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Disease outbreak news: Circulating vaccine-derived poliovirus type 2 – Sudan | WHO.

[1 September 2020]

On 9 August 2020, the Federal Ministry of Health, Sudan notified WHO of the detection of a circulating vaccine-derived poliovirus type 2 (cVDPV2) in the country. According to the notification, the virus is genetically-linked with Chad (sequencing results showed 12 to 19 nucleotide changes). Two Acute Flaccid Paralysis (AFP) cases were notified. The first case, a child of 48 months, had onset of paralysis on 7 March 2020 and was from Sulbi city of Kas locality in South Darfur state. The state is in the west of the country, bordering Central African Republic, South Sudan and close to the border with Chad. The second case, a child of 36 months, had onset of paralysis on 1 April 2020 and was from Shari city of AI Gedarif locality in Gedarif state in the east, close to the border with Eritrea and Ethiopia. Both children received the their last bOPV ( type 1 & 3) dose in 2019. Initial investigation indicates these cases are linked to cVDPV2s from the CHA-NDJ-1 emergence group which was first detected in October 2019 and is currently circulating in Chad and Cameroon. Eleven additional suspected cases have also been confirmed as cVDPV2 and field investigation reports are being consolidated. These cases are in the following states – Red Sea, West Darfur, East Darfur, White Nile, River Nile and Gezira. Hence, between 9 August and 26 August 2020, there have been a total of 13 cVDPV2 cases reported. Additionally, three cVDPV2-positive environmental samples from Soba, Elgoz and Hawasha sites from Khartoum were detected (samples collected on 29 March 2020). Sequencing of viruses isolated in Sudan so far reflects that the viruses are related with viruses reported earlier in neighboring Chad from where there were multiple separate introductions into Sudan from Chad. There is local circulation in Sudan and continued sharing of transmission with Chad.

Public health response.

Following the detection of cVDPV2 in the country, the following response activities are being planned and/or implemented:

  • The Acting Federal Minister of Health declared a cVDPV2 outbreak in Sudan to the Cabinet within eight hours on Day Zero of outbreak (9 August 2020);
  • The Ministry of Health, supported by Global Polio Eradication Initiative (GPEI) partners, implemented a full field investigation, and started implementation of polio outbreak preparedness and response plan from Day Zero;
  • A national task force for outbreak response with representation from WHO and UNICEF has been established, Federal Epidemiological Team finalized Terms of Reference and composition of National Technical Committee for cVDPV2 outbreak control and convened first meeting on 9 August 2020;
  • Undersecretary of Health is chairing the steering committee for outbreak response, and the first meeting was convened on 9 August 2020;
  • Federal Epidemiological Team advised state epidemiological managers of South Darfur and Al Gedarif and other states with cases to activate the state’s emergency committee and start implementation of polio outbreak preparedness and response plan;
  • Response is coordinated with other departments such as health promotion and health emergencies; and cross-border coordination with neighbouring countries is being initiated.

WHO risk assessment.

WHO assesses the risk of further international spread of cVDPV2 across central Africa and the Horn of Africa to be high. With large-scale population movements with other areas of central Africa and the Horn of Africa. A more thorough region-wide risk assessment is being conducted by the polio program. Across the African continent, 172 type 2 cases in 14 countries have been reported in 2020.

WHO advice.

It is important that all countries, in particular those with frequent travel and contacts with polio-affected countries and areas, strengthen surveillance for Acuter Flaccid Paralysis in order to rapidly detect any new virus importation and to facilitate a rapid response. Countries, territories and areas should also maintain uniformly high routine immunization coverage at the district level to minimize the consequences of any new virus introduction.

WHO’s International Travel and Health recommends that all travelers to polio-affected areas be fully vaccinated against polio. Residents (and visitors for more than 4 weeks) from polio-affected areas should receive an additional dose of OPV or inactivated polio vaccine (IPV) within 4 weeks to 12 months of travel.

As per the advice of an Emergency Committee convened under the International Health Regulations (2005), efforts to limit the international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC). Countries affected by poliovirus transmission are subject to Temporary Recommendations. To comply with the Temporary Recommendations issued under the PHEIC, any country infected by poliovirus should declare the outbreak as a national public health emergency and consider vaccination of all international travelers who live or visited the country for four weeks or longer. Countries infected by cVDPV2 should encourage residents and long-term visitors to receive a dose of IPV four weeks to 12 months prior to international travel.

For more information:

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Polio in Afghanistan: The Current Situation amid COVID-19 | The American Journal of Tropical Medicine and Hygiene.

