2017 Issue No. 21 - Week 42 (as of 23 October 2017) HIGHLIGHTS Polio Side Event at the 68th Session of the World Health Organization Regional Committee for the Western Pacific The sixty-eighth session of the World Health Organization Regional Committee for the Western Pacific was held from 9 to 13 October 2017 in Brisbane, Australia. During the meeting, a side event was organized to update the Member States on the polio transition planning and discuss implications for the countries in the Western Pacific region. As the world comes closer to the certification of global eradication of poliomyelitis, partners' and donors' support will gradually decrease. These changes in financing will require countries to proactively plan for a transition away from external support. In the Western Pacific Region, polio transition planning will affect largely the Member States which are currently benefiting from WHO and other partners' technical and financial support. These countries will need to identify the strategies for mainstreaming and financing polio essential functions through country government investment in national systems over time and/or through long-term capacity building. The WHO Regional Office for the Western Pacific is closely working with the Member States of the Region to assess possible implications of polio transition and to identify respective mitigating measures to sustain polio essential functions after global certification of poliomyelitis eradication. 5.5 5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 15 16 CHN 17 15 16 KHM 17 15 16 LAO 17 15 16 MYS 17 15 16 PHL 17 15 16 PNG 17 15 16 VNM 17 0% 15 16 CHN 17 15 16 KHM 17 15 16 LAO 17 15 16 MYS 17 15 16 PHL 17 15 16 PNG 17 15 16 VNM 17 20% 40% 60% 80%
Polio Bulletin
Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2015–2017* 100%
Chart 2. Adequate specimen collection rate, 2015–2017
* AFP rate annualized as of week 42
Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2017 100%
Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2017 CHN 14.3% 0.0% 0.0% 9.3% 8.3% 4.3% 17.3% 0% 5% 10% 15% 20%
80%
KHM LAO MYS
60%
40%
PHL PNG VNM
CONTACT US Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: wproepidata@who.int Web: www.wpro.who.int/immunization
20%
0% CHN KHM LAO MYS 1-2 doses
PHL 0 doses
PNG Unknown
VNM
≥ 3 doses
Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam).
Table 1. Classification of AFP cases with onset in 2017 and key surveillance indicators 2016 Classification Total reported cases Annual expected cases <15 years of age Pending Total reported cases Confirmed wild poliovirus Vaccinederived poliovirus (VDPV) Non-polio AFP rate 2 % % with investigated adequate ≤ 2 days of specimens 3 notification 4 ≥ 80% ≥ 80% Latest report date Days since last report 5
2017 Indicators
Country/area
Poliocompatible
Discarded (Non-polio)
Total
> 90 days 1 # (%)
≥1
≤ 30
Australia Brunei Darussalam Cambodia China China, Hong Kong SAR China, Macao SAR Japan Lao People's Democratic Republic Malaysia Mongolia New Zealand Papua New Guinea Philippines Republic of Korea Singapore Viet Nam Pacific island countries and areas Total 1. 2. 3. 4. 5.
62 1 51 5691 10 1 133 143 7 12 23 417 70 7 382 20 7030
45 1 45 2256 8 1 161 21 77 9 9 31 394 68 6 234 11 3377
39 1 42 3503 13 2 73 108 5 7 23 314 45 5 243 11 4434
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1
1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
28 1 29 2220 9 2 64 68 4 5 15 268 39 5 145 10 2912
10 0 13 1282 4 0 9 40 1 2 8 46 6 0 98 1 1520
3 (7.7%) 0 (0.0%) 0 (0.0%) 502 (14.3%) 2 (15.4%) 0 (0.0%) 0 (0.0%) 10 (9.3%) 0 (0.0%) 1 (14.3%) 1 (4.3%) 26 (8.3%) 0 (0.0%) 0 (0.0%) 42 (17.3%) 0 (0.0%) 587 (13.2%) Green Yellow Red
1.07 1.24 1.16 1.92 2.01 2.48 4.30 1.74 0.69 0.96 0.92 0.99 0.82 1.03 1.29 1.24 1.63
