Polio Bulletin - 2018, Issue no. 20 (Week 40)

Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2016–2018* Chart 2. Adequate specimen collection rate, 2016–2018 100 Days of the Polio Outbreak Response To mark the 100 days since the Government of Papua New Guinea launched the Emergency Response to the Polio Outbreak, the National Department of Health, with support from WHO, UNICEF and other partners released a report on the key accomplishments and highlights from the response operations. The 100 Days Report is dedicated to the thousands of front line polio workers who braved challenges and worked long hours to ensure that children in Papua New Guinea are protected from polio. To read full report please visit: http://www.who.int/docs/default-source/wpro--- documents/emergency/polio/20181004-polio-100- days.pdf?sfvrsn=2f371529_2 Polio Bulletin 2018 Issue No. 20 - Week 40 (as of 10 October 2018) 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 * AFP rate annualized as of week 40 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 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 38.7% 24.1% 15.8% 15.0% 2.5% 0.0% 7.0% 0% 10% 20% 30% 40% 50% 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 61 46 46 0 0 2 27 17 6 (13.0%) 1.30 48% 78% 04-Oct-18 5 Brunei Darrusalam 1 1 2 0 0 0 1 1 0 (0.0%) 2.60 100% 100% 03-Sep-18 36 Cambodia 57 44 59 0 0 0 58 1 0 (0.0%) 1.74 90% 86% 03-Oct-18 6 China 5278 2256 3187 0 1 0 2332 854 223 (7.0%) 1.84 91% 100% 05-Oct-18 4 China, Hong Kong SAR 15 9 9 0 0 0 6 3 0 (0.0%) 1.30 100% 100% 03-Oct-18 6 China, Macao SAR 2 1 2 0 0 0 1 1 0 (0.0%) 2.60 100% 100% 18-Sep-18 21 Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 103 21 40 0 0 0 31 9 1 (2.5%) 2.48 93% 73% 24-Aug-18 46 Malaysia 154 77 127 0 0 0 72 55 19 (15.0%) 2.14 79% 72% 19-Sep-18 20 Mongolia 6 9 5 0 0 0 4 1 0 (0.0%) 0.72 100% 80% 07-Sep-18 32 New Zealand 13 9 6 0 0 0 6 0 0 (0.0%) 0.87 67% 100% 31-Aug-18 39 Papua New Guinea 29 37 141 0 14 2 33 92 34 (24.1%) 4.46 40% 82% 08-Oct-18 1 Philippines 462 338 221 0 0 0 160 61 35 (15.8%) 0.85 62% 94% 02-Oct-18 7 Republic of Korea 68 67 41 0 0 0 31 10 0 (0.0%) 0.80 88% 100% 11-Sep-18 28 Singapore 7 6 8 0 0 0 8 0 0 (0.0%) 1.73 88% 100% 10-Sep-18 29 Viet Nam 385 234 106 0 0 0 50 56 41 (38.7%) 0.59 96% 87% 30-Aug-18 40 Pacific island countries and areas 16 11 1 0 0 0 1 0 0 (0.0%) 0.12 0% 100% 24-Aug-18 46 Total 6657 3327 4001 0 15 4 2821 1161 359 (9.0%) 1.56 87% 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 Discarded (Non-polio) 2018 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 2. Laboratory investigation of stool samples from AFP cases with onset in 2018 and key laboratory indicators Polio Bulletin 3 ≥ 80% ≥ 80% Australia VIDRL 36 0 0 1 33 1 1 92% 3% 04-Oct-18 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 2 0 0 0 2 0 0 50% 0% 10-Sep-18 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 59 0 0 12 47 0 0 92% 18% 01-Oct-18 NIID 0 - - - - - - - - - - - - - China (total) 3136 21 0 259 2760 0 96 98% 7% 05-Oct-18 70 0 15 0 0 0 0 0 47 8 0 0 0 100% China, Anhui Prov. Lab 178 1 0 12 157 0 8 100% 6% Prov. Lab/CCDC 8 0 3 0 0 0 0 0 5 0 0 0 0 100% China, Beijing Prov. Lab 23 0 0 0 23 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 22 0 0 2 18 0 2 85% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 121 1 0 12 101 0 7 100% 9% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Gansu Prov. Lab 69 1 0 4 59 0 5 100% 5% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Guangdong Prov. Lab 262 1 0 15 245 0 1 92% 4% Prov. Lab/CCDC 4 0 0 0 0 0 0 0 4 0 0 0 0 100% China, Guangxi Prov. Lab 131 1 0 14 115 0 1 98% 10% Prov. Lab/CCDC 2 0 1 0 0 0 0 0 1 0 0 0 0 100% China, Guizhou Prov. Lab 101 0 0 7 90 0 4 98% 7% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 170 0 0 23 145 0 2 100% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 68 0 0 2 66 0 0 100% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 359 2 0 46 308 0 3 100% 12% Prov. Lab/CCDC 6 0 2 0 0 0 0 0 4 0 0 0 0 100% China, Hubei Prov. Lab 96 0 0 7 88 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 149 0 0 21 128 0 0 99% 12% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 114 5 0 10 97 0 2 100% 8% Prov. Lab/CCDC 17 0 0 0 0 0 0 0 9 8 0 0 0 100% China, Jiangxi Prov. Lab 103 1 0 5 94 0 3 96% 3% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Jilin Prov. Lab 36 2 0 4 28 0 2 100% 9% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Neimongol Prov. Lab 56 2 0 2 52 0 0 96% 3% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 100% China, Ningxia Prov. Lab 13 0 0 1 11 0 1 100% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 58 0 0 2 54 0 2 88% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 259 2 0 20 230 0 7 100% 6% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 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 83 0 0 1 81 0 1 96% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 180 0 0 5 148 0 27 97% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 16 0 0 0 16 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 91 1 0 7 82 0 1 89% 7% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 166 0 0 24 137 0 5 93% 12% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Zhejiang Prov. Lab 98 1 0 7 88 0 2 100% 7% Prov. Lab/CCDC 5 0 0 0 0 0 0 0 5 0 0 0 0 100% China, Hainan Prov. Lab 25 0 0 5 20 0 0 100% 18% CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 43 0 0 0 36 0 7 100% 0% CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 23 0 0 0 21 0 2 100% 0% CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 3 0 0 1 2 0 0 60% 20% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 9 0 0 0 9 0 0 100% 0% 03-Oct-18 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 19-Sep-18 PHLC 0 - - - - - - - - - - - - - Japan NIID 0 - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 68 1 0 8 59 0 0 99% 7% 02-Oct-18 NIID 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Malaysia IMR 121 0 0 8 113 0 0 92% 5% 30-Aug-18 IMR 0 - - - - - - - - - - - - - Mongolia PHI 5 0 0 2 3 0 0 100% 40% 08-Oct-18 NIID 0 - - - - - - - - - - - - - New Zealand IESR 6 0 0 1 5 0 0 100% 17% 07-Oct-18 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 86 24 0 12 44 0 6 63% 12% 20-Sep-18 VIDRL 55 0 10 26 0 0 0 0 19 0 0 0 0 100% Philippines RITM 291 5 1 13 265 7 0 95% 4% 02-Oct-18 RITM 10 0 2 0 0 0 0 0 8 0 0 0 0 100% Republic of Korea NIH 41 0 0 4 34 3 0 100% 9% 11-Sep-18 NIH 0 - - - - - - - - - - - - - Singapore SGH 9 0 0 2 7 0 0 94% 12% 05-Oct-18 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 126 3 0 14 103 6 0 100% 10% 13-Sep-18 NIHE 4 0 2 0 0 0 0 0 2 0 0 0 0 100% Viet Nam (South) PI 104 6 0 11 86 1 0 100% 11% 03-Oct-18 PI 6 0 0 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 4102 60 1 347 3573 18 103 97% 7% 146 0 29 26 0 0 0 0 83 8 0 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 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 - 1 Total - 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 (2 AFP) aVDPV3 (1 env) ?VDPV3 (1 env) 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 (14 AFP + 6 contacts) ?VDPV1 (1 AFP) ?VDPV1 (2 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 0 171 119 0 163 0 0 0 1 0 396 2 839 0 0 China, Fujian Prov. Lab/CCDC 53 22 0 8 0 0 0 0 0 42 0 331 0 0 49 34 0 9 0 0 0 0 0 77 1 382 0 0 China, Gansu Prov. Lab/CCDC 12 10 0 10 0 0 0 0 0 29 0 18 0 0 8 5 0 2 0 0 0 0 0 7 0 28 0 0 China, Guangdong Prov. Lab/CCDC 48 39 0 18 0 0 0 0 0 87 0 108 0 0 36 31 0 24 0 0 0 0 0 73 1 154 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 20 12 0 3 0 0 0 0 0 24 0 41 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 7 5 0 3 0 0 0 0 0 7 0 25 0 0 China, Xinjiang Prov. Lab/CCDC 36 34 0 108 0 0 0 0 0 267 0 115 0 0 24 24 0 109 0 0 0 1 0 172 0 60 0 0 China, Yunnan Prov. Lab/CCDC 28 0 - - - - - - - - - 57 0 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 58 3 0 2 0 0 0 0 0 1 0 18 0 0 Papua New Guinea RITM - - - - - - - - - - - - - - 4 2 0 0 2 0 0 0 0 0 0 2 0 0 Total 395 198 0 214 0 0 0 1 0 658 0 1205 0 0 250 126 0 167 2 0 0 1 0 397 2 871 0 0 2017 2018 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); 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 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