Friday, August 24, 2018

PRO/EDR> Poliomyelitis update (38): global (Congo DR, Nigeria, Somalia)

POLIOMYELITIS UPDATE (38): GLOBAL (DEMOCRATIC REPUBLIC OF THE CONGO,
NIGERIA, SOMALIA)
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In this update:
[1] Global update (DR Congo, Nigeria, Somalia - GPEI / WHO)
[2] Brazil (SP) catchup house-to-house vaccination - media

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[1] Global update (DR Congo, Nigeria, Somalia - GPEI / WHO)
Date: 24 Aug 2018
Source: Global Polio Eradication Initiative (GPEI) / WHO [edited]
<http://polioeradication.org/polio-today/polio-now/this-week/>


Poliovirus weekly update as of 23 Aug 2018 World Health Organization
-------------------------
New wild poliovirus cases reported this week: 0
Total number of wild poliovirus cases in 2018: 14
Total number of wild poliovirus cases in 2017: 22

New cVDPV cases reported this week: 2
Total number of cVDPV cases (all types) in 2018: 25 [? 4 new cVDPV
case confirmations - 2 in DR Congo, one in Nigeria, one in Somalia -
Mod.MPP]
Total number of cVDPV cases (all types) in 2017: 96

Headlines
Summary of new viruses this week:
- Afghanistan - 2 new wild poliovirus type 1 (WPV1) positive
environmental samples
- Democratic Republic of the Congo (DRC) - circulating vaccine-derived
poliovirus type 2 (cVDPV2) detected in the stool samples of 2 healthy
contacts of 2 different negative acute flaccid paralysis (AFP) cases
- Nigeria - 1 new case of cVDPV2 and 2 new cVDPV2-positive
environmental samples
- Somalia - 1 new case of cVDPV2

Afghanistan
- No new cases of WPV1 were reported this week.
- The total number of cases reported in Afghanistan in 2018 is 11.
- The latest case, from Arghandab district, Kandahar province, had
onset of paralysis on [17 Jul 2018].
- A total of 2 new WPV1-positive environmental samples were reported
in the past week, one from Jalalabad province and one from Kandahar
province.
- During the August [2018] immunization campaign, almost 10 million
children were visited by vaccinators to protect them from the virus.

Pakistan
- No new cases of WPV1 were reported this week.
- The total number of WPV1 cases reported in Pakistan in 2018 is 3.
- The latest case, from Dukki district, Balochistan province, had
onset of paralysis on [18 May 2018].

Nigeria
- No new cases of WPV1 were reported in the past week. The most
recently detected WPV1 case, from Borno state, had onset of paralysis
on [21 Aug 2016].
- One new cVDPV2 case has been reported in the past week, from Nganzai
Local Government Area, Borno state, with onset of paralysis on [13 Jul
2018].
- A total of 2 new cVDPV2-positive environmental samples were reported
in the past week, one from Yobe state and one from Sokoto state.
- The country continues to be affected by 2 separate cVDPV2 outbreaks,
the 1st centered in Jigawa state and the 2nd in Sokoto state.
- In response to cVDPV2 detection, the country continues to conduct
AFP 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 and plan the October [2018]
subnational immunization activity.
- At the same time, outbreak response to WPV1 continues, including
efforts to address surveillance and immunity gaps in parts of Borno
state.

Lake Chad Basin
- The detection of WPV1 and cVDPV2 in Nigeria continues 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
in the region.
- These include efforts to vaccinate children at markets, in
internally displaced persons and refugee camps, and at international
borders.
- Preparations continue for a cross-border synchronized immunization
activity in October [2018].

Central Africa
- No new cases of cVDPV2 were reported in the past week in the DRC.
The total number of cases detected in the country in 2018 remains 11.
- The country is affected by 3 separate strains of cVDPV2, in the
provinces of Mongola, Maniema and Haut Lomami/Tanganika/Haut
Katanga/Ituri.
- In the past week, cVDPV2 was detected in the stool samples of 2
healthy contacts of 2 different negative AFP cases. Based on the
positive contacts, AFP cases will be classified as cVDPV2.
- In response to recent geographic spread of one of the strains,
including to Ituri province close to the border with Uganda,
provincial governors on [26 Jul 2018] convened an urgent meeting and
signed the "Kinshasa Declaration for Polio Eradication."
- The high-level meeting was convened by HE the Minister of Health, as
well as the WHO Director-General and the Regional Director for Africa.
Provincial governors committed to providing the necessary oversight,
accountability and resources needed to urgently improve the quality of
the outbreak response being implemented across the country. Outbreak
response since cVDPV was 1st confirmed in 2017 has been marred by
operational challenges, as too many children continue to remain
unvaccinated or undervaccinated. This level of oversight can help
ensure that operational deficits are rapidly identified and
addressed.
- The polio outbreak response is being conducted simultaneously to an
ongoing Ebola outbreak affecting North Kivu province, in the east of
the country (close to provinces affected by cVDPV2). As in the past,
the polio teams are coordinating closely with the broader humanitarian
emergency network to ensure both outbreaks are addressed in a
coordinated manner (as was the case during the recent Ebola outbreak
in Equateur province, which was successfully stopped).
- Partners of the GPEI will continue to support authorities across the
country to ensure that this new level of commitment rapidly translates
into operational improvements on the ground.