38% 0% 90% 92% 77% 50% 73% 82% 80% 29% 43% 66% 91% 100% 95% 73% 89%
95% 100% 100% 100% 100% 100% 77% 69% 100% 100% 100% 97% 100% 100% 91% 100% 98%
20-Oct-17 11-Oct-17 18-Oct-17 09-Oct-17 06-Oct-17 18-Oct-17 11-Oct-17 21-Sep-17 08-Oct-17 13-Sep-17 10-Oct-17 18-Oct-17 12-Oct-17 09-Oct-17 13-Oct-17 11-Oct-17
3 12 5 14 17 5 12 32 15 40 13 5 11 14 10 12
Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Annualized non-polio AFP rate per 100 000 population under 15 years of age Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Percentage of reported cases investigated within two days of notification Countries are expected to submit data at least once per month to WPRO
Reached o r surpassed target Nearly reached target: 0.5–0.99 fo r no n-po lio A FP rate; 60–79% fo r o ther indicato rs Substantially belo w target
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Polio Bulletin
Table 2. Laboratory investigation of stool samples from AFP cases with onset in 2017 and key laboratory indicators Results of virus isolation for AFP cases Country/area Polio laboratory Total no. of AFP cases with specimens L20B positive L20B positive + NPEV only NPEV % results % reported specimens Pending Latest Pending 14 days ≤ positive for report date ≤ 14 days > 14 days NPEV ≥ 80% Intratypic differentiation/ Sequencing 1 laboratory No. of isolates received Type 1 Wild Sabin VDPV Results of intratypic differentiation (ITD)/sequencing for virus isolates Type 3 Type 2 Wild Sabin VDPV Wild Sabin VDPV NPEV 2 1
Negative
Pending ITD
% ITD results Discordant reported ≤ 7 pending days of sequencing receipt ≥ 80%
Australia Brunei Darussalam Cambodia China (total) China, Anhui China, Beijing China, Chongqing China, Fujian China, Gansu China, Guangdong China, Guangxi China, Guizhou China, Hebei China, Heilongjiang China, Henan China, Hubei China, Hunan China, Jiangsu China, Jiangxi China, Jilin China, Neimongol China, Ningxia China, Shaanxi China, Shandong China, Shanghai China, Shanxi China, Sichuan China, Tianjin China, Xinjiang China, Yunnan China, Zhejiang China, Hainan China, Liaoning China, Qinghai China, Tibet China, Hong Kong SAR China, Macao SAR Japan Lao People's Democratic Republic Malaysia Mongolia New Zealand Papua New Guinea Philippines Republic of Korea Singapore Viet Nam (North) Viet Nam (South) Pacific island countries and areas Total
VIDRL VIDRL NIID Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab PHLC PHLC NIID NIID IMR PHI IESR VIDRL RITM NIH SGH NIHE PI VIDRL
32 0 34 3443 216 26 50 119 65 256 170 135 199 79 322 116 158 145 95 44 58 14 65 252 26 124 205 26 104 168 113 11 60 17 5 13 2 104 138 5 5 23 389 45 5 142 134 11 4525
0 0 38 3 1 0 1 0 2 3 0 4 0 6 0 1 4 1 0 2 0 1 4 0 0 0 0 3 1 1 0 0 0 0 0 0 1 0 0 0 0 6 0 0 1 0 0 46
0 0 0 0 0 0 0 0 0 0 0 0 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 1
4 4 255 8 0 3 3 4 30 25 12 14 4 48 12 17 3 12 5 1 3 2 7 0 5 8 0 8 11 6 2 2 0 0 0 0 9 9 0 0 6 23 4 0 24 24 3 365
25 30 3091 203 24 46 115 60 224 141 119 181 75 264 99 138 134 80 39 55 11 55 240 26 119 191 26 91 149 105 9 51 16 5 12 2 93 129 5 4 12 353 41 5 113 108 7 4030
3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 5 7 0 0 4 2 1 24
0 0 59 2 1 1 0 1 0 1 4 0 0 4 5 2 4 2 0 0 0 7 1 0 0 6 0 2 7 1 0 7 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 59
96% 97% 95% 100% 96% 96% 87% 96% 95% 98% 99% 99% 100% 88% 95% 99% 100% 94% 100% 98% 93% 88% 94% 100% 95% 95% 100% 93% 93% 100% 82% 100% 100% 40% 97% 100% 95% 99% 100% 100% 100% 99% 98% 100% 100% 100% 100% 95%
16% 11% 6% 3% 0% 5% 2% 5% 10% 14% 8% 5% 5% 13% 10% 9% 2% 11% 9% 1% 18% 3% 2% 0% 4% 3% 0% 7% 6% 4% 14% 2% 0% 0% 0% 0% 9% 6% 0% 0% 24% 4% 6% 0% 15% 18% 26% 6%
20-Oct-17 20-Oct-17 09-Oct-17 09-Oct-17
VIDRL VIDRL NIID Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC CCDC CCDC CCDC CCDC
