title: Jason Heyward

text: Through the end of August, the Braves were the NL wild card leader. However, the Cardinals overcame a -game deficit for the wild card position by winning 20 of their final 28 to eliminate the Braves from the playoffs on the final day, consummating one of the epic late-season collapses in MLB history. After battling a shoulder injury from the beginning of the season, Heyward's overall performance dropped off from his rookie season. His batting average dropped 50 points to .227; his other contributions, also in decline, included 14 home runs, 42 RBI, 18 doubles, and nine stolen bases in 128 games. He batted .240 against right-handed pitchers, compared with .192 against left-handers.


title: Jason Heyward

text: To remedy the decline in performance from the season before, Heyward took extra steps in his preseason preparation. He streamlined his swing to mitigate bad habits incorporated after the shoulder injury. He modified his diet to include more fruits, chicken, and fish. Further, he participated in physical therapy to strengthen the shoulder and worked for a leaner weight, dropping from to . He started the 2012 season slowly. However, his bases loaded double on May 13 off Lance Lynn proved the game-winning run as the Braves triumphed over the Cardinals, 7–4.


title: Jason Heyward

text: With a .233 batting average through May, his production increased in June. His first multi-HR game of the season, and second of his career, on June 7 helped secure an 8–2 victory over the Marlins. That month, he batted .353 with six home runs and a 1.080 OPS. He also registered four outfield assists, including one that put Mark Teixeira out at home plate on June 19, preserving a 4–3 win over the New York Yankees.


title: Jason Heyward

text: The following game, also at Yankee Stadium, he launched two home runs for his third career – and second of the season – multi-HR game. It was a contest that featured nine home runs between the two clubs, tying a Yankee Stadium record, including the original incarnation built-in 1923. That same week, ending June 24, he won his first NL Player of the Week Award. In six interleague games, he batted a league-leading .522 (12-for-23) and 1.130 slugging percentage. Further, his three home runs, 12 hits, 26 total bases, and nine runs scored each tied for the league lead. He also added three multi-hit games and five RBI.


title: Jason Heyward

text: In a 12-game hitting streak that spanned from June 13–27, Heyward batted .455 (20-for-44) and homered four times. One hit during that streak was a single on June 16 against the Baltimore Orioles that ended Jason Hammel's no-hit bid in the seventh inning to leave him a one-hit complete game shutout in the Orioles' 5–0 victory. Heyward's home run in an 8–2 defeat of the Marlins on July 30 helped end Atlanta's streak of 16 losses on Mondays.


title: Jason Heyward

text: After the season, Heyward captured his first career defensive awards for right fielders: the singular MLB Fielding Bible Award, and his first NL Rawlings Gold Glove Award. In 158 games, his batting statistics included a .269 average with career highs of 27 home runs, 82 RBI, 93 runs scored, 158 hits, 30 doubles, six triples, .479 slugging percentage and 21 SB. He batted .300 (105-for-350) with 20 home runs against right-handers but just .224 (53-for-237) against left-handers. It was the second time he received consideration in the NL MVP balloting, finishing tied for 28th.


title: Jason Heyward

text: On January 18, 2013, the Braves avoided arbitration with Heyward in his first time eligible, agreeing on a one-year, $3.65 million deal. He was counted on as a component in the outfield including newly acquired brothers Justin and B. J. Upton, with whom he would play until being traded after the 2014 season. An appendectomy on April 22 led him to being placed on the 15-day disabled list. In his first 31 games of the season, he batted .142 (15-for-106) with two home runs and eight RBI. He returned from the appendectomy on May 17, going 2-for-4 in an 8–5 win against the Dodgers. His first multi-HR game of the season came against San Diego on June 10.


title: Jason Heyward

text: In 37 games following the All-Star break, Heyward batted .305 with on OBP of .397 and OPS of .932. He collected 40 hits in 131 at-bats with nine doubles, seven home runs, and 17 RBI. During a 19-game stretch from July 28 to August 17, he batted .400 (30-for-75) with a .457 OBP, six doubles, five home runs – four as a leadoff hitter – 15 RBI, eight BB, and 23 runs scored. On August 17, he hit his second multi-HR game of the season against Washington. In August, his .348 batting average (23 hits in 66 AB) ranked tenth in the NL.


title: Jason Heyward

text: New York Mets pitcher Jon Niese hit Heyward in the face with a pitch on August 21, fracturing his jaw in two places. He had surgery, which required the insertion of two plates, and returned on September 20. Heyward began wearing a protective shield attached to the right side of his batting helmet. He struck out and walked in a 9–5 win against the Chicago Cubs.


title: Jason Heyward

text: Six days later, Heyward set career highs against Philadelphia with five hits, four extra-base hits and matched a career-best three doubles. He also hit his third career – and second of the season – leadoff home run. In his last 31 games of the season, starting July 28, he hit at a .333 (38-for-114) clip. He batted .322 (38-for-118) with a .403 OBP in 30 games as a leadoff hitter. After two stints on the DL, Heyward appeared in 104 total games, batting .254 with 14 home runs, 22 2B, 38 RBI, 67 runs scored, and two stolen bases. The Braves record was 71–33 in the games in which he appeared.


title: Jason Heyward

text: The Braves bought out Heyward's last arbitration-eligible years on February 4, 2014, agreeing on a two-year, $13.3 million contract. Already rated one of the top defensive outfielders in the league, his coverage in right field significantly improved, demonstrated through an increased defensive runs saved (DRS) total. Through May 19, he registered 16 DRS, matching three of his previous four entire season totals. Inside Edge (IE) charted that of all batted balls hit to him, Heyward had missed a total of nine in 358 innings; all nine were rated as having a 10% or lower chance of being caught. Two catches in motion off the bat of Mike Trout – one tumbling on a sinking line drive and one sprinting and leaping at the warning track – helped ensure a 7–3 victory over the Los Angeles Angels of Anaheim on June 15. Heyward also added a home run.


title: Jason Heyward

text: Playing as the Braves' primary leadoff hitter, he played in 149 games and finished with a .271 batting average, .351 on-base percentage, 74 runs scored, 11 home runs, 58 RBI and 20 stolen bases. Caught stealing just four times, his 83.33% success rate placed seventh in the NL. Defensively, Heyward registered a standout season. In 149 games in right field, he led the NL at his position in putouts (365), assists (nine), range factor per nine innings (2.56) and game (2.51), fielding percentage (.997), and total zone runs (30). Among all NL outfielders, he was fifth in assists, third in range factor per game and second in putouts and fielding percentage.


title: Jason Heyward

text: Further, per Baseball-Reference.com, Heyward registered fourth in the league with 2.8 defensive wins above replacement (dWAR) and led all MLB players with 32 total DRS. He saved 40 bases on deep-hit balls, which was the highest output of his career and led all MLB outfielders. Accordingly, Heyward was the recipient of several awards, including his second of both the Rawlings NL Gold Glove Award and the Fielding Bible Award for all MLB right fielders, the latter of which he won unanimously. Wilson Sporting Goods named him their MLB right field Defensive Player of the Year and overall MLB Defensive Player of the Year.


title: Jason Heyward

text: On November 17, 2014, the Braves traded Heyward to the St. Louis Cardinals along with pitcher Jordan Walden for pitchers Shelby Miller and Tyrell Jenkins to replace their former right fielder and top prospect Oscar Taveras, who died in a car accident a month earlier. Cardinals manager Mike Matheny, who wore uniform #22 and had also done so for most of his playing career, gave his number to Heyward. Heyward wears this number to honor his friend Andrew Wilmot. After the trade was announced, Heyward published a Twitter message thanking the Atlanta Braves organization and fans for their support.


title: Jason Heyward

text: Five years to the day of his MLB debut, Heyward appeared in his first game as a Cardinal against the Chicago Cubs on April 5, 2015. He garnered three hits, including two doubles and a stolen base in a 3–0 victory. His first home run as a Cardinals player was on April 18 against the Cincinnati Reds at Busch Stadium with a 5–2 win. After uncharacteristic errors in both of the two previous games, his ninth-inning home run against the Arizona Diamondbacks on May 27 tied the game 3–3, and the Cardinals eventually won with a score of 4–3. He homered in three straight games June 22–24, including successive contests against the Marlins from June 23–24 as St. Louis won both times. On July 18 against the Mets, he matched a career high with five hits in a 12–2 win.


title: Jason Heyward

text: In an August 16 contest against the Marlins, Heyward hit two home runs for his first multi-home run game with the Cardinals. An important defensive play was on September 20 against the Cubs. With the bases loaded and no outs in the eighth inning, Addison Russell hit a fly ball that Heyward caught running and threw home to catcher Yadier Molina to tag out Anthony Rizzo by two steps, preserving a 4–3 win. In the second game of a doubleheader against Pittsburgh on September 30, Heyward hit his second career grand slam in an 11–1 win, giving the Cardinals their 100th victory of the season while clinching their third consecutive National League Central division title. He also robbed both Francisco Cervelli and Michael Morse of hits in this game.


title: Jason Heyward

text: Heyward finished the season with a career-high .293 batting average, .359 on-base percentage, and .439 slugging percentage. Since his major league debut, he also had led all major league fielders in DRS and, for the previous three seasons, was second only to former Braves teammate Andrelton Simmons. Among all outfielders since 2010, Heyward's 96.2 accumulated ultimate zone rating (UZR) led all major league outfielders to second-place Alex Gordon's 68.3 UZR. After becoming a free agent for the first time in his career, Heyward won his third Fielding Bible Award and third Gold Glove Award.


title: Jason Heyward

text: On December 15, 2015, Heyward signed an eight-year, $184 million contract with the Cubs. One of his first acts after signing his contract was to pay for hotel suites large enough to accommodate teammate David Ross, his wife, and their three young children on all of the Cubs' road trips during the 2016 season. Ross, set to retire after the 2016 season, had been Heyward's teammate during his first three seasons in Atlanta, and Heyward considered him a key mentor in his early MLB career. In an interview with the Bleacher Report website, Heyward said,I know how special it is to have teammates like he was my first three years in Atlanta. You don't take it for granted. I wanted to say thank you from the bottom of my heart, as a teammate and as a friend, for what he's done for me.


title: Jason Heyward

text: Heyward struggled in his first season with the Cubs in 2016, batting only .230 with 7 home runs and 49 RBIs, while leading the majors in percentage of soft-hit batted balls (27.1%), though he would win his 4th Gold Glove award that season.


title: Jason Heyward

text: In Game 4 of the 2016 National League Division Series against the San Francisco Giants with the Cubs having a 2–1 series lead, Heyward reached on a bunt force out and moved to second on an errant throw. He scored the go-ahead run on a Javier Baez single, sending the Cubs to the National League Championship Series.


