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Viewing cable 09KHARTOUM423, POLIO CRISIS IN EAST AFRICA

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Reference ID Created Released Classification Origin
09KHARTOUM423 2009-03-25 16:02 2011-08-24 16:30 UNCLASSIFIED Embassy Khartoum
VZCZCXRO9658
OO RUEHROV
DE RUEHKH #0423/01 0841602
ZNR UUUUU ZZH
O 251602Z MAR 09
FM AMEMBASSY KHARTOUM
TO RUEHC/SECSTATE WASHDC IMMEDIATE 3366
INFO RUCNIAD/IGAD COLLECTIVE
RHMFISS/CJTF HOA
UNCLAS SECTION 01 OF 02 KHARTOUM 000423 
 
DEPT FOR AF A A/S CARTER, AF/SPG, AF/E, OES 
DEPT PLS PASS USAID FOR AFR/SUDAN 
ADDIS ABABA ALSO FOR USAU 
 
AIDAC 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: EAID SOCI TBIO PGOV PREL ASEC SU
SUBJECT: POLIO CRISIS IN EAST AFRICA 
 
1. Summary:  For the past nine months, Southern Sudan has 
experienced a large poliomyelitis (polio) outbreak with a total of 
40 cases (24 in 2008 and 16 in 2009). Despite a series of national 
immunization days (NID) in 2008 and 2009, the outbreak continues to 
spread, now including previously polio-free areas of Northern Sudan, 
Uganda, and Kenya. According to the World Health Organization (WHO), 
the current polio outbreak has turned into a "national and 
international public health crisis." Currently, WHO, USAID, and the 
Centers for Disease Control and Prevention (CDC) are working with 
the Ministry of Health (MOH) to implement NID in late March, April, 
and May to begin containing the outbreak.  The USG and WHO are 
encouraging the Government of South Sudan/MOH to take a leading role 
in handling the outbreak.  End Summary 
 
POLIO IN SOUTH SUDAN 
- - - - - - - - - - - 
2. According to the World Health Organization, the last polio case 
in Southern Sudan was reported in April 2001 from Unity State (which 
borders Southern Kordofan in the Three Areas.)  The surveillance 
system did not detect any additional cases until July 2004, when the 
virus was introduced from Nigeria via Chad and Darfur. The outbreak 
ended in January 2005 after several NID were implemented.  A year 
ago, three polio cases were reported in Gambella, Ethiopia, 
bordering South Sudan.  The cases  coincided with many returnees 
coming from Ethiopia. The virus was found to be genetically linked 
to the viruses detected at the tail-end of the 2005 outbreak in both 
North Sudan and Ethiopia.  In June 2008, a polio case was confirmed 
in Ayod County (Jonglei State, South Sudan) despite two NID. 
Genetic tests showed that the Ayod virus was related to that in 
Gambella.  Currently, the virus is present in all but two Southern 
Sudan states (Northern Bahr El Gazal and Western Bahr El Gazal,) and 
has already spread to Northern Sudan (Khartoum and Port Sudan), 
Uganda (Amuru), and Kenya (Turkana), suggesting importation from 
South Sudan to these areas. 
 
RESPONSE TO THE POLIO OUTBREAK 
- - - - - - - - - - - - - - - - 
3. In response to the ongoing outbreak, the Ministry of Health 
(MOH), Government of Southern Sudan (GOSS), conducted a series of 
NIDs, targeting more than 2.8 million children under the age of 
five. Additionally, sub-national vaccination campaigns were 
undertaken in Jonglei, Upper Nile, and Unity states in August 2008; 
and in Northern Bahr El Gazal, Western Bahr El Gazal, Central 
Equatoria, parts of Eastern Equatoria and northern Warrap in 
September 2008. Further NID rounds will be conducted in March, April 
and May 2009. Given the recent regional spread of the virus, these 
campaigns will be synchronized with northern Sudan, Ethiopia, Kenya, 
and Uganda 
 
