H5N1

CIDRAP: News scan for April 11

Via CIDRAP, a reminder of the non-H7N9 world: NEWS SCAN: H5N1 in Nepal, grant for multi-vaccine delivery, chicken pox death, polio declaration, semi-synthetic artemisinin. Click through for all the reports and many links. Excerpt:

Nepal has confirmed nine outbreaks of H5N1 avian flu involving more than 10,000 poultry in February and March, according to a report today from the World Organization for Animal Health (OIE). The outbreaks ranged from 6 birds killed by the virus in a backyard flock of 15, to 1,800 dead birds in a commercial flock of 4,000. 

All told, 3,982 poultry died from the disease and the remaining 6,919 birds were culled to stop H5N1 spread, for a total of 10,901 poultry dead or destroyed, according to the report. The onset of the outbreaks ranged from Feb 12 to Mar 30. Affected premises are being disinfected and other control measures implemented, the report said.

Scientists urge extra security for health workers in polio endgame effort

Via The Guardian: Scientists urge extra security for health workers in polio endgame effort. Excerpt:

Health workers vaccinating children against polio in troubled parts of Pakistan and Nigeria must have extra security to prevent any murders of volunteers derailing a new effort to eradicate the disease, experts say. 

The plan, launched by the Global Polio Eradication Initiative – comprising United Nations bodies, health organisations, Rotary International and governments – is a strategy for the polio endgame, envisaging a polio-free world in 2018. 

Last year there were 223 cases of polio in the world, down 66% on the previous year. Only three countries now have endemic polio – Afghanistan, Pakistan and Nigeria – but without tight control there is a danger that the disease will cross borders and spread again. 

Scientists in 80 countries, including Nobel laureates and the heads of public health institutions, have signed a declaration of support for the plan. Eradication of the disease is "an urgent and achievable global health priority", they say. 

They call on governments and all players in global health to do their part. Polio is highly infectious and spreads quickly. Scaling back, they say, would have devastating consequences. 

But the deaths of volunteer vaccinators at the hands of militant Islamist groups in Pakistan last December and in Nigeria in February are widely seen as a setback to the eradication effort. 

The volunteers appear to have been targeted at least in part in response to the use by the CIA of fake vaccination scheme as a pretext for gathering information on the whereabouts of Osama bin Laden in Pakistan. 

The scientists in their declaration call for Pakistan, Nigeria and Afghanistan and their partners "to strengthen security measures and deepen engagement with community and religious leaders to promote demand and protect vaccination teams and volunteers". 

One of their number, Professor Zulfiqar Bhutta, founding director of the centre of excellence in women and child health at Aga Khan University, which has sites in eight countries including Pakistan, Afghanistan and the UK, said he thought talks with the insurgents would be necessary among other tactics. 

"Pragmatically what is needed is a combination of measures including intelligent provision of security to polio teams in high-risk areas, community engagement and contextually relevant approaches to campaigns and integrating polio with other critically important health areas, especial for women and children," he said. "If needed, as I think it is, [there should be] negotiations with the insurgents to make progress."

Pakistan: Another polio killing

Via The New York Times: Gunman Kills Policeman Guarding Polio Workers in Pakistan. Excerpt:

A gunman shot and killed a policeman and wounded another as they were providing security to a team of anti-polio health workers in northwestern Pakistan on Wednesday, according to government officials. 

There was no immediate claim of responsibility for the attack, but the Pakistani Taliban have repeatedly targeted health workers who are vaccinating against polio, accusing them of being spies. 

The violence has seriously hampered the immunization campaign in Pakistan, which is one of the three countries in the world where polio is endemic. 

The resistance to polio vaccination by Taliban militants stiffened after the May 2011 raid on Osama Bin Laden’s compound in northern Pakistan as revelations surfaced that the Central Intelligence Agency had used Dr. Shakil Afridi, a Pakistani doctor, to run a fake vaccination campaign to gain access into Bin Laden’s hide out. 

Since then, Taliban insurgents have increased their attacks on the vaccination work and issued religious edicts claiming that the United States uses it as a guise to run a spying network. Hard-line religious extremists also claim that the vaccinations aim to sterilize Muslims. 