[Open Access] [Received : 13 Aug 2020; Accepted : 21 Aug 2020; Published online : 27 Aug 2020] [Online First Article]


Polio is a deadly viral disease that has been paralyzing many children in Afghanistan. Despite fundamental efforts, primarily vaccination, to reduce the number of cases in Afghanistan, there are still many children who are deprived of the vaccine every year. Afghanistan is one of the two remaining countries endemic for polio, and the country has undergone various challenges that have hampered the eradication of this disease. The underlying challenges include inaccessibility of unsecured areas, illiteracy, refusal, and, most recently, COVID-19. The country is in the midst of a battle against COVID-19, and polio has almost entirely been neglected. Sadly, polio cases are increasing in the country, particularly in polio-free provinces. After an initial lockdown, many businesses have been allowed to resume, but the mass polio vaccination campaign has not restarted. New cases of polio will surge if endemic regions remain unvaccinated or inaccessible. To curb the further spread of polio, Afghanistan needs to resume nationwide house-to-house vaccination as restrictions due to COVID-19 are loosened.

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Here are the countries using Google and Apple’s COVID-19 Contact Tracing API | XDA Developers.

[August 31, 2020 5:33pm]

Here are the countries using Google and Apple’s COVID-19 Contact Tracing API

Mishaal Rahman writes:

SARS-CoV-2, also known colloquially as just the coronavirus, has wreaked havoc across the world. Many countries shut down large parts of the economy in order to contain the spread of the virus. As countries reopen their economies, many health experts fear a “second wave”, ie. resurgence, of COVID-19. To prevent a second wave, public health experts are advocating that nations adopt contact tracing, ie. tracing all the people who have recently come into contact with a person who has tested positive for COVID-19 and then undertaking steps to isolate those individuals. Contact tracing is difficult to implement correctly without violating an individual’s privacy. The threat to personal privacy was severe enough for Google and Apple to collaborate on an API that developers of public health agencies can use to implement app-based contact tracing solutions. This contact tracing API, which Google and Apple call the Exposure Notification API, is designed to respect user privacy and security.

Video: Exposure Notifications System: Helping Health Authorities fight COVID-19 | Google

Once a user downloads an app that uses the Exposure Notification API and opts in to contact tracing, their device starts generating “proximity identifiers” that are changed every 15 minutes (on average). Via Bluetooth Low Energy, these “proximity identifiers” are periodically shared with nearby devices whose users have also opted into contact tracing. The proximity identifier is then processed on-device and does not reveal information about a user’s location or other personally identifiable information. Once a user confirms a positive diagnosis of COVID-19, they can share their diagnosis with the app they installed, which will then inform other users who have come into close contact with them in the last 14 days. For more information on how the Exposure Notification API works, we recommend reading our initial coverage.

Google first rolled out the Exposure Notification API for Android devices on May 20, 2020, as part of an update to Google Play Services, but its use is restricted to apps that have been developed by official public health agencies (for obvious reasons). However, neither Google nor Apple has made details public about the list of apps that have been whitelisted for using this API, so unless you’re constantly keeping up with the news, it’s hard to know which countries have adopted the API. We’ve previously covered some of the countries that have adopted the Exposure Notification API when we talked about the various open-source contact tracing projects that are out there. In this article, we have compiled a list of official contact tracing apps from designated health agencies from various countries that are using Google and Apple’s Exposure Notification API. Our list contains COVID-19 contact tracing apps that have been released or are currently in development.

We discovered Google’s hidden whitelist of application package names for the API. Subsequently, these package names were traced back to apps, their listing, and the countries they belong to. The information is compiled below in a table for easy reference. We have also added Google Play Store and Apple App Store links, if the app has been publicly released, as well as the source code and the official website link, wherever available. We will update the following tables as more countries/regions adopt the API.

For table "Regions with COVID-19 contact tracing apps based on the Exposure Notifications System (ENS)" see source article.

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Somalia: 400 000 children to be vaccinated against polio and measles in Banadir in midst of COVID-19 pandemic | ReliefWeb.

[Source: WHO] [Posted: 31 Aug 2020] [Originally Published: 31 Aug 2020] [Origin: View original]

30 August 2020 – For 3 days during a blazing Mogadishu summer, across 17 of Banadir’s districts, around 2500 women and 790 men pulled on their masks and sat cautiously at a safe distance from each other to undergo refresher training. They were preparing for no ordinary feat – conducting a health campaign that will see them offering around 400 000 children aged under 5 measles and polio vaccines, and vitamin A and deworming tablets at fixed and outreach sites, all amid a COVID-19 pandemic.

