Poliovirus : éradication pour les prochaines JNI?

Transcription

1 Poliovirus : éradication pour les prochaines JNI? Bruno LINA CNR des entérovirus Laboratoire de virologie EST, GHE, HCL FRE 3011 CNRS UCBL, Lyon Polio Eradication Initiative 1

2 Polio Eradication Progress children 125 countries children 6 countries Polio Eradication Initiative 2

3 Timeline for Polio Eradication Wild Virus Eradication & Regional Cert. Phase OPV Cessation & Verification Phase 'Post OPV' Phase Priority Activities Interrupt wild virus Contain wild viruses Regional Certification Develop stockpile Enhance surveillance Prepare to stop OPV Stop OPV verify no cvdpvs integrate into IHR Impact of Delay in Eradication Earliest Dates Polio Eradication Initiative 3

4 Impact of Previous Synchronized Polio Campaigns, Africa 14 Country Synchronized Immunization Days, Polio Eradication Initiative 4

5 Dilemma: Suspension of polio immunization, Northern Nigeria, August 2003 Polio Vaccines Western Countries Exploit Developing Ones Says Kano State Governor Shekarau BYLINE: Daily Trust The Kano State governor, Malam Ibrahim Shekarau, has asserted that the people's objections to polio vaccines confirmed the exploitative actions of western nations towards developing countries. Polio Eradication Initiative 5

6 Spread of wild polio virus polio-free countries had importations originating in Nigeria Polio transmission re-established in 6 polio-free countries. In HQ as of 4 Polio Eradication Initiative 6

7 Risk: AFP Surveillance Gaps Eliminated viruses 'rediscovered' in 2004 Polio Eradication Initiative 7

8 Wild virus type 1 Wild virus type 3 Endemic countries Countries with imported NIE virus (2003-5) Polio Cases, 2005 (as of 18 May) * Excludes environmental surveillance viruses. Polio Eradication Initiative 8

9 Impact of Intensification, Asia Reported Polio Cases, Reported Polio Cases, India Pakistan Afghanistan Polio Eradication Initiative 9

10 320 PAKISTAN: Reported AFP By Month * Cases (n) Jan 2000 * Data as of Source AFP.Rec file Apr Jul Oct Jan Apr Jul Oct Jan Apr Jul Oct Jan Apr Jul Oct Jan non-polio AFP rate of 1/100,000 children < 15 years Jul Oct Jan Apr Polio Eradication Initiative WHO/NSC non-polio AFP rate of 2/100,000 children < 15 years

11 Indonesia polio outbreak 8 cases confirmed 14 positive contact cases from healthy children First polio in Indonesia since 1995 Imported virus from Sudan/Saudi Arabia, with origin in northern Nigeria Polio Eradication Initiative 11

12 Spread of wild polio virus polio-free countries had importations originating in Nigeria Polio transmission re-established in 6 polio-free countries. In HQ as of 4 Polio Eradication Initiative 12

13 WEAF P1 genetic tree Polio Eradication Initiative 13

14 Location of Wild Poliovirus Polio Eradication Initiative 14

15 Yemen polio outbreak 88 cases confirmed (23/05), likely to far exceed 100 cases before outbreak is controlled First polio in Yemen since AFP surveillance began in 1996 Imported virus from Sudan, with origin in northern Nigeria Polio Eradication Initiative 15

16 Wild PV1 cases and n.-p. AFP cases By laboratory status and epid. Week, Yemen, 2005 (As of 17 ) EMRO May Polio Eradication Initiative 16

17 Type 1 Poliovirus Outbreak, Yemen, Jan to April 2005 (data as of May 1, 2005) Polio Eradication Initiative 17

18 Summary Asia is set to stop polio by end Africa now moving back on track; the greatest risk remains a delay in Nigeria. Importations will occur until all countries are poliofree (highest risk is in the Horn of Africa). Multi-year financing can now secure this global public good for future generations. Polio Eradication Initiative 18