The attack Wednesday took place in the afternoon in the Par Hoti neighborhood of the Mardan district in Khyber-Pakhtunkhwa Province, when the policemen, Raj Wali and Mohammad Ishfaq, were accompanying two female medical workers on the second day of a three-day anti-polio drive, said Wajid Ali, a local police official. 

The policemen were standing guard in the street as the health workers administered polio drops inside a house when an unidentified gunman, who appeared in his early 20s, walked up to them and opened fire. Mr. Wali was killed and Mr. Ishfaq was wounded, Mr. Ali said in a telephone interview. The gunman fled. 

The shooting was widely condemned and officials said that the vaccination campaign would continue despite militant threats and intimidation.

Pakistan: 400,000 children to be administered polio vaccine

Via The Express Tribune, a report datelined Gujrat: The war against polio: 400,000 children to be administered vaccine.

Around 400,000 children under the age of five will be administered the polio vaccine in a three-day campaign in the district that will begin on April 15. 

Talking to The Express Tribune, District Coordination Officer Nawazish Ali said he was hopeful that the target would be met. He said the district government would use all its resources to make the campaign a success. Earlier, while presiding over a meeting to discuss the arrangements and possible challenges, DCO Ali said that parents were being sensitised by district government workers and volunteers. 

Administrator Sameer Ahmed Syed, Executive District Officer (Heath) Dr Khalid Faiz, Executive District Officer (Education) Tahir Kashif, Executive District Officer (CD) Chaudhry Muhammad Nawaz, Aziz Bhatti Hospital Medical Superintendent Dr Tahir Naveed, District Health Officer Dr Mian Wajid, District Coordinator (EPI) Dr Tahir Abbas Gondal and Depurt Superintendent of Police Ghulam Mustafa Gillani were also present. 

DCO Ali also discussed security arrangements at vaccination camps and the police escorts to go with health workers. EDO Faiz briefed the meeting about the vaccination plan. 

He said that 396,235 children had been listed. He said 781 mobile teams would give vaccine to the children at their homes, while 31 transit and 119 fixed centres will be set up where parents could bring their children to be vaccinated. The teams and the centres would be monitored by 164 officers in charge of the areas and 33 zonal officers. 

He lauded the health workers for accepting the challenge.

Pakistan: WHO expresses concern over unpaid polio workers

Via The Express Tribune: Fighting setbacks: WHO expresses concern over unpaid polio workers. Excerpt:

Peshawar: Expressing concerns regarding the non-payment of stipends to polio teams in the city, the World Health Organization (WHO) on Thursday requested the Khyber-Pakhtunkhwa (K-P) government to expedite the remuneration disbursement process. 

The organisation’s International Mission, headed by polio expert Dr Muhammad Al Muhammadi, arrived in the city on Wednesday to discuss the situation, terming the area to be the most dangerous in terms of circulation of the virus. 

The team met high-ranking officials in a bid to streamline campaigns and remove hurdles in the way of providing each child with treatment. 

“The press conference held by the Paramedic Association against non-payment of stipends for polio workers was a cause of concern for the organisation,” said an official requesting anonymity. The official added frontline health workers should be paid on time. 

“We stand with the vaccinators and will not leave a single stone unturned to ensure that each and everyone gets paid on time,” said WHO Chief Coordinator for Polio Eradication in Pakistan Dr Elias Durry. 

Durry said a new process had been initiated under which WHO would directly pay vaccinators. He added, however, some districts in the province were not sending details of Computerised National Identity Cards (CNIC), delaying the payment process. 

“We release the amount in 48 hours after we receive the CNICs. Look at the campaign in Lakki Marwat. It was held on January 21, but we received the cards on March 29 because of the district government,” said Durry.

Pakistan: Polio virus still exists in Quetta

Via The News International: Polio virus still exists in Quetta. Excerpt:

QUETTA: Wild Polio virus type 1 (WPV1) still exists in the provincial capital as samples collected from the city's sewage system suggested persistence of the virus in the environment.

The fresh sewage samples collected by the World Health Organization (WHO) experts on Feb 20 from Sur Put area of Kharotabad, were found positive for the wild polio virus type 1.   

While talking to APP, Dr Sarfraz, WHO Immunization Officer in Balochistan said " Quetta is still under the looming threat of endemic polio virus though WHO, UNICEF and government of Balochistan were striving hard to eliminate the crippling disease by putting all resources available."   

