Dec 21, 2019

Polio Outbreaks Confirmed in 14 African Countries

December 15th, 2019 – The US Centers for Disease Control and Prevention (CDC) increased the polio outbreak Travel Alert for 14 African countries.
The CDC said in a new Level 2 Travel Alert published on December 11, 2019, that ‘there are confirmed polio outbreaks in various countries primarily located in central and eastern Africa.’
Additionally, the Global Polio Eradication Initiative (GPEI) reported ‘polio-endemic countries, which have never stopped the transmission of indigenous wild poliovirus, can also be affected by outbreaks of circulating vaccine-derived poliovirus.’
This ‘Practice Enhanced Precaution’ Travel Alert is an important reminder to all travelers visiting the African countries listed below, to ensure they have previously completed the full polio vaccination series.
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The CDC and the World Health Organization (WHO) both recommend visitors to infected areas for more than 4 weeks should receive an additional dose of oral polio vaccine (OPV) or inactivated polio vaccine (IPV) within 4 weeks to 12 months of travel.
And, adults should discuss with a healthcare provider if it’s appropriate to receive a single booster dose of the polio vaccine.
The CDC and the GPEI have reported the following outbreak information for these 14 African countries:  
  • Angola - There are 71 cVDPV2 cases from seven outbreaks reported in 2019.
  • Benin - There are six cVDPV2 cases in 2019 linked to the Jigawa outbreak in Nigeria.
  • Cameroon - Affected by circulating vaccine-derived poliovirus type 2 (cVDPV2).
  • Central African Republic - There are 16 reported cases in 2019 from six different outbreaks of cVDPV2 in 2019.
  • Chad - There is one cVDPV2 case in the country linked to the Jigawa outbreak in Nigeria.
  • Democratic Republic of the Congo - There are 53 cVDPV2 cases in 2019 and 20 in 2018.
  • Ethiopia - Five cVDPV2 cases reported in Ethiopia in 2019, four of them are linked to the outbreak in neighboring Somalia and the fifth case is part of a newly reported Ethiopian outbreak this week.
  • Ghana - Nine cVDPV2 cases in 2019 linked to the Jigawa outbreak in Nigeria.
  • Mozambique - Circulation of cVDPV2 has been confirmed in Mozambique.
  • Niger - There are nine cVDPV2 cases in 2019 linked to the Jigawa outbreak in Nigeria.
  •  Nigeria - There are 18 cVDPV2 cases reported in 2019. There were 34 cVDPV2 cases in 2018.
  • Somalia - A total of 15 cVDPV cases (eight type 2, six type 3 and one co-infection of both type 2 and type 3) since the beginning of the outbreaks.  
  • Togo - There are three cVDPV2 cases in 2019 in the country linked to Jigawa outbreak in Nigeria.
  • Zambia - There is one cVDPV2 case from the first outbreak in the country.
According to the CDC, the United States has been polio-free since 1979, and the IPV has been the only polio vaccine offered in the USA since 2000. 
IPV is given by a shot in the leg or arm, at 4 different times, depending on the patient’s age. IPV vaccination has not been known to cause serious problems, but side effects are a potential risk, says the CDC.
In the USA, there are various IPV vaccines available, such as Kinrix and Pediarix.
Once vaccinated, your doctor should provide you with an International Certificate of Vaccination or Prophylaxis yellow card. This will serve as your official documentation of polio vaccination.
Polio is a crippling and potentially deadly disease that affects the nervous system. Because the virus lives in the feces of an infected person, people infected with the disease can spread it to others when they do not wash their hands well after defecating. 
People can also be infected with polio if they drink water or eat food contaminated with infected feces.
In rare cases, polio can be fatal if the muscles used for breathing are paralyzed or if there is an infection of the brain, says the CDC.
Recently, there was some good news regarding the elimination of 2 out of 3 polio types.
An independent commission of experts concluded during October 2019, that wild poliovirus type 3 (WPV3) has been ‘eradicated’ around the world. This announcement follows the earlier eradication of wild poliovirus type 2 during 2015.
Additionally, global leaders affirm their commitment to eradicate polio and pledge $2.6 billion on November 19, 2019, as part of the 1st phase of the funding needed to implement the Global Polio Eradication Initiative’s Polio Endgame Strategy 2019-2023.
Prior to traveling abroad, medication and vaccine counseling appointments can be scheduled with a travel specialist at Vax-Before-Travel.
Polio vaccine news published by Vax-Before-Travel.