title: Jason Heyward

text: On October 25, 2016, Heyward, along with teammates Dexter Fowler, Addison Russell, and Carl Edwards Jr., became the first African-Americans to play for the Cubs in a World Series game. Heyward was credited with leading an inspiring players-only meeting during a 17-minute rain delay near the end of Game 7 of the 2016 World Series. The Cubs eventually won the game 8–7 after 10 innings, and gave them their first World Series championship in 108 years. On November 9, Heyward became the first position player in Major League Baseball history to win three straight Gold Glove Awards with three different teams (Braves, Cardinals, and Cubs).


title: Jason Heyward

text: On May 8, 2017, Heyward went on the 10-day disabled list due to a sprained finger he suffered in a game against the Yankees three days prior. In late June, Heyward suffered a left-hand laceration while catching a foul ball in Pittsburgh and was unavailable to play in the next series of games. In 55 of the first 67 games of the 2017 season, Heyward had improved his statistics from the prior year with a batting average of .258, a .315 OBP and .399 SLG. He was third on the team with 29 RBIs and third with 84 total bases. He was placed on the disabled list a month later with a hand injury.


title: Jason Heyward

text: On May 8, 2018, Heyward again went on the disabled list due to concussion protocol after attempting a game-saving catch of a Dexter Fowler 14th inning home run. On June 6 Jason Heyward hit a walk-off grand slam home run with two outs in the bottom of the 9th to give the Cubs a 7–5 win over the Philadelphia Phillies. At the All-Star break Heyward's stats for the year showed continuing improvement over his previous time with the Cubs. He had a .285 batting average with 78 hits in 274 plate appearances with 6 home runs and 41 RBIs, a .344 OBP and a .431 SLG.


title: Jason Heyward

text: Heyward had a fast and quality start to the season. He hit two home runs and stole two bases against the Milwaukee Brewers on April 6, becoming only the 18th player—and first Cub—to have a multi-homer, multi-steal game since 1901. It was also his first multi-homer game as a Cub. On April 24, he hit a dramatic three-run home run late in the game to regain the lead in a 7–6 victory against the Los Angeles Dodgers. On May 8, Heyward hit a walk-off, solo home run against the Miami Marlins in the 11th inning, giving the Cubs a 3–2 win. This was Heyward's third walk-off hit as a Cub (second home run), also snapping a 1-for-20 slump in the process.


title: Jason Heyward

text: In the pandemic-shortened 2020 season, Heyward batted .265/.392/.456 with 6 home runs and 22 RBIs in 50 games. His .848 OPS was his highest since his rookie season in 2010, and he recorded a perfect 1.000 fielding percentage in right field.


title: Jason Heyward

text: On May 8, 2022, Heyward was placed on the injured list with a left quadriceps strain. He returned to the IL in late June. As Heyward remained on the injured list through August, Cubs general manager Jed Hoyer stated that the team would release Heyward at the end of the season.


title: Jason Heyward

text: On December 8, 2022, Heyward signed a minor league contract with the Los Angeles Dodgers that included an invitation to major league spring training.


title: Jason Heyward

text: Standing and weighing , Heyward has shown to be an all-round talent. In the minor leagues, his ability to hit for batting average and power, speed, plus defense and arm strength sufficient to play right field, caused him to be considered a five-tool player. Further, his plate discipline and ability to draw walks are unusual for a player his height. He generates much of his power as a pull hitter.


title: Jason Heyward

text: From very early in his career, Heyward has played with outside anticipation of developing into one of the most dominant players in the league. However, he has mentioned being uncomfortable with the pressure that comes with such expectations. Journalist Bernie Miklasz of the "St. Louis Post-Dispatch" opined that the pressures of stardom obliquely induced the overall descent in performance from his rookie season.


title: Jason Heyward

text: Heyward still has a hole in his swing that has yet to resolve. While he was in the minor leagues, his unorthodox swing was not regarded as a significant issue, but rather was perceived to have worked for him because of his enormous talent. On the contrary, one scout compared it to an awkward golf swing. "You watch him, he really stiff-arms the bat out there," noting Heyward almost fully extends his arms to attempt to power the head of the bat through the strike zone. He does not protect the inside of part of the strike zone as well as the outside. That creates a weakness that allows pitchers – especially power pitchers – to throw inside, thus exploiting an inability to attain contact on inside pitches efficiently.


title: Jason Heyward

text: "The ball he hits well is the ball out away from him," according to the same scout. "If pitchers pitch around him, on the outer half, he'll crush it. ... That's why Niese hit him: He went up and in, and Heyward's a diver." Indeed, charts from STATS LLC depicting Heyward's "Hot Zones," or a hitter's zones of maximum effectiveness, corroborate the scout's findings. Through April 25, 2014, Heyward had swung at 22 of 55 pitches in 2014 that qualified as "up and in," crossing the plate either to the upper left ninth of the strike zone or slightly higher or inside of it. None of those 22 swings had produced a hit.


title: Jason Heyward

text: However, an injury contributed to lost power in 2011. Before that point, Heyward dropped his hands after the start of the swing and rotated his front shoulder in an upward motion in his mode as a pull hitter. Normally, the front half of his upper body generates bat velocity. During the time the injury had not properly healed, it hindered his ability to generate torque from his front shoulder that contributed most to driving the ball.


title: Jason Heyward

text: Despite not reaching his offensive projections, his defense has delivered as promised. Heyward has been rated as one of the top right fielders, if not the top right fielder, in MLB. The Fielding Bible staff has said that he "is the best defensive right fielder in baseball, bar none." He is an expert at instantly picking up and reacting to the path of the batted ball and following it with efficient routes. Such defensive ability was demonstrated on a fly ball off Justin Turner's bat during the 2013 season. The same play was part of a demonstration in 2014 of Major League Baseball Advanced Media's Statcast system, a hybrid of PITCHf/x, FIELDf/x, and a radar-based play tracking. Statcast analyzed that Heyward got a jump off the fly ball the bat in second, ran at and took a route with a 97% efficiency. The ball had 4.0 seconds of hang time and he ran for the catch.


title: Jason Heyward

text: In the rating of three zones to where the ball is hit in the right field in his first five seasons, he was above average at saving bases on shallow-hit (+31) and medium-hit (+40) balls. His greatest strength came with deep-hit balls (+140). In 2014 alone, he saved +40 bases on balls hit to the deepest part of right field, which was the equivalent of 20 doubles. The enormous ground coverage makes up for what would be considered a slightly below-average arm among right fielders. Commented Fielding Bible founder John Dewan, "Heyward has been able to accomplish this (winning the Fielding Bible Award) by starting and finishing every play extremely well. He excels at picking up the ball off the bat and rarely takes the wrong angle. He is not afraid to dive, demonstrating tremendous body control when doing so."


title: Jason Heyward

text: In September 2012, Piedmont Henry Hospital in Stockbridge, Georgia, selected Heyward as one of ten representatives for their Real Men Wear Pink campaign against breast cancer. He stated at the time one of his grandmothers was battling the condition but had improved, and that her battle was an inspiration for him to participate.


title: Jason Heyward

text: Heyward's brother, Jacob, is an outfielder in the San Francisco Giants organization. Jacob Heyward was drafted by the Braves out of high school in the 2013 MLB Draft and the San Francisco Giants in the 2016 MLB Draft.


title: Jason Heyward

text: Heyward is married to Vedrana Heyward. Their son was born in March 2022. They own a $5.9 million mansion in the Gold Coast neighborhood of Chicago.


title: Pierluigi Gollini

text: Pierluigi Gollini (born 18 March 1995) is an Italian professional footballer who plays as a goalkeeper for club Fiorentina, on loan from Atalanta, and the Italy national team. Having graduated from Manchester United's youth academy, Gollini began his senior career with Hellas Verona in 2014 and joined Atalanta in 2018, having played for Aston Villa in 2016.


title: Pierluigi Gollini

text: Gollini joined Hellas Verona in 2014 from Manchester United. He made his Serie A debut on 24 September 2014 as a starter in a 2–2 home draw against Genoa.


title: Pierluigi Gollini

text: After two seasons with Verona, Gollini signed for Championship club Aston Villa on 8 July 2016. He made his first appearance for Aston Villa in an 8–0 friendly win over Austrian side Grazer AK the following day.


title: Pierluigi Gollini

text: Gollini started the season as newly relegated Villa's first-choice goalkeeper under manager Roberto Di Matteo; however, Villa struggled in the early parts of the campaign, with Gollini making notable errors against Sheffield Wednesday and Huddersfield Town. Di Matteo was sacked in early October and replaced by Steve Bruce, who continued to play Gollini until December. The Italian was dropped for the festive period games in favour of Mark Bunn, and on 5 January 2017, Villa brought goalkeeper Sam Johnstone in on loan from Manchester United, and he took over as first-choice goalkeeper.


title: Pierluigi Gollini

text: On 13 January 2017, Gollini signed for Italian club Atalanta on an 18-month loan. On 10 June 2018, Gollini signed permanently for Atalanta for an undisclosed fee. He spent the first half of the year as backup to Etrit Berisha, however claimed the starting spot in the second half of the season. Berisha was loaned out the following summer, making Gollini the undisputed starter. Gollini started every match in Atalanta's debut season in the UEFA Champions League, as they finished second in their group, qualifying for the round of 16.


title: Pierluigi Gollini

text: On 24 July 2021, Gollini joined Premier League club Tottenham Hotspur on loan for the season. He made his debut for the club on 19 August 2021, starting in the UEFA Europa Conference League first leg tie against Paços de Ferreira, which ended in a 1–0 defeat. Gollini returned to his parent club Atalanta on 2 June 2022.


title: Pierluigi Gollini

text: Gollini made his senior debut for Italy under manager Roberto Mancini, on 15 November 2019, coming on as a late substitute for Gianluigi Donnarumma in a 3–0 away win over Bosnia and Herzegovina, in a Euro 2020 qualifier.


title: Pierluigi Gollini

text: In June 2018, under the pseudonym Gollorius, Gollini published a rap music single ""Rapper coi guanti"" (Rapper with gloves); he donated the proceeds to charity.


title: Basque pelota

text: Basque pelota (Basque: "", Spanish: "", French: "") is the name for a variety of court sports played with a ball using one's hand, a racket, a wooden bat or a basket, against a wall ("frontis or fronton") or, more traditionally, with two teams face to face separated by a line on the ground or a net. The roots of this class of games can be traced to the Greek and other ancient cultures.