Even though the trainees have years of experience in planning and conducting immunization campaigns, some are a little anxious about how Somali families will react to them trying to offer health services during an ongoing pandemic of a highly contagious disease. Throughout the campaign, which started on 30 August and will run until 1 September, health workers will observe comprehensive COVID-19 infection prevention measures, such as regular handwashing and wearing face masks, to keep families safe. In addition, health workers will share information with families on how to prevent the further spread of COVID-19.

“I hope that caregivers and parents see that our teams have all been trained and retrained to consider the health safety measures of families above all,” says Mohamed Shire, Polio Eradication Officer for the central region of Somalia. “While ensuring families’ and our own safety, we will conduct our duties to protect every Somali child from diseases.”

Impact of COVID-19 on routine immunization coverage of life-saving vaccines.

Across the globe, while the highly transmissible disease and community spread seems to be continuing, the COVID-19 virus has also taken a swing at both the delivery of health services, and health-seeking behaviour. In Somalia, health facilities have recorded a drop in caregivers’ visits to have their children immunized since March this year, when the first case of COVID-19 was confirmed in Mogadishu. When comparing overall vaccination coverage for the first half of last year with the same period this year, health facilities noted that pentavalent 1 coverage dropped by 11%, pentavalent 3 coverage reduced by 7% and measles 1 coverage dropped by 3%.

The pandemic also meant health workers ‘paused’ other regular, planned activities, such as the integrated polio-measles campaign, as they worked to prevent the spread of COVID-19 and provide much needed treatment for infected people.

Dr Asma Ali, acting Head of WHO’s Polio Programme in Somalia, is relieved to be resuming health activities in Somalia again.

“This campaign in Banadir was supposed to take place in November last year, following a similar intervention in the rest of the country, but was postponed to 2020 due to some technical delays. Unfortunately, COVID-19 came about and took over. Thankfully, we now have a chance to continue to boost the immunity of so many young children again,” Dr Asma explained.

A hub for Somalis and a hotspot for the spread of diseases.

Since the start of the year, 744 children in Banadir have reportedly been infected with measles, which accounts for around half the total number of cases in the country. This highly contagious infectious disease can cause a fever and rash among other symptoms in unvaccinated children.

Home to the largest number of displaced people in Somalia, and a hub for Somalis travelling internationally, Banadir also confirmed cases of 3 children with a rare strain of poliovirus that can be found in pockets of children with low immunity.

Two forms of polioviruses, in circulation in Somalia since the end of 2017, have caused paralysis in 19 children so far across the country.

Protecting children from preventable diseases.

Dr Mamunur Malik, WHO Somalia Representative, emphasized to Somali communities that every adult has a responsibility to help Somali children lead healthy lives.

“I would like to encourage parents, caregivers and all adults in Banadir and surrounding areas to make the most of this opportunity and visit vaccination sites to ensure every child aged under five is vaccinated against polio and measles, and that every child receives additional supplements to keep them healthy. As caregivers we all have an obligation to ensure our children lead healthy and productive lives,” said Dr Malik.

“As the COVID-19 response continues, it is critical that immunization drives are sustained at the same time,” added Penelope Campbell, Chief of Health, UNICEF Somalia. “Measles and polio are vaccine-preventable diseases and through this campaign, we can stop the further spread of these outbreaks and save the lives of countless children.”

More than 1200 teams with skilled personnel will be offering vaccinations against measles and polio, and supplements to children at fixed sites in Banadir during the 3-day campaign. In addition, social mobilizers from target communities will be spreading messages on the benefits of vaccination and supplements.

The successful completion of the current mass immunization campaign against measles and polio in the midst of an ongoing pandemic in Somalia will not only protect an estimated 400 000 Somali children against vaccine-preventable diseases, the campaign will also focus on the importance of resuming essential health care services, like routine immunization activities in fragile settings using standard health safety measures. The campaign will also give a signal to all health partners that despite challenges of maintaining physical distancing, with the use of masks and other measures in health facilities and vaccination sites, it is practically possible to organize such mass campaigns and other routine health services through effective planning, coordination and implementation of appropriate risk mitigation measures addressed at individual and population levels.

Note to editors.

The integrated measles and polio campaign in Banadir is being conducted by Somali health authorities, with technical support from WHO, UNICEF and other Global Polio Eradication Initiative (GPEI) partners, and national and international partners, including Gavi, the Vaccine Alliance.

