Eighteenth Meeting of the Regional Commission for the Certification of Poliomyelitis Eradication in the Western Pacific Region, Beijing, China, 26-30 November 2012 : meeting report

Meeting Report Eighteenth Meeting of the Regional Commission for the Certification of Poliomyelitis Eradication in the Western Pacific Region Beijing, China 26-30 November 2012 www.wpro.who.int 18th Meeting of the RegionalCommission for the Certification of Poliomyelitis Eradication in the Western Pacific Region 28-29 November 2012 • Beijing,China WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC REPORT EIGHTEENTH MEETING OF THE REGIONAL COMMISSION FOR THE CERTIFICATION OF POLIOMYELITIS ERADICATION IN THE WESTERN PACIFIC REGION BEIJING, CHINA 26-30 NOVEMBER 2012 Manila, Philippines May 2013 (WP)/ICP/IVD/1.1/001-A Report series number: RS/2012/GE/55(CHN) English only REPORT EIGHTEENTH MEETING OF THE REGIONAL COMMISSION FOR THE CERTIFICATION OF POLIOMYELITIS ERADICATION IN THE WESTERN PACIFIC REGION Beijing, China 26-30 November 2012 Convened by: WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR THE WESTERN PACIFIC Not for sale Printed and distributed by: World Health Organization Regional Office for the Western Pacific Manila, Philippines September 2013 NOTE The views expressed in this report are those of the participants of the eighteenth meeting of the Regional Commission for the Certification of Poliomyelitis Eradication in the Western Pacific Region and do not necessarily reflect the policies of the World Health Organization. This report has been printed by the Regional Office for the Western Pacific of the World Health Organization for the participants of the seventeenth meeting of the Regional Commission for the Certification of Poliomyelitis Eradication in the Western Pacific Region, which was held in Beijing, China, from 26 to 30 November 2012. CONTENTS Page 1. INTRODUCTION................................................................................................................... 1 1.1 Objectives ..................................................................................................................... 1 1.2 Organization ................................................................................................................. 1 2. PROCEEDINGS ..................................................................................................................... 4 2.1 Global poliomyelitis status (as per Global Polio Eradication Initiative report to WHO Executive Board’s 132nd session) ................................................................................ 4 2.2 Regional status of maintaining poliomyelitis-free status.............................................. 8 3. CONCLUSIONS AND RECOMMENDATIONS.............................................................. 16 3.1 China poliomyelitis outbreak and general .................................................................. 16 3.2 Country-specific conclusions and recommendations ................................................. 18 ANNEXES: ANNEX 1 - TIMETABLE ANNEX 2 - LIST OF PARTICIPANTS Keywords: Poliomyelitis-prevention and control/ Immunization programmes/ Certification/ Epidemiologic surveillance 1. INTRODUCTION The Regional Commission for the Certification of Poliomyelitis Eradication (RCC) in the Western Pacific Region continues to meet on an annual basis in order to review and support maintenance of poliomyelitis-free status and certification standard quality requirements and to fulfil its reporting mandate to the Global Certification Commission (GCC). 1.1 Objectives The objectives of the RCC at its eighteenth meeting were: (1) to update the RCC and national Certification Committees (NCCs) on the global and regional status of poliomyelitis eradication and review the implications of the World Health Assembly 2012 resolution declaring the completion of poliomyelitis eradication as a programmatic emergency for global public health; (2) to review progress reports from all countries and areas on maintaining the poliomyelitis-free status and recommend required action to achieve high-quality surveillance and immunization performance; and (3) to assess the epidemiological situation and control measures implemented by China to interrupt the 2011 transmission of imported wild poliovirus and decide upon China’s poliomyelitis-free status. 1.2 Organization The meeting was attended by seven commission members, two temporary advisers, 22 NCC members and designates, 47 representatives from the Ministry of Health and Chinese Center for Diseases Control and Prevention, 12 partner agencies and 13 World Health Organization (WHO) staff from headquarters, regional offices and country office in China. Annex 1 includes the meeting timetable, and Annex 2 contains a list of participants. 1.3 Opening ceremony WHO Regional Director, Regional Office for the Western Pacific Region, Dr Shin Young-soo conveyed his welcome remarks to the meeting via video-taped message: "Greetings from Manila and the WHO Regional Office for the Western Pacific. I regret not being able to join you in person, but look forward to hearing the positive results of your important meeting. In particular, I would like to send warm regards to senior officials and experts from the Ministry of Health of China and the Chinese Center for Disease Control and Prevention, members of the national certification committees, experts from other agencies and colleagues from other WHO offices. Two years ago, many of us came together in Manila to celebrate the tenth anniversary of the Western Pacific Region being certified poliomyelitis-free. At the time, I warned Member States not to drop their guard because wild poliovirus continues to circulate in some parts of the world. “We cannot become complacent,” I said at the time. “Polio eradication is an unfinished story.” - 2 - Less than a year after that speech, wild poliovirus imported from Pakistan caused an outbreak of 21 cases of polio in western China. China’s response was swift and comprehensive. Everybody involved is commended for containing the outbreak and preventing it from spreading in the Western Pacific Region. Nevertheless, the outbreak should serve as a wake up call to everyone. Countries remain at risk from the remaining polio reservoirs in Pakistan, Afghanistan and Nigeria. Continued immunization gaps — including in older age groups — and decreasing awareness of surveillance requirements make several countries vulnerable for polio re- introduction. These concerns have made 2012 a busy year for global polio eradication efforts. But there is also positive excitement. India was removed from the list of polio- endemic countries in February — a year after the country saw its last polio case. At the moment, polio cases are at an historic low, bringing us closer than ever before to stopping wild poliovirus transmission globally and achieving the ultimate benefit of the huge investments we have made. We are almost there with only three polio-endemic countries left: Afghanistan, Nigeria and Pakistan. Our goal remains feasible and realistic — as proven by the recent success in India — but much work remains to be done. Poliovirus keeps reminding us that almost is not good enough. In times of increased movement of people and goods, the virus can travel long distances from the places where it still exists and find those who are not immunized. Unfortunately, a person can be a carrier and spread poliovirus without knowing it. And anyone who has not been fully vaccinated remains vulnerable. We must realize that we are not just trying to control this disease; we are not just trying to keep cases at a low level. We know that this approach does not work. We need to press for the complete eradication of polio, while the political commitment to end this dreadful disease is stronger than ever. The World Health Assembly passed a resolution in May declaring the completion of polio eradication a programmatic emergency for global public health. All three remaining endemic countries have launched national emergency action plans to bring a rapid end to the disease in their countries. As long as this disease exists, it is a painful reminder that we are failing to bring the most basic health services to every child. The pursuit of polio pushes us to reach the most vulnerable populations in the world. And if we — the international community — can reach them with polio vaccine, then we can provide them much more. I would like to commend your commitment to this vision and your work to sustain our polio-free status and to energize the Expanded Programme on Immunization in the Region. There are too many partners, donors and good friends to thank each one personally. But I do want you to know that we are indeed grateful for your support and for the many millions of children that you help protect from polio and other vaccine- preventable diseases in the Region. Let us continue to find new ways of working together and supporting each other in our efforts to eradicate polio and ensure that no child, anywhere in the world, will ever again suffer its crippling effects.” - 3 - Dr Bruce Aylward, WHO Assistant Director-General, Polio, Emergencies and Country Collaboration, also addressed the meeting via videotaped message: "I would like to warmly greet you at this important meeting, and take this opportunity, on behalf of the entire Global Polio Eradication Initiative, to thank you for your incredible efforts to protect and preserve the polio-free status of this Region. Countries across the Western Pacific have played a key leadership role in the global fight to eradicate polio. This Region developed, evaluated and implemented novel tactics which showed that polio can truly be eradicated everywhere. As your Region, through strong leadership and Herculean efforts, eradicated polio from every single country, you showed the world that every child, no matter where they live, and no matter what the circumstances, can be reached with a life-saving health intervention. And your efforts paid off, as you have been certified polio-free for over a decade now already. It has been a tremendous public health success. And as importantly, these same tactics which you forged here in the Region are even today, still adapted and applied in the remaining three polio-endemic countries in the world, where we are now, finally, seeing strong progress. But you have not rested on the laurels of your success. Since the polio-free certification of this Region in the year 2000, you have remained vigilant, because we all know that polio-free countries remain at risk until the disease has been eradicated globally. Both the ongoing risk of polio, and the value of strong vigilance, were clearly demonstrated last year, when the virus spread from Pakistan into western China. We draw two clear lessons from this event: The first: It offered a very stark reminder that polio will find unimmunized children, no matter where they live, no matter how small the immunity gap may be in their communities. Polio is an unforgiving virus in that sense, and it is essential to identify and urgently fill any remaining immunity gaps at the subnational level in every country. And the second lesson is the value of preparedness. The Government of China had in place strong disease surveillance, and effective outbreak readiness response plans. As soon as the outbreak was detected, it was notified internationally, and a true model response was implemented, led by strong political leadership at all levels, characterized by multisectorial collaboration and the engagement of civil society, all working together with international partners. These efforts saved lives, prevented further cases and resulted in the outbreak being stopped in record time. Other Member States across the Western Pacific Region continue to pursue a similar strategy of maintaining immunity levels, strong surveillance and outbreak readiness plans. WHO commends you for these efforts, and urges you to continue this wise strategy. In the face of