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Papua New Guinea: Polio Outbreak - Emergency Plan of Action Final Report DREF n° MDRPG009

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Situation Report
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Summary:

The International Federation of Red Cross and Red Crescent Societies’ Disaster Relief Emergency Fund (DREF) was granted on 6 July 2018 for CHF 128,582 to the PNGRCS. The DREF reached over 125,477 people directly/indirectly reached through vaccination/mobilisation messages from social mobilisation campaign in 33 villages.

Since December 2018, no new Polio cases were reported, and the epidemic is fairly under control. The declaration of Polio outbreak has yet not lifted. The Department of Health and WHO requested the PNGRCS volunteers to focus on social mobilization in the three target provinces. There were changes in the operation’s targets and timeframe.

With the DREF allocation, PNGRCS met the needs of affected people and implemented a strategy that included hygiene information dissemination and community awareness to minimize or contain the spread of Polio over the five-month timeframe. The scope and budget for this operation enabled the targeted population of approximately 50,000 people to be reached directly. The implementation of activities for the operation was successfully concluded by 6 December 2018. A total of CHF 60,320.00 was returned to DREF. The final financial report is available here.

Summary of major revisions made to emergency plan of action:

Following the addition third and fourth rounds of vaccinations that were explained in operations update #2 and to address the needs of the emergency operation, we also revised the strategy of the ECV (Epidemic Control for Volunteer) training for PNGRCS staff and volunteers. We conducted the training into two rounds. The first round was the ECV training for volunteer which focusing on polio outbreak response. That was one day training to get our volunteers ready to mobilize on the emergency response of polio outbreak. The second round was ECV training as part of capacity building to strengthen PNGRCS staff and volunteers on epidemic/pandemic preparedness and response. This has not impacted the budget lines dedicated for this activity

A. SITUATION ANALYSIS

Description of the disaster

On 25 June 2018, the National Department of Health declared a Polio Outbreak in Papua New Guinea and subsequently on 26 June 2018, the Papua New Guinea National Executive Council and Cabinet declared the polio outbreak as a National Public Health Emergency. National Department of health priority was to response and prevent more children from being infected by the polio disease. WHO, UNICEF and Health Department worked together with other partners including IFRC and PNG Red Cross Society (PNGRCS) to conduct a large-scale immunization campaign and strengthen surveillance system to combat the virus. National Department of Health also collected stool specimens from family members of patients and the community in a “mop-up” immunization campaign targeting children. A system was put in place to rapidly detect and identify cases of polio through enhanced surveillance for acute flaccid paralysis (AFP). By 30 September since the confirmation of the outbreak, Papua New Guinea had reported 21 cases of polio in nine provinces including one in the National Capital District. Last confirmed case had an onset on 18 October 2018.

On 29th June, the National Department of Health and WHO requested engagement from PNGRCS and IFRC to support the mobilization of volunteers for awareness raising and disease prevention activities. This request was made during the polio outbreak urgent health cluster meeting. There were three most high-risk provinces of disease transmission had been identified following the confirmed case of polio was found in Lae, Morobe province.

Due to low immunization coverage in another bordering province, Madang and Eastern Highland were also targeted for polio awareness and immunization which was started in July 2018.

As WHO stated that the version of the virus circulating in the settlement is a "vaccine-derived poliovirus", meaning it is a mutated version of the weaker polio virus used in vaccinations. Vaccine-derived polioviruses are rare and tend to occur in populations with very low vaccination rates. They develop when unvaccinated children are in contact with the excrement of vaccinated children and are exposed to the weaker virus. The WHO and PNG authorities launched an emergency immunization campaign to try to prevent other children from becoming infected.

Lae is the second largest city of PNG located in Morobe province. Morobe province reportedly had a polio vaccination rate of 61 per cent prior to the outbreak. PNG Health Authorities said 845 children had been immunized since the virus was first detected. According to WHO the index case is a six-year-old boy from ‘4 mile’ settlement in Lae, Morobe, VDPV type 1 confirmed from the child’s stool - confirmed by VIDRL (Victorian Infectious Diseases Reference Laboratory) on 21 May 2018. As per WHO guidelines, the total of 22 from Morobe and 20 from Eastern Highlands children in the index case community contacts were tested, to determine if the virus was circulating. On 21 June, results received from lab that the same virus was found in two contacts in Lae. This demonstrates that the virus was circulating in Lae, Morobe; however, missed transmission in other areas could not yet be ruled out.

On 22 June, the National, International Health Regulations (IHR) focal point of Papua New Guinea notified WHO of the index case of cVDPV1 and the confirmation cVDPV1 among two asymptomatic community contacts of the index case. The Government committed PGK 6.7 million (CHF 2 million) to support outbreak response. The Global Polio Eradication Initiative (GPEI) provided initial supported to Papua New Guinea with USD 500,000 (CHF 497,000) for response activities. On 27 June 2018, the National Department of Health activated the National Emergency Operations Centre and formed a National Emergency Response Team.

On 7 September 2018, one new case of polio had been confirmed in 6‐year old boy from 5‐mile settlement, Port Moresby. This is first case reported from Port Moresby, the capital of Papua New Guinea. The National Department of Health (NDOH) announced the finding after laboratory tests conducted by the Victorian Infectious Disease Reference Laboratory, a World Health Organization (WHO) Polio Regional Reference Laboratory in Australia. The United States Centre’s for Disease Control and Prevention confirmed that this case was linked to the ongoing polio outbreak in the country. By this date, Papua New Guinea had confirmed a total of 18 polio cases in the country affecting seven provinces: six in Eastern Highlands, three in Morobe, three in Enga, three in Madang, one in the National Capital District, one in Jiwaka and one in East Sepik.

A National Capital District campaign started on 24 September 2018 and continued nationwide for the 3rd and 4th rounds of vaccination.