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November 26, 1999 / Vol. 48 / No. 46 - page 10 / 20

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1062 Poliomyelitis Eradication — Continued

MMWR

November 26, 1999

Countries with high-quality AFP surveillance that have been polio-free for several years have begun to prepare documentation for review by the Regional Commission for Certification of Polio Eradication. In late 1999, the commission will review docu- mentation from five EMR countries and from an additional 10 countries before the end of 2000.

Reported by: Regional Office for the Eastern Mediterranean Region, Alexandria, Egypt. Vaccine and Biologicals Dept, World Health Organization, Geneva, Switzerland. Respiratory and Enteric Viruses B , Div of Viral and Rickettsial Diseases, National Center for Infectious Diseases; Vaccine Preventable Disease Eradication Di , National Immunization Program, CDC.

Editorial Note: Member countries of EMR have made remarkable progress toward po- lio eradication since 1988. Most EMR countries are now polio-free in the presence of high-quality AFP surveillance, and the intensity of virus transmission is decreasing rapidly in countries where polio is endemic. Supplementary vaccination campaigns and AFP surveillance have been implemented in all EMR countries, including areas in conflict, in Afghanistan, Somalia, and Sudan (1,6 ). Progress made in those countries faced with armed conflict, political instability or economic sanctions, poor health infra- structure, and population displacement is encouraging.

EMR countries have gained sufficient experience in the most challenging circum- stances to implement effectively accelerated polio eradication activities. Accelerated activities to stop virus transmission by the end of 2000 have begun in seven countries of EMR where polio is known or suspected to be endemic. Efforts to improve the qual- ity of vaccination campaigns include advanced preparations, better local level plan- ning, extensive supervision, house-to-house vaccination, community mobilization, and heightened political commitment. Additional NIDs, SNIDs, or “mopping-up” will be conducted during the next 18–24 months in these countries. AFP surveillance is being strengthened through regular active surveillance in major health facilities, des- ignation and training of responsible staff, and strong central coordination, supervi- sion, monitoring, and evaluation.

Rapid reduction in virus transmission during summer 1999 in Egypt and parts of Pakistan where additional intensified campaigns were conducted in spring 1999 has provided strong preliminary evidence of the impact of these accelerated vaccination activities. During 1999, training of designated staff followed by implementation of regular active surveillance at lower administrative levels in selected districts and gov- ernorates of Pakistan and Yemen, have led to rapid improvements in surveillance per- formance in these countries. Undetected circulation of wild poliovirus type 3 in Egypt for >2 years highlight the importance of high quality surveillance at subnational levels. Undetected circulation of wild poliovirus type 1 in Iraq indicates the need for ensuring that all components of an AFP surveillance system, particularly stool specimen collec- tion, storage, transport, and testing in a WHO-accredited laboratory, are functioning adequately. A greater emphasis has been placed on improving surveillance perform- ance at subnational levels in these two countries.

Successfully implementing accelerated activities will require strong and more ef- f e c t i v e p o l i t i c a l c o m m i t m e n t f r o m t h e h i g h e s t l e v e l w i t h i n t h e c o u n t r i e s . F u r t h consolidation is needed among WHO, United Nations Children’s Fund, other United Nations agencies, and nongovernmental organizations (NGOs), particularly in areas of e r

  • ††

    EMR polio eradication efforts are supported by its member countries, WHO, United Nations Children’s Fund (UNICEF), Rotary International, CDC, the United Kingdom, Japan, Canada, Denmark, Norway, and Italy.

(Continued on page 1071)

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