Polio updates - latest update at June 2017

Update June 2017

In Syria, a circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak has been confirmed.  The virus strain was isolated from two cases of acute flaccid paralysis (AFP) and one healthy contact, from Deir-Ez-Zor governorate.  See the ‘Syrian Arab Republic’ section below for more information.

The final decision made by the World Health Assembly on 29 May on polio transition planning is now available online.  The decision follows extensive discussions by Member States on the need to address the challenge of scaling down the polio programme as eradication comes closer, including the potential impact on achieving and sustaining a polio-free world, on health system programmes and on systems currently supported by polio assets.  Delegates welcomed existing efforts to plan for the post-polio world, and stressed the importance of careful, considered and strategic approaches to the transition of polio assets, requesting the Director-General to prepare a detailed transition action plan.

Summary of newly-reported viruses this week: Syria – two new circulating vaccine-derived poliovirus type 2 (cVDPV2) isolated from acute flaccid paralysis (AFP) cases and one cVDPV2 isolated from a healthy contact; and, Pakistan – four new environmental sample positive for wild poliovirus type 1 (WPV1).

Case breakdown by country

NA: onset of paralysis in most recent case is prior to 2015. Figures exclude non-AFP sources. Lao PDR cVDPV1, all others cVDPV2. cVDPV definition: see document “Reporting and classification of vaccine-derived polioviruses” at [pdf]

Weekly country updates as of 7 June 2017

Afghanistan

No new wild poliovirus type 1 (WPV1) cases were reported in the past week.  The total number of cases for 2017 remains three, and for 2016 remains 13.  The most recent case had onset of paralysis on 21 February, from Kunduz province.

With most of Afghanistan polio-free, efforts are focused on continuing to strengthen operations, in close coordination with Pakistan, to address remaining low-level transmission in the common reservoir area of the Quetta-Kandahar corridor.

Afghanistan is carrying out a programme review focusing on the implementation of the National Emergency Action Plan and making necessary adjustments for the second half of 2017

Polio eradication teams from East and South East Afghanistan and neighbouring FATA and Khyber Pakhtunkhwa in Pakistan met in Kabul on 24 – 25 May to review the current coordination mechanisms and agree on additional measures to further improve implementation in the WPV common reservoirs. Core teams from the National Emergency Operation Centres Afghanistan and Pakistan also met to discuss next steps on further improving the vaccination strategies for high risk mobile populations.

Pakistan

No new wild poliovirus type 1 (WPV1) cases were reported in the past week. The total number of WPV1 cases for 2017 remains two, and for 2016 remains 20.  The most recent case had onset of paralysis on 13 February, from Diamir district, Gilgit Baltistan.

Four new positive WPV1 environmental samples were reported in the past week, from Peshawar, Khyber Pakhtunkhwa (KP) collected on 10 May; and, Karachi Gadap, Karachi Landhi and Sukkur, Sindh, collected on 8, 16 and 12 May, respectively.

The year 2016 saw the lowest ever annual number of polio cases in the country but poliovirus continues to be isolated through environmental surveillance over a significant geographical range. Efforts are ongoing through implementation of the national emergency action plan to address remaining gaps in coverage and surveillance, in close coordination with neighbouring Afghanistan.

The National Polio Management Team is meeting on 8 – 9 June to review implementation of the National Emergency Action Plan during the low transmission season, and to agree on essential adjustments to the plan for the second half of 2017.

Nigeria

No new cases of wild poliovirus type 1 (WPV1) were reported in the past week.  The total number of WPV1 cases for 2016 remains four and no cases have been reported in 2017.  The most recent case had onset of paralysis on 21 August 2016 in Monguno Local Government Area (LGA), Borno.

Nigeria continues to implement emergency response to the detected WPV1 strain and circulating vaccine-derived poliovirus type 2 (cVDPV2) strains affecting the country.

The response is part of a broader regional outbreak response, coordinated with neighbouring countries, in particular the Lake Chad sub-region, including northern Cameroon, parts of Central African Republic, Chad and southern Niger.