19 Et aujourd hui hui? Réduction ou pas?. Nigéria OK ou pas. VDPV ou pas? Des sous ou pas?. Polio Eradication Initiative 19

20 Monthly distribution of Wild Poliovirus cases, WPV type Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec WPV type Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Data in WHO/HQ as of 26 May WPV type 1 includes 1 case in 2009, 1 case in 2008, 3 cases in 2007, 2 cases in 2006, 3 cases in 2005, 2004, 2002 and 4 cases in 2001 with a mixture of W1W3 virus. For 2009, cases with onset in May will be reflected end of June

21 Wild Poliovirus infected districts, Country total districts in country** districts infected with W1 districts infected with W3 districts infected with W1W3 districts infected with W1 districts infected with W3 districts infected with W1W3 India May-09 Pakistan May-09 CAR May-09 Nigeria Apr-09 Sudan Apr-09 Afghanistan Apr-09 Kenya Apr-09 Côte d'ivoire Apr-09 Angola Apr-09 Benin Apr-09 Guinea Apr-09 Burkina Faso Apr-09 Chad Apr-09 Togo Mar-09 Niger Mar-09 Uganda Feb-09 DR Congo Feb-09 Mali Jan-09 Ghana Nov-08 Nepal Oct-08 Ethiopia Apr-08 Total Jan-00 Total in endemic countries Jan-00 Total in non-end. countries Jan-00 Countries highlighted in yellow are currently endemic * Data in WHO/HQ as of 27 May 2008 for 2008 data and as of 26 May 2009 for 2009 data ** Source: WHO/UNICEF 2007 Joint Reporting Form 2008 total infected districts 2009 total infected districts 01 Jan - 26 May * date of most recent case Data in WHO HQ as of 26 May 2009

22 circulating Vaccine-derived Poliovirus*, Country Type cvdpv First case Last case Nigeria VDPV Jul Apr-09 Ethiopia VDPV Oct Feb-09 DR Congo VDPV Mar Dec-08 Myanmar VDPV Apr-06 6-Dec-07 Niger*** VDPV May-06 3-Oct-06 Cambodia VDPV Nov Jan-06 Indonesia VDPV Jun Oct-05 Madagascar** VDPV Jul-05 China VDPV Jun Nov-04 Philippines VDPV Mar Jul-01 DOR/Haiti VDPV Jul Jul-01 ** Madgascar: two differents outbreaks (2001/02 and 2005) *** Niger cvdpvs are linked to the Nigeria outbreak * circulating Vaccine-derived poliovirus (cvdpv) is associated with 2 or more cases of AFP Data in WHO/HQ as of 26 May 2009

23 Circulating Vaccine-derived Polioviruses in Nigeria, 2009 cvdpv2 (71 cases) cvdpv2 monthly distribution dots are randomly placed within districts Data in WHO HQ as of 26 May juil- 05 sept- 05 nov- 05 janv- 06 ma rs-06 mai- 06 juil- 06 sept- 06 nov- 06 janv- 07 ma rs-07 mai- 07 juil- 07 sept- 07 nov- 07 janv- 08 ma rs-08 mai- 08 juil- 08 sept- 08 nov- 08 janv- 09 ma rs-09

24 Circulating Vaccine-derived Polioviruses Rolling 6 months 27 Nov May 2009 NIE - cvdpv2 (73 cases) DRC - cvdpv2 (1 case) ETH - cvdpv2 (2 cases) 24 cvdpv2 monthly distribution NIE ETH DRC juil- 05 sept- 05 nov- 05 janv- 06 mars- 06 mai- 06 juil- 06 sept- 06 nov- 06 janv- 07 mars- 07 mai- 07 juil- 07 sept- 07 nov- 07 janv- 08 mars- 08 mai- 08 juil- 08 sept- 08 nov- 08 janv- 09 mars- 09 Data in WHO/HQ as of 26 May 2009