- Egypt is expected to become polio-free "within few months" as the final immunisation programme is going on in the country. Thus, only Niger and Nigeria will become the only remaining countries with "wild polio" in Africa. If local authorities in the Nigerian state of Kano decide to re-start immunisation, neighbouring Niger could also become polio-free this year.
Only six countries worldwide currently remain polio-endemic; Nigeria, Niger, Egypt, India, Pakistan and Afghanistan. Asia and Egypt "could be polio-free within months," the World Health Organisation (WHO) reported from Geneva yesterday as the Health Ministers from the remaining polio-endemic countries had met there. The ministers announced a two-pronged strategy to further accelerate eradication activities.
West and central African countries nevertheless "must change track to stop the virus," according to the data presented in Geneva. In particular the situation in Nigeria - were the northern state of Kano has halted immunisation for one year - was of concern. Polio had spread to ten previously polio-free countries in Africa from Nigeria and was halting the eradication in neighbouring Niger.
Together with India, Pakistan and Afghanistan, Egypt was now experiencing "all-time low levels of polio," WHO reported. Only one case of polio was reported in Egypt last year and one case has been reported so far this year.
Egyptian authorities announced an accelerated strategy to "mop-up" each new virus. Under this ambitious initiative, each new poliovirus found will trigger two massive, tailored immunisation campaigns in response before the virus has the opportunity to spread. Egypt was now on track to meet the end-2004 target for stopping polio.
In Egypt in 2003, poliovirus was concentrated in 2 reservoir areas by end 2003 in the governorate of Menia in Central Egypt and in Greater Cairo, or the cities of Cairo and Giza. Since that, however, Egyptian health authorities have carried out an impressive immunisation campaign.
While only 36 percent of children in Cairo and Giza younger than 5 years had received a polio vaccine in 2002, this number had grown to 63 percent in 2003. By now, 100 percent of young children in Greater Cairo have been immunised, according to WHO.
Only small areas in Egypt now remain uncovered by the nationwide immunisation effort, but they are already being targeted. In the coming months, Egyptian authorities will concentrate on "mopping-up" the possible rest of polio in the country. Within a few months, Egypt expects to be declared polio-free.
In West and Central Africa, progress has been slower due to the Kano state ban on polio vaccines, driven by a rumour that the vaccine was designed to spread AIDS and infertility. Federal Nigerian authorities however report that they now have convinced Kano state to re-start the immunisation programme, which was halted in 2003.
Nigeria remains the world's most polio-infected country, with 335 new cases reported only in 2003. 89 of these cases were registered in Kano state, making it the hotspot of Africa's polio epidemic. 119 new infections have been registered this year already; 70 percent of all cases globally. The northern Nigerian poliovirus has spread to nine neighbour countries and several Nigerian states - including Lagos - where it previously had been eradicated during 2003.
Change is however set to come. Recognising that Kano state has yet to resume immunisation activities, Nigerian Health Minister Eyitayo Lambo yesterday informed the Geneva meeting that "This month, an understanding was reached and signed between Kano state government and federal authorities on the required conditions for re-starting the polio immunization activities in Kano."
- As these conditions are now being met, we have made preparations to support full catch-up immunisation campaigns in Kano, ahead of the nation-wide activities in September, October and November, said Ms Lambo at the Geneva meeting.
This re-start of polio vaccination in Kano was also good news for the government of Niger, which has led an uphill struggle to control the polio epidemic in the country. Polio increased from only 3 registered cases in 2002 to 40 confirmed cases last year. Most new infections were concentrated in the region of Maradi and other areas close to the Nigerian border. 12 new cases have already been registered this year.
The funding partners of the Global Polio Eradication Initiative at yesterday's Geneva meeting warned that the spread of virus from Kano across West and Central Africa already cost US$ 25 million for emergency campaigns in 2003 alone, in response to these re-infections. The further intensification of activities would "result in significant additional costs," WHO said.
At the meeting, a new anti-polio strategy for the African region was agreed upon, including the reintroduction of a mass, synchronised immunisation campaign across 21 countries by early 2005 at the latest. "This strategy will be supplemented, where appropriate, with mop-up campaigns around any importations," according to WHO.
While half of Africa is to see new small-scale immunisation campaigns to meet the recently imported polio cases, focus will nevertheless be on eradicating the disease in Niger and Nigeria.
Nigeria has already conducted three large-scale polio immunisation campaigns in 2004, with all states except Kano participating. Immunisation will now focus on Kano, but there is still a lot to do in the other 36 Nigerian states. In the key polio endemic areas, the recent polio immunisation campaigns reached less than 75 percent of children, with coverage somewhat higher in the high risk and polio-free areas.
In Niger, where authorities two years ago thought they were close to win the battle against polio, there is still more work to be done. At the beginning of this year, only 52 percent of Nigerien children had received vaccines. Three full-fledged National Immunisation Days are however planned and the Nigerien government has given the fight against polio the highest priority.
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