ongoing polio transmission in the remaining three endemic countries, this is the best insurance policy. And I know the WHO Regional Office of the Western Pacific, under the strong leadership of Regional Director Dr Shin Young-Soo, will continue to provide you with all the support you might request. Ultimately, however, the only way to ensure this Region is fully protected is to complete polio eradication globally, once and for all. We are very close, closer than ever. But if we fail now, polio will come roaring back, and within 10 years, we will again see hundreds of thousands of children paralysed for life, each and every year. This would a humanitarian catastrophe that must be prevented at all costs, given that fewer than 200 - 4 - children were paralysed by polio this year, and given irrefutable proof of the ultimate feasibility of eradication. And so I urge you: please help us finish the job by continuing to demonstrate your technical leadership by directly supporting the governments of the remaining endemic countries and by providing the necessary financial resources to help us finish the job everywhere. A polio-free world is within our grasp. Just two weeks ago here in Geneva, the Strategic Advisory Group of Experts on immunization, better known to many of you as SAGE, noted the progress being achieved globally, and provided very clear guidance for the polio endgame. And this brings me to my final point: as the world nears polio eradication, countries must begin to prepare for the polio endgame, including for the eventual cessation of use of the oral polio vaccines in routine immunization. Ladies and gentlemen, we are nearly there. A polio-free world is truly within reach. Together, we can cross the finish line once and for all, and ensure that no child will ever again be paralysed by this terrible disease. Let me again express my congratulations to the people and the Government of China, and my gratitude to all of you, on behalf of the Global Polio Eradication Initiative. I wish you all success in concluding this important meeting and implementing its recommendations.” 2. PROCEEDINGS 2.1 Global poliomyelitis status (as per Global Polio Eradication Initiative report to WHO Executive Board’s 132nd session) In 2012, the Sixty-fifth World Health Assembly in resolution WHA65.5 declared the completion of poliovirus eradication a programmatic emergency for global public health and requested the Director-General to undertake the development and rapid finalization of a comprehensive polio eradication and endgame strategy to the end of 2018. The Global Polio Emergency Action Plan 2012‒2013 was launched on 24 May 2012, during the Sixty-fifth World Health Assembly, in support of national emergency action plans against poliomyelitis from the three remaining countries where the disease remains endemic, namely: Afghanistan, Nigeria and Pakistan. At the international level, the five core agencies working in partnership for the eradication of poliomyelitis have established the Polio Emergency Steering Committee to manage risks and guide operations. The committee reports to the agency heads, who constitute the membership of the Polio Oversight Board, which meets on a quarterly basis. Emergency operations centres and/or procedures have been activated across the core partner agencies, and WHO recruited more than 2500 additional workers to support government efforts against poliomyelitis in areas of Afghanistan, Nigeria and Pakistan affected by the disease or where the outbreak risk was greatest. The United Nations Children’s Fund (UNICEF) engaged more than 2300 additional community mobilizers in these priority areas. - 5 - On 27 September 2012, the United Nations Secretary-General hosted a high-level meeting on the poliomyelitis eradication emergency during the Sixty-seventh Session of the United Nations General Assembly. The aim of the meeting was to reinforce national and international commitment to achieving eradication and mobilizing the necessary financing. It was attended by the heads of state of the three countries where the disease is endemic, the heads of the partner agencies, donors and other stakeholders. In each of those three endemic countries, the head of state or government has appointed a focal point to oversee the national effort to eradicate poliomyelitis and has engaged other sectors of government and public administration to support implementation of the national emergency action plan. In addition, respectively, a presidential task force and a prime ministerial task force in Nigeria and Pakistan have been established to assess progress and ensure the accountability of local authorities. New performance monitoring systems have been put in place (i) to track whether supplementary immunization activities using oral poliovirus vaccine were reaching the vaccination coverage thresholds required to interrupt transmission and (ii) to guide rapid corrective action. In Nigeria, the proportion of very-high-risk local government areas in which the estimated vaccine coverage reached the target threshold of 80% in 2012 increased from 5% in February to 34% in November. In Pakistan, the proportion of highest-risk districts achieving the target threshold of an estimated coverage rate of 95% in 2012 increased from 59% at the start of the year to a peak of 87% in July. In the 13 districts in southern Afghanistan at highest risk for persistent transmission of poliovirus, the number of children inaccessible during the oral poliovirus vaccine campaigns declined from more than 80 000 at the end of 2011 to some 26 000 by October 2012. As a result of this emergency eradication effort, as of 14 November 2012 the numbers of both cases of poliomyelitis and countries experiencing cases were at their lowest-ever recorded levels. Globally, 181 cases were reported, a 64% decline compared with the same period in 2011. Four countries reported cases in 2012 compared with 16 in 2011. In three of these countries — Chad, Pakistan and Afghanistan — case numbers declined by 95%, 65% and 42%, respectively, relative to 2011. In Nigeria, however, case numbers increased by 140% compared with the same period in 2011, despite the recent evidence of improving programme performance in the historically worst-performing areas. Of the two remaining serotypes of wild poliovirus (types 1 and 3), only 21 cases due to type 3 were reported 18 in Nigeria and three in Pakistan. The completion of wild poliovirus eradication continues to be jeopardized by an inconsistent rate of improvement in the quality and coverage of supplementary immunization activities in infected areas, as well as by weak routine immunization programmes in countries affected by poliovirus transmission and countries at highest risk of new importations. The increase in the number of cases of poliomyelitis in Nigeria is a matter of particular concern, given the risk of renewed spread of wild polioviruses, both within the country itself and, from there, into West Africa, particularly Mali. In Pakistan, a series of security incidents targeting workers of the poliomyelitis eradication programme, and the suspension of oral poliovirus vaccine immunization activities since June 2012 in two agencies of the Federally Administered Tribal Areas, are threatening to slow progress. Federal and provincial elections in 2013 could also divert attention from the eradication programme. Weak management capacity and insecurity continue to complicate full strategy implementation in the highest-risk districts of southern Afghanistan. - 6 - Between June and October 2012, WHO coordinated the development of a comprehensive Polio Eradication and Endgame Strategic Plan 2013‒2018, in consultation with countries affected by poliomyelitis, stakeholders, donors, vaccine manufacturers, regulatory agencies and a number of national and international advisory bodies for the eradication of poliomyelitis and routine immunization against the disease. On 6 November 2012, the Strategic Advisory Group of Experts on immunization endorsed the four major objectives of the strategic plan and the associated milestones, namely: the interruption of residual wild poliovirus transmission by the end of 2014; the withdrawal of the type 2 component of the trivalent oral poliovirus vaccine from routine immunization programmes globally as soon as possible; the initiation of legacy planning for the Global Polio Eradication Initiative in 2013‒2014; and the containment of wild poliovirus stocks and certification of wild poliovirus eradication by the end of 2018. The new strategic plan introduces a number of major developments in planning for the eradication of poliomyelitis. First, the plan outlines a concrete six-year timeline and approach for the completion of the Global Polio Eradication Initiative, including the elimination of all paralytic poliomyelitis whether due to wild, vaccine-derived or Sabin-strain polioviruses. Secondly, in order to achieve global containment and certification, the geographical focus of the strategic plan, which is currently on poliomyelitis-affected and high-risk countries, is expanded to include the nearly 130 countries that use the trivalent oral poliovirus vaccine in national routine immunization programmes, and ultimately all countries. Thirdly, very high priority is given to raising routine immunization coverage rates by systematically applying the existing infrastructure and human resources of the global effort to eradicate poliomyelitis to this goal in the context of the Global Vaccine Action Plan and in collaboration with the GAVI Alliance. Finally, policy on routine vaccination against poliomyelitis is updated with the recommendation of the Strategic Advisory Group of Experts on immunization that all countries should introduce at least one dose of inactivated poliovirus vaccine. This policy is designed to mitigate the risks of poliovirus reintroduction or re-emergence following the withdrawal of the type 2 component of the oral poliovirus vaccine globally, and reduce the potential consequences of those risks. In order to achieve the first objective of the strategic plan, authorities in Afghanistan, Nigeria and Pakistan are updating national emergency action plans for poliomyelitis eradication to incorporate innovations, best practices and lessons learnt in 2012. The areas covered by these improvements include programme oversight, monitoring and accountability, detailed planning for supplementary and routine immunization activities, data management, accessing and engaging underserved and mobile populations, and operating in insecure environments. Partner agencies will continue to support national emergency action plans by fully implementing and sustaining the necessary surge in technical support; assisting with the implementation of direct payment mechanisms; enhancing the development and application of processes for assessing in real-time the preparedness for and performance of supplementary immunization activities; refining plans for operations in insecure areas; and dealing with gaps in surveillance performance. An intensive schedule of supplementary immunization activities will continue to be implemented across the 30 countries assessed to be at highest risk of importations of poliovirus and outbreaks of poliomyelitis in the period 2013‒2014. - 7 - The importance of withdrawing the type 2 component of oral poliovirus vaccine as soon as possible from routine immunization programmes globally was reinforced by the detection in 2012 of five outbreaks of poliomyelitis due to circulating type 2 vaccine-derived polioviruses. The outbreaks left 37 children paralyzed in the following six countries: Chad, Democratic Republic of the Congo, Kenya, Nigeria, Pakistan and Somalia. Two of these outbreaks, in Nigeria and Somalia, involve the continuing transmission of a type 2 virus for a period exceeding 36 months. Interrupting the outbreak in central southern Somalia continues to be complicated by the ban on mass vaccination campaigns in areas controlled by specific militants groups. In order