Thursday, July 12, 2018

PRO/EDR> Poliomyelitis update (29): global (Afghanistan, Somalia, Pakistan)

POLIOMYELITIS UPDATE (29): GLOBAL (AFGHANISTAN, SOMALIA, PAKISTAN)
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Date: Thu 12 Jul 2018
Source: Global Polio Eradication Initiative (GPEI), WHO [edited]
<http://polioeradication.org/polio-today/polio-now/this-week/>


Poliovirus Weekly Update, as of 11 Jul 2018, World Health
Organization
----------------------------------------------------------------------
New wild poliovirus cases reported this week: 1
Total number of wild poliovirus cases in 2018: 12
Total number of wild poliovirus cases in 2017: 22

New cVDPV cases reported this week: 1
Total number of cVDPV cases in 2018: 14
Total number of cVDPV cases in 2017: 96

Headlines
- A Disease Outbreak News (DON) notification was issued on [10 Jul
2018] on the Democratic Republic of the Congo's [DRC] 3 concurrent
circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreaks.
- Papua New Guinea prepares for the launch of large-scale immunization
campaigns in Morobe, Madang and Eastern Highlands provinces, set to
commence next week.

Summary of new cases this week:
- Afghanistan: Last week's advance notification of 1 wild poliovirus
type 1 (WPV1) case has been confirmed.
- Somalia: Last week's advance notification of 1 cVDPV2 case with a
cVDPV2 positive community contact has been confirmed.
- Positive environmental samples for WPV1
Afghanistan: 2 new WPV1 positive environmental samples reported
Pakistan: 4 new WPV1 positive environmental samples reported

Afghanistan
- Last week's advance notification of 1 wild poliovirus type 1 (WPV1)
case in Nad-e-Ali district, Helmand province , has been confirmed. The
case had onset of paralysis on [1 Jun 2018]. This brings the total
number of WPV1 cases in 2018 (in Afghanistan) to 9.
- A sub-national immunization day campaign aiming to reach 6.4 million
children under 5 years of age in 225 high risk districts of 27
provinces, primarily in the southern and eastern parts of the country
including Kabul city, has concluded.
- 2 new WPV1 positive environmental samples have been reported: one in
Kandahar City, Kandahar province, and one in Jalalabad, Nangarhar
province.

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.
- 4 new WPV1 positive environmental samples have been reported this
week: 1 in Peshawar and 1 in Kohat, Khyber Pakhtunkhwa province (both
[26 Jun 2018]), 1 in Karachi, Sindh province ([23 Jun 2018]), and 1 in
Islamabad, Punjab province ([24 Jun 2018]).
- A door-to-door polio vaccination round to reach approximately 11
million children in high-risk districts of Pakistan has concluded.

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 circulating vaccine-derived poliovirus type 2 (cVDPV2) positive
environmental sample was 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 carried out 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. A total of 124 833 children
were targeted for vaccination in the island villages in the Lake
District and Hadjer Lamis.
- In a recent meeting in N'Djamena, Chad, the Technical Advisory Group
(TAG) reviewed the status of the recommendations from the previous TAG
meeting 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 1 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
- Last week's advance notification of 1 new case of circulating
vaccine-derived poliovirus type 2 (cVDPV2) case in Somalia has been
confirmed. The case was reported from Dolo district, Gedo region, with
onset on 26 May [2018]. This is the 1st detection of cVDPV2 in Gedo
region in this outbreak.
- 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. 7 national
technical staff were trained on intratypic differentiation of
poliovirus samples, which will allow for more comprehensive testing
and faster identification of results.
- 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
- On [26 Jun 2018], the Papua New Guinea Government 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 were reported in
Lae, Morobe province. The case had onset of paralysis on [24 Apr
2018].
- The National Department of Health (NDOH) is closely working with
GPEI partners in launching a comprehensive response.
- Preparations are underway for the implementation of large-scale
supplementary immunization activities (SIAs), set to take place next
week in Morobe, Madang and Eastern Highlands provinces. 4 immunization
campaigns are planned for July, August, September and October [2018].
- Mop-up vaccination has taken place in Morobe and Eastern Highlands
provinces with bivalent oral polio vaccine (bOPV).
- Intensified surveillance measures to improve detection of acute
flaccid paralysis and poliovirus are being implemented in 6 provinces
and the National Capital District, with on-the-ground training for
provincial and district staff being provided by NDOH and WHO.

Officially reported wild poliovirus cases as of 10 Jul 2018
Total global cases in 2018: 12 (compared with 7 for the same period in
2017)
- Total in endemic countries in 2018: 12 (compared with 7 for the same
period in 2017)
- Total in non-endemic countries in 2018: 0 (compared with 0 for the
same period in 2017)

- Afghanistan: 9 cases in 2018 (compared with 4 for the same period in
2017), onset of paralysis of most recent case: 1 Jun 2018
- Pakistan: 3 cases in 2018 (compared with 3 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 10 Jul 2018
Total global cases in 2018: 14 (compared with 28 for the same period
in 2017)
- Syrian Arab Republic: 0 case in 2018 (compared with 24 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): 5 cases in 2018 (compared with 0 for
the same period in 2017), onset of paralysis of most recent case: 26
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>

[The new news contained in this week's global update not previously
covered in prior updates is the mention of the WPV1 positive
environmental samples in both Afghanistan and Pakistan. While this is
new news, it is in fact old news, as indicative of continued
circulation of the WPV1 in these 2 countries.

The situation with cVDPV's warrants continued monitoring as previously
stated in prior ProMED-mail posts on this. 2017 and 2018 activity of
cVDPVs highlights the continued challenges of the GPEI towards a world
free from polio.

An interactive map showing the locations of WPV1 and cVDPV cases of
polio can be found at:
<http://polioeradication.org/polio-today/polio-now/>.

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

[See Also:
Poliomyelitis update (28): (DR Congo, Papua New Guinea) cVDPVs, WHO
http://promedmail.org/post/20180710.5897456
Poliomyelitis update (27): global
http://promedmail.org/post/20180706.5890218
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 (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]
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