2014 Issue No. 18 - Week 35 (as of 1 September 2014) HIGHLIGHTS All countries requested before end of 2014 to commit to introduction of IPV in 2015 The polio endgame strategic plan (http:// www.polioeradication.org/Resourcelibrary/ Strategyandwork.aspx) includes that by the end of 2014, all countries using only oral polio vaccine (OPV) in their national routine immunization schedules should make a commitment to introduce at least one dose of IPV into their national schedules. IPV should be planned to be introduced into the national immunization schedule before the end of 2015. Currently there are 17 countries and areas that are using only OPV. As this is a global initiative it is important to ensure that all countries and areas are moving in unison towards the introduction of IPV and eventual withdrawal of the type 2 component of oral polio vaccine (tentatively planned for April 2016).
Polio Bulletin 100% 90% 80% 70% 60%
Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age) and adequate specimen collection rate, 2012–2014* 3.0 2.5
Chart 2. Percentage of cases with pending classification > 90 days after onset, 2014 CHN 8.9% 2.9% 4.3% 11.7% 4.2% 100.0% 14.7% 0% 20% 40% 60% 80% 100%
Cases with adequate specimens
KHM LAO MYS PHL PNG VNM
Non-polio AFP rate
2.0 1.5 1.0 0.5 0.0 12 13 14 CHN 12 13 14 KHM 12 13 14 LAO 12 13 14 MYS 12 13 14 PHL 12 13 14 PNG 12 13 14 VNM
50% 40% 30% 20% 10% 0%
* AFP rate annualized as of week 35
Philippines conducting nationwide OPV campaign integrated with measlesrubella From 1–30 September 2014, the Philippines will be conducting a nationwide measlesrubella (MR) and oral polio vaccine (OPV) mass immunization campaign targeting all children 9 to 59 months with MR vaccine and all children 0 to 59 months with OPV.
Chart 3. Polio immunization status of reported AFP cases, 2014 100% 100%
Chart 4. Percentage of samples received at the lab ≤ 3 days of collection, 2014
80%
80% 59% 53% 36% 29%
60%
60%
40%
40%
CONTACT US Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: WPR_EPIdata@wpro.who.int Web: www.wpro.who.int/immunization
20%
20% 0% CHN KHM 0% LAO MYS PHL 0% PNG VNM
0% CHN KHM LAO MYS 1-2 doses
PHL 0 doses
PNG Unknown
VNM
0%
≥ 3 doses
Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam).
Table 1. Classification of AFP cases with onset in 2014 and key surveillance indicators 2013 Classification Total reported cases Annual expected cases <15 years of age Pending Total reported cases Confirmed wild poliovirus Vaccinederived poliovirus (VDPV) Non-polio AFP rate 2 % % with % with % with any investigated 60-day adequate 4 2 days of ≤ specimen 6 specimens 3 5 follow-up notification ≥ 80% ≥ 80% ≥ 80% Latest report date Days since last report 7
2014 Indicators
Poliocompatible
Discarded (Non-polio)
Total
> 90 days 1 # (%)
≥1
Australia Brunei Darussalam Cambodia China Hong Kong (China) Japan Lao People's Democratic Republic Macao (China) Malaysia Mongolia New Zealand Papua New Guinea Philippines Republic of Korea Singapore Viet Nam Pacific island countries Total 1. 2. 3. 4. 5. 6. 7.
62 1 73 5623 12 0 48 1 155 7 12 18 277 84 7 459 8 6847
44 1 45 2225 8 167 25 1 77 8 9 30 378 76 6 241 10 3351
30 1 34 3174 10 0 23 1 103 3 4 7 167 62 5 156 7 3787
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1
22 1 14 2210 9 21 1 86 3 0 0 142 53 5 65 6 2638
8 0 20 963 1 2 0 17 0 4 7 25 9 0 91 1 1148
4 (13.3%) 0 (0.0%) 1 (2.9%) 283 (8.9%) 0 (0.0%) 1 (4.3%) 0 (0.0%) 12 (11.7%) 0 (0.0%) 3 (75.0%) 7 (100.0%) 7 (4.2%) 0 (0.0%) 0 (0.0%) 23 (14.7%) 0 (0.0%) 341 (9.0%) Green Yellow Red
1.01 1.49 1.12 2.12 1.86 1.37 1.49 1.99 0.56 0.66 0.35 0.66 1.21 1.24 0.96 1.04 1.68
33% 100% 94% 92% 90% 43% 0% 77% 100% 50% 0% 64% 79% 80% 92% 71% 89%
67% 100% 100% 99% 100% 83% 100% 98% 100% 75% 100% 91% 100% 100% 96% 100% 98%
83% 100% 85% 100% 100% 91% 100% 56% 100% 100% 57% 96% 97% 100% 93% 100% 98%
0% 100% 82% 100% 92% 100% 42% 50% 0% 8% 77% 100% 42% 50% 62%
14-Aug-14 22-Jul-14 25-Aug-14 27-Aug-14 01-Aug-14 18-Aug-14 15-Aug-14 29-Aug-14 26-Aug-14 08-Aug-14 28-Aug-14 22-Aug-14 26-Aug-14 04-Aug-14 25-Jul-14 28-Jul-14