Post Polio Litaff, Association A.C _APPLAC Mexico

Eradicating polio includes preparing for its possible return

If poliovirus were detected in your country, what actions would be taken to prevent its spread? Who would inform the public and coordinate a campaign to vaccinate vulnerable children? How many vaccine doses would be needed? How would they be procured and stored?
These questions and many more were part of polio outbreak simulation exercises (POSEs) conducted in the past month in Albania and Ukraine to review the countries’ national polio outbreak response plans and identify any gaps in preparedness.
Dr Oleksandr Zaika, Manager of Ukraine’s National Immunization Programme, explained: “This is an important and timely exercise. Critical review of the plan by experts from the Ministry of Health, the Public Health Centre, academia, and other institutions from national and oblast levels with facilitation by WHO/Europe is crucial in ensuring the preparedness of the country to a potential polio outbreak.”

The WHO European Region is polio free – why simulate an outbreak?

In October 2019, wild poliovirus type 3 was declared eradicated. This global milestone signified that, of the three wild strains, only poliovirus type 1 continues to spread anywhere in the world. However, the number of cases caused by this remaining wild strain in Afghanistan and Pakistan has increased sharply in the past year – from 33 in 2018 to 117 in 2019, as of 11 December.
A second concern is the increased detection of circulating vaccine-derived poliovirus (cVDPV) globally, with 216 human cases detected in 16 countries as of 11 December this year (up from 104 cases in 7 countries in 2018). This global trend underlines the urgency of ensuring that countries in all parts of the world are alert and ready to respond if needed.
The Global Polio Eradication Initiative’s standard operating procedures for responding to a poliovirus event or outbreak call for all countries to plan for the eventuality of a poliovirus importation or local detection. They also encourage countries to develop a preparedness plan and test it in a polio outbreak simulation exercise to ensure that public health personnel and emergency systems are prepared to react quickly and effectively if any poliovirus isolate is detected.

Lessons learned in Ukraine

The need for quick action to prevent the re-establishment of polio in Ukraine, and thereby the European Region as a whole, was demonstrated with the detection of 2 cases of cVDPV in Ukraine in 2015. The lessons learned in responding to that outbreak, which was stopped within 6 months with no further cases detected, were a main focus of the POSE conducted in Kyiv on 9–11 December 2019.
Many of the participants responsible for disease surveillance, immunization, outbreak response, vaccine regulation, communication or laboratory services were part of the response in 2015–2016 and could share valuable insights with their colleagues while reviewing the current preparedness plan.
Based on a proposed (fictitious) polio outbreak scenario, participants identified the plan’s strengths and gaps and tested its alignment with international standards. The outcome is a compilation of proposed revisions as well as a timeline and action points for their incorporation into the updated national document.

Actual earthquake during simulated outbreak in Albania

A desktop POSE was also conducted in Tirana, Albania, on 26–27 November 2019 to draft a national polio outbreak response plan and improve understanding of the critical actions needed to respond to a polio-related event or outbreak.
Participants included national policy-makers and senior technical staff from the Ministry of Health and Institute of Public Health. Their dedication to ensuring that the country is fully prepared for a polio outbreak was profoundly demonstrated during the 2-day event, as they continued with the exercise while simultaneously responding to a 6.4-magnitude earthquake that shook the country in the early morning of 26 November.

Post Polio Litaff, Association A.C _APPLAC Mexico

Dec 16, 2019

Nigerians living in poverty rise to nearly 61%

El petróleo se produce en el sureste y algunos grupos militantes allí quieren mantener una mayor parte de la riqueza que proviene de sus pies. Los ataques de militantes contra instalaciones petroleras provocaron una fuerte caída en la producción de Nigeria durante la última década. Pero en 2010, una amnistía del gobierno llevó a miles de combatientes a dejar sus armas.
Los nigerianos que viven en la pobreza aumentan La pobreza ha aumentado en Nigeria, con casi 100 millones de personas viviendo con menos de $ 1 (£ 0.63) por día, a pesar del crecimiento económico, según las estadísticas.