to enhance the affordability and availability of inactivated poliovirus vaccine, a prerequisite for the eventual withdrawal of the type 2 component of the oral poliovirus vaccine, WHO and its partners have undertaken an intensive series of discussions with vaccine manufacturers and regulatory agencies. In response, one manufacturer of inactivated poliovirus vaccine has announced a substantial cut in the price of its existing product, reducing it to US$ 1.15 per dose. Achieving a price substantially below US$ 1 per dose in the near term will require the use of fractional dosing through either intradermal delivery of one-fifth of a full dose of inactivated poliovirus vaccine or intramuscular administration of a product containing an adjuvant. Three manufacturers have agreed to pursue licensure for intradermal delivery of their inactivated poliovirus vaccine for use in emergency situations, and in one case for routine immunization, with a target price US$ .50 per dose and a development timeline of 24‒36 months. Two manufacturers have agreed to develop an inactivated poliovirus vaccine containing an adjuvant, with a target price of between US$ 0.50 and US$ 0.75 per dose and a timeline of 36‒48 months, contingent in one case upon substantial external support. A third manufacturer is considering the fast-track development of a similar product. Although two manufacturers are planning to develop a low-dose inactivated poliovirus vaccine as part of their respective hexavalent products, neither product will be available during the period of the new strategic plan. WHO continues to support the transfer to developing countries of new production technology for inactivated poliovirus vaccine using Sabin-strain polioviruses. It is expected that such Sabin-strain inactivated poliovirus vaccines will be available during the period of the new strategic plan; however, additional development work is needed to finalize timelines and expected pricing. In parallel to these and other development efforts, and as recommended by the Scientific Advisory Group of Experts on immunization, WHO, UNICEF, the GAVI Alliance and the Bill & Melinda Gates Foundation are establishing a supply and funding strategy for timely introduction of inactivated poliovirus vaccine using existing full-dose products for a transition period if needed. Legacy planning for the Global Polio Eradication Initiative will have two main goals: to mainstream into existing public health programmes the poliomyelitis-related work on routine immunization activities, disease surveillance and response, and stockpiling and containment; and to ensure that the knowledge, capacities, processes and assets created by the programme will continue to be of broader benefit to other public health programmes. In 2013, an extensive consultation process on legacy planning will begin with Member States, stakeholders, donors, and implementing partners. The outcomes of this consultative process will be brought to the World Health Assembly through the regional committees. The draft global action plan to minimize poliovirus facility-associated risk after eradication of wild - 8 - polioviruses and cessation of routine oral poliovirus vaccine use will be revised and finalized by 2014 in the context of the new strategic plan. In order to address funding requirements, a cross-agency resource mobilization task force has been established to develop and implement a financing plan to maintain current financing and tackle the residual financing gap. The most urgent priority is to close the financing gap for eradication activities through to the end of 2013. As of 14 November 2012, the gap was US $700 million, against which firm prospects totaled about US$ 500 million. 2.2 Regional status of maintaining poliomyelitis-free status Background After having been certified poliomyelitis-free for 10 years, the Western Pacific Region experienced a wild poliovirus (WPV) importation from Pakistan into western China in 2011, causing a poliomyelitis outbreak of 21 cases in young children and adults in the Xinjiang Uyghur Autonomous Region. Since the outbreak was notified on 26 August 2011, China conducted five rounds of large scale SIAs and significantly enhanced surveillance. The last reported poliomyelitis case had onset on 9 October 2011. An international review conducted on 4–12 June 2012 concluded that the system is sensitive to rapidly detect AFP cases and considered it highly unlikely that undetected WPV circulation continues in the Xinjiang Uyghur Autonomous Region. A detailed summary of the outbreak epidemiology is included in this report. The outbreak in China reaffirmed the continued risk for any country to be re-infected until such time as all wild poliovirus transmission is interrupted globally. In May 2012, the WHO World Health Assembly, concerned about the continued WPV transmission in the remaining endemic areas jeopardizes achieving the global goal and poses significant risks to poliomyelitis- free countries, passed a resolution declaring the completion of polio eradication a programmatic emergency for global public health, requiring the full implementation of current and new eradication strategies. This includes maintaining very high population immunity against polioviruses through routine immunization programmes and where necessary, SIAs. It requires keeping vigilance for poliovirus importations and the emergence of circulating vaccine-derived polioviruses (cVDPVs) by achieving and sustaining certification-standard surveillance and regular risk assessment for polioviruses. The WHA resolution A65/55 is attached as Annex 3. Risk assessment and mitigation activities Risk assessment conducted in 2011 for the other countries in the Region on imported wild poliovirus to cause a poliomyelitis outbreak classified Cambodia, the Lao People’s Democratic, Papua New Guinea and the Philippines at high-risk. Risk mitigation activities such as supplementary immunization and strengthening of surveillance are being implemented. These included: • Cambodia conducted two rounds of oral poliovirus vaccine (OPV) SIAs in high-risk communities, in combination with measles SIAs. From February to April 2011, a total of 344 069 children were targeted and in November a total of 249 914 children up to 59 months of age were targeted. • Lao People’s Democratic Republic conducted three rounds of nationwide OPV SIAs, in combination with child health days (CHDs), tetanus toxoid (TT) SIAs (2010) and measles - 9 - SIA (2011). In November 2011 a total of 798 598 children up to 59 months of age were targeted and the reported coverage was 89%. • Papua New Guinea added OPV to a nationwide phased measles SIA conducted from 2010 to 2011. A total of 435,00 children up to 24 months of age were targeted and the reported coverage was 82%. • The Philippines added OPV to TT SIAs in 10 high-risk areas in the third quarter 2011, targeting 560 000 children up to 59 months of age. In 2012, main poliomyelitis risk mitigation activities in high-risk countries and in general in the Region included the following: • Papua New Guinea provided OPV for children up to 36 months old with the nationwide measles SIA in the first quarter and with TT SIAs in the fourth quarter. • Surveillance enhancement plans were developed for Cambodia and the Philippines. • While subnational risk assessment exercises were conducted by several NIPs (e.g. Brunei Darussalam, Hong Kong[China]), the main focus were priority countries such as Cambodia, China, Lao People’s Democratic Republic, Malaysia, Papua New Guinea, Philippines and Viet Nam. • Risk assessment remains qualitative in nature and considers components of population susceptibility, the ability to rapidly detect and monitor polio cases, and other factors that influence poliovirus exposure and transmission in the population. These components are estimated and monitored by using indicators from a variety of sources and assigned risk points. Subnational risk assessments will be updated annually and assessments are in progress across WHO regions (e.g. Western Pacific and South-East Asia regions and Western Pacific and European regions). Specific actions taken based on subnational risk assessment include the following: Cambodia: For the planning for the second round SIA in November 2011, the NIP further refined the identification and classification of high-risk communities. Not only were they chosen on the basis of socioeconomic risk, but their access to fixed site or outreach immunization services were also assessed. All high-risk communities have been classified into four categories. On the basis of this analysis, the NIP now has a detailed list of over 2100 communities and villages that are considered at high risk of not receiving full immunization services. These communities and villages can be analysed both in terms of socioeconomic status and health service access and targeted outreach may be conducted, as appropriate. Lao People’s Democratic Republic: The NCC communicates the findings of the risk assessment to the Ministry of Health, formulates recommendations for high-risk provinces and undertakes supervisory and monitoring activities in those provinces. Findings are used to focus activities and resources in identified high-risk areas. Malaysia: Results of subnational risk assessment were discussed with family health officers as well as state epidemiologists. The same exercise is recommended at the state level to identify districts for targeted catch-up immunization for eligible children two months to seven years old towards at least three doses of OPV and DTP. Papua New Guinea: In view of the planned second round of TT SIA in September 2012 by the National Department of Health, the NCC recommended that a supplementary OPV dose be provided to all under five years children in the provinces identified at high risk in the subnational assessment, covering approximately 600 000 children. Polio risk assessment was also incorporated in the 2011 vaccine-preventable disease (VPD) surveillance review. - 10 - Viet Nam: The exercise identified 35 districts with OPV3 coverage at less than 90% (2005–2009) in 14 high-risk provinces and 42 districts with international border crossing points to be targeted with two rounds of OPV SIAs for children under the age of five years. The SIAs were conducted in the third and fourth quarter in 2011. Routine immunization against poliomyelitis Importations of wild poliovirus cannot be prevented, and the spread of the virus can threaten countries with high population immunity. The minimum requirement for vaccination coverage in a country is at least 80% as agreed at the World Health Assembly in 2006. The Global Immunization Vision and Strategy (GIVS) calls for at least 90% routine immunization coverage for all EPI antigens. In 2011, three countries reported coverage at or below 80% (Lao People’s Democratic Republic, Papua New Guinea, Philippines). Further data analysis suggests a wide range of subnational performance levels: e.g. in Cambodia 18% of districts, in Lao People's Democratic Republic 50%, in Papua New Guinea 31% and in the Philippines 42% had less than 80% DPT3 coverage (considered surrogate to OPV3). Likewise, immunization status analysis of AFP cases (representing a decent sample of the general population) suggests coverage problems in some countries as well as incomplete case investigation, as no immunization status information may be available. AFP/poliomyelitis surveillance Complete and timely investigation of AFP cases remains essential to reliably detect polioviruses. In terms of key aspects of AFP surveillance quality, four countries (with nationwide AFP surveillance) did not reach the minimum non-polio AFP rate of one per 100 000 children under 15 in 2011 (New Zealand, Papua New Guinea, Philippines, Singapore) while adequate stool specimen collection rates of at least 80% were not reached by several countries including Australia, Lao People’s Democratic Republic, Malaysia, New Zealand, Pacific island countries and areas, Papua New Guinea and the