Syria: Polio Outbreak - Jun 2017Ongoing
A circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak has been confirmed in the Deir-Ez-Zor Governorate of the Syrian Arab Republic. The virus strain was isolated from two cases of acute flaccid paralysis (AFP), with onset of paralysis on 5 March and 6 May, as well as from a healthy child in the same community. (GPEI, 8 Jun 2017)
Since the confirmation of the first VDPV2 during May 2017, AFP surveillance has been intensified in the Governorate, especially in the Al Mayadeen district. As of 6 June 2017, a total of 58 AFP cases have been reported from the Governorate this year. In addition to the two cases that have tested positive for VDPV2, a further 11 have tested negative for polioviruses, with the remaining samples being under process in the laboratories or being transported to the laboratories. (WHO, 13 Jun 2017)
A response task force has been established at the national level to follow-up on the Syria cVDPV2 outbreak. A national response plan for the cVDPV2 outbreak and a micro plan for rural Deir-ez-Zoir campaigns have been developed to conduct two immunization rounds in Deir-ez-Zor with monovalent oral polio vaccine type-2 (mOPV2 targeting 328,000 children under five years of age and Inactivated polio vaccine (IPV) will be used in the secondround targeting 114,500 children aged between 2-24 months). (OCHA, 26 Jun 2017)
Two new cases of [cVDPV2] were reported in the past week, bringing the total of cVDPV2 cases to 24...Although access to Deir-Al-Zour 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. In response to the isolation of cVDPV2 from Raqua governorate, the Syrian Ministry of Health in collaboration with WHO and UNICEF is considering adding the area to the outbreak response. This is under discussion due to ongoing military operations. (GPEI, 4 Jul 2017)
One of the previously-reported cases from Raqua, on re-testing, has been confirmed as negative for circulating vaccine-derived poliovirus type 2 (cVDPV2), and has been removed from the list of cases. The total number of cVDPV2 cases is now 23 (22 from Deir-Al-Zour and one from Raqua). (GPEI, 12 July 2017)
Monovalent type-2 oral polio vaccine (mOPV2) was shipped with 350 vaccine carriers dispatched by MoH to Deir Ez-Zor governorate on 11 July to prepare for the first immunization campaign in the area. An mOPV2 campaign in affected areas of Raqqa governorate is now planned. (WHO, 12 July 2017)
Adding Raqqa Governorate to the outbreak response will increase the target population by almost 120,000 children under 5 years of age. In addition to the outbreak, sector partners are increasingly concerned about limited capacities to provide adequate trauma care particularly in areas close to hostilities. Discussions are taking place amongst health partners seeking to mobilize additional resources and capacities to respond to needs. (OCHA, 14 Jul 2017)
As of 18 July, twenty seven cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) have been confirmed. This is an increase of 4 cases, since the last situation report dated 12 July. The total number of acute flaccid paralysis (AFP) cases detected in Deir Ez - Zor governorate since the beginning of 2017 is 87 ( 66 from Mayadeen, 10 from Deir Ez - Zor, and 11 from Boukamal districts). Raqqa governorate has reported 14 AFP cases (6 from Raqqa, 7 from Tell Abyad, and 1 from Thawra districts). (WHO, 18 July 2017)
An immunization campaign was conducted in Deir-ez-Zor from 22 to 26 July by the Ministry of Health with support from UNICEF and the World Health Organization. A total of 259,950 children under the age of five (U5) were vaccinated (79 per cent of the children to be reached in 2017), including 62,864 children aged 0-11 months (24 per cent of the planned reach) and 2,862 children above the target age group. (UNICEF, 31 Jul 2017)
As of 10 October, one new case of cVDPV2 have been confirmed in the first week of October from Mayadeen district, Deir Ez-Zor governorate. The case, a 19-month-old child with no history of polio vaccination, had onset of paralysis on 19 August. The second immunization round for Raqqa commenced 7 October. mOPV2 is being administered to children 0-59 months of age, and IPV to children aged between 2-23 months. Aqua tabs are being provided to families together with vaccination. (WHO, 10 Oct 2017)
As of 31 October, two outbreak response rounds utilizing mOPV2 have been completed in both Deir Ez-Zor and Raqqa governorates. A single dose of IPV has also been offered to children 2-23 months in all districts of these two governorates except Tell Abyad district, Raqqa. Additional IPV immunization aiming to reach children aged between 2-23 months in high risk areas of Aleppo and Idlib has concluded. IPV activities Hama governorate are ongoing. Total administrative coverage to date reports 223,001 children between ages 2-23 months were vaccinated (representing 98% of the target). IPV vaccination activities continue at border points in Lebanon and Turkey. Lebanon is also using IPV to boost population immunity against poliovirus in identified high risk sub-districts. (WHO, 31 Oct 2017)
As of 15 November, almost 3,000 children under the age of 5 have received all scheduled routine immunization antigens in newly accessible areas of Deir Ez-Zor city. Volunteers ran opportunistic vaccination activities in the areas between 7 – 10 November. (GPEI, 15 Nov 2017)
On 20 Nov, WHO’s Director-General accepted the Emergency Committee under the International Health Regulations (2005) assessment that the risk of the international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC) with respect to WPV1 and cVDPV, and agreed to the extension of revised Temporary Recommendations for a further three months, noting that the ongoing circulation of cVDPV2 in DR Congo, Nigeria, Pakistan and the Syrian Arab Republic demonstrates significant gaps in population immunity at a critical time in the polio endgame. (WHO, 14 Nov 2017)
An inactivated polio vaccine (IPV) immunization round has successfully concluded in Damascus, Al Hassakeh, parts of Aleppo and Rural Damascus governorates. Reportedly, a total of 233,518 children aged 2-23 months received IPV, representing 71% of the estimated target. IPV vaccination is continuing in accessible parts of Aleppo governorate. Overall, post campaign monitoring (that was completed in all implementing governorates) indicates 81% vaccination rates by parental/caregiver recall and 77% by finger marking (WHO, 28 Feb 2018)
An inactivated polio vaccine (IPV) immunization round has started in Ain Arab/Aleppo and its countryside on 24/2/2018 for 5 days. The campaign is targeting 8000 children aged 2-23 months, utilizing mobile and fixed centers (WHO, 01 Mar 2018)
Maps & Infographics
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- (8) Suspected Measles cases were reported during this week in Al-Raqqa governorate (6 in Tabaka, and 2 in Al-Raqqa city).
