Friday, July 6, 2018

PRO/EDR> Poliomyelitis update (27): global

POLIOMYELITIS UPDATE (27): GLOBAL
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A ProMED-mail post
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ProMED-mail is a program of the
International Society for Infectious Diseases
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In this update:
[1] Global update - GPEI
[2] Brazil vaccination coverages - media report

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[1] Global update - GPEI
Date: Thu 5 Jul 2018
Source: Global Polio Eradication Initiative (GPEI), WHO [edited]
<http://polioeradication.org/polio-today/polio-now/this-week/>


Poliovirus weekly update - as of 4 Jul 2018, World Health
Organization
----------------------------------------------------------------------
New wild poliovirus cases reported this week: 0
- Total number of wild poliovirus cases in 2018: 11
- Total number of wild poliovirus cases in 2017: 22

New cVDPV cases reported this week: 0
- Total number of cVDPV cases in 2018: 13
- Total number of cVDPV cases in 2017: 96

Headlines
Summary of new positives this week:
- Afghanistan: an advance notification has been received of 1 new wild
poliovirus type 1 (WPV1) case
- Pakistan: 3 new WPV1 positive environmental samples have been
reported.
- Nigeria: 1 circulating vaccine-derived poliovirus type 2 (cVDPV2)
positive environmental sample has been reported.
- Somalia: an advance notification has been received of 1 new cVDPV2
positive contact.

Afghanistan
- An advance notification has been received of 1 new wild poliovirus
type 1 (WPV1) case in Nad-e-Ali district, Helmand province, with onset
of paralysis on [1 Jun 2018]. This case will be reflected in next
week's data. This will raise the total number of WPV1 cases in 2018 to
9 [see ProMED-mail report Poliomyelitis update (25): Afghanistan (HM)
WPV1 http://promedmail.org/post/20180702.5885357 for details. -
Mod.MPP]
- A sub-national immunization days campaign for polio eradication is
being carried out this week in 225 high risk districts of 27
provinces, primarily in the southern and eastern parts of the country,
including Kabul city. Vaccinators will visit 6.4 million children
under the age of 5.

Pakistan
- No new cases of wild poliovirus type 1 (WPV1) were reported this
week.
- The total number of officially reported WPV1 cases in Pakistan in
2018 is 3.
- The latest case had onset of paralysis on 18 May [2018], from Dukki
district, Balochistan province.
- 3 new WPV1 positive environmental samples have been reported this
week, 1 in Lahore district, Punjab province on [11 Jun 2018], 1 in
Rawalpindi district, Punjab province, on [11 Jun 2018], and 1 in
Peshawar district, Khyber Pakhtunkhwa province, on [9 Jun 2018].
- This week, around 11 million children will be vaccinated against
polio in Pakistan.

Nigeria
- No new cases of wild poliovirus type 1 (WPV1) were reported in the
past week.
- 4 WPV1 cases were reported in Nigeria in 2016 and no cases have been
reported in 2017 or 2018. The most recent WPV1 case (by date of onset)
was reported in Monguno local government area, Borno state, with onset
on [21 Aug 2016].
- 1 new circulating vaccine-derived poliovirus type 2 (cVDPV2)
positive environmental sample has been reported in Jigawa state,
collected on 2 May [2018].
- Since confirmation of cVDPV2 in Nigeria, virus has been isolated
from environmental samples and 1 case with onset of paralysis on [15
Apr 2018].
- In response to cVDPV2 detection, the country has conducted
additional acute flaccid paralysis surveillance strengthening
activities including enhanced active surveillance visits, and
community sampling. The programme has also carried out an extensive
search for type 2 containing vaccines (tOPV/mOPV2) in the areas
surrounding where the virus was detected.
- The GPEI is working with regional and country counterparts and
partners to support an outbreak response.
- A round of mOPV2 vaccination covering part of Jigawa, Gombe, Bauchi,
and Sokoto was implemented in May [2018] and early June [2018].

