2013 Issue No. 3 - Week 22 (as of 3 June 2013) HIGHLIGHTS Somalia outbreak: Horn synchronized response of Africa Chart 1. Non-polio AFP rate and adequate specimen collection rate, 2011–2013 3.0 2.5 100%
Polio Bulletin 80% 70% 60%
Chart 2. Percent cases with pending classification > 90 days after onset, 2013 CHN Cases with adequate specimens (%)
90%
10.5% 10.3% 0.0% 3.0% 26.2% 37.5% 11.9% 0% 5% 10% 15% 20% 25% 30% 35% 40%
After more than six years of being poliofree, Somalia is facing a polio outbreak as a result of an importation. WHO/T. Moran Due to some security constraints, more than 500 000 kids in south and central zones were not reached by successive polio campaigns in recent years, developing a significant immunity gap group. As a result, when the poliovirus was re-introduced, it started spreading in the neighbourhood crossing the border with north Kenya where important refugee camps are settled. Immediate outbreak response is ongoing in coordination with neighbouring countries targeting thousands of kids of different age groups across Somalia, Kenya, Ethiopia and Yemen. To date, four cases have been reported in Somalia and two cases in Kenya. Read the full story here: http://polioeradication.org/tabid/488/iid/305/ Default.aspx WHO’s International Travel and Health recommends that all travellers to and from polio-infected areas be fully vaccinated against polio.
KHM LAO MYS PHL PNG VNM
Non-polio AFP rate
2.0 1.5 1.0 0.5 0.0 11 12 13 CHN 11 12 13 KHM 11 12 13 LAO 11 12 13 MYS 11 12 13 PHL 11 12 13 PNG 11 12 13 VNM
50% 40% 30% 20% 10% 0%
Chart 3. Polio immunization status of reported AFP cases, 2013 100%
Chart 4. Percentage of samples received at the lab ≤ 3 days of collection, 2013 100%
80%
80% 69% 60% 52% 39%
60%
40%
40% 21% 20% 0% CHN KHM 0% LAO MYS PHL 0% PNG
20%
0%
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
CHN
KHM
LAO
MYS 1-2 doses
PHL 0 doses
PNG Unknown
VNM
0%
≥ 3 doses
VNM
NOTES: 1. Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam). 2. Non-polio AFP rate for 2013 is annualized as of polio week 22.
Table 1. Classification of AFP cases with onset in 2013 and key surveillance indicators 2012 Classification Total reported cases Annual expected cases <15 years of age Pending Total reported cases Confirmed wild poliovirus Vaccinederived poliovirus (VDPV) Non-polio AFP rate 2 % % with % with % with any investigated Latest report Days since adequate 60-day 4 ≤ 2 days of specimen 6 date last report 7 specimens 3 5 follow-up notification ≥ 80% ≥ 80% ≥ 80%
2013 Indicators
Poliocompatible
Discarded (Non-polio)
Total
> 90 days 1 # (%)
≥1
Australia Brunei Darussalam Cambodia China Hong Kong (China) Japan Lao People's Democratic Republic Macao (China) Malaysia Mongolia New Zealand Papua New Guinea Philippines Republic of Korea Singapore Viet Nam Pacific island countries Total 1. 2. 3. 4. 5. 6. 7.
56 1 107 6173 14 0 55 0 141 9 8 10 403 94 10 514 4 7599
43 1 45 2225 8 167 25 1 76 7 9 30 371 76 6 241 10 3341
6 1 29 1512 4 0 12 1 66 1 1 8 122 16 4 101 1 1885
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
6 0 10 619 4 9 0 38 0 0 2 44 7 4 32 0 775
0 1 19 893 0 3 1 28 1 1 6 78 9 0 69 1 1110
0 (0.0%) 0 (0.0%) 3 (10.3%) 159 (10.5%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 2 (3.0%) 0 (0.0%) 1 (100.0%) 3 (37.5%) 32 (26.2%) 3 (18.8%) 0 (0.0%) 12 (11.9%) 0 (0.0%) 215 (11.4%) Green Yellow Red
0.33 2.36 1.52 1.61 1.18 1.13 2.36 2.05 0.34 0.26 0.63 0.78 0.50 1.58 0.99 0.24 1.33
50% 100% 69% 93% 100% 92% 100% 92% 100% 0% 38% 66% 94% 100% 89% 100% 90%
67% 100% 90% 99% 100% 100% 100% 98% 100% 0% 75% 91% 100% 100% 97% 100% 98%
100% 100% 83% 99% 100% 100% 100% 52% 100% 100% 100% 100% 100% 100% 92% 100% 97%
0% 56% 66% 100% 20% 100% 40% 2% 0% 27% 46%
15-Apr-13 27-May-13 09-May-13 29-May-13 02-May-13 28-May-13 15-May-13 03-Jun-13 09-May-13 23-May-13 09-May-13 28-May-13 16-May-13 06-May-13 17-May-13 27-May-13
49 7 25 5 32 6 19 0 25 11 25 6 18 28 17 7
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 2013 and key laboratory indicators Virus isolation results Country National polio laboratory Total no. of AFP L20B cases with positive specimens L20B positive + NPEV NPEV only Pending Negative ≤ 14 days Intratypic % % results differentiation Latest Pending reported specimens / Sequencing positive report date > 14 2 ≤ 14 days for NPEV 1 lab days ≥ 80% No. of isolates referred Type 1 W ild Sabin VDPV W ild Type 2 Sabin VDPV W ild Intratypic differentiation (ITD) results Type 3 Sabin VDPV NPEV 3
