2013 Issue No. 14 - Week 46 (as of 19 November 2013) HIGHLIGHTS 19th Meeting of the Regional Commission for the Certification (RCC) of Poliomyelitis Eradication in the Western Pacific Region Manila, Philippines — 12-14 November 2013 Last week, the Regional Director, Dr Shin Young-soo, opened the 19th Polio RCC Meeting, gathering 37 WPRO countries in Manila. All countries presented to the RCC their annual progress reports. This meeting was sadly overshadowed by the tragic aftermath of the typhoon Haiyan which caused thousands of deaths and casualties in the Philippines only a few days before the meeting. All participants presented their deepest condolences to the representatives from the Government of the Philippines and expressed their moral support to the Department of Health workforce. During the plenary session, detailed presentations on the progress of the global, African, Eastern Mediterranean, South East Asia and Western Pacific Region Polio eradication programmes were shared. Additionally, each country presented a summary of their annual progress report which were complemented by fruitful discussions and opportunities for country interactions. The RCC members provided in-depth feedback to each country on their achievements, future efforts required, surveillance challenges, threats to Polio free status, innovative solutions, progress towards endgame strategy and recommendations. At the closing of the meeting, the RCC concluded that the Western Pacific Region retains its polio-free status but recognized that the remaining immunity and surveillance gaps still threaten the polio-free status of the Region.
Polio Bulletin
Chart 1. Non-polio AFP rate and adequate specimen collection rate, 2011–2013 3.0 2.5 100%
Chart 2. Percent cases with pending classification > 90 days after onset, 2013 CHN Cases with adequate specimens (%)
90% 80% 70% 60% 1.5 1.0 0.5 0.0 11 12 13 CHN 11 12 13 KHM 11 12 13 LAO 11 12 13 MYS 11 12 13 PHL 11 12 13 PNG 11 12 13 VNM
4.6% 0.0% 11.1% 2.3% 21.2% 55.0% 23.3% 0% 10% 20% 30% 40% 50% 60%
KHM LAO MYS PHL PNG VNM
Non-polio AFP rate
2.0
50% 40% 30% 20% 10% 0%
Chart 3. Polio immunization status of reported AFP cases, 2013 100% 100%
Chart 4. Percentage of samples received at the lab ≤ 3 days of collection, 2013
80%
80%
60%
60%
54%
58% 41%
40%
40% 21% 20%
20%
0% CHN KHM ≥ 3 doses
LAO
MYS
PHL 0 doses
PNG Unknown
VNM
0% CHN
0% KHM
2% LAO MYS PHL
0% PNG VNM
1-2 doses
NOTES: 1. 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). 2. Non-polio AFP rate for 2013 is annualized as of polio week 46.
Table 1. Classification of AFP cases with onset in 2013 and key surveillance indicators 2012 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 % with % with any investigated adequate 60-day 4 2 days of ≤ specimen 6 specimens 3 5 follow-up notification ≥ 80% ≥ 80% ≥ 80% Latest report date Days since last report 7
2013 Indicators
Poliocompatible
Discarded (Non-polio)
Total
> 90 days 1 # (%)
≥1
Australia Brunei Darussalam Cambodia China Hong Kong (China) Japan Lao People's Democratic Republic Macao (China) Malaysia Mongolia New Zealand Papua New Guinea Philippines Republic of Korea Singapore Viet Nam Pacific island countries Total 1. 2. 3. 4. 5. 6. 7.
56 1 107 6173 14 0 55 0 141 9 8 10 403 95 10 514 4 7600
43 1 45 2225 8 167 25 1 76 7 9 30 371 76 6 241 10 3341
37 1 58 4332 9 0 36 1 130 4 9 20 208 54 7 301 5 5212
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 1 0 0 0 0 1
37 1 51 3291 6 24 1 122 3 4 8 135 23 7 187 4 3904
0 0 7 1041 3 12 0 8 1 5 12 72 31 0 114 1 1307
0 (0.0%) 0 (0.0%) 0 (0.0%) 201 (4.6%) 0 (0.0%) 4 (11.1%) 0 (0.0%) 3 (2.3%) 0 (0.0%) 0 (0.0%) 11 (55.0%) 44 (21.2%) 19 (35.2%) 0 (0.0%) 70 (23.3%) 1 (20.0%) 353 (6.8%) Green Yellow Red
0.97 1.13 1.46 2.20 1.27 1.63 1.13 1.93 0.65 1.13 0.75 0.63 0.80 1.32 1.41 0.57 1.76
38% 100% 78% 92% 78% 64% 100% 87% 75% 0% 15% 67% 94% 71% 97% 80% 90%
73% 100% 95% 99% 89% 86% 100% 100% 100% 67% 85% 93% 100% 100% 99% 100% 98%
100% 100% 84% 100% 100% 100% 100% 78% 100% 89% 70% 98% 98% 86% 89% 100% 98%
0% 77% 77% 0% 23% 76% 100% 33% 41% 59% 67% 100% 60% 0% 67%