4. In December 2008, USAID/Sudan alerted USAID/Washington to the 
seriousness of the situation, while WHO/Sudan alerted its 
headquarters in Geneva and its regional office in Cairo.  These 
warnings resulted in an external review of the Acute Flaccid 
Paralysis (AFP) surveillance systems in January 2009. 
Representatives from WHO, USAID, CDC, NGOs and UNICEF were part of 
the external review team that listed several implementation 
challenges that would have to be overcome to combat this new 
outbreak, including:  difficult access to remote villages and a 
widely dispersed population; high turnover of AFP program staff due 
to low salaries, which affects the quality of surveillance 
activities due to the need to constantly train new hires; limited 
logistics (e.g., vehicles, motorbikes, spare parts for bicycles); 
and lack of social mobilization funds and materials for most states, 
which limits staff's ability to effectively mobilize and engage the 
population.  Although the GOSS receives funding from UNICEF for the 
social mobilization component of the immunizations program, the 
review team learned that the funds were not reaching the communities 
or were being disbursed too late.  As a temporary measure, WHO staff 
are now carrying out social mobilization activities in addition to 
their regular duties.  The review team recommended an international 
monitoring of the NID that was conducted in February of 2009.  WHO 
EMRO organized a team of seven international reviewers, including 
USAID and CDC staff, to observe the February NID in South Sudan. 
Those international reviewers observed problems similar to those 
raised during the January external review. 
 
5. Due to the regional spread of the virus, in February, 2009 the 
Technical Advisory Group (TAG) on polio eradication in the Horn of 
Africa met in Addis Ababa to develop a regional response. In its 
final report the TAG concluded:  "the ongoing outbreak in Sudan is 
an emergency for polio eradication, as it constitutes an ongoing 
risk both within the region and globally.  It requires urgent action 
by Governments and partner agencies to stop this outbreak and once 
again make the whole Horn of Africa region polio-free.  The next six 
months will be crucial to achieve this."  As a result, Kenya, North 
and South Sudan, Uganda, and Ethiopia will have synchronized polio 
campaigns from March to May 2009.  In addition, with support from 
 
KHARTOUM 00000423  002 OF 002 
 
 
USAID/Sudan, CDC's Global Immunization Division has sent two 
epidemiologists with polio expertise to assist WHO and MOH with 
their polio eradication activities in Southern Sudan. 
 
6. WHO and CDC have made the following recommendations to the MOH to 
maximize coverage during the NID that will take place in March, 
April, and May: 1) the Government of South Sudan (GOSS) should 
declare the current outbreak a national health emergency and declare 
March 24 a National Polio Campaign day. 2) The GOSS President must 
address the Governors, State Ministers of Health, County 
Commissioners and Payam Executive Officers to ensure their full 
participation and involvement in the polio eradication efforts in 
their respective States, Counties, Payams and Bomas, while also 
including NGOs working throughout Southern Sudan. 3) The GOSS must 
insure that State Governments contribute to the required rdsources 
needed for preparation, implementation and monitoring of the 
upcoming NID. 
 
COMMENT 
- - - - 
7. WHO has made it clear that polio transmission will stop only when 
every child under the age of five has been adequately vaccinated. 
With the beginning of the rainy season in late April, the window of 
opportunity to accomplish this will close, soon making it difficult 
to reach and vaccinate children. Unless the next three NID are 
properly implemented, there is a significant risk of the further 
spread of the virus.  There is also a lack of commitment from the 
highest level of an overburdened government in South Sudan in 
dealing effectively with the crisis, and there have been no public 
announcements regarding the outbreak. This is partly because the MOH 
has limited staff capacity.  The key person in the EPI department 
needs training in programming, monitoring, and management to 
properly oversee the implementation of the NID and surveillance. 
Although USAID provided $2.2 million for polio and disease 
surveillance in FY2008, the MOH needs additional technical and 
financial assistance to conduct a quality NID, strengthen EPI 
systems and perform routine immunizations, and provide adequate 
staff training.  In order to deal with this outbreak, USAID will 
need an estimated $ 5.2 million to administer this program. 
 
FERNANDEZ 
 
 
 
 
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