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November 26, 1999 / Vol. 48 / No. 46 - page 6 / 20

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1058 Poliomyelitis Eradication — Continued

MMWR

November 26, 1999

Supplementary Vaccination Activities

D u r i n g 1 9 9 8 a n d 1 9 9 9 , N a t i o n a l I m m u n i z a t i o n D a y s ( N I D s ) w e r e c o n d u c t e d i n 19 countries. In 1998, Somalia and Sudan conducted the first countrywide campaigns that covered the war-affected southern parts of each country (1 ). Kuwait did not con- duct NIDs in 1998 but will conduct one round in November 1999. Iran and Tunisia c o n d u c t e d t a r g e t e d S u b n a t i o n a l I m m u n i z a t i o n D a y s ( S N I D s ) § i n p r o v i n c e s a t r i s k f o poliovirus importation and/or with suboptimal vaccination coverage. NIDs have not been necessary in Cyprus because routine coverage is high. Poliovirus circulation has persisted or is suspected in seven EMR countries (Afghanistan, Egypt, Iraq, Pakistan, Somalia, Sudan, and Yemen) because of low routine OPV3 coverage and/or pockets of unvaccinated children not reached during NIDs. Accelerated vaccination activities, which include improving the quality of all campaigns, adding rounds of NIDs or SNIDs, and intensifying house-to-house vaccination in high-risk areas, have been initi- ated in these countries (Figure 1). For example, in early 1999, >11 million children were vaccinated during two rounds of a house-to-house vaccination campaign in three provinces of Pakistan, and Afghanistan and Iraq are conducting two pairs of NIDs in 1999. r

Within EMR, campaigns are coordinated among groups of contiguous countries, including Afghanistan, Iran, and Pakistan; Iran, Iraq, and Syria (and Turkey) (2 ); be- t w e e n m e m b e r s t a t e s o f t h e G u l f C o o p e r a t i o n C o u n c i l ; a n d b e t w e e n M a g h r e b i a n U n ion countries, including Libya, Morocco, and Tunisia. NIDs in several countries have been coordinated with countries in the European region (“Operation MECACAR”) and the African region in the Horn of Africa. NIDs in Pakistan have been synchronized with campaigns in southern Asia (3,4 ). -

Surveillance

By mid-1998, all member countries (except Djibouti) had established acute flaccid paralysis (AFP) surveillance. Fifteen countries (Bahrain, Cyprus, Egypt, Iran, Iraq, Jor- dan, Kuwait, Lebanon, Libya, Oman, Palestine, Qatar, Saudi Arabia, Syria, and Tunisia) had achieved or exceeded the WHO-established minimum AFP reporting rate indica- tive of a sensitive surveillance system (one or more nonpolio AFP case per 100,000 children aged <15 years) during 1998 (Table 1). Among the eight remaining countries, the annualized nonpolio AFP reporting rates during 1999 have exceeded one case per 100,000 in Afghanistan, Pakistan, United Arab Emirates, and Yemen. The regional average reporting rates for nonpolio AFP in 1998 and 1999 were 0.88 and 1.21, respectively. During 1998 and 1999, two adequate** stool samples were col- lected from 64% and 68%, respectively, of the persons with reported AFP in EMR. Dur- ing 1998 and 1999, seven countries (Cyprus, Kuwait, Oman, Palestine, Saudi Arabia,

Mass campaigns over a short period (days to weeks) in which two doses of OPV are administered to all children in the target age group (usually aged <5 years) regardless of previous vaccination history, with an interval of 4–6 weeks between doses. §Focal mass campaigns in high-risk areas over a short period (days to weeks) in which two doses of OPV are administered to all children in the target age group, regardless of previous vaccination history, with an interval of 4–6 weeks between doses. Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates. **Two stool specimens collected at least 24 hours apart within 14 days of onset of paralysis.

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