Polio this week as of 7 June 2017
In Syria, a circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak has been confirmed. The virus strain was isolated from two cases of acute flaccid paralysis (AFP) and one healthy contact, from Deir-Ez-Zor governorate. See the ‘Syrian Arab Republic’ section below for more information.
The final decision made by the World Health Assembly on 29 May on polio transition planning is now available online. The decision follows extensive discussions by Member States on the need to address the challenge of scaling down the polio programme as eradication comes closer, including the potential impact on achieving and sustaining a polio-free world, on health system programmes and on systems currently supported by polio assets. Delegates welcomed existing efforts to plan for the post-polio world, and stressed the importance of careful, considered and strategic approaches to the transition of polio assets, requesting the Director-General to prepare a detailed transition action plan.
Summary of newly-reported viruses this week: Syria – two new circulating vaccine-derived poliovirus type 2 (cVDPV2) isolated from acute flaccid paralysis (AFP) cases and one cVDPV2 isolated from a healthy contact; and, Pakistan – four new environmental sample positive for wild poliovirus type 1 (WPV1).
Weekly country updates as of 7 June 2017
No new wild poliovirus type 1 (WPV1) cases were reported in the past week. The total number of cases for 2017 remains three, and for 2016 remains 13. The most recent case had onset of paralysis on 21 February, from Kunduz province.
With most of Afghanistan polio-free, efforts are focused on continuing to strengthen operations, in close coordination with Pakistan, to address remaining low-level transmission in the common reservoir area of the Quetta-Kandahar corridor.
Afghanistan is carrying out a programme review focusing on the implementation of the National Emergency Action Plan and making necessary adjustments for the second half of 2017 Polio eradication teams from East and South East Afghanistan and neighbouring FATA and Khyber Pakhtunkhwa in Pakistan met in Kabul on 24 – 25 May to review the current coordination mechanisms and agree on additional measures to further improve implementation in the WPV common reservoirs.
Core teams from the National Emergency Operation Centres Afghanistan and Pakistan also met to discuss next steps on further improving the vaccination strategies for high risk mobile populations.
No new wild poliovirus type 1 (WPV1) cases were reported in the past week. The total number of WPV1 cases for 2017 remains two, and for 2016 remains 20. The most recent case had onset of paralysis on 13 February, from Diamir district, Gilgit Baltistan.
Four new positive WPV1 environmental samples were reported in the past week, from Peshawar, Khyber Pakhtunkhwa (KP) collected on 10 May; and, Karachi Gadap, Karachi Landhi and Sukkur, Sindh, collected on 8, 16 and 12 May, respectively.
The year 2016 saw the lowest ever annual number of polio cases in the country but poliovirus continues to be isolated through environmental surveillance over a significant geographical range. Efforts are ongoing through implementation of the national emergency action plan to address remaining gaps in coverage and surveillance, in close coordination with neighbouring Afghanistan.
The National Polio Management Team is meeting on 8 – 9 June to review implementation of the National Emergency Action Plan during the low transmission season, and to agree on essential adjustments to the plan for the second half of 2017.
No new cases of wild poliovirus type 1 (WPV1) were reported in the past week. The total number of WPV1 cases for 2016 remains four and no cases have been reported in 2017. The most recent case had onset of paralysis on 21 August 2016 in Monguno Local Government Area (LGA), Borno.
Nigeria continues to implement emergency response to the detected WPV1 strain and circulating vaccine-derived poliovirus type 2 (cVDPV2) strains affecting the country.
The response is part of a broader regional outbreak response, coordinated with neighbouring countries, in particular the Lake Chad sub-region, including northern Cameroon, parts of Central African Republic, Chad and southern Niger.
Detection of the polio cases in Nigeria underscores the risk posed by low-level undetected transmission and the urgent need to strengthen subnational surveillance.
Lake Chad Basin
The detection of wild poliovirus type 1 (WPV1) and circulating vaccine-derived poliovirus type 2 (cVDPV2) in Nigeria poses a risk to the neighbouring countries of the Lake Chad basin and hence an outbreak response plan is being implemented as part of the response to the Nigeria outbreak.
Emergency outbreak response efforts continue across the Lake Chad basin, together with activities to fill subnational surveillance gaps across the region.
No new cases were reported in the past week. The Democratic Republic of the Congo (DR Congo) is affected by two separate outbreaks of circulating vaccine derived poliovirus type 2 (cVDPV2), in Haut Lomami province (two cases, with onset of paralysis on 8 March and 20 February); and in Maniema province (two cases with onset of paralysis on 26 March and 18 April, with an additional isolate detected in a healthy individual with sample collection on 2 May).
Outbreak response plans are currently being finalised, with supplementary immunization activities using monovalent oral polio vaccine type 2 (mOPV2) in line with internationally-agreed outbreak response protocols. Surveillance and immunization activities are being strengthened in neighbouring countries.
DR Congo is also affected by an Ebola outbreak, in Bas Uele province in the north of the country. Coordination among both outbreak response teams will be necessary and teams are already working on this.
Syrian Arab Republic
In Syria, a circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak has been confirmed. The virus strain was isolated from two cases of acute flaccid paralysis (AFP) and one healthy contact (collection date: 25 April 2017), from Deir-Ez-Zor governorate. The cases had onset of paralysis on 5 March and 6 May.
No case of WPV1 has been reported in Syria since 21 January 2014.
Outbreak response plans are being finalized, in line with internationally-agreed outbreak response protocols. Although access to Deir-Ez-Zor 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.