Lake Chad Basin
- The detection of wild poliovirus type 1 (WPV1) and circulating
vaccine-derived poliovirus type 2 (cVDPV2) in Nigeria continue to pose
a risk to the neighbouring countries of the Lake Chad basin.
- Emergency outbreak response efforts continue across the Lake Chad
basin, together with activities to fill subnational surveillance gaps
across the region.
- These include efforts to vaccinate children at markets, in
internally displaced persons and refugee camps, and at international
borders.
- In June [2018], 1 polio vaccination campaign targeting vulnerable
island populations in Chad took place. This special vaccination
activity concerned the 8 health districts of Bagasola, Bol, Isseirom,
Karal, Kouloudia, Liwa, Mani, and Ngouri. 124 833 children were
targeted in the island villages in the Lake district and Hadjer
Lamis.
- Last week [week of 25 Jun 2018], a Technical Advisory Group (TAG)
meeting took place in N'Djamena, Chad. The TAG reviewed the status of
the recommendations from the previous TAG, and assessed progress
towards closure of the outbreak.

Central Africa
- No new cases of circulating vaccine-derived poliovirus type 2
(cVDPV2) were reported in the past week in the Democratic Republic of
the Congo (DRC).
- The country is affected by 3 separate strains of cVDPV2, in the
provinces of Mongola, Maniema, and Haut Lomami/Tanganika/Haut
Katanga/Ituri.
- The total number of cVDPV2 cases reported in the DRC in 2018 is 7.
- The geographic extent of the outbreak response to all 3 strains is
being re-evaluated, given the confirmed spread of one of the strains
to Ituri and confirmation of the 3rd strain in Mongola. The risk of
further spread is magnified given the proximity of Ituri to Uganda,
and known population movements between affected areas.
- The Ministry of Health, supported by WHO and partners of the Global
Polio Eradication Initiative, remains fully committed to outbreak
response in the affected provinces, including use of monovalent oral
polio vaccine type 2 (mOPV2) across the country, in line with
internationally-agreed outbreak response protocols.

Horn of Africa
- Somalia: an advance notification has been received of 1 new
circulating vaccine-derived poliovirus type 2 (cVDPV2) positive
contact, from a negative index case, from Dolo district, Gedo
province, collected on 29 May [2018]. This is the 1st detection of
cVDPV2 in Gedo province in this outbreak.
- The index case will be officially reported as cVDPV2 in next week's
data.
- The Horn of Africa is currently affected by separate outbreaks of
cVDPV2 and cVDPV3.
- Outbreak response to both strains is currently being implemented, in
line with internationally-agreed guidelines. Large-scale supplementary
immunization activities (SIAs) have been implemented in Banadir, Lower
Shabelle, and Middle Shabelle regions, Somalia, with additional SIAs
planned or carried out in the affected zones of the Horn of Africa.
Special surveillance activities are being undertaken to determine the
origin of the viral circulation.
- WHO and partners continue to support local public health authorities
across the Horn of Africa in conducting field investigations and risk
assessments.

Middle East
- No new cases of circulating vaccine-derived poliovirus type 2
(cVDPV2) were reported in the past week in Syria.
- The total number of officially reported cVDPV2 cases in Syria in
2017 remains 74. There are no cases reported in 2018.
- The most recent case (by date of onset) was reported in Boukamal
district, with onset on [21 Sep 2017].
- In an effort to heighten population immunity against type-2 among
high risk populations, more than 5000 children aged 2-23 months have
received inactivated polio vaccine (IPV) in newly accessible areas of
eastern Ghouta. In addition, a total of 33 836 children under 5 years
of age have received bivalent oral polio vaccine (bOPV). 23
vaccination teams were deployed between March and May 2018 through
fixed centres and mobile clinics that also provided other routine
immunization.
- WHO has supported further upgrades to the Syrian National Polio
Laboratory, to improve poliovirus diagnostic capacity.
- All empty and expired unopened vials of monovalent oral polio
vaccine type-2 (mOPV2) have been destroyed according to global
guidelines, under the direct supervision of WHO staff in country.

