Polio Bulletin 2019

Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2016–2018 Chart 2. Adequate specimen collection rate, 2016–2018 “Zero polio transmission and health for all”, WHO Director-General visit to Afghanistan and Pakistan On 5-8 January 2018, the WHO Director-General Dr Tedros Adhanom Ghebreyesus visited Afghanistan and Pakistan. Dr Tedros highlighted WHO’s commitment to the final push to eradicate polio. He also met with heads of state and senior government officials in both countries and witnessed first- hand WHO-supported health programmes. “We must all give our best on this last mile to eradicate polio once and for all. My wish for 2019 is for zero polio transmission. You have WHO’s full support to help reach every child and stop this virus for good”, Dr Tedros said. Prior to this visit, WHO Director-General Dr Tedros Adhanom Ghebreyesus took over the Chair of the Polio Oversight Board, which guides and oversees the Global Polio Eradication Initiative – spearheaded by national governments, WHO, Rotary International, UNICEF, CDC and the Bill & Melinda Gates Foundation - as a clear sign that the eradication of this disease is a priority for WHO. Full story is available at: https://www.who.int/news-room/detail/08-01-2019-“zero- polio-transmission-and-health-for-all”-who-director-general- gives-new-year’s-wish-to-the-people-of-afghanistan-and- pakistan Polio Bulletin 2019 Issue No. 1 - Week 1 (as of 9 January 2019) Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2018 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2018 Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam). Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: wproepidata@who.int Web: www.wpro.who.int/immunization CONTACT US HIGHLIGHTS 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 13.7% 6.6% 13.2% 16.0% 0.0% 0.0% 10.7% 0% 5% 10% 15% 20% VNM PNG PHL MYS LAO KHM CHN Table 1. Classification of AFP cases with onset in 2018 and key surveillance indicators Polio Bulletin 2 2017 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 60 46 53 0 0 2 47 4 1 (1.9%) 1.15 47% 89% 03-Jan-19 6 Brunei Darussalam 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 13-Oct-18 88 Cambodia 57 44 73 0 0 0 72 1 0 (0.0%) 1.66 92% 85% 03-Jan-19 6 China 5278 2256 4863 0 1 0 3186 1676 519 (10.7%) 2.16 92% 100% 26-Dec-18 14 China, Hong Kong SAR 15 9 10 0 0 0 10 0 0 (0.0%) 1.11 90% 100% 02-Jan-19 - China, Macao SAR 2 1 3 0 0 0 2 1 0 (0.0%) 3.00 100% 100% 14-Dec-18 26 Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 103 21 81 0 0 0 74 7 0 (0.0%) 3.86 79% 78% 14-Dec-18 26 Malaysia 154 77 163 0 0 0 110 53 26 (16.0%) 2.12 79% 75% 04-Dec-18 36 Mongolia 6 9 5 0 0 0 5 0 0 (0.0%) 0.56 100% 80% 12-Dec-18 28 New Zealand 13 9 9 0 0 0 6 3 0 (0.0%) 1.00 56% 100% 31-Oct-18 70 Papua New Guinea 29 37 258 0 26 12 144 76 17 (6.6%) 6.27 46% 76% 20-Dec-18 20 Philippines 462 338 287 0 0 0 237 50 38 (13.2%) 0.85 62% 94% 27-Dec-18 13 Republic of Korea 68 67 65 0 0 0 50 15 0 (0.0%) 0.97 89% 100% 10-Dec-18 30 Singapore 7 6 13 0 0 0 11 2 0 (0.0%) 2.17 77% 100% 08-Jan-19 1 Viet Nam 385 234 182 0 0 0 115 67 25 (13.7%) 0.78 99% 89% 21-Oct-18 80 Pacific island countries and areas 16 11 10 0 0 0 1 9 4 (40.0%) 0.91 30% 100% 17-Dec-18 23 Total 6656 3327 6077 0 27 14 4072 1964 630 (10.4%) 1.82 88% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 2018 Non-polio AFP rate Total % with adequate specimens 2> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Table 2. Laboratory investigation of stool samples from AFP cases with onset in 2018 and key laboratory indicators Polio Bulletin 3 ≥ 80% ≥ 80% Australia VIDRL 43 0 0 1 42 0 0 91% 3% 03-Jan-19 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 2 0 0 0 2 0 0 50% 0% 10-Sep-18 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 73 0 0 13 60 0 0 93% 15% 30-Dec-18 NIID 0 - - - - - - - - - - - - - China (total) 4801 34 0 349 4335 0 83 98% 6% 26-Dec-18 97 0 24 0 0 0 0 0 63 10 0 0 0 99% China, Anhui Prov. Lab 298 3 0 14 276 0 5 100% 4% Prov. Lab/CCDC 8 0 3 0 0 0 0 0 5 0 0 0 0 100% China, Beijing Prov. Lab 32 0 0 0 31 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 55 0 0 3 52 0 0 89% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 169 1 0 13 155 0 0 98% 7% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Gansu Prov. Lab 104 1 0 5 93 0 5 99% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangdong Prov. Lab 398 1 0 20 374 0 3 92% 4% Prov. Lab/CCDC 4 0 0 0 0 0 0 0 4 0 0 0 0 100% China, Guangxi Prov. Lab 188 2 0 16 169 0 1 98% 8% Prov. Lab/CCDC 4 0 3 0 0 0 0 0 1 0 0 0 0 100% China, Guizhou Prov. Lab 185 1 0 13 169 0 2 97% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hebei Prov. Lab 272 0 0 36 235 0 1 100% 10% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 80 0 0 4 75 0 1 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 503 5 0 52 445 0 1 100% 9% Prov. Lab/CCDC 13 0 5 0 0 0 0 0 8 0 0 0 0 100% China, Hubei Prov. Lab 149 1 0 11 135 0 2 99% 7% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Hunan Prov. Lab 217 0 0 24 192 0 1 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 217 8 0 11 192 0 6 100% 5% Prov. Lab/CCDC 25 0 2 0 0 0 0 0 13 10 0 0 0 100% China, Jiangxi Prov. Lab 152 1 0 11 134 0 6 98% 5% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Jilin Prov. Lab 56 2 0 9 44 0 1 100% 12% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Neimongol Prov. Lab 93 2 0 4 87 0 0 98% 4% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 100% China, Ningxia Prov. Lab 22 0 0 2 20 0 0 95% 7% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 91 0 0 2 82 0 7 86% 2% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 0% China, Shandong Prov. Lab 379 2 0 26 351 0 0 100% 5% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 100% China, Shanghai Prov. Lab 39 0 0 0 39 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 124 1 0 6 116 0 1 98% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Sichuan Prov. Lab 280 0 0 13 249 0 18 96% 4% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Tianjin Prov. Lab 20 0 0 0 20 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 125 1 0 7 116 0 1 90% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 242 0 0 32 198 0 12 95% 11% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Zhejiang Prov. Lab 171 2 0 7 160 0 2 99% 4% Prov. Lab/CCDC 7 0 0 0 0 0 0 0 7 0 0 0 0 100% China, Hainan Prov. Lab 31 0 0 6 25 0 0 100% 16% CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 72 0 0 1 65 0 6 98% 1% CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 30 0 0 0 30 0 0 100% 0% CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 7 0 0 1 6 0 0 85% 8% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 10 0 0 0 10 0 0 100% 0% 03-Jan-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 3 0 0 0 3 0 0 100% 0% 24-Dec-18 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 101 1 0 8 92 0 0 98% 5% 30-Dec-18 NIID 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Malaysia IMR 148 0 0 8 138 0 2 94% 4% 09-Nov-18 IMR 0 - - - - - - - - - - - - - Mongolia PHI 6 0 0 3 3 0 0 100% 50% 04-Jan-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 7 0 0 1 6 0 0 100% 14% 01-Jan-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 252 82 1 13 150 0 6 87% 4% 18-Dec-18 VIDRL 175 0 57 46 0 0 0 0 72 0 0 0 0 100% Philippines RITM 373 5 1 13 352 2 0 96% 3% 03-Jan-19 RITM 7 0 2 0 0 0 0 0 4 0 0 1 0 100% Republic of Korea NIH 64 0 0 5 56 3 0 98% 7% 10-Dec-18 NIH 0 - - - - - - - - - - - - - Singapore SGH 12 0 0 2 9 1 0 95% 10% 08-Jan-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 172 3 0 24 144 1 0 100% 12% 14-Dec-18 NIHE 4 0 2 0 0 0 0 0 2 0 0 0 0 100% Viet Nam (South) PI 170 4 0 20 136 10 0 100% 13% 02-Jan-19 PI 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Pacific island countries and areas VIDRL 1 0 0 0 1 0 0 100% 0% 02-May-18 VIDRL 0 - - - - - - - - - - - - - Total 6238 129 2 460 5539 17 91 97% 6% 292 0 87 46 0 0 0 0 148 10 0 1 0 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens posit ive for NPEV Latest report date Discordant pending sequencing 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); NIH (National Institute of Health, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPV NegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2 VDPV Polio Bulletin 4 Table 3. Laboratory confirmation of polio isolates from environmental samples in 2017–2018 1 Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2018 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 Australia aVDPV2 (1 env) Cambodia 2006 - 1 Total - 2 China 2009 - 1Total - 27 aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP) aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP) aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 aVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) Viet Nam aVDPV2 (2 AFP) 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 6 2 0 0 0 0 0 1 0 1 0 4 0 0 17 2 0 2 0 0 0 0 0 0 0 12 0 0 China (total) 325 188 0 213 0 0 0 0 0 650 0 1158 0 0 240 154 0 179 0 0 0 1 0 480 2 1161 0 0 China, Fujian Prov. Lab/CCDC 53 22 0 8 0 0 0 0 0 42 0 331 0 0 67 46 0 16 0 0 0 0 0 97 1 532 0 0 China, Gansu Prov. Lab/CCDC 12 10 0 10 0 0 0 0 0 29 0 18 0 0 9 6 0 2 0 0 0 0 0 8 0 33 0 0 China, Guangdong Prov. Lab/CCDC 48 39 0 18 0 0 0 0 0 87 0 108 0 0 48 41 0 27 0 0 0 0 0 102 1 217 0 0 China, Guangxi Prov. Lab/CCDC 36 20 0 22 0 0 0 0 0 36 0 94 0 0 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab/CCDC 42 17 0 12 0 0 0 0 0 34 0 112 0 0 40 21 0 6 0 0 0 0 0 41 0 105 0 0 China, Shandong Prov. Lab/CCDC 48 28 0 18 0 0 0 0 0 90 0 272 0 0 27 8 0 13 0 0 0 0 0 36 0 149 0 0 China, Shanghai Prov. Lab/CCDC 22 18 0 17 0 0 0 0 0 65 0 51 0 0 8 5 0 3 0 0 0 0 0 7 0 31 0 0 China, Xinjiang Prov. Lab/CCDC 36 34 0 108 0 0 0 0 0 267 0 115 0 0 27 27 0 112 0 0 0 1 0 189 0 79 0 0 China, Yunnan Prov. Lab/CCDC 28 0 - - - - - - - - - 57 0 0 14 0 - - - - - - - - - 15 0 0 Malaysia IMR 24 0 - - - - - - - - - 22 0 0 0 - - - - - - - - - - - - - Philippines RITM 40 8 0 1 0 0 0 0 0 7 0 21 0 0 87 8 0 2 0 0 0 0 0 2 0 24 4 0 Papua New Guinea RITM - - - - - - - - - - - - - - 27 23 0 16 7 0 0 0 0 21 0 9 0 0 Total 395 198 0 214 0 0 0 1 0 658 0 1205 0 0 371 187 0 199 7 0 0 1 0 503 2 1206 4 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); IMR (Institute of Medical Research, Malaysia); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2017 2018 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD

Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2016–2018 Chart 2. Adequate specimen collection rate, 2016–2018 The GAP III Containment Certification Scheme (CCS) Auditor training The GAP III CCS Auditor training was held in Republic of Korea from 14-18 January 2019. The objectives were to: 1. understand the CCS process and mechanism, requirements for certification, and the auditor roles and responsibilities. 2. discuss the need for effective communication during the audit, and 3. understand the audit preparation, conduct opening and closing meeting, on-site auditing activities, preparation of audit findings and conclusions and reporting of audit results and follow-up. Two trainers, three international participants and 17 local participants attended the training. The meeting discussed the GAP III CCS and 16 elements of the GAP III post eradication containment requirements applicable to polio essential facilities. The expected outcome from the meeting included clarifications on containment certification issues related to polio vaccine production and other poliovirus essential facilities, acceptable interim bio risk management measures and build an audit team capacity. A written auditor examination at the end of the course was taken for participants’ assessment. A minimum pass rate of 75% must be attained to receive a certificate of achievement. Polio Bulletin 2019 Issue No. 2 - Week 3 (as of 22 January 2019) Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2018 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2018 Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam). Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: wproepidata@who.int Web: www.wpro.who.int/immunization CONTACT US HIGHLIGHTS 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 15.8% 16.7% 13.2% 16.0% 0.0% 0.0% 9.8% 0% 5% 10% 15% 20% VNM PNG PHL MYS LAO KHM CHN Table 1. Classification of AFP cases with onset in 2018 and key surveillance indicators Polio Bulletin 2 2017 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 60 46 54 0 0 2 47 5 1 (1.9%) 1.17 46% 89% 16-Jan-19 6 Brunei Darussalam 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 13-Oct-18 101 Cambodia 57 44 73 0 0 0 72 1 0 (0.0%) 1.66 92% 85% 03-Jan-19 19 China 5278 2256 5084 0 1 0 3575 1508 496 (9.8%) 2.25 92% 100% 09-Jan-19 13 China, Hong Kong SAR 15 9 11 0 0 0 10 1 0 (0.0%) 1.22 82% 100% 21-Jan-19 1 China, Macao SAR 2 1 3 0 0 0 2 1 0 (0.0%) 3.00 100% 100% 11-Jan-19 11 Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 103 21 81 0 0 0 74 7 0 (0.0%) 3.86 79% 78% 14-Dec-18 39 Malaysia 154 77 163 0 0 0 110 53 26 (16.0%) 2.12 79% 75% 04-Dec-18 49 Mongolia 6 9 6 0 0 0 5 1 0 (0.0%) 0.67 100% 83% 09-Jan-19 13 New Zealand 13 9 9 0 0 0 6 3 0 (0.0%) 1.00 56% 100% 31-Oct-18 83 Papua New Guinea 29 37 281 0 26 12 144 99 47 (16.7%) 6.89 46% 75% 22-Jan-19 0 Philippines 462 338 287 0 0 0 237 50 38 (13.2%) 0.85 62% 94% 27-Dec-18 26 Republic of Korea 68 67 68 0 0 0 61 7 0 (0.0%) 1.01 90% 100% 11-Jan-19 11 Singapore 7 6 13 0 0 0 11 2 0 (0.0%) 2.17 77% 100% 08-Jan-19 14 Viet Nam 385 234 316 0 0 0 235 81 50 (15.8%) 1.35 98% 86% 11-Jan-19 11 Pacific island countries and areas 16 11 10 0 0 0 1 9 4 (40.0%) 0.91 30% 100% 17-Dec-18 36 Total 6656 3327 6461 0 27 14 4592 1828 662 (10.2%) 1.93 88% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO 2018 Non-polio AFP rate Total % with adequate specimens 2> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Table 2. Laboratory investigation of stool samples from AFP cases with onset in 2018 and key laboratory indicators Polio Bulletin 3 ≥ 80% ≥ 80% Australia VIDRL 44 0 0 1 42 0 1 91% 3% 16-Jan-19 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 2 0 0 0 2 0 0 50% 0% 10-Sep-18 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 74 0 0 13 61 0 0 93% 15% 18-Jan-19 NIID 0 - - - - - - - - - - - - - China (total) 5023 38 0 369 4560 0 56 98% 6% 09-Jan-19 97 0 24 0 0 0 0 0 63 10 0 0 0 99% China, Anhui Prov. Lab 316 3 0 15 292 0 6 100% 4% Prov. Lab/CCDC 8 0 3 0 0 0 0 0 5 0 0 0 0 100% China, Beijing Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 56 0 0 2 53 0 1 91% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 172 1 0 13 158 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Gansu Prov. Lab 108 1 0 6 96 0 5 99% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangdong Prov. Lab 410 2 0 20 385 0 3 92% 4% Prov. Lab/CCDC 4 0 0 0 0 0 0 0 4 0 0 0 0 100% China, Guangxi Prov. Lab 202 2 0 18 181 0 1 99% 8% Prov. Lab/CCDC 4 0 3 0 0 0 0 0 1 0 0 0 0 100% China, Guizhou Prov. Lab 182 1 0 14 165 0 2 97% 7% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hebei Prov. Lab 282 1 0 38 242 0 1 100% 10% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 85 0 0 4 80 0 1 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 525 5 0 54 462 0 4 100% 9% Prov. Lab/CCDC 13 0 5 0 0 0 0 0 8 0 0 0 0 100% China, Hubei Prov. Lab 162 1 0 12 145 0 4 99% 7% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Hunan Prov. Lab 230 0 0 24 205 0 1 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 231 8 0 11 207 0 5 100% 5% Prov. Lab/CCDC 25 0 2 0 0 0 0 0 13 10 0 0 0 100% China, Jiangxi Prov. Lab 160 1 0 12 143 0 4 98% 5% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Jilin Prov. Lab 57 2 0 9 46 0 0 98% 11% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Neimongol Prov. Lab 97 2 0 4 91 0 0 98% 4% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 100% China, Ningxia Prov. Lab 25 0 0 2 23 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 92 1 0 2 88 0 1 84% 2% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 0% China, Shandong Prov. Lab 397 2 0 26 368 0 1 100% 5% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 100% China, Shanghai Prov. Lab 40 0 0 0 40 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 119 1 0 7 111 0 0 97% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Sichuan Prov. Lab 297 1 0 16 269 0 11 97% 5% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Tianjin Prov. Lab 20 0 0 0 20 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 135 1 0 7 126 0 1 90% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 257 0 0 36 220 0 1 95% 11% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Zhejiang Prov. Lab 179 2 0 7 169 0 1 99% 4% Prov. Lab/CCDC 7 0 0 0 0 0 0 0 7 0 0 0 0 100% China, Hainan Prov. Lab 33 0 0 6 27 0 0 100% 15% CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 83 0 0 3 79 0 1 98% 2% CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 31 0 0 0 31 0 0 100% 0% CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 8 0 0 1 6 0 1 85% 8% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 11 0 0 0 10 1 0 100% 0% 17-Jan-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 3 0 0 0 3 0 0 100% 0% 24-Dec-18 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 108 1 0 8 99 0 0 95% 4% 18-Jan-19 NIID 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Malaysia IMR 148 0 0 8 138 0 2 94% 4% 09-Nov-18 IMR 0 - - - - - - - - - - - - - Mongolia PHI 6 0 0 3 3 0 0 100% 50% 04-Jan-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 8 0 0 1 6 1 0 100% 14% 14-Jan-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 268 89 1 16 162 0 0 88% 5% 22-Jan-19 VIDRL 185 0 61 46 0 0 0 0 77 0 0 0 1 100% Philippines RITM 373 5 1 14 353 0 0 95% 3% 09-Jan-19 RITM 7 0 2 0 0 0 0 0 4 0 0 1 0 100% Republic of Korea NIH 67 0 0 5 62 0 0 99% 7% 11-Jan-19 NIH 0 - - - - - - - - - - - - - Singapore SGH 13 0 0 2 11 0 0 96% 8% 18-Jan-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 172 3 0 24 144 1 0 100% 12% 14-Dec-18 NIHE 4 0 2 0 0 0 0 0 2 0 0 0 0 100% Viet Nam (South) PI 170 4 0 20 136 10 0 100% 13% 02-Jan-19 PI 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Pacific island countries and areas VIDRL 7 0 0 1 6 0 0 97% 6% 31-Dec-18 VIDRL 0 - - - - - - - - - - - - - Total 6497 140 2 485 5798 13 59 97% 6% 302 0 91 46 0 0 0 0 153 10 0 1 1 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens posit ive for NPEV Latest report date Discordant pending sequencing 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); NIH (National Institute of Health, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPV NegativeNPEV only SabinWild L20B posit ive Pending ≤ 14 days VDPV Type 2 L20B posit ive + NPEV NPEV 2 VDPV Polio Bulletin 4 Table 3. Laboratory confirmation of polio isolates from environmental samples in 2017–2018 1 Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2018 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 Australia aVDPV2 (1 env) Cambodia 2006 - 1 Total - 2 China 2009 - 1Total - 27 aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP) aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP) aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 aVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) Viet Nam aVDPV2 (2 AFP) 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 6 2 0 0 0 0 0 1 0 1 0 4 0 0 17 2 0 2 0 0 0 0 0 0 0 12 0 0 China (total) 325 188 0 213 0 0 0 0 0 650 0 1158 0 0 240 154 0 179 0 0 0 1 0 480 2 1161 0 0 China, Fujian Prov. Lab/CCDC 53 22 0 8 0 0 0 0 0 42 0 331 0 0 67 46 0 16 0 0 0 0 0 97 1 532 0 0 China, Gansu Prov. Lab/CCDC 12 10 0 10 0 0 0 0 0 29 0 18 0 0 9 6 0 2 0 0 0 0 0 8 0 33 0 0 China, Guangdong Prov. Lab/CCDC 48 39 0 18 0 0 0 0 0 87 0 108 0 0 48 41 0 27 0 0 0 0 0 102 1 217 0 0 China, Guangxi Prov. Lab/CCDC 36 20 0 22 0 0 0 0 0 36 0 94 0 0 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab/CCDC 42 17 0 12 0 0 0 0 0 34 0 112 0 0 40 21 0 6 0 0 0 0 0 41 0 105 0 0 China, Shandong Prov. Lab/CCDC 48 28 0 18 0 0 0 0 0 90 0 272 0 0 27 8 0 13 0 0 0 0 0 36 0 149 0 0 China, Shanghai Prov. Lab/CCDC 22 18 0 17 0 0 0 0 0 65 0 51 0 0 8 5 0 3 0 0 0 0 0 7 0 31 0 0 China, Xinjiang Prov. Lab/CCDC 36 34 0 108 0 0 0 0 0 267 0 115 0 0 27 27 0 112 0 0 0 1 0 189 0 79 0 0 China, Yunnan Prov. Lab/CCDC 28 0 - - - - - - - - - 57 0 0 14 0 - - - - - - - - - 15 0 0 Malaysia IMR 24 0 - - - - - - - - - 22 0 0 0 - - - - - - - - - - - - - Philippines RITM 40 8 0 1 0 0 0 0 0 7 0 21 0 0 87 8 0 2 0 0 0 0 0 2 0 24 4 0 Papua New Guinea RITM - - - - - - - - - - - - - - 27 23 0 16 7 0 0 0 0 21 0 9 0 0 Total 395 198 0 214 0 0 0 1 0 658 0 1205 0 0 371 187 0 199 7 0 0 1 0 503 2 1206 4 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); IMR (Institute of Medical Research, Malaysia); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2017 2018 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD

Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2016–2018 Chart 2. Adequate specimen collection rate, 2016–2018 Second Face-to-Face Meeting on Global Polio Certification Risk Assessment Portugal, 31 January – 1 February 2019 The Global Commission for Certification of Poliomyelitis Eradication (GCC) at its 18th meeting in October 2018 reviewed the draft risk assessment model and requested the WHO secretariat to work further to address GCC concerns and present results at the next GCC meeting in February 2019. The second face-to-face meeting between the GCC secretariat and the WHO Regional Offices was convened on 31 January – 1 February 2019 in Portugal. The main objectives of the meeting were: 1. to review the fitness of the current version of the global polio certification risk assessment tool presented during GCC meeting in October 2018; 2. to finalize the guidance document that explains the application of the global certification risk assessment tool and address questions raised by the GCC; and 3. to review usefulness of the risk assessment tool for potential type 3 poliovirus certification. The global risk assessment is not meant to replace regional risk assessments and will be used by the GCC to monitor the progress of the Member States towards achieving and sustaining polio-free status. Polio Bulletin 2019 Issue No. 3 - Week 5 (as of 5 February 2019) Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2018 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2018 Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam). Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: wproepidata@who.int Web: www.who.int/westernpacific CONTACT US HIGHLIGHTS 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 15.6% 16.5% 15.8% 12.1% 0.0% 0.0% 10.6% 0% 5% 10% 15% 20% VNM PNG PHL MYS LAO KHM CHN Table 1. Classification of AFP cases with onset in 2018 and key surveillance indicators Polio Bulletin 2 2017 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 60 46 54 0 0 2 47 5 1 (1.9%) 1.17 46% 89% 16-Jan-19 20 Brunei Darussalam 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 24-Jan-19 - Cambodia 57 44 73 0 0 0 72 1 0 (0.0%) 1.66 92% 85% 03-Jan-19 33 China 5278 2256 5308 0 1 0 3764 1543 562 (10.6%) 2.35 92% 100% 23-Jan-19 13 China, Hong Kong SAR 15 9 11 0 0 0 10 1 0 (0.0%) 1.22 82% 100% 21-Jan-19 15 China, Macao SAR 2 1 3 0 0 0 2 1 0 (0.0%) 3.00 100% 100% 11-Jan-19 25 Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 103 21 94 0 0 0 84 10 0 (0.0%) 4.48 80% 79% 25-Jan-19 11 Malaysia 154 77 174 0 0 0 131 43 21 (12.1%) 2.26 80% 82% 23-Jan-19 13 Mongolia 6 9 6 0 0 0 6 0 0 (0.0%) 0.67 100% 83% 04-Feb-19 - New Zealand 13 9 10 0 0 0 6 4 3 (30.0%) 1.11 60% 100% 28-Jan-19 8 Papua New Guinea 29 37 284 0 26 12 144 102 47 (16.5%) 6.97 46% 74% 25-Jan-19 11 Philippines 462 338 316 0 0 0 248 68 50 (15.8%) 0.93 60% 94% 31-Jan-19 5 Republic of Korea 68 67 68 0 0 0 61 7 0 (0.0%) 1.01 90% 100% 11-Jan-19 25 Singapore 7 6 13 0 0 0 11 2 0 (0.0%) 2.17 77% 100% 08-Jan-19 28 Viet Nam 385 234 315 0 0 0 235 80 49 (15.6%) 1.35 98% 86% 11-Jan-19 25 Pacific island countries and areas 16 11 13 0 0 0 1 12 9 (69.2%) 1.18 31% 92% 04-Feb-19 1 Total 6656 3327 6744 0 27 14 4824 1879 742 (11.0%) 2.02 88% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Discarded (Non-polio) 2018 Non-polio AFP rate Total % with adequate specimens 2 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Table 2. Laboratory investigation of stool samples from AFP cases with onset in 2018 and key laboratory indicators Polio Bulletin 3 ≥ 80% ≥ 80% Australia VIDRL 44 1 0 1 42 0 0 91% 3% 05-Feb-19 VIDRL 1 0 0 0 0 0 0 0 0 0 1 0 0 100% Brunei Darussalam VIDRL 2 0 0 0 2 0 0 50% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 74 0 0 13 61 0 0 93% 15% 18-Jan-19 NIID 0 - - - - - - - - - - - - - China (total) 5243 37 0 376 4739 0 91 98% 6% 23-Jan-19 88 0 24 0 0 0 0 0 63 1 0 0 0 99% China, Anhui Prov. Lab 325 2 0 15 298 0 10 100% 4% Prov. Lab/CCDC 8 0 3 0 0 0 0 0 5 0 0 0 0 100% China, Beijing Prov. Lab 33 0 0 0 33 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 67 0 0 2 65 0 0 93% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 181 1 0 13 167 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Gansu Prov. Lab 113 1 0 6 101 0 5 99% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangdong Prov. Lab 424 2 0 20 398 0 4 92% 4% Prov. Lab/CCDC 4 0 0 0 0 0 0 0 4 0 0 0 0 100% China, Guangxi Prov. Lab 216 2 0 18 195 0 1 99% 8% Prov. Lab/CCDC 4 0 3 0 0 0 0 0 1 0 0 0 0 100% China, Guizhou Prov. Lab 192 1 0 14 172 0 5 97% 7% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hebei Prov. Lab 291 1 0 38 250 0 2 100% 10% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 89 0 0 4 82 0 3 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 548 5 0 56 481 0 6 99% 9% Prov. Lab/CCDC 13 0 5 0 0 0 0 0 8 0 0 0 0 100% China, Hubei Prov. Lab 172 1 0 12 150 0 9 99% 7% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Hunan Prov. Lab 242 0 0 25 216 0 1 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 247 8 0 11 208 0 20 100% 5% Prov. Lab/CCDC 16 0 2 0 0 0 0 0 13 1 0 0 0 100% China, Jiangxi Prov. Lab 174 1 0 12 156 0 5 98% 5% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Jilin Prov. Lab 59 2 0 9 47 0 1 98% 11% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Neimongol Prov. Lab 100 2 0 4 94 0 0 98% 4% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 100% China, Ningxia Prov. Lab 26 0 0 2 24 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 96 1 0 2 88 0 5 84% 2% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 0% China, Shandong Prov. Lab 408 2 0 26 377 0 3 100% 5% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 100% China, Shanghai Prov. Lab 40 0 0 0 40 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 125 1 0 7 117 0 0 98% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Sichuan Prov. Lab 308 1 0 21 283 0 3 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Tianjin Prov. Lab 22 0 0 0 22 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 138 1 0 7 129 0 1 91% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 262 0 0 35 224 0 3 95% 11% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Zhejiang Prov. Lab 184 2 0 7 174 0 1 99% 4% Prov. Lab/CCDC 7 0 0 0 0 0 0 0 7 0 0 0 0 100% China, Hainan Prov. Lab 36 0 0 6 30 0 0 100% 14% CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 85 0 0 3 81 0 1 98% 2% CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 32 0 0 0 31 0 1 100% 0% CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 8 0 0 1 6 0 1 85% 8% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 11 0 0 0 11 0 0 100% 0% 28-Jan-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 3 0 0 0 3 0 0 100% 0% 24-Dec-18 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 114 1 0 8 105 0 0 96% 4% 28-Jan-19 NIID 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Malaysia IMR 148 0 0 8 138 0 2 94% 4% 09-Nov-18 IMR 0 - - - - - - - - - - - - - Mongolia PHI 6 0 0 3 3 0 0 100% 50% 04-Jan-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 8 0 0 1 7 0 0 100% 13% 25-Jan-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 290 93 1 18 178 0 0 89% 5% 05-Feb-19 VIDRL 187 0 63 46 0 0 0 0 78 0 0 0 0 100% Philippines RITM 373 5 1 14 353 0 0 95% 3% 09-Jan-19 RITM 7 0 2 0 0 0 0 0 4 0 0 1 0 100% Republic of Korea NIH 67 0 0 5 62 0 0 99% 7% 11-Jan-19 NIH 0 - - - - - - - - - - - - - Singapore SGH 13 0 0 2 11 0 0 96% 8% 18-Jan-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 175 3 0 24 148 0 0 100% 12% 30-Jan-19 NIHE 4 0 2 0 0 0 0 0 2 0 0 0 0 100% Viet Nam (South) PI 170 4 0 20 136 10 0 100% 13% 02-Jan-19 PI 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Pacific island countries and areas VIDRL 11 0 0 1 10 0 0 97% 6% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Total 6752 144 2 494 6009 10 93 97% 6% 296 0 93 46 0 0 0 0 154 1 1 1 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2 VDPV Pending ITDVDPV NegativeNPEV only SabinWild 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); NIH (National Institute of Health, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Polio Bulletin 4 Table 3. Laboratory confirmation of polio isolates from environmental samples in 2017–2018 1 Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2018 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 Australia aVDPV2 (1 env) Cambodia 2006 - 1 Total - 2 China 2009 - 1Total - 27 aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP) aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP) aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 aVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) Viet Nam aVDPV2 (2 AFP) 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 6 2 0 0 0 0 0 1 0 1 0 4 0 0 17 2 0 2 0 0 0 0 0 0 0 12 0 0 China (total) 325 188 0 213 0 0 0 0 0 650 0 1158 0 0 240 154 0 179 0 0 0 1 0 480 2 1161 0 0 China, Fujian Prov. Lab/CCDC 53 22 0 8 0 0 0 0 0 42 0 331 0 0 67 46 0 16 0 0 0 0 0 97 1 532 0 0 China, Gansu Prov. Lab/CCDC 12 10 0 10 0 0 0 0 0 29 0 18 0 0 9 6 0 2 0 0 0 0 0 8 0 33 0 0 China, Guangdong Prov. Lab/CCDC 48 39 0 18 0 0 0 0 0 87 0 108 0 0 48 41 0 27 0 0 0 0 0 102 1 217 0 0 China, Guangxi Prov. Lab/CCDC 36 20 0 22 0 0 0 0 0 36 0 94 0 0 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab/CCDC 42 17 0 12 0 0 0 0 0 34 0 112 0 0 40 21 0 6 0 0 0 0 0 41 0 105 0 0 China, Shandong Prov. Lab/CCDC 48 28 0 18 0 0 0 0 0 90 0 272 0 0 27 8 0 13 0 0 0 0 0 36 0 149 0 0 China, Shanghai Prov. Lab/CCDC 22 18 0 17 0 0 0 0 0 65 0 51 0 0 8 5 0 3 0 0 0 0 0 7 0 31 0 0 China, Xinjiang Prov. Lab/CCDC 36 34 0 108 0 0 0 0 0 267 0 115 0 0 27 27 0 112 0 0 0 1 0 189 0 79 0 0 China, Yunnan Prov. Lab/CCDC 28 0 - - - - - - - - - 57 0 0 14 0 - - - - - - - - - 15 0 0 Malaysia IMR 24 0 - - - - - - - - - 22 0 0 0 - - - - - - - - - - - - - Philippines RITM 40 8 0 1 0 0 0 0 0 7 0 21 0 0 87 8 0 2 0 0 0 0 0 2 0 24 4 0 Papua New Guinea RITM - - - - - - - - - - - - - - 27 23 0 15 7 0 0 0 0 21 0 9 0 0 Total 395 198 0 214 0 0 0 1 0 658 0 1205 0 0 371 187 0 198 7 0 0 1 0 503 2 1206 4 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); IMR (Institute of Medical Research, Malaysia); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2017 2018 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD

Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2016–2018 Chart 2. Adequate specimen collection rate, 2016–2018 Confirmation of circulating vaccine-derived polio virus in Indonesia On 17 January 2019 the WHO Headquarters reported isolation of vaccine-derived poliovirus type 1 (VDPV1) from an AFP case from Papua province in Indonesia. On 13 February the WHO Headquarters reported confirmation of the second genetically-linked isolate from the stool specimens of a healthy community contact. Following global guidelines this event is now officially classified as a ‘circulating’ VDPV type 1. This second VDPV1 was isolated from a healthy child (28 months old), from Papua province (from Yahukimo district, the same district from where the first isolate was reported). The index isolate is from an AFP case with onset of paralysis on 27 November 2018, also from Papua province. The two genetically-linked viruses have a 61 and 58 nucleotide divergence (respectively) from Sabin 1. This outbreak is not genetically linked to the ongoing cVDPV1 outbreak in Papua New Guinea. A rapid outbreak response in the affected district is already underway and a broader outbreak response is now being planned, potentially to conduct SIAs in key areas targeting children aged under 15-years. Polio Bulletin 2019 Issue No. 4 - Week 7 (as of 19 February 2019) Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2018 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2018 Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam). Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: wproepidata@who.int Web: www.who.int/westernpacific CONTACT US HIGHLIGHTS 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 15.6% 21.7% 15.8% 12.1% 0.0% 0.0% 13.4% 0% 5% 10% 15% 20% 25% VNM PNG PHL MYS LAO KHM CHN Table 1A. Classification of AFP cases with onset in 2018 and key surveillance indicators Polio Bulletin 2 2017 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 60 46 57 0 0 3 54 0 0 (0.0%) 1.24 44% 89% 14-Feb-19 - Brunei Darussalam 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 24-Jan-19 - Cambodia 57 44 73 0 0 0 72 1 0 (0.0%) 1.66 92% 85% 03-Jan-19 47 China 5278 2256 5419 0 1 0 3914 1504 726 (13.4%) 2.40 92% 100% 07-Feb-19 12 China, Hong Kong SAR 15 9 11 0 0 0 10 1 0 (0.0%) 1.22 82% 100% 21-Jan-19 29 China, Macao SAR 2 1 3 0 0 0 2 1 0 (0.0%) 3.00 100% 100% 11-Jan-19 39 Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 103 21 94 0 0 0 84 10 0 (0.0%) 4.48 80% 79% 13-Feb-19 6 Malaysia 154 77 174 0 0 0 131 43 21 (12.1%) 2.26 80% 82% 23-Jan-19 27 Mongolia 6 9 6 0 0 0 6 0 0 (0.0%) 0.67 100% 83% 04-Feb-19 - New Zealand 13 9 10 0 0 0 6 4 3 (30.0%) 1.11 60% 100% 28-Jan-19 22 Papua New Guinea 29 37 286 0 26 12 168 80 62 (21.7%) 7.03 45% 74% 15-Feb-19 4 Philippines 462 338 316 0 0 0 248 68 50 (15.8%) 0.93 60% 94% 31-Jan-19 19 Republic of Korea 68 67 70 0 0 0 65 5 0 (0.0%) 1.04 90% 100% 11-Feb-19 8 Singapore 7 6 13 0 0 0 13 0 0 (0.0%) 2.17 77% 100% 08-Feb-19 - Viet Nam 385 234 315 0 0 0 235 80 49 (15.6%) 1.35 98% 86% 11-Jan-19 39 Pacific island countries and areas 16 11 13 0 0 0 1 12 9 (69.2%) 1.18 31% 100% 07-Feb-19 12 Total 6656 3327 6862 0 27 15 5011 1809 920 (13.4%) 2.05 88% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 2018 Non-polio AFP rate Total % with adequate specimens 2> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Table 1B. Classification of AFP cases with onset in 2019 and key surveillance indicators Polio Bulletin 3 2017 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 57 47 6 0 0 0 4 2 0 (0.0%) 0.95 50% 100% 14-Feb-19 5 Brunei Darussalam 2 1 1 0 0 0 0 1 0 (0.0%) 7.43 100% 100% 24-Jan-19 26 Cambodia 73 44 4 0 0 0 0 4 0 (0.0%) 0.68 100% 75% 12-Feb-19 7 China 5419 2256 0 - - - - - - - - - 07-Feb-19 12 China, Hong Kong SAR 11 9 4 0 0 0 0 4 0 (0.0%) 3.30 75% 100% 14-Feb-19 5 China, Macao SAR 3 1 0 - - - - - - - - - 19-Feb-19 0 Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 94 23 6 0 0 0 0 6 0 (0.0%) 1.94 67% 83% 13-Feb-19 6 Malaysia 174 78 0 - - - - - - - - - 23-Jan-19 27 Mongolia 6 9 0 - - - - - - - - - 04-Feb-19 15 New Zealand 10 9 1 0 0 0 0 1 0 (0.0%) 0.83 100% 100% 28-Jan-19 22 Papua New Guinea 286 33 9 0 0 0 0 9 0 (0.0%) 2.03 56% 89% 15-Feb-19 4 Philippines 316 344 0 - - - - - - - - - 31-Jan-19 19 Republic of Korea 70 66 0 - - - - - - - - - 11-Feb-19 8 Singapore 13 6 1 0 0 0 0 1 0 (0.0%) 1.24 100% 100% 08-Feb-19 11 Viet Nam 315 234 0 - - - - - - - - - 11-Jan-19 39 Pacific island countries and areas 13 11 1 0 0 0 0 1 0 (0.0%) 0.68 100% 100% 07-Feb-19 12 Total 6862 3332 33 0 0 0 4 29 0 (0.0%) 0.07 70% 91% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO 2018 Non-polio AFP rate 2 Total % with adequate specimens 3> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2018 and key laboratory indicators Polio Bulletin 4 ≥ 80% ≥ 80% Australia VIDRL 44 1 0 1 42 0 0 91% 3% 05-Feb-19 VIDRL 1 0 0 0 0 0 0 0 0 0 1 0 0 100% Brunei Darussalam VIDRL 2 0 0 0 2 0 0 50% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 74 0 0 13 61 0 0 93% 15% 18-Jan-19 NIID 0 - - - - - - - - - - - - - China (total) 5350 38 0 379 4883 0 50 98% 6% 07-Feb-19 88 0 24 0 0 0 0 0 63 1 0 0 0 99% China, Anhui Prov. Lab 339 3 0 16 315 0 5 100% 4% Prov. Lab/CCDC 8 0 3 0 0 0 0 0 5 0 0 0 0 100% China, Beijing Prov. Lab 35 0 0 0 35 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 69 0 0 2 67 0 0 93% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 181 1 0 13 167 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Gansu Prov. Lab 114 1 0 6 102 0 5 99% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangdong Prov. Lab 432 2 0 20 405 0 5 91% 4% Prov. Lab/CCDC 4 0 0 0 0 0 0 0 4 0 0 0 0 100% China, Guangxi Prov. Lab 220 2 0 18 199 0 1 99% 8% Prov. Lab/CCDC 4 0 3 0 0 0 0 0 1 0 0 0 0 100% China, Guizhou Prov. Lab 198 1 0 14 183 0 0 97% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hebei Prov. Lab 299 1 0 38 258 0 2 100% 10% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 91 0 0 4 86 0 1 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 555 5 0 56 490 0 4 99% 9% Prov. Lab/CCDC 13 0 5 0 0 0 0 0 8 0 0 0 0 100% China, Hubei Prov. Lab 173 1 0 13 158 0 1 99% 7% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Hunan Prov. Lab 246 0 0 25 220 0 1 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 251 8 0 11 232 0 0 100% 4% Prov. Lab/CCDC 16 0 2 0 0 0 0 0 13 1 0 0 0 100% China, Jiangxi Prov. Lab 175 1 0 12 157 0 5 98% 5% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Jilin Prov. Lab 58 2 0 9 47 0 0 98% 11% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Neimongol Prov. Lab 100 2 0 4 94 0 0 98% 4% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 100% China, Ningxia Prov. Lab 26 0 0 2 24 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 101 1 0 2 92 0 6 84% 2% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 0% China, Shandong Prov. Lab 418 2 0 27 387 0 2 100% 5% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 100% China, Shanghai Prov. Lab 42 0 0 0 42 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 129 1 0 7 121 0 0 98% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Sichuan Prov. Lab 313 1 0 21 289 0 2 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Tianjin Prov. Lab 22 0 0 0 22 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 145 1 0 7 136 0 1 91% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 269 0 0 35 230 0 4 95% 11% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Zhejiang Prov. Lab 187 2 0 7 177 0 1 99% 3% Prov. Lab/CCDC 7 0 0 0 0 0 0 0 7 0 0 0 0 100% China, Hainan Prov. Lab 36 0 0 6 30 0 0 100% 14% CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 86 0 0 3 81 0 2 98% 2% CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 32 0 0 0 31 0 1 100% 0% CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 8 0 0 1 6 0 1 85% 8% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 11 0 0 0 11 0 0 100% 0% 28-Jan-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 3 0 0 0 3 0 0 100% 0% 24-Dec-18 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 115 1 0 8 106 0 0 96% 4% 18-Feb-19 NIID 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Malaysia IMR 148 0 0 8 138 0 2 94% 4% 09-Nov-18 IMR 0 - - - - - - - - - - - - - Mongolia PHI 6 0 0 3 3 0 0 100% 50% 04-Jan-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 8 0 0 1 7 0 0 100% 13% 25-Jan-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 296 93 1 20 181 1 0 88% 5% 19-Feb-19 VIDRL 187 0 63 46 0 0 0 0 78 0 0 0 0 100% Philippines RITM 395 5 1 14 374 1 0 96% 3% 12-Feb-19 RITM 7 0 2 0 0 0 0 0 4 0 0 1 0 100% Republic of Korea NIH 69 0 0 5 64 0 0 97% 7% 11-Feb-19 NIH 0 - - - - - - - - - - - - - Singapore SGH 13 0 0 2 11 0 0 96% 8% 30-Jan-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 175 3 0 24 148 0 0 100% 12% 30-Jan-19 NIHE 4 0 2 0 0 0 0 0 2 0 0 0 0 100% Viet Nam (South) PI 170 4 0 20 136 10 0 100% 13% 02-Jan-19 PI 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Pacific island countries and areas VIDRL 11 0 0 1 10 0 0 97% 6% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Total 6890 145 2 499 6180 12 52 97% 6% 296 0 93 46 0 0 0 0 154 1 1 1 0 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens posit ive for NPEV Latest report date Discordant pending sequencing 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); NIH (National Institute of Health, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPV NegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2 VDPV Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2019 and key laboratory indicators Polio Bulletin 5 ≥ 80% ≥ 80% Australia VIDRL 4 0 0 0 2 2 0 100% 0% 14-Feb-19 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 2 0 0 0 2 0 0 100% 0% 07-Feb-19 NIID 0 - - - - - - - - - - - - - China (total) 0 - - - - - - - - 07-Feb-19 0 - - - - - - - - - - - - - China, Anhui Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Beijing Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangxi Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hubei Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Ningxia Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Yunnan Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 0 - - - - - - - - - CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 0 - - - - - - - - - CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 0 - - - - - - - - - CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 0 - - - - - - - - - CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 4 0 0 0 4 0 0 100% 0% 18-Feb-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - - PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 4 0 0 0 6 0 0 100% 0% 18-Feb-19 NIID 0 - - - - - - - - - - - - - Malaysia IMR 0 - - - - - - - - - IMR 0 - - - - - - - - - - - - - Mongolia PHI 2 0 0 0 1 1 0 100% 0% 14-Feb-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 1 0 0 0 1 0 0 100% 0% 18-Feb-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 2 0 0 1 0 0 1 100% 67% 19-Feb-19 VIDRL 3 0 0 0 0 0 0 0 0 0 2 0 1 100% Philippines RITM 12 0 0 0 5 7 0 100% 0% 12-Feb-19 RITM 0 - - - - - - - - - - - - - Republic of Korea NIH 0 - - - - - - - - 11-Feb-19 NIH 0 - - - - - - - - - - - - - Singapore SGH 1 0 0 0 1 0 0 100% 0% 15-Feb-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 1 0 0 0 1 0 0 100% 0% 15-Feb-19 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 8 0 0 1 6 1 0 100% 14% 18-Feb-19 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 1 0 0 0 1 0 0 0% 0% 13-Feb-19 VIDRL 0 - - - - - - - - - - - - - Total 43 0 0 2 31 11 1 100% 7% 3 0 0 0 0 0 0 0 0 0 2 0 1 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); NIH (National Institute of Health, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPV NegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B posit ive + NPEV NPEV 2 VDPV Polio Bulletin 6 Table 3. Laboratory confirmation of polio isolates from environmental samples in 2017–2018 1 Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2018 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 Australia aVDPV2 (1 env) Cambodia 2006 - 1 Total - 2 China 2009 - 1Total - 27 aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP) aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP) aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 aVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) Viet Nam aVDPV2 (2 AFP) 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 6 2 0 0 0 0 0 1 0 1 0 4 0 0 17 2 0 2 0 0 0 0 0 0 0 12 0 0 China (total) 325 188 0 213 0 0 0 0 0 650 0 1158 0 0 265 171 0 195 0 0 0 1 0 539 2 1348 0 0 China, Fujian Prov. Lab/CCDC 53 22 0 8 0 0 0 0 0 42 0 331 0 0 67 46 0 16 0 0 0 0 0 97 1 532 0 0 China, Gansu Prov. Lab/CCDC 12 10 0 10 0 0 0 0 0 29 0 18 0 0 9 6 0 2 0 0 0 0 0 8 0 33 0 0 China, Guangdong Prov. Lab/CCDC 48 39 0 18 0 0 0 0 0 87 0 108 0 0 48 41 0 27 0 0 0 0 0 102 1 217 0 0 China, Guangxi Prov. Lab/CCDC 36 20 0 22 0 0 0 0 0 36 0 94 0 0 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab/CCDC 42 17 0 12 0 0 0 0 0 34 0 112 0 0 40 21 0 6 0 0 0 0 0 41 0 105 0 0 China, Shandong Prov. Lab/CCDC 48 28 0 18 0 0 0 0 0 90 0 272 0 0 39 16 0 21 0 0 0 0 0 63 0 282 0 0 China, Shanghai Prov. Lab/CCDC 22 18 0 17 0 0 0 0 0 65 0 51 0 0 8 5 0 3 0 0 0 0 0 7 0 31 0 0 China, Xinjiang Prov. Lab/CCDC 36 34 0 108 0 0 0 0 0 267 0 115 0 0 36 36 0 120 0 0 0 1 0 221 0 109 0 0 China, Yunnan Prov. Lab/CCDC 28 0 - - - - - - - - - 57 0 0 18 0 - - - - - - - - - 39 0 0 Malaysia IMR 24 0 - - - - - - - - - 22 0 0 0 - - - - - - - - - - - - - Philippines RITM 40 8 0 1 0 0 0 0 0 7 0 21 0 0 87 8 0 2 0 0 0 0 0 2 0 24 4 0 Papua New Guinea RITM - - - - - - - - - - - - - - 27 23 0 15 7 0 0 0 0 21 0 9 0 0 Total 395 198 0 214 0 0 0 1 0 658 0 1205 0 0 396 204 0 214 7 0 0 1 0 562 2 1393 4 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); IMR (Institute of Medical Research, Malaysia); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2017 2018 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD

Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2017–2019* Chart 2. Adequate specimen collection rate, 2017–2019 The Meeting of the Global Commission for the Certification of Poliomyelitis Eradication (GCC) On 26-27 February 2019, the Global Commission for Certification of Poliomyelitis Eradication (GCC) met in Geneva, Switzerland, to review the progress toward wild poliovirus (WPV) eradication and poliovirus containment and to consider the appraisal of options with respect to WPV certification with or without consideration of verification/ certification of circulation of vaccine-derived poliovirus (VDPV). The GCC concluded that:  deeper analysis of WPV1 epidemiology was helpful and should continue;  polio surveillance in priority countries and areas significantly improved since the last meeting in October 2018; and  the number and duration of cVDPV outbreaks is a concern. The GCC, noting that new modelling work and updated regional and laboratory data reinforced the previous GCC conclusion that WPV3 has been eradicated, reaffirmed its decision to undertake sequential certification of WPV3 in order to once again demonstrate that eradication of all polioviruses is achievable as a motivator. Polio Bulletin 2019 Issue No. 5 - Week 10 (as of 12 March 2019) Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2018 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2019 Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam). Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: wproepidata@who.int Web: www.who.int/westernpacific CONTACT US HIGHLIGHTS 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 15.6% 24.8% 15.8% 12.1% 0.0% 0.0% 14.5% 0% 5% 10% 15% 20% 25% 30% VNM PNG PHL MYS LAO KHM CHN * AFP rate annualized as of week 10 Table 1A. Classification of AFP cases with onset in 2018 and key surveillance indicators Polio Bulletin 2 2017 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 60 46 57 0 0 3 54 0 0 (0.0%) 1.24 44% 89% 14-Feb-19 - Brunei Darussalam 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 24-Jan-19 - Cambodia 57 44 73 0 0 0 72 1 0 (0.0%) 1.66 92% 85% 03-Jan-19 68 China 5278 2256 5397 0 1 0 4347 1049 784 (14.5%) 2.39 92% 100% 06-Mar-19 6 China, Hong Kong SAR 15 9 11 0 0 0 10 1 0 (0.0%) 1.22 82% 100% 21-Jan-19 50 China, Macao SAR 2 1 3 0 0 0 3 0 0 (0.0%) 3.00 100% 100% 19-Feb-19 - Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 103 21 94 0 0 0 84 10 0 (0.0%) 4.48 80% 79% 13-Feb-19 27 Malaysia 154 77 174 0 0 0 131 43 21 (12.1%) 2.26 80% 82% 23-Jan-19 48 Mongolia 6 9 6 0 0 0 6 0 0 (0.0%) 0.67 100% 83% 04-Feb-19 - New Zealand 13 9 10 0 0 0 10 0 0 (0.0%) 1.11 60% 100% 28-Feb-19 - Papua New Guinea 29 37 286 0 26 12 168 80 71 (24.8%) 7.03 44% 74% 23-Feb-19 17 Philippines 462 338 316 0 0 0 248 68 50 (15.8%) 0.93 60% 94% 31-Jan-19 40 Republic of Korea 68 67 70 0 0 0 70 0 0 (0.0%) 1.04 90% 100% 11-Mar-19 - Singapore 7 6 13 0 0 0 13 0 0 (0.0%) 2.17 77% 100% 08-Mar-19 - Viet Nam 385 234 315 0 0 0 235 80 49 (15.6%) 1.35 98% 86% 11-Jan-19 60 Pacific island countries and areas 16 11 13 0 0 0 1 12 9 (69.2%) 1.18 31% 100% 18-Feb-19 22 Total 6656 3327 6840 0 27 15 5454 1344 984 (14.4%) 2.05 88% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO 2018 Non-polio AFP rate Total % with adequate specimens 2> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Table 1B. Classification of AFP cases with onset in 2019 and key surveillance indicators Polio Bulletin 3 2018 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 57 47 6 0 0 0 4 2 0 (0.0%) 0.66 50% 100% 14-Feb-19 26 Brunei Darussalam 2 1 1 0 0 0 0 1 0 (0.0%) 5.20 100% 100% 24-Jan-19 47 Cambodia 73 46 4 0 0 0 0 4 0 (0.0%) 0.45 100% 75% 12-Feb-19 28 China 5397 2256 421 0 0 0 12 409 0 (0.0%) 0.97 92% 100% 06-Mar-19 6 China, Hong Kong SAR 11 9 5 0 0 0 2 3 0 (0.0%) 2.89 100% 80% 04-Mar-19 8 China, Macao SAR 3 1 0 - - - - - - - - - 19-Feb-19 21 Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 94 23 6 0 0 0 0 6 0 (0.0%) 1.36 67% 83% 13-Feb-19 27 Malaysia 174 78 0 - - - - - - - - - 23-Jan-19 48 Mongolia 6 9 2 0 0 0 0 2 0 (0.0%) 1.16 100% 100% 09-Mar-19 3 New Zealand 10 9 1 0 0 0 1 0 0 (0.0%) 0.58 100% 100% 28-Feb-19 12 Papua New Guinea 286 33 29 0 0 0 0 29 0 (0.0%) 4.57 79% 93% 08-Mar-19 4 Philippines 316 344 4 0 0 0 0 4 0 (0.0%) 0.06 75% 100% 11-Mar-19 1 Republic of Korea 70 66 4 0 0 0 0 4 0 (0.0%) 0.32 75% 100% 11-Mar-19 1 Singapore 13 6 1 0 0 0 1 0 0 (0.0%) 0.87 100% 100% 08-Mar-19 4 Viet Nam 315 234 8 0 0 0 0 8 1 (12.5%) 0.18 88% 100% 19-Feb-19 21 Pacific island countries and areas 13 11 1 0 0 0 0 1 0 (0.0%) 0.47 100% 100% 07-Feb-19 33 Total 6840 3334 493 0 0 0 20 473 1 (0.2%) 0.77 90% 99% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO Discarded (Non-polio) 2019 Non-polio AFP rate 2 Total % with adequate specimens 3 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2018 and key laboratory indicators Polio Bulletin 4 ≥ 80% ≥ 80% Australia VIDRL 44 1 0 1 42 0 0 91% 3% 05-Feb-19 VIDRL 1 0 0 0 0 0 0 0 0 0 1 0 0 100% Brunei Darussalam VIDRL 2 0 0 0 2 0 0 50% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 74 0 0 13 61 0 0 93% 15% 18-Jan-19 NIID 0 - - - - - - - - - - - - - China (total) 5329 37 0 378 4909 0 5 97% 6% 06-Mar-19 88 0 24 0 0 0 0 0 63 1 0 0 0 99% China, Anhui Prov. Lab 340 3 0 18 319 0 0 100% 5% Prov. Lab/CCDC 8 0 3 0 0 0 0 0 5 0 0 0 0 100% China, Beijing Prov. Lab 31 0 0 0 31 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 69 0 0 2 67 0 0 93% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 179 1 0 12 166 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Gansu Prov. Lab 115 1 0 6 105 0 3 99% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangdong Prov. Lab 431 2 0 21 406 0 2 91% 4% Prov. Lab/CCDC 4 0 0 0 0 0 0 0 4 0 0 0 0 100% China, Guangxi Prov. Lab 220 2 0 18 200 0 0 99% 8% Prov. Lab/CCDC 4 0 3 0 0 0 0 0 1 0 0 0 0 100% China, Guizhou Prov. Lab 191 0 0 14 177 0 0 97% 7% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hebei Prov. Lab 299 1 0 38 260 0 0 100% 10% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 91 0 0 4 87 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 557 5 0 57 495 0 0 99% 9% Prov. Lab/CCDC 13 0 5 0 0 0 0 0 8 0 0 0 0 100% China, Hubei Prov. Lab 176 1 0 13 162 0 0 99% 7% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Hunan Prov. Lab 246 0 0 25 221 0 0 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 252 8 0 11 233 0 0 100% 4% Prov. Lab/CCDC 16 0 2 0 0 0 0 0 13 1 0 0 0 100% China, Jiangxi Prov. Lab 176 1 0 12 163 0 0 97% 5% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Jilin Prov. Lab 58 2 0 9 47 0 0 98% 11% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Neimongol Prov. Lab 101 2 0 4 95 0 0 98% 3% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 100% China, Ningxia Prov. Lab 26 0 0 2 24 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 99 1 0 2 96 0 0 84% 2% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 0% China, Shandong Prov. Lab 414 2 0 27 385 0 0 100% 5% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 100% China, Shanghai Prov. Lab 42 0 0 0 42 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 129 1 0 7 121 0 0 98% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Sichuan Prov. Lab 313 1 0 21 291 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Tianjin Prov. Lab 22 0 0 0 22 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 147 1 0 7 139 0 0 91% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 254 0 0 31 223 0 0 94% 10% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Zhejiang Prov. Lab 188 2 0 7 179 0 0 99% 3% Prov. Lab/CCDC 7 0 0 0 0 0 0 0 7 0 0 0 0 100% China, Hainan Prov. Lab 36 0 0 6 30 0 0 100% 14% CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 87 0 0 3 84 0 0 98% 2% CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 32 0 0 0 32 0 0 100% 0% CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 8 0 0 1 7 0 0 73% 7% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 11 0 0 0 11 0 0 100% 0% 28-Jan-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 3 0 0 0 3 0 0 100% 0% 24-Dec-18 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 116 1 0 8 107 0 0 96% 4% 11-Mar-19 NIID 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Malaysia IMR 180 0 0 10 170 0 0 89% 4% 19-Feb-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 6 0 0 3 3 0 0 100% 50% 04-Jan-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 8 0 0 1 7 0 0 100% 13% 25-Jan-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 297 93 1 21 182 0 0 88% 5% 28-Feb-19 VIDRL 187 0 63 46 0 0 0 0 78 0 0 0 0 100% Philippines RITM 396 5 1 14 375 1 0 96% 3% 26-Feb-19 RITM 7 0 2 0 0 0 0 0 5 0 0 0 0 100% Republic of Korea NIH 69 0 0 5 64 0 0 97% 7% 11-Feb-19 NIH 0 - - - - - - - - - - - - - Singapore SGH 13 0 0 2 11 0 0 96% 8% 30-Jan-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 175 3 0 24 148 0 0 100% 12% 30-Jan-19 NIHE 4 0 2 0 0 0 0 0 2 0 0 0 0 100% Viet Nam (South) PI 175 4 0 21 150 0 0 100% 12% 25-Feb-19 PI 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Pacific island countries and areas VIDRL 11 0 0 1 10 0 0 97% 6% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Total 6909 144 2 502 6255 1 5 97% 6% 296 0 93 46 0 0 0 0 155 1 1 0 0 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens posit ive for NPEV Latest report date Discordant pending sequencing 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); NIH (National Institute of Health, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPV NegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2 VDPV Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2019 and key laboratory indicators Polio Bulletin 5 ≥ 80% ≥ 80% Australia VIDRL 4 0 0 0 2 0 2 100% 0% 14-Feb-19 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 4 0 0 0 4 0 0 100% 0% 02-Mar-19 NIID 0 - - - - - - - - - - - - - China (total) 406 1 0 13 339 0 53 95% 3% 06-Mar-19 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Anhui Prov. Lab 22 0 0 0 22 0 0 100% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Beijing Prov. Lab 3 0 0 0 3 0 0 100% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 3 0 0 0 1 0 2 0% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 12 0 0 0 12 0 0 100% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 7 0 0 0 6 0 1 100% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 30 0 0 1 28 0 1 100% 3% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangxi Prov. Lab 19 0 0 1 16 0 2 100% 6% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 21 0 0 2 15 0 4 100% 12% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 27 0 0 0 27 0 0 100% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 9 0 0 0 9 0 0 100% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 32 0 0 1 30 0 1 90% 3% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hubei Prov. Lab 14 0 0 1 12 0 1 85% 8% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 20 0 0 1 19 0 0 100% 5% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 16 0 0 0 14 0 2 100% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 8 0 0 0 8 0 0 88% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 4 0 0 0 1 0 3 100% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 11 1 0 0 10 0 0 100% 0% - Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Ningxia Prov. Lab 2 0 0 0 2 0 0 100% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 3 0 0 0 1 0 2 100% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 20 0 0 1 14 0 5 73% 3% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 2 0 0 0 2 0 0 100% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 12 0 0 0 12 0 0 92% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 27 0 0 3 7 0 17 100% 30% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 2 0 0 0 2 0 0 100% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 17 0 0 0 16 0 1 100% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Yunnan Prov. Lab 27 0 0 2 20 0 5 91% 4% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 19 0 0 0 18 0 1 100% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 1 0 0 0 1 0 0 100% 0% - CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 8 0 0 0 7 0 1 100% 0% - CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 4 0 0 0 0 0 4 - - - CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 4 0 0 0 4 0 0 25% 0% - CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 5 0 0 0 4 1 0 100% 0% 07-Mar-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - - PHLC 0 - - - - - - - - - - - - - Japan NIID 0 - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 7 0 0 0 9 0 0 100% 0% 11-Mar-19 NIID 0 - - - - - - - - - - - - - Malaysia IMR 0 - - - - - - - - - IMR 0 - - - - - - - - - - - - - Mongolia PHI 2 0 0 0 2 0 0 100% 0% 11-Mar-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 1 0 0 0 1 0 0 100% 0% 11-Mar-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 8 0 0 2 5 0 1 100% 27% 11-Mar-19 VIDRL 3 0 0 0 0 0 0 0 0 0 2 0 1 100% Philippines RITM 12 0 0 0 5 7 0 100% 0% 12-Feb-19 RITM 0 - - - - - - - - - - - - - Republic of Korea NIH 4 0 0 0 4 0 0 100% 0% 11-Mar-19 NIH 0 - - - - - - - - - - - - - Singapore SGH 1 0 0 0 1 0 0 100% 0% 08-Mar-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 1 0 0 0 1 0 0 100% 0% 15-Feb-19 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 8 0 0 1 6 1 0 100% 14% 25-Feb-19 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 1 0 0 0 1 0 0 95% 4% 13-Feb-19 VIDRL 0 - - - - - - - - - - - - - Total 465 1 0 16 385 9 56 95% 4% 4 0 1 0 0 0 0 0 0 0 2 0 1 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B posit ive + NPEV NPEV 2 VDPV Pending ITDVDPV NegativeNPEV only SabinWild 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); NIH (National Institute of Health, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Polio Bulletin 6 Table 3. Laboratory confirmation of polio isolates from environmental samples in 2018–2019 1 Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2019 Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 17 2 0 2 0 0 0 0 0 0 0 12 0 0 0 - - - - - - - - - - - - - China (total) 281 180 0 199 0 0 0 1 0 560 2 1409 0 0 15 11 0 7 0 0 0 0 0 28 0 47 0 0 China, Fujian Prov. Lab/CCDC 73 51 0 20 0 0 0 0 0 107 1 577 0 0 6 4 0 2 0 0 0 0 0 4 0 22 0 0 China, Gansu Prov. Lab/CCDC 12 7 0 2 0 0 0 0 0 12 0 40 0 0 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab/CCDC 48 41 0 27 0 0 0 0 0 102 1 217 0 0 4 4 0 2 0 0 0 0 0 10 0 10 0 0 China, Guangxi Prov. Lab/CCDC 0 - - - - - - - - - - - - - 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab/CCDC 42 22 0 6 0 0 0 0 0 44 0 106 0 0 0 - - - - - - - - - - - - - China, Shandong Prov. Lab/CCDC 40 16 0 21 0 0 0 0 0 63 0 282 0 0 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab/CCDC 12 7 0 3 0 0 0 0 0 11 0 37 0 0 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab/CCDC 36 36 0 120 0 0 0 1 0 221 0 109 0 0 3 3 0 3 0 0 0 0 0 14 0 8 0 0 China, Yunnan Prov. Lab/CCDC 18 0 - - - - - - - - - 41 0 0 2 0 - - - - - - - - - 7 0 0 Philippines RITM 87 8 0 2 0 0 0 0 0 6 0 24 0 0 17 5 0 2 0 0 0 0 0 3 0 10 0 0 Papua New Guinea RITM 27 23 0 15 7 0 0 0 0 21 0 9 0 0 10 7 0 3 0 0 0 0 0 5 0 8 1 0 Total 412 213 0 218 7 0 0 1 0 587 2 1454 0 0 42 23 0 12 0 0 0 0 0 36 0 65 1 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2018 2019 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP) aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP) aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 aVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) Viet Nam aVDPV2 (2 AFP) 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3).

Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2017–2019* Chart 2. Adequate specimen collection rate, 2017–2019 First polio outbreak simulation exercise in the Western Pacific Region On 12-14 March 2019, WHO WPRO with support from WHO EURO conducted the first polio outbreak simulation exercise (POSE) in the Western Pacific Region for Cambodia, China, Lao People’s Democratic Republic, and Viet Nam. The participants critically reviewed their national action plans and noted areas for improvement. The main issues identified during the POSE and to be followed up were to:  revise the national plan of action, in line with the current GPEI SOPs;  perform a current assessment to understand who and where the high-risk/marginalized population groups (including travellers, nomads) are;  identify strategies to reach these high-risk groups with polio eradication interventions;  sustain high routine vaccination coverage and increase vaccination coverage in high-risk populations;  sustain quality of acute flaccid paralysis and environmental surveillance. The full report of the WPRO POSE I, including the countries’ plans of action and next steps, will be published soon. Based on the lessons learned, WPRO intends to continue inter-country and national POSEs. Polio Bulletin 2019 Issue No. 6 - Week 12 (as of 26 March 2019) Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2018 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2019 Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam). Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: wproepidata@who.int Web: www.who.int/westernpacific CONTACT US HIGHLIGHTS * AFP rate annualized as of week 12 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 15.6% 24.8% 16.3% 7.0% 0.0% 0.0% 7.6% 0% 5% 10% 15% 20% 25% 30% VNM PNG PHL MYS LAO KHM CHN Table 1A. Classification of AFP cases with onset in 2018 and key surveillance indicators Polio Bulletin 2 2017 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 60 46 57 0 0 3 54 0 0 (0.0%) 1.24 44% 89% 14-Feb-19 - Brunei Darussalam 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 24-Jan-19 - Cambodia 57 44 73 0 0 0 73 0 0 (0.0%) 1.66 92% 85% 15-Mar-19 - China 5278 2256 5361 0 1 0 4893 467 409 (7.6%) 2.38 92% 100% 20-Mar-19 6 China, Hong Kong SAR 15 9 11 0 0 0 10 1 0 (0.0%) 1.22 82% 100% 15-Mar-19 11 China, Macao SAR 2 1 3 0 0 0 3 0 0 (0.0%) 3.00 100% 100% 19-Feb-19 - Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 103 21 94 0 0 0 84 10 0 (0.0%) 4.48 80% 79% 13-Feb-19 41 Malaysia 154 77 172 0 0 0 160 12 12 (7.0%) 2.23 80% 87% 13-Mar-19 13 Mongolia 6 9 6 0 0 0 6 0 0 (0.0%) 0.67 100% 83% 04-Feb-19 - New Zealand 13 9 10 0 0 0 10 0 0 (0.0%) 1.11 60% 100% 28-Feb-19 - Papua New Guinea 29 37 286 0 26 12 168 80 71 (24.8%) 7.03 44% 74% 23-Feb-19 31 Philippines 462 338 313 0 0 0 261 52 51 (16.3%) 0.93 62% 94% 25-Mar-19 1 Republic of Korea 68 67 70 0 0 0 70 0 0 (0.0%) 1.04 90% 100% 11-Mar-19 - Singapore 7 6 13 0 0 0 13 0 0 (0.0%) 2.17 77% 100% 08-Mar-19 - Viet Nam 385 234 315 0 0 0 235 80 49 (15.6%) 1.35 98% 86% 11-Jan-19 74 Pacific island countries and areas 16 11 13 0 0 0 1 12 9 (69.2%) 1.18 31% 100% 18-Feb-19 36 Total 6656 3327 6799 0 27 15 6043 714 601 (8.8%) 2.04 88% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) 2018 Non-polio AFP rate Total % with adequate specimens 2 Table 1B. Classification of AFP cases with onset in 2019 and key surveillance indicators Polio Bulletin 3 2018 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 57 47 6 0 0 0 4 2 0 (0.0%) 0.55 50% 100% 14-Feb-19 40 Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 4.33 100% 100% 21-Mar-19 5 Cambodia 73 46 4 0 0 0 0 4 0 (0.0%) 0.38 100% 75% 12-Feb-19 42 China 5361 2256 548 0 0 0 26 522 0 (0.0%) 1.05 92% 100% 20-Mar-19 6 China, Hong Kong SAR 11 9 5 0 0 0 2 3 0 (0.0%) 2.41 100% 80% 22-Mar-19 4 China, Macao SAR 3 1 0 - - - - - - - - - 13-Mar-19 13 Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 94 23 6 0 0 0 0 6 0 (0.0%) 1.13 67% 83% 13-Feb-19 41 Malaysia 172 78 23 0 0 0 1 22 0 (0.0%) 1.28 65% 17% 13-Mar-19 13 Mongolia 6 9 2 0 0 0 0 2 0 (0.0%) 0.96 100% 100% 09-Mar-19 17 New Zealand 10 9 1 0 0 0 1 0 0 (0.0%) 0.48 100% 100% 28-Feb-19 26 Papua New Guinea 286 33 40 0 0 0 0 40 0 (0.0%) 5.25 70% 88% 25-Mar-19 1 Philippines 313 344 4 0 0 0 0 4 0 (0.0%) 0.05 75% 100% 11-Mar-19 15 Republic of Korea 70 66 4 0 0 0 0 4 0 (0.0%) 0.26 75% 100% 11-Mar-19 15 Singapore 13 6 1 0 0 0 1 0 0 (0.0%) 0.72 100% 100% 08-Mar-19 18 Viet Nam 315 234 13 0 0 0 0 13 1 (7.7%) 0.24 92% 85% 14-Mar-19 12 Pacific island countries and areas 13 11 1 0 0 0 0 1 0 (0.0%) 0.39 100% 100% 07-Feb-19 47 Total 6799 3334 659 0 0 0 36 623 1 (0.2%) 0.86 89% 95% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO Discarded (Non-polio) 2019 Non-polio AFP rate 2 Total % with adequate specimens 3 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2018 and key laboratory indicators Polio Bulletin 4 ≥ 80% ≥ 80% Australia VIDRL 44 1 0 1 42 0 0 91% 3% 05-Feb-19 VIDRL 1 0 0 0 0 0 0 0 0 0 1 0 0 100% Brunei Darussalam VIDRL 2 0 0 0 2 0 0 50% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 74 0 0 13 61 0 0 93% 15% 18-Jan-19 NIID 0 - - - - - - - - - - - - - China (total) 5293 37 0 377 4877 0 2 97% 6% 20-Mar-19 88 0 24 0 0 0 0 0 63 1 0 0 0 99% China, Anhui Prov. Lab 339 3 0 18 318 0 0 100% 5% Prov. Lab/CCDC 8 0 3 0 0 0 0 0 5 0 0 0 0 100% China, Beijing Prov. Lab 31 0 0 0 31 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 69 0 0 2 67 0 0 93% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 176 1 0 12 163 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Gansu Prov. Lab 101 1 0 5 94 0 1 99% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangdong Prov. Lab 431 2 0 21 407 0 1 91% 4% Prov. Lab/CCDC 4 0 0 0 0 0 0 0 4 0 0 0 0 100% China, Guangxi Prov. Lab 221 2 0 18 201 0 0 99% 7% Prov. Lab/CCDC 4 0 3 0 0 0 0 0 1 0 0 0 0 100% China, Guizhou Prov. Lab 188 0 0 14 174 0 0 97% 7% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hebei Prov. Lab 299 1 0 38 260 0 0 100% 10% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 91 0 0 4 87 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 557 5 0 57 495 0 0 99% 9% Prov. Lab/CCDC 13 0 5 0 0 0 0 0 8 0 0 0 0 100% China, Hubei Prov. Lab 177 1 0 13 163 0 0 99% 7% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Hunan Prov. Lab 245 0 0 25 220 0 0 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 252 8 0 11 233 0 0 100% 4% Prov. Lab/CCDC 16 0 2 0 0 0 0 0 13 1 0 0 0 100% China, Jiangxi Prov. Lab 176 1 0 12 163 0 0 97% 5% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Jilin Prov. Lab 58 2 0 9 47 0 0 98% 11% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Neimongol Prov. Lab 101 2 0 4 95 0 0 98% 3% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 100% China, Ningxia Prov. Lab 26 0 0 2 24 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 99 1 0 2 96 0 0 84% 2% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 0% China, Shandong Prov. Lab 415 2 0 27 386 0 0 100% 5% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 100% China, Shanghai Prov. Lab 42 0 0 0 42 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 129 1 0 7 121 0 0 98% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Sichuan Prov. Lab 298 1 0 21 276 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Tianjin Prov. Lab 22 0 0 0 22 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 147 1 0 7 139 0 0 91% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 250 0 0 31 219 0 0 93% 10% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Zhejiang Prov. Lab 188 2 0 7 179 0 0 99% 3% Prov. Lab/CCDC 7 0 0 0 0 0 0 0 7 0 0 0 0 100% China, Hainan Prov. Lab 36 0 0 6 30 0 0 100% 14% CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 89 0 0 3 86 0 0 98% 2% CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 32 0 0 0 32 0 0 100% 0% CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 8 0 0 1 7 0 0 73% 7% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 11 0 0 0 11 0 0 100% 0% 28-Jan-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 3 0 0 0 3 0 0 100% 0% 24-Dec-18 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 115 1 0 8 106 0 0 96% 4% 12-Mar-19 NIID 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Malaysia IMR 180 0 0 10 170 0 0 89% 4% 19-Feb-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 6 0 0 3 3 0 0 100% 50% 04-Jan-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 8 0 0 1 7 0 0 100% 13% 25-Jan-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 297 93 1 21 182 0 0 88% 5% 28-Feb-19 VIDRL 187 0 63 46 0 0 0 0 78 0 0 0 0 100% Philippines RITM 396 5 1 14 375 1 0 96% 3% 26-Feb-19 RITM 7 0 2 0 0 0 0 0 5 0 0 0 0 100% Republic of Korea NIH 69 0 0 5 64 0 0 97% 7% 11-Feb-19 NIH 0 - - - - - - - - - - - - - Singapore SGH 13 0 0 2 11 0 0 96% 8% 30-Jan-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 175 3 0 24 148 0 0 100% 12% 30-Jan-19 NIHE 4 0 2 0 0 0 0 0 2 0 0 0 0 100% Viet Nam (South) PI 175 4 0 21 150 0 0 100% 12% 18-Mar-19 PI 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Pacific island countries and areas VIDRL 11 0 0 1 10 0 0 97% 6% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Total 6872 144 2 501 6222 1 2 97% 6% 296 0 93 46 0 0 0 0 155 1 1 0 0 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); NIH (National Institute of Health, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPV NegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B posit ive + NPEV NPEV 2 VDPV Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2019 and key laboratory indicators Polio Bulletin 5 ≥ 80% ≥ 80% Australia VIDRL 4 0 0 0 2 0 2 100% 0% 14-Feb-19 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 4 0 0 0 4 0 0 100% 0% 02-Mar-19 NIID 0 - - - - - - - - - - - - - China (total) 532 2 0 25 477 0 28 96% 4% 20-Mar-19 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Anhui Prov. Lab 26 0 0 0 26 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Beijing Prov. Lab 6 0 0 0 6 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 5 0 0 0 3 0 2 67% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 16 0 0 0 15 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 8 0 0 0 8 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 39 0 0 1 36 0 2 100% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangxi Prov. Lab 28 0 0 2 26 0 0 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 26 0 0 3 20 0 3 100% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 41 0 0 1 39 0 1 100% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 12 0 0 0 12 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 37 0 0 2 35 0 0 91% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hubei Prov. Lab 19 0 0 2 15 0 2 88% 12% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 24 0 0 1 23 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 19 0 0 0 18 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 11 0 0 0 11 0 0 91% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 5 1 0 0 4 0 0 100% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Neimongol Prov. Lab 13 1 0 0 12 0 0 100% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Ningxia Prov. Lab 2 0 0 0 2 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 5 0 0 0 4 0 1 75% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 30 0 0 1 29 0 0 87% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 4 0 0 0 4 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 15 0 0 0 14 0 1 93% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 37 0 0 10 25 0 2 96% 23% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 2 0 0 0 2 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 19 0 0 0 19 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Yunnan Prov. Lab 37 0 0 2 26 0 9 93% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 26 0 0 0 25 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 1 0 0 0 1 0 0 100% 0% CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 10 0 0 0 8 0 2 100% 0% CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 5 0 0 0 5 0 0 80% 0% CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 4 0 0 0 4 0 0 25% 0% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 5 0 0 0 5 0 0 100% 0% 22-Mar-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - - PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 8 0 0 0 10 0 0 100% 0% 12-Mar-19 NIID 0 - - - - - - - - - - - - - Malaysia IMR 6 0 0 0 6 0 0 100% 0% 19-Feb-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 2 0 0 0 2 0 0 100% 0% 23-Mar-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 1 0 0 0 1 0 0 100% 0% 18-Mar-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 14 0 0 2 11 0 1 100% 15% 26-Mar-19 VIDRL 3 0 0 0 0 0 0 0 0 0 2 0 1 100% Philippines RITM 34 0 0 2 23 9 0 95% 8% 22-Mar-19 RITM 0 - - - - - - - - - - - - - Republic of Korea NIH 4 0 0 0 4 0 0 100% 0% 11-Mar-19 NIH 0 - - - - - - - - - - - - - Singapore SGH 1 0 0 0 1 0 0 100% 0% 22-Mar-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 1 0 0 0 1 0 0 100% 0% 15-Feb-19 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 10 0 0 1 9 0 0 100% 10% 18-Mar-19 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 1 0 0 0 1 0 0 96% 4% 13-Feb-19 VIDRL 0 - - - - - - - - - - - - - Total 628 2 0 30 558 9 31 96% 4% 5 0 2 0 0 0 0 0 0 0 2 0 1 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens posit ive for NPEV Latest report date Discordant pending sequencing 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); NIH (National Institute of Health, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPV NegativeNPEV only SabinWild L20B posit ive Pending ≤ 14 days VDPV Type 2 L20B posit ive + NPEV NPEV 2 VDPV Polio Bulletin 6 Table 3. Laboratory confirmation of polio isolates from environmental samples in 2018–2019 1 Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2019 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP) aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP) aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 aVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) Viet Nam aVDPV2 (2 AFP) 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 17 2 0 2 0 0 0 0 0 0 0 12 0 0 0 - - - - - - - - - - - - - China (total) 281 180 0 199 0 0 0 1 0 560 2 1409 0 0 15 11 0 7 0 0 0 0 0 28 0 47 0 0 China, Fujian Prov. Lab/CCDC 73 51 0 20 0 0 0 0 0 107 1 577 0 0 6 4 0 2 0 0 0 0 0 4 0 22 0 0 China, Gansu Prov. Lab/CCDC 12 7 0 2 0 0 0 0 0 12 0 40 0 0 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab/CCDC 48 41 0 27 0 0 0 0 0 102 1 217 0 0 4 4 0 2 0 0 0 0 0 10 0 10 0 0 China, Guangxi Prov. Lab/CCDC 0 - - - - - - - - - - - - - 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab/CCDC 42 22 0 6 0 0 0 0 0 44 0 106 0 0 0 - - - - - - - - - - - - - China, Shandong Prov. Lab/CCDC 40 16 0 21 0 0 0 0 0 63 0 282 0 0 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab/CCDC 12 7 0 3 0 0 0 0 0 11 0 37 0 0 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab/CCDC 36 36 0 120 0 0 0 1 0 221 0 109 0 0 3 3 0 3 0 0 0 0 0 14 0 8 0 0 China, Yunnan Prov. Lab/CCDC 18 0 - - - - - - - - - 41 0 0 2 0 - - - - - - - - - 7 0 0 Philippines RITM 87 8 0 2 0 0 0 0 0 6 0 24 0 0 25 5 0 2 0 0 0 0 0 3 0 10 5 0 Papua New Guinea RITM 27 23 0 15 7 0 0 0 0 21 0 9 0 0 10 8 0 4 0 0 0 0 0 5 0 9 0 0 Total 412 213 0 218 7 0 0 1 0 587 2 1454 0 0 50 24 0 13 0 0 0 0 0 36 0 66 5 0 2018 2019 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed

Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2017–2019* Chart 2. Adequate specimen collection rate, 2017–2019 Eight Meeting Of Vaccine-Preventable Diseases Laboratory Networks in The Western Pacific Region The Eight Meeting Of Vaccine-Preventable Diseases Laboratory Networks in the Western Pacific Region was held in Manila from 18-22 March 2019 comprising of polio, measles and rubella laboratory meeting and workshop on genetic analysis of molecular data for measles and rubella. Polio laboratory experts from the Western Pacific Region have gathered over a two-day meeting consisting of a series of 12 sessions to discuss: polio endgame strategies, update on global progress towards polio eradication, updates on maintaining polio-free status in the Western Pacific Region, updates on global and regional polio laboratory networks, discuss new methods and perspectives, review the performances of the polio network laboratories, review laboratory quality management systems, discuss the implementation of polio containment requirements following the implementation of GAPIII, contingency planning in polio- free regions, environmental surveillance, data management and post-certification planning. Polio Bulletin 2019 Issue No. 7 - Week 14 (as of 8 April 2019) Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2018 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2019 Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam). Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: wproepidata@who.int Web: www.who.int/westernpacific CONTACT US HIGHLIGHTS * AFP rate annualized as of week 14 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 15.6% 23.4% 16.3% 7.0% 0.0% 0.0% 5.8% 0% 5% 10% 15% 20% 25% VNM PNG PHL MYS LAO KHM CHN Table 1A. Classification of AFP cases with onset in 2018 and key surveillance indicators Polio Bulletin 2 2017 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 60 46 57 0 0 3 54 0 0 (0.0%) 1.24 44% 89% 14-Feb-19 - Brunei Darussalam 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 24-Jan-19 - Cambodia 57 44 73 0 0 0 73 0 0 (0.0%) 1.66 92% 85% 15-Mar-19 - China 5278 2256 5332 0 1 0 5020 311 311 (5.8%) 2.36 92% 100% 03-Apr-19 5 China, Hong Kong SAR 15 9 11 0 0 0 10 1 1 (9.1%) 1.22 82% 100% 03-Apr-19 5 China, Macao SAR 2 1 3 0 0 0 3 0 0 (0.0%) 3.00 100% 100% 19-Feb-19 - Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 103 21 94 0 0 0 84 10 0 (0.0%) 4.48 80% 79% 13-Feb-19 54 Malaysia 154 77 172 0 0 0 160 12 12 (7.0%) 2.23 80% 87% 13-Mar-19 26 Mongolia 6 9 6 0 0 0 6 0 0 (0.0%) 0.67 100% 83% 04-Feb-19 - New Zealand 13 9 10 0 0 0 10 0 0 (0.0%) 1.11 60% 100% 28-Feb-19 - Papua New Guinea 29 37 286 0 26 16 176 68 67 (23.4%) 7.03 44% 74% 26-Mar-19 13 Philippines 462 338 313 0 0 0 261 52 51 (16.3%) 0.93 62% 94% 25-Mar-19 14 Republic of Korea 68 67 70 0 0 0 70 0 0 (0.0%) 1.04 90% 100% 11-Mar-19 - Singapore 7 6 13 0 0 0 13 0 0 (0.0%) 2.17 77% 100% 08-Mar-19 - Viet Nam 385 234 315 0 0 0 235 80 49 (15.6%) 1.35 98% 86% 11-Jan-19 87 Pacific island countries and areas 16 11 13 0 0 0 1 12 9 (69.2%) 1.18 31% 100% 18-Feb-19 49 Total 6656 3327 6770 0 27 19 6178 546 500 (7.4%) 2.03 88% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 2018 Non-polio AFP rate Total % with adequate specimens 2 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Table 1B. Classification of AFP cases with onset in 2019 and key surveillance indicators Polio Bulletin 3 2018 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 57 47 6 0 0 0 4 2 0 (0.0%) 0.47 50% 100% 14-Feb-19 53 Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 3.71 100% 100% 21-Mar-19 18 Cambodia 73 46 8 0 0 0 0 8 0 (0.0%) 0.65 100% 88% 03-Apr-19 5 China 5332 2256 738 0 0 0 138 600 28 (3.8%) 1.22 92% 100% 03-Apr-19 5 China, Hong Kong SAR 11 9 5 0 0 0 5 0 0 (0.0%) 2.06 100% 80% 03-Apr-19 5 China, Macao SAR 3 1 0 - - - - - - - - - 13-Mar-19 26 Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 94 23 16 0 0 0 7 9 0 (0.0%) 2.58 94% 69% 29-Mar-19 10 Malaysia 172 78 23 0 0 0 1 22 0 (0.0%) 1.10 65% 17% 13-Mar-19 26 Mongolia 6 9 2 0 0 0 0 2 0 (0.0%) 0.83 100% 100% 09-Mar-19 30 New Zealand 10 9 1 0 0 0 1 0 0 (0.0%) 0.41 100% 100% 28-Feb-19 39 Papua New Guinea 286 33 40 0 0 0 0 40 0 (0.0%) 4.50 70% 88% 25-Mar-19 14 Philippines 313 344 4 0 0 0 0 4 0 (0.0%) 0.04 75% 100% 11-Mar-19 28 Republic of Korea 70 66 4 0 0 0 0 4 0 (0.0%) 0.23 75% 100% 11-Mar-19 28 Singapore 13 6 1 0 0 0 1 0 0 (0.0%) 0.62 100% 100% 08-Mar-19 31 Viet Nam 315 234 13 0 0 0 0 13 1 (7.7%) 0.21 92% 85% 14-Mar-19 25 Pacific island countries and areas 13 11 1 0 0 0 0 1 0 (0.0%) 0.34 100% 100% 07-Feb-19 60 Total 6770 3334 863 0 0 0 158 705 29 (3.4%) 0.96 90% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO Discarded (Non-polio) 2019 Non-polio AFP rate 2 Total % with adequate specimens 3 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2018 and key laboratory indicators Polio Bulletin 4 ≥ 80% ≥ 80% Australia VIDRL 44 1 0 1 42 0 0 91% 3% 05-Feb-19 VIDRL 1 0 0 0 0 0 0 0 0 0 1 0 0 100% Brunei Darussalam VIDRL 2 0 0 0 2 0 0 50% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 74 0 0 13 61 0 0 93% 15% 18-Jan-19 NIID 0 - - - - - - - - - - - - - China (total) 5268 37 0 376 4854 0 1 97% 6% 03-Apr-19 88 0 24 0 0 0 0 0 63 1 0 0 0 99% China, Anhui Prov. Lab 337 3 0 18 316 0 0 100% 5% Prov. Lab/CCDC 8 0 3 0 0 0 0 0 5 0 0 0 0 100% China, Beijing Prov. Lab 31 0 0 0 31 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 61 0 0 2 59 0 0 92% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 176 1 0 12 163 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Gansu Prov. Lab 92 1 0 5 86 0 0 99% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangdong Prov. Lab 431 2 0 21 407 0 1 91% 4% Prov. Lab/CCDC 4 0 0 0 0 0 0 0 4 0 0 0 0 100% China, Guangxi Prov. Lab 221 2 0 18 201 0 0 99% 7% Prov. Lab/CCDC 4 0 3 0 0 0 0 0 1 0 0 0 0 100% China, Guizhou Prov. Lab 186 0 0 14 172 0 0 97% 7% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hebei Prov. Lab 299 1 0 38 260 0 0 100% 10% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 91 0 0 4 87 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 557 5 0 57 495 0 0 99% 9% Prov. Lab/CCDC 13 0 5 0 0 0 0 0 8 0 0 0 0 100% China, Hubei Prov. Lab 177 1 0 13 163 0 0 99% 7% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Hunan Prov. Lab 245 0 0 25 220 0 0 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 252 8 0 11 233 0 0 100% 4% Prov. Lab/CCDC 16 0 2 0 0 0 0 0 13 1 0 0 0 100% China, Jiangxi Prov. Lab 176 1 0 12 163 0 0 97% 5% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Jilin Prov. Lab 58 2 0 9 47 0 0 98% 11% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Neimongol Prov. Lab 100 2 0 4 94 0 0 98% 4% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 100% China, Ningxia Prov. Lab 26 0 0 2 24 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 99 1 0 2 96 0 0 84% 2% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 0% China, Shandong Prov. Lab 412 2 0 26 384 0 0 100% 4% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 100% China, Shanghai Prov. Lab 42 0 0 0 42 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 130 1 0 7 122 0 0 98% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Sichuan Prov. Lab 298 1 0 21 276 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Tianjin Prov. Lab 22 0 0 0 22 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 148 1 0 7 140 0 0 91% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 248 0 0 31 217 0 0 93% 10% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Zhejiang Prov. Lab 188 2 0 7 179 0 0 99% 3% Prov. Lab/CCDC 7 0 0 0 0 0 0 0 7 0 0 0 0 100% China, Hainan Prov. Lab 36 0 0 6 30 0 0 100% 14% CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 89 0 0 3 86 0 0 98% 2% CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 32 0 0 0 32 0 0 100% 0% CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 8 0 0 1 7 0 0 73% 7% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 11 0 0 0 11 0 0 100% 0% 28-Jan-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 3 0 0 0 3 0 0 100% 0% 24-Dec-18 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 115 1 0 8 106 0 0 96% 4% 12-Mar-19 NIID 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Malaysia IMR 180 0 0 10 170 0 0 89% 4% 19-Feb-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 6 0 0 3 3 0 0 100% 50% 04-Jan-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 8 0 0 1 7 0 0 100% 13% 25-Jan-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 297 93 1 21 182 0 0 88% 5% 28-Feb-19 VIDRL 187 0 63 46 0 0 0 0 78 0 0 0 0 100% Philippines RITM 396 5 1 14 375 1 0 96% 3% 26-Feb-19 RITM 7 0 2 0 0 0 0 0 5 0 0 0 0 100% Republic of Korea NIH 69 0 0 5 64 0 0 97% 7% 11-Feb-19 NIH 0 - - - - - - - - - - - - - Singapore SGH 13 0 0 2 11 0 0 96% 8% 30-Jan-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 175 3 0 24 148 0 0 100% 12% 30-Jan-19 NIHE 4 0 2 0 0 0 0 0 2 0 0 0 0 100% Viet Nam (South) PI 175 4 0 21 150 0 0 100% 12% 18-Mar-19 PI 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Pacific island countries and areas VIDRL 11 0 0 1 10 0 0 97% 6% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Total 6847 144 2 500 6199 1 1 97% 6% 296 0 93 46 0 0 0 0 155 1 1 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2 VDPV Pending ITDVDPV NegativeNPEV only SabinWild 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); NIH (National Institute of Health, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens posit ive for NPEV Latest report date Discordant pending sequencing Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2019 and key laboratory indicators Polio Bulletin 5 ≥ 80% ≥ 80% Australia VIDRL 4 0 0 0 2 0 2 100% 0% 14-Feb-19 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 7 0 0 0 7 0 0 100% 0% 08-Apr-19 NIID 0 - - - - - - - - - - - - - China (total) 721 4 0 31 643 1 42 96% 3% 03-Apr-19 9 0 4 0 0 0 0 0 5 0 0 0 0 100% China, Anhui Prov. Lab 40 1 0 0 37 0 2 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Beijing Prov. Lab 9 0 0 0 9 0 0 100% 0% Prov. Lab/CCDC 0 - - China, Chongqing Prov. Lab 8 0 0 0 6 0 2 83% 0% Prov. Lab/CCDC 0 - - China, Fujian Prov. Lab 20 1 0 0 18 0 1 100% 0% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Gansu Prov. Lab 12 0 0 0 11 0 1 100% 0% Prov. Lab/CCDC 0 - - China, Guangdong Prov. Lab 54 0 0 2 50 0 2 98% 3% Prov. Lab/CCDC 0 - - China, Guangxi Prov. Lab 34 0 0 2 32 0 0 100% 4% Prov. Lab/CCDC 0 - - China, Guizhou Prov. Lab 32 0 0 3 27 0 2 100% 8% Prov. Lab/CCDC 0 - - China, Hebei Prov. Lab 46 0 0 1 44 0 1 100% 1% Prov. Lab/CCDC 0 - - China, Heilongjiang Prov. Lab 12 0 0 0 11 0 1 100% 0% Prov. Lab/CCDC 0 - - China, Henan Prov. Lab 60 0 0 3 56 0 1 94% 4% Prov. Lab/CCDC 0 - - China, Hubei Prov. Lab 23 0 0 2 16 0 5 89% 11% Prov. Lab/CCDC 0 - - China, Hunan Prov. Lab 32 0 0 1 31 0 0 100% 3% Prov. Lab/CCDC 0 - - China, Jiangsu Prov. Lab 35 0 0 0 30 1 4 100% 0% Prov. Lab/CCDC 0 - - China, Jiangxi Prov. Lab 17 0 0 0 17 0 0 94% 0% Prov. Lab/CCDC 0 - - China, Jilin Prov. Lab 8 1 0 0 7 0 0 100% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Neimongol Prov. Lab 15 1 0 0 13 0 1 100% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Ningxia Prov. Lab 4 0 0 0 3 0 1 100% 0% Prov. Lab/CCDC 0 - - China, Shaanxi Prov. Lab 8 0 0 0 7 0 1 71% 0% Prov. Lab/CCDC 0 - - China, Shandong Prov. Lab 50 0 0 3 47 0 0 92% 3% Prov. Lab/CCDC 0 - - China, Shanghai Prov. Lab 5 0 0 0 5 0 0 100% 0% Prov. Lab/CCDC 0 - - China, Shanxi Prov. Lab 27 0 0 0 26 0 1 96% 0% Prov. Lab/CCDC 0 - - China, Sichuan Prov. Lab 47 0 0 10 31 0 6 96% 20% Prov. Lab/CCDC 0 - - China, Tianjin Prov. Lab 2 0 0 0 2 0 0 100% 0% Prov. Lab/CCDC 0 - - China, Xinjiang Prov. Lab 19 0 0 0 19 0 0 100% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Yunnan Prov. Lab 44 0 0 3 33 0 8 92% 6% Prov. Lab/CCDC 0 - - China, Zhejiang Prov. Lab 32 0 0 1 31 0 0 100% 2% Prov. Lab/CCDC 0 - - China, Hainan Prov. Lab 2 0 0 0 2 0 0 100% 0% CCDC 0 - - China, Liaoning Prov. Lab 13 0 0 0 13 0 0 100% 0% CCDC 0 - - China, Qinghai Prov. Lab 7 0 0 0 5 0 2 80% 0% CCDC 0 - - China, Tibet Prov. Lab 4 0 0 0 4 0 0 25% 0% CCDC 0 - - China, Hong Kong SAR PHLC 5 0 0 0 5 0 0 100% 0% 29-Mar-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - - PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 11 0 0 0 13 0 0 91% 0% 08-Apr-19 NIID 0 - - - - - - - - - - - - - Malaysia IMR 6 0 0 0 6 0 0 100% 0% 19-Feb-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 3 0 0 0 2 1 0 100% 0% 05-Apr-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 1 0 0 0 1 0 0 100% 0% 05-Apr-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 27 1 0 6 19 0 1 100% 19% 02-Apr-19 VIDRL 9 0 2 0 0 0 0 0 2 0 4 0 1 100% Philippines RITM 34 2 0 2 25 5 0 96% 6% 02-Apr-19 RITM 4 0 0 0 0 0 0 0 1 0 0 3 0 100% Republic of Korea NIH 4 0 0 0 4 0 0 100% 0% 11-Mar-19 NIH 0 - - - - - - - - - - - - - Singapore SGH 2 0 0 0 1 1 0 100% 0% 05-Apr-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 8 0 0 0 5 3 0 100% 0% 01-Apr-19 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 12 0 0 1 9 2 0 100% 10% 26-Mar-19 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 1 0 0 0 1 0 0 96% 4% 13-Feb-19 VIDRL 0 - - - - - - - - - - - - - Total 847 7 0 40 744 13 45 96% 4% 22 0 6 0 0 0 0 0 8 0 4 3 1 100% 2. NPEV growing in L20B cells L20B posit ive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2 VDPV Pending ITDVDPV NegativeNPEV only SabinWild 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); NIH (National Institute of Health, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens posit ive for NPEV Latest report date Discordant pending sequencing Polio Bulletin 6 Table 3. Laboratory confirmation of polio isolates from environmental samples in 2018–2019 1 Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2019 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP) aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP) aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 aVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) Viet Nam aVDPV2 (2 AFP) 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 17 2 0 2 0 0 0 0 0 0 0 12 0 0 0 - - - - - - - - - - - - - China (total) 281 180 0 199 0 0 0 1 0 560 2 1409 0 0 15 11 0 7 0 0 0 0 0 28 0 47 0 0 China, Fujian Prov. Lab/CCDC 73 51 0 20 0 0 0 0 0 107 1 577 0 0 6 4 0 2 0 0 0 0 0 4 0 22 0 0 China, Gansu Prov. Lab/CCDC 12 7 0 2 0 0 0 0 0 12 0 40 0 0 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab/CCDC 48 41 0 27 0 0 0 0 0 102 1 217 0 0 4 4 0 2 0 0 0 0 0 10 0 10 0 0 China, Guangxi Prov. Lab/CCDC 0 - - - - - - - - - - - - - 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab/CCDC 42 22 0 6 0 0 0 0 0 44 0 106 0 0 0 - - - - - - - - - - - - - China, Shandong Prov. Lab/CCDC 40 16 0 21 0 0 0 0 0 63 0 282 0 0 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab/CCDC 12 7 0 3 0 0 0 0 0 11 0 37 0 0 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab/CCDC 36 36 0 120 0 0 0 1 0 221 0 109 0 0 3 3 0 3 0 0 0 0 0 14 0 8 0 0 China, Yunnan Prov. Lab/CCDC 18 0 - - - - - - - - - 41 0 0 2 0 - - - - - - - - - 7 0 0 Philippines RITM 87 8 0 2 0 0 0 0 0 6 0 24 0 0 28 5 0 2 0 0 0 0 0 3 0 13 3 0 Papua New Guinea RITM 27 23 0 15 7 0 0 0 0 21 0 9 0 0 18 15 0 10 0 0 0 0 0 9 0 11 0 0 Total 412 213 0 218 7 0 0 1 0 587 2 1454 0 0 61 31 0 19 0 0 0 0 0 40 0 71 3 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2018 2019 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD

Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2017–2019* Chart 2. Adequate specimen collection rate, 2017–2019 Polio Eradication, Certification, and Integration: The Endgame Strategy 2019–2023 The 2019–2023 Global Polio Eradication Initiative (GPEI) Endgame Strategy is now published on the GPEI website. It reviews current approaches, provides revisions and outlines innovations required to achieve the eradication goal, certify the world free of polio and strengthen our integration with immunization and emergency efforts. The document addresses three key risks towards achieving global eradication of wild poliovirus:  insecurity and conflict;  weak or fragile health systems; and  operational, management and resource risks The 2019–2023 GPEI Endgame Strategy supports the Strategic Action Plan on Polio Transition and provides a bridge to the Polio Post-Certification Strategy (PCS). It lays the groundwork for both the transition in polio-free countries and the post-certification period of a polio-free world. The full document can be accessed following this link: http://polioeradication.org/wp-content/ uploads/2019/03/polio-endgame-strategy-2019- 2023.pdf Polio Bulletin 2019 Issue No. 8 - Week 16 (as of 24 April 2019) Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2019 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2019 Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam). Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: wproepidata@who.int Web: www.who.int/westernpacific CONTACT US HIGHLIGHTS * AFP rate annualized as of week 16 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 16.1% 18.0% 0.0% 32.1% 0.0% 0.0% 16.6% 0% 5% 10% 15% 20% 25% 30% 35% VNM PNG PHL MYS LAO KHM CHN Table 1A. Classification of AFP cases with onset in 2018 and key surveillance indicators Polio Bulletin 2 2017 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 60 46 57 0 0 3 54 0 0 (0.0%) 1.24 44% 89% 14-Feb-19 - Brunei Darussalam 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 24-Jan-19 - Cambodia 57 44 73 0 0 0 73 0 0 (0.0%) 1.66 92% 85% 15-Mar-19 - China 5278 2256 5309 0 1 0 5278 30 30 (0.6%) 2.35 92% 100% 17-Apr-19 7 China, Hong Kong SAR 15 9 11 0 0 0 10 1 1 (9.1%) 1.22 82% 100% 03-Apr-19 21 China, Macao SAR 2 1 3 0 0 0 3 0 0 (0.0%) 3.00 100% 100% 19-Feb-19 - Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 103 21 115 0 0 0 114 1 1 (0.9%) 5.48 79% 80% 08-Apr-19 16 Malaysia 154 77 171 0 0 0 171 0 0 (0.0%) 2.22 80% 88% 15-Apr-19 - Mongolia 6 9 6 0 0 0 6 0 0 (0.0%) 0.67 100% 83% 04-Feb-19 - New Zealand 13 9 10 0 0 0 10 0 0 (0.0%) 1.11 60% 100% 28-Feb-19 - Papua New Guinea 29 37 286 0 26 23 221 16 16 (5.6%) 7.03 44% 74% 23-Apr-19 1 Philippines 462 338 313 0 0 0 261 52 51 (16.3%) 0.93 62% 94% 25-Mar-19 30 Republic of Korea 68 67 70 0 0 0 70 0 0 (0.0%) 1.04 90% 100% 11-Mar-19 - Singapore 7 6 13 0 0 0 13 0 0 (0.0%) 2.17 77% 100% 08-Mar-19 - Viet Nam 385 234 330 0 0 0 311 19 19 (5.8%) 1.41 98% 85% 11-Apr-19 13 Pacific island countries and areas 16 11 13 0 0 0 1 12 12 (92.3%) 1.18 31% 100% 12-Apr-19 12 Total 6656 3327 6782 0 27 26 6598 131 130 (1.9%) 2.03 88% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 2018 Non-polio AFP rate Total % with adequate specimens 2> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Table 1B. Classification of AFP cases with onset in 2019 and key surveillance indicators Polio Bulletin 3 2018 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 57 47 19 0 0 0 8 11 0 (0.0%) 1.31 37% 100% 17-Apr-19 7 Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 3.25 100% 100% 21-Mar-19 34 Cambodia 73 46 9 0 0 0 8 1 0 (0.0%) 0.64 89% 89% 19-Apr-19 5 China 5309 2256 977 0 0 0 183 794 162 (16.6%) 1.41 92% 100% 17-Apr-19 7 China, Hong Kong SAR 11 9 6 0 0 0 5 1 0 (0.0%) 2.17 100% 83% 08-Apr-19 16 China, Macao SAR 3 1 0 - - - - - - - - - 11-Apr-19 13 Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 115 23 16 0 0 0 7 9 0 (0.0%) 2.26 94% 69% 29-Mar-19 26 Malaysia 171 78 28 0 0 0 2 26 9 (32.1%) 1.17 71% 21% 15-Apr-19 9 Mongolia 6 9 3 0 0 0 1 2 0 (0.0%) 1.08 100% 100% 10-Apr-19 14 New Zealand 10 9 2 0 0 0 1 1 1 (50.0%) 0.72 50% 50% 09-Apr-19 15 Papua New Guinea 286 33 61 0 0 0 13 48 11 (18.0%) 6.01 75% 79% 23-Apr-19 1 Philippines 313 344 4 0 0 0 0 4 0 (0.0%) 0.04 75% 100% 11-Mar-19 44 Republic of Korea 70 66 11 0 0 0 2 9 0 (0.0%) 0.54 91% 100% 15-Apr-19 9 Singapore 13 6 2 0 0 0 1 1 0 (0.0%) 1.08 100% 100% 09-Apr-19 15 Viet Nam 330 234 31 0 0 0 4 27 5 (16.1%) 0.43 97% 97% 11-Apr-19 13 Pacific island countries and areas 13 11 3 0 0 0 0 3 0 (0.0%) 0.89 67% 100% 12-Apr-19 12 Total 6782 3334 1173 0 0 0 236 937 188 (16.0%) 1.14 90% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO Discarded (Non-polio) 2019 Non-polio AFP rate 2 Total % with adequate specimens 3 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2018 and key laboratory indicators Polio Bulletin 4 ≥ 80% ≥ 80% Australia VIDRL 44 1 0 1 42 0 0 91% 3% 05-Feb-19 VIDRL 1 0 0 0 0 0 0 0 0 0 1 0 0 100% Brunei Darussalam VIDRL 2 0 0 0 2 0 0 50% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 74 0 0 13 61 0 0 93% 15% 18-Jan-19 NIID 0 - - - - - - - - - - - - - China (total) 5245 36 0 379 4829 0 1 97% 6% 17-Apr-19 88 0 24 0 0 0 0 0 63 1 0 0 0 99% China, Anhui Prov. Lab 332 2 0 17 313 0 0 100% 5% Prov. Lab/CCDC 8 0 3 0 0 0 0 0 5 0 0 0 0 100% China, Beijing Prov. Lab 31 0 0 0 31 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 52 0 0 2 50 0 0 90% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 176 1 0 12 163 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Gansu Prov. Lab 92 1 0 6 85 0 0 99% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangdong Prov. Lab 431 2 0 21 407 0 1 91% 4% Prov. Lab/CCDC 4 0 0 0 0 0 0 0 4 0 0 0 0 100% China, Guangxi Prov. Lab 221 2 0 18 201 0 0 99% 7% Prov. Lab/CCDC 4 0 3 0 0 0 0 0 1 0 0 0 0 100% China, Guizhou Prov. Lab 190 0 0 14 176 0 0 97% 7% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 37 0 0 6 31 0 0 100% 14% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 299 1 0 38 260 0 0 100% 10% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 91 0 0 4 87 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 555 5 0 57 493 0 0 99% 9% Prov. Lab/CCDC 13 0 5 0 0 0 0 0 8 0 0 0 0 100% China, Hubei Prov. Lab 177 1 0 13 163 0 0 99% 7% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Hunan Prov. Lab 245 0 0 25 220 0 0 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 252 8 0 11 233 0 0 100% 4% Prov. Lab/CCDC 16 0 2 0 0 0 0 0 13 1 0 0 0 100% China, Jiangxi Prov. Lab 176 1 0 12 163 0 0 97% 5% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Jilin Prov. Lab 58 2 0 9 47 0 0 98% 11% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Liaoning Prov. Lab 89 0 0 6 83 0 0 97% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 100 2 0 4 94 0 0 98% 4% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 100% China, Ningxia Prov. Lab 26 0 0 2 24 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 99 1 0 2 96 0 0 84% 2% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 0% China, Shandong Prov. Lab 412 2 0 26 384 0 0 100% 4% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 100% China, Shanghai Prov. Lab 42 0 0 0 42 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 118 1 0 7 110 0 0 97% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Sichuan Prov. Lab 298 1 0 21 276 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Tianjin Prov. Lab 22 0 0 0 22 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 148 1 0 7 140 0 0 91% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 248 0 0 31 217 0 0 93% 10% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Zhejiang Prov. Lab 188 2 0 7 179 0 0 99% 3% Prov. Lab/CCDC 7 0 0 0 0 0 0 0 7 0 0 0 0 100% China, Tibet Prov. Lab 8 0 0 1 7 0 0 73% 7% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 11 0 0 0 11 0 0 100% 0% 28-Jan-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 3 0 0 0 3 0 0 100% 0% 24-Dec-18 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 115 1 0 8 106 0 0 96% 4% 12-Mar-19 NIID 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Malaysia IMR 180 0 0 10 170 0 0 89% 4% 19-Feb-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 6 0 0 3 3 0 0 100% 50% 04-Jan-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 8 0 0 1 7 0 0 100% 13% 25-Jan-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 297 93 1 21 182 0 0 88% 5% 28-Feb-19 VIDRL 187 0 63 46 0 0 0 0 78 0 0 0 0 100% Philippines RITM 397 5 1 14 377 0 0 96% 3% 16-Apr-19 RITM 7 0 2 0 0 0 0 0 5 0 0 0 0 100% Republic of Korea KCDC 70 0 0 5 65 0 0 97% 6% 23-Apr-19 KCDC 0 - - - - - - - - - - - - - Singapore SGH 13 0 0 2 11 0 0 96% 8% 30-Jan-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 175 3 0 24 148 0 0 100% 12% 30-Jan-19 NIHE 4 0 2 0 0 0 0 0 2 0 0 0 0 100% Viet Nam (South) PI 175 4 0 21 150 0 0 100% 12% 18-Mar-19 PI 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Pacific island countries and areas VIDRL 11 0 0 1 10 0 0 97% 6% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Total 6826 143 2 503 6177 0 1 97% 6% 296 0 93 46 0 0 0 0 155 1 1 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B posit ive + NPEV NPEV 2 VDPV Pending ITDVDPV NegativeNPEV only SabinWild 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2019 and key laboratory indicators Polio Bulletin 5 ≥ 80% ≥ 80% Australia VIDRL 11 0 0 1 6 4 0 92% 8% 17-Apr-19 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 8 0 0 0 8 0 0 100% 0% 18-Apr-19 NIID 0 - - - - - - - - - - - - - China (total) 955 9 0 39 846 0 61 97% 3% 17-Apr-19 17 0 8 0 0 0 0 0 9 0 0 0 0 100% China, Anhui Prov. Lab 51 1 0 0 40 0 10 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Beijing Prov. Lab 10 0 0 0 10 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 14 0 0 0 7 0 7 86% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 25 1 0 1 23 0 0 100% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Gansu Prov. Lab 16 0 0 0 15 0 1 93% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 75 0 0 2 72 0 1 96% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangxi Prov. Lab 44 0 0 2 42 0 0 100% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 39 0 0 3 36 0 0 100% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 3 0 0 0 3 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 55 0 0 3 52 0 0 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 14 0 0 0 14 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 82 0 0 4 74 0 4 96% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hubei Prov. Lab 42 0 0 3 16 0 23 89% 16% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 45 0 0 1 44 0 0 100% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 41 0 0 0 41 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 26 0 0 0 26 0 0 94% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 9 1 0 0 8 0 0 100% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Liaoning Prov. Lab 16 0 0 0 15 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 22 2 0 0 20 0 0 95% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Ningxia Prov. Lab 6 0 0 0 5 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 9 0 0 0 9 0 0 89% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 13 0 0 0 11 0 2 73% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 62 1 0 3 55 0 3 93% 3% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Shanghai Prov. Lab 6 0 0 0 6 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 34 0 0 0 33 0 1 97% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 70 0 0 12 54 0 4 98% 15% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 2 0 0 0 2 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 28 3 0 0 25 0 0 100% 0% Prov. Lab/CCDC 5 0 3 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 55 0 0 4 48 0 3 92% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 37 0 0 1 36 0 0 100% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 4 0 0 0 4 0 0 25% 0% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 6 0 0 0 6 0 0 100% 0% 18-Apr-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - 11-Apr-19 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 16 0 0 1 15 0 0 93% 3% 18-Apr-19 NIID 0 - - - - - - - - - - - - - Malaysia IMR 24 0 0 0 23 0 1 98% 0% 08-Apr-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 3 0 0 0 3 0 0 100% 0% 22-Apr-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 1 0 0 0 1 0 0 100% 0% 23-Apr-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 57 4 1 10 41 0 1 100% 15% 24-Apr-19 VIDRL 18 0 9 0 0 0 0 0 2 0 6 0 1 100% Philippines RITM 47 2 0 2 39 4 0 96% 4% 16-Apr-19 RITM 6 0 2 0 0 0 0 0 4 0 0 0 0 100% Republic of Korea KCDC 11 0 0 0 8 3 0 100% 0% 15-Apr-19 KCDC 0 - - - - - - - - - - - - - Singapore SGH 2 0 0 0 2 0 0 100% 0% 18-Apr-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 8 0 0 0 5 3 0 100% 0% 01-Apr-19 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 20 0 0 1 18 1 0 100% 5% 22-Apr-19 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 1 0 0 0 1 0 0 97% 4% 13-Feb-19 VIDRL 0 - - - - - - - - - - - - - Total 1171 15 1 54 1023 15 63 97% 4% 41 0 19 0 0 0 0 0 15 0 6 0 1 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPV NegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B posit ive + NPEV NPEV 2 VDPV Polio Bulletin 6 Table 3. Laboratory confirmation of polio isolates from environmental samples in 2018–2019 1 Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2019 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP) aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP) aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 aVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) Viet Nam aVDPV2 (2 AFP) 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 17 2 0 2 0 0 0 0 0 0 0 12 0 0 0 - - - - - - - - - - - - - China (total) 281 180 0 199 0 0 0 1 0 560 2 1409 0 0 43 31 0 49 0 0 0 0 0 117 0 106 0 0 China, Fujian Prov. Lab/CCDC 73 51 0 20 0 0 0 0 0 107 1 577 0 0 9 6 0 7 0 0 0 0 0 5 0 29 0 0 China, Gansu Prov. Lab/CCDC 12 7 0 2 0 0 0 0 0 12 0 40 0 0 2 2 0 5 0 0 0 0 0 11 0 1 0 0 China, Guangdong Prov. Lab/CCDC 48 41 0 27 0 0 0 0 0 102 1 217 0 0 12 9 0 5 0 0 0 0 0 19 0 29 0 0 China, Guangxi Prov. Lab/CCDC 0 - - - - - - - - - - - - - 3 3 0 0 0 0 0 0 0 8 0 16 0 0 China, Heilongjiang Prov. Lab/CCDC 42 22 0 6 0 0 0 0 0 44 0 106 0 0 0 - - - - - - - - - - - - - China, Shandong Prov. Lab/CCDC 40 16 0 21 0 0 0 0 0 63 0 282 0 0 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab/CCDC 12 7 0 3 0 0 0 0 0 11 0 37 0 0 2 2 0 2 0 0 0 0 0 8 0 0 0 0 China, Xinjiang Prov. Lab/CCDC 36 36 0 120 0 0 0 1 0 221 0 109 0 0 9 9 0 30 0 0 0 0 0 66 0 14 0 0 China, Yunnan Prov. Lab/CCDC 18 0 - - - - - - - - - 41 0 0 6 0 - - - - - - - - - 17 0 0 Philippines RITM 87 8 0 2 0 0 0 0 0 6 0 24 0 0 30 8 0 4 0 0 0 0 0 6 0 13 0 0 Papua New Guinea RITM 27 23 0 15 7 0 0 0 0 21 0 9 0 0 18 15 0 10 0 0 0 0 0 9 0 11 0 0 Total 412 213 0 218 7 0 0 1 0 587 2 1454 0 0 91 54 0 63 0 0 0 0 0 132 0 130 0 0 2018 2019 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed

Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2017–2019* Chart 2. Adequate specimen collection rate, 2017–2019 Poliovirus Containment Certification Scheme Training for Auditors Copenhagen, Denmark, 6-10 May 2019 Following the Resolution 71.16 on poliovirus containment endorsed by the World Health Assembly in 2018, all Member States that are planning to retain polioviruses in designated poliovirus-essential facilities (PEF) are expected to have these PEF formally engaged in the global containment certification process no later than by the end of 2019. The WHO considers as one of its high priorities to provide technical support to all Member States in their effort to set up a mechanism of containment certification in accordance with Containment Certification Scheme (CCS).Due to the increased demand in countries, for the trained auditors, the WHO Regional Office for Europe is planning to organize an additional 5-day GAPIII CCS training course for auditors, in Copenhagen, Denmark, 06-10 May 2019. Two delegates from Japan - one from National Institute of Infectious Disease and another from Division of Infectious Disease Control, Ministry of Health, Labor and Welfare - were nominated. This will be an opportunity for Japan to strengthen its containment certification capacity and identify individuals with appropriate expertise that will become active auditing team members, as described in CCS. The expected outcome from the meeting will help the participants regarding clarifications on containment certification issues related to polio vaccine production and other poliovirus essential facilities, acceptable interim bio risk management measures and build an audit team capacity. A written auditor examination at the end of the course will be taken for participants’ assessment. A minimum pass rate of 75% must be attained to receive a certificate of achievement. Polio Bulletin 2019 Issue No. 9 - Week 18 (as of 9 May 2019) Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2019 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2019 Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam). Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: wproepidata@who.int Web: www.who.int/westernpacific CONTACT US HIGHLIGHTS * AFP rate annualized as of week 18 0% 20% 40% 60% 80% 100% 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 11.3% 14.5% 28.2% 32.1% 0.0% 0.0% 20.8% 0% 5% 10% 15% 20% 25% 30% 35% VNM PNG PHL MYS LAO KHM CHN 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM Table 1A. Classification of AFP cases with onset in 2018 and key surveillance indicators Polio Bulletin 2 2017 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 60 46 57 0 0 3 54 0 0 (0.0%) 1.24 44% 89% 14-Feb-19 - Brunei Darussalam 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 24-Jan-19 - Cambodia 57 44 73 0 0 0 73 0 0 (0.0%) 1.66 92% 85% 15-Mar-19 - China 5278 2256 5298 0 1 0 5294 3 3 (0.1%) 2.35 92% 100% 30-Apr-19 9 China, Hong Kong SAR 15 9 11 0 0 0 10 1 1 (9.1%) 1.22 82% 100% 03-Apr-19 36 China, Macao SAR 2 1 3 0 0 0 3 0 0 (0.0%) 3.00 100% 100% 19-Feb-19 - Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 103 21 115 0 0 0 114 1 1 (0.9%) 5.48 79% 80% 08-Apr-19 31 Malaysia 154 77 171 0 0 0 171 0 0 (0.0%) 2.22 80% 88% 15-Apr-19 - Mongolia 6 9 6 0 0 0 6 0 0 (0.0%) 0.67 100% 83% 04-Feb-19 - New Zealand 13 9 10 0 0 0 10 0 0 (0.0%) 1.11 60% 100% 28-Feb-19 - Papua New Guinea 29 37 286 0 26 23 230 7 7 (2.4%) 7.03 44% 74% 30-Apr-19 9 Philippines 462 338 313 0 0 0 261 52 51 (16.3%) 0.93 62% 94% 25-Mar-19 45 Republic of Korea 68 67 70 0 0 0 70 0 0 (0.0%) 1.04 90% 100% 11-Mar-19 - Singapore 7 6 13 0 0 0 13 0 0 (0.0%) 2.17 77% 100% 08-Mar-19 - Viet Nam 385 234 330 0 0 0 311 19 19 (5.8%) 1.41 98% 85% 11-Apr-19 28 Pacific island countries and areas 16 11 13 0 0 0 5 8 8 (61.5%) 1.18 31% 100% 09-May-19 0 Total 6656 3327 6771 0 27 26 6627 91 90 (1.3%) 2.03 88% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-po lio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Discarded (Non-polio) 2018 Non-polio AFP rate Total % with adequate specimens 2 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Table 1B. Classification of AFP cases with onset in 2019 and key surveillance indicators Polio Bulletin 3 2018 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 57 47 20 0 0 0 8 12 0 (0.0%) 1.23 50% 100% 08-May-19 1 Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 2.89 100% 100% 21-Mar-19 49 Cambodia 73 46 15 0 0 0 9 6 0 (0.0%) 0.94 87% 93% 08-May-19 1 China 5298 2256 1215 0 0 0 209 1006 253 (20.8%) 1.56 93% 100% 30-Apr-19 9 China, Hong Kong SAR 11 9 6 0 0 0 5 1 0 (0.0%) 1.93 100% 83% 08-Apr-19 31 China, Macao SAR 3 1 0 - - - - - - - - - 11-Apr-19 28 Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 115 23 18 0 0 0 16 2 0 (0.0%) 2.26 94% 72% 30-Apr-19 9 Malaysia 171 78 28 0 0 0 2 26 9 (32.1%) 1.04 71% 21% 15-Apr-19 24 Mongolia 6 9 3 0 0 0 1 2 0 (0.0%) 0.96 100% 100% 10-Apr-19 29 New Zealand 10 9 2 0 0 0 1 1 1 (50.0%) 0.64 50% 50% 09-Apr-19 30 Papua New Guinea 286 33 83 0 0 0 13 70 12 (14.5%) 7.27 72% 82% 30-Apr-19 9 Philippines 313 344 39 0 0 0 12 27 11 (28.2%) 0.33 64% 92% 08-May-19 1 Republic of Korea 70 66 11 0 0 0 2 9 0 (0.0%) 0.48 91% 100% 08-May-19 1 Singapore 13 6 2 0 0 0 1 1 0 (0.0%) 0.96 100% 100% 09-Apr-19 30 Viet Nam 330 234 71 0 0 0 46 25 8 (11.3%) 0.88 96% 97% 07-May-19 2 Pacific island countries and areas 13 11 6 0 0 0 1 5 0 (0.0%) 1.58 67% 100% 08-May-19 1 Total 6771 3334 1520 0 0 0 327 1193 294 (19.3%) 1.32 90% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO Discarded (Non-polio) 2019 Non-polio AFP rate 2 Total % with adequate specimens 3 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2018 and key laboratory indicators Polio Bulletin 4 ≥ 80% ≥ 80% Australia VIDRL 44 1 0 1 42 0 0 91% 3% 05-Feb-19 VIDRL 1 0 0 0 0 0 0 0 0 0 1 0 0 100% Brunei Darussalam VIDRL 2 0 0 0 2 0 0 50% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 74 0 0 13 61 0 0 93% 15% 18-Jan-19 NIID 0 - - - - - - - - - - - - - China (total) 5237 36 0 379 4822 0 0 97% 6% 30-Apr-19 88 0 24 0 0 0 0 0 63 1 0 0 0 99% China, Anhui Prov. Lab 332 2 0 17 313 0 0 100% 5% Prov. Lab/CCDC 8 0 3 0 0 0 0 0 5 0 0 0 0 100% China, Beijing Prov. Lab 31 0 0 0 31 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 52 0 0 2 50 0 0 90% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 176 1 0 12 163 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Gansu Prov. Lab 92 1 0 6 85 0 0 99% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangdong Prov. Lab 431 2 0 21 408 0 0 91% 4% Prov. Lab/CCDC 4 0 0 0 0 0 0 0 4 0 0 0 0 100% China, Guangxi Prov. Lab 221 2 0 18 201 0 0 99% 7% Prov. Lab/CCDC 4 0 3 0 0 0 0 0 1 0 0 0 0 100% China, Guizhou Prov. Lab 190 0 0 14 176 0 0 97% 7% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 37 0 0 6 31 0 0 100% 14% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Hebei Prov. Lab 299 1 0 38 260 0 0 100% 10% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 91 0 0 4 87 0 0 100% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Henan Prov. Lab 554 5 0 57 492 0 0 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hubei Prov. Lab 177 1 0 13 163 0 0 99% 7% Prov. Lab/CCDC 13 0 5 0 0 0 0 0 8 0 0 0 0 100% China, Hunan Prov. Lab 245 0 0 25 220 0 0 99% 9% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Jiangsu Prov. Lab 252 8 0 11 233 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 176 1 0 12 163 0 0 97% 5% Prov. Lab/CCDC 16 0 2 0 0 0 0 0 13 1 0 0 0 100% China, Jilin Prov. Lab 58 2 0 9 47 0 0 98% 11% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Liaoning Prov. Lab 89 0 0 6 83 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Neimongol Prov. Lab 100 2 0 4 94 0 0 98% 4% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Ningxia Prov. Lab 26 0 0 2 24 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 7 0 0 0 0 0 0 0 7 0 0 0 0 100% China, Shaanxi Prov. Lab 99 1 0 2 96 0 0 84% 2% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 100% China, Shandong Prov. Lab 412 2 0 26 384 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 42 0 0 0 42 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 118 1 0 7 110 0 0 97% 5% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 0% China, Sichuan Prov. Lab 298 1 0 21 276 0 0 97% 6% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 100% China, Tianjin Prov. Lab 22 0 0 0 22 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 141 1 0 7 133 0 0 91% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 248 0 0 31 217 0 0 93% 10% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Zhejiang Prov. Lab 188 2 0 7 179 0 0 99% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 8 0 0 1 7 0 0 73% 7% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 11 0 0 0 11 0 0 100% 0% 28-Jan-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 3 0 0 0 3 0 0 100% 0% 24-Dec-18 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 115 1 0 8 106 0 0 96% 4% 12-Mar-19 NIID 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Malaysia IMR 180 0 0 10 170 0 0 89% 4% 19-Feb-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 6 0 0 3 3 0 0 100% 50% 04-Jan-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 8 0 0 1 7 0 0 100% 13% 25-Jan-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 297 93 1 21 182 0 0 88% 5% 28-Feb-19 VIDRL 187 0 63 46 0 0 0 0 78 0 0 0 0 100% Philippines RITM 397 5 1 14 377 0 0 96% 3% 16-Apr-19 RITM 7 0 2 0 0 0 0 0 5 0 0 0 0 100% Republic of Korea KCDC 70 0 0 5 65 0 0 97% 6% 23-Apr-19 KCDC 0 - - - - - - - - - - - - - Singapore SGH 13 0 0 2 11 0 0 96% 8% 30-Jan-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 175 3 0 24 148 0 0 100% 12% 30-Jan-19 NIHE 4 0 2 0 0 0 0 0 2 0 0 0 0 100% Viet Nam (South) PI 175 4 0 21 150 0 0 100% 12% 18-Mar-19 PI 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Pacific island countries and areas VIDRL 11 0 0 1 10 0 0 97% 6% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Total 6818 143 2 503 6170 0 0 97% 6% 296 0 93 46 0 0 0 0 155 1 1 0 0 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPV NegativeNPEV only SabinWild L20B posit ive Pending ≤ 14 days VDPV Type 2 L20B posit ive + NPEV NPEV 2 VDPV Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2019 and key laboratory indicators Polio Bulletin 5 ≥ 80% ≥ 80% Australia VIDRL 15 0 0 1 11 3 0 95% 5% 08-May-19 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 10 0 0 0 10 0 0 90% 0% 06-May-19 NIID 0 - - - - - - - - - - - - - China (total) 1187 8 0 54 1061 0 64 97% 4% 30-Apr-19 17 0 8 0 0 0 0 0 9 0 0 0 0 100% China, Anhui Prov. Lab 62 1 0 0 52 0 9 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Beijing Prov. Lab 12 0 0 0 12 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 15 0 0 0 8 0 7 88% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 29 0 0 1 28 0 0 100% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Gansu Prov. Lab 23 0 0 0 23 0 0 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 88 0 0 2 86 0 0 97% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangxi Prov. Lab 49 0 0 2 46 0 1 100% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 52 0 0 4 47 0 1 100% 7% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 3 0 0 0 3 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 72 0 0 5 66 0 1 100% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 16 0 0 0 16 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 110 0 0 5 102 0 3 97% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hubei Prov. Lab 51 0 0 6 41 0 4 96% 13% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 55 0 0 1 54 0 0 100% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 49 0 0 0 42 0 7 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 30 0 0 0 29 0 1 95% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 11 1 0 0 10 0 0 100% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Liaoning Prov. Lab 19 0 0 0 15 0 4 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 26 2 0 0 24 0 0 96% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Ningxia Prov. Lab 7 0 0 0 6 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 10 0 0 1 9 0 0 90% 10% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 22 0 0 1 17 0 4 78% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 77 1 0 3 72 0 1 95% 2% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Shanghai Prov. Lab 7 0 0 0 7 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 42 0 0 0 39 0 3 97% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 99 0 0 17 74 0 8 98% 15% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 2 0 0 0 2 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 35 3 0 0 32 0 0 100% 0% Prov. Lab/CCDC 5 0 3 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 69 0 0 5 55 0 9 93% 7% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 41 0 0 1 40 0 0 100% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 4 0 0 0 4 0 0 25% 0% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 6 0 0 0 6 0 0 100% 0% 03-May-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - - PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 18 0 0 1 17 0 0 88% 3% 01-May-19 NIID 0 - - - - - - - - - - - - - Malaysia IMR 24 0 0 0 23 0 1 98% 0% 08-Apr-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 3 0 0 0 3 0 0 100% 0% 03-May-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 1 0 0 0 1 0 0 100% 0% 07-May-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 92 4 1 22 51 13 1 100% 23% 08-May-19 VIDRL 18 0 9 0 0 0 0 0 2 0 6 0 1 100% Philippines RITM 52 2 0 2 45 3 0 96% 4% 29-Apr-19 RITM 6 0 2 0 0 0 0 0 4 0 0 0 0 100% Republic of Korea KCDC 11 0 0 0 11 0 0 100% 0% 08-May-19 KCDC 0 - - - - - - - - - - - - - Singapore SGH 2 0 0 0 2 0 0 100% 0% 07-May-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 8 0 0 0 5 3 0 100% 0% 01-Apr-19 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 34 0 0 2 29 3 0 100% 6% 06-May-19 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 2 0 0 0 2 0 0 97% 4% 07-May-19 VIDRL 0 - - - - - - - - - - - - - Total 1466 14 1 82 1278 25 66 97% 4% 41 0 19 0 0 0 0 0 15 0 6 0 1 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens posit ive for NPEV Latest report date Discordant pending sequencing 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPV NegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2 VDPV Polio Bulletin 6 Table 3. Laboratory confirmation of polio isolates from environmental samples in 2018–2019 1 Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2019 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP) aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP) aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 aVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) Viet Nam aVDPV2 (2 AFP) 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 17 2 0 2 0 0 0 0 0 0 0 12 0 0 0 - - - - - - - - - - - - - China (total) 281 180 0 199 0 0 0 1 0 560 2 1409 0 0 43 31 0 49 0 0 0 0 0 117 0 106 0 0 China, Fujian Prov. Lab/CCDC 73 51 0 20 0 0 0 0 0 107 1 577 0 0 9 6 0 7 0 0 0 0 0 5 0 29 0 0 China, Gansu Prov. Lab/CCDC 12 7 0 2 0 0 0 0 0 12 0 40 0 0 2 2 0 5 0 0 0 0 0 11 0 1 0 0 China, Guangdong Prov. Lab/CCDC 48 41 0 27 0 0 0 0 0 102 1 217 0 0 12 9 0 5 0 0 0 0 0 19 0 29 0 0 China, Guangxi Prov. Lab/CCDC 0 - - - - - - - - - - - - - 3 3 0 0 0 0 0 0 0 8 0 16 0 0 China, Heilongjiang Prov. Lab/CCDC 42 22 0 6 0 0 0 0 0 44 0 106 0 0 0 - - - - - - - - - - - - - China, Shandong Prov. Lab/CCDC 40 16 0 21 0 0 0 0 0 63 0 282 0 0 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab/CCDC 12 7 0 3 0 0 0 0 0 11 0 37 0 0 2 2 0 2 0 0 0 0 0 8 0 0 0 0 China, Xinjiang Prov. Lab/CCDC 36 36 0 120 0 0 0 1 0 221 0 109 0 0 9 9 0 30 0 0 0 0 0 66 0 14 0 0 China, Yunnan Prov. Lab/CCDC 18 0 - - - - - - - - - 41 0 0 6 0 - - - - - - - - - 17 0 0 Philippines RITM 87 8 0 2 0 0 0 0 0 6 0 24 0 0 37 10 0 6 0 0 0 0 0 7 0 13 0 0 Papua New Guinea RITM 27 23 0 15 7 0 0 0 0 21 0 9 0 0 26 23 0 14 0 0 0 0 0 16 0 14 0 0 Total 412 213 0 218 7 0 0 1 0 587 2 1454 0 0 106 64 0 69 0 0 0 0 0 140 0 133 0 0 2018 2019 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed

Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2017–2019* Chart 2. Adequate specimen collection rate, 2017–2019 Seventh Meeting of the Combined Sub-regional Committees for the Certification of Poliomyelitis Eradication and Verification of Measles and Rubella Elimination in Pacific Island Countries and Areas The seventh meeting of the combined sub-regional committees for the certification of poliomyelitis eradication and verification of measles elimination in Pacific island countries and areas convened on 14-16 May 2019 in Manila, Philippines. The main objectives of the meeting were:  to review and classify all pending acute flaccid paralysis cases;  to draft the annual report on progress in maintaining poliomyelitis-free status in Pacific island countries and areas for submission to the 2019 Regional Certification Commission at its 25th meeting; and  to draft the annual report on progress towards achieving measles and rubella elimination in Pacific island countries and areas for submission to the 2019 Regional Verification Commission at its eighth meeting. The Committee also reviewed the global and regional progress in measles and rubella elimination and polio eradication and developed general and country specific recommendations for the Pacific island countries and areas. Polio Bulletin 2019 Issue No. 10 - Week 21 (as of 28 May 2019) Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2019 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2019 Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam). Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: wproepidata@who.int Web: www.who.int/westernpacific CONTACT US HIGHLIGHTS * AFP rate annualized as of week 21 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 11.3% 14.5% 36.8% 32.1% 0.0% 0.0% 14.1% 0% 5% 10% 15% 20% 25% 30% 35% 40% VNM PNG PHL MYS LAO KHM CHN Table 1A. Classification of AFP cases with onset in 2018 and key surveillance indicators Polio Bulletin 2 2017 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 60 46 57 0 0 3 54 0 0 (0.0%) 1.24 44% 89% 14-Feb-19 - Brunei Darussalam 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 24-Jan-19 - Cambodia 57 44 73 0 0 0 73 0 0 (0.0%) 1.66 92% 85% 15-Mar-19 - China 5278 2256 5292 0 1 0 5291 0 0 (0.0%) 2.35 92% 100% 15-May-19 - China, Hong Kong SAR 15 9 11 0 0 0 10 1 1 (9.1%) 1.22 82% 100% 03-Apr-19 55 China, Macao SAR 2 1 3 0 0 0 3 0 0 (0.0%) 3.00 100% 100% 19-Feb-19 - Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 103 21 115 0 0 0 114 1 1 (0.9%) 5.48 79% 80% 08-Apr-19 50 Malaysia 154 77 171 0 0 0 171 0 0 (0.0%) 2.22 80% 88% 15-Apr-19 - Mongolia 6 9 6 0 0 0 6 0 0 (0.0%) 0.67 100% 83% 04-Feb-19 - New Zealand 13 9 10 0 0 0 10 0 0 (0.0%) 1.11 60% 100% 28-Feb-19 - Papua New Guinea 29 37 286 0 26 23 230 7 7 (2.4%) 7.03 44% 74% 30-Apr-19 28 Philippines 462 338 313 0 0 0 261 52 51 (16.3%) 0.93 62% 94% 25-Mar-19 64 Republic of Korea 68 67 70 0 0 0 70 0 0 (0.0%) 1.04 90% 100% 11-Mar-19 - Singapore 7 6 13 0 0 0 13 0 0 (0.0%) 2.17 77% 100% 08-Mar-19 - Viet Nam 385 234 330 0 0 0 311 19 19 (5.8%) 1.41 98% 85% 11-Apr-19 47 Pacific island countries and areas 16 11 13 0 0 0 5 8 8 (61.5%) 1.18 31% 100% 09-May-19 19 Total 6656 3327 6765 0 27 26 6624 88 87 (1.3%) 2.03 88% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 2018 Non-polio AFP rate Total % with adequate specimens 2> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Table 1B. Classification of AFP cases with onset in 2019 and key surveillance indicators Polio Bulletin 3 2018 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 57 47 23 0 0 0 8 15 1 (4.3%) 1.21 43% 100% 24-May-19 4 Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 2.48 100% 100% 21-Mar-19 68 Cambodia 73 46 19 0 0 0 9 10 0 (0.0%) 1.02 84% 95% 21-May-19 7 China 5292 2256 1487 0 0 0 403 1084 209 (14.1%) 1.63 92% 100% 15-May-19 13 China, Hong Kong SAR 11 9 6 0 0 0 5 1 0 (0.0%) 1.65 100% 83% 08-Apr-19 50 China, Macao SAR 3 1 0 - - - - - - - - - 15-May-19 13 Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 115 23 24 0 0 0 18 6 0 (0.0%) 2.58 92% 75% 27-May-19 1 Malaysia 171 78 28 0 0 0 2 26 9 (32.1%) 0.89 71% 21% 15-Apr-19 43 Mongolia 6 9 3 0 0 0 2 1 0 (0.0%) 0.83 100% 100% 13-May-19 15 New Zealand 10 9 3 0 0 0 1 2 2 (66.7%) 0.83 33% 100% 22-May-19 6 Papua New Guinea 286 33 83 0 0 0 13 70 12 (14.5%) 6.23 72% 82% 30-Apr-19 28 Philippines 313 344 57 0 0 0 12 45 21 (36.8%) 0.41 58% 89% 23-May-19 5 Republic of Korea 70 66 24 0 0 0 6 18 0 (0.0%) 0.90 96% 100% 10-May-19 18 Singapore 13 6 3 0 0 0 1 2 0 (0.0%) 1.24 67% 100% 10-May-19 18 Viet Nam 330 234 71 0 0 0 46 25 8 (11.3%) 0.75 96% 97% 07-May-19 21 Pacific island countries and areas 13 11 6 0 0 0 1 5 0 (0.0%) 1.35 67% 100% 08-May-19 20 Total 6765 3334 1838 0 0 0 528 1310 262 (14.3%) 1.37 89% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date 2019 Non-polio AFP rate 2 Total % with adequate specimens 3 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2018 and key laboratory indicators Polio Bulletin 4 ≥ 80% ≥ 80% Australia VIDRL 44 1 0 1 42 0 0 91% 3% 05-Feb-19 VIDRL 1 0 0 0 0 0 0 0 0 0 1 0 0 100% Brunei Darussalam VIDRL 2 0 0 0 2 0 0 50% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 74 0 0 13 61 0 0 93% 15% 18-Jan-19 NIID 0 - - - - - - - - - - - - - China (total) 5237 36 0 379 4822 0 0 97% 6% 15-May-19 88 0 24 0 0 0 0 0 63 1 0 0 0 99% China, Anhui Prov. Lab 332 2 0 17 313 0 0 100% 5% Prov. Lab/CCDC 8 0 3 0 0 0 0 0 5 0 0 0 0 100% China, Beijing Prov. Lab 31 0 0 0 31 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 52 0 0 2 50 0 0 90% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 176 1 0 12 163 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Gansu Prov. Lab 92 1 0 6 85 0 0 99% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangdong Prov. Lab 431 2 0 21 408 0 0 91% 4% Prov. Lab/CCDC 4 0 0 0 0 0 0 0 4 0 0 0 0 100% China, Guangxi Prov. Lab 221 2 0 18 201 0 0 99% 7% Prov. Lab/CCDC 4 0 3 0 0 0 0 0 1 0 0 0 0 100% China, Guizhou Prov. Lab 190 0 0 14 176 0 0 97% 7% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 41 0 0 6 35 0 0 100% 12% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Hebei Prov. Lab 299 1 0 38 260 0 0 100% 10% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 91 0 0 4 87 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 552 5 0 58 489 0 0 99% 9% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Hubei Prov. Lab 177 1 0 13 163 0 0 99% 7% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 245 0 0 25 220 0 0 99% 9% Prov. Lab/CCDC 13 0 5 0 0 0 0 0 8 0 0 0 0 100% China, Jiangsu Prov. Lab 252 8 0 11 233 0 0 100% 4% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Jiangxi Prov. Lab 176 1 0 12 163 0 0 97% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 58 2 0 9 47 0 0 98% 11% Prov. Lab/CCDC 16 0 2 0 0 0 0 0 13 1 0 0 0 100% China, Liaoning Prov. Lab 89 0 0 6 83 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Neimongol Prov. Lab 100 2 0 4 94 0 0 98% 4% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Ningxia Prov. Lab 26 0 0 2 24 0 0 96% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Qinghai Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 99 1 0 2 96 0 0 84% 2% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Shandong Prov. Lab 410 2 0 25 383 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 42 0 0 0 42 0 0 100% 0% Prov. Lab/CCDC 7 0 0 0 0 0 0 0 7 0 0 0 0 100% China, Shanxi Prov. Lab 118 1 0 7 110 0 0 97% 5% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 100% China, Sichuan Prov. Lab 298 1 0 21 276 0 0 97% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 22 0 0 0 22 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 141 1 0 7 133 0 0 91% 4% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 0% China, Yunnan Prov. Lab 248 0 0 31 217 0 0 93% 10% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 100% China, Zhejiang Prov. Lab 188 2 0 7 179 0 0 99% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 8 0 0 1 7 0 0 73% 7% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 11 0 0 0 11 0 0 100% 0% 28-Jan-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 3 0 0 0 3 0 0 100% 0% 24-Dec-18 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 115 1 0 8 106 0 0 96% 4% 12-Mar-19 NIID 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Malaysia IMR 180 0 0 10 170 0 0 89% 4% 19-Feb-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 6 0 0 3 3 0 0 100% 50% 04-Jan-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 8 0 0 1 7 0 0 100% 13% 25-Jan-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 297 93 1 21 182 0 0 88% 5% 28-Feb-19 VIDRL 187 0 63 46 0 0 0 0 78 0 0 0 0 100% Philippines RITM 397 5 1 14 377 0 0 96% 3% 16-Apr-19 RITM 7 0 2 0 0 0 0 0 5 0 0 0 0 100% Republic of Korea KCDC 70 0 0 5 65 0 0 97% 6% 23-Apr-19 KCDC 0 - - - - - - - - - - - - - Singapore SGH 13 0 0 2 11 0 0 96% 8% 30-Jan-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 175 3 0 24 148 0 0 100% 12% 30-Jan-19 NIHE 4 0 2 0 0 0 0 0 2 0 0 0 0 100% Viet Nam (South) PI 175 4 0 21 150 0 0 100% 12% 18-Mar-19 PI 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Pacific island countries and areas VIDRL 11 0 0 1 10 0 0 97% 6% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Total 6818 143 2 503 6170 0 0 97% 6% 296 0 93 46 0 0 0 0 155 1 1 0 0 100% 2. NPEV growing in L20B cells L20B posit ive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2 VDPV Pending ITDVDPV NegativeNPEV only SabinWild 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2019 and key laboratory indicators Polio Bulletin 5 ≥ 80% ≥ 80% Australia VIDRL 16 0 0 2 14 0 0 97% 10% 24-May-19 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 15 0 0 0 15 0 0 93% 0% 27-May-19 NIID 0 - - - - - - - - - - - - - China (total) 1460 8 0 67 1326 0 59 98% 4% 15-May-19 21 0 10 0 0 0 0 0 11 0 0 0 0 100% China, Anhui Prov. Lab 76 1 0 0 67 0 8 100% 0% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Beijing Prov. Lab 16 0 0 0 13 0 3 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 16 0 0 0 12 0 4 92% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 37 0 0 2 35 0 0 100% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Gansu Prov. Lab 29 0 0 0 29 0 0 97% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 111 0 0 4 105 0 2 97% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangxi Prov. Lab 61 0 0 4 57 0 0 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 65 0 0 5 51 0 9 100% 7% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 4 0 0 0 4 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 96 0 0 7 87 0 2 100% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 24 0 0 0 24 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 133 0 0 5 125 0 3 97% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hubei Prov. Lab 63 0 0 7 51 0 5 97% 12% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 65 0 0 2 63 0 0 100% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 61 0 0 0 61 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 35 0 0 0 35 0 0 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 12 1 0 0 11 0 0 100% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Liaoning Prov. Lab 23 0 0 0 20 0 3 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 32 2 0 0 30 0 0 97% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Ningxia Prov. Lab 7 0 0 0 6 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 13 0 0 1 12 0 0 92% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 30 0 0 1 24 0 5 76% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 93 1 0 4 85 0 3 96% 2% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Shanghai Prov. Lab 8 0 0 0 8 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 48 0 0 0 46 0 2 98% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 121 0 0 19 98 0 4 98% 14% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 2 0 0 0 2 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 45 3 0 0 42 0 0 100% 0% Prov. Lab/CCDC 5 0 3 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 81 0 0 5 71 0 5 95% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 49 0 0 1 48 0 0 100% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 4 0 0 0 4 0 0 25% 0% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 6 0 0 0 6 0 0 100% 0% 17-May-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - - PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 21 0 0 2 19 0 0 90% 8% 27-May-19 NIID 0 - - - - - - - - - - - - - Malaysia IMR 24 0 0 0 23 0 1 98% 0% 08-Apr-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 4 0 0 0 3 1 0 100% 0% 24-May-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 2 0 0 0 1 1 0 100% 0% 20-May-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 92 6 2 28 56 0 0 100% 24% 28-May-19 VIDRL 29 0 18 0 0 0 0 0 4 0 7 0 0 96% Philippines RITM 66 2 0 3 53 8 0 95% 5% 20-May-19 RITM 6 0 2 0 0 0 0 0 4 0 0 0 0 100% Republic of Korea KCDC 24 0 0 0 22 0 2 100% 0% 10-May-19 KCDC 0 - - - - - - - - - - - - - Singapore SGH 4 0 0 0 3 1 0 100% 0% 24-May-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 40 0 0 7 23 10 0 100% 20% 14-May-19 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 41 0 0 2 36 3 0 100% 5% 21-May-19 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 2 0 0 0 2 0 0 98% 5% 07-May-19 VIDRL 0 - - - - - - - - - - - - - Total 1818 16 2 111 1603 24 62 98% 5% 56 0 30 0 0 0 0 0 19 0 7 0 0 98% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPV NegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B posit ive + NPEV NPEV 2 VDPV Polio Bulletin 6 Table 3. Laboratory confirmation of polio isolates from environmental samples in 2018–2019 1 Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2019 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP) aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP) aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 aVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) Viet Nam aVDPV2 (2 AFP) 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 17 2 0 2 0 0 0 0 0 0 0 12 0 0 0 - - - - - - - - - - - - - China (total) 281 180 0 199 0 0 0 1 0 560 2 1409 0 0 62 45 0 52 0 0 0 0 0 145 0 186 0 0 China, Fujian Prov. Lab/CCDC 73 51 0 20 0 0 0 0 0 107 1 577 0 0 18 12 0 7 0 0 0 0 0 17 0 73 0 0 China, Gansu Prov. Lab/CCDC 12 7 0 2 0 0 0 0 0 12 0 40 0 0 2 2 0 5 0 0 0 0 0 11 0 1 0 0 China, Guangdong Prov. Lab/CCDC 48 41 0 27 0 0 0 0 0 102 1 217 0 0 16 13 0 7 0 0 0 0 0 26 0 56 0 0 China, Guangxi Prov. Lab/CCDC 0 - - - - - - - - - - - - - 3 3 0 0 0 0 0 0 0 8 0 16 0 0 China, Heilongjiang Prov. Lab/CCDC 42 22 0 6 0 0 0 0 0 44 0 106 0 0 6 4 0 1 0 0 0 0 0 9 0 9 0 0 China, Shandong Prov. Lab/CCDC 40 16 0 21 0 0 0 0 0 63 0 282 0 0 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab/CCDC 12 7 0 3 0 0 0 0 0 11 0 37 0 0 2 2 0 2 0 0 0 0 0 8 0 0 0 0 China, Xinjiang Prov. Lab/CCDC 36 36 0 120 0 0 0 1 0 221 0 109 0 0 9 9 0 30 0 0 0 0 0 66 0 14 0 0 China, Yunnan Prov. Lab/CCDC 18 0 - - - - - - - - - 41 0 0 6 0 - - - - - - - - - 17 0 0 Philippines RITM 87 8 0 2 0 0 0 0 0 6 0 24 0 0 46 10 0 6 0 0 0 0 0 8 0 14 1 0 Papua New Guinea RITM 27 23 0 15 7 0 0 0 0 21 0 9 0 0 28 25 0 15 0 0 0 0 0 18 0 15 0 0 Total 412 213 0 218 7 0 0 1 0 587 2 1454 0 0 136 80 0 73 0 0 0 0 0 171 0 215 1 0 2018 2019 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed

Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2017–2019* Chart 2. Adequate specimen collection rate, 2017–2019 The second assessment of outbreak response in Papua New Guinea During 27-31 May 2019, a joint WHO/UNICEF/ US CDC team conducted the second outbreak response assessment in Papua New Guinea. The main objectives of the assessment were:  to review the progress in addressing recommendations of the first outbreak response assessment;  to assess whether virus transmission has been interrupted; and  to produce recommendations to assist the country to maintain achievements. Based on the findings of the assessment, the outbreak response assessment (OBRA) team concluded that the transmission of cVDPV1 has likely been interrupted. However, due to remaining surveillance and population immunity gaps, it would be important to further strengthen the current level of performance (surveillance and routine immunization) for the next six months for the outbreak to be declared closed. A follow-up outbreak response assessment should be planned in November- December 2019. Polio Bulletin 2019 Issue No. 11 - Week 23 (as of 10 June 2019) Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2019 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2019 Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam). Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: wproepidata@who.int Web: www.who.int/westernpacific CONTACT US HIGHLIGHTS * AFP rate annualized as of week 23 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 11.3% 0.9% 36.8% 38.3% 0.0% 0.0% 15.9% 0% 10% 20% 30% 40% 50% VNM PNG PHL MYS LAO KHM CHN Table 1A. Classification of AFP cases with onset in 2018 and key surveillance indicators Polio Bulletin 2 2017 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 60 46 57 0 0 3 54 0 0 (0.0%) 1.24 44% 89% 14-Feb-19 - Brunei Darussalam 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 24-Jan-19 - Cambodia 57 44 73 0 0 0 73 0 0 (0.0%) 1.66 92% 85% 15-Mar-19 - China 5278 2256 5292 0 1 0 5291 0 0 (0.0%) 2.35 92% 100% 15-May-19 - China, Hong Kong SAR 15 9 11 0 0 0 10 1 1 (9.1%) 1.22 82% 100% 03-Jun-19 7 China, Macao SAR 2 1 3 0 0 0 3 0 0 (0.0%) 3.00 100% 100% 19-Feb-19 - Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 103 21 94 0 0 0 94 0 0 (0.0%) 4.48 80% 79% 03-Jun-19 - Malaysia 154 77 171 0 0 0 171 0 0 (0.0%) 2.22 80% 88% 15-Apr-19 - Mongolia 6 9 6 0 0 0 6 0 0 (0.0%) 0.67 100% 83% 04-Feb-19 - New Zealand 13 9 10 0 0 0 10 0 0 (0.0%) 1.11 60% 100% 28-Feb-19 - Papua New Guinea 29 37 286 0 26 23 230 7 7 (2.4%) 7.03 44% 74% 30-Apr-19 41 Philippines 462 338 313 0 0 0 261 52 51 (16.3%) 0.93 62% 94% 25-Mar-19 77 Republic of Korea 68 67 70 0 0 0 70 0 0 (0.0%) 1.04 90% 100% 11-Mar-19 - Singapore 7 6 13 0 0 0 13 0 0 (0.0%) 2.17 77% 100% 08-Mar-19 - Viet Nam 385 234 330 0 0 0 311 19 19 (5.8%) 1.41 98% 85% 11-Apr-19 60 Pacific island countries and areas 16 11 13 0 0 0 13 0 0 (0.0%) 1.18 31% 100% 03-Jun-19 - Total 6656 3327 6744 0 27 26 6612 79 78 (1.2%) 2.02 88% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 2018 Non-polio AFP rate Total % with adequate specimens 2 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Table 1B. Classification of AFP cases with onset in 2019 and key surveillance indicators Polio Bulletin 3 2018 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 57 47 27 0 0 0 8 19 4 (14.8%) 1.30 41% 100% 07-Jun-19 3 Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 2.26 100% 100% 03-Jun-19 7 Cambodia 73 46 22 0 0 0 19 3 0 (0.0%) 1.08 86% 91% 07-Jun-19 3 China 5292 2256 1753 0 0 0 458 1295 278 (15.9%) 1.76 92% 100% 29-May-19 12 China, Hong Kong SAR 11 9 8 0 0 0 5 3 0 (0.0%) 2.01 75% 88% 10-Jun-19 0 China, Macao SAR 3 1 0 - - - - - - - - - 15-May-19 26 Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 94 23 27 0 0 0 23 4 0 (0.0%) 2.65 89% 74% 04-Jun-19 6 Malaysia 171 78 47 0 0 0 11 36 18 (38.3%) 1.36 72% 43% 29-May-19 12 Mongolia 6 9 4 0 0 0 3 1 0 (0.0%) 1.00 100% 100% 06-Jun-19 4 New Zealand 10 9 3 0 0 0 1 2 2 (66.7%) 0.75 33% 100% 22-May-19 19 Papua New Guinea 286 33 115 0 0 0 95 20 1 (0.9%) 7.88 75% 79% 05-Jun-19 5 Philippines 313 344 57 0 0 0 12 45 21 (36.8%) 0.37 58% 89% 23-May-19 18 Republic of Korea 70 66 24 0 0 0 9 15 0 (0.0%) 0.82 96% 100% 10-Jun-19 0 Singapore 13 6 4 0 0 0 2 2 0 (0.0%) 1.51 100% 100% 06-Jun-19 4 Viet Nam 330 234 71 0 0 0 46 25 8 (11.3%) 0.69 96% 97% 07-May-19 34 Pacific island countries and areas 13 11 7 0 0 0 5 2 0 (0.0%) 1.44 71% 100% 03-Jun-19 7 Total 6744 3334 2170 0 0 0 698 1472 332 (15.3%) 1.47 89% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date 2019 Non-polio AFP rate 2 Total % with adequate specimens 3 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2018 and key laboratory indicators Polio Bulletin 4 ≥ 80% ≥ 80% Australia VIDRL 44 1 0 1 42 0 0 91% 3% 05-Feb-19 VIDRL 1 0 0 0 0 0 0 0 0 0 1 0 0 100% Brunei Darussalam VIDRL 2 0 0 0 2 0 0 50% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 74 0 0 13 61 0 0 93% 15% 18-Jan-19 NIID 0 - - - - - - - - - - - - - China (total) 5237 36 0 379 4822 0 0 97% 6% 15-May-19 88 0 24 0 0 0 0 0 63 1 0 0 0 99% China, Anhui Prov. Lab 332 2 0 17 313 0 0 100% 5% Prov. Lab/CCDC 8 0 3 0 0 0 0 0 5 0 0 0 0 100% China, Beijing Prov. Lab 31 0 0 0 31 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 52 0 0 2 50 0 0 90% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 176 1 0 12 163 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Gansu Prov. Lab 92 1 0 6 85 0 0 99% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangdong Prov. Lab 431 2 0 21 408 0 0 91% 4% Prov. Lab/CCDC 4 0 0 0 0 0 0 0 4 0 0 0 0 100% China, Guangxi Prov. Lab 221 2 0 18 201 0 0 99% 7% Prov. Lab/CCDC 4 0 3 0 0 0 0 0 1 0 0 0 0 100% China, Guizhou Prov. Lab 190 0 0 14 176 0 0 97% 7% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 41 0 0 6 35 0 0 100% 12% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 299 1 0 38 260 0 0 100% 10% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 91 0 0 4 87 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 552 5 0 58 489 0 0 99% 9% Prov. Lab/CCDC 13 0 5 0 0 0 0 0 8 0 0 0 0 100% China, Hubei Prov. Lab 177 1 0 13 163 0 0 99% 7% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Hunan Prov. Lab 245 0 0 25 220 0 0 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 252 8 0 11 233 0 0 100% 4% Prov. Lab/CCDC 16 0 2 0 0 0 0 0 13 1 0 0 0 100% China, Jiangxi Prov. Lab 176 1 0 12 163 0 0 97% 5% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Jilin Prov. Lab 58 2 0 9 47 0 0 98% 11% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Liaoning Prov. Lab 89 0 0 6 83 0 0 97% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 100 2 0 4 94 0 0 98% 4% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 100% China, Ningxia Prov. Lab 26 0 0 2 24 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 99 1 0 2 96 0 0 84% 2% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 0% China, Shandong Prov. Lab 410 2 0 25 383 0 0 100% 4% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 100% China, Shanghai Prov. Lab 42 0 0 0 42 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 118 1 0 7 110 0 0 97% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Sichuan Prov. Lab 298 1 0 21 276 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Tianjin Prov. Lab 22 0 0 0 22 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 141 1 0 7 133 0 0 91% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 248 0 0 31 217 0 0 93% 10% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Zhejiang Prov. Lab 188 2 0 7 179 0 0 99% 3% Prov. Lab/CCDC 7 0 0 0 0 0 0 0 7 0 0 0 0 100% China, Tibet Prov. Lab 8 0 0 1 7 0 0 73% 7% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 11 0 0 0 11 0 0 100% 0% 28-Jan-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 3 0 0 0 3 0 0 100% 0% 24-Dec-18 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 115 1 0 8 106 0 0 96% 4% 12-Mar-19 NIID 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Malaysia IMR 180 0 0 10 170 0 0 89% 4% 19-Feb-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 6 0 0 3 3 0 0 100% 50% 04-Jan-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 8 0 0 1 7 0 0 100% 13% 25-Jan-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 297 93 1 21 182 0 0 88% 5% 28-Feb-19 VIDRL 187 0 63 46 0 0 0 0 78 0 0 0 0 100% Philippines RITM 397 5 1 14 377 0 0 96% 3% 16-Apr-19 RITM 7 0 2 0 0 0 0 0 5 0 0 0 0 100% Republic of Korea KCDC 70 0 0 5 65 0 0 97% 6% 23-Apr-19 KCDC 0 - - - - - - - - - - - - - Singapore SGH 13 0 0 2 11 0 0 96% 8% 30-Jan-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 175 3 0 24 148 0 0 100% 12% 30-Jan-19 NIHE 4 0 2 0 0 0 0 0 2 0 0 0 0 100% Viet Nam (South) PI 175 4 0 21 150 0 0 100% 12% 18-Mar-19 PI 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Pacific island countries and areas VIDRL 11 0 0 1 10 0 0 97% 6% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Total 6818 143 2 503 6170 0 0 97% 6% 296 0 93 46 0 0 0 0 155 1 1 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B posit ive + NPEV NPEV 2 VDPV Pending ITDVDPV NegativeNPEV only SabinWild 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2019 and key laboratory indicators Polio Bulletin 5 ≥ 80% ≥ 80% Australia VIDRL 18 0 0 2 14 2 0 97% 10% 07-Jun-19 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 21 0 0 0 21 0 0 95% 0% 10-Jun-19 NIID 0 - - - - - - - - - - - - - China (total) 1715 8 0 79 1551 0 77 98% 4% 29-May-19 24 0 11 0 0 0 0 0 13 0 0 0 0 100% China, Anhui Prov. Lab 89 2 0 0 79 0 8 100% 0% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Beijing Prov. Lab 18 0 0 0 17 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 19 0 0 0 16 0 3 94% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 41 0 0 2 39 0 0 100% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Gansu Prov. Lab 42 0 0 0 42 0 0 98% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 131 0 0 6 123 0 2 96% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangxi Prov. Lab 71 0 0 5 66 0 0 100% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 74 0 0 6 68 0 0 100% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 4 0 0 0 4 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 112 0 0 7 103 0 2 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 36 0 0 0 35 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 165 0 0 10 153 0 2 96% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hubei Prov. Lab 71 0 0 7 51 0 13 97% 12% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 72 0 0 3 68 0 1 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 70 0 0 1 68 0 1 100% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 38 0 0 0 38 0 0 93% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 12 1 0 0 11 0 0 100% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Liaoning Prov. Lab 27 0 0 0 20 0 7 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 41 2 0 0 39 0 0 98% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Ningxia Prov. Lab 8 0 0 0 7 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 16 0 0 1 15 0 0 94% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 36 0 0 1 29 0 6 80% 2% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Shandong Prov. Lab 109 1 0 5 101 0 2 96% 2% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Shanghai Prov. Lab 9 0 0 0 9 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 51 0 0 0 49 0 2 98% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 138 0 0 19 99 0 20 98% 14% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 3 0 0 0 3 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 51 2 0 0 49 0 0 100% 0% Prov. Lab/CCDC 5 0 3 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 99 0 0 5 89 0 5 96% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 58 0 0 1 57 0 0 100% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 4 0 0 0 4 0 0 25% 0% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 6 0 0 0 6 0 0 100% 0% 10-Jun-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - - PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 23 0 0 2 21 0 0 91% 7% 03-Jun-19 NIID 0 - - - - - - - - - - - - - Malaysia IMR 24 0 0 0 23 0 1 98% 0% 08-Apr-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 4 0 0 0 4 0 0 100% 0% 07-Jun-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 2 0 0 0 2 0 0 100% 0% 03-Jun-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 92 6 2 28 56 0 0 100% 24% 10-Jun-19 VIDRL 31 0 20 0 0 0 0 0 4 0 7 0 0 97% Philippines RITM 78 2 0 3 66 7 0 96% 4% 04-Jun-19 RITM 6 0 2 0 0 0 0 0 4 0 0 0 0 100% Republic of Korea KCDC 24 0 0 0 22 0 2 100% 0% 10-May-19 KCDC 0 - - - - - - - - - - - - - Singapore SGH 4 0 0 1 3 0 0 100% 25% 07-Jun-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 40 0 0 7 23 10 0 100% 20% 14-May-19 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 51 0 0 2 43 6 0 100% 4% 03-Jun-19 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 3 0 0 0 3 0 0 98% 5% 28-May-19 VIDRL 0 - - - - - - - - - - - - - Total 2106 16 2 124 1859 25 80 98% 5% 61 0 33 0 0 0 0 0 21 0 7 0 0 98% 2. NPEV growing in L20B cells L20B posit ive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2 VDPV Pending ITDVDPV NegativeNPEV only SabinWild 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Polio Bulletin 6 Table 3. Laboratory confirmation of polio isolates from environmental samples in 2018–2019 1 Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2019 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP) aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP) aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 aVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) Viet Nam aVDPV2 (2 AFP) 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 17 2 0 2 0 0 0 0 0 0 0 12 0 0 0 - - - - - - - - - - - - - China (total) 281 180 0 199 0 0 0 1 0 560 2 1409 0 0 80 58 0 76 0 0 0 0 0 188 0 257 2 0 China, Fujian Prov. Lab/CCDC 73 51 0 20 0 0 0 0 0 107 1 577 0 0 23 14 0 7 0 0 0 0 0 21 0 95 2 0 China, Gansu Prov. Lab/CCDC 12 7 0 2 0 0 0 0 0 12 0 40 0 0 2 2 0 5 0 0 0 0 0 11 0 1 0 0 China, Guangdong Prov. Lab/CCDC 48 41 0 27 0 0 0 0 0 102 1 217 0 0 20 15 0 10 0 0 0 0 0 29 0 87 0 0 China, Guangxi Prov. Lab/CCDC 0 - - - - - - - - - - - - - 5 5 0 1 0 0 0 0 0 9 0 28 0 0 China, Heilongjiang Prov. Lab/CCDC 42 22 0 6 0 0 0 0 0 44 0 106 0 0 6 4 0 1 0 0 0 0 0 9 0 9 0 0 China, Shandong Prov. Lab/CCDC 40 16 0 21 0 0 0 0 0 63 0 282 0 0 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab/CCDC 12 7 0 3 0 0 0 0 0 11 0 37 0 0 3 3 0 5 0 0 0 0 0 14 0 4 0 0 China, Xinjiang Prov. Lab/CCDC 36 36 0 120 0 0 0 1 0 221 0 109 0 0 15 15 0 47 0 0 0 0 0 95 0 16 0 0 China, Yunnan Prov. Lab/CCDC 18 0 - - - - - - - - - 41 0 0 6 0 - - - - - - - - - 17 0 0 Philippines RITM 87 8 0 2 0 0 0 0 0 6 0 24 0 0 50 11 0 7 0 0 0 0 0 8 0 15 0 0 Papua New Guinea RITM 27 23 0 15 7 0 0 0 0 21 0 9 0 0 31 28 0 17 0 0 0 0 0 21 0 16 0 0 Total 412 213 0 218 7 0 0 1 0 587 2 1454 0 0 161 97 0 100 0 0 0 0 0 217 0 288 2 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2018 2019 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD

Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2017–2019* Chart 2. Adequate specimen collection rate, 2017–2019 28th Meeting of the Technical Advisory Group on Immunization in the WHO Western Pacific Region 18–21 June 2019 — Manila, Philippines The 28th meeting of the Technical Advisory Group (TAG) was held in Manila on 18-21 June 2019. The TAG reviewed the progress towards achieving regional immunization goals; discussed critical issues and priority actions; as well as identified opportunities to enhance collaboration and coordination among immunization partners. The TAG congratulated Papua New Guinea on successful implementation of polio outbreak response activities that may have resulted in interruption of cVDPV1 circulation and efforts to establish environmental surveillance for polioviruses. The TAG commended the Victorian Infectious Diseases Reference Laboratory, Australia; Research Institute for Tropical Medicine, Philippines; and National Institute of Infectious Diseases, Japan, for their support of the response to the cVDPV1 outbreak in Papua New Guinea with laboratory testing of AFP and environmental samples in 2018 and 2019. The TAG also made general and country-specific recommendations to maintain achievements and ensure further progress in regional efforts to eliminate paralysis due to any type of polio virus. Polio Bulletin 2019 Issue No. 12 - Week 25 (as of 24 June 2019) Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2019 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2019 Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam). Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: wproepidata@who.int Web: www.who.int/westernpacific CONTACT US HIGHLIGHTS * AFP rate annualized as of week 25 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 11.7% 0.9% 36.8% 38.3% 0.0% 0.0% 21.6% 0% 10% 20% 30% 40% 50% VNM PNG PHL MYS LAO KHM CHN Table 1A. Classification of AFP cases with onset in 2018 and key surveillance indicators Polio Bulletin 2 2017 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 60 46 57 0 0 3 54 0 0 (0.0%) 1.24 44% 89% 14-Feb-19 - Brunei Darussalam 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 24-Jan-19 - Cambodia 57 44 73 0 0 0 73 0 0 (0.0%) 1.66 92% 85% 15-Mar-19 - China 5278 2256 5292 0 1 0 5291 0 0 (0.0%) 2.35 92% 100% 15-May-19 - China, Hong Kong SAR 15 9 11 0 0 0 10 1 1 (9.1%) 1.22 82% 100% 03-Jun-19 21 China, Macao SAR 2 1 3 0 0 0 3 0 0 (0.0%) 3.00 100% 100% 19-Feb-19 - Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 103 21 94 0 0 0 94 0 0 (0.0%) 4.48 80% 79% 03-Jun-19 - Malaysia 154 77 171 0 0 0 171 0 0 (0.0%) 2.22 80% 88% 15-Apr-19 - Mongolia 6 9 6 0 0 0 6 0 0 (0.0%) 0.67 100% 83% 04-Feb-19 - New Zealand 13 9 10 0 0 0 10 0 0 (0.0%) 1.11 60% 100% 28-Feb-19 - Papua New Guinea 29 37 287 0 26 23 238 0 0 (0.0%) 7.05 44% 74% 10-Jun-19 - Philippines 462 338 313 0 0 0 261 52 51 (16.3%) 0.93 62% 94% 25-Mar-19 91 Republic of Korea 68 67 70 0 0 0 70 0 0 (0.0%) 1.04 90% 100% 11-Mar-19 - Singapore 7 6 13 0 0 0 13 0 0 (0.0%) 2.17 77% 100% 08-Mar-19 - Viet Nam 385 234 330 0 0 0 311 19 19 (5.8%) 1.41 98% 85% 11-Apr-19 74 Pacific island countries and areas 16 11 13 0 0 0 13 0 0 (0.0%) 1.18 31% 100% 03-Jun-19 - Total 6656 3327 6745 0 27 26 6620 72 71 (1.1%) 2.02 88% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Discarded (Non-polio) 2018 Non-polio AFP rate Total % with adequate specimens 2 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Table 1B. Classification of AFP cases with onset in 2019 and key surveillance indicators Polio Bulletin 3 2018 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 57 47 27 0 0 0 8 19 5 (18.5%) 1.19 41% 100% 19-Jun-19 5 Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 2.08 100% 100% 03-Jun-19 21 Cambodia 73 46 26 0 0 0 21 5 0 (0.0%) 1.18 88% 88% 19-Jun-19 5 China 5292 2256 1968 0 0 0 541 1427 425 (21.6%) 1.81 92% 100% 12-Jun-19 12 China, Hong Kong SAR 11 9 8 0 0 0 5 3 0 (0.0%) 1.85 88% 88% 13-Jun-19 11 China, Macao SAR 3 1 0 - - - - - - - - - 13-Jun-19 11 Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 94 23 27 0 0 0 23 4 0 (0.0%) 2.44 89% 74% 04-Jun-19 20 Malaysia 171 78 47 0 0 0 11 36 18 (38.3%) 1.25 72% 43% 29-May-19 26 Mongolia 6 9 4 0 0 0 3 1 0 (0.0%) 0.92 100% 100% 06-Jun-19 18 New Zealand 10 9 3 0 0 0 1 2 2 (66.7%) 0.69 33% 100% 22-May-19 33 Papua New Guinea 287 33 115 0 0 0 95 20 1 (0.9%) 7.25 75% 79% 05-Jun-19 19 Philippines 313 344 57 0 0 0 12 45 21 (36.8%) 0.34 58% 89% 23-May-19 32 Republic of Korea 70 66 30 0 0 0 15 15 0 (0.0%) 0.95 97% 100% 13-Jun-19 11 Singapore 13 6 4 0 0 0 2 2 0 (0.0%) 1.39 100% 100% 06-Jun-19 18 Viet Nam 330 234 120 0 0 0 35 85 14 (11.7%) 1.07 96% 95% 19-Jun-19 5 Pacific island countries and areas 13 11 7 0 0 0 5 2 0 (0.0%) 1.32 71% 100% 03-Jun-19 21 Total 6745 3334 2444 0 0 0 778 1666 486 (19.9%) 1.52 89% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) 2019 Non-polio AFP rate 2 Total % with adequate specimens 3 Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2018 and key laboratory indicators Polio Bulletin 4 ≥ 80% ≥ 80% Australia VIDRL 44 1 0 1 42 0 0 91% 3% 05-Feb-19 VIDRL 1 0 0 0 0 0 0 0 0 0 1 0 0 100% Brunei Darussalam VIDRL 2 0 0 0 2 0 0 50% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 74 0 0 13 61 0 0 93% 15% 18-Jan-19 NIID 0 - - - - - - - - - - - - - China (total) 5237 36 0 379 4822 0 0 97% 6% 15-May-19 88 0 24 0 0 0 0 0 63 1 0 0 0 99% China, Anhui Prov. Lab 332 2 0 17 313 0 0 100% 5% Prov. Lab/CCDC 8 0 3 0 0 0 0 0 5 0 0 0 0 100% China, Beijing Prov. Lab 31 0 0 0 31 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 52 0 0 2 50 0 0 90% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 176 1 0 12 163 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Gansu Prov. Lab 92 1 0 6 85 0 0 99% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangdong Prov. Lab 431 2 0 21 408 0 0 91% 4% Prov. Lab/CCDC 4 0 0 0 0 0 0 0 4 0 0 0 0 100% China, Guangxi Prov. Lab 221 2 0 18 201 0 0 99% 7% Prov. Lab/CCDC 4 0 3 0 0 0 0 0 1 0 0 0 0 100% China, Guizhou Prov. Lab 190 0 0 14 176 0 0 97% 7% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 41 0 0 6 35 0 0 100% 12% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 299 1 0 38 260 0 0 100% 10% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 91 0 0 4 87 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 552 5 0 58 489 0 0 99% 9% Prov. Lab/CCDC 13 0 5 0 0 0 0 0 8 0 0 0 0 100% China, Hubei Prov. Lab 177 1 0 13 163 0 0 99% 7% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Hunan Prov. Lab 245 0 0 25 220 0 0 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 252 8 0 11 233 0 0 100% 4% Prov. Lab/CCDC 16 0 2 0 0 0 0 0 13 1 0 0 0 100% China, Jiangxi Prov. Lab 176 1 0 12 163 0 0 97% 5% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Jilin Prov. Lab 58 2 0 9 47 0 0 98% 11% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Liaoning Prov. Lab 89 0 0 6 83 0 0 97% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 100 2 0 4 94 0 0 98% 4% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 100% China, Ningxia Prov. Lab 26 0 0 2 24 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 99 1 0 2 96 0 0 84% 2% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 0% China, Shandong Prov. Lab 410 2 0 25 383 0 0 100% 4% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 100% China, Shanghai Prov. Lab 42 0 0 0 42 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 118 1 0 7 110 0 0 97% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Sichuan Prov. Lab 298 1 0 21 276 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Tianjin Prov. Lab 22 0 0 0 22 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 141 1 0 7 133 0 0 91% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 248 0 0 31 217 0 0 93% 10% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Zhejiang Prov. Lab 188 2 0 7 179 0 0 99% 3% Prov. Lab/CCDC 7 0 0 0 0 0 0 0 7 0 0 0 0 100% China, Tibet Prov. Lab 8 0 0 1 7 0 0 73% 7% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 11 0 0 0 11 0 0 100% 0% 28-Jan-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 3 0 0 0 3 0 0 100% 0% 24-Dec-18 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 115 1 0 8 106 0 0 96% 4% 12-Mar-19 NIID 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Malaysia IMR 180 0 0 10 170 0 0 89% 4% 19-Feb-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 6 0 0 3 3 0 0 100% 50% 04-Jan-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 8 0 0 1 7 0 0 100% 13% 25-Jan-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 297 93 1 21 182 0 0 88% 5% 28-Feb-19 VIDRL 191 0 65 46 0 0 0 0 80 0 0 0 0 100% Philippines RITM 397 5 1 14 377 0 0 96% 3% 16-Apr-19 RITM 7 0 2 0 0 0 0 0 5 0 0 0 0 100% Republic of Korea KCDC 70 0 0 5 65 0 0 97% 6% 23-Apr-19 KCDC 0 - - - - - - - - - - - - - Singapore SGH 13 0 0 2 11 0 0 96% 8% 30-Jan-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 175 3 0 24 148 0 0 100% 12% 30-Jan-19 NIHE 4 0 2 0 0 0 0 0 2 0 0 0 0 100% Viet Nam (South) PI 175 4 0 21 150 0 0 100% 12% 18-Mar-19 PI 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Pacific island countries and areas VIDRL 11 0 0 1 10 0 0 97% 6% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Total 6818 143 2 503 6170 0 0 97% 6% 300 0 95 46 0 0 0 0 157 1 1 0 0 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPV NegativeNPEV only SabinWild L20B posit ive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2 VDPV Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2019 and key laboratory indicators Polio Bulletin 5 ≥ 80% ≥ 80% Australia VIDRL 20 0 0 2 15 1 2 97% 10% 14-Jun-19 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 22 0 0 0 22 0 0 95% 0% 23-Jun-19 NIID 0 - - - - - - - - - - - - - China (total) 1931 10 0 93 1769 0 59 98% 4% 12-Jun-19 24 0 11 0 0 0 0 0 13 0 0 0 0 100% China, Anhui Prov. Lab 102 2 0 0 92 0 8 100% 0% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Beijing Prov. Lab 19 0 0 0 18 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 20 0 0 0 16 0 4 94% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 47 0 0 2 45 0 0 100% 3% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Gansu Prov. Lab 47 0 0 0 46 0 1 98% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 152 1 0 8 142 0 1 97% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangxi Prov. Lab 82 0 0 7 75 0 0 100% 7% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 78 0 0 6 71 0 1 100% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 5 0 0 0 5 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 122 0 0 7 113 0 2 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 48 0 0 0 46 0 2 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 193 0 0 12 179 0 2 95% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hubei Prov. Lab 80 0 0 10 67 0 3 97% 13% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 81 0 0 4 73 0 4 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 74 0 0 1 69 0 4 100% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 48 0 0 1 46 0 1 93% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 13 1 0 0 12 0 0 100% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Liaoning Prov. Lab 32 0 0 0 30 0 2 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 46 2 0 0 44 0 0 98% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Ningxia Prov. Lab 7 0 0 0 6 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 16 0 0 1 15 0 0 94% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 42 0 0 1 33 0 8 79% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Shandong Prov. Lab 127 1 0 6 118 0 2 97% 2% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Shanghai Prov. Lab 12 0 0 0 12 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 55 0 0 0 52 0 3 98% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 156 1 0 20 132 0 3 99% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 4 0 0 0 4 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 55 2 0 0 53 0 0 100% 0% Prov. Lab/CCDC 5 0 3 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 98 0 0 5 89 0 4 97% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 64 0 0 2 60 0 2 100% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 6 0 0 0 6 0 0 50% 0% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 7 0 0 0 6 1 0 100% 0% 20-Jun-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - - PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 25 0 0 2 23 0 0 92% 6% 14-Jun-19 NIID 0 - - - - - - - - - - - - - Malaysia IMR 24 0 0 0 23 0 1 98% 0% 08-Apr-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 4 0 0 0 4 0 0 100% 0% 22-Jun-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 2 0 0 0 2 0 0 100% 0% 17-Jun-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 102 5 2 31 63 0 1 100% 25% 21-Jun-19 VIDRL 27 0 18 0 0 0 0 0 2 0 7 0 0 97% Philippines RITM 93 2 0 3 75 13 0 96% 4% 18-Jun-19 RITM 6 0 2 0 0 0 0 0 4 0 0 0 0 100% Republic of Korea KCDC 30 0 0 0 30 0 0 100% 0% 11-Jun-19 KCDC 0 - - - - - - - - - - - - - Singapore SGH 4 0 0 1 3 0 0 100% 25% 21-Jun-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 58 0 0 18 37 3 0 100% 29% 13-Jun-19 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 55 0 0 2 53 0 0 100% 4% 18-Jun-19 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 6 0 0 1 5 0 0 98% 5% 21-Jun-19 VIDRL 0 - - - - - - - - - - - - - Total 2384 17 2 153 2131 18 63 98% 5% 57 0 31 0 0 0 0 0 19 0 7 0 0 98% 2. NPEV growing in L20B cells L20B posit ive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2 VDPV Pending ITDVDPV NegativeNPEV only SabinWild 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Polio Bulletin 6 Table 3. Laboratory confirmation of polio isolates from environmental samples in 2018–2019 1 Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2019 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP) aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP) aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 aVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) Viet Nam aVDPV2 (2 AFP) 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 17 2 0 2 0 0 0 0 0 0 0 12 0 0 0 - - - - - - - - - - - - - China (total) 281 180 0 199 0 0 0 1 0 560 2 1409 0 0 80 58 0 76 0 0 0 0 0 188 0 257 2 0 China, Fujian Prov. Lab/CCDC 73 51 0 20 0 0 0 0 0 107 1 577 0 0 23 14 0 7 0 0 0 0 0 21 0 95 2 0 China, Gansu Prov. Lab/CCDC 12 7 0 2 0 0 0 0 0 12 0 40 0 0 2 2 0 5 0 0 0 0 0 11 0 1 0 0 China, Guangdong Prov. Lab/CCDC 48 41 0 27 0 0 0 0 0 102 1 217 0 0 20 15 0 10 0 0 0 0 0 29 0 87 0 0 China, Guangxi Prov. Lab/CCDC 0 - - - - - - - - - - - - - 5 5 0 1 0 0 0 0 0 9 0 28 0 0 China, Heilongjiang Prov. Lab/CCDC 42 22 0 6 0 0 0 0 0 44 0 106 0 0 6 4 0 1 0 0 0 0 0 9 0 9 0 0 China, Shandong Prov. Lab/CCDC 40 16 0 21 0 0 0 0 0 63 0 282 0 0 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab/CCDC 12 7 0 3 0 0 0 0 0 11 0 37 0 0 3 3 0 5 0 0 0 0 0 14 0 4 0 0 China, Xinjiang Prov. Lab/CCDC 36 36 0 120 0 0 0 1 0 221 0 109 0 0 15 15 0 47 0 0 0 0 0 95 0 16 0 0 China, Yunnan Prov. Lab/CCDC 18 0 - - - - - - - - - 41 0 0 6 0 - - - - - - - - - 17 0 0 Philippines RITM 87 8 0 2 0 0 0 0 0 6 0 24 0 0 51 11 0 7 0 0 0 0 0 8 0 16 0 0 Papua New Guinea RITM 27 23 0 15 7 0 0 0 0 21 0 9 0 0 39 30 0 18 0 0 0 0 0 22 0 20 0 0 Total 412 213 0 218 7 0 0 1 0 587 2 1454 0 0 170 99 0 101 0 0 0 0 0 218 0 293 2 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2018 2019 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD

Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2017–2019* Chart 2. Adequate specimen collection rate, 2017–2019 Confirmation of circulating vaccine-derived poliovirus type 2 in China On 2 July 2019, the IHR National Focal Point of China notified WHO on detection of vaccine derived poliovirus type 2 (VDPV2) from both stool samples of an AFP case from Liangshan Yi Autonomous prefecture, Sichuan province. The case, a five-year-old boy, had onset of paralysis on 25 April 2019 and stool specimens were collected on 17 and 18 May 2019. The virus has undergone 28 nucleotide changes from Sabin type 2 virus and is genetically linked to a VDPV2 (13 nucleotides changes from Sabin 2) isolated from an environmental sample collected from Xinjiang province (Urumqi city) on 18 April 2018, indicating that this vaccine-derived poliovirus has likely been circulating for about three years. Public health authorities of China carried out a risk assessment and field investigations and are implementing rapid response in the affected and neighbouring prefectures. The WHO is closely working with the country counterparts and partners in supporting local public health authorities in defining and implementing response strategies and activities. Polio Bulletin 2019 Issue No. 13 - Week 27 (as of 8 July 2019) Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2019 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2019 Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam). Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: wproepidata@who.int Web: www.who.int/westernpacific CONTACT US HIGHLIGHTS * AFP rate annualized as of week 27 0% 20% 40% 60% 80% 100% 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 11.7% 0.7% 52.5% 38.3% 0.0% 0.0% 25.8% 0% 10% 20% 30% 40% 50% 60% VNM PNG PHL MYS LAO KHM CHN 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM Table 1A. Classification of AFP cases with onset in 2018 and key surveillance indicators Polio Bulletin 2 2017 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 60 46 57 0 0 3 54 0 0 (0.0%) 1.24 44% 89% 14-Feb-19 - Brunei Darussalam 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 24-Jan-19 - Cambodia 57 44 73 0 0 0 73 0 0 (0.0%) 1.66 92% 85% 15-Mar-19 - China 5278 2256 5292 0 1 0 5291 0 0 (0.0%) 2.35 92% 100% 15-May-19 - China, Hong Kong SAR 15 9 11 0 0 0 10 1 1 (9.1%) 1.22 82% 100% 03-Jun-19 35 China, Macao SAR 2 1 3 0 0 0 3 0 0 (0.0%) 3.00 100% 100% 19-Feb-19 - Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 103 21 94 0 0 0 94 0 0 (0.0%) 4.48 80% 79% 03-Jun-19 - Malaysia 154 77 171 0 0 0 171 0 0 (0.0%) 2.22 80% 88% 15-Apr-19 - Mongolia 6 9 6 0 0 0 6 0 0 (0.0%) 0.67 100% 83% 04-Feb-19 - New Zealand 13 9 10 0 0 0 10 0 0 (0.0%) 1.11 60% 100% 28-Feb-19 - Papua New Guinea 29 37 287 0 26 23 238 0 0 (0.0%) 7.05 44% 74% 10-Jun-19 - Philippines 462 338 313 0 0 0 261 52 51 (16.3%) 0.93 62% 94% 25-Mar-19 105 Republic of Korea 68 67 70 0 0 0 70 0 0 (0.0%) 1.04 90% 100% 11-Mar-19 - Singapore 7 6 13 0 0 0 13 0 0 (0.0%) 2.17 77% 100% 08-Mar-19 - Viet Nam 385 234 352 0 0 0 334 18 18 (5.1%) 1.50 98% 86% 08-Jul-19 0 Pacific island countries and areas 16 11 13 0 0 0 13 0 0 (0.0%) 1.18 31% 100% 03-Jun-19 - Total 6656 3327 6767 0 27 26 6643 71 70 (1.0%) 2.03 88% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO 2018 Non-polio AFP rate Total % with adequate specimens 2> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Table 1B. Classification of AFP cases with onset in 2019 and key surveillance indicators Polio Bulletin 3 2018 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 57 47 30 0 0 0 23 7 1 (3.3%) 1.23 43% 100% 04-Jul-19 4 Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.93 100% 100% 03-Jun-19 35 Cambodia 73 46 29 0 0 0 25 4 0 (0.0%) 1.21 86% 90% 08-Jul-19 0 China 5292 2486 2315 0 0 0 847 1468 597 (25.8%) 1.79 92% 100% 03-Jul-19 5 China, Hong Kong SAR 11 9 8 0 0 0 5 3 1 (12.5%) 1.71 63% 88% 02-Jul-19 6 China, Macao SAR 3 1 0 - - - - - - - - - 13-Jun-19 25 Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 94 23 34 0 0 0 27 7 0 (0.0%) 2.85 85% 71% 08-Jul-19 0 Malaysia 171 78 47 0 0 0 11 36 18 (38.3%) 1.16 72% 43% 29-May-19 40 Mongolia 6 9 4 0 0 0 3 1 0 (0.0%) 0.86 100% 100% 06-Jun-19 32 New Zealand 10 9 3 0 0 0 1 2 2 (66.7%) 0.64 33% 100% 22-May-19 47 Papua New Guinea 287 33 142 0 0 0 114 28 1 (0.7%) 8.29 71% 77% 02-Jul-19 6 Philippines 313 344 80 0 0 0 16 64 42 (52.5%) 0.45 46% 91% 03-Jul-19 5 Republic of Korea 70 66 30 0 0 0 15 15 0 (0.0%) 0.88 97% 100% 13-Jun-19 25 Singapore 13 6 4 0 0 0 3 1 0 (0.0%) 1.28 100% 100% 02-Jul-19 6 Viet Nam 330 234 120 0 0 0 35 85 14 (11.7%) 0.99 96% 95% 19-Jun-19 19 Pacific island countries and areas 13 11 11 0 0 0 5 6 0 (0.0%) 1.93 64% 100% 02-Jul-19 6 Total 6745 3564 2858 0 0 0 1131 1727 676 (23.7%) 1.54 89% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date 2019 Non-polio AFP rate 2 Total % with adequate specimens 3 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2018 and key laboratory indicators Polio Bulletin 4 ≥ 80% ≥ 80% Australia VIDRL 44 1 0 1 42 0 0 91% 3% 05-Feb-19 VIDRL 1 0 0 0 0 0 0 0 0 0 1 0 0 100% Brunei Darussalam VIDRL 2 0 0 0 2 0 0 50% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 74 0 0 13 61 0 0 93% 15% 18-Jan-19 NIID 0 - - - - - - - - - - - - - China (total) 5237 36 0 379 4822 0 0 97% 6% 15-May-19 88 0 24 0 0 0 0 0 63 1 0 0 0 99% China, Anhui Prov. Lab 332 2 0 17 313 0 0 100% 5% Prov. Lab/CCDC 8 0 3 0 0 0 0 0 5 0 0 0 0 100% China, Beijing Prov. Lab 31 0 0 0 31 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 52 0 0 2 50 0 0 90% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 176 1 0 12 163 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Gansu Prov. Lab 92 1 0 6 85 0 0 99% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangdong Prov. Lab 431 2 0 21 408 0 0 91% 4% Prov. Lab/CCDC 4 0 0 0 0 0 0 0 4 0 0 0 0 100% China, Guangxi Prov. Lab 221 2 0 18 201 0 0 99% 7% Prov. Lab/CCDC 4 0 3 0 0 0 0 0 1 0 0 0 0 100% China, Guizhou Prov. Lab 190 0 0 14 176 0 0 97% 7% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 41 0 0 6 35 0 0 100% 12% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 299 1 0 38 260 0 0 100% 10% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 91 0 0 4 87 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 552 5 0 58 489 0 0 99% 9% Prov. Lab/CCDC 13 0 5 0 0 0 0 0 8 0 0 0 0 100% China, Hubei Prov. Lab 177 1 0 13 163 0 0 99% 7% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Hunan Prov. Lab 245 0 0 25 220 0 0 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 252 8 0 11 233 0 0 100% 4% Prov. Lab/CCDC 16 0 2 0 0 0 0 0 13 1 0 0 0 100% China, Jiangxi Prov. Lab 176 1 0 12 163 0 0 97% 5% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Jilin Prov. Lab 58 2 0 9 47 0 0 98% 11% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Liaoning Prov. Lab 89 0 0 6 83 0 0 97% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 100 2 0 4 94 0 0 98% 4% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 100% China, Ningxia Prov. Lab 26 0 0 2 24 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 99 1 0 2 96 0 0 84% 2% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 0% China, Shandong Prov. Lab 410 2 0 25 383 0 0 100% 4% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 100% China, Shanghai Prov. Lab 42 0 0 0 42 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 118 1 0 7 110 0 0 97% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Sichuan Prov. Lab 298 1 0 21 276 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Tianjin Prov. Lab 22 0 0 0 22 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 141 1 0 7 133 0 0 91% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 248 0 0 31 217 0 0 93% 10% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Zhejiang Prov. Lab 188 2 0 7 179 0 0 99% 3% Prov. Lab/CCDC 7 0 0 0 0 0 0 0 7 0 0 0 0 100% China, Tibet Prov. Lab 8 0 0 1 7 0 0 73% 7% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 11 0 0 0 11 0 0 100% 0% 28-Jan-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 3 0 0 0 3 0 0 100% 0% 24-Dec-18 PHLC 0 - - - - - - - - - - - - - Japan NIID 0 - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 115 1 0 8 106 0 0 96% 4% 12-Mar-19 NIID 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Malaysia IMR 180 0 0 10 170 0 0 89% 4% 19-Feb-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 6 0 0 3 3 0 0 100% 50% 04-Jan-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 8 0 0 1 7 0 0 100% 13% 25-Jan-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 297 93 1 21 182 0 0 88% 5% 28-Feb-19 VIDRL 191 0 65 46 0 0 0 0 80 0 0 0 0 100% Philippines RITM 397 5 1 14 377 0 0 96% 3% 16-Apr-19 RITM 7 0 2 0 0 0 0 0 5 0 0 0 0 100% Republic of Korea KCDC 70 0 0 5 65 0 0 97% 6% 23-Apr-19 KCDC 0 - - - - - - - - - - - - - Singapore SGH 13 0 0 2 11 0 0 96% 8% 30-Jan-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 175 3 0 24 148 0 0 100% 12% 30-Jan-19 NIHE 4 0 2 0 0 0 0 0 2 0 0 0 0 100% Viet Nam (South) PI 175 4 0 21 150 0 0 100% 12% 18-Mar-19 PI 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Pacific island countries and areas VIDRL 11 0 0 1 10 0 0 97% 6% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Total 6818 143 2 503 6170 0 0 97% 6% 300 0 95 46 0 0 0 0 157 1 1 0 0 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens posit ive for NPEV Latest report date Discordant pending sequencing 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPV NegativeNPEV only SabinWild L20B posit ive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2 VDPV Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2019 and key laboratory indicators Polio Bulletin 5 ≥ 80% ≥ 80% Australia VIDRL 22 0 0 2 17 3 0 97% 9% 04-Jul-19 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 25 0 0 0 25 0 0 96% 0% 06-Jul-19 NIID 0 - - - - - - - - - - - - - China (total) 2279 11 0 112 2073 0 83 97% 4% 03-Jul-19 30 0 11 0 0 0 2 0 17 0 0 0 0 100% China, Anhui Prov. Lab 128 2 0 1 117 0 8 100% 1% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Beijing Prov. Lab 19 0 0 0 19 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 22 0 0 0 21 0 1 80% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 56 0 0 3 53 0 0 100% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Gansu Prov. Lab 59 0 0 0 59 0 0 97% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 189 1 0 10 178 0 0 96% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangxi Prov. Lab 106 0 0 13 92 0 1 100% 10% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 98 0 0 9 79 0 10 99% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 12 0 0 0 11 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 134 0 0 10 123 0 1 100% 6% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 53 0 0 0 50 0 3 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 229 0 0 14 213 0 2 95% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hubei Prov. Lab 90 0 0 11 71 0 8 98% 13% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 96 0 0 5 86 0 5 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 93 0 0 1 73 0 19 100% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 58 0 0 1 55 0 2 95% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 15 1 0 0 14 0 0 100% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Liaoning Prov. Lab 36 0 0 0 33 0 3 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 53 2 0 1 50 0 0 98% 2% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Ningxia Prov. Lab 7 0 0 0 6 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 17 0 0 1 16 0 0 94% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 51 0 0 1 44 0 6 78% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Shandong Prov. Lab 154 1 0 2 151 0 0 97% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Shanghai Prov. Lab 13 0 0 0 13 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 60 0 0 0 58 0 2 98% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 163 2 0 20 141 0 0 99% 10% Prov. Lab/CCDC 4 0 0 0 0 0 2 0 2 0 0 0 0 100% China, Tianjin Prov. Lab 9 0 0 0 9 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 65 2 0 0 63 0 0 100% 0% Prov. Lab/CCDC 5 0 3 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 119 0 0 5 104 0 10 98% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 69 0 0 4 65 0 0 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 6 0 0 0 6 0 0 50% 0% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 7 0 0 0 7 0 0 100% 0% 03-Jul-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - 03-Jul-19 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 27 0 0 2 25 0 0 92% 6% 25-Jun-19 NIID 0 - - - - - - - - - - - - - Malaysia IMR 43 0 0 0 42 0 1 99% 0% 25-Jun-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 4 0 0 0 4 0 0 100% 0% 05-Jul-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 2 0 0 0 2 0 0 100% 0% 26-Jun-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 124 7 2 38 77 0 0 100% 25% 05-Jul-19 VIDRL 27 0 18 0 0 0 0 0 2 0 7 0 0 97% Philippines RITM 102 2 0 6 89 5 0 97% 6% 05-Jul-19 RITM 6 0 2 0 0 0 0 0 4 0 0 0 0 100% Republic of Korea KCDC 30 0 0 0 30 0 0 100% 0% 11-Jun-19 KCDC 0 - - - - - - - - - - - - - Singapore SGH 4 0 0 1 3 0 0 100% 25% 04-Jul-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 58 0 0 18 37 3 0 100% 29% 13-Jun-19 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 62 0 0 2 57 3 0 100% 3% 08-Jul-19 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 7 0 0 2 5 0 0 98% 5% 01-Jul-19 VIDRL 0 - - - - - - - - - - - - - Total 2797 20 2 183 2494 14 84 98% 5% 63 0 31 0 0 0 2 0 23 0 7 0 0 98% 2. NPEV growing in L20B cells L20B posit ive Pending ≤ 14 days VDPV Type 2 L20B posit ive + NPEV NPEV 2 VDPV Pending ITDVDPV NegativeNPEV only SabinWild 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens posit ive for NPEV Latest report date Discordant pending sequencing Polio Bulletin 6 Table 3. Laboratory confirmation of polio isolates from environmental samples in 2018–2019 1 Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2019 Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 17 2 0 2 0 0 0 0 0 0 0 12 0 0 0 - - - - - - - - - - - - - China (total) 281 180 0 199 0 0 0 1 0 560 2 1409 0 0 87 62 0 82 0 0 0 0 0 197 0 293 2 0 China, Fujian Prov. Lab/CCDC 73 51 0 20 0 0 0 0 0 107 1 577 0 0 23 14 0 7 0 0 0 0 0 21 0 95 2 0 China, Gansu Prov. Lab/CCDC 12 7 0 2 0 0 0 0 0 12 0 40 0 0 5 5 0 11 0 0 0 0 0 19 0 1 0 0 China, Guangdong Prov. Lab/CCDC 48 41 0 27 0 0 0 0 0 102 1 217 0 0 24 16 0 10 0 0 0 0 0 30 0 123 0 0 China, Guangxi Prov. Lab/CCDC 0 - - - - - - - - - - - - - 5 5 0 1 0 0 0 0 0 9 0 28 0 0 China, Heilongjiang Prov. Lab/CCDC 42 22 0 6 0 0 0 0 0 44 0 106 0 0 6 4 0 1 0 0 0 0 0 9 0 9 0 0 China, Shandong Prov. Lab/CCDC 40 16 0 21 0 0 0 0 0 63 0 282 0 0 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab/CCDC 12 7 0 3 0 0 0 0 0 11 0 37 0 0 3 3 0 5 0 0 0 0 0 14 0 4 0 0 China, Xinjiang Prov. Lab/CCDC 36 36 0 120 0 0 0 1 0 221 0 109 0 0 15 15 0 47 0 0 0 0 0 95 0 16 0 0 China, Yunnan Prov. Lab/CCDC 18 0 - - - - - - - - - 41 0 0 6 0 - - - - - - - - - 17 0 0 Philippines RITM 87 8 0 2 0 0 0 0 0 6 0 24 0 0 62 12 0 7 0 0 0 0 0 9 0 19 0 0 Papua New Guinea RITM 27 23 0 15 7 0 0 0 0 21 0 9 0 0 43 30 0 18 0 0 0 0 0 22 0 20 8 0 Total 412 213 0 218 7 0 0 1 0 587 2 1454 0 0 192 104 0 107 0 0 0 0 0 228 0 332 10 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2018 2019 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP) aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP) aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 1 contact) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) Viet Nam aVDPV2 (2 AFP) 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3).

Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2017–2019* Chart 2. Adequate specimen collection rate, 2017–2019 Rolling timeline for review of containment certification applications Deadline for National Authorities for Containment to submit applications for Certificate of Participation (CP) in the GAP III Containment Certification Scheme is 31 December 2019. The Global Commission for the Certification of Eradication of Poliomyelitis - Containment Working Group (GCC-CWG) has developed a rolling timeline for the review of containment certification applications. National Authorities for Containment are asked to observe the below schedule when submitting applications to the GCC-CWG for Certificate of Participation (CP), Interim Certificate of Containment (ICC) and Certificate of Containment (CC) in the GAP III Containment Certification Scheme. * Applications should be submitted to: containment_certification@workspace.who.int. Specified cut-off dates will be observed. Early submission is strongly encouraged. More information on the containment is available at the latest Containment Newsletter (June 2019): http://polioeradication.org/wp-content/uploads/2019/05/ containment-corner-poliovirus-june-2019.pdf Important upcoming meetings: 15 October 2019: WHO-UNICEF consultation with oral polio vaccine and inactivated polio vaccine manufacturers and National Authorities for Containment – Geneva 17-18 October 2019: Global Certification Commission of Eradication of Poliomyelitis meeting – Geneva Polio Bulletin 2019 Issue No. 14 - Week 29 (as of 23 July 2019) Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2019 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2019 Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam). Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: wproepidata@who.int Web: www.who.int/westernpacific CONTACT US HIGHLIGHTS * AFP rate annualized as of week 29 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 11.7% 1.3% 52.5% 37.1% 0.0% 0.0% 25.8% 0% 10% 20% 30% 40% 50% 60% VNM PNG PHL MYS LAO KHM CHN Period of acceptance for completed CP applications for review* GCC will review completed CP applications by: 1 June – 31 August 2019 30 September 2019 1 September – 30 November 2019 17 December 2019 Table 1A. Classification of AFP cases with onset in 2018 and key surveillance indicators Polio Bulletin 2 2017 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 60 46 57 0 0 3 54 0 0 (0.0%) 1.24 44% 89% 14-Feb-19 - Brunei Darussalam 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 24-Jan-19 - Cambodia 57 44 73 0 0 0 73 0 0 (0.0%) 1.66 92% 85% 15-Mar-19 - China 5278 2256 5292 0 1 0 5291 0 0 (0.0%) 2.35 92% 100% 15-May-19 - China, Hong Kong SAR 15 9 11 0 0 0 10 1 1 (9.1%) 1.22 82% 100% 03-Jun-19 50 China, Macao SAR 2 1 3 0 0 0 3 0 0 (0.0%) 3.00 100% 100% 19-Feb-19 - Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 103 21 94 0 0 0 94 0 0 (0.0%) 4.48 80% 79% 03-Jun-19 - Malaysia 154 77 171 0 0 0 171 0 0 (0.0%) 2.22 80% 88% 15-Apr-19 - Mongolia 6 9 6 0 0 0 6 0 0 (0.0%) 0.67 100% 83% 04-Feb-19 - New Zealand 13 9 10 0 0 0 10 0 0 (0.0%) 1.11 60% 100% 28-Feb-19 - Papua New Guinea 29 37 287 0 26 23 238 0 0 (0.0%) 7.05 44% 74% 10-Jun-19 - Philippines 462 338 313 0 0 0 261 52 51 (16.3%) 0.93 62% 94% 25-Mar-19 120 Republic of Korea 68 67 70 0 0 0 70 0 0 (0.0%) 1.04 90% 100% 11-Mar-19 - Singapore 7 6 13 0 0 0 13 0 0 (0.0%) 2.17 77% 100% 08-Mar-19 - Viet Nam 385 237 352 0 0 0 334 18 18 (5.1%) 1.49 98% 86% 08-Jul-19 15 Pacific island countries and areas 16 11 13 0 0 0 13 0 0 (0.0%) 1.18 31% 100% 03-Jun-19 - Total 6656 3330 6767 0 27 26 6643 71 70 (1.0%) 2.02 88% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) 2018 Non-polio AFP rate Total % with adequate specimens 2 Table 1B. Classification of AFP cases with onset in 2019 and key surveillance indicators Polio Bulletin 3 2018 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 57 47 31 0 0 0 23 8 0 (0.0%) 1.18 42% 100% 22-Jul-19 1 Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.79 100% 100% 03-Jun-19 50 Cambodia 73 46 33 0 0 0 25 8 0 (0.0%) 1.29 88% 91% 19-Jul-19 4 China 5292 2486 2315 0 0 0 847 1468 597 (25.8%) 1.67 92% 100% 03-Jul-19 20 China, Hong Kong SAR 11 9 8 0 0 0 5 3 1 (12.5%) 1.59 63% 88% 02-Jul-19 21 China, Macao SAR 3 1 0 - - - - - - - - - 16-Jul-19 7 Japan - 154 - - - - - - - - - - - - Lao People's Democratic Republic 94 23 36 0 0 0 27 9 0 (0.0%) 2.81 86% 72% 16-Jul-19 7 Malaysia 171 78 70 0 0 0 17 53 26 (37.1%) 1.61 73% 49% 22-Jul-19 1 Mongolia 6 9 4 0 0 0 4 0 0 (0.0%) 0.80 100% 100% 09-Jul-19 14 New Zealand 10 9 3 0 0 0 1 2 2 (66.7%) 0.60 33% 100% 22-May-19 62 Papua New Guinea 287 33 159 0 0 0 114 45 2 (1.3%) 8.64 75% 77% 22-Jul-19 1 Philippines 313 344 80 0 0 0 16 64 42 (52.5%) 0.42 46% 91% 03-Jul-19 20 Republic of Korea 70 66 37 0 0 0 30 7 0 (0.0%) 1.01 95% 100% 12-Jul-19 11 Singapore 13 6 4 0 0 0 3 1 0 (0.0%) 1.20 100% 100% 02-Jul-19 21 Viet Nam 352 237 120 0 0 0 35 85 14 (11.7%) 0.91 96% 95% 19-Jun-19 34 Pacific island countries and areas 13 11 11 0 0 0 5 6 0 (0.0%) 1.79 64% 100% 02-Jul-19 21 Total 6767 3560 2912 0 0 0 1153 1759 684 (23.5%) 1.47 89% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date 2019 Non-polio AFP rate 2 Total % with adequate specimens 3 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2018 and key laboratory indicators Polio Bulletin 4 ≥ 80% ≥ 80% Australia VIDRL 44 1 0 1 42 0 0 91% 3% 05-Feb-19 VIDRL 1 0 0 0 0 0 0 0 0 0 1 0 0 100% Brunei Darussalam VIDRL 2 0 0 0 2 0 0 50% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 74 0 0 13 61 0 0 93% 15% 18-Jan-19 NIID 0 - - - - - - - - - - - - - China (total) 5237 36 0 379 4822 0 0 97% 6% 15-May-19 88 0 24 0 0 0 0 0 63 1 0 0 0 99% China, Anhui Prov. Lab 332 2 0 17 313 0 0 100% 5% Prov. Lab/CCDC 8 0 3 0 0 0 0 0 5 0 0 0 0 100% China, Beijing Prov. Lab 31 0 0 0 31 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 52 0 0 2 50 0 0 90% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 176 1 0 12 163 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Gansu Prov. Lab 92 1 0 6 85 0 0 99% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangdong Prov. Lab 431 2 0 21 408 0 0 91% 4% Prov. Lab/CCDC 4 0 0 0 0 0 0 0 4 0 0 0 0 100% China, Guangxi Prov. Lab 221 2 0 18 201 0 0 99% 7% Prov. Lab/CCDC 4 0 3 0 0 0 0 0 1 0 0 0 0 100% China, Guizhou Prov. Lab 190 0 0 14 176 0 0 97% 7% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 41 0 0 6 35 0 0 100% 12% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 299 1 0 38 260 0 0 100% 10% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 91 0 0 4 87 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 552 5 0 58 489 0 0 99% 9% Prov. Lab/CCDC 13 0 5 0 0 0 0 0 8 0 0 0 0 100% China, Hubei Prov. Lab 177 1 0 13 163 0 0 99% 7% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Hunan Prov. Lab 245 0 0 25 220 0 0 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 252 8 0 11 233 0 0 100% 4% Prov. Lab/CCDC 16 0 2 0 0 0 0 0 13 1 0 0 0 100% China, Jiangxi Prov. Lab 176 1 0 12 163 0 0 97% 5% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Jilin Prov. Lab 58 2 0 9 47 0 0 98% 11% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Liaoning Prov. Lab 89 0 0 6 83 0 0 97% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 100 2 0 4 94 0 0 98% 4% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 100% China, Ningxia Prov. Lab 26 0 0 2 24 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 99 1 0 2 96 0 0 84% 2% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 0% China, Shandong Prov. Lab 410 2 0 25 383 0 0 100% 4% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 100% China, Shanghai Prov. Lab 42 0 0 0 42 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 118 1 0 7 110 0 0 97% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Sichuan Prov. Lab 298 1 0 21 276 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Tianjin Prov. Lab 22 0 0 0 22 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 141 1 0 7 133 0 0 91% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 248 0 0 31 217 0 0 93% 10% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Zhejiang Prov. Lab 188 2 0 7 179 0 0 99% 3% Prov. Lab/CCDC 7 0 0 0 0 0 0 0 7 0 0 0 0 100% China, Tibet Prov. Lab 8 0 0 1 7 0 0 73% 7% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 11 0 0 0 11 0 0 100% 0% 28-Jan-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 3 0 0 0 3 0 0 100% 0% 24-Dec-18 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 115 1 0 8 106 0 0 96% 4% 12-Mar-19 NIID 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Malaysia IMR 180 0 0 10 170 0 0 89% 4% 19-Feb-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 6 0 0 3 3 0 0 100% 50% 04-Jan-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 8 0 0 1 7 0 0 100% 13% 25-Jan-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 300 96 1 21 182 0 0 89% 5% 23-Jul-19 VIDRL 191 0 65 46 0 0 0 0 80 0 0 0 0 100% Philippines RITM 397 5 1 14 377 0 0 96% 3% 16-Apr-19 RITM 7 0 2 0 0 0 0 0 5 0 0 0 0 100% Republic of Korea KCDC 70 0 0 5 65 0 0 97% 6% 23-Apr-19 KCDC 0 - - - - - - - - - - - - - Singapore SGH 13 0 0 2 11 0 0 96% 8% 30-Jan-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 175 3 0 24 148 0 0 100% 12% 30-Jan-19 NIHE 4 0 2 0 0 0 0 0 2 0 0 0 0 100% Viet Nam (South) PI 175 4 0 21 150 0 0 100% 12% 18-Mar-19 PI 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Pacific island countries and areas VIDRL 11 0 0 1 10 0 0 97% 6% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Total 6821 146 2 503 6170 0 0 97% 6% 300 0 95 46 0 0 0 0 157 1 1 0 0 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens posit ive for NPEV Latest report date Discordant pending sequencing 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPV NegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2 VDPV Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2019 and key laboratory indicators Polio Bulletin 5 ≥ 80% ≥ 80% Australia VIDRL 22 0 0 2 20 0 0 98% 8% 15-Jul-19 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 27 0 0 0 27 0 0 96% 0% 16-Jul-19 NIID 0 - - - - - - - - - - - - - China (total) 2279 11 0 112 2073 0 83 97% 4% 03-Jul-19 30 0 11 0 0 0 2 0 17 0 0 0 0 100% China, Anhui Prov. Lab 128 2 0 1 117 0 8 100% 1% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Beijing Prov. Lab 19 0 0 0 19 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 22 0 0 0 21 0 1 80% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 56 0 0 3 53 0 0 100% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Gansu Prov. Lab 59 0 0 0 59 0 0 97% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 189 1 0 10 178 0 0 96% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangxi Prov. Lab 106 0 0 13 92 0 1 100% 10% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 98 0 0 9 79 0 10 99% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 12 0 0 0 11 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 134 0 0 10 123 0 1 100% 6% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 53 0 0 0 50 0 3 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 229 0 0 14 213 0 2 95% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hubei Prov. Lab 90 0 0 11 71 0 8 98% 13% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 96 0 0 5 86 0 5 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 93 0 0 1 73 0 19 100% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 58 0 0 1 55 0 2 95% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 15 1 0 0 14 0 0 100% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Liaoning Prov. Lab 36 0 0 0 33 0 3 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 53 2 0 1 50 0 0 98% 2% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Ningxia Prov. Lab 7 0 0 0 6 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 17 0 0 1 16 0 0 94% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 51 0 0 1 44 0 6 78% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Shandong Prov. Lab 154 1 0 2 151 0 0 97% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Shanghai Prov. Lab 13 0 0 0 13 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 60 0 0 0 58 0 2 98% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 163 2 0 20 141 0 0 99% 10% Prov. Lab/CCDC 4 0 0 0 0 0 2 0 2 0 0 0 0 100% China, Tianjin Prov. Lab 9 0 0 0 9 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 65 2 0 0 63 0 0 100% 0% Prov. Lab/CCDC 5 0 3 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 119 0 0 5 104 0 10 98% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 69 0 0 4 65 0 0 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 6 0 0 0 6 0 0 50% 0% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 7 0 0 0 7 0 0 100% 0% 18-Jul-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - 18-Jul-19 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 32 0 0 3 29 0 0 90% 8% 17-Jul-19 NIID 0 - - - - - - - - - - - - - Malaysia IMR 57 0 0 0 55 0 2 90% 0% 11-Jul-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 4 0 0 0 4 0 0 100% 0% 22-Jul-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 3 0 0 0 3 0 0 100% 0% 19-Jul-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 157 9 4 49 95 0 0 100% 26% 23-Jul-19 VIDRL 27 0 18 0 0 0 0 0 2 0 7 0 0 97% Philippines RITM 120 2 0 7 97 14 0 97% 7% 19-Jul-19 RITM 6 0 2 0 0 0 0 0 4 0 0 0 0 100% Republic of Korea KCDC 37 0 0 0 32 0 5 100% 0% 12-Jul-19 KCDC 0 - - - - - - - - - - - - - Singapore SGH 5 0 0 1 3 1 0 100% 25% 19-Jul-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 58 0 0 18 37 3 0 100% 29% 13-Jun-19 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 69 0 0 2 60 7 0 100% 3% 15-Jul-19 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 9 0 0 4 5 0 0 97% 6% 08-Jul-19 VIDRL 0 - - - - - - - - - - - - - Total 2887 22 4 198 2548 25 90 97% 6% 63 0 31 0 0 0 2 0 23 0 7 0 0 98% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPV NegativeNPEV only SabinWild L20B posit ive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2 VDPV Polio Bulletin 6 Table 3. Laboratory confirmation of polio isolates from environmental samples in 2018–2019 1 Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2019 Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 17 2 0 2 0 0 0 0 0 0 0 12 0 0 0 - - - - - - - - - - - - - China (total) 281 180 0 199 0 0 0 1 0 560 2 1409 0 0 87 62 0 82 0 0 0 0 0 197 0 293 2 0 China, Fujian Prov. Lab/CCDC 73 51 0 20 0 0 0 0 0 107 1 577 0 0 23 14 0 7 0 0 0 0 0 21 0 95 2 0 China, Gansu Prov. Lab/CCDC 12 7 0 2 0 0 0 0 0 12 0 40 0 0 5 5 0 11 0 0 0 0 0 19 0 1 0 0 China, Guangdong Prov. Lab/CCDC 48 41 0 27 0 0 0 0 0 102 1 217 0 0 24 16 0 10 0 0 0 0 0 30 0 123 0 0 China, Guangxi Prov. Lab/CCDC 0 - - - - - - - - - - - - - 5 5 0 1 0 0 0 0 0 9 0 28 0 0 China, Heilongjiang Prov. Lab/CCDC 42 22 0 6 0 0 0 0 0 44 0 106 0 0 6 4 0 1 0 0 0 0 0 9 0 9 0 0 China, Shandong Prov. Lab/CCDC 40 16 0 21 0 0 0 0 0 63 0 282 0 0 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab/CCDC 12 7 0 3 0 0 0 0 0 11 0 37 0 0 3 3 0 5 0 0 0 0 0 14 0 4 0 0 China, Xinjiang Prov. Lab/CCDC 36 36 0 120 0 0 0 1 0 221 0 109 0 0 15 15 0 47 0 0 0 0 0 95 0 16 0 0 China, Yunnan Prov. Lab/CCDC 18 0 - - - - - - - - - 41 0 0 6 0 - - - - - - - - - 17 0 0 Philippines RITM 87 8 0 2 0 0 0 0 0 6 0 24 0 0 69 14 0 7 1 0 0 0 0 9 0 21 2 0 Papua New Guinea RITM 27 23 0 15 7 0 0 0 0 21 0 9 0 0 47 34 0 21 0 0 0 0 0 26 0 23 8 0 Total 412 213 0 218 7 0 0 1 0 587 2 1454 0 0 203 110 0 110 1 0 0 0 0 232 0 337 12 0 2018 2019 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP) aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP) aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 1 contact) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) ?VDPV1 (1 env) Viet Nam aVDPV2 (2 AFP) 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3).

Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2017–2019* Chart 2. Adequate specimen collection rate, 2017–2019 Poliovirus vs Smallpox Containment: An Interview with David Heymann Public health legend and head of the Containment Advisory Group Professor David Heymann talks about some of the similarities and differences between poliovirus and smallpox containment, and work of the CAG. Last month, we spoke with head of the Containment Advisory Group Professor David Heymann about some of the similarities and differences between poliovirus and smallpox containment, and work of the CAG. With decades of public health experience David has worked to manage and curb the spread of SARS, Ebola, Zika virus, HIV, malaria, and measles – and that’s in addition to polio and smallpox eradication efforts! Read the full story here: http://polioeradication.org/news-post/poliovirus-vs -smallpox-containment-an-interview-with-david- heymann Polio Bulletin 2019 Issue No. 15 - Week 31 (as of 5 August 2019) Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2019 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2019 Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam). Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: wproepidata@who.int Web: www.who.int/westernpacific CONTACT US HIGHLIGHTS * AFP rate annualized as of week 31 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 11.7% 1.3% 52.5% 37.1% 0.0% 0.0% 20.7% 0% 10% 20% 30% 40% 50% 60% VNM PNG PHL MYS LAO KHM CHN Table 1A. Classification of AFP cases with onset in 2018 and key surveillance indicators Polio Bulletin 2 2017 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 60 46 57 0 0 3 54 0 0 (0.0%) 1.24 46% 89% 01-Aug-19 - Brunei Darussalam 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 24-Jan-19 - Cambodia 57 44 73 0 0 0 73 0 0 (0.0%) 1.66 92% 85% 15-Mar-19 - China 5278 2256 5292 0 1 0 5291 0 0 (0.0%) 2.35 92% 100% 15-May-19 - China, Hong Kong SAR 15 9 11 0 0 0 11 0 0 (0.0%) 1.22 82% 100% 24-Jul-19 - China, Macao SAR 2 1 3 0 0 0 3 0 0 (0.0%) 3.00 100% 100% 19-Feb-19 - Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 103 21 94 0 0 0 94 0 0 (0.0%) 4.48 80% 79% 03-Jun-19 - Malaysia 154 77 171 0 0 0 171 0 0 (0.0%) 2.22 80% 88% 15-Apr-19 - Mongolia 6 9 6 0 0 0 6 0 0 (0.0%) 0.67 100% 83% 04-Feb-19 - New Zealand 13 9 10 0 0 0 10 0 0 (0.0%) 1.11 60% 100% 28-Feb-19 - Papua New Guinea 29 37 287 0 26 23 238 0 0 (0.0%) 7.05 44% 74% 10-Jun-19 - Philippines 462 338 332 0 0 0 332 0 0 (0.0%) 0.98 61% 93% 01-Aug-19 - Republic of Korea 68 67 70 0 0 0 70 0 0 (0.0%) 1.04 90% 100% 11-Mar-19 - Singapore 7 6 13 0 0 0 13 0 0 (0.0%) 2.17 77% 100% 08-Mar-19 - Viet Nam 385 237 352 0 0 0 334 18 18 (5.1%) 1.49 98% 86% 08-Jul-19 28 Pacific island countries and areas 16 11 13 0 0 0 13 0 0 (0.0%) 1.18 31% 100% 03-Jun-19 - Total 6656 3330 6786 0 27 26 6715 18 18 (0.3%) 2.03 88% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 2018 Non-polio AFP rate Total % with adequate specimens 2 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Table 1B. Classification of AFP cases with onset in 2019 and key surveillance indicators Polio Bulletin 3 2018 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 57 47 35 0 0 0 24 11 0 (0.0%) 1.25 43% 100% 02-Aug-19 3 Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.68 100% 100% 03-Jun-19 63 Cambodia 73 46 36 0 0 0 28 8 0 (0.0%) 1.31 89% 92% 04-Aug-19 1 China 5292 2486 2628 0 0 0 1296 1332 544 (20.7%) 1.77 92% 100% 24-Jul-19 12 China, Hong Kong SAR 11 9 8 0 0 0 8 0 0 (0.0%) 1.49 63% 88% 01-Aug-19 4 China, Macao SAR 3 1 0 - - - - - - - - - 16-Jul-19 20 Japan - 154 - - - - - - - - - - - - Lao People's Democratic Republic 94 23 36 0 0 0 34 2 0 (0.0%) 2.63 86% 72% 05-Aug-19 0 Malaysia 171 78 70 0 0 0 17 53 26 (37.1%) 1.51 73% 49% 22-Jul-19 14 Mongolia 6 9 4 0 0 0 4 0 0 (0.0%) 0.75 100% 100% 09-Jul-19 27 New Zealand 10 9 3 0 0 0 1 2 2 (66.7%) 0.56 33% 100% 22-May-19 75 Papua New Guinea 287 33 159 0 0 0 114 45 2 (1.3%) 8.08 75% 77% 22-Jul-19 14 Philippines 332 344 80 0 0 0 16 64 42 (52.5%) 0.39 46% 91% 03-Jul-19 33 Republic of Korea 70 66 37 0 0 0 30 7 0 (0.0%) 0.94 95% 100% 12-Jul-19 24 Singapore 13 6 4 0 0 0 3 1 0 (0.0%) 1.12 100% 100% 02-Jul-19 34 Viet Nam 352 237 120 0 0 0 35 85 14 (11.7%) 0.85 96% 95% 19-Jun-19 47 Pacific island countries and areas 13 11 10 0 0 0 6 4 3 (30.0%) 1.52 60% 100% 05-Aug-19 0 Total 6786 3560 3231 0 0 0 1617 1614 633 (19.6%) 1.52 89% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date 2019 Non-polio AFP rate 2 Total % with adequate specimens 3> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2018 and key laboratory indicators Polio Bulletin 4 ≥ 80% ≥ 80% Australia VIDRL 44 1 0 1 42 0 0 91% 3% 05-Feb-19 VIDRL 1 0 0 0 0 0 0 0 0 0 1 0 0 100% Brunei Darussalam VIDRL 2 0 0 0 2 0 0 50% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 74 0 0 13 61 0 0 93% 15% 18-Jan-19 NIID 0 - - - - - - - - - - - - - China (total) 5237 36 0 379 4822 0 0 97% 6% 15-May-19 88 0 24 0 0 0 0 0 63 1 0 0 0 99% China, Anhui Prov. Lab 332 2 0 17 313 0 0 100% 5% Prov. Lab/CCDC 8 0 3 0 0 0 0 0 5 0 0 0 0 100% China, Beijing Prov. Lab 31 0 0 0 31 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 52 0 0 2 50 0 0 90% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 176 1 0 12 163 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Gansu Prov. Lab 92 1 0 6 85 0 0 99% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangdong Prov. Lab 431 2 0 21 408 0 0 91% 4% Prov. Lab/CCDC 4 0 0 0 0 0 0 0 4 0 0 0 0 100% China, Guangxi Prov. Lab 221 2 0 18 201 0 0 99% 7% Prov. Lab/CCDC 4 0 3 0 0 0 0 0 1 0 0 0 0 100% China, Guizhou Prov. Lab 190 0 0 14 176 0 0 97% 7% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 41 0 0 6 35 0 0 100% 12% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 299 1 0 38 260 0 0 100% 10% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 91 0 0 4 87 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 552 5 0 58 489 0 0 99% 9% Prov. Lab/CCDC 13 0 5 0 0 0 0 0 8 0 0 0 0 100% China, Hubei Prov. Lab 177 1 0 13 163 0 0 99% 7% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Hunan Prov. Lab 245 0 0 25 220 0 0 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 252 8 0 11 233 0 0 100% 4% Prov. Lab/CCDC 16 0 2 0 0 0 0 0 13 1 0 0 0 100% China, Jiangxi Prov. Lab 176 1 0 12 163 0 0 97% 5% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Jilin Prov. Lab 58 2 0 9 47 0 0 98% 11% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Liaoning Prov. Lab 89 0 0 6 83 0 0 97% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 100 2 0 4 94 0 0 98% 4% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 100% China, Ningxia Prov. Lab 26 0 0 2 24 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 99 1 0 2 96 0 0 84% 2% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 0% China, Shandong Prov. Lab 410 2 0 25 383 0 0 100% 4% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 100% China, Shanghai Prov. Lab 42 0 0 0 42 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 118 1 0 7 110 0 0 97% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Sichuan Prov. Lab 298 1 0 21 276 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Tianjin Prov. Lab 22 0 0 0 22 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 141 1 0 7 133 0 0 91% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 248 0 0 31 217 0 0 93% 10% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Zhejiang Prov. Lab 188 2 0 7 179 0 0 99% 3% Prov. Lab/CCDC 7 0 0 0 0 0 0 0 7 0 0 0 0 100% China, Tibet Prov. Lab 8 0 0 1 7 0 0 73% 7% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 11 0 0 0 11 0 0 100% 0% 28-Jan-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 3 0 0 0 3 0 0 100% 0% 24-Dec-18 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 115 1 0 8 106 0 0 96% 4% 12-Mar-19 NIID 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Malaysia IMR 180 0 0 10 170 0 0 89% 4% 19-Feb-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 6 0 0 3 3 0 0 100% 50% 04-Jan-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 8 0 0 1 7 0 0 100% 13% 25-Jan-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 300 96 1 21 182 0 0 89% 5% 23-Jul-19 VIDRL 191 0 65 46 0 0 0 0 80 0 0 0 0 100% Philippines RITM 397 5 1 14 377 0 0 96% 3% 16-Apr-19 RITM 7 0 2 0 0 0 0 0 5 0 0 0 0 100% Republic of Korea KCDC 70 0 0 5 65 0 0 97% 6% 23-Apr-19 KCDC 0 - - - - - - - - - - - - - Singapore SGH 13 0 0 2 11 0 0 96% 8% 30-Jan-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 175 3 0 24 148 0 0 100% 12% 30-Jan-19 NIHE 4 0 2 0 0 0 0 0 2 0 0 0 0 100% Viet Nam (South) PI 175 4 0 21 150 0 0 100% 12% 18-Mar-19 PI 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Pacific island countries and areas VIDRL 11 0 0 1 10 0 0 97% 6% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Total 6821 146 2 503 6170 0 0 97% 6% 300 0 95 46 0 0 0 0 157 1 1 0 0 100% 2. NPEV growing in L20B cells L20B posit ive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2 VDPV Pending ITDVDPV NegativeNPEV only SabinWild 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2019 and key laboratory indicators Polio Bulletin 5 ≥ 80% ≥ 80% Australia VIDRL 24 0 0 2 20 2 0 98% 8% 01-Aug-19 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 28 0 0 0 28 0 0 96% 0% 22-Jul-19 NIID 0 - - - - - - - - - - - - - China (total) 2584 15 0 140 2344 0 85 97% 5% 24-Jul-19 35 0 11 0 0 0 2 0 20 2 0 0 0 97% China, Anhui Prov. Lab 154 2 0 5 140 0 7 100% 3% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Beijing Prov. Lab 22 0 0 0 22 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 23 0 0 0 21 0 2 80% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 64 0 0 5 59 0 0 100% 6% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Gansu Prov. Lab 65 0 0 0 65 0 0 97% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 227 1 0 12 212 0 2 96% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangxi Prov. Lab 123 0 0 17 106 0 0 100% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 113 0 0 12 97 0 4 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 13 0 0 0 12 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 145 1 0 10 134 0 0 100% 6% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 57 0 0 0 53 0 4 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 249 2 0 17 228 0 2 95% 5% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 67% China, Hubei Prov. Lab 104 0 0 12 81 0 11 98% 13% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 114 0 0 8 104 0 2 100% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 109 0 0 2 91 0 16 100% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 64 0 0 1 60 0 3 95% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 17 2 0 0 15 0 0 100% 0% Prov. Lab/CCDC 3 0 1 0 0 0 0 0 0 2 0 0 0 100% China, Liaoning Prov. Lab 37 0 0 0 34 0 3 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 56 2 0 1 50 0 3 98% 2% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Ningxia Prov. Lab 8 0 0 0 7 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 18 0 0 1 16 0 1 94% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 53 0 0 1 51 0 1 75% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Shandong Prov. Lab 169 1 0 1 167 0 0 98% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Shanghai Prov. Lab 16 0 0 0 16 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 70 0 0 0 70 0 0 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 182 2 0 21 153 0 6 99% 10% Prov. Lab/CCDC 4 0 0 0 0 0 2 0 2 0 0 0 0 100% China, Tianjin Prov. Lab 9 0 0 0 9 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 80 2 0 0 76 0 2 100% 0% Prov. Lab/CCDC 5 0 3 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 136 0 0 5 118 0 13 96% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 79 0 0 9 69 0 1 100% 10% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 8 0 0 0 8 0 0 38% 0% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 7 0 0 0 7 0 0 100% 0% 18-Jul-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - 18-Jul-19 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 34 0 0 3 31 0 0 91% 8% 22-Jul-19 NIID 0 - - - - - - - - - - - - - Malaysia IMR 57 0 0 0 55 0 2 90% 0% 11-Jul-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 4 0 0 0 4 0 0 100% 0% 29-Jul-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 3 0 0 0 3 0 0 100% 0% 30-Jul-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 175 11 5 56 103 0 0 100% 27% 05-Aug-19 VIDRL 35 0 24 0 0 0 0 0 4 0 7 0 0 97% Philippines RITM 130 2 0 8 113 7 0 98% 7% 31-Jul-19 RITM 6 0 2 0 0 0 0 0 4 0 0 0 0 100% Republic of Korea KCDC 37 0 0 0 32 0 5 100% 0% 12-Jul-19 KCDC 0 - - - - - - - - - - - - - Singapore SGH 5 0 0 1 4 0 0 100% 20% 02-Aug-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 86 0 0 21 61 4 0 100% 23% 26-Jul-19 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 73 0 0 3 66 4 0 100% 4% 29-Jul-19 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 9 0 0 4 5 0 0 97% 6% 08-Jul-19 VIDRL 0 - - - - - - - - - - - - - Total 3257 28 5 238 2877 17 92 97% 6% 76 0 37 0 0 0 2 0 28 2 7 0 0 97% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPV NegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B posit ive + NPEV NPEV 2 VDPV Polio Bulletin 6 Table 3. Laboratory confirmation of polio isolates from environmental samples in 2018–2019 1 Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2019 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP) aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP) aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 1 contact) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) ?VDPV1 (1 env) Viet Nam aVDPV2 (2 AFP) 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 17 2 0 2 0 0 0 0 0 0 0 12 0 0 0 - - - - - - - - - - - - - China (total) 281 180 0 199 0 0 0 1 0 560 2 1409 0 0 87 62 0 82 0 0 0 0 0 197 0 293 2 0 China, Fujian Prov. Lab/CCDC 73 51 0 20 0 0 0 0 0 107 1 577 0 0 23 14 0 7 0 0 0 0 0 21 0 95 2 0 China, Gansu Prov. Lab/CCDC 12 7 0 2 0 0 0 0 0 12 0 40 0 0 5 5 0 11 0 0 0 0 0 19 0 1 0 0 China, Guangdong Prov. Lab/CCDC 48 41 0 27 0 0 0 0 0 102 1 217 0 0 24 16 0 10 0 0 0 0 0 30 0 123 0 0 China, Guangxi Prov. Lab/CCDC 0 - - - - - - - - - - - - - 5 5 0 1 0 0 0 0 0 9 0 28 0 0 China, Heilongjiang Prov. Lab/CCDC 42 22 0 6 0 0 0 0 0 44 0 106 0 0 6 4 0 1 0 0 0 0 0 9 0 9 0 0 China, Shandong Prov. Lab/CCDC 40 16 0 21 0 0 0 0 0 63 0 282 0 0 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab/CCDC 12 7 0 3 0 0 0 0 0 11 0 37 0 0 3 3 0 5 0 0 0 0 0 14 0 4 0 0 China, Xinjiang Prov. Lab/CCDC 36 36 0 120 0 0 0 1 0 221 0 109 0 0 15 15 0 47 0 0 0 0 0 95 0 16 0 0 China, Yunnan Prov. Lab/CCDC 18 0 - - - - - - - - - 41 0 0 6 0 - - - - - - - - - 17 0 0 Philippines RITM 87 8 0 2 0 0 0 0 0 6 0 24 0 0 71 14 0 8 1 0 0 0 0 9 0 22 1 0 Papua New Guinea RITM 27 23 0 15 7 0 0 0 0 21 0 9 0 0 50 37 0 24 0 0 0 0 0 28 0 25 7 0 Total 412 213 0 218 7 0 0 1 0 587 2 1454 0 0 208 113 0 114 1 0 0 0 0 234 0 340 10 0 2018 2019 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed

Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2017–2019* Chart 2. Adequate specimen collection rate, 2017–2019 The Philippine Department of Health intensifies efforts to prevent polio On 17 August 2019, the Philippine Department of Health issued a press release on intensification of efforts to prevent polio in the country. For the past years, vaccination coverage for the third dose of the oral polio vaccine has fallen below 95% and the surveillance on acute flaccid paralysis has been consistently poor. "Unless we act quickly in putting our surveillance on alert to detect signs of poliovirus transmission, in strengthening our immunization programme, and in improving environmental hygiene and sanitation, we risk losing our polio-free status," Secretary Francisco Duque III emphasized. Department of Health has planned measures to enhance polio surveillance in the country and implement polio immunization campaign for children under five years old in selected high-risk areas. The vaccination in Manila city started on 19 August 2019 and will last for two weeks. After that, the immunization will expand to the entire National Capital Region in October and eventually to other priority regions in November 2019. Polio Bulletin 2019 Issue No. 16 - Week 33 (as of 20 August 2019) Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2019 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2019 Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam). Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: wproepidata@who.int Web: www.who.int/westernpacific CONTACT US HIGHLIGHTS * AFP rate annualized as of week 33 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 16.2% 1.2% 52.5% 37.1% 0.0% 0.0% 19.6% 0% 10% 20% 30% 40% 50% 60% VNM PNG PHL MYS LAO KHM CHN Table 1A. Classification of AFP cases with onset in 2018 and key surveillance indicators Polio Bulletin 2 2017 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 60 46 57 0 0 3 54 0 0 (0.0%) 1.24 44% 89% 19-Aug-19 - Brunei Darussalam 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 24-Jan-19 - Cambodia 57 44 73 0 0 0 73 0 0 (0.0%) 1.66 92% 85% 15-Mar-19 - China 5278 2256 5292 0 1 0 5291 0 0 (0.0%) 2.35 92% 100% 15-May-19 - China, Hong Kong SAR 15 9 11 0 0 0 11 0 0 (0.0%) 1.22 82% 100% 24-Jul-19 - China, Macao SAR 2 1 3 0 0 0 3 0 0 (0.0%) 3.00 100% 100% 19-Feb-19 - Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 103 21 94 0 0 0 94 0 0 (0.0%) 4.48 80% 79% 03-Jun-19 - Malaysia 154 77 171 0 0 0 171 0 0 (0.0%) 2.22 80% 88% 15-Apr-19 - Mongolia 6 9 6 0 0 0 6 0 0 (0.0%) 0.67 100% 83% 04-Feb-19 - New Zealand 13 9 10 0 0 0 10 0 0 (0.0%) 1.11 60% 100% 28-Feb-19 - Papua New Guinea 29 37 287 0 26 23 238 0 0 (0.0%) 7.05 44% 74% 10-Jun-19 - Philippines 462 338 332 0 0 0 332 0 0 (0.0%) 0.98 61% 93% 01-Aug-19 - Republic of Korea 68 67 70 0 0 0 70 0 0 (0.0%) 1.04 90% 100% 11-Mar-19 - Singapore 7 6 13 0 0 0 13 0 0 (0.0%) 2.17 77% 100% 08-Mar-19 - Viet Nam 385 237 352 0 0 0 352 0 0 (0.0%) 1.49 98% 86% 06-Aug-19 - Pacific island countries and areas 16 11 13 0 0 0 13 0 0 (0.0%) 1.18 31% 100% 03-Jun-19 - Total 6656 3330 6786 0 27 26 6733 0 0 (0.0%) 2.03 88% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 fo r non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Discarded (Non-polio) 2018 Non-polio AFP rate Total % with adequate specimens 2 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Table 1B. Classification of AFP cases with onset in 2019 and key surveillance indicators Polio Bulletin 3 2018 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 57 47 39 0 0 0 33 6 2 (5.1%) 1.31 38% 100% 19-Aug-19 1 Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.58 100% 100% 03-Jun-19 78 Cambodia 73 46 36 0 0 0 28 8 0 (0.0%) 1.23 89% 92% 04-Aug-19 16 China 5292 2486 2827 0 1 0 1434 1392 553 (19.6%) 1.79 92% 100% 07-Aug-19 13 China, Hong Kong SAR 11 9 10 0 0 0 8 2 0 (0.0%) 1.75 70% 90% 15-Aug-19 5 China, Macao SAR 3 1 0 - - - - - - - - - 13-Aug-19 7 Japan - 154 - - - - - - - - - - - - Lao People's Democratic Republic 94 23 40 0 0 0 36 4 0 (0.0%) 2.74 83% 70% 13-Aug-19 7 Malaysia 171 78 70 0 0 0 17 53 26 (37.1%) 1.41 73% 49% 22-Jul-19 29 Mongolia 6 9 4 0 0 0 4 0 0 (0.0%) 0.70 100% 100% 05-Aug-19 15 New Zealand 10 9 3 0 0 0 1 2 2 (66.7%) 0.53 33% 100% 22-May-19 90 Papua New Guinea 287 33 173 0 0 0 142 31 2 (1.2%) 8.26 76% 77% 07-Aug-19 13 Philippines 332 344 80 0 0 0 16 64 42 (52.5%) 0.37 46% 91% 03-Jul-19 48 Republic of Korea 70 66 45 0 0 0 32 13 1 (2.2%) 1.07 93% 100% 12-Aug-19 8 Singapore 13 6 5 0 0 0 4 1 0 (0.0%) 1.31 100% 100% 06-Aug-19 14 Viet Nam 352 237 167 0 0 0 85 82 27 (16.2%) 1.11 97% 92% 06-Aug-19 14 Pacific island countries and areas 13 11 10 0 0 0 6 4 3 (30.0%) 1.43 60% 100% 05-Aug-19 15 Total 6786 3560 3510 0 1 0 1847 1662 658 (18.7%) 1.55 89% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 fo r non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date 2019 Non-polio AFP rate 2 Total % with adequate specimens 3 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2018 and key laboratory indicators Polio Bulletin 4 ≥ 80% ≥ 80% Australia VIDRL 44 1 0 1 42 0 0 91% 3% 05-Feb-19 VIDRL 1 0 0 0 0 0 0 0 0 0 1 0 0 100% Brunei Darussalam VIDRL 2 0 0 0 2 0 0 50% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 74 0 0 13 61 0 0 93% 15% 18-Jan-19 NIID 0 - - - - - - - - - - - - - China (total) 5237 36 0 379 4822 0 0 97% 6% 15-May-19 88 0 24 0 0 0 0 0 63 1 0 0 0 99% China, Anhui Prov. Lab 332 2 0 17 313 0 0 100% 5% Prov. Lab/CCDC 8 0 3 0 0 0 0 0 5 0 0 0 0 100% China, Beijing Prov. Lab 31 0 0 0 31 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 52 0 0 2 50 0 0 90% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 176 1 0 12 163 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Gansu Prov. Lab 92 1 0 6 85 0 0 99% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangdong Prov. Lab 431 2 0 21 408 0 0 91% 4% Prov. Lab/CCDC 4 0 0 0 0 0 0 0 4 0 0 0 0 100% China, Guangxi Prov. Lab 221 2 0 18 201 0 0 99% 7% Prov. Lab/CCDC 4 0 3 0 0 0 0 0 1 0 0 0 0 100% China, Guizhou Prov. Lab 190 0 0 14 176 0 0 97% 7% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 41 0 0 6 35 0 0 100% 12% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 299 1 0 38 260 0 0 100% 10% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 91 0 0 4 87 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 552 5 0 58 489 0 0 99% 9% Prov. Lab/CCDC 13 0 5 0 0 0 0 0 8 0 0 0 0 100% China, Hubei Prov. Lab 177 1 0 13 163 0 0 99% 7% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Hunan Prov. Lab 245 0 0 25 220 0 0 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 252 8 0 11 233 0 0 100% 4% Prov. Lab/CCDC 16 0 2 0 0 0 0 0 13 1 0 0 0 100% China, Jiangxi Prov. Lab 176 1 0 12 163 0 0 97% 5% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Jilin Prov. Lab 58 2 0 9 47 0 0 98% 11% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Liaoning Prov. Lab 89 0 0 6 83 0 0 97% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 100 2 0 4 94 0 0 98% 4% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 100% China, Ningxia Prov. Lab 26 0 0 2 24 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 99 1 0 2 96 0 0 84% 2% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 0% China, Shandong Prov. Lab 410 2 0 25 383 0 0 100% 4% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 100% China, Shanghai Prov. Lab 42 0 0 0 42 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 118 1 0 7 110 0 0 97% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Sichuan Prov. Lab 298 1 0 21 276 0 0 97% 6% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Tianjin Prov. Lab 22 0 0 0 22 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 141 1 0 7 133 0 0 91% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 248 0 0 31 217 0 0 93% 10% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Zhejiang Prov. Lab 188 2 0 7 179 0 0 99% 3% Prov. Lab/CCDC 7 0 0 0 0 0 0 0 7 0 0 0 0 100% China, Tibet Prov. Lab 8 0 0 1 7 0 0 73% 7% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 11 0 0 0 11 0 0 100% 0% 28-Jan-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 3 0 0 0 3 0 0 100% 0% 28-Jan-19 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 115 1 0 8 106 0 0 96% 4% 12-Mar-19 NIID 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Malaysia IMR 180 0 0 10 170 0 0 89% 4% 19-Feb-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 6 0 0 3 3 0 0 100% 50% 04-Jan-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 8 0 0 1 7 0 0 100% 13% 25-Jan-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 300 96 1 21 182 0 0 89% 5% 23-Jul-19 VIDRL 191 0 65 46 0 0 0 0 80 0 0 0 0 100% Philippines RITM 397 5 1 14 377 0 0 96% 3% 16-Apr-19 RITM 7 0 2 0 0 0 0 0 5 0 0 0 0 100% Republic of Korea KCDC 70 0 0 5 65 0 0 97% 6% 23-Apr-19 KCDC 0 - - - - - - - - - - - - - Singapore SGH 13 0 0 2 11 0 0 96% 8% 30-Jan-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 175 3 0 24 148 0 0 100% 12% 30-Jan-19 NIHE 4 0 2 0 0 0 0 0 2 0 0 0 0 100% Viet Nam (South) PI 175 4 0 21 150 0 0 100% 12% 18-Mar-19 PI 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Pacific island countries and areas VIDRL 11 0 0 1 10 0 0 97% 6% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Total 6821 146 2 503 6170 0 0 97% 6% 300 0 95 46 0 0 0 0 157 1 1 0 0 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPV NegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2 VDPV Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2019 and key laboratory indicators Polio Bulletin 5 ≥ 80% ≥ 80% Australia VIDRL 27 0 0 2 23 2 0 98% 7% 19-Aug-19 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 33 0 0 2 31 0 0 97% 3% 17-Aug-19 NIID 0 - - - - - - - - - - - - - China (total) 2776 15 0 161 2514 0 86 97% 5% 07-Aug-19 35 0 11 0 0 0 2 0 20 2 0 0 0 97% China, Anhui Prov. Lab 166 2 0 6 157 0 1 100% 3% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Beijing Prov. Lab 24 0 0 0 24 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 25 0 0 1 24 0 0 80% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 72 0 0 5 67 0 0 100% 6% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Gansu Prov. Lab 71 0 0 0 71 0 0 97% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 241 1 0 15 222 0 3 96% 6% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangxi Prov. Lab 131 0 0 20 111 0 0 100% 12% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 125 0 0 13 101 0 11 98% 10% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 14 0 0 0 14 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 154 1 0 11 141 0 1 100% 6% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 58 0 0 0 53 0 5 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 271 2 0 21 245 0 3 95% 6% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 67% China, Hubei Prov. Lab 110 0 0 12 81 0 17 98% 13% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 129 0 0 8 119 0 2 98% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 112 0 0 2 94 0 16 100% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 72 0 0 1 67 0 4 96% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 18 2 0 1 15 0 0 100% 6% Prov. Lab/CCDC 3 0 1 0 0 0 0 0 0 2 0 0 0 100% China, Liaoning Prov. Lab 41 0 0 0 38 0 3 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 59 2 0 1 53 0 3 98% 2% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Ningxia Prov. Lab 10 0 0 0 8 0 2 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 18 0 0 1 17 0 0 94% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 55 0 0 1 53 0 1 74% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Shandong Prov. Lab 180 1 0 1 178 0 0 98% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Shanghai Prov. Lab 17 0 0 0 17 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 74 0 0 1 73 0 0 99% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 192 2 0 23 163 0 4 98% 11% Prov. Lab/CCDC 4 0 0 0 0 0 2 0 2 0 0 0 0 100% China, Tianjin Prov. Lab 11 0 0 0 11 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 85 2 0 1 80 0 2 100% 1% Prov. Lab/CCDC 5 0 3 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 150 0 0 7 135 0 8 97% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 83 0 0 9 74 0 0 100% 10% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 8 0 0 0 8 0 0 38% 0% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 9 0 0 0 8 1 0 100% 0% 19-Aug-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - 19-Aug-19 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 34 0 0 3 31 0 0 91% 8% 22-Jul-19 NIID 0 - - - - - - - - - - - - - Malaysia IMR 76 0 0 2 74 0 0 91% 1% 15-Aug-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 4 0 0 0 4 0 0 100% 0% 16-Aug-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 3 0 0 0 3 0 0 100% 0% 19-Aug-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 186 12 5 60 109 0 0 99% 28% 14-Aug-19 VIDRL 37 0 25 0 0 0 0 0 4 0 8 0 0 97% Philippines RITM 143 2 0 9 125 7 0 97% 7% 14-Aug-19 RITM 6 0 2 0 0 0 0 0 4 0 0 0 0 100% Republic of Korea KCDC 45 0 1 4 37 1 2 100% 12% 12-Aug-19 KCDC 2 0 0 0 0 0 0 0 0 0 2 0 0 100% Singapore SGH 7 0 0 1 4 2 0 100% 20% 16-Aug-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 86 0 0 21 61 4 0 100% 23% 26-Jul-19 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 84 0 0 3 80 1 0 100% 4% 13-Aug-19 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 10 0 0 5 5 0 0 97% 7% 05-Aug-19 VIDRL 0 - - - - - - - - - - - - - Total 3524 29 6 273 3110 18 88 97% 7% 80 0 38 0 0 0 2 0 28 2 10 0 0 97% 2. NPEV growing in L20B cells L20B posit ive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2 VDPV Pending ITDVDPV NegativeNPEV only SabinWild 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Polio Bulletin 6 Table 3. Laboratory confirmation of polio isolates from environmental samples in 2018–2019 1 Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2019 Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 17 2 0 2 0 0 0 0 0 0 0 12 0 0 0 - - - - - - - - - - - - - China (total) 281 180 0 199 0 0 0 1 0 560 2 1409 0 0 145 89 0 100 0 0 0 0 0 283 0 593 3 0 China, Fujian Prov. Lab/CCDC 73 51 0 20 0 0 0 0 0 107 1 577 0 0 35 21 0 10 0 0 0 0 0 40 0 195 1 0 China, Gansu Prov. Lab/CCDC 12 7 0 2 0 0 0 0 0 12 0 40 0 0 5 5 0 11 0 0 0 0 0 19 0 1 0 0 China, Guangdong Prov. Lab/CCDC 48 41 0 27 0 0 0 0 0 102 1 217 0 0 28 17 0 10 0 0 0 0 0 31 0 162 0 0 China, Guangxi Prov. Lab/CCDC 0 - - - - - - - - - - - - - 6 6 0 2 0 0 0 0 0 14 0 33 0 0 China, Heilongjiang Prov. Lab/CCDC 42 22 0 6 0 0 0 0 0 44 0 106 0 0 12 7 0 3 0 0 0 0 0 19 0 23 0 0 China, Shandong Prov. Lab/CCDC 40 16 0 21 0 0 0 0 0 63 0 282 0 0 14 8 0 1 0 0 0 0 0 13 0 78 1 0 China, Shanghai Prov. Lab/CCDC 12 7 0 3 0 0 0 0 0 11 0 37 0 0 6 4 0 6 0 0 0 0 0 18 0 17 1 0 China, Xinjiang Prov. Lab/CCDC 36 36 0 120 0 0 0 1 0 221 0 109 0 0 21 19 0 54 0 0 0 0 0 127 0 45 0 0 China, Yunnan Prov. Lab/CCDC 18 0 - - - - - - - - - 41 0 0 18 2 0 3 0 0 0 0 0 2 0 39 0 0 Philippines RITM 87 8 0 2 0 0 0 0 0 6 0 24 0 0 73 15 0 8 2 0 0 0 0 10 0 23 0 0 Papua New Guinea RITM 27 23 0 15 7 0 0 0 0 21 0 9 0 0 54 44 0 27 0 0 0 0 0 34 0 31 4 0 Total 412 213 0 218 7 0 0 1 0 587 2 1454 0 0 272 148 0 135 2 0 0 0 0 327 0 647 7 0 2018 2019 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP) aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP) aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts) ?VDPV3 (1 AFP) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) ?VDPV1 (2 env) Viet Nam aVDPV2 (2 AFP) 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3).

&KDUW1RQ-SROLR$)3UDWHSHUSHUVRQV\HDUVRIDJH – &KDUW$GHTXDWHVSHFLPHQFROOHFWLRQUDWH– 1LJHULDLVWKUHH\HDUVIUHHIURPZLOGSROLRYLUXV  $XJXVW  PDUNV WKUHH \HDUV VLQFH 1LJHULD ODVW UHSRUWHG D FDVH RI ZLOGSROLRYLUXV7KLV LV DQ LPSRUWDQW SXEOLF KHDOWK PLOHVWRQH IRU WKH FRXQWU\ DQG WKH HQWLUH$IULFD5HJLRQZKLFKLVQRZDVWHSQRZFORVHUWR SROLR-IUHH FHUWLILFDWLRQ ,QQRYDWLRQ SDUWQHUVKLS DQG UHVROYH KDYH DOO XQGHUSLQQHG DGYDQFHPHQWV PDGH LQ 1LJHULD WRJHWKHU ZLWK WKH FRPPLWPHQW RI WHQV RI WKRXVDQGVRIKHDOWKZRUNHUV³6LQFHWKHODVWRXWEUHDNRI ZLOG SROLR LQ  LQ WKH QRUWKHDVW 1LJHULD KDV VWUHQJWKHQHGVXSSOHPHQWDU\LPPXQL]DWLRQDFWLYLWLHVDQG URXWLQHLPPXQL]DWLRQLPSOHPHQWHGLQQRYDWLYHVWUDWHJLHV WRYDFFLQDWHKDUG-WR-UHDFKFKLOGUHQDQGLPSURYHGDFXWH IODFFLG SDUDO\VLV DQG HQYLURQPHQWDO VXUYHLOODQFH´ VDLG :+2¶V2IILFHU LQ&KDUJH IRU1LJHULD'U3HWHU&OHPHQW &RQWLQXHGZRUN WRUHDFKHYHU\ ODVWFKLOGZLWK WKHSROLR YDFFLQH DV ZHOO DV VWUHQJWKHQLQJ VXUYHLOODQFH DQG URXWLQH LPPXQL]DWLRQ DFURVV WKH UHJLRQ ZLOO EH NH\ WR NHHSLQJ ZLOG SROLR DW ED\ DQG SURWHFWLQJ WKH JDLQV DFKLHYHG )RUIXUWKHUGHWDLOVSOHDVHYLVLW KWWSSROLRHUDGLFDWLRQRUJQHZV-SRVWQLJHULD-WKUHH- \HDUV-IUHH-IURP-ZLOG-SROLRYLUXV 3ROLR%XOOHWLQ ,VVXH1R-:HHNDVRI6HSWHPEHU &KDUW3HUFHQWDJHRIUHSRUWHG$)3FDVHVZLWKSHQGLQJFODVVLILFDWLRQ !GD\VDIWHURQVHW &KDUW3HUFHQWDJHRIUHSRUWHG$)3FDVHVE\QXPEHURI SROLRYDFFLQDWLRQGRVHV 1RWH3ULRULW\FRXQWULHVZHUHVHOHFWHGIRUWKHFKDUWV2IILFLDO:+2DFURQ\PVKDYHEHHQXVHGIRUDEEUHYLDWLRQ&+1&KLQD.+0&DPERGLD /$2/DR3HRSOH¶V'HPRFUDWLF5HSXEOLF0<60DOD\VLD3+/3KLOLSSLQHV31*3DSXD1HZ*XLQHDDQG9109LHW1DP ([SDQGHG3URJUDPPHRQ,PPXQL]DWLRQ 5HJLRQDO2IILFHIRUWKH:HVWHUQ3DFLILF :RUOG+HDOWK2UJDQL]DWLRQ 32%R[0DQLOD3KLOLSSLQHV 3KRQH )D[ (PDLOZSURHSLGDWD#ZKRLQW :HEZZZZKRLQWZHVWHUQSDFLILF &217$&786 +,*+/,*+76 $)3UDWHDQQXDOL]HGDVRIZHHN 0% 20% 40% 60% 80% 100% 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 16.2% 1.1% 36.4% 37.1% 0.0% 0.0% 22.9% 0% 5% 10% 15% 20% 25% 30% 35% 40% VNM PNG PHL MYS LAO KHM CHN 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 7DEOH&ODVVLILFDWLRQRI$)3FDVHVZLWKRQVHWLQDQGNH\VXUYHLOODQFHLQGLFDWRUV 3ROLR%XOOHWLQ  2018 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 57 47 43 0 0 0 33 10 3 (7.0%) 1.32 33% 98% 09-Sep-19 1 Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.44 100% 100% 05-Sep-19 5 Cambodia 73 46 38 0 0 0 37 1 0 (0.0%) 1.19 87% 92% 06-Sep-19 4 China 5292 2486 3174 0 2 0 1765 1407 727 (22.9%) 1.84 92% 100% 04-Sep-19 6 China, Hong Kong SAR 11 9 10 0 0 0 9 1 0 (0.0%) 1.60 70% 90% 20-Aug-19 21 China, Macao SAR 3 1 0 - - - - - - - - - 13-Aug-19 28 Japan - 154 - - - - - - - - - - - - Lao People's Democratic Republic 94 23 47 0 0 0 40 7 0 (0.0%) 2.95 79% 74% 04-Sep-19 6 Malaysia 171 78 70 0 0 0 17 53 26 (37.1%) 1.30 73% 49% 22-Jul-19 50 Mongolia 6 9 4 0 0 0 4 0 0 (0.0%) 0.64 100% 100% 05-Aug-19 36 New Zealand 10 9 3 0 0 0 3 0 0 (0.0%) 0.48 67% 100% 05-Sep-19 5 Papua New Guinea 287 33 182 0 0 0 165 17 2 (1.1%) 7.97 75% 78% 04-Sep-19 6 Philippines 332 344 107 0 0 0 63 44 39 (36.4%) 0.45 56% 93% 30-Aug-19 11 Republic of Korea 70 66 45 0 0 0 32 13 1 (2.2%) 0.98 93% 100% 12-Aug-19 29 Singapore 13 6 5 0 0 0 5 0 0 (0.0%) 1.20 100% 100% 04-Sep-19 6 Viet Nam 352 237 167 0 0 0 85 82 27 (16.2%) 1.02 97% 92% 06-Aug-19 35 Pacific island countries and areas 13 11 15 0 0 0 10 5 2 (13.3%) 1.97 60% 93% 25-Aug-19 16 Total 6786 3560 3911 0 2 0 2269 1640 827 (21.1%) 1.59 89% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO Discarded (Non-polio) 2019 Non-polio AFP rate 2 Total % with adequate specimens 3 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date 7DEOH/DERUDWRU\LQYHVWLJDWLRQRIVWRROVDPSOHVIURP$)3FDVHVZLWKRQVHWLQDQGNH\ODERUDWRU\LQGLFDWRUV 3ROLR%XOOHWLQ  ≥ 80% ≥ 80% Australia VIDRL 29 0 0 2 26 1 0 98% 6% 09-Sep-19 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 36 0 0 2 34 0 0 97% 3% 05-Sep-19 NIID 0 - - - - - - - - - - - - - China (total) 3116 17 0 196 2814 0 89 97% 6% 04-Sep-19 36 0 12 0 0 0 2 0 20 2 0 0 0 97% China, Anhui Prov. Lab 188 2 0 8 176 0 2 100% 4% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Beijing Prov. Lab 26 0 0 0 26 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 32 0 0 1 26 0 5 81% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 87 0 0 6 81 0 0 100% 6% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Gansu Prov. Lab 79 0 0 0 79 0 0 97% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 270 1 0 16 251 0 2 96% 6% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangxi Prov. Lab 153 0 0 25 128 0 0 100% 13% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 133 0 0 14 119 0 0 98% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 17 0 0 0 16 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 169 1 0 14 154 0 0 100% 6% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 66 0 0 2 61 0 3 100% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 315 3 0 26 284 0 2 95% 7% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 67% China, Hubei Prov. Lab 116 0 0 13 82 0 21 98% 14% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 145 0 0 10 132 0 3 99% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 124 0 0 5 116 0 3 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 81 0 0 1 75 0 5 96% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 21 2 0 1 18 0 0 100% 5% Prov. Lab/CCDC 3 0 1 0 0 0 0 0 0 2 0 0 0 100% China, Liaoning Prov. Lab 42 0 0 0 39 0 3 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 60 2 0 1 57 0 0 98% 2% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Ningxia Prov. Lab 13 0 0 0 12 0 1 92% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 20 0 0 2 17 0 1 95% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 63 0 0 3 56 0 4 75% 3% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Shandong Prov. Lab 203 1 0 1 183 0 18 98% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Shanghai Prov. Lab 18 0 0 0 18 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 81 0 0 2 79 0 0 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 223 2 0 25 186 0 10 98% 10% Prov. Lab/CCDC 4 0 0 0 0 0 2 0 2 0 0 0 0 100% China, Tianjin Prov. Lab 16 0 0 0 16 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 93 3 0 1 88 0 1 100% 1% Prov. Lab/CCDC 6 0 4 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 159 0 0 7 148 0 4 96% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 95 0 0 12 83 0 0 100% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 8 0 0 0 8 0 0 38% 0% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 9 0 0 0 9 0 0 100% 0% 02-Sep-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - 02-Sep-19 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 42 0 0 7 35 0 0 93% 13% 09-Sep-19 NIID 0 - - - - - - - - - - - - - Malaysia IMR 76 0 0 2 74 0 0 91% 1% 15-Aug-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 4 0 0 0 4 0 0 100% 0% 07-Sep-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 3 0 0 0 3 0 0 100% 0% 02-Sep-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 197 12 5 65 115 0 0 99% 28% 09-Sep-19 VIDRL 37 0 25 0 0 0 0 0 4 0 8 0 0 97% Philippines RITM 161 2 0 9 137 13 0 97% 6% 28-Aug-19 RITM 6 0 2 0 0 0 0 0 4 0 0 0 0 100% Republic of Korea KCDC 45 0 1 4 37 0 3 100% 12% 12-Aug-19 KCDC 2 0 0 0 0 0 0 0 0 0 2 0 0 100% Singapore SGH 7 0 0 1 6 0 0 100% 14% 06-Sep-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 110 0 0 24 84 2 0 99% 20% 06-Sep-19 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 95 0 0 3 89 3 0 100% 3% 03-Sep-19 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 12 0 0 5 7 0 0 97% 7% 04-Sep-19 VIDRL 0 - - - - - - - - - - - - - Total 3943 31 6 320 3475 19 92 97% 7% 81 0 39 0 0 0 2 0 28 2 10 0 0 97% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPV NegativeNPEV only SabinWild 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 3ROLR%XOOHWLQ  7DEOH/DERUDWRU\FRQILUPDWLRQRISROLRLVRODWHVIURPHQYLURQPHQWDOVDPSOHVLQ– 7DEOH9DFFLQH-GHULYHGSROLRYLUXVLGHQWLILHGIURPODERUDWRU\WHVWLQJ– Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 17 2 0 2 0 0 0 0 0 0 0 12 0 0 0 - - - - - - - - - - - - - China (total) 281 180 0 199 0 0 0 1 0 560 2 1409 0 0 145 89 0 100 0 0 0 0 0 283 0 593 3 0 China, Fujian Prov. Lab/CCDC 73 51 0 20 0 0 0 0 0 107 1 577 0 0 35 21 0 10 0 0 0 0 0 40 0 195 1 0 China, Gansu Prov. Lab/CCDC 12 7 0 2 0 0 0 0 0 12 0 40 0 0 5 5 0 11 0 0 0 0 0 19 0 1 0 0 China, Guangdong Prov. Lab/CCDC 48 41 0 27 0 0 0 0 0 102 1 217 0 0 28 17 0 10 0 0 0 0 0 31 0 162 0 0 China, Guangxi Prov. Lab/CCDC 0 - - - - - - - - - - - - - 6 6 0 2 0 0 0 0 0 14 0 33 0 0 China, Heilongjiang Prov. Lab/CCDC 42 22 0 6 0 0 0 0 0 44 0 106 0 0 12 7 0 3 0 0 0 0 0 19 0 23 0 0 China, Shandong Prov. Lab/CCDC 40 16 0 21 0 0 0 0 0 63 0 282 0 0 14 8 0 1 0 0 0 0 0 13 0 78 1 0 China, Shanghai Prov. Lab/CCDC 12 7 0 3 0 0 0 0 0 11 0 37 0 0 6 4 0 6 0 0 0 0 0 18 0 17 1 0 China, Xinjiang Prov. Lab/CCDC 36 36 0 120 0 0 0 1 0 221 0 109 0 0 21 19 0 54 0 0 0 0 0 127 0 45 0 0 China, Yunnan Prov. Lab/CCDC 18 0 - - - - - - - - - 41 0 0 18 2 0 3 0 0 0 0 0 2 0 39 0 0 Philippines RITM 87 8 0 2 0 0 0 0 0 6 0 24 0 0 82 15 0 8 2 0 0 0 0 10 0 23 7 0 Papua New Guinea RITM 27 23 0 15 7 0 0 0 0 21 0 9 0 0 54 44 0 27 0 0 0 0 0 34 0 31 4 0 Total 412 213 0 218 7 0 0 1 0 587 2 1454 0 0 281 148 0 135 2 0 0 0 0 327 0 647 14 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2018 2019 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP) aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP) aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts) ?VDPV3 (1 AFP) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) ?VDPV1 (2 env) Viet Nam aVDPV2 (2 AFP) 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3).