22-Oct-13 17-Aug-13 07-Nov-13 14-Nov-13 07-Oct-13 04-Nov-13 11-Sep-13 18-Nov-13 09-Nov-13 06-Nov-13 07-Nov-13 13-Sep-13 17-Sep-13 06-Nov-13 29-Oct-13 07-Oct-13
28 94 12 5 43 15 69 1 10 13 12 67 63 13 21 43
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 with at least one specimen Percentage of reported cases investigated within two days of notification Percentage of reported cases with inadequate specimens followed-up within 60 days of onset of paralysis Countries are expected to submit data at least once per month to WPRO
Reached or surpassed target Nearly reached target: 0.5–0.99 for non-polio AFP rate; 60–79% for other indicators Substantially below target
2
Polio Bulletin
Table 2. Laboratory investigation of AFP cases with onset in 2013 and key laboratory indicators Virus isolation results Country National polio laboratory Total no. of AFP L20B cases with positive specimens L20B positive + NPEV NPEV only Pending Negative ≤ 14 days Intratypic % % results differentiation Latest Pending reported specimens / Sequencing positive report date > 14 2 ≤ 14 days for NPEV lab 1 days ≥ 80% No. of isolates referred Type 1 W ild Sabin VDPV W ild Type 2 Sabin Intratypic differentiation (ITD) results Type 3 VDPV W ild Sabin VDPV NPEV 3
1
Non-EV
Pending ITD
% ITD results Discordant reported ≤ 7 pending days of sequencing receipt ≥ 80%
Australia Brunei Darussalam Papua New Guinea Pacific island countries Japan Cambodia Lao People's Democratic Republic Malaysia Mongolia New Zealand Philippines Republic of Korea Singapore Viet Nam, North Viet Nam, South China (total) China, Anhui China, Beijing China, Fujian China, Gansu China, Guangdong China, Guangxi China, Hebei China, Heilongjiang China, Henan China, Hunan China, Jiangsu China, Jiangxi China, Jilin China, Shaanxi China, Shandong China, Shanghai China, Shanxi China, Sichuan China, Tianjin China, Xinjiang China, Yunnan China, Zhejiang China, Chongqing China, Guizhou China, Hainan China, Hubei China, Liaoning China, Neimongol China, Ningxia China, Qinghai China, Tibet Hong Kong (China) Macao (China) Total
VIDRL VIDRL VIDRL VIDRL NIID NIID NIID IMR PHI IESR RITM NIH SGH NIHE PI CCDC 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
38 1 16 5 0 48 32 131 3 5 316 65 7 188 162 4276 185 30 117 107 271 179 302 106 431 229 234 144 61 80 286 20 163 268 23 76 186 95 67 204 27 176 93 65 32 10 9 11 0 5304
0 0 0 0 0 0 0 0 0 0 0 1 1 1 67 1 1 2 6 2 2 6 1 8 2 8 2 0 1 6 1 3 0 1 3 3 3 0 0 0 3 0 2 0 0 0 0 70
0 0 0 0 0 0 0 0 0 1 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 1
8 0 2 3 16 8 6 0 1 39 0 0 30 15 53 2 0 1 1 16 12 1 0 9 0 0 0 0 0 0 0 0 3 0 0 0 1 3 1 0 0 2 0 0 1 0 0 181
30 1 14 2 32 24 122 3 4 273 64 6 154 146 4086 180 29 112 98 253 161 293 103 414 223 220 138 59 70 271 19 160 257 22 70 182 89 64 197 27 173 89 63 32 9 9 10 4971
0 0 0 0 0 0 1 0 0 1 1 0 1 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 5
0 0 0 0 0 0 2 0 0 2 0 0 2 3 70 2 0 2 2 0 4 2 2 0 4 6 4 2 9 9 0 0 8 0 3 1 2 0 6 0 0 2 0 0 0 0 0 79
100% 100% 100% 100% 93% 95% 98% 100% 100% 97% 100% 100% 93% 97% 58% 52% 77% 72% 72% 56% 23% 63% 86% 55% 91% 33% 68% 70% 87% 68% 98% 33% 30% 87% 81% 72% 35% 77% 77% 65% 30% 73% 65% 55% 40% 11% 97% 65%
20% 0% 11% 60% 28% 22% 4% 0% 22% 11% 0% 0% 14% 8% 1% 1% 0% 0% 1% 5% 6% 0% 0% 1% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0% 0% 1% 3% 0% 0% 0% 2% 0% 0% 5% 0% 0% 3%
08-Nov-13 08-Nov-13 12-Nov-13 08-Nov-13 11-Sep-13 30-Oct-13 12-Nov-13 10-Oct-13 07-Nov-13 15-Nov-13 13-Nov-13 19-Nov-13 12-Nov-13 04-Nov-13 14-Nov-13
VIDRL VIDRL VIDRL VIDRL NIID NIID NIID IMR NIID IESR VIDRL NIID SGH NIID 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 CCDC CCDC CCDC CCDC CCDC CCDC CCDC CCDC CCDC
0 0 0 0 0 0 0 0 0 0 3 0 2 2 2 166 8 11 5 12 8 6 6 1 15 4 11 20 0 0 14 7 4 0 2 7 5 7 0 0 1 6 0 1 5 0 0 0 0 175
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 47 3 3 2 1 2 0 4 1 5 0 9 0 5 3 2 0 0 1 1 0 3 0 2 48
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
1 2 2 0 66 3 6 3 6 5 2 1 0 9 2 1 7 2 4 2 2 6 0 2 0 1 0 2 71
