HEALTH TOPICS A TO Z

Poliomyelitis and its symptoms: Poliomyelitis (polio) is a highly infectious disease caused by a virus. It invades the nervous system, and can cause total paralysis in a matter of hours. The virus enters the body through the mouth and multiplies in the intestine. Initial symptoms are fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. One in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5%–10% die when their breathing muscles become immobilized.

Persons at risk of polio: Polio mainly affects children under five years of age.

Prevention of polio: There is no cure for polio, it can only be prevented. Polio vaccine, given multiple times, can protect a child for life.

Polio caseload: Polio cases have decreased by over 99% since 1988, from an estimated more than 350 000 cases in more than 125 endemic countries, to 1951 reported cases in 2005. In 2006, only four countries in the world remain endemic for the disease - the lowest number in history. The reduction is the result of the global effort to eradicate the disease.

The Global Polio Eradication Initiative

Launch: In 1988, the forty-first World Health Assembly, consisting then of delegates from 166 Member States, adopted a resolution for the worldwide eradication of polio. It marked the launch of the Global Polio Eradication Initiative, spearheaded by the World Health Organization (WHO), Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF. This followed the certification of the eradication of smallpox in 1980, progress during the 1980s towards elimination of the poliovirus in the Americas, and Rotary International’s commitment to raise funds to protect all children from the disease.

Progress: Overall, in the 17 years since the Global Polio Eradication Initiative was launched, the number of cases has fallen by over 99%, from an estimated more than 350 000 cases in 1988 to 1951 reported cases in 2005. In 2006, only four countries in the world remain polio-endemic, down from more than 125 in 1988.

In 1994, the World Health Organization (WHO) Region of the Americas (36 countries) was certified polio-free, followed by the WHO Western Pacific Region (37 countries and areas including China) in 2000 and the WHO European Region (51 countries) in June 2002. Widely endemic on five continents in 1988, polio is now found only in parts of Africa and south Asia.

In 2005, more than 400 million children were immunized in 49 countries during 220 supplementary immunization activities (SIAs). Globally, polio surveillance improved in 2005, as reflected in an increase in acute flaccid paralysis (AFP) rates from 2.29 (per 100 000 population aged <15 years) in 2004 to 3.34 in 2005, representing even better detection of AFP cases.

Despite these achievements, the Global Polio Eradication Initiative faces an increase in global cases in 2006, due to an ongoing outbreak in northern Nigeria, and a new outbreak in western Uttar Pradesh, India.

Objectives:

The objectives of the Global Polio Eradication Initiative are:

• To interrupt transmission of the wild poliovirus as soon as possible;
• To achieve certification of global polio eradication;
• To contribute to health systems development and strengthening routine immunization and surveillance for communicable diseases in a systematic way.

Strategies:

There are four core strategies to stop transmission of the wild poliovirus in areas affected by the disease or which are considered at high risk of re-infection:

• high infant immunization coverage with four doses of OPV in the first year of life;
• supplementary doses of OPV to all children under five years of age during SIAs;
• surveillance for wild poliovirus through reporting and laboratory testing of all AFP cases among children under fifteen years of age;
• targeted “mop-up” campaigns once wild poliovirus transmission is limited to a specific focal area.

Before a WHO region can be certified polio-free, three conditions must be satisfied: (a) at least three years of zero polio cases due to wild poliovirus; (b) excellent certification standard surveillance; (c) each country must illustrate the capacity to detect, report and respond to “imported” polio cases. Laboratory stocks must be contained and safe management of the wild virus in inactivated polio vaccine (IPV) manufacturing sites must be assured before the world can be certified polio-free.

The Advisory Committee on Polio Eradication, the independent, technical oversight body of the Global Polio Eradication Initiative, is overseeing a programme of research and consensus-building which will lead to the development of post-eradication polio immunization policy options, which will be considered by the World Health Assembly.