Papua New Guinea
- The Papua New Guinea Government has declared the circulating
vaccine-derived poliovirus type 1 (cVDPV1) outbreak in Morobe province
a National Public Health Emergency.
- 1 case of cVDPV1 and 2 cVDPV1 community contacts have been
reported.
- The National Department of Health (NDOH) is closely working with
GPEI partners in launching a comprehensive response. Some of the
immediate steps include conducting large-scale immunization campaigns
and strengthening surveillance systems that help detect the virus
early. These activities are also being strengthened in neighbouring
provinces.

Officially reported wild poliovirus cases as of 3 Jul 2018
Total global cases in 2018: 11 (compared with 6 for the same period in
2017)
- Total in endemic countries in 2018: 11 (compared with 6 for the same
period in 2017)
- Total in non-endemic countries in 2018: 0 (compared with 0 for the
same period in 2017)

- Afghanistan: 8 cases in 2018 (compared with 4 for the same period in
2017), onset of paralysis of most recent case: 27 Apr 2018
- Pakistan: 3 cases in 2018 (compared with 2 for the same period in
2017), onset of paralysis of most recent case: 18 May 2018
- Nigeria: 0 case in 2018 (compared with 0 for the same period in
2017), onset of paralysis of most recent case: 21 Aug 2016

Total global cases in 2017: 22
- Total in endemic countries: 22
- Total in non-endemic countries: 0

Officially reported cVDPV cases as of 3 Jul 2018
Total global cases in 2018: 13 (compared with 27 for the same period
in 2017)
- Syrian Arab Republic: 0 case in 2018 (compared with 23 for the same
period in 2017), onset of paralysis of most recent case: 21 Sep 2017
- Democratic Republic of the Congo: 7 cases in 2018 (compared with 4
for the same period in 2017), onset of paralysis of most recent case:
14 May 2018
- Nigeria: 1 case in 2018 (compared with 0 for the same period in
2017), onset of paralysis of most recent case: 15 Apr 2018
- Somalia (type 2 and type 3): 4 cases in 2018 (compared with 0 for
the same period in 2017), onset of paralysis of most recent case: 23
May 2018
- Papua New Guinea (type 1): 1 case in 2018 (compared with 0 for the
same period in 2017), onset of paralysis of most recent case: 25 Apr
2018

Total global cases in 2017: 96
- Total in endemic countries: 0
- Total in non-endemic countries: 96

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[HealthMap/ProMED-mail maps of the countries discussed in the report
above can be found at
Pakistan: <http://healthmap.org/promed/p/140>
Afghanistan: <http://healthmap.org/promed/p/137>
Nigeria: <http://healthmap.org/promed/p/2594>
Papua New Guinea: <http://healthmap.org/promed/p/188>
DR Congo: <http://healthmap.org/promed/p/194>
Somalia: <http://healthmap.org/promed/p/125>]

******
[2] Brazil
Date: Thu 5 Jul 2018
Source: Precision Vaccinations [excerpted, edited]
<https://www.precisionvaccinations.com/polio-vaccination-suggested-who-prior-visiting-risk-areas>


312 Brazilian municipalities report below 50 percent polio vaccination
rate
---------------------------------------------------------------------------
A report from the Brazilian Ministry of Health dated [30 Jun 2018],
showed that 312 municipalities in Brazil are below the minimum
immunization target against child paralysis, reports Vaaju. According
to the Ministry of Health, the low vaccination rate against
poliomyelitis is the lowest in the past 16 years. Brazil's minimum
vaccination target rate for polio is 95 percent.

The poliomyelitis vaccine was introduced in Brazil with the 1st mass
vaccination campaign conducted in the cities of Petropolis, state of
Rio de Janeiro, and Santo Andre, state of Sao Paulo, in 1961. Among
the municipalities at risk of recurrence of the disease is Natal,
which met 42.6 percent of the vaccine coverage. The city with the
lowest immunization rate was Monte das Gameleiras, with only 18.1
percent of the children up to 1 year old vaccinated. The Health
Coordinator of the State Secretariat for Public Health, Maria de Lima,
assures that the vaccines are in stock against poliomyelitis.

