http://www.nytimes.com/2008/10/28/health/28glob.html?_r=1&ref=world_&oref=slogin
Polio Spreads to New Countries and Increases Where It's Endemic
By DONALD G. McNEIL JR
Published: October 27, 2008
Since April, outbreaks have been found in 10 countries beyond the 4 in which polio is considered endemic — Afghanistan, India, Nigeria and Pakistan. And in those four countries, the number of cases is more than double the number found by this time in 2007.
In Africa, cases have been found as far south as Angola and as far west as Ethiopia. Each detected case implies another 200 cases with few or no symptoms, experts say.
There have been outbreaks of both type 1 and type 3 polio, which frustrate W.H.O. plans, begun in 2005, to concentrate on a monovalent vaccine against type 1. Recent studies show that vaccine to be far more effective against type 1 than the old trivalent vaccine was. But it does not protect against type 3, and a new monovalent vaccine against that is being introduced. (Type 2 was eliminated in 1999.)
Pakistan, which has seen a rapid rise in cases, now has 86,000 vaccination teams going house to house and dosing children at train stations and border crossings. But tribal areas on the Afghan border and contiguous parts of Afghanistan are barely covered because travel is unsafe for vaccinators.
The Indian Academy of Pediatrics has endorsed adding injectable vaccine as a backup for those who can afford it, because it can protect children whose oral doses are eliminated by diarrhea.
Nigeria, whose northern provinces are the epicenter of Africa's epidemic, recently dismissed the head of its national vaccination program.