The WHO Director-General called the 37th meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) on the global spread of the poliovirus on December 12, 2023. Committee members and advisors met in person and virtually with affected nations, with assistance from the WHO Secretariat. The Emergency Committee examined data on circulating vaccine-derived polioviruses (cVDPV) and wild polioviruses (WPV1) in light of the global goal of eliminating WPV and stopping cVDPV2 outbreaks. The following nations' situations have been updated technically: Afghanistan, Egypt, Guinea, Mauritania, Nigeria, Pakistan, and Zimbabwe.
Uncontrolled poliovirus
Since the last meeting, Pakistan has had four additional cases of WPV1, increasing the total to six cases in 2023. In addition, there has been a noticeable rise in environmental detections; in the three months from September to November, sixty positive samples were discovered, bringing the total to 82 in 2023. New transmission is taking place in the Quetta Block in Balochistan, Karachi in Sindh, Islamabad / Rawalpindi, and Peshawar in the Khyber Pakhtunkhwa (KP) province, following a period of non-detection. 160,000 more children have received vaccinations in southern KP as a result of the implementation of a polio action plan, but the situation is still difficult due to political unrest, insecurity in some areas, front-line workers needing police patrols to accompany them, and vaccination boycotts in communities. request additional services in return for granting permission to receive the polio vaccine. There are still many youngsters in Pakistan who are not included in the project.
There are still six WPV1 cases in Afghanistan, all of which are from the province of Nangarhar, as of the last conference. No new cases have been reported from Afghanistan. Thus far in 2023, 46 environmental samples have tested positive for WPV1, primarily from the endemic East Region (the provinces of Nangarhar and Kunar), but more recently, environmental samples from the provinces of Kabul, Kandahar, Zabul, and Balkh have also tested positive.
This represents a reversal of previous gains and suggests the expansion of WPV1 from the endemic zones of Afghanistan (East Region) and Pakistan (South KP). The programme is reaching more children than ever before and running excellent campaigns, but the quality needs to be maintained and raised even more. Because of the high rate of people movement, any setback in Afghanistan could jeopardise the initiative in Pakistan.
Afghanistan keeps up a rigors campaign pace, emphasising quick responses to WPV1 detections across the nation and enhancing quality in the endemic zone. Microplan validation, increasing the participation of female vaccinators, social mobilizers, and monitors, intensified and well-supervised trainings of polio health workers, increased monitoring, using polio campaign microplans to expedite routine immunisation, and extending the campaign-target age group up to 10 years in the areas that were inaccessible prior to 2021 are some of the quality improvement interventions in the East Region. Although campaign quality in the East Region has improved in 2023, there are still issues in the South Region, where lot quality assurance sampling (LQAS) indicates that campaign quality is subpar and about 200,000 children are not reached during the campaigns.
The humanitarian situation in Afghanistan has gotten worse as a result of the recent significant rise in the number of Afghans returning from Pakistan. Between mid-September and mid-November, the nation received approximately 0.3 million Afghans who had returned; 1.7 million are anticipated to have returned in total. The risk of poliovirus spreading both within the two countries and across borders is greatly increased by this large-scale population mobility. The Afghan polio programme has triggered a backup plan and sent more teams and supervisors to strategic locations and routes to vaccinate the children in the populations of returnees. For information sharing and immunisation at their centres, close collaboration is maintained with UNHCR and IOM. The future polio vaccination campaigns will cover districts that have had a substantial number of returnees.
With the last case beginning to become paralysed on August 10, 2022 in Mozambique, it has been almost 15 months since the WPV1 was discovered in south-east Africa. It has also been two years since the lone case was discovered in Malawi. The Committee observed that in November 2023, the GPEI conducted independent outbreak response assessments, or OBRAs, in Malawi and Mozambique. There are encouraging indications that imported WPV1 is no longer being transmitted in Mozambique. Still, there was not yet access to all twelve months of finalised surveillance data. The OBRA team in Malawi came to the conclusion that WPV1 transmission there has most likely ceased. But the WPV1 outbreak won't be deemed over until a comparable decision is made forZambia. The WHO Regional office will formally close the epidemic after receiving approval from the Regional Certification Commission.
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