1. Situation overview and Meeting Objectives The Middle East Polio Outbreak Phase II Review

2. Overview 38 cases since October 2013 36 Syria 2 Iraq Most recent Case: onset 7 April 2014 Mada'in district, Baghdad-Resafa governorate 34-months old unvaccinated child Response: Over 40 SIAs reaching over 100 million children

3. Impact of polio response activities: Syria

4. Zone 1: Primary Outbreak Intervention Zone: Syrian Arab Republic, Iraq Zone 2: Risk Reduction Zone: Turkey Lebanon Jordan Palestine Egypt Iran Risk Assessment Phase II Outbreak response Plan May 2014 – Dec 2014 “Reaching the Unreached” with vaccine Intensified Surveillance Strengthened routine immunization services

5. Interrupt polio virus transmission by August 2014 – Identify and map unreached children – Increase the quality of vaccination campaigns Detect, investigate and classify all cases acute flaccid paralysis cases (AFP) Sustain polio-free status through increased routine immunization coverage and periodic SIAs Phase II - Goals A focus on Reach and Quality !!

6. 1.At least 2 NIDs by November, reaching 95% coverage 2.Targeted SNIDs in areas with low coverage or high risk of transmission reaching coverage of 95% 3.Any new governorate with confirmed WPV1 implements mop-up response within 14 days. 4.Annualized NPAFP Rate ≥2/100,000 and ≥80% of AFP cases with adequate stool specimens by September 2014 Zone 1 Targets (Syria & Iraq)

7. 1.At least one NID with 95% coverage 2.At least 2 SNIDs in low coverage/high risk areas 3.Polio vaccination of 95% of refugees under 5 on arrival 4.Any country with confirmed WPV1 implements a mop- up within 14 days and response plan within 21 days 5.Non-polio AFP (NPAFP) Rate ≥2/100,000 by Sept 2014 6.POL-3 95% of children with a coverage ≥85% in all governorates Zone 2 Targets

8. Phase II Priority Activities Mapping high risk populations in all countries by June Targeted SIAs in all countries with synchronised NIDs later in the year Surveillance reviews and strengthening plans Updated Regional Communications Strategy Developing plan for strengthening routine immunization services in Syria, Iraq, and Lebanon

9. Review Meeting Objectives Review current status of the response in each country Review Phase II implementation at national and regional levels Identify remaining gaps, challenges and risks Recommendations for priority actions to support final achievements of targets