2017 Issue No. 17 - Week 34 (as of 29 August 2017) HIGHLIGHTS Situation with global supply of Inactivated Poliomyelitis Vaccine (IPV) is expected to stabilize in 2018 Based on the current projections from manufacturers, one full-dose IPV will be available for the routine immunization programmes in Tier 3 and Tier 4 countries starting from November 2017. In the Western Pacific Region, this news concerns Mongolia and Viet Nam - the remaining two countries that have not yet introduced IPV vaccine into the routine immunization due to the shortage of the global supply. The supply to these countries is scheduled for February-March 2018. Concerning catch-up immunization of the birth cohorts that did not receive IPV since implementation of the switch from trivalent oral polio vaccine (OPV) to bivalent OPV in April 2016, and therefore are not immunized against type 2 poliovirus, there are two options for the allocation of IPV for campaign: 1. In case of one full dose, the vaccine will be available from 2019. 2. In case of one fractional dose, the vaccine will be available at the same time as the routine shipment. The WHO Regional Office for the Western Pacific and respective country offices are closely working with the National Counterparts, partners and donors to ensure smooth and effective introduction of the vaccine. 5.5 5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 15 16 CHN 17 15 16 KHM 17 15 16 LAO 17 15 16 MYS 17 15 16 PHL 17 15 16 PNG 17 15 16 VNM 17 0% 15 16 CHN 17 15 16 KHM 17 15 16 LAO 17 15 16 MYS 17 15 16 PHL 17 15 16 PNG 17 15 16 VNM 17 20% 40% 60% 80%
Polio Bulletin
Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2015–2017* 100%
Chart 2. Adequate specimen collection rate, 2015–2017
* AFP rate annualized as of week 34
Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2017 100%
Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2017 CHN 12.3% 0.0% 0.0% 7.4% 7.1% 37.5% 30.9% 0% 5% 10% 15% 20% 25% 30% 35% 40%
80%
KHM LAO MYS
60%
40%
PHL PNG VNM
CONTACT US 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
20%
0% CHN KHM LAO MYS 1-2 doses
PHL 0 doses
PNG Unknown
VNM
≥ 3 doses
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).
Table 1. Classification of AFP cases with onset in 2017 and key surveillance indicators 2016 Classification Total reported cases Annual expected cases <15 years of age Pending Total reported cases Confirmed wild poliovirus Vaccinederived poliovirus (VDPV) Non-polio AFP rate 2 % % with investigated adequate ≤ 2 days of specimens 3 notification 4 ≥ 80% ≥ 80% Latest report date Days since last report 5
2017 Indicators
Country/area
Poliocompatible
Discarded (Non-polio)
Total
> 90 days 1 # (%)
≥1
≤ 30
Australia Brunei Darussalam Cambodia China China, Hong Kong SAR China, Macao SAR Japan Lao People's Democratic Republic Malaysia Mongolia New Zealand Papua New Guinea Philippines Republic of Korea Singapore Viet Nam Pacific island countries and areas Total 1. 2. 3. 4. 5.