18 41 7 5 31 14 17 3 6 24 4 10 6 28 38 35
Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Annualized non-polio AFP rate per 100 000 population under 15 years of age Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Percentage of reported cases with at least one specimen Percentage of reported cases investigated within two days of notification Percentage of reported cases with inadequate specimens followed-up within 60 days of onset of paralysis Countries are expected to submit data at least once per month to WPRO
Reached or surpassed target Nearly reached target: 0.5–0.99 for non-polio AFP rate; 60–79% for other indicators Substantially below target
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Polio Bulletin
Table 2. Laboratory investigation of AFP cases with onset in 2014 and key laboratory indicators Virus isolation results Country National polio laboratory Total no. of AFP L20B cases with specimens positive L20B positive + NPEV NPEV only Pending ≤ 14 Negative days Intratypic % % results differentiation Latest Pending reported specimens / Sequencing positive report date > 14 2 ≤ 14 days for NPEV 1 lab days ≥ 80% No. of isolates referred Type 1 W ild Sabin VDPV W ild Type 2 Sabin VDPV Wild Intratypic differentiation (ITD) results Type 3 Sabin VDPV NPEV 3
1
Pending ITD
% ITD results Discordant reported ≤ 7 days of pending receipt sequencing ≥ 80%
Australia Brunei Darussalam Papua New Guinea Pacific island countries Japan Cambodia Lao People's Democratic Republic Malaysia Mongolia New Zealand Philippines Republic of Korea Singapore Viet Nam, North Viet Nam, South China (total) China, Anhui China, Beijing China, Fujian China, Gansu China, Guangdong China, Guangxi China, Hebei China, Heilongjiang China, Henan China, Hunan China, Jiangsu China, Jiangxi China, Jilin China, Shaanxi China, Shandong China, Shanghai China, Shanxi China, Sichuan China, Tianjin China, Xinjiang China, Yunnan China, Zhejiang China, Chongqing China, Guizhou China, Hainan China, Hubei China, Liaoning China, Neimongol China, Ningxia China, Qinghai China, Tibet Hong Kong (China) Macao (China) Total
VIDRL VIDRL VIDRL VIDRL NIID NIID NIID IMR PHI IESR RITM NIH SGH NIHE PI CCDC Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab PHLC PHLC
23 1 7 7 0 34 19 114 3 2 208 62 5 112 83 3136 144 20 125 77 217 149 155 88 284 135 169 104 38 56 218 17 138 210 11 46 158 106 49 125 18 107 80 59 20 12 1 9 0 3825
0 0 0 0 4 0 0 0 0 1 0 0 0 0 55 4 0 0 1 1 3 4 0 2 2 11 1 0 0 2 2 3 3 0 1 11 2 0 1 0 0 0 0 1 0 0 0 60
0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3
2 0 3 0 7 5 3 0 1 9 5 0 13 8 334 11 0 19 6 27 32 16 4 33 18 2 12 6 4 19 0 1 23 2 3 26 14 10 16 5 15 7 2 0 1 0 1 391
18 1 3 6 22 14 104 3 1 193 54 5 88 68 2681 126 19 104 70 188 113 132 82 244 109 147 88 32 45 193 14 133 182 9 42 119 88 36 106 13 92 70 55 19 10 1 8 3269
3 0 0 1 0 0 7 0 0 0 2 0 5 4 2 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 24
0 0 0 0 1 0 0 0 0 7 0 0 6 3 63 3 1 2 0 0 1 2 2 5 6 9 3 0 7 3 1 1 2 0 0 2 2 3 2 0 0 3 2 0 1 0 0 80
95% 0% 100% 100% 94% 100% 100% 100% 100% 90% 95% 100% 100% 92% 65% 67% 79% 91% 64% 76% 36% 59% 84% 73% 80% 60% 90% 55% 77% 73% 97% 38% 31% 91% 93% 48% 55% 70% 89% 67% 57% 81% 61% 58% 95% 0% 85% 68%
5% 0% 58% 0% 18% 24% 2% 0% 50% 3% 9% 0% 12% 10% 9% 7% 0% 11% 6% 10% 18% 8% 4% 9% 12% 1% 11% 13% 8% 7% 0% 1% 9% 14% 5% 13% 10% 16% 12% 22% 14% 7% 2% 0% 9% 0% 4% 9%
01-Aug-14 01-Aug-14 01-Aug-14 01-Aug-14 25-Aug-14 13-Aug-14 12-Aug-14 07-Jul-14 08-Aug-14 20-Aug-14 26-Aug-14 20-Aug-14 11-Aug-14 07-Aug-14 27-Aug-14
VIDRL VIDRL VIDRL VIDRL NIID NIID NIID IMR NIID IESR RITM NIH SGH NIHE PI Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab CCDC CCDC CCDC CCDC CCDC CCDC CCDC CCDC CCDC
0 0 0 0 0 8 0 0 0 0 2 2 0 0 0 157 12 5 0 6 4 7 5 1 5 2 29 1 0 0 4 6 10 10 2 4 24 8 4 4 0 2 2 0 0 0 0 0 0 169
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 40 2 2 2 2 0 2 0 1 2 7 1 2 0 2 4 0 2 7 0 0 0 2 0 40
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
8 2 0 54 5 0 2 2 2 2 0 1 0 15 0 0 2 4 4 0 2 7 2 2 2 0 0 64