Philippines. Reporting of AFP cases in 2012 (as of 18 November 2012) is below the minimum rate in Australia, New Zealand, Pacific island countries and areas and Papua New Guinea. Poliomyelitis laboratory network The poliomyelitis network laboratories in the Western Pacific Region except China introduced the new algorithm for virus isolation and intratypic differentiation (ITD) and vaccine derived poliovirus (VDPV) screening to reduce the time for the detection and identification of polioviruses during 2009–2010 following the recommendations of the WHO global poliomyelitis laboratory network. After experiencing the WPV type 1 outbreak in the Xinjiang Uyghur Autonomous Region in 2011, the China Center for Disease Control and Prevention (China CDC) decided to introduce the new virus isolation algorithm in all 31 subnational provincial laboratories and the real-time PCR for ITD of polioviruses and VDPV in selected provincial laboratories. China CDC organized a national poliomyelitis laboratory workshop in February 2012 and a hands-on training workshop in March 2012 for 24 provincial laboratories to introduce the real-time PCR for ITD and VDPV screening. The WHO Regional Office for the Western Pacofic also decided to conduct another hands- on training workshop in December 2012 to introduce the real-time PCR techniques in the two remaining ITD countries which still use the conventional PCR method for ITD and to upgrade - 11 - the national poliomyelitis laboratories in Viet Nam and the Philippines to poliomyelitis ITD laboratories. The effort to introduce the real-time PCR into all ITD laboratories and to expand to two WHO poliomyelitis national laboratories will allow rapid detection of wild poliovirus and VDPVs in the Region. Vaccine-derived poliovirus emergence In 2011, in China six VDPVs (1 type 1, 4 type 2 and 1 type 3) were identified in six non related AFP cases, two of which are considered iVDV. Additionally, three type 2 VDPV were isolated in 3 non related non-AFP cases; one is considered iVDPV. In China in 2012, in China five VDPVs (four type 2 and one mixed type 2 and 3) were identified; of which is considered iVDPV. All VDPV occurrences have been fully investigated and required response measures have been taken. Final confirmation is still pending if the type 2 VDPV isolated from AFP cases (one in 2011 and two in 2012) in Sichuan is to be considered as cVDPV. In Viet Nam, two VDPV type 2 in two non-related AFP cases were detected. A comprehensive investigation of the first VDPV to emerge has been conducted while the investigation for the second VDPV is still in progress. Response immunization activities will commence shortly. Wild poliovirus importation preparedness Following the RCC requirement, all countries submitted importation preparedness plans (at least in draft) in November 2011. While the RCC appreciated that most countries had updated their plans, it noted the great diversity in country situations and expressed that regional guidelines are general in nature. The RCC requested the WHO Secretariat to conduct systematic review of all plans using a template and provide detailed feedback to all countries. This is work in progress. Summary on the epidemiology of the poliomyelitis outbreak in the Xinjiang Uyghur Autonomous Region in China On 25 August 2011, a case of wild poliovirus type 1 (WPV1) was confirmed in a resident of Lop County, Hotan Prefecture, in Xinjiang Uyghur Autonomous Region, the first WPV case in China in 12 years (last case due to imported WPV was in Qinghai in 1999). Genetic sequencing of this virus suggests that its closest relative (99% homology) is a virus circulating in southern Pakistan in late 2010. The case is a 16 month old girl who experienced an onset of paralysis on 3 July 2011. She was hospitalized on 5 July at the Hotan Prefecture Hospital. Stools specimens were collected on 7 and 8 July. Specimens were received by the provincial laboratory on 13 July and virus isolation was completed on 2 August (type 1). The isolate was sent to the national laboratory later on 19 August, with three other isolates from three other AFP cases from Hotan Prefecture received on 25 July and 4 August. On 25 August 2011, the national laboratory at the Chinese Center for Disease Control and Prevention confirmed the presence of WPV1 in all four AFP cases from Hotan Prefecture, Xinjiang Uyghur Autonomous Region. - 12 - Figure 1: Weekly distribution of AFP cases, Xinjiang Uyghur Autonomous Region, 2011–2012 Geographic spread During the period July–October 2011, a total of 21 cases of WPV1 were detected in four southern prefectures of Xinjiang Uyghur Autonomous Region. Between July and the end of August, all reported cases (n=12) were from the prefecture of Hotan. Five counties were affected: Lop County (onset of first case on 3 July), Moyu County (onset of first case on 7 July), Hotan City (onset of first case on 9 July), Yutian County (onset of first case on 26 July), and Hotan County (onset of first case on 2 August). In September, five more prefectures were affected: Bazhou Preferture (n=1, Quiemo County, onset on 5 September) followed by the prefecture of Kashgar (n= 6; Bachu County, onset of first case on 10 September; Shache County, onset of first case on 16 September; Yingjisha County, onset of first case on 17 September; and Shule County, onset of first case on 18 September). In October, one more prefecture was affected: Aksu with one case in Aksu City, with onset on 9 October. - 13 - A Figure 2: Distribution of poliomyelitis cases by week of onset, by county, 2011 Characteristics of poliomyelitis cases In terms of the demographic characteristics of the confirmed poliomyelitis cases, half of the cases were in the age group zero to two years old (43%) and the other half (52%) in the age group 15 to 65 years old; 62% of the cases were male (See Figure 3). The clinically compatible poliomyelitis cases were slightly older than the laboratory- confirmed cases with 68% of the cases among those 16 to 65 years old. In terms of OPV immunization status of the cases, 24% (n=5) received no doses, 19% (n=4) had received one to three doses, and 19% (n=4) received four to six doses. For 38% (n=8) of the cases, the OPV status is unknown (those eight cases are all in the older age group i.e. >15 years old). Figure 3: Characteristics of reported poliomyelitis cases, Xinjiang Uyghur Autonomous Region, China, 2011 (Data as of 3 May 2012; source: WHO Regional Office for the Western Pacific) Demographic characteristics Reported cases of polio Laboratory confirmed cases Clinically compatible cases # % # % Age 0‐ <2 years old 9 43% 3 14% 2‐ <5 years old 1 5% 3 14% 5‐ 15 years old 0 0% 1 5% 16‐65 years old 11 52% 15 68% < 65 years old 0 0% 0 0% Sex Male 13 62% 20 91% Female 8 38% 2 9% Total 21 100% 22 100% - 14 - Response Following the detection of the poliomyelitis outbreak, the Government of China carried out a large and aggressive response with intensification of surveillance: retrospective case search, serosurvey, contact samplings and training on AFP surveillance (the AFP case definition was modified to include all age groups for the southern prefectures of Xinjiang Uyghur Autonomous Region). In addition, a series of immunization response took place in Xinjiang Uyghur Autonomous Region (see Figure 4) as well as in the rest of the country. In Xinjiang Uyghur Autonomous Region, between September 2011 and April 2012, five immunization rounds were carried out with monovalent and trivalent OPV. Based on the profile of the poliomyelitis cases, three age groups were targeted by the campaigns: under five years old, under 15 years old and under 40 years old. Figure 4: Immunization outbreak response activities, 2011–2012 (source: WHO Regional Office for the Western Pacific) Dates of SIA Southern Prefectures (Aksu, Hotan, Bazhou, Kezhou, Kashgar) Urumqui Others Age group Vaccine Age group Vaccine Age group Vaccine Sept 2011 0–39 years tOPV 0–15 years tOPV 0-5 years tOPV Oct 2011 0–15 years tOPV 0–15 years tOPV 0-5 years tOPV Nov 2011 0–39 years mOPV1 0–15 years mOPV1 0-5 years mOPV1 Mar 2012 0–39 years mOPV1 0–15 years mOPV1 0-15 years mOPV1 Apr 2012 0–39 years tOPV 0–15 years tOPV 0-15 years tOPV Quality of the SIA rounds: The strategy used was a mixed of fixed posts and house visits. Arm and ear markings and vaccination cards were used as proof of vaccination. Particular focus was placed on the migrant populations. In terms of reported coverage available for the three rounds of OPV SIAs in 2011, all prefectures reported more than 95% coverage in all age groups targeted. Independent monitoring was carried out in markets, bus and train stations and communities with migrant populations in the early or interim stage during three rounds of OPV SIAs in 2011 and the OPV SIA in March 2012. The result of the independent monitoring varied from 0% to 20% in the children under five years of age, 0% to 9% in the children aged five to 14 years old, and 0% to 30% in the adults older than 15 years. The Xinjiang Uyghur Autonomous Region Health Department conducted rapid coverage assessment after the completion of each round of OPV SIAs. The available results in the three rounds of OPV SIAs in 2011 indicated 97% to 100% coverage achieved in all target age-groups in all prefectures. - 15 - Figure 5: Population Vaccinated in SIA, Xinjiang Uyghur Autonomous Region, September 2011–April 2012 Dates of SIA Target age-group Immunized (million) Rapid coverage assessment Number of people surveyed % of people vaccinated September 2011 0–14 years 4.17 4506 99.20% 15–39 years 5.31 6649 99.50% October 2011 0–14 years 4.16 3601 99.60% November 2011 0–14 years 4.18 4739 98.50% 15–39 years 5.2 4332 97.60% March 2012 0–14 years 5.28 7229 98.80% 15–39 years 4.97 7610 98.30% April 2012 0–14 years 5.34 8108 98.80% 15–39 years 4.97 8546 98.20% A total of 43.6 million children were vaccinated. A joint international/national AFP surveillance review conducted in Xinjiang Uyghur Autonomous Region from 4 to 12 June 2012 concluded that “the system is sensitive to rapidly detect AFP cases and considered it highly unlikely that undetected WPV circulation continues in Xinjiang Uygur Autonomous Region”. Factors contributing to the outbreak While the time, source and route of the WPV1 importation could not be identified, several factors may have facilitated the poliomyelitis outbreak: • insufficient immunity in adult population due to limited exposure to WPV when still endemic, as well as limited infant and supplementary immunization; • actual routine immunization coverage lower than reported due to factors such as incomplete target denominator, population movements, unregistered children, limited resources and systems capacities; • declining quality of preventive SIAs for example due to extended period without polio (more than15 years) and shifting priorities, lack of understanding of its importance by health workers, political decision-makers and caretakers, and reduced resources; • routine AFP surveillance with insufficient alert mechanisms mainly due to extended period without poliomyelitis and many health workers never having seen polio cases; • increasing population movements into and out of the province and to and from poliomyelitis affected areas; and • very wide spread WPV circulation in Pakistan in 2011. - 16 - 3. CONCLUSIONS AND RECOMMENDATIONS 3.1 China poliomyelitis outbreak and general The RCC welcomed the clear and comprehensive report from the China NCC which described known vulnerabilities of the Xinjiang Uyghur Autonomous Region prior to outbreak and limitations in AFP surveillance in some areas before and following the outbreak, and efforts to address the vulnerabilities. The RCC commended plans for further strengthening of routine immunization services and AFP surveillance in critical areas, while systematically undertaking risk assessments. The outbreak detection was considered prompt through a sensitive AFP surveillance system and a precise, proficient and innovative laboratory system working in clear collaboration within