"The factors influencing vaccination rates are lack of information,
low-risk perception and spread of false news," said Maria de Lima. The
decline in vaccine coverage against poliomyelitis is emblematic, but
low immunization also extends to other diseases such as tuberculosis,
hepatitis B, diphtheria, tetanus, pertussis, meningitis, measles, red
dogs, mumps, and chickenpox. "The major concern is the recurrence of
these diseases, some of which are already eliminated as poliomyelitis
and others eradicated as measles. The low rate of vaccination can
cause major health problems to newborns, and in addition to the
children of other states, we are in danger of the whole of Brazil,"
said Maria de Lima.

[Byline: Don Ward Hackett]

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[So much for the apparent "lull" in WPV1 activity; as reported by the
media earlier this week (see in Poliomyelitis update (25): Afghanistan
(HM) WPV1 http://promedmail.org/post/20180702.5885357); there is
confirmation of a case of WPV1 in Helmand province of Afghanistan with
onset of paralysis on 1 Jun 2018. There were also 3 positive
environmental samples for WPV1 in Pakistan, 2 in Punjab province
(Lahore district and Rawalpindi district, 2 large cities in Punjab
province, separated by 257 kilometers/160 mi, an estimated 5 hour
drive by roadway), and 1 in Peshawar district, Khyber Pakhtunkhwa
province (approximately 144.8 km/90 mi from Rawalpindi, and 376 km/234
mi from Lahore, as the crow flies). Hence one can surmise that there
is probably more than one area of introduction and circulation of the
WPV1 in Pakistan.

And unfortunately, there hasn't been a lull in circulating vaccine
derived poliovirus (cVDPV), with environmental positive reports from
Nigeria (cVDPV2); a new cVDPV2 isolate was obtained from a contact of
the "negative" index case in Gedo province, a new geographic area. The
other new information with respect to the cVDPV outbreaks in the
Democratic Republic of the Congo (DR Congo) is that there are 3
separate outbreaks of cVDPV2 ongoing in the country, based on genetic
results on the isolates - Mongola (1 outbreak), Maniema (1 outbreak),
and Haut Lomami/Tanganika/Haut Katanga/Ituri (1 outbreak with
extension to multiple provinces).

The inclusion of the report on the vaccination coverages reported by
Brazil is to highlight the potentially precarious situation in a
country that was one of the leader countries in polio control and
ultimately eradication in the 1980s. While there haven't been reports
of cVDPV isolates from Brazil, the low vaccination coverages are
definitely of concern. Brazil changed from a pure OPV (oral polio
vaccines) schedule to a sequential IPV (inactivated polio vaccine),
tOPV (trivalent OPV) schedule in 2012, and in 2016, switched from tOPV
to bOPV (bivalent oral polio vaccine), eliminating the OPV2, as per
the global recommendations. That being said, Somalia was on the list
of countries that made the change to bOPV in 2016 as well, and now is
dealing with a combined cVDPV2 and cVDPV3 problem. Hence, 2 years post
cessation of the use of OPV2, cVDPV2 is a problem in Somalia.

A HealthMap/ProMED-mail map of Brazil can be found at
<http://healthmap.org/promed/p/6>.
A map showing the locations of WPV1 and cVDPV(2) cases can be found at
<http://polioeradication.org/polio-today/polio-now/>. - Mod.MPP]