0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1
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 2 44 2 2 0 5 1 4 1 0 1 2 1 4 7 0 0 0 1 4 4 1 2 1 1 47
0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 8
0 0 0 0 9 0 0 0 2 0 6 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 9
0 0 0 0 2 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 2
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
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
15-Nov-13 15-Nov-13
PHLC PHLC
1. 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, Hong Kong); 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. The target of 14 days for the timeliness of virus isolation will be used for all polio laboratories 3. NPEV growing in L20B cells 4. Twenty-two provincial laboratories in China perform ITD from 2013
3
Polio Bulletin
Table 3. Laboratory confirmation of polio isolates from other sources in 2013 Non-AFP cases Country Intratypic Total number Total number differentiation of non-AFP of non-AFP lab 2 cases tested cases with polio isolates for polio Type 1 Wild Sabin VDPV Wild Type 2 Sabin VDPV Wild Type 3 Sabin NPEV Discordant Total number Pending grown Non-EV pending of samples ITD sequencing processed VDPV in L20B Total number of samples with polio isolates Type 1 Wild Sabin VDPV
1
Environmental samples Type 2 Wild Sabin VDPV Wild Type 3 Sabin NPEV Discordant Pending grown Non-EV pending ITD sequencing VDPV in L20B
Australia Japan Malaysia Mongolia New Zealand Philippines Republic of Korea Singapore Viet Nam, North Viet Nam, South China (total) China, Anhui China, Beijing China, Fujian China, Gansu China, Guangdong China, Guangxi China, Hebei China, Heilongjiang China, Henan China, Hunan China, Jiangsu China, Jiangxi China, Jilin China, Shaanxi China, Shandong China, Shanghai China, Shanxi China, Sichuan China, Tianjin China, Xinjiang China, Yunnan China, Zhejiang China, Chongqing China, Guizhou China, Hainan China, Hubei China, Liaoning China, Neimongol China, Ningxia China, Qinghai China, Tibet Hong Kong (China) Total
VIDRL NIID IMR PHI IESR VIDRL NIID SGH NIID 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 CCDC CCDC CCDC CCDC CCDC CCDC CCDC CCDC CCDC PHLC
222 0 0 127 0 6 0 0 0 0 20 0 0 0 7 4 0 0 0 0 0 0 2 0 0 2 2 0 1 1 0 0 0 0 1 0 0 0 0 0 0 0 1 376
1 0 0 0 0 6 0 0 0 0 16 0 0 0 7 1 0 0 0 0 0 0 2 0 0 2 2 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 24
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 5 11 7 0 0 2 1 0 1 0 1 17
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 1 6 4 0 1 1 0 0 0 0 0 8
0 0 0 1 0 1 0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 1 9 4 0 1 1 1 1 1 0 0 10
0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 43 0 1 0 0 0 0 0 0 0 1 0 44
0 0 0 3 0 3 0 0 0 0 0 0 0 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 10 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 10
0 0 2 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 2
0 0
0 0
0 0
0 0
1 1
0 0
0 0
1 1
0 0
7 7
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); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, Hong Kong); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia)
4
Polio Bulletin
Table 4. Vaccine-derived poliovirus, 2000–2013 Country Cambodia iVDPV1 (1 case) aVDPV1 (1 case) aVDPV1 (1 case) aVDPV3 (1 case) aVDPV3 (1 case)
2000
2001
2002
2003
2004
2005 cVDPV3 (1 case)
2006 cVDPV3 (1 case)
2007
2008
2009
2010
2011
2012
2013
China
cVDPV1 (2 cases) aVDPV1 (1 case) aVDPV1 (3 cases) ?VDPV1 (4 cases) iVDPV2 (1 case) ?VDPV1 (7 cases) ?VDPV1 (1 case) ?VDPV2 (1 case) VDPV3 (1 case) ?VDPV? (3 cases) ?VDPV? (1 case) aVDPV2 (1 case) ?VDPV? (2 cases) ?VDPV? (1 case) ?VDPV3 (1 case)
aVDPV1 (1 case) aVDPV1 (1 case) aVDPV2 (3 cases) aVDPV2 (2 cases) aVDPV2 (1 case) aVDPV2 (5 cases) aVDPV2 (1 case) cVDPV2 (2 cases) cVDPV2 (3 cases) iVDPV2 (1 case) aVDPV3 (2 cases) iVDPV2 (2 cases) iVDPV2 (1 case) iVDPV3 (1 case) iVDPV3 (1 case) iVDPV3 (1 case)
Hong Kong (China) Japan Lao People's Democratic Republic Mongolia Philippines Viet Nam cVDPV1 (3 cases)
aVDPV2 (2 cases)
5
Polio Bulletin