Papua New Guinea: Polio Outbreak - Emergency Plan of Action Update n° 2 DREF n° MDRPG009

Situation Report
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Summary of major revisions made to emergency plan of action:

Following the remaining and discovery of new cases in August and September, the PNG health authorities in coordination with WHO and stakeholders had decided to conduct a third round of vaccinations and subsequently a fourth round. PNGRCS has worked closely with them to adapt to the continuous needs and the last vaccination round was originally set to be conducted between 29 October and 9 November. However due to last minutes changes, this fourth round will be conducted between 5 to 18 November 2018 nationwide, and therefore PNGRCS is requesting an additional month for the timeframe of the operation to extend its current end date of 6 November to 6 December 2018 in order to allow the activities to be completed under the DREF. Financial reconciliations are still ongoing, but there is still underspending with the DREF that would enable to activities to move forward. Activities will remain in additional populations within the same three provinces.


Description of the disaster

On 25 June 2018, the National Department of Health has 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 National Public Health Emergency. National Department of health priority now is to response and prevent more children from being infected by the polio disease. WHO, UNICEF and Health Department have been working together with other partners including IFRC and PNG Red Cross Society to conduct a large-scale immunization campaign and strengthen surveillance system that would be detect the virus. National Department of Health are also collecting stool specimens from family members of patients and the community in a “mop-up” immunization campaign targeting children.

On 29 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 are three most high-risk provinces of disease transmission have 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 has been 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 have 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 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 is circulating. On 21 June, results received from lab that the same virus was found in two contacts in Lae. This demonstrates that the virus is circulating in Lae, Morobe; however, missed transmission in other areas cannot 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 has 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 is linked to the ongoing polio outbreak in the country. By this date1, Papua New Guinea has 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 since October 2018 for the 3rd and 4th rounds of vaccination.