Status of Polio Certification In the African Region

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Status of Polio Certification In the African
Region

• 11th TFI and 10th ARICC Meeting
• 2nd 3rd Dec 2003, Angola
• By Prof. Rose Leke

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Introduction

• This presentation will focus on
• Background
• Progress made so far
• Challenges
• Issues for TFI
• MNTE validation proposal
• Conclusion

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Background

• In 1995, The Global Certification Commission
  (GCC) decided that Regional Certification
  Commission (RCC) is the only level below GCC that
  has the authority to certify polio eradication
• Accordingly, Africa Regional Certification
  Commission (ARCC) was appointed and Inaugurated
  by RD in 1998.
  
• Structures established at country level include
• National Polio Expert Committee (NPEC
• National Certification Committee (NCC)
• National Task Force (NTF) for Containment

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Background Cont

• Main function of NPEC is to classify AFP cases
  with particular focus on late stool cases.
  
• NCC Independently assesses the progress made in
  polio eradication at country level through
  
• Providing annual progress reports
• When set criteria have been met, prepare complete
  country documentation claiming polio free status
  
• NTF documents appropriate containment of wild
  polioviruses and potentially infectious materials

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Progress made so far

• Documents to guide certification developed
• Guidelines for
• function of NPEC, NCC and NTF
• Annual progress reports
• Full country documentation of eradication of
  polio
  
• All the 46 countries have established NCC and
  NPEC
  
• S. Africa, Lesotho and Swaziland established an
  Inter-Country Certification Committee (ICCC)
  

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Progress Cont

• Chairpersons of NPEC and NCC of all 46 countries
  have been oriented up from 42 by end of 2002.
  
• All 46 countries have presented at least one
  annual progress report to ARCC up from only 32 by
  end of 2002.
  
• Virological classification of AFP cases used in
  all 46 countries compared to 43 in 2002

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Progress on Containment

• Containment of wild polioviruses and potentially
  infectious materials is a prerequisite for global
  certification
  
• 32 out of 46 countries have established NTF
  compared to 7 at end of 2002
  
• Botswana became first country in the region to
  implement the full set of phase one containment
  activities
  
• Validation of report from Botswana was
  satisfactory
  

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Progress Cont
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Strengthening Cert. Process

• Since inauguration ARCC has held
• 5 orientation meetings to build capacity in
  country committees
  
• 5 Annual general meetings mainly to
• Review progress on certification and make
  recommendations for improvement
  
• Plan activities for the following year
• As a result of tremendous progress made countries
  to present complete country documentation have
  been selected.

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Selection criteria for complete documentation

• No wild poliovirus in past 3 years
• Non polio AFP rate of at least 1/ 100,000
  children below 15 years
  
• All stools tested in a WHO accredited laboratory
• At least 80 of the stools collected within 14
  days of onset of paralysis
  
• Presence of a functional NCC and NPEC

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Countries selected

• Total countries selected 15
• Malawi, Rwanda, Burundi, Tanzania, Cameroon,
  Guinea, Gambia and Senegal to present in June
  2004
  
• Swaziland, Zambia, Zimbabwe, Mali, Lesotho,
  Guinea Bissau and Republic of Congo to present in
  Oct. 2004

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Challenges

• Funding gap that has led to curtailing of
  Certification especially containment activities
  in 2003
  
• Orientation of the chairpersons of NTF defered to
  2004
  
• Pilot Containment activities in 6 countries
  defered to 4th quarter 2003
  
• Recurrent changes in country committee
  membership.
  
• Enlisting full country support of the
  certification process
  
• Achievements made towards documenting
  certification against a background of continuing
  intense wild poliovirus transmission in Nigeria

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Issues for TFI

• Currently, the certification process that had
  picked up well is threatened by the persistent
  wild poliovirus transmission in West Africa.
  
• While routine immunisation is not among the
  specified criteria for certification, the current
  level of OPV3 coverage (of great concern to the ARCC

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MNTE Validation Proposal

• Strategic Advisory Group of Experts (SAGE) 2002
  recommeded that
  
•  WHO regions should ensure that existing
  independent technical bodies confirm
  countriesMNT elimination 
  
• Proposal for ARCC to take up this responsibility
  was presented at 5th annual general meeting.

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MNTE Validation Proposal

• This was shared with the GCC in Oct. 2003.
• General consesus was that TFI would be a more
  appropriate body.
  
• MNTE group advised to present the same proposal
  to TFI at this meeting.

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Conclusion

• Significant progress has been made towards
  documenting the certification of eradication of
  poliomyelitis in the region.
  
• However, the momentum built can more easily be
  sustained if transmission of wild poliovirus in
  the remaining countries is achieved by end of 2004

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Sincere appreciation to all those that have
supported certification thus far

• Thank you

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