title: Basque pelota

text: The term "" probably comes from the Vulgar Latin term "pilotta" (ball game). It is a diminutive form of the word "" which may relate to a hard linen or leather ball filled with "" (fur or hair) or to the Latin words for strike or and is related to the English word "pellet".


title: Basque pelota

text: Today, Basque pelota is played in several countries. In Europe, this sport is concentrated in Spain and France, especially in the Basque Country. The sport is also played in Latin American countries such as Argentina, Chile, Uruguay, and Cuba. Operated as a gaming enterprise called jai alai, it is seen in parts of the U.S. such as Florida, Connecticut, Nevada, and Rhode Island.


title: Basque pelota

text: In Valencia, Valencian pilota is considered the national sport; it is also played in Belgium, northern Italy, Mexico, and Argentina.


title: Basque pelota

text: Since its creation, the International Federation of Basque Pelota has standardised the different varieties into four modalities and fourteen disciplines, with fixed ball weights, rules and court sizes. The four modalities— wall, wall, wall and "trinquete"—admit fourteen disciplines, depending the use of bare hand, leather ball, rubber ball, "paleta" (pelota paleta), racket (frontennis) and "xare". Two of the fourteen disciplines are played by both men and women (frontenis and rubber pelota in trinquete); the other twelve are played only by men. This allows championship play at the international level, and allows the participation of players and teams from around the world using the same rules. There is, however, criticism about this, since purists might argue that some of the original traits of each particular modality could be lost.


title: Basque pelota

text: Even with protection, accidents do happen. With the ball easily travelling at , pelota can kill if safety equipment is not used properly or at all; while rare, occasional deaths do occur.


title: Basque pelota

text: The origin of this sport is tied to the decline of the ancient jeu de paume (jeu de paume au gant), ca. 1700. While the game evolved to the modern jeu de paume (with racquet, called real tennis in England) and eventually to lawn tennis, rural Alpine and Pyrenean communities kept the tradition.


title: Basque pelota

text: In the Basque Country the "" and "", local versions of the paume evolved to the peculiar style of the pilota: instead of playing face to face, with a net in the midfield, the Basques began to fling the ball against a wall.


title: Basque pelota

text: According to the Basque pilota historian Chipitey Etcheto, the first recorded matches took place in Napoleonic times; it is believed that the game was close to currently rare speciality of "".


title: Basque pelota

text: The mid-19th century saw the explosion of the "pelota craze". The player "Gantxiki" is considered the original "father" of the chistera, the basket-shaped racquet that can propel the ball at high speeds, introduced around 1850.


title: Basque pelota

text: The top champions of the end of the 19th century, such as "Chiquito de Cambo", were immensely popular and the best-paid sportsmen of their time. The first official competitions were organized in the 1920s and led to the world championship in the 1950s.


title: Basque pelota

text: In 1924, the United States built its first fronton, in Miami. Jai-Alai is used for betting. During the '80s and '90s, Jai-Alai was especially popular in Miami and Florida, where the frontons had press boxes and restaurants and going to the Jai-Alai was seen to be a privilege. Men often came in suits and women came in elaborate dresses for the "special event". Nowadays, Jai-Alai has dropped in popularity. Instead of thousands of people who came to watch, now there are barely a couple hundred.


title: Basque pelota

text: Pelota is usually played in the Basque regions of south-western France and north-western Spain, where it originated. There are also federations of Basque ball in Argentina, Bolivia, Brazil, Canada, Costa Rica, Cuba, Chile, the Dominican Republic, Ecuador, El Salvador, the Philippines, Guatemala, Italy, Mexico, Paraguay, Peru, Puerto Rico, Uruguay, the United States, Venezuela, the Netherlands, Sweden, India and Greece. Due to the origin of the game, there are many good players who are Basques, either natives or from the Basque diaspora.The sport is part of the Pan-American Games since 1995 and was dropped at the 1999,2007 and 2015 editions due the low popularity in Brazil and Canada.


title: Basque pelota

text: Basque pelota was an official Olympic sport once, in the 1900 Paris Games, and a demonstration sport in 1924 (men), 1968 (men) and 1992 (men and women). See also Basque pelota at the 1900 Summer Olympics.


title: Basque pelota

text: In the 1900 Paris Games there were only two teams entered, France and Spain, but the French team, Maurice Durquetty and Etchegaray, withdrew. Therefore, the tournament was scratched and the Spanish team, Amezola and Villota, were subsequently awarded the gold medal.


title: Basque pelota

text: Basque pelota is usually played in a two walled court ( or , French: "fronton", Spanish: "frontón"). As seen in the picture, there are also courts with one wall, a modality prevailing on the French side of the Basque Country, some spots of Navarre or at the highly exceptional court of Zubieta in province Gipuzkoa. Yet they are not recognized by the International Federation of Basque Pelota for international tournaments, and usually reserved to joko-garbia and open-air grand chistera games.


title: Basque pelota

text: The trinquet is a court in Pelota where there is a front wall, a glass wall on the right and a wall on the left that has a dugout built into it and lastly a wall at the back. where the right wall and the front wall meet there is small 45-degree wall. The trinquet is 8.50 meters high, 28.50 meters long and 9.30 meters wide.


title: Basque pelota

text: The mur a gauche is French for 'wall on the left' which it truly is, as represented in the diagram below where there is a front wall called a frontis, a left wall and a back wall called a rebot. The mur a gauche is 36 meters long, 10 meters wide and 10 meters high.


title: Basque pelota

text: The Jai-Alai court has the same layout as the mur a gauche, but instead of being 36 meters long, it is 54 meters long.


title: Basque pelota

text: The basic principle in hand-pelota is that there are two teams of two players each. The team to serve bounces the ball, then propels it towards the playing area of the narrow, front wall where it has to rebound between the low line demarcating the low off-area and the high line demarcating the high off-area.


title: Basque pelota

text: The ball may either be played so it rebounds directly off the front wall onto the playing floor or onto the long side wall first. The opposing team may either play the ball immediately after rebounding from the front wall or side wall without rebounding from the playing floor or after having rebounded from the playing floor once.


title: Basque pelota

text: The ball used to play pelota is called "pilota" in Basque, "pelote" in French, and "pelota" in Spanish. There are different sizes, different weights and different materials for each discipline that is played.


title: Basque pelota

text: The ball is made out of a boxwood core from in diameter. This is wrapped in a latex wire (for Hand Pelota, Grand Chistera, Jai-Alai, and open-air Pala). The core of the ball is different for individual age groups so that the weight limit is respected. The core can also be made from latex (for Cesta Punta, Xare, Pala Corta, and Remonte).


title: Basque pelota

text: A wire of pure new wool is then wrapped carefully around the core so that the ball is round and even throughout. A structure of cotton wire is sewed on the surface of the ball so that the wool stays in place. Number eight shapes are cut out from goat skin and are sewn together onto the ball in one or two layers.


title: Basque pelota

text: The Palas and Paletas are wooden made rackets that are used to strike or hit the ball. The difference between them is their weight, length, and width.


title: Basque pelota

text: This is the version known outside Europe as jai alai. It is called "zesta punta" in Basque and "cesta-punta" in Spanish (literally: 'edged basket'). It uses a special glove that extends into a long pointed curved basket (hence the name), circa 60 cm long in straight line and 110 cm by curved line. The basket ("xistera" in Basque and "chistera" in French) was introduced by Gantchiqui Dithurbide from Saint-Pée, France in 1860, and its long version by Melchior Curuchage, from Buenos Aires in 1888. The players use it to catch the rubber ball and propel it back against the main court. The Basque Government claims it as "the fastest game on Earth", the record being 302 km/h or 187.65 mi/h (José Ramón Areitio at the Newport Jai Alai, Rhode Island, USA on 3 August 1979).


title: Basque pelota

text: It is a modern Mexican fusion between tennis and Basque pelota. It uses tennis rackets in a short court, although the ball has a different surface to the tennis one. Men and women both play this game. It is played only in 30 meter courts.


title: Basque pelota

text: Hand-pelota (Basque: "esku huska" or "esku huskako pilota", Spanish: "pelota a mano") is played barehanded (or with minimal protections) and with a traditional ball made of wool around a hard core and covered with leather. The standard ball should weigh 92–95 grams. It is played in the short court either individually (one vs. one) or by pairs (two vs. two). Traditionally and professionally it is reserved for men. Players can be distinguished by the swelling of their hitting hand.


title: Basque pelota

text: It was originally played in the 13th century in the Basque region of Spain and France, and has been played for a long time in Mexico, South America, Cuba, Italy and many US states, including Florida. The sport is similar to squash or fives, players hit the ball against the end wall, trying to get the ball out of the opponent's reach.


title: Basque pelota

text: Also called "Argentine paleta goma", this is played with a short and broad wooden bat, called "paleta" in both Spanish and Basque, and a gas-filled rubber ball.


title: Basque pelota

text: The ball is neither solid nor hollow. It is made from two-halves glued together. Before being glued, the core is filled with a special gas which gives the ball firmness and bounce, and thus greater speed.


title: Basque pelota

text: Paleta goma can be played by either men or women. This version of paleta was invented in Argentina and is widely played there. The Argentine male "pelotaris" are used to dominate international competitions.


title: Basque pelota

text: This variant is played with a bat similar to the previous one but with a traditional leather ball. This game is mainly played by men.


title: Basque pelota

text: This is played with somewhat shorter but thicker and much narrower bat ("pala ancha"). The ball is leather or rubber. It is reserved, in principle, for men.


title: Basque pelota

text: Is played with a longer bat ("pala larga"), again thick and not much wide. Leather or rubber ball in the long court. In principle, this game is reserved for men.


title: Basque pelota

text: This version of the sport is played essentially in France by 2 teams of 3 players on an outside court referred to as "place libre", meaning "free space" in French, or "Cancha", meaning "court" in Spanish. The court is 16 m wide and 100 m long with the limit for play being at 80 m from the wall or Fronton and has no side walls. The sport is played with the same glove as the zesta punta.


title: Basque pelota

text: A variant of the above. The basket-glove is shorter and less deep and it is allowed to retain the ball only momentarily.


title: Basque pelota

text: The Basque name "joko garbi" means "pure game", in opposition to the abuse of "atxiki" (unfair retention of the ball), typical of the late 19th century style of playing, dubbed "joko zikin" ("dirty game").


title: Basque pelota

text: Similar to joko-garbi, but the xistera is flatter and doesn't allow the atchiki foul. It can be played by individuals or teams of two players.