62 1 51 5691 10 1 133 143 7 12 23 417 70 7 382 20 7030
45 1 45 2256 8 1 161 21 77 9 9 31 394 68 6 234 11 3377
31 1 27 2835 8 1 49 81 4 5 16 226 39 4 178 9 3514
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1
1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
20 1 26 1624 6 1 46 62 4 0 6 184 27 4 81 9 2101
10 0 1 1210 2 0 3 19 0 5 10 42 12 0 97 0 1411
3 (9.7%) 0 (0.0%) 0 (0.0%) 349 (12.3%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 6 (7.4%) 0 (0.0%) 4 (80.0%) 6 (37.5%) 16 (7.1%) 0 (0.0%) 0 (0.0%) 55 (30.9%) 0 (0.0%) 439 (12.5%) Green Yellow Red
1.05 1.53 0.92 1.92 1.53 1.53 3.57 1.61 0.68 0.85 0.79 0.88 0.88 1.02 1.16 1.25 1.59
42% 0% 93% 92% 63% 0% 80% 81% 75% 20% 44% 64% 90% 100% 96% 67% 89%
94% 100% 100% 100% 100% 100% 80% 78% 100% 100% 94% 98% 100% 100% 92% 100% 98%
25-Aug-17 24-Jul-17 29-Aug-17 23-Aug-17 03-Aug-17 15-Aug-17 11-Aug-17 28-Aug-17 07-Aug-17 23-Jun-17 11-Aug-17 10-Aug-17 11-Aug-17 10-Aug-17 16-Aug-17 11-Aug-17
4 36 0 6 26 14 18 1 22 67 18 19 18 19 13 18
Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Annualized non-polio AFP rate per 100 000 population under 15 years of age Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Percentage of reported cases investigated within two days of notification Countries are expected to submit data at least once per month to WPRO
Reached o r surpassed target Nearly reached target: 0.5–0.99 fo r no n-po lio A FP rate; 60–79% fo r o ther indicato rs Substantially belo w target
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Polio Bulletin
Table 2. Laboratory investigation of stool samples from AFP cases with onset in 2017 and key laboratory indicators Results of virus isolation for AFP cases Country/area Polio laboratory Total no. of AFP cases w ith specimens L20B positive L20B positive + NPEV only NPEV % results % reported specimens Pending Pending Latest 14 days ≤ ≤ 14 days > 14 days positive for report date NPEV ≥ 80% Intratypic differentiation/ Sequencing 1 laboratory No. of isolates received Type 1 W ild Sabin VDPV Results of intratypic differentiation (ITD)/sequencing for virus isolates Type 2 Type 3 W ild Sabin VDPV W ild Sabin VDPV NPEV 2 1
Negative
Pending ITD
% ITD results Discordant reported ≤ 7 pending days of sequencing receipt ≥ 80%
Australia Brunei Darussalam Cambodia China (total) China, Anhui China, Beijing China, Chongqing China, Fujian China, Gansu China, Guangdong China, Guangxi China, Guizhou China, Hebei China, Heilongjiang China, Henan China, Hubei China, Hunan China, Jiangsu China, Jiangxi China, Jilin China, Neimongol China, Ningxia China, Shaanxi China, Shandong China, Shanghai China, Shanxi China, Sichuan China, Tianjin China, Xinjiang China, Yunnan China, Zhejiang China, Hainan China, Liaoning China, Qinghai China, Tibet China, Hong Kong SAR China, Macao SAR Japan Lao People's Democratic Republic Malaysia Mongolia New Zealand Papua New Guinea Philippines Republic of Korea Singapore Viet Nam (North) Viet Nam (South) Pacific island countries and areas Total
VIDRL VIDRL NIID Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab PHLC PHLC NIID NIID IMR PHI IESR VIDRL RITM NIH SGH NIHE PI VIDRL
24 0 27 2790 183 23 43 103 44 217 144 110 155 58 260 98 121 116 79 37 47 12 55 211 23 97 158 18 81 126 97 8 46 15 5 9 1 80 110 5 3 15 317 39 5 104 106 9 3644
0 0 32 4 1 0 1 0 2 3 0 2 0 4 0 1 4 1 0 1 0 1 3 0 0 0 0 3 0 1 0 0 0 0 0 0 2 0 0 0 0 6 0 0 0 0 0 40
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
4 4 195 7 0 3 2 3 27 22 8 8 1 34 11 12 2 11 3 1 2 2 6 0 4 7 0 6 7 3 1 2 0 0 0 0 7 7 0 0 5 15 2 0 18 18 3 278
17 23 2516 171 22 37 99 41 188 117 101 145 57 217 84 105 109 67 34 45 9 48 202 23 93 147 18 71 108 93 7 41 13 4 8 1 71 101 5 2 10 277 29 4 75 87 6 3232
3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 19 8 1 11 1 0 45
0 0 47 1 0 3 1 0 0 2 1 0 0 5 3 3 1 0 0 0 1 4 0 0 0 4 0 1 11 0 0 3 2 1 0 0 0 2 0 0 0 0 0 0 0 0 0 49
