Africa is the home of many new, and old, bacteria, virus and fungus, that have been major threats to humanity in the past. This threat has worsened with the advent of airflight travel. Indeed, the U.S. has had at least two close calls with Ebolavirus.

Diseases that have been considered eradicated will, predictably, often turn up again in Africa. With unstable social situations, such as brought on by war, disease can spread literally like wildfire.

The latest is the outbreak of poliomyelitis. Right now it is in Chad and Yemen, as well as Sudan, Saudi Arabia and Indonesia, but since there is an active war in Yemen, in which the U.S. is now secretly participating, with thousands of Yemen civilians fleeing their country--we are looking at a big threat of polio becoming, again, a living terrorist in our lives.

This calls for an improved quality of polio vaccine for vaccination of children. So far, in 2010 and 2011, the response to this international threat has been inadequate, and WHO designates it as "high risk" for spread internationally.

Just a reminder that war can spread very bad diseases (polio not being one of the worst) that can be transported back to us by the military contractors, soldiers, etc. who are active in the war.

---------------

Poliomyelitis in Chad
---------------------
Chad is experiencing outbreaks of both wild poliovirus type 1 (WPV1 -
65 cases in 2011) and wild poliovirus type 3 (WPV3 - 3 cases).

The WPV3 outbreak has been ongoing since November 2007, and Chad is
therefore considered to have re-established WPV3 transmission. A WPV1
outbreak began in September 2010 (as a result of a newly-imported
virus from northern Nigeria), and has since been intensifying.
Originally restricted to the greater N'Djamena area, WPV1 has spread
in 2011 to other areas of the country, to the south (including areas
bordering Central African Republic [CAR] and Cameroon) and to the east
(including areas bordering Sudan).

Historically, Chad has been associated with further international
spread of poliovirus. Between 2004 and 2006, WPV1 spread from eastern
Chad into Sudan, and subsequently to other areas of the Horn of
Africa, Saudi Arabia, Yemen, and Indonesia, resulting in 1230 cases in
these countries and over USD 500 million in international emergency
outbreak response costs. Additionally, in 2008 and 2009, WPV3 from
southern Chad spread into Cameroon and CAR.

The 2 outbreaks in Chad require urgent action to improve the quality
of vaccination activities in order to reach a higher proportion of
children with oral polio vaccine (OPV) across the entire country, and
particularly in the greater N'Djamena area, in the south and in the
east of the country. Due to gaps in the quality of acute flaccid
paralysis (AFP) surveillance at subnational levels, additional
undetected WPV circulation cannot be ruled out.

To urgently address the situation, the Government of Chad with the
technical support of partners has just finalized a 6 month national
polio emergency plan. National immunization days (NIDs) using bivalent
OPV have been conducted in May [2011], with further supplementary
immunization activities (SIAs) planned for June [2011]. The Government
of Chad and partners are working to ensure that technical support is
allocated to priority areas; special strategies will be used to reach
high-risk populations and technical capacity to fill subnational
surveillance gaps will be scaled up. As part of efforts to increase
accountability for programme implementation, key indicators will be
regularly monitored. Under the National Polio Emergency Plan, heads of
district administrations will be charged with overseeing
implementation reviews following each SIA, and providing summaries
with clear outcomes and recommendations to provincial governors, whose
offices will oversee direct oversight of the operationalisation of the
plan. At the national level, monthly implementation reports will be
prepared by the Ministry of Health and shared with the office of the
Prime Minister.

Throughout 2010 and 2011, countries neighbouring Chad -- notably
Cameroon, CAR, and Sudan -- have all conducted multiple SIAs, to
minimise the risk of re-infection. It is important that countries
across central Africa and the Horn of Africa strengthen AFP
surveillance in order to rapidly detect any poliovirus importations
and facilitate a timely response. Countries should also continue to
boost routine immunization coverage against polio to further
strengthen population immunity and minimize the risk of any
importation.

Potential for international spread
----------------------------------
In 2010 and 2011, outbreak response has been inadequate. Given the
uncontrolled and widespread geographic transmission of both WPV
serotypes, historical spread to neighbouring countries, recent
geographic expansion of WPV1 across Chad (including close to the
borders with CAR and Sudan), the World Health Organization (WHO) rates
as high the risk of further international spread. With the Hajj
(pilgrimage to Mecca, Kingdom of Saudi Arabia) expected to begin in
early November [2011] and Ramadan in early August [2011], it is
anticipated that pilgrims are now beginning to move across west and
central Africa, further increasing the risk of polio spread. The
Kingdom of Saudi Arabia last month [May 2011] issued polio vaccination
requirements for travellers to the Hajj.

WHO recommendation
------------------
WHO recommends that all travellers from polio-infected areas be fully
vaccinated prior to travel. As per recommendations outlined in WHO's
International travel and health (ITH), travelers to and from Chad
should be fully protected by vaccination. Travelers to Chad who have
in the past received 3 or more doses of OPV should be offered another
dose of polio vaccine before departure. Any unimmunized individuals
intending to travel to Chad require a complete course of vaccine.
Travelers from Chad should have a full course of vaccination against
polio before leaving Chad, with a minimum one dose of OPV before
departure. Some polio-free countries may also require travelers from
Chad to be immunized against polio in order to obtain an entry visa.

--

[From the description of the situation in Chad, there is significant
cause for concern -- the history of prior exportations of cases in
neighboring countries combined with an acknowledged weakness in acute
flaccid paralysis (AFP) surveillance suggesting a high likelihood that
there are as yet undetected cases of polio, is a worrisome situation.
Now that Nigeria appears to be approaching interruption of
transmission, there seems to be a chance that Chad will replace
Nigeria as and exporter of cases in the region.

-----------------