Updates on CDC’s Polio Eradication Efforts, January 4, 2013

January 4, 2013

CDC Continues to Support the Global Polio Eradication Effort

The eradication of polio is an important priority for the Centers for Disease Control and Prevention (CDC). We are closer than we have ever been to eradicating polio and it is critical that we take advantage of this opportunity.

On December 2, 2011, CDC Director Thomas R. Frieden, MD, MPH, activated CDC’s Emergency Operations Center (EOC) to strengthen the agency’s partnership engagement through the Global Polio Eradication Initiative (GPEI), which is committed to completing the eradication of polio. On December 14, Dr. Frieden enlisted the support of the entire CDC community to become active participants in an intensified effort to eradicate polio worldwide.

CDC’s Involvement
In the final push toward global polio eradication, CDC continues its close collaboration with partners, including the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), Rotary International, and the Bill and Melinda Gates Foundation to ensure a coordinated global and country-level response.

CDC polio eradication activities and staff have moved into the EOC operational structure to ensure maximum use of CDC resources to support polio eradication, and to scale up timely technical expertise and support for polio-infected countries (Angola, Chad, Democratic Republic of the Congo, Nigeria, Afghanistan, and Pakistan) and for countries at risk of polio outbreaks (at-risk countries), in coordination with GPEI partners.

A total of 411 personnel have worked in the EOC and in the field since the activation on December 2, 2011, to support CDC’s headquarters polio eradication efforts. Of these, 129 personnel have completed 302 field deployments to Angola, Chad, Nigeria, Cote d’Ivoire, and other areas. On a daily basis, an average of 70-80 CDC personnel are working in the EOC.

Activation of the EOC has provided enhanced capacity for CDC’s STOP Transmission of Polio (STOP) program, which trains public health volunteers in the United States and globally to improve polio surveillance and help plan, implement, and evaluate vaccination campaigns. Since December 2, 2011, 160 individuals have been deployed to work with the STOP program in Nigeria, Chad, Kenya, and other countries.

In addition, the EOC has provided enhanced capacity to scale up in-country technical expertise and support for – polio surveillance, planning, implementation, and monitoring of polio vaccination campaigns – strengthening routine immunization, strengthening management and accountability.

A few additional examples of CDC polio eradication activities include:

• An in-depth review of priority countries’ polio eradication plans to assess program gaps and training needs, and elaboration of plans for CDC’s engagement in those countries.
• Publication of several joint World Health Organization Weekly Epidemiologic Record/CDC Morbidity and Mortality Weekly Reports (MMWR) highlighting polio eradication progress in Afghanistan and Pakistan, Africa, Chad, and Nigeria.
• Collaboration with GPEI partners on detailed country-plans for expanded technical and management support, including assistance with outbreak responses, surveillance reviews, vaccination campaign planning and monitoring, and data management.
• Provision of operational support to Nigeria for the country’s FY 2012 Polio Eradication Emergency Response Plan. The plan focuses on enhancing management and leadership skills to improve program performance.
• The development of indicators for monitoring polio vaccination campaign performance in the areas of planning, implementation, and evaluation.
• Review of WHO proposed outbreak response protocols for all polio-affected countries
• Creation of plans for needs assessments of immunization systems in Chad and Angola.

The Global Push toward the Finish Line
Polio incidence has dropped more than 99 percent since the launch of global polio eradication efforts in 1988. According to global polio surveillance data from January 1^st, 2013, 218 polio cases were reported from four countries, the bulk of which (97% or 212 of the 218 cases) are from the three remaining endemic countries. This figure is the lowest number of cases globally to have been recorded during a one-year period in the last ten years.

On February 25, 2012, WHO removed India, one of the four remaining endemic countries, from the list of countries considered to have never interrupted the transmission of wild poliovirus. India has not had a case of polio since January 13, 2011 and no recent environmental samples have detected wild poliovirus. Activities continue in India to secure the gains achieved. Large-scale polio vaccination campaigns are ongoing and active surveillance for acute flaccid paralysis (AFP) cases continues. Ongoing reports of suspected AFP cases from India will not be unexpected or unusual. In fact, identification of suspected AFP cases means disease surveillance is working and enables India to quickly test cases to rule out polio as the cause.

While no polio cases have been detected in India for more than a year, poliovirus transmission is ongoing in the other three endemic countries – Afghanistan, Nigeria, and Pakistan. GPEI’s Independent Monitoring Board considers Nigeria and Pakistan to be the greatest challenges for eradicating polio.

In addition, Angola, Chad, and the Democratic Republic of Congo had eliminated polio in the past but have experienced reestablished transmission of poliovirus that has continued for more than one year, raising concerns that a window of opportunity to eradicate this crippling and sometimes deadly disease may be closing.

It is therefore imperative that we make this final push toward eradication one of our highest priorities. As Dr. Frieden has stated, “If we fail to get over the finish line, we will need to continue expensive control measures for the indefinite future…More importantly, without eradication, a resurgence of polio could paralyze more than 200,000 children worldwide every year within a decade.” Now is the time, we must not fail.

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