He said that WHO in line with its commitment and responsibilities collects samples from across the country on routine basis and dispatch to the National Institute of Health (NIH), Islamabad.   

"Samples gathered on November 28 and Dec 28 from the localities including Jamia Salfia Airport Road, Takhtani Bypass and Kharotabad were negative for the polio virus, however, sample collected on Feb 20 were found positive ringing alarming bells for the dwellers", Dr Sarfraz further said.   

He said that though there is massive decline in the cases of polio in Balochistan, yet threat still persists as evident from the recent report.   

When contacted to Additional Secretary Health and provincial focal person on polio, Noor-ul-Haq Baloch said that detection of polio virus type 1, the environment samples is though a matter of concern, however, we are committed to eliminate the polio virus and our concerted efforts have brought the dreaded virus to almost its end.   

Giving overview of the polio cases and endeavors jointly made by the government, UNICEF and WHO, he said that previous year only four cases were reported, three in Quetta and one in Shirani district against the number of 58 cases detected in 2011.   

Due to the comprehensive response in line with international outbreak response guidelines, no case has been reported in the prevailing year.

Pakistan: Parents smuggling in polio vaccine

Via The Express Tribune, an IRIN report datelined Bannu: Immunisation activities: In the realm of fear, fight for polio continues.Excerpt:

Parents are going to great lengths to immunise children after militants imposed a ban on polio vaccinations in North Waziristan Agency. Government officials are withholding money and identity documents from groups affiliated with the ban, and parents are travelling long distances to get their children vaccinated, in some cases smuggling the vaccine back home. 

Abdul Hassan [fictitious name] emerged recently from a hospital in Bannu, just outside the agency, clutching his toddler son and niece. Their 100-km bus ride from Miranshah, was well worth it, he said, because he was able to get the children vaccinated. 

“The children have received polio drops and that is a relief,” he said. Militants in the area banned all polio vaccinations in June 2012, to protest the killing of civilians by drones. 

“Around 200,000 children have been missed as a result of the ban in Waziristan,” said Mazhar Nisar, health education adviser at the Prime Minister’s Polio Monitoring and Coordination Cell. 

Battling the ban 

The government is trying to get the ban reversed. “We are making efforts to bring the ban to an end, so the anti-polio campaign can resume,” said Fawad Khan, health director at the Federally Administered Tribal Areas (FATA) Secretariat in Peshawar. 

Nisar said that the Khyber-Pakhtunkhwa governor, officials at the FATA Secretariat and the political agent were “all attempting to talk to tribal elders and sort out matters so anti-polio drives could resume.” 

In December 2012, the political agent for North Waziristan put in place measures that included denying tribal people of North Waziristan passports, national identity cards and other official documentation if community leaders don’t overturn the ban. 

A small honorarium to tribal elders was also stopped and development work in some areas has been suspended. Militants had also imposed a polio vaccination ban in South Waziristan but Nisar said this had since been somewhat relaxed. 

“They told me how to give the drops, and I brought home enough for two neighbours with small children. I was really scared the militants would discover what I was doing.” 

A doctor, requesting anonymity, said, "Generally people are allowed to bring children into the hospital to receive anti-polio drops, but teams are not permitted to move in the field to deliver them.” So far, the government’s tactics in North Wazirstan have not led to a relaxation of the unofficial community ban. 

Parents act to protect their children 

“Our children are still not receiving drops,” said Amina Bibi [fictitious name], from near Miranshah. Bibi said she had seen “adults who had suffered polio” and “was scared of what could happen if the children are not protected.” 

“Some parents take their children to larger towns like Peshawar or Bannu to receive the polio drops,” said Ayesha Hasan, a journalist. 

“My son is too young to travel, so I went to Bannu and brought back some vaccines. Doctors there put it in a plastic bottle, packed ice around it and I hid it in a tin of dried milk,” Hazir Gul [fictitious name], said. “I brought home enough for two neighbours with small children,” he said.

UNICEF: 240,000 Pakistani children missed polio vaccinations in tribal regions

Via The Montreal Gazette, an Associated Press report: UNICEF official says 240,000 Pakistani children missed polio vaccinations in tribal regions. Excerpt:

A top UNICEF official says as many as 240,000 children have missed U.N.-backed vaccinations against polio because of security concerns in Pakistan's tribal regions bordering Afghanistan. 

