A new poliomyelitis outbreak, spreading from Nigeria to neighbouring countries and putting 15 million children at risk, required a massive immunization campaign across five countries in west and central Africa. Beginning 22 October, hundreds of thousands of volunteers and health workers in Benin, Burkina Faso, Ghana, Niger, and Togo aimed to reach every child in those countries with polio vaccine in just 3 days.

The campaign was organized, at a cost of more than US$10 million, in response to a number of children being paralyzed in Burkina Faso, Ghana, Niger, and Togo by poliovirus genetically traced to northern Nigeria. A further case recently reported in Chad has led to similar campaigns being planned in that country and in Cameroon for mid-November. The polio-infected states in Nigeria, centred around Kano state, have reinfected other areas of the country, most worryingly the city of Lagos with its 10 million inhabitants.

Senior epidemiologists from the Global Polio Eradication Initiative convened a high-level meeting with the Nigerian Minister of Health at the end of September, at which the Minister provided his commitment to eradicating polio in Nigeria by the end of 2004. To achieve this goal, strong political support must be established or strengthened at the sub-national level. Political and community leaders must be engaged to facilitate the logistics of immunization campaigns and ensure that all children are reached.

Nigeria now has the highest number of polio cases in the world, and the disease continues to spread, both to areas of the country that were polio-free and to neighbouring countries. This situation poses a grave public health threat, and jeopardizes the goal of a polio-free world; it has become the last major challenge on the road to global polio eradication.

The tremendous progress made in 2002 resulted in the focus of polio eradication tactics and resources being shifted in 2003 to the few countries that remain endemic. Now, the situation in Nigeria is forcing eradication efforts back to countries that had already eliminated polio. The massive immunization campaign is thus critical, to prevent these isolated viruses from again paralyzing children in areas that had previously been polio-free.

Epidemiologists attribute the marked increase in cases in Nigeria, around the state of Kano, to insufficient coverage by both polio immunization campaigns and routine services. Monitoring data have highlighted at least one state in which as few as 16% of children have been adequately immunized. A difficult environment has severely compromised the quality of immunization campaigns and helped to propagate rumours about the safety of the oral polio vaccine.

Despite the apparent setback, however, epidemiologists remain convinced that polio can be eradicated from Nigeria. Much of the country, including Lagos, was polio-free for more than 2 years. The challenge now is to improve the quality of polio campaigns in the key endemic areas of Nigeria and to reach all children during immunization activities.

Since 1985, Rotary International has made ending polio its main philanthropic goal and has committed more than US$500 million to the effort. Rotary International has stressed the need for the international community to provide the necessary additional funds as quickly as possible - for the sake of all children across western Africa.

Further resources are required for this unforeseen campaign, but the Nigeria outbreak is only one of the threats to the goal of a polio-free world - globally the Initiative faces a funding gap of US$210 million for activities planned through 2005.

The Global Polio Eradication Initiative is spearheaded by WHO, Rotary International, the US Centers for Disease Control and Prevention, and UNICEF. The poliovirus is now circulating in only seven countries - Afghanistan, Egypt, India, Niger, Nigeria, Pakistan, and Somalia - compared with 125 when the Initiative was launched in 1988. Additionally, polioviruses from endemic countries have been imported into Burkina Faso, Ghana, Lebanon, Niger, and Togo in 2003.

The polio eradication coalition includes governments of countries affected by polio; private foundations; development banks; donor governments; the European Commission; humanitarian and non-governmental organizations; and corporate partners. Volunteers in developing countries also play a key role; 20 million have participated in mass immunization campaigns.

Source:    WHO Weekly Epidemiological Report, Vol 78, No 44, 2003.

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