Horn of Africa
- The Horn of Africa is currently affected by separate outbreaks of
cVDPV2 and cVDPV3, reporting both cases and environmental positives.
- One new cVDPV2 case was reported in Somalia in the past week, from
Daynile district, Banadir province, with onset of paralysis on [10 Jul
2018].
- Somalia has reported a total of 5 cases in 2018: 2 cVDPV2, 2 cVDPV3
and one cVDPV2&3.
- cVDPV2 has also been detected during 2018 in one environmental
sample in Kenya.
- Outbreak response to both virus types 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.

Papua New Guinea
- No new cases of cVDPV1 were reported this week.
- The total number of cases in the country in 2018 is 4 (one from
Eastern Highland, one from Enga and 2 from Morobe province).
- The latest case, from Eastern Highland province, had onset of
paralysis on [8 Jul 2018].
- Papua New Guinea officially launched the outbreak response campaign
on [16 Jul 2018] in Morobe, Madang and Eastern Highland provinces. In
addition, 3 more campaigns are planned for late August, September and
October [2018].
- With confirmation of recent cases in Eastern Highland and Enga
provinces, the geographic extent of the outbreak response is currently
being reviewed and will be expanded as necessary.
- Intensified surveillance measures to improve detection of AFP and
poliovirus are being implemented across the country, with
on-the-ground training for provincial and district staff being
provided by NDOH and WHO.

Middle East
- No new cases of 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].

Officially reported wild poliovirus cases as of 21 Aug 2018
Total global cases in 2018: 14 (compared with 9 for the same period in
2017)
Total in endemic countries in 2018: 14 (compared with 9 for the same
period in 2017)
Total in nonendemic countries in 2018: 0 (compared with 0 for the same
period in 2017)

- Afghanistan: 11 cases in 2018 (compared with 6 for the same period
in 2017), onset of paralysis of most recent case: 17 Jul 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 nonendemic countries: 0

Officially reported cVDPV cases as of 21 Aug 2018
Total global cases in 2018: 25 (compared with 41 for the same period
in 2017)
- Syrian Arab Republic: 0 case in 2018 (compared with 33 for the same
period in 2017), onset of paralysis of most recent case: 21 Sep 2017
- DRC: 11 cases in 2018 (compared with 8 for the same period in 2017),
onset of paralysis of most recent case: 24 Jun 2018
- Nigeria: 4 cases in 2018 (compared with 0 for the same period in
2017), onset of paralysis of most recent case: 15 Jul 2018
- Somalia (type 2 and type 3): 5 cases (one cVDPV2 and one cVDPV3
isolated from the same child) in 2018 (compared with 0 for the same
period in 2017), onset of paralysis of most recent case: 10 Jul 2018
- Papua New Guinea (type 1): 4 cases in 2018 (compared with 0 for the
same period in 2017), onset of paralysis of most recent case: 8 Jul
2018

Total global cases in 2017: 96
Total in endemic countries: 0
Total in nonendemic countries: 96

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

[Once again there is good news and not so good news. The good news is
the absence of newly confirmed cases of WPV1 in Pakistan, Afghanistan,
and Nigeria, with the most recent dates of onset of cases in Pakistan
18 May 2018, Afghanistan 17 Jul 2018, and Nigeria 21 Aug 2016, as well
as the absence of identification of new cases of cVDPV1 in Papua New
Guinea. The not so good news: 2 positive WPV1 environmental samples in
Afghanistan, 2 cVDPV2 cases identified in DRC Congo (confirming AFP
cases), one cVDPV2 case in Nigeria (Borno), 2 cVDPV2-positive
environmental samples in Nigeria (Yobe, Sokoto), and one cVDPV2 case
in Somalia (Banadir). Hence, VDPVs continue to be a significant issue
confronting the polio eradication goal with current circulation and
outbreaks identified in Nigeria, DRC, and Somalia, as well as
continued circulation of WPV1 in Afghanistan.

