommendations.[2,5] However, the nations that are no longer infected by wild poliovirus but are still vulnerable to international spread should strengthen their routine vaccination and surveillance mechanism, especially among the mobile and vulnerable populations; enhance the level of cooperation and cross-border coordination to enable prompt detection of wild poliovirus and vaccination of high-risk population groups; and provide a comprehensive report every year regarding prevention and control measures.[2,6] In addition, implementation of cost-effective measures to neutralize the existing insecurity and inaccessibility to the healthcare services, especially in the conflict-affected nations can also prevent a major outbreak of wild poliovirus.[4,5,6] To conclude, a critical end stage has been achieved by the world for global polio eradication and any form of ignorance can either reverse or even prevent the world from achieving this goal. Thus, it is high time that both affected nations and even other nations continue to work according to the laid recommendations so that polio eradication can be achieved.

Killings in Nigeria

Nine nurses and 3 North Korean physicians involved in a polio vaccination campaign have been murdered in northern Nigeria in recent weeks (http://tinyurl.com/bm9y6jn). No group has claimed responsibility for the attacks, but security experts suspect the radical Islamic sect Boko Haram. In early February, gunmen killed 9 female health workers and injured 3 others in 2 separate incidents in Kano, the regional capital in the predominantly Muslim north that has the country's largest number of polio cases. These deaths follow the December and January murders in Pakistan of 16 health workers involved in immunizing against polio.

Polio eradication strategies in India Successes, concerns & future perspectives

Abstract Polio Eradication Initiative (GPEI) was launched in 1988 with a multinational effort (World Health Assembly resolution) to control, eliminate and eradicate Poliomyelitis from the world by 2008. Prior to 1988, 3,50,000 children were getting paralyzed due to Poliomyelitis. The objective was to achieve global immunity against wild polio viruses (WPVs) by the year 2008. By the year 2000, there were only 2971 confirmed cases with the elimination of P2 Virus since 1999. Polio incidence remained around 2000 cases a year. During the years 2000–2007, there was a mixture of success and unanticipated set backs, viz. there was a continued reduction in the number of Polio cases but continued circulation of the Polio Virus in the four Polio endemic countries—India, Pakistan, Afghanistan and Nigeria. By the year 2009, 210 Countries were Polio free, of which 134 were certified and there were only 1606 cases in 4 endemic countries with 23 infected countries. The Advisory Committee On Polio Eradication (ACPE) initiated the “Program of Work 2009” and the “Strategic Plan 2010–2012”. As of 1st June, in 2010, only 21 Cases were reported from India (WPV1–3 & WPV3–18) as against 59 cases for the corresponding period in 2009. 2 cases, due to cVDPV2, were reported from UP. bOPV 1 & 3 were introduced in the endemkic zones of western UP and Kosy river belt in Bihar since January 2010. This is an encouraging trend for the first time in 22 years since the inception of GPEI. The interruption of WPV 3 could happen by the low force of transmission (FoT) season of 2011. The hope is that by 2011, India would achieve the elimination of WPVs 1&3. Since Polio eradication means the elimination of both wPV and vDPV, India should move to the bOPV 1&3 — eIPV sequential / exclusive eIPV schedule, as recommended by the India Experts Advisory Group (IEAG), in future even in the pre eradication phase and continue the same strategy in the post eradication phase as guided by the WHO. By all positive signals, India could obtain “Polio free certification” from the World Health Organization (WHO) by the year 2015.

Role of catch-up campaigns in improving immunization services in a developing country