&KDUW1RQ-SROLR$)3UDWHSHUSHUVRQV\HDUVRIDJH – &KDUW$GHTXDWHVSHFLPHQFROOHFWLRQUDWH– 7KH3KLOLSSLQHVGHFODUHVSROLRYLUXVRXWEUHDN 2Q6HSWHPEHUWKH'HSDUWPHQWRI+HDOWK '2+ DQQRXQFHG DQ RXWEUHDN RI SROLR LQ WKH 3KLOLSSLQHV2QHYDFFLQH-GHULYHGSROLRYLUXV W\SH 9'39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³:H VWURQJO\ XUJH SDUHQWV KHDOWK ZRUNHUV DQG ORFDO JRYHUQPHQWV WR IXOO\ SDUWLFLSDWH LQ WKH V\QFKURQL]HG SROLR YDFFLQDWLRQ´ +HDOWK 6HFUHWDU\ )UDQFLVFR 'XTXH ,,, VDLG DGGLQJ WKDW ³,W LV WKH RQO\ZD\WRVWRSWKHSROLRRXWEUHDNDQGWRSURWHFW FKLOGUHQDJDLQVWWKLVSDUDO\]LQJGLVHDVH´ 3ROLR%XOOHWLQ ,VVXH1R-:HHNDVRI6HSWHPEHU &KDUW3HUFHQWDJHRIUHSRUWHG$)3FDVHVZLWKSHQGLQJFODVVLILFDWLRQ !GD\VDIWHURQVHW &KDUW3HUFHQWDJHRIUHSRUWHG$)3FDVHVE\QXPEHURI SROLRYDFFLQDWLRQGRVHV 1RWH3ULRULW\FRXQWULHVZHUHVHOHFWHGIRUWKHFKDUWV2IILFLDO:+2DFURQ\PVKDYHEHHQXVHGIRUDEEUHYLDWLRQ&+1&KLQD.+0&DPERGLD /$2/DR3HRSOH¶V'HPRFUDWLF5HSXEOLF0<60DOD\VLD3+/3KLOLSSLQHV31*3DSXD1HZ*XLQHDDQG9109LHW1DP ([SDQGHG3URJUDPPHRQ,PPXQL]DWLRQ 5HJLRQDO2IILFHIRUWKH:HVWHUQ3DFLILF :RUOG+HDOWK2UJDQL]DWLRQ 32%R[0DQLOD3KLOLSSLQHV 3KRQH )D[ (PDLOZSURHSLGDWD#ZKRLQW :HEZZZZKRLQWZHVWHUQSDFLILF &217$&786 +,*+/,*+76 $)3UDWHDQQXDOL]HGDVRIZHHN 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 20.0% 1.1% 31.4% 37.1% 0.0% 0.0% 25.6% 0% 5% 10% 15% 20% 25% 30% 35% 40% VNM PNG PHL MYS LAO KHM CHN 7DEOH&ODVVLILFDWLRQRI$)3FDVHVZLWKRQVHWLQDQGNH\VXUYHLOODQFHLQGLFDWRUV 3ROLR%XOOHWLQ  2018 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 57 47 43 0 0 0 33 10 3 (7.0%) 1.25 35% 98% 23-Sep-19 1 Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.37 100% 100% 05-Sep-19 19 Cambodia 73 46 38 0 0 0 37 1 0 (0.0%) 1.13 87% 92% 06-Sep-19 18 China 5292 2486 3340 0 2 0 1832 1506 855 (25.6%) 1.84 92% 100% 19-Sep-19 5 China, Hong Kong SAR 11 9 10 0 0 0 10 0 0 (0.0%) 1.52 70% 90% 16-Sep-19 8 China, Macao SAR 3 1 0 - - - - - - - - - 13-Sep-19 11 Japan - 154 - - - - - - - - - - - - Lao People's Democratic Republic 94 23 50 0 0 0 40 10 0 (0.0%) 2.97 78% 74% 13-Sep-19 11 Malaysia 171 78 70 0 0 0 17 53 26 (37.1%) 1.23 73% 49% 22-Jul-19 64 Mongolia 6 9 4 0 0 0 4 0 0 (0.0%) 0.61 100% 100% 10-Sep-19 14 New Zealand 10 9 3 0 0 0 3 0 0 (0.0%) 0.46 67% 100% 11-Sep-19 13 Papua New Guinea 287 33 182 0 0 0 165 17 2 (1.1%) 7.55 75% 78% 04-Sep-19 20 Philippines 332 344 137 0 0 0 76 61 43 (31.4%) 0.54 55% 93% 20-Sep-19 4 Republic of Korea 70 66 48 0 0 0 37 11 1 (2.1%) 1.00 94% 98% 16-Sep-19 8 Singapore 13 6 5 0 0 0 5 0 0 (0.0%) 1.14 100% 100% 04-Sep-19 20 Viet Nam 352 237 210 0 0 0 90 120 42 (20.0%) 1.21 97% 92% 09-Sep-19 15 Pacific island countries and areas 13 11 16 0 0 0 10 6 3 (18.8%) 1.99 63% 88% 11-Sep-19 13 Total 6786 3560 4157 0 2 0 2360 1795 975 (23.5%) 1.60 89% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for o ther indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) 2019 Non-polio AFP rate 2 Total % with adequate specimens 3 7DEOH/DERUDWRU\LQYHVWLJDWLRQRIVWRROVDPSOHVIURP$)3FDVHVZLWKRQVHWLQDQGNH\ODERUDWRU\LQGLFDWRUV 3ROLR%XOOHWLQ  ≥ 80% ≥ 80% Australia VIDRL 29 0 0 2 27 0 0 98% 6% 23-Sep-19 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 37 0 0 3 34 0 0 97% 5% 13-Sep-19 NIID 0 - - - - - - - - - - - - - China (total) 3279 18 0 208 2964 0 89 97% 6% 19-Sep-19 39 0 14 0 0 0 2 0 21 2 0 0 0 94% China, Anhui Prov. Lab 197 2 0 9 185 0 1 100% 4% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Beijing Prov. Lab 30 0 0 0 30 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 34 0 0 1 30 0 3 79% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 93 0 0 6 86 0 1 100% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Gansu Prov. Lab 82 0 0 0 81 0 1 98% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 282 1 0 16 263 0 2 96% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangxi Prov. Lab 158 0 0 25 131 0 2 100% 13% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 139 0 0 14 119 0 6 98% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 17 0 0 0 16 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 180 1 0 14 164 0 1 100% 6% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 69 0 0 3 62 0 4 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 324 3 0 27 292 0 2 95% 7% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 75% China, Hubei Prov. Lab 118 0 0 13 94 0 11 98% 12% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 152 0 0 10 139 0 3 99% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 130 0 0 7 121 0 2 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 88 0 0 1 82 0 5 96% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 24 2 0 1 20 0 1 100% 4% Prov. Lab/CCDC 3 0 1 0 0 0 0 0 0 2 0 0 0 100% China, Liaoning Prov. Lab 44 0 0 0 40 0 4 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 64 2 0 1 60 0 1 98% 2% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Ningxia Prov. Lab 14 0 0 0 13 0 1 92% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 21 0 0 2 17 0 2 95% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 68 1 0 3 59 0 5 75% 3% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 50% China, Shandong Prov. Lab 216 1 0 8 205 0 2 98% 3% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Shanghai Prov. Lab 18 0 0 0 18 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 86 0 0 2 84 0 0 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 237 2 0 25 200 0 10 98% 10% Prov. Lab/CCDC 4 0 0 0 0 0 2 0 2 0 0 0 0 100% China, Tianjin Prov. Lab 16 0 0 0 16 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 98 3 0 1 92 0 2 99% 1% Prov. Lab/CCDC 6 0 4 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 171 0 0 7 148 0 16 96% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 101 0 0 12 89 0 0 100% 10% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 8 0 0 0 8 0 0 38% 0% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 9 0 0 0 9 0 0 100% 0% 13-Sep-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - - PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 47 0 0 8 39 0 0 91% 14% 19-Sep-19 NIID 0 - - - - - - - - - - - - - Malaysia IMR 96 0 0 2 94 0 0 92% 1% 17-Sep-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 4 0 0 0 4 0 0 100% 0% 20-Sep-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 4 0 0 0 3 1 0 100% 0% 23-Sep-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 200 12 5 65 118 0 0 99% 27% 16-Sep-19 VIDRL 37 0 25 0 0 0 0 0 4 0 8 0 0 97% Philippines RITM 206 4 0 12 171 19 0 96% 6% 20-Sep-19 RITM 14 0 2 0 0 0 8 0 4 0 0 0 0 100% Republic of Korea KCDC 48 0 1 4 41 0 2 100% 11% 16-Sep-19 KCDC 2 0 0 0 0 0 0 0 0 0 2 0 0 100% Singapore SGH 7 0 0 1 6 0 0 100% 14% 20-Sep-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 110 0 0 24 84 2 0 99% 20% 06-Sep-19 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 105 0 0 4 97 4 0 100% 4% 24-Sep-19 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 13 0 0 5 8 0 0 97% 7% 16-Sep-19 VIDRL 0 - - - - - - - - - - - - - Total 4195 34 6 338 3700 26 91 97% 7% 92 0 41 0 0 0 10 0 29 2 10 0 0 96% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPV NegativeNPEV only SabinWild 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 3ROLR%XOOHWLQ  7DEOH/DERUDWRU\FRQILUPDWLRQRISROLRLVRODWHVIURPHQYLURQPHQWDOVDPSOHVLQ– 7DEOH9DFFLQH-GHULYHGSROLRYLUXVLGHQWLILHGIURPODERUDWRU\WHVWLQJ– Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 17 2 0 2 0 0 0 0 0 0 0 12 0 0 0 - - - - - - - - - - - - - China (total) 281 180 0 199 0 0 0 1 0 560 2 1409 0 0 175 99 0 102 0 0 0 0 0 301 0 722 0 0 China, Fujian Prov. Lab/CCDC 73 51 0 20 0 0 0 0 0 107 1 577 0 0 47 24 0 10 0 0 0 0 0 45 0 273 0 0 China, Gansu Prov. Lab/CCDC 12 7 0 2 0 0 0 0 0 12 0 40 0 0 5 5 0 11 0 0 0 0 0 19 0 1 0 0 China, Guangdong Prov. Lab/CCDC 48 41 0 27 0 0 0 0 0 102 1 217 0 0 32 20 0 10 0 0 0 0 0 35 0 172 0 0 China, Guangxi Prov. Lab/CCDC 0 - - - - - - - - - - - - - 6 6 0 2 0 0 0 0 0 14 0 33 0 0 China, Heilongjiang Prov. Lab/CCDC 42 22 0 6 0 0 0 0 0 44 0 106 0 0 20 10 0 4 0 0 0 0 0 26 0 48 0 0 China, Shandong Prov. Lab/CCDC 40 16 0 21 0 0 0 0 0 63 0 282 0 0 20 9 0 2 0 0 0 0 0 15 0 94 0 0 China, Shanghai Prov. Lab/CCDC 12 7 0 3 0 0 0 0 0 11 0 37 0 0 6 4 0 6 0 0 0 0 0 18 0 17 0 0 China, Xinjiang Prov. Lab/CCDC 36 36 0 120 0 0 0 1 0 221 0 109 0 0 21 19 0 54 0 0 0 0 0 127 0 45 0 0 China, Yunnan Prov. Lab/CCDC 18 0 - - - - - - - - - 41 0 0 18 2 0 3 0 0 0 0 0 2 0 39 0 0 Philippines RITM 87 8 0 2 0 0 0 0 0 6 0 24 0 0 98 23 0 15 8 0 0 12 0 24 0 29 6 0 Papua New Guinea RITM 27 23 0 15 7 0 0 0 0 21 0 9 0 0 54 47 0 29 0 0 0 0 0 37 0 35 0 0 Total 412 213 0 218 7 0 0 1 0 587 2 1454 0 0 327 169 0 146 8 0 0 12 0 362 0 786 6 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2018 2019 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP) aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP) aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts) ?VDPV3 (1 AFP) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) ?VDPV1 (4 env) cVDPV2 (1 AFP + 3 env) ?VDPV2 (1 AFP) Viet Nam aVDPV2 (2 AFP) 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3).

Polio Bulletin 2019 Issue No. 19 - Week 40 (as of 9 October 2019) Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific Update on polio outbreak response in the Philippines Preparation for the polio outbreak response in the Philippines is in progress. The Department of Health supported by WHO, UNICEF and other GPEI partners is initiating a comprehensive response to the outbreaks of circulating vaccine-derived polio virus type 1 and type 2. The main objectives of the response include: 1. To interrupt circulation and prevent new emergence of cVDPVs by: a. achieving at least 95% vaccination coverage in children below five years of age with mOPV2 in outbreak-affected areas; b. achieving at least 95% vaccination coverage in children below five years of age with bOPV. 2. To enhance AFP surveillance, especially in high risk areas of the country. The vaccination rounds will start on 14 October in Davao city, Davao del Sur and Lanao del Sur with mOPV2 and in the National Capital Region with bOPV. Further details are available at the following web link: https://reliefweb.int/sites/reliefweb.int/files/resources/ UNICEF%20WHO%20PHL%20SitRep%203_Polio%20 Outbreak_8Oct2019.pdf CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2017–2019* Chart 2. Adequate specimen collection rate, 2017–2019 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2019 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2019 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 20.0% 5.2% 29.8% 37.1% 0.0% 0.0% 25.5% 0% 5% 10% 15% 20% 25% 30% 35% 40% VNM PNG PHL MYS LAO KHM CHN * AFP rate annualized as of week 40 2018 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 57 47 48 0 0 0 41 7 1 (2.1%) 1.33 33% 100% 08-Oct-19 1 Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.30 100% 100% 05-Sep-19 34 Cambodia 73 46 42 0 0 0 37 5 0 (0.0%) 1.19 86% 90% 24-Sep-19 15 China 5292 2486 3439 0 2 0 1934 1503 878 (25.5%) 1.80 92% 100% 30-Sep-19 9 China, Hong Kong SAR 11 9 11 0 0 0 10 1 0 (0.0%) 1.59 73% 100% 02-Oct-19 7 China, Macao SAR 3 1 0 - - - - - - - - - 13-Sep-19 26 Japan - 154 - - - - - - - - - - - - Lao People's Democratic Republic 94 23 52 0 0 0 50 2 0 (0.0%) 2.94 79% 75% 08-Oct-19 1 Malaysia 171 78 70 0 0 0 17 53 26 (37.1%) 1.17 73% 49% 22-Jul-19 79 Mongolia 6 9 4 0 0 0 4 0 0 (0.0%) 0.58 100% 100% 10-Sep-19 29 New Zealand 10 9 3 0 0 0 3 0 0 (0.0%) 0.43 67% 100% 11-Sep-19 28 Papua New Guinea 287 33 194 0 0 0 169 25 10 (5.2%) 7.64 77% 76% 07-Oct-19 2 Philippines 332 344 245 0 0 0 108 137 73 (29.8%) 0.93 46% 93% 30-Sep-19 9 Republic of Korea 70 66 48 0 0 0 37 11 1 (2.1%) 0.95 94% 98% 16-Sep-19 23 Singapore 13 6 5 0 0 0 5 0 0 (0.0%) 1.08 100% 100% 08-Oct-19 1 Viet Nam 352 237 210 0 0 0 90 120 42 (20.0%) 1.15 97% 92% 09-Sep-19 30 Pacific island countries and areas 13 11 18 0 0 0 10 8 3 (16.7%) 2.13 61% 89% 08-Oct-19 1 Total 6786 3560 4390 0 2 0 2516 1872 1034 (23.6%) 1.60 88% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO 2019 Non-polio AFP rate 2 Total % with adequate specimens 3> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) Days since last report 5 % investigated ≤  2 days of notification 4 Indicators Latest report date Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Table 1. Classification of AFP cases with onset in 2019 and key surveillance indicators 2 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 33 0 0 2 28 3 0 98% 5% 08-Oct-19 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 37 0 0 3 34 0 0 97% 5% 13-Sep-19 NIID 0 - - - - - - - - - - - - - China (total) 3379 19 0 220 3058 0 82 97% 6% 30-Sep-19 41 0 14 0 0 0 2 0 23 2 0 0 0 94% China, Anhui Prov. Lab 204 2 0 9 193 0 0 100% 4% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Beijing Prov. Lab 31 0 0 0 30 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 34 0 0 1 32 0 1 80% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 94 0 0 6 86 0 2 100% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Gansu Prov. Lab 84 0 0 1 82 0 1 98% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 289 1 0 17 269 0 2 95% 6% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangxi Prov. Lab 163 0 0 25 136 0 2 100% 13% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 144 0 0 16 127 0 1 97% 10% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Hainan Prov. Lab 19 0 0 0 18 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 190 1 0 15 173 0 1 100% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 71 0 0 3 65 0 3 100% 4% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 75% China, Henan Prov. Lab 336 3 0 27 303 0 3 95% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hubei Prov. Lab 121 0 0 13 94 0 14 98% 12% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 160 0 0 10 147 0 3 99% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 134 0 0 7 122 0 5 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 93 0 0 1 86 0 6 97% 1% Prov. Lab/CCDC 3 0 1 0 0 0 0 0 0 2 0 0 0 100% China, Jilin Prov. Lab 22 2 0 1 18 0 1 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 44 0 0 0 41 0 3 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 68 2 0 1 65 0 0 99% 1% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Ningxia Prov. Lab 15 0 0 0 14 0 1 93% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 21 0 0 2 17 0 2 95% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 69 1 0 3 62 0 3 72% 3% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 50% China, Shandong Prov. Lab 224 1 0 11 209 0 3 98% 4% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Shanghai Prov. Lab 20 0 0 0 20 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 86 0 0 1 85 0 0 99% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 239 2 0 25 195 0 17 98% 10% Prov. Lab/CCDC 4 0 0 0 0 0 2 0 2 0 0 0 0 100% China, Tianjin Prov. Lab 17 0 0 1 16 0 0 94% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 99 3 0 1 92 0 3 99% 1% Prov. Lab/CCDC 6 0 4 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 174 1 0 11 159 0 3 94% 4% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Zhejiang Prov. Lab 105 0 0 12 93 0 0 100% 10% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 9 0 0 0 9 0 0 33% 0% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 10 0 0 0 9 1 0 100% 0% 02-Oct-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - 02-Oct-19 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 50 1 0 10 39 0 0 92% 17% 30-Sep-19 NIID 2 0 0 0 0 0 0 0 2 0 0 0 0 100% Malaysia IMR 96 0 0 2 94 0 0 92% 1% 17-Sep-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 4 0 0 0 4 0 0 100% 0% 08-Oct-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 4 0 0 0 4 0 0 100% 0% 08-Oct-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 214 12 5 66 124 7 0 100% 27% 09-Oct-19 VIDRL 37 0 25 0 0 0 0 0 4 0 8 0 0 97% Philippines RITM 327 4 0 15 234 74 0 96% 7% 04-Oct-19 RITM 14 0 2 0 0 0 8 0 4 0 0 0 0 100% Republic of Korea KCDC 48 0 1 4 41 0 2 100% 11% 16-Sep-19 KCDC 2 0 0 0 0 0 0 0 0 0 2 0 0 100% Singapore SGH 8 0 0 1 6 1 0 100% 14% 04-Oct-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 110 0 0 24 84 2 0 99% 20% 06-Sep-19 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 122 0 0 5 109 8 0 100% 4% 07-Oct-19 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 13 0 0 5 8 0 0 97% 7% 16-Sep-19 VIDRL 0 - - - - - - - - - - - - - Total 4456 36 6 357 3877 96 84 97% 7% 96 0 41 0 0 0 10 0 33 2 10 0 0 96% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPV NegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Table 2. Laboratory investigation of stool samples from AFP cases with onset in 2019 and key laboratory indicators 3 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 17 2 0 2 0 0 0 0 0 0 0 12 0 0 0 - - - - - - - - - - - - - China (total) 281 180 0 199 0 0 0 1 0 560 2 1409 0 0 175 99 0 102 0 0 0 0 0 301 0 722 0 0 China, Fujian Prov. Lab/CCDC 73 51 0 20 0 0 0 0 0 107 1 577 0 0 47 24 0 10 0 0 0 0 0 45 0 273 0 0 China, Gansu Prov. Lab/CCDC 12 7 0 2 0 0 0 0 0 12 0 40 0 0 5 5 0 11 0 0 0 0 0 19 0 1 0 0 China, Guangdong Prov. Lab/CCDC 48 41 0 27 0 0 0 0 0 102 1 217 0 0 32 20 0 10 0 0 0 0 0 35 0 172 0 0 China, Guangxi Prov. Lab/CCDC 0 - - - - - - - - - - - - - 6 6 0 2 0 0 0 0 0 14 0 33 0 0 China, Heilongjiang Prov. Lab/CCDC 42 22 0 6 0 0 0 0 0 44 0 106 0 0 20 10 0 4 0 0 0 0 0 26 0 48 0 0 China, Shandong Prov. Lab/CCDC 40 16 0 21 0 0 0 0 0 63 0 282 0 0 20 9 0 2 0 0 0 0 0 15 0 94 0 0 China, Shanghai Prov. Lab/CCDC 12 7 0 3 0 0 0 0 0 11 0 37 0 0 6 4 0 6 0 0 0 0 0 18 0 17 0 0 China, Xinjiang Prov. Lab/CCDC 36 36 0 120 0 0 0 1 0 221 0 109 0 0 21 19 0 54 0 0 0 0 0 127 0 45 0 0 China, Yunnan Prov. Lab/CCDC 18 0 - - - - - - - - - 41 0 0 18 2 0 3 0 0 0 0 0 2 0 39 0 0 Philippines RITM 87 8 0 2 0 0 0 0 0 6 0 24 0 0 97 24 0 15 26 0 0 12 0 18 0 30 1 0 Papua New Guinea RITM 27 23 0 15 7 0 0 0 0 21 0 9 0 0 58 48 0 30 0 0 0 0 0 37 0 39 0 0 Total 412 213 0 218 7 0 0 1 0 587 2 1454 0 0 330 171 0 147 26 0 0 12 0 356 0 791 1 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2018 2019 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD Table 3. Laboratory confirmation of polio isolates from environmental samples in 2018–20191 4 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2019 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Australia aVDPV2 (1 env) Cambodia 2006 - 1 Total - 2 China 2009 - 1Total - 27 aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP) aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP) aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) ?VDPV3 (1 AFP) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1 Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (8 env) cVDPV2 (1 AFP + 3 env) ?VDPV2 (1 AFP) Viet Nam aVDPV2 (2 AFP) 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3).

Polio Bulletin 2019 Issue No. 20 - Week 42 (as of 22 October 2019) Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific Wild poliovirus type 3 is globally eradicated! In an historic announcement on World Polio Day, 24 October 2019, an independent commission of experts concluded that wild poliovirus type 3 (WPV3) has been eradicated worldwide. WPV3 is the second strain of the poliovirus to be wiped out, following the certification of the eradication of WPV2 in 2015. The last case of WPV3 was detected in northern Nigeria in 2012. Following the meeting of the independent Global Certification Commission (GCC) for Poliomyelitis Eradication on 17–18 October 2019, Professor David Salisbury, Chairperson of the GCC, will present the official certificate of WPV3 eradication to WHO Director-General, Dr Tedros Adhanom Ghebreyesus at a celebration event at the WHO Headquarters in Geneva, Switzerland. “Wild poliovirus type 3 is globally eradicated,” said Professor Salisbury. “This is a significant achievement that should reinvigorate the eradication process and provides motivation for the final step – the eradication of wild poliovirus type 1.” The event will be web-streamed via Webex on 24 October 2019 (Thursday) 17:30 hrs (GMT+2) at this link: h t tps : / /who-mee t i ng .webex . com/who-mee t i ng / j . php?MTID=mc6de133ddfff591d99190733c4b8ef67 CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2017–2019* Chart 2. Adequate specimen collection rate, 2017–2019 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2019 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2019 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 17 18 19 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 15.3% 5.2% 29.8% 17.3% 0.0% 0.0% 6.8% 0% 5% 10% 15% 20% 25% 30% 35% VNM PNG PHL MYS LAO KHM CHN * AFP rate annualized as of week 42 Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam). 2018 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 57 47 53 0 0 0 41 12 2 (3.8%) 1.40 36% 100% 21-Oct-19 1 Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.24 100% 100% 05-Sep-19 47 Cambodia 73 46 43 0 0 0 41 2 0 (0.0%) 1.16 86% 91% 11-Oct-19 11 China 5292 2486 3678 0 2 0 2843 833 249 (6.8%) 1.83 92% 100% 17-Oct-19 5 China, Hong Kong SAR 11 9 11 0 0 0 10 1 0 (0.0%) 1.51 73% 100% 10-Oct-19 12 China, Macao SAR 3 1 1 0 0 0 0 1 0 (0.0%) 1.24 100% 100% 14-Oct-19 8 Japan - 154 - - - - - - - - - - - - Lao People's Democratic Republic 94 23 55 0 0 0 50 5 0 (0.0%) 2.96 78% 76% 15-Oct-19 7 Malaysia 171 78 104 0 0 0 66 38 18 (17.3%) 1.65 76% 70% 17-Oct-19 5 Mongolia 6 9 4 0 0 0 4 0 0 (0.0%) 0.55 100% 100% 11-Oct-19 11 New Zealand 10 9 3 0 0 0 3 0 0 (0.0%) 0.41 67% 100% 11-Sep-19 41 Papua New Guinea 287 33 194 0 0 0 169 25 10 (5.2%) 7.28 77% 76% 07-Oct-19 15 Philippines 332 344 245 0 0 0 108 137 73 (29.8%) 0.88 46% 93% 30-Sep-19 22 Republic of Korea 70 66 53 0 0 0 45 8 0 (0.0%) 0.99 92% 100% 17-Oct-19 5 Singapore 13 6 5 0 0 0 5 0 0 (0.0%) 1.03 100% 100% 08-Oct-19 14 Viet Nam 352 237 248 0 0 0 175 73 38 (15.3%) 1.30 96% 92% 16-Oct-19 6 Pacific island countries and areas 13 11 18 0 0 0 10 8 3 (16.7%) 2.03 61% 89% 08-Oct-19 14 Total 6786 3560 4716 0 2 0 3571 1143 393 (8.3%) 1.64 88% 97% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Days since last report 5 % investigated ≤  2 days of notification 4 Indicators Latest report date 2019 Non-polio AFP rate 2 Total % with adequate specimens 3> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Table 1. Classification of AFP cases with onset in 2019 and key surveillance indicators 2 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 37 0 0 2 31 4 0 95% 5% 21-Oct-19 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 04-Feb-19 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 41 0 0 3 38 0 0 98% 5% 10-Oct-19 NIID 0 - - - - - - - - - - - - - China (total) 3621 19 0 245 3281 1 75 97% 6% 17-Oct-19 41 0 14 0 0 0 2 0 23 2 0 0 0 94% China, Anhui Prov. Lab 228 2 0 11 209 0 6 100% 5% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Beijing Prov. Lab 32 0 0 0 30 0 2 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 34 0 0 1 31 0 2 79% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 101 0 0 6 94 0 1 100% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Gansu Prov. Lab 91 0 0 3 87 0 1 97% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 305 1 0 17 283 0 4 95% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangxi Prov. Lab 169 0 0 25 144 0 0 100% 12% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 162 0 0 19 139 1 3 97% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 19 0 0 0 18 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 210 1 0 15 193 0 1 100% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 74 0 0 3 66 0 5 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 363 3 0 31 326 0 3 96% 7% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 75% China, Hubei Prov. Lab 131 0 0 16 113 0 2 98% 12% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 174 0 0 12 159 0 3 99% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 139 0 0 8 131 0 0 100% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 98 0 0 2 92 0 4 97% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 24 2 0 1 18 0 3 100% 7% Prov. Lab/CCDC 3 0 1 0 0 0 0 0 0 2 0 0 0 100% China, Liaoning Prov. Lab 48 0 0 0 45 0 3 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 76 2 0 1 73 0 0 97% 1% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Ningxia Prov. Lab 15 0 0 0 14 0 1 93% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 21 0 0 2 18 0 1 95% 10% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 74 1 0 3 68 0 2 74% 3% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 50% China, Shandong Prov. Lab 244 1 0 13 218 0 12 98% 5% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Shanghai Prov. Lab 25 0 0 0 25 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 77 0 0 0 76 0 1 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 266 2 0 26 228 0 10 98% 9% Prov. Lab/CCDC 4 0 0 0 0 0 2 0 2 0 0 0 0 100% China, Tianjin Prov. Lab 19 0 0 1 18 0 0 95% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 104 3 0 4 95 0 2 96% 4% Prov. Lab/CCDC 6 0 4 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 176 1 0 12 161 0 2 93% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Zhejiang Prov. Lab 113 0 0 13 100 0 0 99% 10% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 9 0 0 0 9 0 0 33% 0% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 10 0 0 0 10 0 0 100% 0% 15-Oct-19 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - 15-Oct-19 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 50 1 0 10 39 0 0 92% 17% 30-Sep-19 NIID 2 0 0 0 0 0 0 0 2 0 0 0 0 100% Malaysia IMR 109 0 0 3 106 0 0 93% 2% 12-Oct-19 IMR 0 - - - - - - - - - - - - - Mongolia PHI 4 0 0 0 4 0 0 100% 0% 18-Oct-19 NIID 0 - - - - - - - - - - - - - New Zealand IESR 4 0 0 0 4 0 0 100% 0% 21-Oct-19 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 214 12 5 70 127 0 0 99% 28% 15-Oct-19 VIDRL 37 0 25 0 0 0 0 0 4 0 8 0 0 97% Philippines RITM 417 4 0 22 291 100 0 96% 8% 15-Oct-19 RITM 18 0 2 0 0 0 12 0 4 0 0 0 0 100% Republic of Korea KCDC 53 0 1 4 48 0 0 100% 10% 17-Oct-19 KCDC 2 0 0 0 0 0 0 0 0 0 2 0 0 100% Singapore SGH 8 0 0 1 7 0 0 100% 13% 18-Oct-19 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 137 0 0 28 102 7 0 100% 19% 19-Oct-19 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 129 0 0 5 113 11 0 100% 4% 14-Oct-19 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 13 0 0 5 8 0 0 97% 7% 16-Sep-19 VIDRL 0 - - - - - - - - - - - - - Total 4848 36 6 398 4210 123 75 97% 7% 100 0 41 0 0 0 14 0 33 2 10 0 0 96% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); KCDC (Korea Centers for Disease Control and Prevention, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2. Laboratory investigation of stool samples from AFP cases with onset in 2019 and key laboratory indicators 3 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 17 2 0 2 0 0 0 0 0 0 0 12 0 0 0 - - - - - - - - - - - - - China (total) 281 180 0 199 0 0 0 1 0 560 2 1409 0 0 171 102 0 112 0 0 0 0 0 345 0 701 3 0 China, Fujian Prov. Lab/CCDC 73 51 0 20 0 0 0 0 0 107 1 577 0 0 35 21 0 10 0 0 0 0 0 40 0 195 1 0 China, Gansu Prov. Lab/CCDC 12 7 0 2 0 0 0 0 0 12 0 40 0 0 12 10 0 19 0 0 0 0 0 58 0 21 0 0 China, Guangdong Prov. Lab/CCDC 48 41 0 27 0 0 0 0 0 102 1 217 0 0 36 23 0 11 0 0 0 0 0 39 0 186 0 0 China, Guangxi Prov. Lab/CCDC 0 - - - - - - - - - - - - - 8 7 0 5 0 0 0 0 0 24 0 37 0 0 China, Heilongjiang Prov. Lab/CCDC 42 22 0 6 0 0 0 0 0 44 0 106 0 0 12 7 0 3 0 0 0 0 0 19 0 23 0 0 China, Shandong Prov. Lab/CCDC 40 16 0 21 0 0 0 0 0 63 0 282 0 0 14 8 0 1 0 0 0 0 0 13 0 78 1 0 China, Shanghai Prov. Lab/CCDC 12 7 0 3 0 0 0 0 0 11 0 37 0 0 8 5 0 6 0 0 0 0 0 23 0 28 1 0 China, Xinjiang Prov. Lab/CCDC 36 36 0 120 0 0 0 1 0 221 0 109 0 0 24 19 0 54 0 0 0 0 0 127 0 68 0 0 China, Yunnan Prov. Lab/CCDC 18 0 - - - - - - - - - 41 0 0 22 2 0 3 0 0 0 0 0 2 0 65 0 0 Philippines RITM 87 8 0 2 0 0 0 0 0 6 0 24 0 0 114 34 0 17 29 0 0 12 0 24 0 38 0 0 Papua New Guinea RITM 27 23 0 15 7 0 0 0 0 21 0 9 0 0 58 48 0 30 0 0 0 0 0 37 0 39 0 0 Total 412 213 0 218 7 0 0 1 0 587 2 1454 0 0 343 184 0 159 29 0 0 12 0 406 0 778 3 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2018 2019 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD Table 3. Laboratory confirmation of polio isolates from environmental samples in 2018–20191 4 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2019 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP) aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP) aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP) aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) ?VDPV3 (1 AFP) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (10 env) cVDPV2 (1 AFP + 3 env) iVDPV2 (1 AFP) Viet Nam aVDPV2 (2 AFP) 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3).