Detection of the polio cases in Nigeria underscores the risk posed by low-level undetected transmission and the urgent need to strengthen subnational surveillance.

Lake Chad Basin

The detection of wild poliovirus type 1 (WPV1) and circulating vaccine-derived poliovirus type 2 (cVDPV2) in Nigeria poses a risk to the neighbouring countries of the Lake Chad basin and hence an outbreak response plan is being implemented as part of the response to the Nigeria outbreak.

Emergency outbreak response efforts continue across the Lake Chad basin, together with activities to fill subnational surveillance gaps across the region.

Central Africa

No new cases were reported in the past week.  The Democratic Republic of the Congo (DR Congo) is affected by two separate outbreaks of circulating vaccine derived poliovirus type 2 (cVDPV2), in Haut Lomami province (two cases, with onset of paralysis on 8 March and 20 February); and in Maniema province (two cases with onset of paralysis on 26 March and 18 April, with an additional isolate detected in a healthy individual with sample collection on 2 May).

Outbreak response plans are currently being finalised, with supplementary immunization activities using monovalent oral polio vaccine type 2 (mOPV2) in line with internationally-agreed outbreak response protocols. Surveillance and immunization activities are being strengthened in neighbouring countries.

DR Congo is also affected by an Ebola outbreak, in Bas Uele province in the north of the country.  Coordination among both outbreak response teams will be necessary and teams are already working on this.

Syrian Arab Republic

In Syria, a circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak has been confirmed.  The virus strain was isolated from two cases of acute flaccid paralysis (AFP) and one healthy contact (collection date: 25 April 2017), from Deir-Ez-Zor governorate.  The cases had onset of paralysis on 5 March and 6 May.

No case of WPV1 has been reported in Syria since 21 January 2014.

Outbreak response plans are being finalized, in line with internationally-agreed outbreak response protocols.  Although access to Deir-Ez-Zor is compromised due to insecurity, the Governorate has been partially reached by several vaccination campaigns against polio and other vaccine-preventable diseases since the beginning of 2016. Most recently, two campaigns have been conducted in March and April 2017 using the bivalent oral polio vaccine (OPV). However, only limited coverage was possible through these campaigns.

Update April 2017

The Strategic Advisory Group of Experts on immunization (SAGE) is meeting this week in Geneva, Switzerland.  The group is expected to review the global polio eradication status and advise on additional measures that should be undertaken to fully implement the Polio Endgame Strategic Plan and secure a lasting polio-free world.

The GPEI Secretariat Report to the upcoming World Health Assembly (WHA) has been finalized and is available here.  The report summarises the current status against all four objectives of the Polio Endgame Plan, and will be the main tool to inform discussions by Member States at next month’s WHA.

This week marks the World Immunization Week, aimed at raising global awareness of the need to ensure all children are vaccinated against polio and all vaccine-preventable diseases.  The GPEI has launched two animations to help mark this special week, on the Polio Surveillance System and Reaching Every Last Child.

New on polioeradication.orgthis week:  the GPEI Semi-annual Status Report July-December 2016.

Summary of newly-reported viruses this week:  Afghanistan:  two new wild poliovirus type 1 (WPV1) environmental positive samples; and, Pakistan:  four new WPV1 environmental positive samples.  See country sections below for further information.

Wild poliovirus type 1 and Circulating vaccine-derived poliovirus cases

Case breakdown by country

NA: onset of paralysis in most recent case is prior to 2015. Figures exclude non-AFP sources. Lao PDR cVDPV1, all others cVDPV2. cVDPV definition: see document “Reporting and classification of vaccine-derived polioviruses” at [pdf]

Weekly country updates as of 25 April 2017

Afghanistan

No new wild poliovirus type 1 (WPV1) cases were reported in the past week.  The total number of cases for 2017 remains three, and for 2016 remains 13.  The most recent case had onset of paralysis on 21 February, from Kunduz province.

Two new wild poliovirus type 1 (WPV1) environmental positive samples were reported in the past week, from Nangahar and Kandahar, collected on 25 March and 9 March, respectively.