95% 98% 95% 99% 96% 95% 90% 97% 96% 97% 99% 99% 100% 86% 94% 98% 100% 92% 100% 98% 100% 88% 93% 100% 94% 93% 100% 96% 90% 100% 88% 100% 100% 50% 96% 100% 100% 98% 100% 100% 100% 99% 100% 100% 99% 100% 100% 95%
19% 13% 6% 3% 0% 6% 1% 6% 11% 14% 7% 4% 2% 11% 11% 8% 2% 12% 5% 1% 14% 4% 2% 0% 4% 3% 0% 7% 5% 3% 6% 2% 0% 0% 0% 0% 8% 6% 0% 0% 26% 4% 3% 0% 18% 17% 56% 6%
28-Aug-17 28-Aug-17 28-Aug-17 23-Aug-17
VIDRL VIDRL NIID Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC CCDC CCDC CCDC CCDC
0 0 0 76 8 1 4 1 0 8 6 0 3 0 13 0 4 8 1 0 2 0 1 5 0 0 2 0 7 0 2 0 0 0 0 0 0 0 0 0 0 0 14 0 0 0 0 0 90
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
30 6 0 0 0 6 2 0 2 3 2 0 2 0 1 2 4 0 4 34
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
39 2 1 2 1 2 4 3 6 1 6 1 0 1 4 0 3 2 10 49
1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1
6 0 0 2 0 0 0 0 4 0 0 0 0 0 0 0 0 0 0 6
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
99% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% 99%
18-Aug-17 18-Aug-17 28-Aug-17 10-Aug-17 28-Aug-17 21-Aug-17 28-Aug-17 22-Aug-17 11-Aug-17 25-Aug-17 08-Aug-17 22-Aug-17 28-Aug-17
PHLC PHLC NIID NIID IMR NIID IESR VIDRL RITM NIH SGH NIHE PI VIDRL
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) 2. NPEV growing in L20B cells
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Polio Bulletin
Table 3. Laboratory confirmation of polio isolates from environmental samples in 2016–2017 1 2016 Country/area Intratypic differentiation lab 2 Total number of samples processed Total number of samples with polio isolates Polio isolates Type 1 Wild Sabin VDPV Wild Type 2 Sabin VDPV Wild Type 3 Sabin VDPV NPEV Pending ITD Discordant Total number pending of samples sequencing processed Total number of samples with polio isolates Type 1 Wild Sabin VDPV Wild
2017 Polio isolates Type 2 Sabin VDPV Wild Type 3 Sabin VDPV NPEV Pending ITD Discordant pending sequencing
Australia China (total) China, Fujian China, Gansu China, Guangdong China, Guangxi China, Heilongjiang China, Shandong China, Shanghai China, Xinjiang China, Yunnan Malaysia Philippines Total
VIDRL Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC IMR RITM
0 345 60 13 48 36 45 45 24 36 38 10 0 355
171 12 8 35 13 21 28 18 36 0 0 171
0 0 0 0 0 0 0 0 0 0
179 3 5 19 1 0 25 17 109 179
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
174 1 5 4 4 5 15 4 136 174
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
507 11 13 62 52 46 42 34 247 507
0 0 0 0 0 0 0 0 0 0
229 42 2 39 23 32 40 18 25 8 6 235
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 150 16 6 28 15 20 20 12 18 15 2 15 167
87 3 4 24 7 6 14 11 18 0 0 3 90
0 0 0 0 0 0 0 0 0 0 0
137 1 4 14 3 1 15 11 88 0 137
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
365 5 13 57 15 18 60 27 170 3 368
0 0 0 0 0 0 0 0 0 0 0
304 63 2 54 23 25 67 18 41 11 0 2 306
1 0 0 0 1 0 0 0 0 0 0 9 10
0 0 0 0 0 0 0 0 0 0 0 0 0
1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. 2. CCDC (Chinese Center for Disease Control and Prevention, China); IMR (Institute of Medical Research, Malaysia); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia)
Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2017 Country/area Cambodia
2000–2009 3 2006 - 1 Total - 2 2009 - 1 Total - 27
2010
2011
2012
2013
2014
2015
2016
2017
China
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)
aVDPV3 (1 AFP)
aVDPV3 (1 AFP)
China, Hong Kong SAR Japan Lao People's Democratic Republic Mongolia Philippines Viet Nam
2005 - 3 2005 - 1 Total - 2 2004 - 3 2003 - 1 2001 - 3 aVDPV2 (2 AFP) aVDPV2 (1 AFP) cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts)
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). 2. Source of specimens could be AFP cases, contacts, or non-AFP cases 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009
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Polio Bulletin