La Oficina Nacional de Estadísticas dijo que el 60.9% de los nigerianos en 2010 vivían en "pobreza absoluta"; esta cifra había aumentado del 54.7% en 2004.
La oficina predijo que esta tendencia al alza probablemente continuaría.
Nigeria es el mayor productor de petróleo de África, pero el sector ha sido contaminado por acusaciones de corrupción.

Según el informe, la pobreza absoluta se mide por el número de personas que solo pueden permitirse los elementos esenciales básicos de vivienda, comida y ropa.
División norte-sur
La NBS, una agencia gubernamental, dijo que había una paradoja en el corazón de Nigeria, ya que la economía iba cada vez más fuerte, principalmente debido a la producción de petróleo, pero los nigerianos se estaban empobreciendo.
"A pesar de que la economía nigeriana está creciendo, la proporción de nigerianos que viven en la pobreza aumenta cada año, aunque disminuyó entre 1985 y 1992, y entre 1996 y 2004", dijo el jefe de la oficina de la NBS, Yemi Kale.
La población de Nigeria en pobreza

1980: 17,1 millones
1985: 34,7 millones
1992: 39,2 millones
1996: 67,1 millones
2004: 68,7 millones
2010: 112,47 millones

Fuente: Oficina Nacional de Estadística de Nigeria.
El petróleo representa alrededor del 80% de los ingresos estatales de Nigeria, pero apenas tiene capacidad para refinar el petróleo crudo en combustible, que debe importarse.
El mes pasado, hubo una huelga nacional cuando el gobierno intentó eliminar el subsidio al combustible, enojando a muchos nigerianos que lo ven como el único beneficio que recibieron de la vasta riqueza petrolera del país.
La NBS dijo que la pobreza relativa era más evidente en el norte del país, con la tasa de pobreza del estado de Sokoto la más alta con 86.4%.
En el noroeste y el noreste del país, las tasas de pobreza se registraron en 77.7% y 76.3% respectivamente, en comparación con el suroeste en 59.1%.
El analista de la BBC África Richard Hamilton dice que tal vez no sea sorprendente que grupos extremistas, como Boko Haram, sigan teniendo un atractivo en las partes del norte del país, donde la pobreza y el subdesarrollo son más severos.
El informe también reveló que los nigerianos se consideran cada vez más pobres.
En 2010, el 93.9% de los encuestados se sintieron pobres en comparación con el 75.5% seis años antes.
Kale dice que publicar tales estadísticas de vez en cuando es crucial para una planificación gubernamental efectiva.
"Este tipo de datos les ayuda a saber lo que realmente está sucediendo para que puedan seguir sus políticas y programas", dijo al programa Focus on Africa de la BBC.
"Les da la oportunidad de ver lo que están haciendo ... y si hay áreas que necesitan cambiar, facilita la modificación de las estrategias", agregó.
Nigeria: una nación dividida

A pesar de sus vastos recursos, Nigeria se encuentra entre los países más desiguales del mundo, según la ONU. La pobreza en el norte está en marcado contraste con los estados del sur más desarrollados. Mientras se encuentran en el sureste rico en petróleo, los residentes de Delta y Akwa Ibom se quejan de que toda la riqueza que generan fluye por el oleoducto hacia Abuja y Lagos.

Los 160 millones de personas de Nigeria están divididos entre numerosos grupos etnolingüísticos y también en líneas religiosas. En general, los hausa-fulani del norte son en su mayoría musulmanes. Los yorubas del sudoeste están divididos entre musulmanes y cristianos, mientras que los igbos del sudeste y los grupos vecinos son en su mayoría cristianos o animistas. El Cinturón Medio es el hogar de cientos de grupos con diferentes creencias, y alrededor de Jos hay frecuentes enfrentamientos entre musulmanes que hablan causa y miembros cristianos de la comunidad de Berom.