Confusing information is presented in the cumulative totals of cases
reported. The cumulative total number of cVDPV cases globally is
listed as 25 this week, the same number of cumulative cases listed
last week, yet new cases were identified and confirmed during this
week. Clarification of these figures would be greatly appreciated. -
Mod.MPP

An interactive map showing cases of WPV1 and cVDPV cases reported this
year [2018] can be found at:
<http://polioeradication.org/polio-today/polio-now/>.

HealthMap/ProMED-mail maps of countries mentioned in the global
update:
Pakistan:<http://healthmap.org/promed/p/140>
Afghanistan: <http://healthmap.org/promed/p/137>
Nigeria: <http://healthmap.org/promed/p/62>
Congo DR: <http://healthmap.org/promed/p/194>
Somalia: <http://healthmap.org/promed/p/125>
Papua New Guinea: <http://healthmap.org/promed/p/188>]

******
[2] Brazil (SP), catchup house-to-house vaccination - media
Date: 24 Aug 2018
Source: Folha de S. Paolo [edited]
<https://www1.folha.uol.com.br/internacional/en/scienceandhealth/2018/08/1979835-sp-government-will-knock-door-to-door-to-find-unvaccinated-children.shtml>


Health workers will search house by house for children yet to be
vaccinated against measles and polio in the state's capital, São
Paulo, in a government effort to reach the vaccination goals set for
this year. They will knock door to door to explain to residents the
importance of vaccines and give guidance on the topic.

This campaign is part of a pack of measures planned by the city
administration, which also include vaccination in city schools, a
pop-up vaccination booth in Avenida Paulista and an Action Day next
Saturday [25 Aug 2018], when all city health clinics will be open for
people who want to vaccinate their children.

The measures' targets are children between one and 5 years of age, who
are the focus of the ongoing national vaccination campaign against
both diseases. The campaign ends on 31 Aug 2018.

The campaign goal is to vaccinate 95% of children in that age-group,
but so far, only 59% of them received vaccines in the state's capital,
São Paulo. "If we continue like this, we won't reach our goal," said
Maria Lígia Nerge, São Paulo's vaccination program's coordinator.

Another attempt was mandating that city schools ask for students'
immunization records earlier this month. Beginning next week, students
with incomplete records and proper parent or guardian authorizations
will be able to be vaccinated by healthcare works who will go from
school to school to administer vaccines.

[Byline: Angela Pinho]

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

[I have included this media report from Sao Paolo to highlight the
problems identified in major areas where local poliovirus transmission
has long been interrupted -- declining vaccination coverages leaving
large pockets of susceptible persons should the virus be introduced. 
It is comforting to see the identification of this problem and the
control measures implemented in Sao Paolo to rectify this situation.
The estimated population of Sao Paolo in 2017 was 12.1 million, a
sizable population. - Mod.MPP

The HealthMap/ProMED interactive map of Sao Paulo, Brazil:
<http://healthmap.org/promed/p/45784>.]

[See Also:
Poliomyelitis update (37): global (Afghanistan, Nigeria, Papua New
Guinea) http://promedmail.org/post/20180817.5972364
Poliomyelitis update (36): Papua New Guinea (EH)
http://promedmail.org/post/20180816.5970562
Poliomyelitis update (35): (Papua New Guinea, Nigeria, El Salvador)
OPV3, RFI http://promedmail.org/post/20180812.5961142
Poliomyelitis update (34): Nigeria, cVDPV, WHO
http://promedmail.org/post/20180808.595402
Poliomyelitis update (33): Papua New Guinea (EG)
http://promedmail.org/post/20180806.5950667
Poliomyelitis update (32): global (DR Congo, Nigeria, Papua New
Guinea), cVDPV http://promedmail.org/post/20180803.5946019
Poliomyelitis update (31): global, Afghanistan, Nigeria
http://promedmail.org/post/20180727.5932111
Poliomyelitis update (30): global, WPV, cVDPV, vaccine reaction,
fatigue
Poliomyelitis update (20): (Pakistan) WPV1 conf.
http://promedmail.org/post/20180610.5849085
Poliomyelitis update (10): Congo DR, cVDPV
http://promedmail.org/post/20180316.5692109
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]
.................................................mpp/rd/lxl
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