title: Basque pelota

text: "Xare" or "sare" (from name of the racket, which means "net" in Basque; also spelled "share" in Spanish) is played with a wooden ring strung with a net, meaning that the ball is thrown instead of hit. It is played only on the trinquet court. Xare is known for the quick, precise and sharp movements of the "pelotaris" who are capable of reaching balls considered impossible for "pelotaris" of other specialties. Bicycle-like helmets are also worn. It is traditionally strong in South American countries, especially Argentina, as a result of which it is also known as "raqueta argentina" and "raquette argentine" in Spanish and French.


title: Basque pelota

text: Professional competitions and exhibitions in the Basque Country are organized by Asegarce and ASPE for the discipline of handball, Orriamendi for Remonte, Inpala for Pala Larga. Various tournaments exist for Cesta Punta professional players in France and Spain.


title: Basque pelota

text: In the United States pelota is mainly a professional sport, strongly tied to betting and the pari-mutuel system.


title: Basque pelota

text: In 1994, the production company Asegarce started painting the courts green so that the ball would be more visible on TV.


title: Basque pelota

text: Professional games are open to betting on the results, as usual in most traditional Basque competitions. In the US and Macau it is mainly this aspect of the competition that has given it some popularity. Besides the federations, there are professional competitions such as the League of Companies of Basque Pilota. The International Jai-Alai Players Association is a union defending the players of Jai Alai.


title: Basque pelota

text: The International Federation of Basque Pelota has organized the Basque Pelota World Championships since 1952.


title: Laddu

text: Laddu or laddoo (; ; ) is a spherical sweet originating from India and spread through the Indian subcontinent and the Malay world. Laddus are primarily made from flour, fat (ghee/butter/oil) and sugar or jaggery. Laddus are often made of gram flour but can also be made with semolina. Sometimes ingredients such as chopped nuts and/or dried raisins can also be added. The type of ingredients used vary by recipe.


title: Laddu

text: At the Harappa archaeological site near Binjor in western Rajasthan, seven similarly sized laddus, consisting of legumes and cereals such as barley, wheat, chickpea and mung bean, were found in intact form, along with two figurines of bulls and a hand-held copper adze, during 2017 archeological excavations. According to Rajesh Agnihotri, the presence of bull figurines, adze and a Harappan seal along with the food balls indicates that Indus valley civilization people might have revered these items to perform some kind of ritual.


title: Laddu

text: Common flours used for laddu include gram flour (chickpea flour), wheat semolina and ground coconut. These are combined with sugar and other flavorings, cooked in ghee, and molded into a ball shape. Some laddu recipes are prepared using Ayurvedic medicinal ingredients, including methi laddu, multigrain, and resin laddu. Nuts such as pistachios and almonds are commonly stuffed into laddus.


title: Laddu

text: Boondi laddu or bundiar laddu is made from bengal gram flour (besan) based boondi. It is often served on festivals such as Raksha Bandhan and Diwali.


title: Laddu

text: Motichoor laddu (Moti-choor means crushed pearls in Hindi) is made from fine boondi where the balls are tiny and are cooked with ghee or oil. The recipe for this laddu originated in north India and is now popular throughout the Indian subcontinent.


title: Laddu

text: Besan laddu is a popular Indian sweet dish made of besan (chickpea flour or gram flour), sugar, and ghee. Besan is roasted in ghee until it has a golden brown appearance with a nutty fragrance. Then sugar is added to it. Pistachio pieces may also be included in the mixture. Sweet balls are then made from this mixture. It has a long shelf life. It is often served at festivals, family events and religious occasions in India.


title: Laddu

text: There are multiple coconut laddu recipes. Its earliest form "Narayl Nakru" dates back to the time of the Chola Empire, when it was a sweet that was packed for travelers and warriors as a symbol of good luck for their expeditions.


title: Laddu

text: In the Malay world, laddus made with palm sugar are known as klepon (in Indonesia) or onde-onde (in Malaysia, Brunei and Singapore).


title: Laddu

text: Peda (cream balls) is a popular dessert in the Indian subcontinent, prepared from khoa (milk solids by evaporation). In India, among Hindus, it is often prepared as an offering to the gods.


title: Laddu

text: This is a laddu prepared from rava (semolina), sugar and ghee. A variant on the recipe includes khoa cheese as an additional ingredient.


title: Laddu

text: Till laddu made with sesame seeds and then mixed with cheese to form balls are famous in India and Bangladesh during the months of winter.


title: Laddu

text: In India, these are traditionally given to lactating mothers as they help in the production of milk. These laddus are called "dinkache ladoo" in Marathi and "gond ka laddu" in Hindi. The main ingredient is gum arabic which is collected from the babhul tree. Other ingredients include coconut, almonds, cashews, dates, spices such as nutmeg and cardamom, poppy seeds, ghee, and sugar.


title: Laddu

text: An alternative multigrain recipe will have a portion of gum replaced by grains and legume flours such as besan, urid, ragi (nachani in Marathi) and wheat.


title: Laddu

text: This version of laddu is typically made with peanut butter, chocolate syrup, and flavored whiskey. A non-alcoholic version substitutes water for whiskey. The taste is similar to a Rum ball and Reese's Peanut Butter Cups. Some of the ingredients are smoked.


title: Laddu

text: Laddu can be prepared from a variety of grains, legumes, and seeds. Some popular ones include laddu made with roasted wheat, amaranth, garden cress seeds, fenugreek seeds, and peanuts.


title: Laddu

text: The largest individual laddu weighs and was achieved by PVVS Mallikharjuna Rao (India), in Tapeswaram, Andhra Pradesh, India, on 6 September 2016. The laddu was made to a traditional Boondi recipe. The ingredients included ghee, refined oil, cashew nuts, sugar, almonds, cardamom, and water.


title: Laddu

text: In the "Sesame Street" episode "Rakhi Road", laddus are featured prominently as a favored Indian dessert. Elmo is shown making laddus and enjoying eating them as part of the celebrations around the Indian festival of Rakhi.


title: Laddu

text: A laddu weighing 6,300 kg was made for a Ganesh festival in Andhra Pradesh, India in September 2012. This was claimed to be the largest known laddu.


title: Laddu

text: In the movie "English Vinglish", the protagonist Shashi Godbole (Sridevi) is a housewife who makes and sells laddoos for living.


title: Billy Crystal filmography

text: Billy Crystal is an American actor, comedian, singer, writer, producer, director and television host. The filmography of his work as follows.


title: Billy Crystal filmography

text: Crystal started his career in the 1970s for playing Jodie Dallas on the ABC sitcom "Soap" and became a Hollywood film star during the late 1980s and 1990s, appearing in the critical and box office successes "When Harry Met Sally..." (1989), "City Slickers" (1991), and "Analyze This" (1999) and providing the voice of Mike in the "Monsters, Inc." franchise. He has hosted the Academy Awards nine times from 1990 through the 84th Academy Awards in 2012.


title: Mithila (region)

text: Mithila (), also known as Tirhut, Tirabhukti and Mithilanchal is a geographical and cultural region of the Indian subcontinent bounded by the Mahananda River in the east, the Ganges in the south, the Gandaki River in the west and by the foothills of the Himalayas in the north. It comprises certain parts of Bihar and Jharkhand of India and adjoining districts of the Province No. 1, Bagmati Pradesh and Madhesh Province of Nepal. The native language in Mithila is Maithili, and its speakers are referred to as Maithils.


title: Mithila (region)

text: The name Mithila is commonly used to refer to the Videha Kingdom, as well as to the modern-day territories that fall within the ancient boundaries of Videha. Till the 20th century, Mithila was still ruled in part by the Raj Darbhanga.


title: Mithila (region)

text: Mithila first gained prominence after being settled by Indo-Aryan peoples who established the Videha kingdom. During the Later Vedic period (c. 1100–500 BCE), Videha became one of the major political and cultural centers of Ancient India, along with Kuru and Panchala. The kings of the Videha Kingdom were called "Janakas". The Videha Kingdom was later incorporated into the Vajjika League, which had its capital in the city of Vaishali, which is also in Mithila.


title: Mithila (region)

text: From the 11th century to the 20th century, Mithila was ruled by various indigenous dynasties. The first of these were the Karnatas, the Oiniwar Dynasty and the Khandwala Dynasty a.k.a. Raj Darbhanga. The Malla dynasty and licchivi dynasty of Nepal were also Maithil in origin. The rulers of the Oiniwar Dynasty and the Raj Darbhanga were Maithil Brahmins. It was during the reign of the Raj Darbhanga family that the capital of Mithila was shifted to Darbhanga.


title: Mithila (region)

text: Tughlaq had attacked and taken control of Bihar, and from the end of the Tughlaq Dynasty until the establishment of the Mughal Empire in 1526, there was anarchy and chaos in the region. Akbar (reigned from 1556 to 1605) realised that taxes from Mithila could only be collected if there was a king who could ensure peace there. The Brahmins were dominant in the Mithila region and Mithila had Brahmin kings in the past.


title: Mithila (region)

text: Akbar summoned Rajpandit Chandrapati Thakur to Delhi and asked him to name one of his sons who could be made caretaker and tax collector for his lands in Mithila. Chandrapati Thakur named his middle son, Mahesh Thakur, and Akbar declared Mahesh Thakur as the caretaker of Mithila on the day of Ram Navami in 1557 AD.


title: Mithila (region)

text: Lakshmeshwar Singh (reigned from 1860 to 1898) was the eldest son of Maharaja Maheshwar Singh of Darbhanga. He, along with his younger brother, Rameshwar Singh received a western education from Government appointed tutors as well as a traditional Indian education from a Sanskrit Pandit. He spent approximately £300,000 on relief work during the Bihar famine of 1873–74. He constructed hundreds of miles of roads in various parts of the Raj, planting them with tens of thousands of trees for the comfort of travellers, as part of generating employment for people effected by famine. He constructed iron bridges over all the navigable rivers


title: Mithila (region)

text: He built, and entirely supported, a first-class Dispensary at Darbhanga, which cost £3400; a similar one at Kharakpur, which cost £3500; and largely contributed to many others.


title: Mithila (region)

text: He built an Anglo-vernacular school at a cost of £1490, which he maintained, as well as nearly 30 vernacular schools of different grades; and subsidised a much larger number of educational institutions. He was also one of the founders of Indian National Congress as well as one of the main financial contributors thereto. Maharaja Lakshmeshwar Singh is known for purchasing Lowhter Castle for the venue of the 1888 Allahabad Congress session when the British denied permission to use any public place. The British Governor commissioned Edward Onslow Ford to make a statue of Lakshmeshwar Singh. This is installed at Dalhousie Square in Kolkata.


title: Mithila (region)

text: On the occasion of the Jubilee of the reign of Queen Victoria, Lakshmeshwar Singh was declared as a Knight Commander of the Most Eminent Order of the Indian Empire, and was promoted to Knight Grand Commander in 1897.