La alfabetización femenina se considera la clave para elevar el nivel de vida de la próxima generación. Por ejemplo, un niño recién nacido tiene muchas más probabilidades de sobrevivir si su madre está bien educada. En Nigeria vemos un marcado contraste entre el norte principalmente musulmán y el sur cristiano y animista. En algunos estados del norte, menos del 5% de las mujeres saben leer y escribir, mientras que en algunas áreas de Igbo más del 90% saben leer y escribir.
Nigeria es el mayor productor de petróleo de África y uno de los más grandes del mundo, pero la mayoría de su población subsiste con menos de $ 2 por día. El petróleo se produce en el sureste y algunos grupos militantes allí quieren mantener una mayor parte de la riqueza que proviene de sus pies. Los ataques de militantes contra instalaciones petroleras provocaron una fuerte caída en la producción de Nigeria durante la última década. Pero en 2010, una amnistía del gobierno llevó a miles de combatientes a acostarse.

Nigeria's population in poverty

  • 1980: 17.1 million
  • 1985: 34.7 million
  • 1992: 39.2 million
  • 1996: 67.1 million
  • 2004: 68.7 million
  • 2010: 112.47 million
Source: Nigeria's National Bureau of Statistics

Post Polio Litaff, Association A.C _APPLAC Mexico

Mutant Strains Of Polio Vaccine Now Cause More Paralysis Than Wild Polio

For the first time, the number of children paralyzed by mutant strains of the polio vaccine are greater than the number of children paralyzed by polio itself.
So far in 2017, there have been only six cases of "wild" polio reported anywhere in the world. By "wild," public health officials mean the disease caused by polio virus found naturally in the environment.
By contrast, there have been 21 cases of vaccine-derived polio this year. These cases look remarkably similar to regular polio. But laboratory tests show they're caused by remnants of the oral polio vaccine that have gotten loose in the environment, mutated and regained their ability to paralyze unvaccinated children
"It's actually an interesting conundrum. The very tool you are using for [polio] eradication is causing the problem," says Raul Andino, a professor of microbiology at the University of California at San Francisco.
The oral polio vaccine used throughout most of the developing world contains a form of the virus that has been weakened in the laboratory. But it's still a live virus. (This is a different vaccine than the injectable one used in the U.S. and most developed countries. The injectable vaccine is far more expensive and does not contain live forms of the virus.)

