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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This report is produced by the OCHA Syria Crisis offices with the contribution of all sectors in the hubs and at the Whole of Syria (WoS) level. The response update covers the period from 1–31 January 2018
Humanitarian Response Update
Displacement dynamics remained stable with limited new arrivals to IDP sites recorded, mostly in Deir-ez-Zor Governorate, particularly Abu Kamal
This report is produced by the OCHA Syria Crisis offices with the contribution of all sectors in the hubs and at the Whole of Syria (WoS) level. The situation overview covers the period from 1 February – 14 March 2018. The next report will be issued on or around 10 April 2018.
As of 12 March 2018 an estimated 95,000 individuals reportedly returned to Ar-Raqqa city since the end of hostilities in October 2017.
More than 11.3 million Syrians are in need of health assistance, including almost 3 million people living in besieged or hard-to-reach areas.
Polio this week as of 13 March 2018 New on www.polioeradication.org: For International Women’s Day, we highlighted the critical role that women play in global polio eradication efforts. Dr Adele Daleke Lisi Aluma works to reach children who have never been vaccinated, whilst in Somalia, women are the face of polio eradication. In Nigeria, dedicated female mobilizers are ending polio, one home at a time.
We also launched the Gender and Polio section of our website.
Close to 400 000 men, women and children remain besieged in eastern Ghouta, where intense hostilities continue to exact a heavy toll on the civilian population. The besieged enclave has seen a dramatic upsurge in civilian casualties amid a sharp escalation in airstrikes and ground-based attacks.
North-east Syria, much of which was under the control of the Islamic State of Iraq and the Levant (ISIL), was the focus of intense fighting in 2017. Health care services in all three north-eastern governorates1 were severely disrupted, leaving civilians caught up in the conflict more vulnerable than ever. Hundreds of thousands of people were displaced, many of them more than once, as they sought to escape shifting battle lines.
No new cases of cVDPV2 have been reported in 2018. The most recent case (by date of onset of paralysis) is 21 September 2017 from Boukamal district, Deir Ez-Zor governorate. The total number of cVDPV2 cases remains 74.
A nationwide immunization round utilizing bivalent OPV (bOPV) is ongoing in 13 governorates in Syria. The campaign aims to reach 2.4 million children aged less than 5 years.
12 March 2018 – The World Health Organization (WHO) and UNICEF are supporting a nationwide polio vaccination campaign in the Syrian Arab Republic that aims to vaccinate more than 2.4 million children under 5 years of age in 13 governorates. The campaign, which is being managed by the Ministry of Health, was launched on 11 March and will last for 5 days.
General developments & political & security situation
The UN Security Resolution 2401 (2018) on 30-day cessation of hostilities in Syria to enable humanitarian aid delivery is adopted on 24 February.
The announcement by the Russian forces of a daily humanitarian pause from 9 am to 2 pm for exit of civilian population from eastern Ghouta.
High level advocacy continues on the worsening humanitarian situation and on eastern Ghouta and Idlib, with a focus on escalation and attacks on health facilities, urgent access for medicine and medical supplies to HTR and besieged areas and sustainable and regular medical evacuations.
The latest UN Security Resolution 2401 (2018) on 30-day cessation of hostilities in Syria is to enable humanitarian aid delivery.
New on http://polioeradication.org/: Reaching all children in the Lake Chad basin.
23 February marked 64 years since the first large-scale trial of inactivated polio vaccine (IPV). Developed by Joseph Salk, IPV was found to be safe and effective, and is now part of routine vaccination programmes worldwide. Each year, it confers lifelong protection against polio to millions of young children.
According to UNHCR 5,582,018 have now fled Syria to surrounding countries in the region. 1.4 million of them fled in 2014 alone with an average of more than 3.935 people per day. In 2015 more than 617,188 Syrians fled the country, an average of more than 1,714 per day. In 2017 more than 623,374 Syrians fled the country, an average of more than 1,731 per day. Children now make up 47.6% of the refugee population, meaning there are an estimated 2,657,040 refugee children in the region.
In January 2018, 28 verified incidents of violence against the health care infrastructure were reported, resulting in the deaths of four health workers and injuring nineteen.
In January 2018, 33 doctors, nurses, midwives and community health workers were trained by three Health Cluster partners.
SIG vaccinated more than 2000 children among the newly displaced in Idleb governorate
No new cases of cVDPV2 were reported this week. The total number of cVDPV2 cases remains 74. The most recent case (by date of onset of paralysis) is 21 September 2017 from Boukamal district, Deir Ez-Zor governorate.
General developments & political & security situation
The security situation in the country remains volatile and unpredictable. Hot spots are: East Ghouta, Idlib, Aleppo, Afrin and Deir Ez-Zor. Developments in these areas have direct impact on the general security situation countrywide. They are also likely to affect UN operations and activities.
Airstrikes on the province of Idlib struck the last functioning hospital in the southeastern strip of the rebel enclave.
The present report is the forty-eighth submitted pursuant to paragraph 17 of Security Council resolution 2139 (2014), paragraph 10 of resolution 2165 (2014), paragraph 5 of resolution 2191 (2014), paragraph 5 of resolution 2258 (2015), paragraph 5 of resolution 2332 (2016) and paragraph 6 of resolution 2393 (2017), in which the Council requested the Secretary-General to report, every 30 days, on the implementation of the resolutions by all parties to the conflict in the Syrian Arab Republic.
- 10 AFP cases were detected; 2 cases from Damascus, 3 cases from Al-Hassakeh, 3 cases from Deir-ez-Zor, one case from rural Damascus, and one cases from Hama.
64 SM were detected mostly from Al-Hassakeh 33 cases, and from Ar-Raqqa 18 cases.
Completeness & Timeliness of Reporting