title: Mithila (region)

text: He was also a member of the Royal Commission on Opium of 1895, formed by British Government along with Haridas Viharidas Desai who was the Diwan of Junagadh. The Royal Opium Commission consisted of a 9-member team of which 7 were British and 2 were Indians and its chairman was Earl Brassey.


title: Mithila (region)

text: Mithila is a distinct geographical region with natural boundaries like rivers and hills. It is largely a flat and fertile alluvial plain criss-crossed by numerous rivers which originate from the Himalayas. Due to the flat plains and fertile land Mithila has a rich variety of biotic resources; however, because of frequent floods people could not take full advantage of these resources.


title: Mithila (region)

text: Seven major rivers flow through Mithila: Mahananda, Gandak, Kosi, Bagmati, Kamala, Balan, and the Budhi Gandak. They flow from the Himalayas in the north to the Ganges river in the south. These rivers regularly flood, depositing silt onto the farmlands and sometimes causing death or hardship.


title: Mithila (region)

text: Men and women in Mithila are very religious and dress for the festivals as well.The costumes of Mithila stem from the rich traditional culture of Mithila. Panjabi Kurta and Dhoti with a Maroon Gamchha with Mithila Painting Border, Yellow Gamchha and Red Bengali Gamchha are common clothing items for men. Men wear gold ring in their nose which symbolizes prosperity, happiness and wealth inspired by Lord Vishnu. Also wear Balla on their wrist and Mithila Paag on their Head. In ancient times there was no colour option in Mithila, so the Maithil women wore white or yellow Saree with red Border but now they have a lot of variety and colour options, and wear "Laal-Paara" (the traditional red-boarded white or yellow sari) on some special occasions, and also wear "Shakha-Pola" with lahthi in their hand. In Mithila culture, this represents new beginnings, passion and prosperity. Red also represents the Hindu goddess Durga, a symbol of new beginnings and feminine power. During Chhaith, the women of Mithila wear pure cotton dhoti without stitching which reflects the pure, traditional Culture of Mithila. Usually crafted from pure cotton for daily use and from pure silk for more glamorous occasions, traditional attire for the women of Mithila includes Jamdani, Banarisi and Bhagalpuri and many more.


title: Mithila (region)

text: Many festivals are celebrated throughout the year in Mithila. Chhath, Durga Puja and Kali puja is celebrated as perhaps the most important of all the celebrations of Mithila.


title: Mithila (region)

text: The Paag is a headdress in the Mithila region of India and Nepal worn by Maithil people. It is a symbol of honour and respect and a significant part of Maithil culture.


title: Mithila (region)

text: The Paag dates back to pre-historic times when it was made of plant leaves. It exists today in a modified form. The Paag is wore by the whole Maithil community. The colour of the Paag also carries a lot of significance. The red Paag is worn by the bridegroom and by those who are undergoing the sacred thread rituals. Paag of mustard colour is donned by those attending wedding ceremonies and the elders wear a white Paag.


title: Mithila (region)

text: This Paag now features place in the popular Macmillan Dictionary. For now, Macmillan Dictionary explains Paag as “a kind of headwear worn by people in the Mithila belt of India.”


title: Mithila (region)

text: On 10 February 2017, India Posts released a set of sixteen commemorative postage stamps on "Headgears of India". The Mithila Paag was featured on one of those postage stamps.


title: Mithila (region)

text: People of Mithila region speak Maithili primarily and are well versed in other languages like English, Bangla for other different purposes.


title: Mithila (region)

text: While Maithilis living in Nepal also use Nepali language. And some also use Bengali language in significant part of Bihar-Bengal region.


title: Mithila (region)

text: This language is an Indo-Aryan language native to the Indian subcontinent, mainly spoken in India and Nepal and is one of the 22 recognised Indian languages. In Nepal, it is spoken in the eastern Terai and is the second most prevalent language of Nepal. Tirhuta is formerly the primary script for written Maithili. Less commonly, it was also written in the local variant of Kaithi. Today it is written in the Devanagari adopted script.


title: Mithila (region)

text: Maithil cuisine is a part of Indian cuisine and Nepalese cuisine. It is a culinary style which originated in Mithila. Some traditional Maithil dishes are:


title: Mithila (region)

text: It was traditionally created by the women of different communities of the Mithila region. It is named after Madhubani district of Bihar, India which is where it originated.


title: Mithila (region)

text: This painting as a form of wall art was practiced widely throughout the region; the more recent development of painting on paper and canvas originated among the villages around Madhubani, and it is these latter developments that may correctly be referred to as "Madhubani art."


title: Mithila (region)

text: Maithili language speakers are referred to as Maithils and they are an Indo-Aryan ethno-linguistic group. There are an estimated 75 million Maithils in India alone. The vast majority of them are Hindu.


title: Mithila (region)

text: The people of Mithila can be split into various caste/clan affiliations such as Brahmins, Kayasthas, Kewats, Bhumihars, Rajputs, Koeris, Baniyas, Kamatas, Ahirs, Kurmis, Dushads, Koeris, Kujras, Manush and many more.


title: Mithila (region)

text: There is an ongoing movement in the Maithili speaking region of Bihar and Jharkhand for a separate Indian state of Mithila.


title: Mithila (region)

text: There was a movement in the Maithili speaking areas of Nepal for a separate province. Province No. 2 was established under the 2015 Constitution, which transformed Nepal into a Federal Democratic Republic, with a total of 7 provinces. Province No. 2 has a substantial Maithili speaking population and consists most of the Maithili speaking areas of Nepal. It was demanded by some Mithila activists that Province No. 2 be named 'Mithila Province'.


title: Mithila (region)

text: On 23 December 2021, four different names for the Province No. 2 were presented by the various parties of the Provincial Assembly of Madhesh Province. The four names were ‘Madhesh Pradesh’, ‘Janaki Pradesh’, ‘Madhya Madhesh Pradesh’ and ‘Mithila Bhojpura’.


title: Mithila (region)

text: Among the four names, Madhesh Pradesh (Madhesh Province) was chosen and finalized on 17 January 2022. The name was finalized with 80 percent majority in the Provincial Assembly. Janakpur was named as the capital of the province.


title: Polio eradication

text: Polio eradication, the permanent global cessation of circulation by the poliovirus and hence elimination of the poliomyelitis (polio) it causes, is the aim of a multinational public health effort begun in 1988, led by the World Health Organization (WHO), the United Nations Children's Fund (UNICEF) and the Rotary Foundation. These organizations, along with the U.S. Centers for Disease Control and Prevention (CDC) and The Gates Foundation, have spearheaded the campaign through the Global Polio Eradication Initiative (GPEI). Successful eradication of infectious diseases has been achieved twice before, with smallpox in humans and rinderpest in ruminants.


title: Polio eradication

text: Prevention of disease spread is accomplished by vaccination. There are two kinds of polio vaccine—oral polio vaccine (OPV), which uses weakened poliovirus, and inactivated polio vaccine (IPV), which is injected. OPV is less expensive and easier to administer, and can spread immunity beyond the person vaccinated, creating contact immunity. It has been the predominant vaccine used. However, under conditions of long-term vaccine virus circulation in under-vaccinated populations, mutations can reactivate the virus to produce a polio-inducing strain, while OPV can also, in rare circumstances, induce polio or persistent asymptomatic infection in vaccinated individuals, particularly those who are immunodeficient. Being inactivated, IPV is free of these risks but does not induce contact immunity. IPV is more costly and the logistics of delivery are more challenging.


title: Polio eradication

text: Nigeria is the latest country to have officially stopped endemic transmission of wild poliovirus, with its last reported case in 2016. Wild poliovirus has been eradicated in all continents except Asia, and , Afghanistan and Pakistan are the only two countries where the disease is still classified as endemic.


title: Polio eradication

text: Recent polio cases arise from two sources, the original 'wild' poliovirus (WPV), and the much more prevalent mutated oral vaccine strains, so-called circulating vaccine-derived poliovirus (cVDPV). Vaccines against each of the three wild strains of polio have given rise to strains of cVDPV, with cVDPV2 being most prominent. cVDPV caused 698 reported paralytic polio cases worldwide in 2021.


title: Polio eradication

text: There were 6 reported WPV cases in 2021, a decrease from 2019's 5-year high, a reduction from the 719 diagnosed cases in 2000 and a reduction from the estimated 350,000 cases when the eradication effort began in 1988. Of the three strains of WPV, the last recorded wild case caused by type2 (WPV2) was in 1999, and WPV2 was declared eradicated in 2015. Type3 (WPV3) is last known to have caused polio in 2012, and was declared eradicated in 2019. All wild-virus cases since that date have been due to type1 (WPV1).


title: Polio eradication

text: Eradication of polio has been defined in various ways—as elimination of the occurrence of poliomyelitis even in the absence of human intervention, as extinction of poliovirus, such that the infectious agent no longer exists in nature or in the laboratory, as control of an infection to the point at which transmission of the disease ceased within a specified area, and as reduction of the worldwide incidence of poliomyelitis to zero as a result of deliberate efforts, and requiring no further control measures.


title: Polio eradication

text: In theory, if the right tools were available, it would be possible to eradicate all infectious diseases that reside only in a human host. In reality, there are distinct biological features of the organisms and technical factors of dealing with them that make their potential eradicability more or less likely. Three indicators, however, are considered of primary importance in determining the likelihood of successful eradication: that effective interventional tools are available to interrupt transmission of the agent, such as a vaccine; that diagnostic tools, with sufficient sensitivity and specificity, be available to detect infections that can lead to transmission of the disease; and that humans are required for the life-cycle of the agent, which has no other vertebrate reservoir and cannot amplify in the environment.


title: Polio eradication

text: The most important step in eradication of polio is interruption of endemic transmission of poliovirus. Stopping polio transmission has been pursued through a combination of routine immunization, supplementary immunization campaigns and surveillance of possible outbreaks. Several key strategies have been outlined for stopping polio transmission:


title: Polio eradication

text: There are two distinct types of polio vaccine. Oral polio vaccine (OPV, or Sabin vaccine) contains attenuated poliovirus. Attenuated poliovirus is 10,000 times less able than wild poliovirus to enter the bloodstream and cause polio.