Andino studies how viruses mutate. In a study published in March, he and his colleagues found that the laboratory-weakened virus used in the oral polio vaccine can very rapidly regain its strength if it starts spreading on its own. After a child is vaccinated with live polio virus, the virus replicates inside the child's intestine and eventually is excreted. In places with poor sanitation, fecal matter can enter the drinking water supply and the virus is able to start spreading from person to person.
"We discovered there's only a few [mutations] that have to happen and they happen rather quickly in the first month or two post-vaccination," Andino says. "As the virus starts circulating in the community, it acquires further mutations that make it basically indistinguishable from the wild-type virus. It's polio in terms of virulence and in terms of how the virus spreads."
In June, the World Health Organization reported 15 cases of children paralyzed in Syria by vaccine-derived forms of polio. These cases come on top of two other vaccine-derived polio cases earlier this year in Syria and four in the Democratic Republic of the Congo.
"In Syria, there may be more cases coming up," says Michel Zaffran, the director of polio eradication at the World Health Organization. He says lab work is still being done on about a dozen more cases of paralysis to confirm whether they're polio or something else.
The cases in Syria are all in the east of the country near the border with Iraq.
It has become fairly common each year for there to be one or two small outbreaks of vaccine-derived polio. These outbreaks tend to happen in conflict zones where health care systems have collapsed.
"These outbreaks are occurring only in very rare cases and only in places where children are not immunized," says Zaffran. The regular polio vaccine protects children from vaccine-derived strains of the virus just as it protects them from regular polio. Vaccine-derived outbreaks, he says, "occur where there are large pockets of unimmunized children, pockets sufficiently large to allow for the circulation of the virus."
WHO is staging a massive response to the Syrian outbreak. WHO plans to work with local health officials and aid groups to vaccinate a quarter of a million children in early July. The goal is to reach every child younger than 5 in the area with two doses of two different types of polio vaccine, spaced one to two weeks apart. This would be a logistical challenge in most parts of the world, never mind in war-torn Syria.
"The access in these areas is a bit limited because of the presence of ISIS," Zaffran says in what seems like an understatement. Eastern Syria is home right now to Syrians who've fled from Raqqa (the ISIS capital in Syria), other parts of the country and even Iraq. "Also there's a risk that the fighting might actually move to this area."
Zaffran is confident that the rogue vaccine-derived virus circulating in eastern Syria right now can be wiped out with a massive blast of more vaccine.
"We knew that we were going to have such outbreaks. We've had them in the past. We continue to have them now. We know how to find them, and we know how to interrupt them. We have the tools to do that," Zaffran says. "So it's hiccup ... a very regrettable hiccup for the poor children that have been paralyzed, of course. But with regards to the whole initiative, you know it's not something that is unexpected."
WHO is attempting to phase out the use of live oral polio vaccine to eliminate the risk that the active virus in the vaccine could mutate into a form that can harm unvaccinated children.
But for now, the live vaccine continues to be the workhorse of the global polio eradication campaign for a couple of reasons. First it's cheap, costing only about 10 cents a dose versus $3 a dose for the injectable, killed vaccine. Second, it can be given as drops into a child's mouth, which makes it far easier to administer than the inactivated or "killed" vaccine, which has to be injected. Third, there simply isn't enough killed vaccine on the market to vaccinate every child on the planet, and vaccine manufacturers don't have the capacity to produce the quantities that would be needed if such a switch happened immediately.
And finally, the live vaccine stops transmission of the polio virus entirely in a community if sufficient numbers of people are vaccinated. The killed vaccine doesn't fully block the virus from spreading because a person who is immunized can still carry and spread the polio virus. And this is an important difference between these two types of vaccines when the goal is to exterminate the polio virus.
"The fact is this [the live oral polio vaccine] is the only tool that we have that can eradicate the disease," says Zaffran.
That eradication effort has been incredibly successful. In 1988, when the campaign began, there were 350,000 cases of polio around the world each year compared with the six so far this year.
Zaffran credits the oral polio vaccine with getting the world incredibly close to wiping out a terrible disease.
"Four regions of the world have totally eradicated the disease with the use of the oral polio vaccine," he notes. "Of course we need to recognize that there have been a few cases of children paralyzed because of the vaccine virus, which is regrettable. But, you know, from a public health perspective, the benefits far outweigh the risk."

Post Polio Litaff, Association A.C _APPLAC Mexico

Dec 9, 2019

Health Ministry denies #polio cases caused by vaccination

In view of news published in the social media, which state that the oral polio antidote being administered has been causing children to acquire the polio disease instead of immunising them, the Health Ministry has responded categorically that these allegations do not correspond to the truth.
“After the finding of new cases of poliomyelitis in May this year vaccination campaigns were held to block its progression (...)”, reads the note issued by the Health Ministry.
The note states also that so far 49 cases were recorded and 4.5 million children bellow the age of five were immunised and in no area covered by the vaccination campaign has been recorded new polio cases.  
This shows that the vaccination programme has actually been avoiding the propagation of the illness, reads the document.
The Health Ministry calls on the citizens to continue to join the vaccination campaign against poliomyelitis, stressing that this is the most effective way to protect children against this illness.
The present vaccination campaign takes place after eighteen new polio cases were recorded four months ago, with major incidence in the eastern provinces of Lunda Norte, Lunda Sul and Moxico.
Luanda Province recorded one case.
Poliomyelitis is an infectious disease caused by a virus that attacks the nervous system and can provoke paralysis of the limbs.

Post Polio Litaff, Association A.C _APPLAC Mexico

Even one polio case is an outbreak

KUALA LUMPUR (Bernama): The three-month-old infant from Tuaran, Sabah who contracted polio was under-immunised with polio vaccine and was thus not protected, says consultant paediatrician and clinical immunologist Datuk Dr Musa Mohd Nordin.