1
Non-EV
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 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
4 1 7 1 0 26 11 60 1 0 149 16 5 59 60 1500
0 0 0 0 0 0 0 0 0 0 1 0 0 30 1 0 0 3 1 1 2 0 7 1 1 0 0 0 3 0 2 0 1 2 1 2 0 0 0 2 0 0 0 0 0 0 31
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 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1
1 0 1 0 9 3 0 0 20 0 0 8 8 59 2 1 1 0 8 6 6 1 11 0 0 3 0 0 3 0 0 3 0 0 9 0 3 1 0 0 1 0 0 0 0 0 109
3 1 6 1 17 8 55 1 111 14 4 41 49 1358 65 12 52 24 77 51 82 38 153 73 64 37 24 23 87 10 50 83 5 19 63 36 33 60 7 69 20 22 14 1 4 4 1673
0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2
0 0 0 0 0 0 4 0 20 2 0 10 3 52 0 0 3 1 1 5 0 0 12 0 9 9 0 1 0 0 0 6 0 0 1 0 0 1 0 2 0 0 0 0 1 0 91
100% 100% 100% 100% 88% 95% 97% 100% 98% 100% 100% 76% 92% 54% 47% 77% 62% 62% 48% 21% 74% 87% 50% 93% 8% 39% 81% 66% 72% 100% 44% 29% 100% 93% 63% 36% 86% 77% 86% 6% 50% 50% 50% 0% 25% 88% 61%
29% 0% 8% 0% 31% 18% 0% 0% 12% 0% 0% 15% 12% 3% 2% 8% 1% 0% 7% 9% 5% 1% 4% 0% 0% 5% 0% 0% 2% 0% 0% 3% 0% 0% 12% 0% 6% 1% 0% 0% 5% 0% 0% 0% 0% 0% 5%
12-Apr-13 15-May-13 23-May-13 23-Apr-13 27-May-13 03-Jun-13 16-May-13 09-May-13 06-May-13 30-May-13 16-May-13 28-May-13 12-May-13 12-May-13 29-May-13
VIDRL VIDRL VIDRL VIDRL NIID NIID NIID IMR NIID IESR VIDRL NIID SGH NIID NIID
0 0 0 0 0 0 0 0 0 0 3 0 1 0 0 53
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 15 1 0 0 5 0 0 0 3 0 0 2 0 1 0 0 1 1 1 0 16
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 1 21 1 1 0 4 1 1 1 3 1 1 1 1 1 1 2 0 0 0 1 23
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 17 1 0 0 4 1 1 0 1 0 1 3 0 0 0 1 2 1 1 0 18
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 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 1 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 0 0 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 2
100% 100% -
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
68 13 56 28 87 63 90 39 183 74 74 49 24 24 93 10 52 92 6 21 75 38 36 62 7 73 21 22 14 1 5 4 0 1904
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 15-May-13 15-May-13 CCDC PHLC PHLC
3 1 0 13 2 2 1 0 7 1 2 0 0 0 6 1 2 0 1 3 3 2 0 0 0 2 0 0 1 0 0 0 0 57
-
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 2013 Non-AFP cases Country Intratypic Total number differentiation of non-AFP lab 2 cases with polio isolates Type 1 Wild Sabin VDPV Wild Type 2 Sabin VDPV Wild Type 3 Sabin Discordant NPEV Pending pending grown Non-EV ITD sequencing VDPV in L20B Total number of samples with polio isolates Type 1 Wild Sabin VDPV Wild
1
Environmental samples Type 2 Sabin VDPV Wild Type 3 Sabin NPEV Discordant Pending grown Non-EV pending ITD sequencing VDPV in L20B
Australia Japan Malaysia New Zealand Philippines Republic of Korea Singapore Viet Nam, North Viet Nam, South China China, Gansu China, Guangdong China, Guangxi China, Heilongjiang China, Jilin China, Shandong China, Shanghai China, Sichuan China, Xinjiang China, Yunnan China, Hainan China, Ningxia China, Qinghai Hong Kong (China) Total
VIDRL NIID IMR IESR VIDRL NIID SGH NIID NIID CCDC Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab CCDC CCDC CCDC PHLC
0 0 0 0 6 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 7
0 0 0
5 1 6
0 0 0
0 0 0
1 0 1
0 0 0
0 0 0
1 0 1
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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); PHLC (Public Health Laboratory Center, Hong Kong); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia)
Table 4. Vaccine-derived poliovirus, 2000–2013 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
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 (2 cases) aVDPV2 (5 cases) cVDPV2 (2 cases) cVDPV2 (3 cases) aVDPV3 (2 cases) iVDPV2 (2 cases) iVDPV2 (1 case) iVDPV3 (1 case) iVDPV3 (1 case)
Hong Kong (China) Japan Lao People's Democratic Republic Mongolia Philippines Viet Nam cVDPV1 (3 cases)
aVDPV2 (2 cases)
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Polio Bulletin