title: Polio eradication

text: OPV is delivered as oral drops or infused into sugar cubes. It is highly effective and inexpensive (about per dose in 2016) and its availability has bolstered efforts to eradicate polio. A study carried out in an isolated Inuit village showed that antibodies produced from subclinical wild virus infection persisted for at least 40 years. Because the immune response to oral polio vaccine is very similar to that of natural polio infection, it is expected that oral polio vaccination provides similar lifelong immunity to the virus. Because of its route of administration, it induces an immunization of the intestinal mucosa that protects against subsequent infection, though multiple doses are necessary to achieve effective prophylaxis. It can also produce contact immunity. Attenuated poliovirus derived from the oral polio vaccine is excreted, infecting and indirectly inducing immunity in unvaccinated individuals, and thus amplifying the effects of the doses delivered. The oral administration does not require special medical equipment or training. Taken together, these advantages have made it the favored vaccine of many countries, and it has long been preferred by the global eradication initiative.


title: Polio eradication

text: The primary disadvantage of OPV derives from its inherent nature. As an attenuated but active virus, it can induce vaccine-associated paralytic poliomyelitis (VAPP) in approximately one individual per every 2.4million doses administered. Likewise, mutation during the course of persistent circulation in undervaccinated populations can lead to vaccine-derived poliovirus strains (cVDPV) that can induce polio at much higher rates than the original vaccine. Until recent times, a trivalent OPV containing all three virus strains was used, but with the eradication of wild poliovirus type2 this was phased out in 2016 and replaced with bivalent vaccine containing just types 1 and 3, supplemented with monovalent type2 OPV in regions with documented cVDPV2 circulation. A novel OPV2 vaccine (nOPV2) genetically modified to reduce the likelihood of disease-causing activating mutations was introduced in March 2021 on a limited basis, and later in the year it was recommended for expanded use, with full rollout expected in 2023.


title: Polio eradication

text: The inactivated polio vaccine (IPV, or Salk) contains trivalent fully inactivated virus, administered by injection. This vaccine cannot induce VAPP nor do cVDPV strains arise from it, but it likewise cannot induce contact immunity and thus must be administered to every individual. Added to this are greater logistical challenges. Though a single dose is sufficient for protection, administration requires medically trained vaccinators armed with single-use needles and syringes. Taken together, these factors result in substantially higher delivery costs. Original protocols involved intramuscular injection in the arm or leg, but recently subcutaneous injection using a lower dose (so-called fractional-dose IPV, fIPV) has been found to be effective, lowering costs and also allowing for more convenient and cost-effective delivery systems. The use of IPV results in serum immunity, but no intestinal immunity arises. As a consequence, vaccinated individuals are protected from contracting polio, but their intestinal mucosa may still be infected and serve as a reservoir for the excretion of live virus. For this reason, IPV is ineffective at halting ongoing outbreaks of WPV or cVDPV, but it has become the vaccine of choice for industrialized, polio-free countries.


title: Polio eradication

text: While IPV does not itself induce mucosal immunity, it has been shown to boost the mucosal immunity from OPV, and the WHO now favors a combined protocol. It is recommended that vulnerable children receive a dose of OPV at birth, then beginning at the age of six weeks a 'primary series' consisting of three OPV doses at least four weeks apart, along with one dose of IPV after 14 weeks. This combined IPV/OPV approach has also been used in outbreak suppression.


title: Polio eradication

text: Polio vaccination is also important in the development of herd immunity. For polio to occur in a population, there must be an infecting organism (poliovirus), a susceptible human population, and a cycle of transmission. Poliovirus is transmitted only through person-to-person contact, and the transmission cycle of polio is from one infected person to another person susceptible to the disease. If the vast majority of the population is immune to a particular agent, the ability of that pathogen to infect another host is reduced; the cycle of transmission is interrupted, and the pathogen cannot reproduce and dies out. This concept, called community immunity or herd immunity, is important to disease eradication, because it means that it is not necessary to inoculate 100% of the population—a goal that is often logistically very difficult—to achieve the desired result. If the number of susceptible individuals can be reduced to a sufficiently small number through vaccination, then the pathogen will eventually die off.


title: Polio eradication

text: When many hosts are vaccinated, especially simultaneously, the transmission of wild virus is blocked, and the virus is unable to find another susceptible individual to infect. Because poliovirus can only survive for a short time in the environment (a few weeks at room temperature, and a few months at 0–8 °C (32–46 °F)), without a human host, the virus dies out.


title: Polio eradication

text: Herd immunity is an important supplement to vaccination. Among those individuals who receive oral polio vaccine, only 95 percent will develop immunity after three doses. This means that five of every 100 given the vaccine will not develop any immunity and will be susceptible to developing polio. According to the concept of herd immunity, the population for whom the vaccine fails is still protected by the immunity of those around them. Herd immunity may only be achieved when vaccination levels are high. It is estimated that 80–86 percent of individuals in a population must be immune to polio for the susceptible individuals to be protected by herd immunity. If routine immunization were to be stopped, the number of unvaccinated, susceptible individuals would soon exceed the capability of herd immunity to protect them.


title: Polio eradication

text: While vaccination has played an instrumental role in the reduction of polio cases worldwide, the use of attenuated virus in the oral vaccine carries with it an inherent risk. The oral vaccine is a powerful tool in fighting polio in part because of its person-to-person transmission and resulting contact immunity. However, under conditions of long-term circulation in undervaccinated populations, the virus can accumulate mutations that reverse the attenuation and result in vaccine virus strains that themselves cause polio. As a result of such circulating vaccine-derived poliovirus (cVDPV) strains, polio outbreaks have periodically recurred in regions that have long been free of the wild virus, but where vaccination rates have fallen. Oral vaccines can also give rise to persistent infection in immunodeficient individuals, with the virus eventually mutating into a more virulent immunodeficiency-associated vaccine-derived poliovirus (iVDPV). In particular, the type2 strain seems prone to reversions, so in 2016 the eradication effort abandoned the trivalent oral vaccine containing attenuated strains of all three virus types and replaced it with a bivalent oral vaccine lacking the type2 virus, while a separate monovalent type2 vaccine (mOPV2) was to be used only to target existing cVDPV2 outbreaks. Further, a novel oral vaccine targeting type2 (nOPV2) that has been genetically stabilized to make it less prone to give rise to circulating vaccine-derived strains is now in limited use. Eradication efforts will eventually require all oral vaccination to be discontinued in favor of the use of injectable vaccines. These vaccines are more expensive and more difficult to deliver, and they lack the ability to induce contact immunity because they contain only killed virus, but they likewise are incapable of giving rise to vaccine-derived viral strains.


title: Polio eradication

text: A global program of surveillance for the presence of polio and the poliovirus plays a critical role in assessment of eradication and in outbreak detection and response. Two distinct methods are used in tandem: acute flaccid paralysis (AFP) surveillance and environmental surveillance.


title: Polio eradication

text: Monitoring for AFP aims at identifying outbreaks of polio by screening patients displaying symptoms consistent with, but not exclusive to, severe poliovirus infection. Stool samples are collected from children presenting with AFP and evaluated for the presence of poliovirus by accredited laboratories in the Global Polio Laboratory Network. Since rates of non-polio AFP are expected to be constant and large compared to the number of polio cases, the frequency of non-polio AFP reported in a population is indicative of the effectiveness of surveillance, as is the proportion of AFP patients from whom high-quality stool samples are collected and tested, with a target of at least 80%.


title: Polio eradication

text: Environmental surveillance is used to supplement AFP surveillance. This entails the routine testing of sewage samples for the presence of virus, which not only allows the effectiveness of vaccination efforts to be evaluated in countries with active transmission, but also allows the detection of new outbreaks in countries without known transmission. In 2018, the GPEI conducted environmental surveillance in 44 countries, 24 of which are in Africa.


title: Polio eradication

text: Among the greatest obstacles to global polio eradication are the lack of basic health infrastructure, which limits vaccine distribution and delivery, the crippling effects of civil war and internal strife, and the sometimes oppositional stance that marginalized communities take against what is perceived as a potentially hostile intervention by outsiders. Another challenge has been maintaining the potency of live (attenuated) vaccines in extremely hot or remote areas. The oral polio vaccine must be kept at for vaccination to be successful.


title: Polio eradication

text: An independent evaluation of obstacles to polio eradication requested by the WHO and conducted in 2009 considered the major obstacles in detail by country. In Afghanistan and Pakistan, the researchers concluded that the most significant barrier was insecurity, but that managing human resources, political pressures, the movement of large populations between and within both countries, and inadequately resourced health facilities also posed problems, as did technical issues with the vaccine. In India, the major challenge appeared to be the high efficiency of transmission within the populations of Bihar and Uttar Pradesh states, set against the low (~80% after three doses against type1) seroconversion response seen from the vaccine. In Nigeria, the most critical barriers identified were management issues, in particular the highly variable importance ascribed to polio by different authorities at the local government level, although funding issues, community perceptions of vaccine safety, inadequate mobilisation of community groups, and issues with the cold chain also played a role. In those countries where international spread from endemic countries had resulted in the reestablishment of transmission, namely Angola, Chad, and South Sudan, the key issues identified were underdeveloped health systems and low routine vaccine coverage, although the low level of resources committed to Angola and South Sudan for the purpose of curtailing the spread of polio and climatic factors was also identified as playing a role.


title: Polio eradication

text: Two additional challenges are found in unobserved polio transmission and in vaccine-derived poliovirus. First, most individuals infected with poliovirus are asymptomatic or exhibit minor symptoms, with fewer than 1% of infections leading to paralysis, and most infected people are unaware that they carry the disease, allowing polio to spread widely before cases are seen. In 2000, using new screening techniques for the molecular characterization of outbreak viral strains, it was discovered that some of the outbreaks were actually caused by circulating vaccine-derived poliovirus, following mutations or recombinations in the attenuated strain used for the oral polio vaccine. This discovery altered the strategy for the discontinuation of vaccination following polio eradication, necessitating an eventual switch to the more expensive and logistically more problematic inactivated polio vaccine, as continued use of the oral inactivated virus would continue to produce such revertant infection-causing strains. The risk of vaccine-derived polio will persist long after the switch to inactivated vaccine, as a small number of chronic excretors continue to produce active virus for years (or even decades) after their initial exposure to the oral vaccine.


title: Polio eradication

text: In a 2012 interview with Pakistani newspaper "Dawn", Dr. Hussain A. Gezari, the WHO's special envoy on global polio eradication and primary healthcare, gave his views on obstacles to eradication. He said that the biggest hurdle preventing Pakistan from becoming polio-free was holding district health officials properly accountable—in national eradication campaigns officials had hired their own relatives, even young children. Gezari asked, "How do you expect a seven-year-old thumb-sucking kid to implement a polio campaign of the government?" and added that, in spite of this, "the first national campaign was initiated by your government in 1994 and that year Pakistan reported 25,000 polio cases, and the number was just 198 last year, which clearly shows that the programme is working."


title: Polio eradication

text: One factor contributing to the continued circulation of polio immunization programs has been opposition to vaccination in some countries.