the Global Polio Laboratory Network to confirm outbreak on 25 August 2011 and determine the origin of the WPV as importation from Pakistan. The RCC considered the outbreak investigation exemplary with prompt and massive efforts in retrospective and active, prospective case finding, serologic testing to determine susceptibility, extensive virologic testing of healthy individuals and environmental sampling in the Xinjiang Uyghur Autonomous Region. The RCC commended the model decision-making with rapid, effective mobilization of substantial human and financial resources after outbreak confirmation, and rapid development and use of monovalent OPV1, implementation of response activities occurred with the shortest possible interval between immunization rounds, targeting an expanded age group in the SIA response based on epidemiological findings in the prefectures of the Xinjiang Uyghur Autonomous Region. SIAs were also conducted in other provinces, following comprehensive risk assessment. The RCC concluded that China met all criteria of the 2006 World Health Assembly resolution on wild poliovirus outbreaks; that is: o investigation and local response within 72 hours of outbreak confirmation; o more than three rounds of SIA conducted, with the first one in less than four weeks after confirmation (first SIA began on 8 September, while a total of five SIAs were completed); o more than two million children targeted (over four million children and almost five million people aged 16–39 years were immunized); o SIA monitoring to document coverage more than 95%; o at least two SIAs conducted following the latest case (Xinjiang Uyghur Autonomous Region completed three SIAs after the last (two rounds used mOPV1); o surveillance enhanced to detect more than two non-polio AFP per 100 000 children for more than 12 months following latest case (achieved by all - 17 - prefectures of the Xinjiang Uyghur Autonomous Region, as well as nearly all western provinces); and o sustained routine immunization coverage at more than 80% and sensitive surveillance. The RCC commended the exemplary response. The response in the southern Xinjiang Uyghur Autonomous Region following wild poliovirus importation limited the outbreak to 1.5 months from laboratory confirmation (25 August 2011) to the onset of latest poliomyelitis case (9 October 2011). The outbreak control also fully met the less than six months outbreak milestone of the Global Polio Eradication Initiative Strategic Plan 2010–2012. The RCC commended the extensive collaboration of authorities within health and other sectors of government, as well as the intercountry and interregional coordination and collaboration with Global Polio Eradication Initiative partners, also acknowledging that China fully met all requirements of timely reporting by the International Health Regulations (IHR) 2005. In terms of augmented surveillance, the RCC noted the enhancement of more than 12 months in the Xinjiang Uyghur Autonomous Region and other provinces at higher risk following the latest poliomyelitis case. The national AFP reporting mechanism was extensively upgraded with added functionality, including real-time, online data entry. These upgrades the international surveillance review carried out in June 2012 allowed the RCC to reach its final conclusions on the outbreak based on: The contents of the comprehensive report allowed the RCC to declare China as retaining its poliomyelitis-free status. Outbreak investigation and response actions undertaken in China in 2011 are models for any other outbreak following importation globally. In general terms, the RCC reminded that certification in 2000 referred to indigenous wild poliovirus and adequate preparedness to effectively respond to imported wild poliovirus. Shortly after certification, the cVDPV risk emerged and countries in the Region have continuously stayed alert and taken adequate control measures for poliovirus emergence. Subsequently, the RCC reviews the situation on the following: o continued absence of indigenous / re-established wild poliovirus; o response to imported wild poliovirus; and o detection of and response to VDPVs. The RCC welcomed the 2012 World Health Assembly resolution to declare completion of poliomyelitis eradication an international public health emergency. The RCC considers poliomyelitis eradication a global activity and an ongoing process that involves everyone, including poliomyelitis-free countries and regions. The RCC reminded that certification of poliomyelitis-free status is not a guarantee. The 2012 World Health Assembly resolution reiterates what the RCC has continuously urged countries in the Western Pacific to consider to maintaining their poliomyelitis-free status. - 18 - The RCC encouraged all countries and poliomyelitis partners again to take additional measures—as appropriate—to reduce the risk of new outbreaks caused by the international spread of wild polioviruses or the emergence of cVDPV. These measures include: o strengthening supplementary and routine immunization activities to close gaps in population immunity; o attaining very high-quality surveillance; o considering vaccination of travellers to and from polio-affected areas; o conducting regular risk assessment, including at subnational levels as appropriate, and o ensuring that updated importation preparedness plans are in place. The RCC sincerely thanked all NCCs and the Subregional Certification Committee (SRCC) for the Pacific island countries and areas for their continued oversight and active involvement of keeping their respective countries poliomyelitis-free. The RCC considered NCC and SRCC efforts as crucial and significant to the overall goal of finally ridding the world of poliomyelitis. After having accepted all country progress reports, the RCC concluded at the following: Given China’s poliomyelitis-free status and the review of progress reports from all other countries, the RCC announced the Western Pacific Region has been free of circulating poliovirus for the past 12 months and is retaining its poliomyelitis-free certification status. 3.2 Country-specific conclusions and recommendations Australia The RCC particularly commended Australia for the various efforts to boost AFP surveillance through expansion of the network, a comprehensive system review and the efforts in enterovirus and environmental surveillance. The RCC noted that high performance of the regional poliomyelitis reference laboratory at Victorian Infectious Diseases Reference Laboratory (VIDRL) remains the backbone of high quality poliomyelitis surveillance; not only for Australia but the entire Region. The RCC welcomes specific efforts to review population immunity including coverage assessments for risk populations and the serosurvey in the fourth quarter 2012. The RCC considers the comprehensive risk assessment conducted as very valid and a model for other developed countries. Brunei Darussalam The RCC noted that all key quality indicators in surveillance and immunization were met and that the current outbreak preparedness plan in place reflects the 2011 shift to IPV. The RCC also noted examples of innovative awareness building, such as the "Polio Point Programme" launched by the International School Brunei Darussalam. - 19 - The RCC commended Brunei Darussalam for its continued financial contribution to the Global Polio Eradication Initiative. Cambodia The RCC noted that key surveillance indicators have been improving but areas of weakness remain and need to be addressed. These include silent areas, late follow-up of AFP cases with inadequate samples, late shipment of specimens and decline in zero reporting. While routine immunization coverage remains relatively high it is not uniform enough. The RCC strongly encouraged that opportunities for OPV SIAs be used. The RCC acknowledged that the subnational risk assessment has been updated and some improvements were noted; the exercise should continue on a regular basis and be used for targeted action. China Rapid and effective mobilization of substantial human and financial resources after outbreak confirmation and the extensive collaboration of health authorities and authorities within other sectors of government were exemplary. Also commendable were the intercountry and interregional coordination and collaboration with Global Polio Eradication Initiative partners that was enhanced during the outbreak and remains ongoing. The NCC report documents the intensity and large scale of the outbreak investigation. This investigation included prompt and massive efforts in case-finding (both retrospective and active prospective), serologic testing to determine the extent of susceptibility to wild poliovirus, and virologic testing of ill and healthy individuals and environmental specimens to determine the extent of wild poliovirus circulation in the Xinjiang Uyghur Autonomous Region. This outbreak was widespread within several southern prefectures within a short time following onset of the first confirmed case. The setting was not typically associated with extensive wild poliovirus transmission given population density and relatively high vaccination coverage. Surveillance enhancement and virologic testing of ill and healthy individuals in other areas of the country were fruitful in explicitly showing that WPV circulation was apparently limited to the southern Xinjiang Uyghur Autonomous Region. The exceptionally prompt and extensive immunization response appropriately addressed the age groups and areas at highest risk while also judiciously mitigating the potential for further geographic spread by addressing other risk areas in the country. Decisions to rapidly develop and use mOPV1, implement response activities with the shortest possible interval between rounds, and target an expanded group that reached a very high coverage led to rapid control and interruption of the outbreak. The AFP surveillance system was sensitive to promptly detect the outbreak; a precise, proficient and innovative laboratory system worked in clear collaboration within the Global Polio Laboratory Network to confirm the outbreak and the origin of the wild poliovirus. Surveillance was enhanced in the Xinjiang Uyghur Autonomous Region. The Xinjiang Uyghur Autonomous Region and nearly all other provinces considered at higher risk for more than 12 months following the latest case in the outbreak and the national AFP reporting mechanism was extensively upgraded with added functionality, including real- time, online data entry. - 20 - The excellent investigations that documented the involvement of older individuals in the outbreak provide lessons that are relevant to other poliomyelitis-free countries of the Western Pacific Region and elsewhere. The known vulnerabilities of the Xinjiang Uyghur Autonomous Region prior to the outbreak and the limitations in AFP surveillance in some areas before and following the outbreak are well described in the report, as well as the efforts to address these. The RCC commended the plans for further strengthening of routine immunization services and AFP surveillance in critical areas, systematically undertaking risk assessments and sustaining all other activities to retain poliomyelitis-free status. Hong Kong (China) The RCC noted that all key quality indicators in surveillance and immunization were met, that the current outbreak preparedness plan in place is reflecting IPV use in routine immunization and that the high quality laboratory remains fully accredited, also for ITD functions. The RCC commended the various measures taken to assess coverage, also in the context of extensive population movements in and out of Hong Kong (China). Japan The RCC acknowledged the continued extensive enterovirus surveillance and healthy children stool surveys which led to poliovirus isolation from five AFP cases and three non-AFP cases, including identification of a type 2 VDPV in a young child. This is supported by the high performance of the Global Specialized Laboratory at National Institute of Infectious Diseases (NIID) which continues to also play a critical role in the regional and global polio laboratory networks. The RCC noted the shift to IPV in September 2012 but remains concerned about immunity gaps in certain age groups and strongly recommends catch-up immunization. The RCC commended the development of a draft importation preparedness plan and encouraged its finalization as soon as possible. Lao People’s Democratic Republic The RCC noted that while overall AFP reporting remains high, there are gaps in performance including low stool specimen collection rate, subnational performance variation, missed cases in retrospective reviews and declining zero reporting. These aspects to be addressed as a matter of priority. The RCC also noted that while overall routine immunization coverage is increasing, there are remaining gaps; 56% of districts have below 80% OPV3 coverage. Of further concern to the RCC is that the Lao Socio Economic Indicator Survey 2012 indicated a substantially lower coverage as well as the immunization status of AFP cases. The RCC therefore encouraged that opportunities for OPV SIAs will be used and welcomed the planned polio SIA in 2014. The RCC acknowledged that the subnational risk assessment has been updated. The exercise should continue on a regular basis and be used for targeted action. - 21 - Malaysia The RCC commended Malaysia for surveillance performance improvements and, following its recommendation, the introduction of environmental surveillance which already identified 11 polioviruses (Sabin strains). The RCC noted the generally high routine immunization coverage. One state had below 90% coverage, but there were catch-up supplementary immunization activities for all antigens at districts below 95% coverage, ensuring greater universal population immunity in children. The RCC commended how the subnational risk assessment in 2011 was used for concrete mitigation actions. Macao (China) The RCC noted that all key quality indicators in surveillance and immunization were met and that the current outbreak preparedness plan in place is reflecting IPV use in routine immunization. Mongolia The RCC noted that all key AFP performance indicators have were and that the system is supported by supplemental surveillance activities, enterovirus and environmental surveillance, healthy children stool surveys, and various awareness-building measures. The RCC noted the high routine immunization coverage and that the annual supplementary immunization activities (SIAs 2012) for all antigens were placed under a specific polio slogan. New Zealand The RCC commended New Zealand on the various efforts made to address low surveillance indicators and welcomed the extension of the Ministry of Health contract with the New Zealand Pediatric Surveillance Unit. The RCC noted the good immunization coverage, also within ethnic groups. The RCC noted that the outbreak preparedness plan from May 2009 will soon be reviewed and wishes to receive the updated version at its next meeting. Pacific island countries and areas The RCC welcomed the targeted SRCC recommendations but noted that no meeting was conducted in 2012. The RCC encouraged annual meetings of national and subregional certification bodies. The RCC was concerned that AFP surveillance is again declining but also understood that large resource input are required for substantial improvements. The RCC recommended a balanced approach. The RCC noted that routine immunization coverage remains generally high in all countries and considers this as the key barrier against poliovirus reintroduction. The RCC was still concerned about the SIA opportunity missed in Samoa and Solomon Islands - 22 - The RCC still recommended the adoption of the updated generic importation preparedness plan (2010) for the three largest countries (Fiji, Solomon Islands, Vanuatu). Papua New Guinea The RCC shared the NCC concerns that the AFP surveillance performance remains chronically low and that most likely no improvements can be achieved in near future. The RCC was alarmed that the OPV3 coverage in 2011 decreased to 57%, with large variance among districts and systemic problems such as vaccine shortages. The RCC noted that OPV was given during the measles SIAs April-May 2012 and the relatively good reported coverage. However, the RCC was concerned that coverage remained below 80% in the Highlands where large populations reside. The RCC wishes to receive coverage figures of the tetanus toxoid SIAs conducted October to November 2012 (as integrated MCH outreach) and recommends future targeted SIAs required in highly populated areas (like the capital and the highland provinces) The RCC noted that the subnational risk assessment was updated in early 2012 and used for SIA planning. Philippines The RCC welcomed the thorough, frank, and well-written report from the Philippines NCC. The RCC concurred with the conclusion reached by the NCC that the Philippines remains polio-free. The RCC also fully shared the serious concerns expressed in the report, and supported the conclusions and recommendations from the NCC, to improve performance. The RCC recognized the improvements in performance of AFP surveillance, including increased reporting of non-polio AFP (annualized rate at 1.12 per 100 000 population under 15 years of age), increased rates of collection of adequate stool specimens (but still below the required 80%), improved timeliness in follow-up (at 81%), and the continued excellent technical performance of the National Polio Laboratory. However, as clearly shown in the risk assessment, very serious threats to the polio-free status of the Philippines remain. As emphasized by the NCC, 50% of all cities and provinces are considered at high risk of outbreaks from importation of wild poliovirus, and another 39% are considered to be at medium risk. Moreover, the RCC noted that most of these provinces/cities were the same ones categorized as higher-risk in 2011. These findings point to increasing numbers of unprotected children in many parts of the country, establishing a very real and rapidly growing risk of explosive and widespread outbreaks either from imported wild polioviruses or indigenously emerging VDPVs. A poliomyelitis outbreak in the Philippines would have severe repercussions for the country, the Western Pacific Region, and the Global Polio Eradication Initiative. In view of the NCC report, the RCC made the following urgent recommendations: Concrete, detailed plans should be made to close the widening immunity gaps with quality, well-conducted and ideally nationwide campaigns of at least two rounds with trivalent OPV. The OPV campaigns should be combined with measles campaigns, as appropriate, and both activities should be given equal priority. - 23 - Areas for particularly intensified efforts should be based on risk assessment for of polio and measles. The management structure for vaccine delivery and surveillance should be critically reviewed to assess whether it is optimal to support maintenance of polio-free status, to support timely measles elimination and rubella control, and to assure effective control of other vaccine- preventable diseases. The RCC fully supported the NCC recommendations on strengthening vaccine preventable disease surveillance, immunization activities and performance monitoring. Singapore The RCC noted that key quality indicators in surveillance were met and innovations were introduced, such as the migration from ICD9 to ICD10 coding for at-risk diagnosis system. The RCC commended the continued high immunization coverage and the current outbreak preparedness plan put in place. Viet Nam The RCC concurred with the conclusions and recommendations of the NCC. While general AFP surveillance indicators were met the RCC was concerned that retrospective reviews found an increasing number of unreported AFP cases supporting the observations of the NCC that awareness levels on the requirements of AFP surveillance are declining. Regular health staff orientations and training are required. While reported routine immunization coverage generally remains high, the recent identification of independent VDPV emergences confirms immunity gaps at local levels which need to be closed as a matter of priority. Regular subnational risk assessments, including community risk profiling, are recommended. EIGHTEENTH MEETING OF THE REGIONAL COMMISSION FOR THE CERTIFICATION OF ANNEX 1 POLIOMYELITIS ERADICATION IN THE WESTERN PACIFIC REGION English only Beijing, China, 28-29 November 2012 TENTATIVE TIMETABLE Time Wednesday, 28 November 2012 Time Thursday, 29 November 2012 07:30–08:30 08:30–09:30 09:30–10:00 REGISTRATION Opening • Welcome remarks by the Responsible Officer • Opening remarks by the Regional Director • Welcome remarks by the Government of China • Self-introduction, Election of Officers (Chair, Vice-Chair, Rapporteur) • Remarks by the Regional Certification Commission (RCC) Chairperson • Administrative announcements 1. Keynote presentation: Global poliomyelitis eradication — from emergency to endgame 08:30–08:50 08:50–09:10 09:10–09:30 09:30–09:50 Making poliomyelitis-free status sustainable — immunization 6.1 Papua New Guinea: service package approach in complex environment 6.2 Japan: shifting from oral poliovirus vaccine (OPV) to inactivated polio vaccine (IPV) 6.3 Malaysia: two years' experience with IPV schedule Discussion 10:00–10:30 GROUP PHOTO AND COFFEE BREAK 09:50–10:20 COFFEE BREAK 10:30–10:50 10:50–11:10 11:10–11:30 11:30–12:00 12:00–12:15 12:15–12:30 Poliomyelitis and its different scenarios 2. Endemic and recently endemic countries 2.1. Afghanistan, Nigeria and Pakistan: highlights on current situation 2.2. India: Lessons learnt to stop endemic transmission in challenging environments Discussions and conclusions 3. Poliomyelitis outbreaks following importation 3.1 Epidemiology and response to 2011 outbreak in China 3.2 International acute flaccid paralysis (AFP) surveillance review in China Discussion 10:20–10:40 10:40–11:00 11:00–11:20 11:20–11:40 11:40–12:00 Making poliomyelitis-free status sustainable — surveillance 7.1 Australia: polio surveillance review 7.2 China: real-time online AFP surveillance system 7.3 Latest development of the poliomyelitis laboratory networks 7.4 Role of non-AFP surveillance systems Discussion 12:30–14:00 LUNCH BREAK 12:00–13:00 LUNCH BREAK 14:00–14:20 14:20–14:40 14:40–14:55 14:55–15:15 15:15–15:30 Vaccine-derived polioviruses (VDPV) 4.1 VDPV emergence in Viet Nam and lessons learnt 4.2 Laboratory surveillance for VDPV in China 4.3 Myanmar VDPV detection in China 4.4 Global update on VDPV Discussion 13:00–13:15 13:15–13:30 13:30–13:50 13:50–14:10 14:10–14:40 14:40–15:00 15:00–15:30 Making poliomyelitis-free status sustainable — working together beyond borders 8.1 Latest developments in global certification 8.2 World Immunization Week 8.3 Synergies with verification of measles elimination 8.4 Cross-regional collaboration Feature presentation: Pakistan – latest developments and epidemiology Discussion 9. The voices of partners 15:30-16:00 COFFEE BREAK 15:30–16:00 COFFEE BREAK 16:00–16:20 16:20–16:40 16:40–17:00 17:00–17:10 17:10–17:30 Making poliomyelitis-free status sustainable in a diversity of settings 5.1 New developments in risk assessment and coordinated mitigation 5.2 Keeping the momentum — using Europe as an example 5.3 Western Pacific regional status — RCC observations and concerns 5.4 21st Technical Advisory Group Meeting on Immunization and Vaccine Preventable Diseases — recommendations for staying poliomyelitis-free Discussion 16:00–16:30 16:30–16:45 16:45–16:55 16:55–17:05 17:05–17:15 17:15–17:30 10. RCC conclusions and recommendations Closing • Statement by Government of China • Statement by Global Polio Eradication Initiative • Statement by UNICEF • Closing remarks by WHO Regional Director • Closing remarks by RCC Chairperson ANNEX 2 W O R L D H E A L T H ORGANIZATION ORGANISATION MONDIALE DE LA SANTE REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL EIGHTEENTH MEETING OF THE REGIONAL COMMISSION FOR THE