China – one year polio-free
Model response stopped 2011 outbreak in record time
9 October 2012 marks the 12-month anniversary since China’s last polio case had onset of paralysis. In 2011, polio from Pakistan had infected China to cause an outbreak in southern Xinjiang Uyghur Autonomous Region. China had previously been polio-free since 1999 when an importation from India had occurred. The last indigenous polio case dates back to 1994.
Immediately upon detecting the outbreak, the Government of China mounted what can only be described as a true model response, mobilizing every sector of the government and civil society.
Within just a few hours of confirmation of the outbreak on 25 August 2011, a ‘level two’ public health emergency was declared, and both the Minister and Vice-Minister of Health immediately travelled to the affected region to get a first-hand overview of the situation and personally lead response efforts.
Within days, more than five million doses of oral polio vaccine (OPV) had been airlifted to the province, supported by a public health army of more than 500 experts from around the country. More than 500 000 volunteers, health workers and government officials were mobilized to support the immunization campaigns, going not just house-to-house, but setting up vaccination posts at key gathering sites including bus- and railway-stations, schools, airports, bazaars, city intersections, on motorways, at road check points and in the remotest spots. Teachers, religious leaders and other community leaders were engaged to spread the word about the importance of immunization, through TV, radio and cellphone announcements, and supported by millions of informational banners, posters and leaflets. At village squares, stage plays were set up warning of the dangers of the disease and illustrating the benefits of the vaccine. Extensive monitoring systems were established, including ear-, finger- and arm-marking of persons immunized or vaccination certificates issued, to ensure that no one was missed.
At the same time, the epidemiology of the virus was carefully tracked, enabling further targeting of the outbreak response. In particular, efforts were doubled to make sure no cases went undetected. More than 200 000 hospital records were reviewed, and almost two million households actively searched for additional suspected cases. Samples from more than 1000 acute flaccid paralysis (AFP) cases were collected and virologically-tested for the presence/absence of poliovirus.
Altogether, five large-scale immunization campaigns were conducted in Xinjiang, during which, more than 43 million doses of OPV were administered to populations of all ages. In total, the Government of China allocated an estimate of more than RMB 340.7 million (approximately US$ 55 million) to the outbreak response effort.
In June 2012, to assess the overall quality of the outbreak response and determine the likelihood of ongoing transmission, the Government of China welcomed an international team of experts from the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC). The team was on the ground in Xinjiang and conducted a rigorous assessment of the surveillance sensitivity. The team’s conclusion: it is ‘highly unlikely’ that undetected wild poliovirus is continuing in the Region.
China’s rigorous response succeeded in stopping the outbreak in record-time — within just three months from index to last polio case. Thanks to such decisive actions, it is anticipated that the Western Pacific Region will be able to maintain its polio-free certified status. Much more important than that, however: this model response saved lives and prevented further people from being affected by the devastating, life-long effects of polio.