title: Polio eradication

text: In the context of the United States invasion of Afghanistan and the subsequent 2003 invasion of Iraq, rumours arose in the Muslim world that immunization campaigns were using intentionally-contaminated vaccines to sterilize local Muslim populations or to infect them with HIV. In Nigeria these rumours fit in with a longstanding suspicion of modern biomedicine, which since its introduction during the era of colonialism has been viewed as a projection of the power of western nations. Refusal of vaccination came to be viewed as resistance to western expansionism, and when the contamination rumours led the Nigerian Supreme Council for Sharia to call for a region-wide boycott of polio vaccination, polio cases in the country increased more than five-fold between 2002 and 2006, with the uncontrolled virus then spreading across Africa and globally. In Afghanistan and Pakistan, fears that the vaccine contained contraceptives were one reason given by the Taliban in issuing "fatwas" against polio vaccination. Religious boycotts based on contamination concerns have not been limited to the Muslim world. In 2015, after claiming that a tetanus vaccine contained a contraceptive, a group of Kenyan Catholic bishops called on their followers to boycott a planned round of polio vaccination. This did not have a major effect on vaccination rates, and dialog along with vaccine testing forestalled further boycott calls.


title: Polio eradication

text: Other religion-inspired refusals arise from concern over whether the virus contains pig-derived products, and hence are "haram" (forbidden) in Islam, concern that vaccine production may have involved a prohibited taking of animal life, or a resistance to interfering with disease processes perceived to be divinely-directed. Concerns were addressed through extensive outreach, directed both toward the communities involved and respected clerical bodies, as well as promoting local ownership of the eradication campaign in each region. In early 2012, some parents refused to get their children vaccinated in Khyber Pakhtunkhwa (KPK) and in the Federally Administered Tribal Areas (FATA) but religious refusals in the rest of the country had "decreased manifold". Even with the express support of political leaders, polio workers or their accompanying security guards have been kidnapped, beaten, or assassinated.


title: Polio eradication

text: Skepticism in the Muslim world was exacerbated when it was learned that in 2011 the Central Intelligence Agency (CIA) had conducted a fake hepatitis B immunization campaign, hoping to collect blood samples from Osama bin Laden's compound in Abbottabad in order to confirm the genetic identity of the children living there, and by implication his own presence, leading directly to his killing. In a letter written to CIA director Leon Panetta, the InterAction Alliance, a union of about 200 U.S.-based non-government organizations, deplored the actions of the CIA in using a vaccination campaign as a cover. Pakistan reported the world's highest number of polio cases (198), in 2011. and more than 60 polio vaccination workers were killed December from 2012 to April 2014. In May 2014, CIA director John Brennan prohibited his agency both from using vaccinations to cover operations and from testing samples collected by authentic vaccination campaigns.


title: Polio eradication

text: Polio vaccination efforts have also faced resistance in another form. The priority placed on vaccination by national authorities has turned it into a bargaining chip, with communities and interest groups resisting vaccination, not due to direct opposition, but to leverage other concessions from governmental authorities. In Nigeria this has taken the form of 'block rejection' of vaccination that is only resolved when state officials agree to repair or improve schools and health-care facilities, pave roads or install electricity. There have been several instances of threatened boycotts by health workers in Pakistan over payment disputes. Some governments have been accused of withholding vaccination or the necessary accompanying infrastructure from regions where opposition to their rule is high.


title: Polio eradication

text: A country is regarded as polio-free or non-endemic if no cases have been detected for a year. However, it is still possible for polio to circulate under these circumstances, as was the case for Nigeria, where a particular strain of virus resurfaced after five years in 2016. This can be due to chance, limited surveillance and under-vaccinated populations. Moreover, for WPV1—the only type of the virus which is currently circulating following the eradication of WPV2 and WPV3—only 1 in 200 infection cases exhibit symptoms of polio paralysis in non-vaccinated children, and possibly even fewer in vaccinated children.


title: Polio eradication

text: According to modeling, it can take four to six months of no reported cases to achieve only a 50% chance of eradication, and one to two years for e.g. 95% chance. Sensitivity of monitoring for circulation can be improved by sampling sewage. In Pakistan in the last couple of years, the number of paralysis cases has dropped relatively faster than the positive environmental samples, which has shown no progress since 2015. The presence of multiple infections with the same strain in the upstream area may not be detectable, so there are some saturation effects when monitoring the number of positive environmental samples. Furthermore, virus may shed beyond the expected duration of several weeks in certain individuals. Contagiousness can not be readily excluded. For a polio virus to be certified as eradicated worldwide, at least three years of good surveillance without cases needs to be achieved, though this period may need to be longer for a strain like WPV3, where a lower proportion of those infected demonstrate symptoms, or if virus-positive environmental samples continue to be reported. Wild poliovirus type2 was certified eradicated in 2015, the last case having been detected in 1999. Wild poliovirus type3 has not been detected since 2012, and was certified eradicated in 2019.


title: Polio eradication

text: Following the widespread use of poliovirus vaccine in the mid-1950s, the incidence of poliomyelitis declined rapidly in many industrialized countries. Czechoslovakia became the first country in the world to scientifically demonstrate nationwide eradication of poliomyelitis in 1960. In 1962—just one year after Sabin's oral polio vaccine (OPV) was licensed in most industrialized countries—Cuba began using the oral vaccine in a series of nationwide polio campaigns. The early success of these mass vaccination campaigns suggested that polioviruses could be globally eradicated. The Pan American Health Organization (PAHO), under the leadership of Ciro de Quadros, launched an initiative to eradicate polio from the Americas in 1985.


title: Polio eradication

text: Much of the work towards eradication was documented by Brazilian photographer Sebastião Salgado, as a UNICEF Goodwill Ambassador, in the book "The End of Polio: Global Effort to End a Disease".


title: Polio eradication

text: In 1988, the World Health Organization (WHO), together with Rotary International, UNICEF, and the U.S. Centers for Disease Control and Prevention (CDC) passed the Global Polio Eradication Initiative (GPEI), with the goal of eradicating polio by the year 2000. The initiative was inspired by Rotary International's 1985 pledge to raise $120million toward immunising all of the world's children against the disease. The last case of wild poliovirus poliomyelitis in the Americas was reported in Peru, August 1991.


title: Polio eradication

text: On 20 August 1994, the Americas were certified as polio-free. This achievement was a milestone in efforts to eradicate the disease.


title: Polio eradication

text: In 1994, the Indian Government launched the Pulse Polio Campaign to eliminate polio. The current campaign involves annual vaccination of all children under age five.


title: Polio eradication

text: In 1995, Operation MECACAR (Mediterranean, Caucasus, Central Asian Republics, and Russia) was launched; National Immunization Days were coordinated in 19 European and Mediterranean countries. In 1998, Melik Minas of Turkey became the last case of polio reported in Europe. In 1997, Mum Chanty of Cambodia became the last person to contract polio in the Indo-West Pacific region. In 2000, the Western Pacific Region (including China) was certified polio-free.


title: Polio eradication

text: In October 1999, the last isolation of type2 poliovirus occurred in India. This type of poliovirus was declared eradicated.


title: Polio eradication

text: Also in October 1999, The CORE Group—with funding from the United States Agency for International Development (USAID)—launched its effort to support national eradication efforts at the grassroots level. The CORE Group commenced this initiative in Bangladesh, India, and Nepal in South Asia, and in Angola, Ethiopia, and Uganda in Africa.


title: Polio eradication

text: By 2001, 575million children (almost one-tenth the world's population) had received some two billion doses of oral polio vaccine. The World Health Organization announced that Europe was polio-free on 21 June 2002, in the Copenhagen Glyptotek.


title: Polio eradication

text: In 2002, an outbreak of polio occurred in India. The number of planned polio vaccination campaigns had recently been reduced, and populations in northern India, particularly from the Islamic background, engaged in mass resistance to immunization. At this time, the Indian state Uttar Pradesh accounted for nearly two-thirds of total worldwide cases reported. (See the .) However, by 2004, India had adopted strategies to increase ownership of polio vaccinations in marginalized populations, and the immunity gap in vulnerable groups rapidly closed.


title: Polio eradication

text: In August 2003, rumors spread in some states in Nigeria, especially Kano, that the vaccine caused sterility in girls. This resulted in the suspension of immunization efforts in the state, causing a dramatic rise in polio rates in the already endemic country. On 30 June 2004, the WHO announced that after a 10-month ban on polio vaccinations, Kano had pledged to restart the campaign in early July. During the ban the virus spread across Nigeria and into 12 neighboring countries that had previously been polio-free. By 2006, this ban would be blamed for 1,500 children being paralyzed and had cost $450million for emergency activities. In addition to the rumors of sterility and the ban by Nigeria's Kano state, civil war and internal strife in Sudan and Côte d'Ivoire have complicated WHO's polio eradication goal. In 2004, almost two-thirds of all the polio cases in the world occurred in Nigeria (760 out of 1,170 total).


title: Polio eradication

text: In May 2004, the first case of the polio outbreak in Sudan was detected. The reemergence of polio led to stepped up vaccination campaigns. In the city of Darfur, 78,654 children were immunized and 20,432 more in southern Sudan (Yirol and Chelkou).


title: Polio eradication

text: In 2005, there were 1,979 cases of wild poliovirus (excluding vaccine-derived poliovirus). Most cases were located in two areas: the Indian subcontinent and Nigeria. Eradication efforts in the Indian sub-continent met with a large measure of success. Using the Pulse Polio campaign to increase polio immunization rates, India recorded just 66 cases in 2005, down from 135 cases reported in 2004, 225 in 2003, and 1,600 in 2002.


title: Polio eradication

text: Yemen, Indonesia, and Sudan, countries that had been declared polio-free since before 2000, each reported hundreds of cases—probably imported from Nigeria. On 5 May 2005, news reports broke that a new case of polio was diagnosed in Java, Indonesia, and the virus strain was suspected to be the same as the one that has caused outbreaks in Nigeria. New public fears over vaccine safety, which were unfounded, impeded vaccination efforts in Indonesia. In summer 2005, the WHO, UNICEF and the Indonesian government made new efforts to lay the fears to rest, recruiting celebrities and religious leaders in a publicity campaign to promote vaccination.


title: Polio eradication

text: In the United States on 29 September 2005, the Minnesota Department of Health identified the first occurrence of vaccine derived polio virus (VDPV) transmission in the United States since OPV was discontinued in 2000. The poliovirus type1 infection occurred in an unvaccinated, immunocompromised infant girl aged seven months (the index patient) in an Amish community whose members predominantly were not vaccinated for polio.