0 0 0 91 8 1 4 1 2 8 6 0 7 0 17 0 4 8 1 0 5 0 1 6 0 0 2 0 7 1 2 0 0 0 0 0 0 4 0 0 0 0 14 0 0 2 0 0 111
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
35 6 0 0 0 0 6 2 4 2 3 2 0 3 0 1 2 4 0 0 0 4 0 39
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
47 2 1 2 1 0 2 4 3 10 1 6 1 2 1 5 0 3 1 2 2 10 2 61
1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1
8 0 0 2 0 2 0 0 0 4 0 0 0 0 0 0 0 0 0 0 2 0 0 10
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
99% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% 100% 100% 100% 99%
12-Oct-17 12-Oct-17 21-Oct-17 13-Oct-17 23-Oct-17 16-Oct-17 20-Oct-17 18-Oct-17 12-Oct-17 20-Oct-17 13-Oct-17 18-Oct-17 20-Oct-17
PHLC PHLC NIID NIID IMR NIID IESR VIDRL RITM NIH SGH NIHE PI VIDRL
1. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); NIH (National Institute of Health, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) 2. NPEV growing in L20B cells
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Polio Bulletin
Table 3. Laboratory confirmation of polio isolates from environmental samples in 2016–2017 1 2016 Country/area Intratypic differentiation lab 2 Total number of samples processed Total number of samples with polio isolates Polio isolates Type 1 Wild Sabin VDPV Wild Type 2 Sabin VDPV Wild Type 3 Sabin VDPV NPEV Pending ITD Discordant Total number pending of samples sequencing processed Total number of samples with polio isolates Type 1 Wild Sabin VDPV Wild
2017 Polio isolates Type 2 Sabin VDPV Wild Type 3 Sabin VDPV NPEV Pending ITD Discordant pending sequencing
Australia China (total) China, Fujian China, Gansu China, Guangdong China, Guangxi China, Heilongjiang China, Shandong China, Shanghai China, Xinjiang China, Yunnan Malaysia Philippines Total
VIDRL Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC IMR RITM
0 345 60 13 48 36 45 45 24 36 38 10 0 355
171 12 8 35 13 21 28 18 36 0 0 171
0 0 0 0 0 0 0 0 0 0
179 3 5 19 1 0 25 17 109 179
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
174 1 5 4 4 5 15 4 136 174
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
507 11 13 62 52 46 42 34 247 507
0 0 0 0 0 0 0 0 0 0
229 42 2 39 23 32 40 18 25 8 6 235
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 203 31 7 32 23 28 20 14 27 21 14 25 242
110 7 5 26 12 9 14 12 25 0 0 9 119
0 0 0 0 0 0 0 0 0 0 0
162 1 4 16 10 5 15 13 98 1 163
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
424 12 16 58 22 21 60 28 207 8 432
0 0 0 0 0 0 0 0 0 0 0
553 172 2 65 52 49 67 26 85 35 10 13 576
1 0 0 0 1 0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 0 0 0 0 0 0
1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. 2. CCDC (Chinese Center for Disease Control and Prevention, China); IMR (Institute of Medical Research, Malaysia); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia)
Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2017 Country/area Cambodia
2000–2009 3 2006 - 1 Total - 2 2009 - 1 Total - 27
2010
2011
2012
2013
2014
2015
2016
2017
China
aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP)
aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (2 AFP) iVDPV2 (1 AFP + 1 non-AFP) iVDPV3 (1 AFP)
aVDPV1 (1 AFP) aVDPV2 (2 AFP) cVDPV2 (2 AFP + 1 contact) iVDPV2 + iVDPV3 (1 AFP)
aVDPV2 (1 non-AFP) iVDPV2 + iVDPV3 (1 AFP)
aVDPV1 (1 non-AFP) aVDPV2 (2 AFP) iVDPV3 (1 AFP)
aVDPV1 (1 AFP) aVDPV2 (1 AFP) iVDPV2 (1 AFP)
aVDPV3 (1 AFP)
aVDPV3 (1 AFP)
China, Hong Kong SAR Japan Lao People's Democratic Republic Mongolia Philippines Viet Nam
2005 - 3 2005 - 1 Total - 2 2004 - 3 2003 - 1 2001 - 3 aVDPV2 (2 AFP) aVDPV2 (1 AFP) cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts)
1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, or non-AFP cases 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009
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Polio Bulletin