According to the Malaysian National Immunisation Schedule, infants are to receive the inactivated polio vaccine (IPV) at ages two months, three months and five months. A booster shot also needs to be administered when the child is 18-months-old in order to be fully protected.

However, the infected infant had only received the first dose of polio immunisation, making him under immunised, said Dr Musa.

A statement by the Health Ministry on Sunday (Dec 8) revealed that the baby was admitted to the intensive care unit of a hospital there before being diagnosed with vaccine-derived poliovirus type 1 (VDPV1) on Friday (Dec 6).

"I suspect he acquired the VDPV1 from the environment via contaminated water or food or because of poor sanitation. (The virus was) most probably imported from the Philippines since the genetic lineage of the VDPV1 was similar to the one found during the outbreak in that country,” he told Bernama in an email interview.

This is the first polio case in the country in 27 years.
Health Minister Datuk Seri Dr Dzulkefly Ahmad on Monday said that the infant was already ill when he received the second dosage of the polio vaccine, which was supposed to have an immunisation rate of between 60 to 80 per cent.

"The first dosage has about 30 to 40 per cent immunity against the virus,” he said.


Vaccine-derived polio is related to the use of the oral polio vaccine (OPV). According to WHO, OPV contains a weakened vaccine-virus that activates an immune response in the body. When a child is immunised with OPV, the weakened vaccine-virus replicates in the intestine for a limited period, thereby developing immunity by building up antibodies. During this time, the vaccine-virus is also excreted.

The WHO website explains: "In areas of inadequate sanitation, this excreted vaccine-virus can spread in the immediate community before eventually dying out. However, if a population is seriously under-immunised, an excreted vaccine-virus can continue to circulate for an extended period of time. The longer it is allowed to survive, the more genetic changes it undergoes. In very rare instances, the vaccine-virus can genetically change into a form that can paralyse - this is what is known as a circulating vaccine-derived poliovirus (cVDPV).”

The IPV, on the other hand, does not contain live virus, so people who receive this vaccine do not shed the virus or infect others. The vaccine also cannot cause disease.

Given the risks associated with the administration of OPV, why do some countries still use it?

"OPV is cheap, easy to administer and excellent at both protecting the individual and the community,” said Dr Musa.

He said that since 1988, the administration of OPV has helped to decrease the burden of polio by 99.9 per cent - from 350,000 cases to less than 120 wild polio cases in 2019.

"The downside is that it is excreted in the stool and survives for six weeks in the environment. This live-attenuated (weakened) vaccine poliovirus may mutate and regain its neuro-virulence and infect the unimmunised child.

"Since 2000, 10 billion doses of OPV have been used worldwide, preventing 13 million polio cases. Only less than 750 cases of VDPV have been reported,” he revealed.

Malaysia has also been administering the OPV up until 2008 when it started using the IPV.

"Part of the endgame strategy of polio eradication is to shift from OPV to IPV to reduce the risk of VDPV and vaccine-associated paralytic poliomyelitis to zero,” said Dr Musa.


Dr Musa said that at least 95 per cent of the community need to be immunised against polio in order to be protected from the crippling disease.

"The IPV as part of the five-in-one combination (shots) provided by the Health Ministry is an excellent vaccine. Apart from polio, it also protects from diphtheria, pertussis, tetanus and haemophilus influenza B,” he said.

Although the uptake of the third dose of the polio vaccine in Malaysia is in excess of 95 per cent, said Dr Musa, there are still pockets of communities where the coverage is low due to either refusal of the vaccine or the failure to access these groups, which include migrants or the stateless.

Health director-general Datuk Dr Noor Hisham Abdullah on Sunday said that as of Dec 5, investigations into polio-infected children living in Sabah had found that 23 out of 199 children (11.6 per cent), aged between two months and 15 years, had not received the polio vaccine.

He said that environmental monitoring in high-risk areas such as settlements of foreign nationals from countries with polio should be expanded while ensuring that polio immunisation coverage exceeds 95 per cent in all localities in Malaysia at all times.

