Africa

Strategic Plan 2010-2012

Interrupting wild poliovirus transmission in Africa

Focus turns to Nigeria, Angola and DR Congo
Polio transmission sustained over large geographic areas
Transmission of both endemic (northern Nigeria) and imported polioviruses in Africa has been sustained over larger geographic areas than in Asia. However, unlike in Asia, a lower critical threshold of population immunity is required to stop polio (in Africa, if 8085% of children are immune, poliovirus transmission will stop). Multiple re-infections across the same areas of Africa have resulted in a clearly identifiable 'importation belt' of sub-Saharan Africa, with defined high-risk routes for international spread. Many of these routes remain susceptible to polio reinfection due to inadequate (or barely existent) routine immunization services.

While the full application of international outbreak response guidelines ( as adopted by the World Health Assembly in 2006) rapidly stops outbreaks, the failure to apply these guidelines can lead to longer outbreaks that spread to wider geographical areas and result in a higher number of cases.

It can even lead to the reestablishment of polio transmission - defined as having persistent transmission of one genetic chain of polio for more than 12 months - as is the case in Angola, Chad and Democratic Republic of Congo (DR Congo).

Since 2009, significant operational improvements in northern Nigeria have resulted in a dramatic fall in case numbers, directly reducing the risk of renewed international spread from this country.

planning, implementation and monitoring of outbreak response activities. In particular, international technical staff will be deployed for a longer time period to ensure continuity and understanding. New 'real-time' independent monitoring of SIAs will provide a rapid, clear picture of the effectiveness of the outbreak response, allowing for real-time mid-course corrections where necessary. Pre-planned SIAs will focus on identified high-risk areas, and enable the timely and appropriate allocation of resources to ensure the highest possible quality can be achieved. SIAs will be planned using the full toolbox of available vaccines, with the introduction of the new bivalent OPV dramatically simplifying SIA logistics by

Fewer but higher-quality SIAs - over a larger geographic area

Given that in Africa, polio is spread over wide geographical areas, and that if four out of five children are reached in immunization campaigns, polio will be stopped, the key to success is to boost immunity levels over a wide geographic area at the same time. To achieve this, focus must be on increasing the quality of supplementary immunization activities (SIAs). Technical support will be scaled up to support the

offering the highest possible protection per dose to both types of polio (type 1 and 3). The vast GPEI infrastructure will be used to systematically strengthen routine immunization systems, particularly in areas that have been identified as at highest risk of both importations and outbreaks following reinfection. This will aim to a) minimise the risk of an importation from occurring; and, b) minimise the consequences if an importation does occur.

And now?
All tools and approaches are in place to complete the job of polio eradication once and for all. If fully financed and implemented, the GPEI Strategic Plan 2010-2012 can lead to a polio-free world by 2013.

GPEI Strategic Plan 2010-2012 available at www.polioeradication.org