- Based on the data collected by the outreach teams (Al-Raqqa initiative); an increase in the number of Leishmaniasis cases has been reported in rural Raqqa.
Polio this week as of 27 December 2017
General developments & political & security situation
Joint statement by Iran, Russia and Turkey is released on the International Meeting on Syria in Astana 21-22 December 2017
The enclave of Beit Jin is the last rebel-held bastion in Western Ghouta. The Syrian Army and its allies began an operation to retake the area two months ago.
• In November 2017, five verified incidents of violence against the health care infrastructure were reported, resulting in the deaths of five people
• In November 2017, 616 doctors, nurses, midwives and community health workers were trained by Health Cluster partners.
• Health cluster partners vaccinated more than 720 000 children with the oral polio vaccine (OPV) in November.
As host to some of the world’s biggest emergencies, the Eastern Mediterranean Region carries the largest burden of people in need of aid, with more than 76 million people directly or indirectly affected by political conflict, environmental threats, and natural disasters.
According to UNHCR 5,456,108 have fled Syria to surrounding countries in the region. Children make up 47.7% of the refugee population, meaning there are an estimated 2,602,563 refugee children in the region.
To date we have reached 4,228,070 people in Lebanon, Jordan, Iraq, Egypt, Turkey and Syria, including approx. 2,774,823 children. (note: our total reach has gone down due to cleaning of data)
During this week 4 AFP case was reported; 3 cases from Damascus and one case from Hama.
(20) Suspected Measles cases were reported during this week; mostly from Damascus 8 cases, Ar-Raqqa 6 cases, Aleppo 3 cases.
As of 18 December 2017, the UNICEF 2017/18 winter response in Syria and Syrian refugee host countries reached over 630,000 children but remains 58% underfunded (out of US$72 million appeal) and 880,000 children remain in dire need for support.
General developments & political & security situation
• The Security Council on 19 December renewed the authorization for United Nations relief agencies and their partners to use routes across conflict lines and border crossings to deliver lifesaving assistance to millions in north-west and southern Syria through Turkey and Jordan.
Polio this week as of 20 December 2017
New on polioeradication.org: In 2017, global progress and renewed commitment brought us closer than ever to a world without polio.
Germany announced additional critically needed funding for polio eradication in Pakistan.
Polio eradication remains a top priority for the Organization of Islamic Cooperation.
UN Security Council Resolution 2165/2191/2258/2332
Resolution 2332 [formerly 2258 (2015), 2165 (2014) and 2191 (2014)] authorizes UN agencies and their partners to use routes across conflict lines and the border crossings at Bab al-Salam, Bab al-Hawa, Al Yarubiyah and Al-Ramtha, to deliver humanitarian assistance to the people in need in Syria. The Government of Syria is notified in advance of each shipment and a UN Monitoring Mechanism oversees and confirms the humanitarian nature of consignments. The first UN shipment from Turkey started on 24 July 2014.
No new cases of cVDPV2 were reported this week. The most recent case (by date of onset) is 21 September 2017 from Boukamal district.
The total number of confirmed cVDPV2 cases remains 74.
Planning continues for the second phase of the outbreak response. GPEI continues to assist the Syrian Ministry of Health in the planning process.
The second phase of the outbreak response will utilize mOPV2 and IPV in two additional immunization rounds through house-to-house and fixed center vaccination.
The overall humanitarian and protection situation for civilians displaced from Ar-Raqqa city remains of high concern, particularly with regard to explosive hazards contamination, amongst other factors. Surveys and clearance of potentially contaminated areas is required to ensure access for humanitarian partners and create a safe environment that is conducive for safe, voluntary and informed returns.
Global progress and renewed commitment brought us closer than ever to a world without polio
Polio this week as of 13 December 2017
New on polioeradication.org: Technical advisory groups met last week to review progress made to eradicate polio in Pakistan and Afghanistan, and advise on the way forward to further improve the quality of programme implementation during the low transmission season.
In Pakistan, the polio eradication programme and the routine immunization programme are working hand in hand to increase vaccination coverage in urban areas.