0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 2
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 58 5 3 2 0 5 1 0 3 0 7 0 2 4 2 2 2 0 10 4 2 2 0 2 58
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 2 3 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 5
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
100% 100% 100% 96% 100% 100% 100% 50% 100% 100% 100% 100% 100% 95% 100% 100% 100% 88% 100% 100% 100% 93% 100% 100% 100% 100% 100% 96%
22-Aug-14 22-Aug-14
PHLC PHLC
1. IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); NIH (National Institute of Health, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, Hong Kong); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) 2. The target of 14 days for the timeliness of virus isolation will be used for all polio laboratories 3. NPEV growing in L20B cells 4. Twenty-two provincial laboratories in China perform ITD from 2013
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Polio Bulletin
Table 3. Laboratory confirmation of polio isolates from other sources in 2014 Non-AFP cases Country Intratypic Total number Total number differentiation of non-AFP of non-AFP lab 2 cases tested cases with polio isolates for polio Type 1 Wild Sabin VDPV Wild Type 2 Sabin VDPV Wild Type 3 Sabin Discordant Total number NPEV Pending pending of samples grown ITD sequencing processed VDPV in L20B Total number of samples with polio isolates Type 1 Wild Sabin VDPV
1
Environmental samples Type 2 Wild Sabin VDPV Wild Type 3 Sabin NPEV Discordant Pending grown pending ITD sequencing VDPV in L20B
Australia Japan Malaysia Mongolia New Zealand Philippines Republic of Korea Singapore Viet Nam, North Viet Nam, South China (total) China, Anhui China, Beijing China, Fujian China, Gansu China, Guangdong China, Guangxi China, Hebei China, Heilongjiang China, Henan China, Hunan China, Jiangsu China, Jiangxi China, Jilin China, Shaanxi China, Shandong China, Shanghai China, Shanxi China, Sichuan China, Tianjin China, Xinjiang China, Yunnan China, Zhejiang China, Chongqing China, Guizhou China, Hainan China, Hubei China, Liaoning China, Neimongol China, Ningxia China, Qinghai China, Tibet Hong Kong (China) Total
VIDRL NIID IMR PHI IESR VIDRL NIID SGH NIID NIID Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab CCDC CCDC CCDC CCDC CCDC CCDC CCDC CCDC CCDC PHLC
10 0 0 132 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 144
0 0 0 1 1 1
0 0 0 0 0 0
0 0 0 1 1 1
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 0 0 0 0 0
0 13 0 0 0 13
0 0 0 0 0 0
0 0 0 0 0 0
0 0 9 0 0 0 0 0 0 0 78 0 0 0 0 24 0 0 10 0 0 0 0 0 0 24 8 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 87
6 78 24 10 24 8 12 84
0 0 0 0 0 0 0 0
1 43 12 7 5 5 14 44
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0 69 15 19 6 8 21 69
0 2 0 1 0 0 1 2
0 0 0 0 0 0 0 0
4 50 6 13 15 2 14 54
0 0 0 0 0 0 0 0
4 0 0 0 0 0 0 4
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. 2. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, Hong Kong); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia)
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Polio Bulletin
Table 4. Vaccine-derived poliovirus, 2000–2014 Country Cambodia iVDPV1 (1 case) aVDPV1 (1 case) aVDPV3 (1 case) aVDPV3 (1 case)
2000
2001
2002
2003
2004
2005 cVDPV3 (1 case)
2006 cVDPV3 (1 case)
2007
2008
2009
2010
2011
2012
2013
2014
China
aVDPV1 (1 case)
cVDPV1 (2 cases) aVDPV1 (1 case) aVDPV1 (3 cases) ?VDPV1 (4 cases) iVDPV2 (1 case) ?VDPV1 (7 cases) ?VDPV1 (1 case) ?VDPV2 (1 case) VDPV3 (1 case) ?VDPV? (3 cases) ?VDPV? (1 case) aVDPV2 (1 case) ?VDPV? (2 cases) ?VDPV? (1 case) ?VDPV3 (1 case)
aVDPV2 (1 case)
aVDPV1 (1 case) aVDPV1 (1 case) aVDPV2 (3 cases) aVDPV2 (5 cases) aVDPV2 (2 cases) aVDPV2 (1 case) cVDPV2 (2 cases) aVDPV2 (1 case) aVDPV3 (2 cases) cVDPV2 (3 cases) iVDPV2 + iVDPV3 (1 case) iVDPV2 (2 cases) iVDPV2 + iVDPV3 (1 case) iVDPV3 (1 case)
Hong Kong (China) Japan Lao People's Democratic Republic Mongolia Philippines Viet Nam cVDPV1 (3 cases)
aVDPV2 (2 cases)
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Polio Bulletin