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25 polio cases recorded in Philippines; 16 permanently disabled | PH Lifestyle News.

[August 28, 2020] Margret Fermin writes:

The Department of Health reported 25 polio infections in the Philippines from September 2019 to June 2020. Sixteen of whom experienced permanent disability.

Dr. Wilda Silva, program manager of the DOH immunization program, said polio immunization was hindered in NCR and Calabarzon in the first semester of 2020 due to the COVID-19 pandemic.

The Philippines has been polio-free for 19 years until  confirmed September 14, 2019, that a 3-year-old girl had the disease and “now apparently well but with residual paralysis.”

According to UNICEF and WHO, the poliovirus type 2 would likely spread rapidly due to the “low level of population immunity” against the virus. The organizations also consider the virus as a public health emergency.

WHO and UNICEF pointed out that the poliovirus resurfaced due to persistently low routine immunization coverage.

The drop in polio immunization was traced back to the Dengvaxia vaccine scare in 2017. The government approved the school-based dengue vaccination in 2015. As of today, there are 145 deaths (142 children and three adults) allegedly caused by Dengvaxia.

Meanwhile, on August 25, the Africa Regional Certification Commission certified the WHO African Region as wild polio-free after four years without a case.

Also read: Philippines polio vaccine drive: 200 Red Cross assembled

Polio in the Philippines.

WHO added, “five of the six WHO regions – representing over 90% of the world’s population – are now free of the wild poliovirus, moving the world closer to achieving global polio eradication.”

To date, only two countries, Pakistan and Afghanistan, continue to see wild poliovirus transmission.

“Ending wild polio virus in Africa is one of the greatest public health achievements of our time and provides powerful inspiration for all of us to finish the job of eradicating polio globally,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “I thank and congratulate the governments, health workers, community volunteers, traditional and religious leaders, and parents across the region who have worked together to kick wild polio out of Africa.”

“During a challenging year for global health, the certification of the African region as wild poliovirus-free is a sign of hope and progress that shows what can be accomplished through collaboration and perseverance,” said Rotary International President Holger Knaack.

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Pakistan: IMB says if drastic measures not adopted then polio could be worse in six months | The News International.

[August 31, 2020]

The Independent Monitoring Board  (IMB) in its latest assessment of the global polio eradication programme warned that if Pakistan does not adopt transformative measures to eradicate poliovirus from the country in the next six months, the situation could become dire.

The 18th report of the IMB, which comprises global experts, is hopeful that Pakistan still has a chance to root out the crippling disease. “There is a new impetus for change and for rapid progress to be made,” it highlights.

“If that does not happen in the next six months, if those changes do not get rolling, the wheels will come off the Pakistan bus.”

Citing modelling data, the report notes that Pakistan is at the risk of wild poliovirus cases reaching 500 by the end of 2020 and vaccine-derived poliovirus cases reaching 1,000.

“Unless renewed, well-planned and sustained polio vaccination is resumed for the remainder of 2020, the consequences of the inevitable large outbreaks of both kinds of poliovirus will be dire for Pakistan, Afghanistan and probably other countries as well,” it adds.

The situation is “extremely worrying” as the outbreak of the poliovirus spreads to previously polio-free areas in the country.

Before the release of the independent assessment report, the IMB team was briefed by Dr Zafar Mirza, the former special assistant to the prime minister for Health.

He was accompanied by the National Emergency Operations Centre Coordinator and a representative of the Pakistan Army.

The report notes that Dr Mirza left his post “unexpectedly” while the report was being compiled. “There was no inkling of it when he attended the IMB meeting.”

At the moment, there is no focal person to the prime minister for polio eradication, after the departure of Babar bin Atta in October.

“The current duality of Minister and Head of the National Emergency Operations Centre has replaced the previous, three-person team that included a Prime Minister’s Focal Person for Polio Eradication,” the report observes, “The IMB expressed its concern to the then Minister [Dr Zafar Mirza] that his heavy personal workload…inevitably meant that his time for polio would be under severe pressure.”

Another setback to the program, notes the report comes from the absence of political unity.

At the November 2019 meeting, Dr Mirza had announced that he would bring all political parties and interests together for regular meetings at the national level.

However, later the doctor told the Board that no formal meeting of this kind had yet taken place by explaining that there had been a change in his approach to engaging with the political leadership. Instead of having big meetings, he was working with them at a more personal level ‘behind the scenes’, the report states. “This sends a confusing message about the government’s ability and determination to create an unambiguous and non-partisan commitment to everything necessary for success in polio eradication.”

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