Background: Bellary district of India had highest number of Polio cases in the world during the year 2003. This is mainly because of low level of routine immunization coverage. Successful implementation of supplementary immunization activities interrupted Polio transmission in 2003. It is important to sustain the gains made in polio immunization as well as make attempts to improve the immunization coverage against other vaccine preventable diseases. We wanted to look at the immunization coverage rates before and after the catch up campaigns to strengthen routine immunization services in this high-risk district. Aims: Our objective was to evaluate the impact of catch up campaign through estimation of immunization coverage after conclusion of catch-up campaigns in the district of Bellary. Settings and Design: The evaluation data is from a cross sectional study done in Bellary district, India by following multi stage and systematic random sampling. Materials and Methods: The study was done in three stages; In stage one, the district specific DLHS data was analyzed. In stage two; systemic issues were identified by going through immunization registers, records and identified key reasons for low vaccination coverage. In stage three, immediately after catch up immunization sessions, the coverage rates were captured using simple random sampling, and compared with DLHS data. Statistical Analysis: Data analysis was performed using SPSS Statistics 17.0 (Rel. 11.0.1 2001-SPSS Inc), R 2.11, Microsoft Excel (MS office, Version 2007, Microsoft Corporation, USA). Results: The results demonstrate that the coverage for all antigens improved due to the conduct of catch-up campaigns. Conclusions: This study compares estimates of the age-specific population immunization coverage against BCG, OPV, DPT, TT, and Measles before and after the catch up campaigns. Catch-up sessions help to address systemic issues related to routine immunization, and sustain high immunization coverage in developing countries like India.

The Polio Endgame

Infection with poliovirus can have devastating consequences, including paralysis and death. In 1988, a year when an estimated 350,000 or more children were paralyzed by polio, the World Health Assembly initiated a global effort to eradicate the infection once and for all. It was an audacious undertaking, given that the virus circulates largely undetected, requires laborious cell-culture techniques to confirm infection, and is tackled with vaccines that provide imperfect protection in the gut. Initially, the number of polio cases and countries with infections fell rapidly, particularly as financing and political support increased in the mid-1990s. The last case of paralytic . . .

Economics of polio vaccination in the post-eradication era: Should OPV-using countries adopt IPV?

The continued use of oral polio vaccine (OPV) poses a threat to polio virus eradication. Stopping all polio vaccination in the post-certification era is no longer considered to be a practical option. Policy makers agree that OPV use must stop immediately after certification. Therefore, the pragmatic alternative is for the OPV-using countries to switch to IPV. This study estimates the cost of switching to IPV, and the cost-effectiveness of this switch. Using data on the number of polio cases and the number of unvaccinated children in different countries of the world, the risks of polio and polio outbreaks have been calculated. The current cost of routine and intensive OPV immunisation is about US $2143 million in the 148 OPV-using countries. Routine use of IPV in these countries should cost US $1246 million. If the current costs of routine and intensive polio immunisation are considered, adopting IPV to replace OPV will not increase the total global cost. Even if the cost of intensive polio immunisation is ignored, cost-effectiveness ratio of adopting IPV remains less than the average GNI per capita of OPV-using countries. The incremental cost of adopting IPV to replace OPV is relatively low, about US $1 per child per year, and most countries should be able to afford this additional cost.

Poliomyelitis surveillance: the model used in India for polio eradication.

Poliomyelitis surveillance in India previously involved the passive reporting of clinically suspected cases. The capacity for detecting the disease was limited because there was no surveillance of acute flaccid paralysis (AFP). In October 1997, 59 specially trained Surveillance Medical Officers were deployed throughout the country to establish active AFP surveillance; 11,533 units were created to report weekly on the occurrence of AFP cases at the district, state and national levels; timely case investigation and the collection of stool specimens from AFP cases was undertaken; linkages were made to support the polio laboratory network; and extensive training of government counterparts of the Surveillance Medical Officers was conducted. Data reported at the national level are analysed and distributed weekly. Annualized rates of non-polio AFP increased from 0.22 per 100,000 children aged under 15 years in 1997 to 1.39 per 100,000 in 1999. The proportion of cases with two adequate stools collected within two weeks of the onset of paralysis increased from 34% in 1997 to 68% in 1999. The number of polio cases associated with the isolation of wild poliovirus decreased from 211 in the first quarter of 1998 to 77 in the first quarter of 1999. Widespread transmission of wild poliovirus types 1 and 3 persists throughout the country; type 2 occurs only in Bihar and Uttar Pradesh. In order to achieve polio eradication in India during 2000, extra national immunization days and house-to-house mopping-up rounds should be organized.