For the state of Sabah, which is closest to the Philippines, high immunisation coverage is essential to protect children from polio infection, said Dr Noor Hisham.

In July, the Philippines' Ambassador to Malaysia Charles C. Jose told a local English daily that there were between 400,000 and 500,000 illegal Filipino workers in Sabah.

Meanwhile, Dr Musa said that just a single case of polio was indicative of the severity of the situation.

"Even one case of polio equals an epidemic. A comprehensive outbreak response must be undertaken to immunise and protect the community to prevent the spread.

"There is no cure for polio but there is an effective and safe vaccine to prevent it.”- Bernama

Post Polio Litaff, Association A.C _APPLAC Mexico

Circulating vaccine-derived poliovirus type 1 – The Philippines

Disease outbreak news: Update 
23 October 2019
On 27 September 2019 , a circulating vaccine-derived poliovirus type 1 (cVDPV1) has been confirmed in environmental samples in Philippines. 
The virus has been isolated from ten environmental samples, all genetically related, which were collected from one sewage collection site and its tributary pumping stations in Manila, between 1 July and 23 September 2019. This sewage collection site in the city of Manila has a catchment area of over 600,000 people. 
Vaccine-derived polioviruses are rarely occurring forms of the poliovirus that have genetically changed from the attenuated (weakened) virus contained in oral polio vaccine. They only occur when the vaccine virus is allowed to pass from person to person for a long time, which can only happen in places with limited immunization coverage and inadequate sanitation and hygiene. Over time, as it is passed between more unimmunized people, it can regain the ability to cause disease. When the population is fully immunized with both oral polio vaccine and inactivated polio vaccine, this kind of transmission cannot take place. The gut immunity in people immunized with oral polio vaccine stops the virus from being passed on. Full immunization therefore protects against both vaccine-derived and wild polio viruses. 
Philippines reported it’s last indigenous wild poliovirus in 1993 and the country is currently having an ongoing circulating vaccine derived poliovirus type 2 (cVDPV2) outbreak since September 2019. There has been persistently suboptimal immunization coverage for oral polio vaccine (OPV) and inactivated polio vaccine (IPV) in the country: 66% and 41% respectively in 2018.

Public health response

The Department of Health is coordinating the response activities, with the support of partners including the Global Polio Eradication Initiative (GPEI) and WHO. Public health response measures include:
  • Outbreak response with bivalent OPV in the National Capital Region, strengthened routine immunization activities including inactivated polio vaccine (IPV) and strengthening of acute flaccid paralysis (AFP) and environmental surveillance.
  • Polio outbreak investigation to determine the number and characteristics of cases and the context for environmental isolates, along with determining the geographic extent and assessing the risk of further transmission.
  • Ongoing retrospective records review in health facilities to identify AFP cases for investigation.

WHO risk assessment

Given the subnational surveillance and immunity gaps and high levels of population movement within the country, the risk of national spread associated with this confirmed cVDPV1 is considered to be high. 
The country is currently being affected by an ongoing cVDPV2 outbreak (Please see the Disease outbreak news published on 24 September 2019).

WHO advice

Countries, territories and areas should maintain uniformly high routine immunization coverage at the district level to minimize the consequences of any possible polio virus introduction or transmission. It is important that all countries, in particular those with frequent travel links and contacts with polio-affected countries and areas, strengthen surveillance for AFP cases in order to rapidly detect any new virus importation and to facilitate a rapid response. 
WHO’s International Travel and Health recommends that all travellers and residents in polio-affected areas be fully vaccinated against polio. Residents (and visitors for more than 4 weeks) from infected areas should receive an additional dose of oral polio vaccine (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 travellers.
Post Polio Litaff, Association A.C _APPLAC Mexico

Nigerians living in poverty rise to nearly 61%

Nigeria is Africa's biggest oil producer and among the biggest in the world but most of its people subsist on less than $2 a day.

