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Viewing cable 07ABUJA2237, OUTBREAK OF VACCINE DERIVED POLIOVIRUS IN NIGERIA

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Reference ID Created Released Classification Origin
07ABUJA2237 2007-10-22 10:08 2011-08-25 00:00 UNCLASSIFIED Embassy Abuja
VZCZCXRO5635
PP RUEHHM RUEHLN RUEHMA RUEHPA RUEHPB RUEHPOD
DE RUEHUJA #2237/01 2951008
ZNR UUUUU ZZH
P 221008Z OCT 07
FM AMEMBASSY ABUJA
TO RUEHC/SECSTATE WASHDC PRIORITY 1249
INFO RUEHOS/AMCONSUL LAGOS 8119
RUEHZK/ECOWAS COLLECTIVE
RUEHPH/CDC ATLANTA GA
RUEAUSA/DEPT OF HHS WASHDC
RUEHZN/ENVIRONMENT SCIENCE AND TECHNOLOGY COLLECTIVE
UNCLAS SECTION 01 OF 02 ABUJA 002237 
 
SIPDIS 
 
SIPDIS 
 
CDC ALSO FOR DIRECTORS EMERGENCY OPERATION CENTER 
 
E.O. 12958: N/A 
TAGS: TBIO EAID DEOC SOCI PGOV NI
 
SUBJECT: OUTBREAK OF VACCINE DERIVED POLIOVIRUS IN NIGERIA 
 
 
1. Summary.  An outbreak of at least 69 circulating Vaccine Derived 
Polio Virus (cVDPV) cases have been reported between 2006-7 mostly 
in Nigeria's northern states of Kano, Kaduna, Katsina, Bauchi, and 
Jigawa due to low immunization of children under five years. 
Internationally, cVDPVs has been known to appear in areas with low 
polio vaccination coverage.  Immunization activities have 
subsequently been increased in these states which have limited the 
number of cVDPVs cases and their spread.  Wild Polio Virus (WPV) 
remains a greater threat to children in Nigeria than cVDPVs. 
Achieving high polio immunization coverage is the only way to 
prevent further cVDPV outbreaks.  End Summary. 
 
Nigeria's Outbreak 
------------------ 
 
2. cVDPV is a rare, mutated, but weakened form of poliovirus that is 
transmitted from immunized to un-immunized or poorly immunized 
children that causes paralysis.  This transmission occurs when 
un-immunized or under-immunized children come in contact with the 
faeces excreted from vaccinated children or a faecally contaminated 
source which contains the mutated form of poliovirus.  These cases 
are generally found in environments with poor hygiene, sanitation 
and low immunization coverage. 
 
3. In 2006, the Global Polio Laboratory Network (CDC/Atlanta) 
alerted the WHO and the Nigerian National Program on Immunization 
about the circulation of VDPV in several states in Northern Nigeria. 
 As of August 17, 2007 there are an estimated 69 cases of cVDPVs. 
The cVDPVs detected in Nigeria are of the Type 2 polio virus.  Most 
of the cases have been reported from the northern states of Kano, 
Kaduna, Katsina, Bauchi, and Jigawa - states that have also reported 
significant numbers of wild poliovirus cases. 
 
4. The same areas that are affected by Wild Polio Virus (WPV) 
transmission are also affected by cVDPVs. This is due to the low 
polio immunization status of children under five years.  Although 
more and more children are being reached with polio immunization, up 
to 30% of children under five years are still not immunized in some 
areas, leading to low population immunity against polio. The factors 
that contribute to this very low population immunity are: (a) low 
routine immunization coverage, (b) sub-optimal quality of 
Immunization Plus Days (IPDs or "polio rounds") with significant 
numbers of children missed and remaining unvaccinated after the 
rounds, and (c) the limited use of trivalent Oral Polio Vaccine 
(tOPV), which prevents the occurrence of all three types of polio 
virus (Types 1, 2 and 3).  Monovalent OPV1 and monovalent OPV3 are 
being used due to their effectiveness against Type 1 and Type 3 
poliovirus, which are the viruses seen in Nigeria. 
 
5. From January 2006 to July 2007 an estimated 230 million doses of 
OPV have been administered to children under five years in Nigeria. 
The total number of reported WPV cases for that same period is 
1,325. However, the number of cVDPV cases reported as of August 17, 
2007 is 69.  This clearly demonstrates that WPV remains both more 
prevalent and a far greater threat to children in Nigeria than 
cVDPVs.  Moreover, there is some belief that reported WPV cases may 
in fact be under-estimated. 
 
The Response 
------------ 
 
6. In response to the preliminary information on possible 
circulation of VDPVs in 2006, efforts were undertaken to improve 
population immunity in all the affected states, as well as other 
high risk states in Northern Nigeria.  In line with the Global Polio 
Eradication Initiative (GPEI) recommendation, polio campaigns using 
trivalent OPV that provides immunity against all three strains of 
wild polio virus were conducted in Nigeria (November 2006, January 
2007, March 2007 and September 2007).  Since the Nigerian cVDPV is a 
similar, but actually weaker form of the Type 2 WPV, the trivalent 
vaccine remains very effective in limiting the incidence of cVDPVs. 
These rounds of immunization have limited the number of cases of 
cVDPVs and their geographical spread and have also reduced the 
incidence of wild polio virus cases in Northern Nigeria.  However 
the use of the trivalent vaccine for this purpose has not eliminated 
the need for Nigeria to continue with focused monovalent rounds. 
 
7. Information on the Nigerian cases was made public on September 
21, 2007 in CDC's Mortality and Morbidity Review (MMWR) and in the 
WHO Weekly Epidemiological Record (WER).  Since then and with 
support from development partners, the government of Nigeria (GON) 
has initiated dialogue with religious and traditional leaders. 
Detailed plans with media strategies for reassuring state and 
district leadership, general public, and technical experts have also 
been developed. However, the public response from the GON has been 
very slow despite increasing pressure from development partners. 
 
ABUJA 00002237  002 OF 002 
 
 
 
Global situation 
---------------- 
 
8. It should be noted that cVDPV cases have been recorded in other 
countries where immunization coverage was low, such as Egypt, 
Indonesia, Cambodia, China, and Myanmar. These situations were 
brought under control by increasing immunization coverage with the 
use of trivalent OPV.  Less than 200 cVDPV cases have been reported 
over the past 10 years, while over 10 billion doses of polio vaccine 
have been administered to more than 2 billion children.  During the 
same period, more than 33,000 children were paralyzed by wild 
poliovirus, while more than 6.5 million polio cases were prevented 
by the polio vaccine. 
 
9. Comment. Wild polio virus remains a greater threat to children in 
Nigeria than circulating vaccine derived polio virus.  Achieving 
high immunization coverage is the only way to prevent further cVDPV 
outbreaks.  The GON needs to act quickly on this issue to sustain 
the gains made in polio eradication and to prevent a potential 
backlash.  Post has also recommended to key Ministry of Health 
counterparts the need for clear and consistent public education to 
allay fears, increase understanding and acceptance of GON 
immunization strategies, and to significantly improve immunization 
coverage.  End Comment. 
 
PIASCIK