title: Polio eradication

text: In 2006, only four countries in the world (Nigeria, India, Pakistan, and Afghanistan) were reported to have endemic polio. Cases in other countries are attributed to importation. A total of 1,997 cases worldwide were reported in 2006; of these the majority (1,869 cases) occurred in countries with endemic polio. Nigeria accounted for the majority of cases (1,122 cases) but India reported more than ten times more cases in 2006 than in 2005 (676 cases, or 30% of worldwide cases). Pakistan and Afghanistan reported 40 and 31 cases respectively in 2006. Polio re-surfaced in Bangladesh after nearly six years of absence with 18 new cases reported. "Our country is not safe, as neighbours India and Pakistan are not polio free", declared Health Minister ASM Matiur Rahman. (See: )


title: Polio eradication

text: In 2007, there were 1,315 cases of poliomyelitis reported worldwide. Over 60% of cases (874) occurred in India; while in Nigeria, the number of polio cases fell dramatically, from 1,122 cases reported in 2006 to 285 cases in 2007. Officials credit the drop in new infections to improved political control in the southern states and resumed immunisation in the north, where Muslim clerics led a boycott of vaccination in late 2003. Local governments and clerics allowed vaccinations to resume on the condition that the vaccines be manufactured in Indonesia, a majority Muslim country, and not in the United States. Turai Yar'Adua, wife of recently elected Nigerian president Umaru Yar'Adua, made the eradication of polio one of her priorities. Attending the launch of immunization campaigns in Birnin Kebbi in July 2007, Turai Yar'Adua urged parents to vaccinate their children and stressed the safety of oral polio vaccine.


title: Polio eradication

text: In July 2007, a student traveling from Pakistan imported the first polio case to Australia in over 20 years. Other countries with significant numbers of wild polio virus cases include the Democratic Republic of the Congo, which reported 41 cases, Chad with 22 cases, and Niger and Myanmar, each of which reported 11 cases.


title: Polio eradication

text: In 2008, 18 countries reported cases and the total number of cases was 1,651. Of these, 1,505 occurred in the four endemic countries and 146 elsewhere. The largest numbers were in Nigeria (798 cases) and India (559 cases): these two countries combined had 82.2 percent of all cases. Outside endemic countries, Chad reported the greatest number (37 cases).


title: Polio eradication

text: In 2009, a total of 1,604 cases were reported in 23 countries. Four endemic countries accounted for 1,256 of these, with the remaining 348 in 19 sub-Saharan countries with imported cases or re-established transmission. Once again, the largest numbers were in India (741) and Nigeria (388). All other countries had less than one hundred cases: Pakistan had 89 cases, Afghanistan 38, Chad 64, Sudan 45, Guinea 42, Angola 29, Côte d'Ivoire 26, Benin 20, Kenya 19, Burkina Faso 15, Niger 15, Central African Republic 14, Mauritania 13, and Liberia and Sierra Leone both had 11. The following countries had single-digit numbers of cases: Uganda with 8 cases, Togo 6, Cameroon 3, the Democratic Republic of the Congo 3, Burundi 2, and Mali 2.


title: Polio eradication

text: According to figures updated in April 2012, the WHO reported that there were 1,352 cases of wild polio in 20 countries in 2010. Reported cases of polio were down 95% in Nigeria (to a historic low of 21 cases) and 94% in India (to a historic low of 42 cases) compared to the previous year, with little change in Afghanistan (from 38 to 25 cases) and an increase in cases in Pakistan (from 89 to 144 cases). An acute outbreak in Tajikistan gave rise to 460 cases (34% of the global total), and was associated with a further 18 cases across Central Asia (Kazakhstan and Turkmenistan) and the Russian Federation, with the most recent case from this region being reported from Russia 25 September. These were the first cases in the WHO European region since 2002. The Republic of Congo (Brazzaville) saw an outbreak with 441 cases (30% of the global total). At least 179 deaths were associated with this outbreak, which is believed to have been an importation from the ongoing type1 outbreak in Angola (33 cases in 2010) and the Democratic Republic of the Congo (100 cases).


title: Polio eradication

text: In 2011, 650 WPV cases were reported in sixteen countries: the four endemic countries—Pakistan, Afghanistan, Nigeria, and India—as well as twelve others. Polio transmission recurred in Angola, Chad and the Democratic Republic of the Congo. Kenya reported its first case since 2009, while China reported 21 cases, mostly among the Uyghurs of Hotan prefecture, Xinjiang, the first cases since 1994.


title: Polio eradication

text: The total number of wild-virus cases reported in 2012 was 223, lower than any previous year. These were limited to five countries—Nigeria, Pakistan, Afghanistan, Chad, and Niger—of which all except Nigeria had fewer cases than in 2011. Several additional countries, Chad, Democratic Republic of the Congo, Somalia, and Yemen, saw outbreaks of circulating vaccine-derived polio. The last reported type3 case of polio worldwide had its onset 11 November 2012 in Nigeria; the last wild case outside Nigeria was in April 2012 in Pakistan, and its absence from sewage monitoring in Pakistan suggests that active transmission of this strain has ceased there. A total of 416 wild-virus cases were reported in 2013, almost double the previous year. Of these, cases in endemic countries dropped from 197 to 160, while those in non-endemic countries jumped from 5 to 256 owing to two outbreaks: one in the Horn of Africa, and one in Syria.


title: Polio eradication

text: In April, a case of wild polio in Mogadishu was reported, the first in Somalia since 2007. By October, over 170 cases had been reported in the country, with more cases in neighboring Kenya and the Somali Region of Ethiopia.


title: Polio eradication

text: Routine sewage monitoring in 2012 had detected a WPV1 strain of Pakistani origin in Cairo, sparking a major vaccination push there. The strain spread to Israel, where there was widespread environmental detection, but like Egypt, no paralysis cases. It had more severe consequences when it spread to neighboring Syria, with the total number of cases eventually reaching 35, the first outbreak there since 1999.


title: Polio eradication

text: In April 2013, the WHO announced a new $5.5billion, 6-year cooperative plan (called the 2013–18 Polio Eradication and Endgame Strategic Plan) to eradicate polio from its last reservoirs. The plan called for mass immunization campaigns in the three remaining endemic countries, and also dictated a switch to inactivated virus injections, to avoid the risk of the vaccine-derived outbreaks that occasionally occur from use of the live-virus oral vaccine.


title: Polio eradication

text: In 2014, there were 359 reported cases of wild poliomyelitis, spread over twelve countries. Pakistan had the most with 306, an increase from 93 in 2013, which was blamed on Al Qaeda and Taliban militants preventing aid workers from vaccinating children in rural regions of the country. On 27 March 2014, the WHO announced the eradication of poliomyelitis in the South-East Asia Region, in which the WHO includes eleven countries: Bangladesh, Bhutan, North Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor-Leste. With the addition of this region, the proportion of world population living in polio-free regions reached 80%. The last case of wild polio in the South-East Asia Region was reported in India on 13 January 2011.


title: Polio eradication

text: During 2015, 74 cases of wild poliomyelitis were reported worldwide, 54 in Pakistan and 20 in Afghanistan. There were 32 circulating vaccine-derived poliovirus (cVDPV) cases in 2015.


title: Polio eradication

text: On 25 September 2015, the WHO declared that Nigeria was no longer considered endemic for wild polio virus, with no reported case of wild polio virus having been reported since 24 July 2014. A WPV1 strain not seen in five years resurfaced in Nigeria the following year.


title: Polio eradication

text: The WPV2 virus was declared eradicated in September 2015 as it had not been detected in circulation since 1999 and WPV3 was declared eradicated in October 2019, having last been detected in 2012. Both types persist in the form of circulating vaccine-derived strains, the product of years-long evolution of transmissible oral vaccine in under-immunized populations.


title: Polio eradication

text: There were 37 reported WPV1 cases with an onset of paralysis in 2016, half as many as in 2015, with the majority of the cases in Pakistan and Afghanistan. A small number of additional cases in Nigeria, caused by WPV1, were viewed as a setback, the first being detected there in almost two years, yet the virus had been circulating undetected in regions inaccessible due to the activities of Boko Haram. There was also a cVDPV1 outbreak in Laos, while new strains of cVDPV2 arose separately in Nigeria's Borno and Sekoto states, and in the Quetta area of Pakistan, collectively causing five cases.


title: Polio eradication

text: Because cVDPV2 strains continued to arise from trivalent oral vaccine that included attenuated PV2, this vaccine was replaced with a bivalent version lacking WPV2 as well as trivalent injected inactivated vaccine that cannot lead to cVDPV cases. This was expected to prevent new strains of cVDPV2 from arising and allow eventual cessation of WPV2 vaccination. The resulting global use of the injectable vaccine caused shortages, and a protocol using vaccine at one-fifth the normal dose (fractional-dose Inactivated Polio Vaccine, or fIPV) was introduced.


title: Polio eradication

text: There were 22 reported WPV1 polio cases with onset of paralysis in 2017, down from 37 in 2016. Eight of the cases were in Pakistan and 14 in Afghanistan, where genetic typing showed repeated introduction from Pakistan as well as local transmission. In Pakistan, transmission of several genetic lineages of WPV1 seen in 2015 had been interrupted by September 2017, though at least two genetic clusters remain. In spite of a significant drop in detected cases in Pakistan, there was an increase in the percentage of environmental samples that test positive for the polio virus, suggesting gaps in identification of infected individuals. In the third country where polio remained endemic, Nigeria, there were no cases, though as few as 7% of infants were fully vaccinated in some districts. An April 2017 spill at a vaccine production facility in the Netherlands only resulted in one asymptomatic WPV2 infection, despite release into the sewer system.


title: Polio eradication

text: Laos was declared free of cVDPV1 in March, but three distinct cVDPV2 outbreaks occurred in the Democratic Republic of the Congo, one of them of recent origin, the other two having circulated undetected for more than a year. Together they caused 20 cases by year's end. In Syria, a large outbreak began at Mayadin, Deir ez-Zor Governorate, a center of fighting in the Syrian Civil War, and also spreading to neighboring districts saw 74 confirmed cases from a viral strain that had circulated undetected for about two years. Circulation of multiple genetic lines of cVDPV2 was also detected in Banadir province, Somalia, but no infected individuals were identified. WHO's Strategic Advisory Group of Experts on Immunization recommended that cVDPV2 suppression be prioritized over targeting WPV1, and according to protocol OPV2 is restricted to this purpose.


title: Polio eradication

text: The 2016 global switch in vaccination methods resulted in shortages of the injectable vaccine, and led the WHO in April 2017 to recommend general use of the fIPV vaccination protocol, involving subcutaneous injection of a lower dose than used in the standard intramuscular delivery.