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      Investigation et riposte à une épidémie de poliovirus sauvage à Kinshasa


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          La République Démocratique du Congo a été considérée comme un pays à circulation rétablie de poliovirus sauvage (PVS). Cet article décrit l’épidémie de PVS qui a sévit dans la province de Kinshasa de 2010 à 2011.


          Les analyses ont porté sur les cas de paralysie flasque aigüe (PFA) enregistrés de décembre 2010 à décembre 2011, les données de surveillance des PFA, les données de couverture vaccinale et celles du monitorage indépendant des activités de vaccination supplémentaires.


          Entre décembre 2010 à décembre 2011, 298 cas de PFA ont été enregistrés par les zones de santé parmi lesquels 34 cas de PVS confirmés. 58% des cas de PVS avaient plus de 15 ans avec plus d'hommes que de femmes. 10 passages d'activités de vaccination supplémentaires ont été mis en œuvre dont 4 avaient ciblé toute la population de Kinshasa. Il n'y a plus eu de cas de PVS après le 3e passage. Le monitorage des activités de vaccination a montré une proportion de sujets non vaccinés allant de 4 à 13%. La performance du système de surveillance était globalement bonne.


          La prédominance des adultes parmi les cas notifiés traduit leur susceptibilité alors qu'ils ne sont généralement pas concernés lors des campagnes de vaccination supplémentaires. Ceci devrait engager les autorités sanitaires à envisager des activités vaccinales supplémentaires ciblant les adultes afin de casser plus rapidement la chaîne de transmission. Les faiblesses subsistant dans le système de surveillance pourraient être jugulées par le renforcement de la surveillance à base communautaire.

          Most cited references19

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          The global polio eradication initiative: lessons learned and prospects for success.

          Following the rapid progress towards interrupting indigenous wild poliovirus transmission in the Americas in the early 1980s, the Global Polio Eradication Initiative (GPEI) was launched with a resolution of the World Health Assembly (WHA) in 1988. The GPEI built on many lessons learned from smallpox eradication, including the large-scale deployment of technical assistance, implementing agendas of innovation and research and the use of professionally planned and guided advocacy. By the year 2000, the incidence of polio globally had decreased by 99% compared with the estimated >350,000 cases reported from 125 endemic countries in 1988. By 2002, three WHO Regions (the Americas, Western Pacific and European Regions) had been certified polio-free. By 2005, transmission of indigenous wild poliovirus (WPV) had been interrupted in all but 4 'endemic' countries: India, Nigeria, Pakistan and Afghanistan, where eradication efforts effectively stalled. WPV exported from northern Nigeria and northern India subsequently caused >50 outbreaks and paralysed >1500 children in previously polio-free countries across Asia and Africa. In each of the four remaining polio-endemic countries different challenges, or a combination of factors, prevented to build up sufficient levels of population immunity to stop transmission. Consequently, specific strategies were increasingly tailored to each setting. A new 2010-2012 GPEI Strategic Plan was developed which brought together several approaches to overcome the remaining hurdles to eradication, including the large-scale use of bivalent oral poliovaccine (bOPV) in supplementary immunization activities (SIAs). By the end of 2010, the impact of the new GPEI Strategic Plan 2010-2012 was apparent. Compared to 2009, the number of new polio cases in 2010 fell by 95% in both northern Nigeria and northern India, the world's largest remaining reservoirs of indigenous WPVs. By mid-2011, India had not reported a polio case for more than 5 months, and in Nigeria, endemic transmission appeared to be restricted to the north-east and north-west corners of the country. While polio cases due to WPV type 3 were still being detected in west and central Africa, the overall level of WPV3 transmission globally was at an all-time low. Uncontrolled WPV transmission appeared to be restricted to Chad and Pakistan, which increasingly represented the greatest risks to the GPEI. Although insufficient financing continued to be a major concern, political support for completing polio eradication in polio-infected countries was stronger than ever by mid-2011. While continued transmission in some areas, particularly in Pakistan and Chad, still had to be controlled as a matter of urgency, there were real opportunities to achieve new landmarks in polio eradication, especially in the key WPV reservoirs of India and Nigeria, setting the stage for polio to soon follow smallpox into the history books. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Polio vaccines and polio immunization in the pre-eradication era: WHO position paper.

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              Enquête Démographique et de Santé, République Démocratique du Congo 2007


                Author and article information

                Pan Afr Med J
                Pan Afr Med J
                The Pan African Medical Journal
                The African Field Epidemiology Network
                31 May 2013
                : 15
                : 37
                [1 ]Médecin Epidémiologiste Coordonateur, Organisation Mondiale de la Santé, Sous-Bureau de Kinshasa, Avenue des Cliniques, Gombe, Kinshasa
                [2 ]Représentant, Organisation Mondiale de la Santé, République Démocratique du Congo, Avenue des Cliniques, Gombe, Kinshasa
                [3 ]Focal Point of Immunization Vaccine and Development, Organisation Mondiale de la Santé, République Démocratique du Congo, Avenue des Cliniques, Gombe, Kinshasa
                [4 ]Organisation Mondiale de la Santé, République Démocratique du Congo, Avenue des Cliniques, Gombe, Kinshasa
                [5 ]Centre de Recherche Epidémiologie, Biostatistiques et recherche clinique, Ecole de Santé Publique, Université Libre de Bruxelles, Belgique, Campus Erasme - CP598, 808 route de Lennik, 1070 Bruxelles
                [6 ]Département de Santé Publique, Faculté de Médecine, Université de Kisangani, BP 2012, Kisangani, République Démocratique du Congo
                Author notes
                [& ]Corresponding author: Muriel Nzazi Nsambu, Médecin Epidémiologiste Coordonateur, Organisation Mondiale de la Santé, Sous-Bureau de Kinshasa, 42, Avenue des Cliniques, Gombe, Kinshasa, Congo RD
                © Muriel Nzazi Nsambu et al.

                The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                : 30 March 2013
                : 14 May 2013

                paralysie flasque aigüe,poliovirus sauvage,épidémie,république démocratique du congo,acute flaccid paralysis,wild polio virus,outbreak,vaccination,democratic republic of congo


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