 The oil is produced in the south-east and some militant groups there want to keep a greater share of the wealth which comes from under their feet. Attacks by militants on oil installations led to a sharp fall in Nigeria's output during the last decade. But in 2010, a government amnesty led thousands of fighters to lay down their weapons.
Nigerians living in poverty  rise Poverty has risen in Nigeria, with almost 100 million people living on less than a $1 (£0.63) a day, despite economic growth, statistics have shown.
The National Bureau of Statistics said 60.9% of Nigerians in 2010 were living in "absolute poverty" - this figure had risen from 54.7% in 2004.
The bureau predicted this rising trend was likely to continue.
Nigeria is Africa's biggest oil producer but the sector has been tainted by accusations of corruption.
According to the report, absolute poverty is measured by the number of people who can afford only the bare essentials of shelter, food and clothing.
North-south divide

The NBS, a government agency, said there was a paradox at the heart of Nigeria as the economy was going from strength to strength, mainly because of oil production - yet Nigerians were getting poorer.
"Despite the fact that the Nigerian economy is growing, the proportion of Nigerians living in poverty is increasing every year, although it declined between 1985 and 1992, and between 1996 and 2004," head of the NBS bureau Yemi Kale said.
Nigeria's population in poverty

1980: 17.1 million
1985: 34.7 million
1992: 39.2 million
1996: 67.1 million
2004: 68.7 million
2010: 112.47 million

Source: Nigeria's National Bureau of Statistics
Oil accounts for some 80% of Nigeria's state revenues but it has hardly any capacity to refine crude oil into fuel, which has to be imported.
Last month, there was a nationwide strike when the government tried to remove the subsidy on fuel, angering many Nigerians who see it as the only benefit they received from the country's vast oil wealth.
The NBS said that relative poverty was most apparent in the north of the country, with Sokoto state's poverty rate the highest at 86.4%.
In the north-west and north-east of the country poverty rates were recorded at 77.7% and 76.3% respectively, compared to the south-west at 59.1%.
BBC Africa analyst Richard Hamilton says it is perhaps no surprise that extremist groups, such as Boko Haram, continue to have an appeal in northern parts of the country, where poverty and underdevelopment are at their most severe.
The report also revealed that Nigerians consider themselves to be getting poorer.
In 2010, 93.9% of respondents felt themselves to be poor compared to 75.5% six years earlier.
Mr Kale says releasing such statistics from time to time is crucial for effective government planning.
"This kind of data helps them to know what is really happening so they can track their policies and programmes," he told the BBC's Focus on Africa programme.
"It gives them the opportunity to look at what they are doing... and if there are areas they need to change, it makes it easier to modify strategies," he added.
Nigeria: A nation divided

Despite its vast resources, Nigeria ranks among the most unequal countries in the world, according to the UN. The poverty in the north is in stark contrast to the more developed southern states. While in the oil-rich south-east, the residents of Delta and Akwa Ibom complain that all the wealth they generate flows up the pipeline to Abuja and Lagos.

Nigeria's 160 million people are divided between numerous ethno-linguistic groups and also along religious lines. Broadly, the Hausa-Fulani people based in the north are mostly Muslims. The Yorubas of the south-west are divided between Muslims and Christians, while the Igbos of the south-east and neighbouring groups are mostly Christian or animist. The Middle Belt is home to hundreds of groups with different beliefs, and around Jos there are frequent clashes between Hausa-speaking Muslims and Christian members of the Berom community.

Female literacy is seen as the key to raising living standards for the next generation. For example, a newborn child is far likelier to survive if its mother is well-educated. In Nigeria we see a stark contrast between the mainly Muslim north and the Christian and animist south. In some northern states less than 5% of women can read and write, whereas in some Igbo areas more than 90% are literate.

Nigeria is Africa's biggest oil producer and among the biggest in the world but most of its people subsist on less than $2 a day. The oil is produced in the south-east and some militant groups there want to keep a greater share of the wealth which comes from under their feet. Attacks by militants on oil installations led to a sharp fall in Nigeria's output during the last decade. But in 2010, a government amnesty led thousands of fighters to lay down.

Nigeria's population in poverty

  • 1980: 17.1 million
  • 1985: 34.7 million
  • 1992: 39.2 million
  • 1996: 67.1 million
  • 2004: 68.7 million
  • 2010: 112.47 million
Source: Nigeria's National Bureau of Statistics

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