[See Also:
Poliomyelitis update (26): Papua New Guinea, WHO, Congo DR, cVDPVs
http://promedmail.org/post/20180704.5888125
Poliomyelitis update (25): Afghanistan (HM) WPV1
http://promedmail.org/post/20180702.5885357
Poliomyelitis update (24): Global (Papua New Guinea, DR Congo,
Somalia), cVDPVs http://promedmail.org/post/20180628.5881311
Poliomyelitis update (23): Papua New Guinea
http://promedmail.org/post/20180625.5875455
Poliomyelitis update (22): Global (Papua New Guinea, Congo DR,
Somalia), cVDPVs http://promedmail.org/post/20180622.5870865
Poliomyelitis update (21): global (Pakistan, Venezuela) PAHO update
http://promedmail.org/post/20180616.5858106
Poliomyelitis update (20): (Pakistan) WPV1 conf
http://promedmail.org/post/20180610.5849085
Poliomyelitis update (19): Venezuela, vaccine virus found, VAPP susp
http://promedmail.org/post/20180609.5848416
Poliomyelitis update (18): Pakistan (BA) RFI:
http://promedmail.org/post/20180609.5848153
Poliomyelitis update (17): Venezuela, cases conf. global (Pakistan),
RFI http://promedmail.org/post/20180607.5845259
Poliomyelitis update (16): Global (Afghanistan), Pakistan
http://promedmail.org/post/20180531.5831364
Poliomyelitis update (15): Pakistan (BA) RFI
http://promedmail.org/post/20180529.5825949
Poliomyelitis update (14): global, cVDPV Horn of Africa, PV2 post
erad. stocks http://promedmail.org/post/20180526.5819775
Poliomyelitis update (13): positive environmental samples
http://promedmail.org/post/20180511.5791991
Poliomyelitis update (12): global (Afghanistan, Pakistan)
http://promedmail.org/post/20180405.5728514
Poliomyelitis update (11): global (Afghanistan, DR Congo)
http://promedmail.org/post/20180324.5706145
Poliomyelitis update (10): Congo DR, cVDPV
http://promedmail.org/post/20180316.5692109
Poliomyelitis update (09): Afghanistan (WPV), Congo DR (cVDPV)
http://promedmail.org/post/20180315.5689842
Poliomyelitis update (08): Somalia, cVDPV environmental samples
http://promedmail.org/post/20180313.5684227
Poliomyelitis update (07): (Pakistan, Afghanistan, Congo DR)
http://promedmail.org/post/20180208.5615989
Poliomyelitis update (06): Global (Afghanistan)
http://promedmail.org/post/20180202.5603446
Poliomyelitis update (05): Afghanistan, RFI
http://promedmail.org/post/20180131.5597699
Poliomyelitis update (04): global (Afghanistan, Pakistan), Nigeria
rumors http://promedmail.org/post/20180125.5584166
Poliomyelitis update (03): global (Afghanistan, Pakistan, Congo DR),
violence http://promedmail.org/post/20180118.5569033
Poliomyelitis update (02): (Pakistan, Afghanistan, Congo DR)
http://promedmail.org/post/20180113.5558200
Poliomyelitis update (01): global (Afghanistan)
http://promedmail.org/post/20180105.5539242
2017
----
Poliomyelitis update (47): Pakistan, global (Congo DR)
http://promedmail.org/post/20171229.5526565
Poliomyelitis update (46): global (Pakistan, Afghanistan), Lake Chad
Region http://promedmail.org/post/20171221.5518292
Poliomyelitis update (45): Pakistan, Afghanistan, Gabon
http://promedmail.org/post/20171214.5504166
Poliomyelitis update (44): (Australia), pos. environmental sample,
iVDPV2 iden. http://promedmail.org/post/20171215.5506586
Poliomyelitis update (43): (Australia), positive environmental sample,
RFI http://promedmail.org/post/20171215.5506172
Poliomyelitis update (42): global (Pakistan, Afghanistan, Syria)
http://promedmail.org/post/20171214.5504166
Poliomyelitis update (41): Syria
http://promedmail.org/post/20171213.5500907
Poliomyelitis update (40): global (Pakistan, Afghanistan, Syria)
http://promedmail.org/post/20171207.5489424
Poliomyelitis update (30): global (Afghanistan, Pakistan, Syria)
http://promedmail.org/post/20171012.5377178
Poliomyelitis update (20): global (Syria, Afghanistan)
http://promedmail.org/post/20170720.5193070
Poliomyelitis update (10): Syria (DY), Congo DR, cVDPV, WHO
http://promedmail.org/post/20170613.5103235
Poliomyelitis (01): Pakistan (GB), global, RFI
http://promedmail.org/post/20170314.4898724
2016
----
Poliomyelitis update (21): IPV shortage, global
http://promedmail.org/post/20161231.4733243
Poliomyelitis update (01): India, VDPV, wild type-free
http://promedmail.org/post/20160115.3939297]
.................................................mpp/mj/jh
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