With most of Afghanistan polio-free, efforts are focused on continuing to strengthen operations, in close coordination with Pakistan, to address remaining low-level transmission in the common reservoir area of the Quetta-Kandahar corridor.

Pakistan

No new wild poliovirus type 1 (WPV1) cases were reported in the past week. The total number of WPV1 cases for 2017 remains two, and for 2016 remains 20.  The most recent case had onset of paralysis on 13 February, from Diamir district, Gilgit Baltistan.

Four new WPV1 positive environmental samples were reported in the past week, three from Balochistan (two from Killa Abdullah and one from Quetta), and one from Sindh (Gadap, greater Karachi), collected on 1 April, 17 March, 14 March and 13 March, respectively.

The year 2016 saw the lowest ever annual number of polio cases in the country but poliovirus continues to be isolated through environmental surveillance over a significant geographical range. Efforts are ongoing through implementation of the national emergency action plan to address remaining gaps in coverage and surveillance, in close coordination with neighbouring Afghanistan.

Nigeria

No new cases of wild poliovirus type 1 (WPV1) were reported in the past week.  The total number of WPV1 cases for 2016 remains four and no cases have been reported in 2017.  The most recent case had onset of paralysis on 21 August in Monguno Local Government Area (LGA), Borno.

Nigeria continues to implement emergency outbreak response to the detected WPV1 strain and circulating vaccine-derived poliovirus type 2 (cVDPV2) strains affecting the country.

The response is part of a broader regional outbreak response, coordinated with neighbouring countries, in particular the Lake Chad sub-region, including northern Cameroon, parts of Central African Republic, Chad and southern Niger.

Detection of polio cases underscores the risk posed by low-level undetected transmission and the urgent need to strengthen subnational surveillance.

Lake Chad Basin

The detection of wild poliovirus type 1 (WPV1) and circulating vaccine-derived poliovirus type 2 (cVDPV2) in Nigeria poses a risk to the neighbouring countries of the Lake Chad basin and hence an outbreak response plan is being implemented as part of the response to the Nigeria outbreak.

Emergency outbreak response efforts continue across the Lake Chad basin, together with activities to fill subnational surveillance gaps across the region.

Update 2013

In 2005, polio spread from the Horn of Africa and across the Gulf of Aden to cause a devastating outbreak in Yemen, which left 479 children paralysed for life. The adoption of international outbreak response standards and the development of new vaccines since then has considerably reduced the severity and duration of such outbreaks, as of 13th August there were 100 reported cases in Somalia and 10 in Kenya

Details of the Polio Eradication and Endgame Strategic Plan 2013-2018 can be found by following the link - http://www.polioeradication.org/ - that takes you to the home page of the Global Polio Eradication Initiative website. When you get to the home page, please scroll down to the box labelled Latest Publications and click on Executive Summary of the Polio Eradication & Endgame Strategic Plan 2013-2018 to download the PDF of the summary, providing a more in-depth overview of the new plan.

National Immunization Day (NID) in India - The Delhi Polio Office of Rotary confirmed that there will be National Immunization Day (NID) in India during November and there will be an Rotary GB&I group going to assist our Rotary colleagues. Assuming there are no cases in India before the 3 year clear period ends next January this might be one of the last groups to travel to India for this purpose. Further details can be obtained from Rotarian Mike Yates via mike.yates@yates-international.co.uk - if you do attend please let me have photographs, ideally wearing your Crocus Buttonhole.

Projects - Last year Zone 17 surpassed its target, as we move into 2013-14 the task is no easier and I have outlined as an appendix the fundraising initiatives that I have heard of.  Please let me know your ideas and I will gladly share them in the next edition.

My colleague in Zone 18A covering the southern districts of Rotary GB&I, Reg Ling, reg_ling@talktalk.net, produces regular detailed updates on the End Polio Now programme and would be pleased to add new people to his already comprehensive distribution list.

I hope you found this Communique informative & of use. I really would welcome your feedback. Mike Parry   RI End Polio Now Coordinator   Zone 17 (Wales, Isle of Man, Scotland, Ireland and northern England)   mjparry111@hotmail.com