Coalition: TThe Global Polio Eradication Initiative (GPEI) is spearheaded by WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and the United Nations Children’s Fund (UNICEF).

The polio eradication coalition includes governments of countries affected by polio; private sector foundations (e.g. United Nations Foundation, Bill & Melinda Gates Foundation); development banks (e.g. the World Bank); donor governments (e.g. Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, Japan, Luxembourg, Malaysia, Monaco, the Netherlands, New Zealand, Norway, Oman, Portugal, Qatar, the Republic of Korea, the Russian Federation, Saudi Arabia, Spain, Sweden, Switzerland, Turkey, United Arab Emirates, the United Kingdom and the United States of America); the European Commission; humanitarian and nongovernmental organizations (e.g. the International Red Cross and Red Crescent societies) and corporate partners (e.g. Sanofi Pasteur, De Beers, Wyeth). Volunteers in developing countries also play a key role; 20 million have participated in mass immunization campaigns.

Countries at risk from polio

As long as a single child remains infected with poliovirus, children in all countries are at risk of contracting the disease. The poliovirus can easily be imported into a polio-free country and can spread rapidly amongst unimmunized populations. Between 2003 and 2005, 25 previously polio-free countries were re-infected due to importations.

The four polio-endemic countries are: Nigeria, India, Afghanistan and Pakistan.

Priorities for polio eradication

In order to stop transmission of the wild poliovirus and optimize the benefits of polio eradication, the global priorities are:

Closing the funding gap: Substantial external financial resources are required to support the efforts of developing countries to eradicate polio. A funding gap of US$50 million for 2006 must urgently be filled, to ensure that planned immunization activities through the rest of the year can proceed. An additional funding gap of US$390 million for activities in 2007-2008 must be filled.

Stopping wild poliovirus transmission in endemic countries: The highest priority is reaching all children during SIAs in the remaining four endemic countries. To succeed, political commitment must be strengthened at national, state/province and district levels, in the four remaining endemic countries.

Further priority emphasis will be placed on providing support to the other remaining endemic countries.

Impact of the Global Polio Eradication Initiative

The Global Polio Eradication Initiative was launched in 1988. More than five million people who would otherwise have been paralysed are today walking because they have been immunized against polio since then.

By preventing a debilitating disease, the Global Polio Eradication Initiative is helping reduce poverty, and is giving children and their families a greater chance of leading healthy and productive lives.

By establishing the capacity to access children everywhere, more than two billion children worldwide have been immunized during SIAs, demonstrating that well-planned health interventions can reach even the most remote, conflict-affected or poorest areas. In 2005 alone, more than 400 million children were reached as part of these efforts in 49 countries.

Planning for NIDs provides key demographic data – “finding” children in remote villages and households for the first time, and putting them on the map for future health services.

In most countries, the Global Polio Eradication Initiative has expanded the capacity to tackle other diseases by building effective disease-reporting and surveillance systems, training epidemiologists and establishing a global laboratory network.

Routine immunization services have been strengthened by bolstering the cold chain, transport and communications systems for immunization.

Vitamin A is often administered during polio SIAs. Since 1988, more than 1.2 million childhood deaths have been prevented through provision of Vitamin A during polio SIAs.

On average, one in every 250 people in a country have been involved in polio immunization campaigns. More than 20 million healthworkers and volunteers have been trained to deliver OPV and vitamin A, fostering a culture of disease prevention.

Through the synchronization of SIAs, many countries have established a new mechanism for coordinating major cross-border health initiatives aimed at reaching all people – a model for regional and international cooperation for health.

Future benefits of polio eradication

Once polio is eradicated, the world can celebrate not only the eradication of a disease but the delivery of a global public good – something from which every person, regardless of race, sex, ethnicity, economic status or religious belief, can benefit for all time, no matter where they live.

The humanitarian benefit is tremendous. Without eradication, more than ten million new cases of polio worldwide would manifest themselves between 2005 and 2040.