CERTIFICATION OF POLIOMYELITIS ERADICATION IN THE WESTERN PACIFIC REGION Beijing, China ENGLISH ONLY 28─29 November 2012 INFORMATION BULLETIN NO. 2 PROVISIONAL LIST OF REGIONAL CERTIFICATION COMMISSION MEMBERS, TEMPORARY ADVISERS, PARTICIPANTS (NATIONAL CERTIFICATION COMMITTEE MEMBERS), OBSERVERS/REPRESENTATIVES AND SECRETARIAT 1. REGIONAL CERTIFICATION COMMISSION MEMBERS Professor Anthony I. Adams, Chairman, Regional Certification Commission, No. 6/2-4 Chapman Crescent, Avoca Beach, New South Wales 2251, Australia Telephone: +61 2 4382 6516, E-mail: aarr@netspeed.com.au Dr Nobuhiko Okabe, (Vice-Chairman, Regional Certification Commission) Director General, Kawasaki City Institute for Public Health, 5-13-10 Oshima Kawasaki-ku Kawasaki City, Kanagawa 210-0834, Japan, Telephone: +81 4 4 2444985, Facsimile: +81 4 2462602, E-mail: okabe-n@city.kawasaki.jp Professor Nguyen Dinh Huong, National Manager, Viet Nam Stop TB Partnership 104 C10 Giang Vo. Badinh, Hanoi, Viet Nam, Telephone: +844 38463601, Facsimile: +844 38326162, E-mail: ngdhuonghn@yahoo.com.vn Dr Olen M. Kew, Chief, Molecular Virology Section, Division of Viral Diseases Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, United States of America, Telephone: +1 404 639 3940, Facsimile: +1 404 639 4011 E-mail: omk1@cdc.gov Dr Aida M. Salonga, Director, Institute of Child Health and Human Development, National Institute of Health, University of the Philippines, 623 Pedro Gil Street, Ermita, Manila, Philippines, Telephone: +63 2 5218450 (local 2405), Facsimile: +63 2 525 4996, E-mail: aida.salonga@yahoo.com Dr Steven Gary Fite Wassilak, Medical Epidemiologist, Global Immunization Division Centers for Disease Control and Prevention, Mailstop MS-E05, Clifton Road, Atlanta, GA 30333, United States of America, Telephone: +1 404 639 1867, Facsimile: +1 404 639 8573, E-mail: sgw1@cdc.gov Dr Hui Zhuang, Professor, Department of Microbiology, Beijing Medical University 38 Xue-Yuan Road, Haidian District, Beijing 100083, People's Republic of China United States of America, Telephone: +(8610) 82802221, Facsimile: +(8610)82801617 E-mail: zhuangbmu@126.com 2. TEMPORARY ADVISERS Dr Robert Hall, Senior Lecturer, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Commercial Road, Melbourne, Victoria 3004, Australia, Telephone: 61 3 9093 0452, Facsimile: 61 3 9903 0556, E-mail: robert.hall@monash.edu Professor David Durrheim, Director Health Protection, Hunter New England Population Health, New Lambton, New South Wales 2305, Australia Telephone: 61 2 6926 6395, Facsimile: 61 2 4924 6215, E-mail: david.durrheim@newcastle.edu.au 3. PARTICIPANTS (NATIONAL CERTIFICATION COMMITTEE MEMBERS – DESIGNATES) BRUNEI DARUSSALAM Dr Yung Chee Tee, Child Health Program Manager, Department of Health Services, Ministry of Health, P.O. Box 201, Jalan Menteri Besar, Bandar Seri Begawan 8670, Telephone: +67 32 878 6111 Facsimile: +67 32 381 980, E-mail: cheetee@yahoo.com CAMBODIA Dr Sok Touch, Director, Communicable Disease Control Department Ministry of Health, #151-153, Kampuchea Krom Avenue, Phnom Penh Telephone: +855 12 856848, Facsimile: +855 23 882317 E-mail: touch358@moh.gov.kh CHINA Dr Hou Yunde, Professor of Virology, President of Chinese Association of Medical Virology, Institute of Viral Disease Control 100 Ying Xin Jie, Xuan Wu Qu, Beijing 100050, Telephone: +86 10 64519566, E-mail: houyd20022003@yahoo.com.cn HONG KONG (CHINA) Dr Vivian Chan, Senior Medical Officer (Surveillance Section) Room 425, Centre for Health Protection, 147C Argyle Street Kownloon, Hong Kong, Telephone: +852 21252230 Facsimile: +852 27110927, E-mail: smo_ss3@dh.gov.hk MACAO (CHINA) Dr Lui Kin Man, Chief of Service and Consultant Pediatrician Service of Pediatrics, Centro Hospitalar, Conde de Sao Januario Macao, Telephone: +853 83908154, Facsimile: +853 83908130 E-mail: luikm@ssm.gov.mo JAPAN Dr Tatsuo Miyamura, Emeritus Member (ex Director General) National Institute of Infectious Diseases, 1-23-1 Toyama Shinjuku Tokyo 162 0052, Telefax: +81 3 3316 5988, E-mail: Tmiyam@aol.com LAO PEOPLE'S DEMOCRATIC REPUBLIC Dr Bounleua Oudavong, Director, Children's Hospital Ministry of Health, Km 3, Thadeua Road, Vientiane Telephone: +856 20 77829797, Facsimile: +856 20 77829797, E-mail: oudavong@gmail.com MALAYSIA Dr Chong Chee Kheong, Director of Disease Control, Ministry of Health Malaysia, Level 12, Block E7, Complex E, Federal Government Administrative Centre, 62590 Putrajaya, Telephone: +603 8883 4419/+6019 578 7001, Facsimile: +603 88890643, E-mail: drchongck@moh.gov.my MONGOLIA Dr Janchiv Oyunbileg, Director, Public Health Institute, Peace Avenue – 17, Ulaanbaatar – 49, Telephone: +976 11 458645 Facsimile: +976 11 458645, E-mail: jobileg@gmail.com NEW ZEALAND Dr Stephen T. Chambers, Professor, Department of Infectious Diseases, Christchurch Hospital, Private Bag 4710, Christchurch Telephone: +64 3 364 0951, Facsimile: +64 3 3640952 E-mail: steve.chambers@cdhb.govt.nz PAPUA NEW GUINEA Professor John Vince, Director of Trauma Postgraduate Studies and Research Centre, Deputy Dean, School of Medicine and Health Sciences, P.O. Box 5255, Boroko, Telephone: +67 5 311 2626 Facsimile: +67 5 325 0809, E-mail: johndvince@gmail.com PHILIPPINES Dr Nina G. Gloriani, Dean, University of the Philippines Manila College of Public Health, No. 625 Pedro Gil Street, Ermita, Manila Telephone: +63 2 524 2703, Facsimile: +63 2 521 1394, E-mail: ninagloriani@gmail.com REPUBLIC OF KOREA Dr Lee Dukhyoung, Director of Disease Prevention Center, Korea Centers for Disease Control and Prevention, Osong Health Technology Administration Complex, Cheongwon-gun, Chungbuk-do 363-951 Telephone: +82 10 32050747, Facsimile: +82 437197339 E-mail: leeduk0125@hanmail.net SINGAPORE Dr Jeffery Cutter, Director, Communicable Diseases Division Ministry of Health, 16 College Road, Singapore 169854, Telephone: 65 63259018, Facsimile: 65 63251168 E-mail: jeffery_cutter@moh.gov.sg SOUTH PACIFIC (FIJI) Dr Adi Lisikoveni Vesikula Tikoduadua, Consultant Pediatrician Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji Telephone: +67 9 992 5082, Facsimile: +67 9 330 3232 E-mail: liztiko@gmail.com VIET NAM Professor Le Duc Hinh, Professor of Neurology, Department of Neurology, Bach Mai Hospital, Hanoi, Telephone: (04) 37-761254 Facsimile: (844) 38-691607, E-mail: hunganhvatcoxnk@gmail.com THAILAND Dr Supamit Chunsuttiwat, Chair of South-east Asia Regional Certification Commission for Polio Eradication, Senior Medical Officer Division of General Communicable Diseases, Ministry of Public Health Tivanond Road, Nonthaburi 11000, Telephone: +662 590 3370 Facsimile: +662 9273585, E-mail: schunsutti@yahoo.com 4. OBSERVERS/REPRESENTATIVES BILL AND MELINDA GATES FOUNDATION BEIJING REPRESENTATIVE OFFICE Ms Bin Pei, Senior Program Officer, Policy and Advocacy, Bill and Melinda Gates Foundation, Beijing Representative Office, 19th Floor, Tower B, Ping An International Finance Center, Chaoyang District Beijing, Telephone: (86-10)8454 7500, Facsimile: (86-10)8454 7620 E-mail: Bin.Pei@gatesfoundation.org Ms Min Dai, Senior Program Officer, China HIV Program Bill and Melinda Gates Foundation, Beijing Representative Office 19th Floor, Tower B, Ping An International Finance Center, Chaoyang District, Beijing, Telephone: (86-10)8454 7500, Facsimile: (86-10)8454 7620, E-mail: Dai.Min@gatesfoundation.org CHINA NATIONAL CERTIFICATION COMMITTEE Professor ZHAO Kai, Member, National Certification Committee for Polio Eradication, Sanjianfangnanli 4, Chaoyang District, Beijing Telephone: 010-65756627, Facsimile: 010-65762404, E-mail: zhaok@yeah.net Professor GU Fangzhou, Member, National Certification Committee for Polio Eradication, 1003, Zongluquan Building No.1, Chaoyang Park, No 8 County Yard, Beijing 100026, Telephone: 010-65397655 E-mail: gufz@vip.sina.com Professor JIANG Zaifang, Member, National Certification Committee for Polio Eradication, 56 Nanlishi Lu, Xicheng Qu, Beijing 100045 Telephone: (86-10) 6802 2386, Facsimile: (86-10) 6801 1503, E-mail: ekxh@netchina.com.cn Professor HU Shanlian, Member, National Certification Committee for Polio Eradication, Handan Rd.220,Shanghai, Telephone: 13916896789, Facsimile: 021-54237263, E-mail: hushanlian@hotmail.com Professor LIANG Xiaofeng, Member, National Certification Committee for Polio Eradication, Changbai Rd.155, Changping Dst. Beijing, Telephone: 010-58900213, Facsimile: 010-58900213 E-mail: liangxf@hotmail.com CHINESE CENTER FOR DISEASE CONTROL AND PREVENTION (CHINA CDC) Dr WANG Yu, Director General, Chinese Center for Disease Control and Prevention, Changbai Road 155, Changping District, Beijing Telephone: 010-58900301, Facsimile: 010-58900346, E-mail: wangyu@chinacdc.cn Dr YANG Weizhong, Deputy Director General, Chinese Center for Disease Control and Prevention, Changbai Road 155, Changping District, Beijing, Telephone: 010-58900311, Facsimile: 010-58900346 E-mail: yangwz@chinacdc.cn Dr Li Li, Chief, National Immunization Program, Chinese Center for Disease Control and Prevention, Nanwei Road 27, Xicheng District Beijing, Telephone: 010-63068203, Facsimile: 010-63068203 E-mail: llsdjn@163.com Dr XU Wenbo, Chief, WPRO Polio and Measles Reference Laboratory, National Institute for Viral Disease Control and Prevention Chinese Center for Disease Control and Prevention, Changbai Road 155 Changping District, Beijing, Telephone: 010-58900187, Facsimile: 010-58900187, E-mail: wenbo_xul@yahoo.com.cn Dr LUO Huiming, Deputy Chief, National Immunization Program Chinese Center for Disease Control and Prevention, Nanwei Road 27 Xicheng District, Beijing, Telephone: 010-83159501 Facsimile: 010-83159501, E-mail: hmluo@vip.sina.com Dr WANG Zhao, Chief of the Steering Committee, WU JIEPING Medical Foundation, Youanmenwaiyulinli A102, Fengtai District, Beijing, Telephone: 13901185497, Facsimile: 63051016 E-mail: 13901185497@163.com Dr XU Aiqiang, Deputy Director, Shandong Provincial Center for Disease Control and Prevention, Jingshi Rd.16992, Jinan, Telephone: 18615281696, Facsimile: 0531-82679620, E-mail: aqxuepi@163.com Dr MA Chengpeng, Principal Staff Member, Yunnan Provincial Health Department, Guanshangguomao Road 85, Kunming, Telephone: 0871-7195190, Facsimile: 0871-7195282, E-mail: machengpeng@126.com Dr LIU Qinglian, Deputy Chief, Sichuan Provincial Center for Disease Control and Prevention, Zhongxue Road 6, Chengdu, Telephone: 18981958371, Facsimile: 028-85586725 E-mail: lql0112@126.com Dr XIN Jianping, Division Director, Health Department of the Tibet Autonomous Region, Beijingzhong Road 103, Lhasa, Telephone: 0891-6289615, Facsimile: 0891-6289615 E-mail: xzbjc_001@163.com Dr MA Minghui, Division Director, Health Department of Xinjiang Uygur Autonomous Region, Longquan St.191, Urumqi, Telephone: 13369690555, Facsimile: 0991-8567240, E-mail: xjwstdbb@163.com Fuerhati·Wushouer, Section Chief, Xinjiang Autonomous Region Center for Disease Control and Prevention, Henandong Road 860, Urumqi, Telephone: 15999155198, Facsimile: 0991-3855162 E-mail: xjnip@126.com Dr NING Jing, Associate Chief Physician, Uygur Autonomous Region Center for Disease Control and Prevention, Henandong Road 860, Urumqi, Telephone: 13579990998, Facsimile: 0991-3855162 E-mail: ningjing_xj@163.com Dr ZHANG Yufeng, Deputy Division Director, Health Bureau of Xinjiang Production and Construction Corps, Guangming Road196, Urumqi, Telephone: 18999161466, Facsimile: 0991-2890807 E-mail: zyf168863@sohu.com Dr LI Yongguang, Director, Aksu prefecture, Center for Disease Control and Prevention, Xinjiang Uyghur Autonomous Region #24 Jian She Road, Aksu city, Xinjiang, China, Telephone: 13999661268, Facsimile: 0997-2556910 Dr WANG Tongpin, Deputy Director of EPI Division, Kashigar prefecture, Center for Disease Control and Prevention, Xinjiang Uyghur Autonomous Region, #45 Xia Ma Le Ba Ge Road, Kashigar city, Xinjiang, China, Telephone: 18909985171, Facsimile: 0998-2582670, E-mail: wtm1123@163.com Dr DA Wa, Deputy Director of EPI Division, Center for Disease Control and Prevention, Tibet Autonomous Region, #21 Linkuo Bei Road, Tibet, China, Telephone: 