Dr. Nima Saeed Abid, acting UNICEF chief for the polio eradication program in Pakistan, says health workers have not been able to immunize children in the North and South Waziristan regions — Taliban strongholds — since July 2012. 

Pakistan is one of the few remaining countries, along with Afghanistan and Nigeria, where polio is rampant. Up to 58 cases were reported in Pakistan in 2012, down from 198 in 2011. 

Abid said Friday that 15 health workers have been killed in the anti-polio campaign in Pakistan since July 2012.

Nigeria: Nine wild polio cases so far in 2013

Via allAfrica.com, a NAN report: Nigeria Records Nine Wild Polio Cases in Abuja, Three Other States in 2013. Excerpt:

The National Primary Health Care Development Agency, NPHCDA, has said nine cases of wild polio virus have been recorded in four states and Abuja in the last three months. 

Ado Mohammed, the Executive Secretary, told journalists in Sokoto shortly after the 2013 First Quarter meeting of Northern Traditional Leaders Committee on Primary Health Care delivery that the cases were recorded from January this year to date. 

He listed the affected states as Nasarawa, Bauchi, Borno, Yobe and Abuja. 

He said that there was, however, a remarkable reduction in the number of the cases compared to the 29 recorded during the same period in 2012. 

"Even in the hitherto sanctuaries of the cases, progress had been achieved. This is courtesy of the involvement of the traditional rulers actively in the fight against polio. 

"Efforts are on also to provide plausible solutions to some of the formidable security challenges affecting the polio campaign in some parts of Nigeria. We are engaging the traditional rulers and religious leaders as well as all the stakeholders in finding solutions to the problem," Mr. Mohammed said. 

According to him, the agency is strengthening routine immunisation while other ailments like measles and malaria will be included in its activities.

Battling militants’ ban on polio vaccines in Pakistan’s North Waziristan

Via IRIN Asia, a long, informative article: Battling militants’ ban on polio vaccines in Pakistan’s North Waziristan. Excerpt:

Parents and officials are going to great lengths to immunize children after militants imposed a ban on polio vaccinations in Pakistan’s restive North Waziristan Agency. Government officials are withholding money and identity documents from groups affiliated with the ban, and parents are travelling long distances to get their children vaccinated, in some cases smuggling the vaccine back home. 

Abdul Hassan [fictitious name] emerged recently from the district hospital in Bannu, just outside North Waziristan, clutching his toddler son and niece. Their 100km bus ride from Miranshah, the administrative centre of North Waziristan, was well worth it, he said, because he was able to get the children vaccinated. 

“The children have received polio drops, which they had not received for over a year, and that is a relief,” he told IRIN. 

Militants in the area banned all polio vaccinations in June 2012, to protest the killing of civilians by drones. 

Around “200,000 children have been missed [by polio immunization drives] as a result of the ban in North and South Waziristan”, said Mazhar Nisar, health education adviser at the Prime Minister’s Polio Monitoring and Coordination Cell in Islamabad. 

He said this “of course meant greater chances of the virus spreading and endangering more children.” 

Despite eradication efforts, polio remains endemic in Afghanistan, Pakistan and Nigeria. 

Battling the ban 

The government is trying a carrot-and-stick approach to get the ban reversed. 

“We are making what efforts we can to bring [the ban] to an end, so the anti-polio campaign can resume,” said Fawad Khan, health director at the Federally Administered Tribal Areas (FATA) Secretariat in Peshawar.  

Nisar told IRIN that the Governor of Khyber Pakhtunkhwa (KP) Province, officials at the FATA Secretariat and the political agent - a representative of the federal government - in North Waziristan were “all attempting to talk to tribal elders and sort out matters so anti-polio drives could resume.” 

In addition to the negotiations, they are also using colonial-era legislation to impose collective punishment on the areas. 

In December 2012, using powers available to him under the Frontier Crimes Regulation of 1901, the political agent for North Waziristan put in place measures that included denying tribal people of North Waziristan passports, national identity cards and other official documentation if community leaders don’t overturn the ban. 

A small honorarium to tribal elders was also stopped and development work in some areas has been suspended. 

The steps were taken after the Wazir and Dawar tribes declined to back the anti-polio programme, Political Agent Siraj Ahmed Khan said.