13659545599 Dr WANG Huaqing, Deputy Chief, National Immunization Program Chinese Center for Disease Control and Prevention, Nanwei Road 27, Xicheng District, Beijing, China, Telephone: 13391737600, Facsimile: 63171892, E-mail: hqwang@vip.sina.com Dr HAO Lixin, Director of Division, National Immunization Program Chinese Center for Disease Control and Prevention. Nanwei Road 27, Xicheng District, Beijing, China, Telephone: 15201347661, Facsimile: 63027946-8, E-mail: lixinh2010@163.com Dr WEN Ning, Deputy Director of Division, National Immunization Program, Chinese Center for Disease Control and Prevention, Nanwei Road 27, Xicheng District, Beijing, China, Telephone: 13621380979 Facsimile: 63027946-8, E-mail: ning_wen@163.com Dr YU Wenzhou, Deputy Director of Division, National Immunization Program, Chinese Center for Disease Control and Prevention, Nanwei Road 27, Xicheng District, Beijing, China Telephone: 13811942899, Facsimile: 63027946-8, E-mail: wenzhouyu69@hotmail.com Dr FAN Cunxiang, Staff, National Immunization Program Chinese Center for Disease Control and Prevention, Nanwei Road 27, Xicheng District, Beijing, China, Telephone: 13552083480 Facsimile: 63027946-8, E-mail: fanchx98@163.com Dr WANG Haibo, Staff, National Immunization Program, Chinese Center for Disease Control and Prevention, Nanwei Road 27, Xicheng District, Beijing, China, Telephone: 13521204583, Facsimile: 63027946-8, E-mail: hbwang2005@163.com Dr DONG Changxin, Staff, National Immunization Program Chinese Center for Disease Control and Prevention, Nanwei Road 27, Xicheng District, Beijing, China, Telephone: 15611095900, Facsimile: 63027946-8, E-mail: cxdong18@gmail.com Dr SONG Kaijun, Staff, National Immunization Program, Chinese Center for Disease Control and Prevention, Nanwei Road 27, Xicheng District, Beijing, China, Telephone: 15501123116, Facsimile: 63027946-8, E-mail: songkaijun1981@hotmail.com Dr ZHENG Jingshan, Director of Division, National Immunization Program, Chinese Center for Disease Control and Prevention, Nanwei Road 27, Xicheng District, Beijing, China, Telephone: 13501215245 Facsimile: 63042355, E-mail: zhengjsh@hotmail.com Dr YIN Dapeng, Deputy Director of Division, National Immunization Program, Chinese Center for Disease Control and Prevention, Nanwei Road 27, Xicheng District, Beijing, China, Telephone: 13522711537 Facsimile: 83159833, E-mail: yindapeng2001@263.net Dr ZHOU Yuqing, Director of Division, National Immunization Program, Chinese Center for Disease Control and Prevention, Nanwei Road 27, Xicheng District, Beijing, China, Telephone: 15001235548 Facsimile: 83159800, E-mail: susanz6@hotmail.com Dr LIU Dawei, Director of Division, National Immunization Program Chinese Center for Disease Control and Prevention, Nanwei Road 27, Xicheng District, Beijing, China, Telephone: 13521843456, Facsimile: 83166239, E-mail: liudw929@126.com Dr XIA Wei, Staff, National Immunization Program, Chinese Center for Disease Control and Prevention, Nanwei Road 27, Xicheng District Beijing, China, Telephone: 13683022949, Facsimile: 83159833 E-mail: damonshou@163.com Dr ZHANG Yong, Deputy Director, Polio Laboratory, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, #155 Changbai Road, Changping District, Beijing, Telephone: 13001924218, Facsimile: 58900184 E-mail: yongzhang75@hotmail.com Dr YAN Dongmei, Staff, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention #155 Changbai Road, Changping District, Beijing, Telephone: 13611333194, Facsimile: 58900184, E-mail: dongmeiyan1976@hotmail.com Dr ZHU Shuangli, Staff, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention #155 Changbai Road, Changping District, Beijing, Telephone: 13341097189, Facsimile: 58900184, E-mail: zhusli@126.com Dr TAN Xiaojuan, Staff, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention #155 Changbai Road, Changping District, Beijing, Telephone: 13581928115, Facsimile: 58900184, E-mail: cherry_517@sina.com CHINA NATIONAL BIOTEC GROUP COMPANY LTD. (CNBG) Dr YANG Xiaoming, Chief Executive Officer, China National Biotec Group Company Ltd., 26th Floor, Fortune Tower A, No.4 Huixin East Street, Chaoyang District, Beijing, China, Telephone: 010-84663998 Facsimile: 010-84663322 HOTAN PREFECTURE HEALTH BUREAU, XINJIANG UYGHUR AUTONOMOUS REGION Dr YIN Chenghong, Deputy Director, Hotan Prefecture Health Bureau, #230 Na Wa Ge Road, Hotan City, Xinjiang, China, Telephone: 13911211878, Facsimile: 0903-2028261, E-mail: modscn@yahoo.com.cn INSTITUTE OF MEDICAL BIOLOGY, CHINESE ACADEMY OF MEDICAL SCIENCES Dr XIE Zhongping, Deputy Director, Institute of Medical Biology Chinese Academy of Medical Sciences, #935 Jiaoling Road, Kumming City, Yunnan province, China, Telephone: 13108712330, Facsimile: 0871-8334483, E-mail: xzp@imbcams.com.cn JAPAN INTERNATIONAL COOPERATION AGENCY (JICA) Mr Ryotaro Oda, JICA China Office, Room 400, Beijing Fortune Building, No. 5, Dong SanHuanBei Road, Chaoyang District Beijing, China, Telephone: +86-10-6590-9250(ext.84) Facsimile: +86-10-6590-9260, E-mail: Oda.Ryotaro@jica.go.jp KOREA CENTERS FOR DISEASE CONTROL AND PREVENTION Dr Junwoo Kim, Medical Officer and Epidemic Intelligence Service Officer, Korea Centers for Disease control and Prevention, Osong Health Technology Administration Complex, Cheongwon-gun, Chungbuk-do 363-951, Republic of Korea, Telephone: +82-10-9230-5616, Facsimile: +82-43-719-7356 E-mail: junwoo-kim@hanmail.net MINISTRY OF HEALTH, CHINA Dr YU Jingjin, Director General, Bureau of Disease Prevention and Control, Ministry of Health, Xizhimenwainan Road 1, Beijing, China Telephone: 010-68792331, E-mail: yujj@moh.gov.cn Dr LEI Zhenglong, Deputy Director General, Bureau of Disease Prevention and Control, Ministry of Health, Xizhimenwainan Road 1 Beijing, China, Telephone: 010-68792632, E-mail: leizl@moh.gov.cn Dr LI Mingzhu, Deputy Director General, Department of International Cooperation, Ministry of Health, Xizhimenwainan Road 1 Beijing, Telephone: 010-68792293, Facsimile: 010-68792293 E-mail: limz@moh.gov.cn Dr LIU Yue, Director, Department of International Cooperation Ministry of Health, Xizhimenwainan Road 1, Beijing, Telephone: 010-68792275, Facsimile: 010-68792279, E-mail: liuyue@moh.gov.cn Dr LI Quanle, Director, Bureau of Disease Prevention and Control Ministry of Health, Xizhimenwainan Road 1, Beijing, China, Telephone: 010-68792958, Facsimile: 010-68792357, E-mail: liql@moh.gov.cn Dr XU Min, Deputy Director, Health Emergency Response Office Ministry of Health, Xizhimenwainan Road 1, Beijing, China, Telephone: 010-68792976, Facsimile: 010-68792646, E-mail: xumin@moh.gov.cn Ms RU Lixia, Ministry of Health, Xizhimenwainan Road 1, Beijing China, Telephone: 86-10 68792414, Facsimile: 86-10 6879 2279 E-mail: rulx@moh.gov.cn Dr FENG Yun, Bureau of Disease Prevention and Control, Ministry of Health, Xizhimenwainan Road 1, Beijing, China, Telephone: 86-10 6879 2712, Facsimile: 86-10 6879 2357 E-mail: fengyun@moh.gov.cn ROTARY INTERNATIONAL POLIOPLUS Dr Robert Scott, Chair, Rotary International PolioPlus, 239 Queen Street, Coburg, Ontario, Canada, Facsimile: 1 905 3720820 E-mail: bobscott@eagle.com UNITED NATIONS CHILDREN'S FUND (UNICEF) CHINA Ms Gillian Mellsop, UNICEF Representative to China UNICEF China, 12 Sanlitun Lu, Chaoyang District 100600 Beijing, China, Facsimile: 8610 65323107, E-mail: gmellsop@unicef.org Mr Robert Scherpbier, Chief of Health and Nutrition, UNICEF China 12 Sanlitun Lu, Chaoyang District 100600, Beijing, China, Facsimile: 8610 65323107, E-mail: rscherpbier@unicef.org Mr Tim Sutton, Deputy Representative, UNICEF China, 12 Sanlitun Lu, Chaoyang District 100600, Beijing, China, Facsimile: 8610 65323107, E-mail: tsutton@unicef.org Dr Zhu Xu, Immunization Specialist, UNICEF China, 12 Sanlitun Lu, Chaoyang District 100600, Beijing, China Facsimile: 8610 65323107, E-mail: xzhu@unicef.org UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT (US AID), CHINA Ms Maria Rendon, Development Counselor, United States Agency for International Development, Np. 55 An Jia Lou Lu 100600, Beijing, China, E-mail: rendonmc@state.gov UNITED STATES CENTERS FOR DISEASE CONTROL AND PREVENTION (US CDC) Dr Stephen L. Cochi, Senior Advisor, Global Immunization, Division, Center for Global Health, Centers for Disease Control and Prevention, 1600 Clifton Road, NE – Mailstop A-04, Atlanta, Georgia 30333, United States of America, Telephone: 1 404 639 8723, Facsimile: 1 404 639 8573, E-mail: scochi@cdc.gov; slc1@cdc.gov 5. SECRETARIAT WHO REGIONAL OFFICE FOR THE WESTERN PACIFIC (WPRO) Dr John Patrick Ehrenberg, Director, Combating Communicable Diseases, World Health Organization, Regional Office for the Western Pacific , United Nations Avenue, 1000 Manila, Telephone: 63 2 528 8001, Facsimile: 63 2 521 1036 E-mail: ehrenbergj@wpro.who.int Dr Sergey Diorditsa, Team Leader, Expanded Programme on Immunization, World Health Organization, Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines Telephone: +63 2 528 9745, Facsimile: +63 2 526 0279 E-mail: diorditsas@wpro.who.int Dr Sigrun Roesel, Medical Officer, Expanded Programme on Immunization, World Health Organization, Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila, Philippines Telephone: +63 2 528 9741 Facsimile: +63 2 526 0279 E-mail: roesels@wpro.who.int Dr Youngmee Jee, Scientist (Laboratory Virologist), Expanded Programme on Immunization, World Health Organization, Regional Office for the Western Pacific, United Nations Avenue, 1000 Manila Philippines, Telephone: +63 2 528 9744, Facsimile: +63 2 526 0279 E-mail: jeey@wpro.who.int Mr Gabriel Anaya, Programme Management Officer, Expanded Programme on Immunization, World Health Organization Regional Office for the Western Pacific, United Nations Avenue 1000 Manila, Telephone: 63 2 528 9740, Facsimile: 63 2 521 1036 E-mail: anayag@wpro.who.int WHO/CHINA Dr Michael O'Leary, WHO Representative Office in China, World Health Organization, 401, Dongqai Diplomatic Office Building 23, Dongzhimenwai Dajie, Chaoyang District, 100600 Beijing China, Telephone: 8610 6532-7189, Facsimile: 86 10 6532 2359 Email: olearym@wpro.who.int Dr Lawrence Rodewald, Team Leader, Expanded Programme on Immunization, WHO Representative Office in China 401, Dongwai Diplomatic Office Building, Chaoyang District, Beijing 100600, Telephone: 86 10 6532 7189 to 92, Facsimile: 86 10 6532 2359, E-mail: rodewaldl@wpro.who.int Dr Zuo Shuyan, National Programme Officer, WHO Representative Office in China, 401, Dongwai Diplomatic Office Building, 23, Dongzhimenwai Dajie, Chaoyang District, Beijing 1000600 People's People's Republic of China, Telephone: +86 10 6532 7189 Facsimile: +86 10 6532 2359, E-mail: zuos@wpro.who.int WHO HEADQUARTERS GENEVA Dr Rudolf Tangermann, Medical Officer, Surveillance, Data and Certification, World Health Organization, CH-1211 Geneva 27 Switzerland, Telephone: 41 22 791358, Facsimile: 41 22 791 0746 E-mail: tangermannrW@who.int Ms Liliane Boualam, Technical Officer, Strategy and Surge Support Unit, World Health Organization, CH-1211 Geneva 27, Switzerland Telephone: 41 22 7913074, Facsimile: 41 22 791 0746, E-mail: boualaml@who.int WHO/PAKISTAN Dr Elias Durry, Emergency Coordinator Pakistan, WHO Representative Office in Pakistan, National Institute of Health Chak Shahzad, Islamabad, Pakistan, Telephone: +92 518432420 Facsimile: +92 519255083, E-mail: durrye@pak.emro.who.int WHO REGIONAL OFFICE FOR EUROPE (EURO) Dr Dragan Jankovic, Technical Officer, Communicable Diseases, Vaccine Preventable Diseases and Immunization, The World Health Organization, Regional Office for Europe (EURO), 8, Scherfigsvej DK-2100 Copenhagen, Denmark, Telephone: 45 39171258 Facsimile: 45 39171818, E-mail: dja@euro.who.int WHO REGIONAL OFFICE FOR SOUTH EAST ASIA (SEARO) Dr Patrick Michael O'Connor, Regional Adviser-Polio & VPD Surveillance Immunization and Vaccine Development, The World Health Organization, Regional Office for South-East Asia (SEARO) World Health House, Indraprastha Estate, Mahatma Gandhi Road New Delhi 110002, India, Telephone: +91 11 2337 0804 Facsimile: +91 98101 74725, E-mail: oconnorp@searo.who.int