Polio Bulletin 2021

Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific 27th Meeting of the Regional Commission for the Certification of Poliomyelitis Eradication in the Western Pacific Due to the on-going COVID-19 pandemic, the Regional Commission for the Certification of Poliomyelitis Eradication (RCC) in the Western Pacific met again virtually this year from 9 to 11 November 2021 to review and evaluate the status of polio eradication activities of the member states including the impact of the COVID-19 pandemic. This year, significant progress was made such as the successful closure of the type 1 and type 2 circulating vaccine-derived polioviruses (cVDPV1 and cVDPV2) in Philippines and Malaysia, the introduction of the second IPV dose in three OPV-using countries, the implementation of poliovirus containment in most countries and completion of inventories of facilities storing poliovirus potentially infectious materials (PIM). The RCC concluded that despite on-going challenges posed by the pandemic, the Western Pacific Region remains free of indigenous and imported wild poliovirus transmission. The RCC recommended to continue efforts to mitigate the negative impact of COVID-19 pandemic on performance of routine vaccination and poliovirus surveillance programs, proceed with introduction of second IPV dose in the remaining 12 OPV-using countries, offer vaccination services free of charge to all citizens and non-citizens, continue efforts to initiate surveillance for immunodeficiency-associated vaccine-derived poliovirus (iVDPV) among persons with primary immunodeficiencies, and update annually the national inventories for poliovirus type 2 and poliovirus PIM. Polio Bulletin 2021 Issue No. 24 - Week 47 (as of 22 November 2021) CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2019–2021 Chart 2. Adequate specimen collection rate, 2019–2021 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2021 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2021 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 72.3% 12.1% 4.4% 3.4% 80.0% 0.0% 28.0% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% VNM PNG PHL MYS LAO KHM CHN 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). 2019 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 63 47 51 0 0 0 51 0 0 (0.0%) 1.09 63% 100% 24-Feb-21 - Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.00 100% 100% 11-Jan-21 - Cambodia 55 47 72 0 0 0 14 58 27 (37.5%) 1.53 92% 94% 23-Dec-20 334 China 5183 2370 4315 0 0 0 4315 0 0 (0.0%) 1.82 93% 99% 24-Oct-21 - China, Hong Kong SAR 14 9 12 0 0 0 12 0 0 (0.0%) 1.33 92% 100% 07-Jul-21 - China, Macao SAR 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 17-Feb-21 - Japan - 152 - - - - - - - - - - - - Lao People's Democratic Republic 65 23 43 0 0 0 43 0 0 (0.0%) 1.87 74% 100% 28-Sep-21 - Malaysia 194 78 161 0 1 2 158 0 0 (0.0%) 2.05 83% 77% 25-Mar-21 - Mongolia 5 10 1 0 0 0 1 0 0 (0.0%) 0.10 100% 100% 10-Mar-21 - New Zealand 8 9 11 0 0 0 11 0 0 (0.0%) 1.22 55% 73% 20-Oct-21 - Papua New Guinea 222 36 65 0 0 0 65 0 0 (0.0%) 1.81 54% 80% 02-Aug-21 - Philippines 872 330 883 0 2 3 878 0 0 (0.0%) 2.67 64% 98% 26-Aug-21 - Republic of Korea 81 63 48 0 0 0 48 0 0 (0.0%) 0.76 85% 100% 14-Apr-21 - Singapore 5 6 3 0 0 0 3 0 0 (0.0%) 0.50 100% 67% 07-Jan-21 - Viet Nam 353 241 430 0 0 0 430 0 0 (0.0%) 1.78 95% 62% 12-May-21 - Pacific island countries and areas 21 11 12 0 0 0 12 0 0 (0.0%) 1.09 67% 92% 26-Jul-21 - Total 7144 3434 6110 0 3 5 6044 58 27 (0.4%) 1.78 88% 95% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Discarded (Non-polio) 2020 Non-polio AFP rate Total % with adequate specimens 2 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Table 1A. Classification of AFP cases with onset in 2020 and key surveillance indicators 2 Polio Bulletin 2020 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 51 48 50 0 0 0 43 7 0 (0.0%) 1.15 66% 100% 22-Nov-21 0 Brunei Darussalam 1 1 1 0 0 0 1 0 0 (0.0%) 1.11 100% 100% 19-Oct-21 34 Cambodia 72 48 5 0 0 0 0 5 0 (0.0%) 0.12 100% 80% 01-Mar-21 266 China 4315 2370 3502 0 0 0 1373 2129 981 (28.0%) 1.63 85% - 25-Oct-21 28 China, Hong Kong SAR 12 9 6 0 0 0 5 1 0 (0.0%) 0.74 100% 100% 04-Nov-21 18 China, Macao SAR 2 1 1 0 0 0 1 0 0 (0.0%) 1.11 100% 100% 09-Nov-21 13 Japan - 152 - - - - - - - - - - - - Lao People's Democratic Republic 43 23 15 0 0 0 0 15 12 (80.0%) 0.72 73% 67% 25-Oct-21 28 Malaysia 161 80 88 0 0 0 78 10 3 (3.4%) 1.22 75% 69% 19-Nov-21 3 Mongolia 1 10 1 0 0 0 1 0 0 (0.0%) 0.11 100% 100% 18-Oct-21 35 New Zealand 11 10 8 0 0 0 6 2 0 (0.0%) 0.89 38% 63% 16-Nov-21 6 Papua New Guinea 65 36 33 0 0 0 23 10 4 (12.1%) 1.01 52% 82% 17-Nov-21 5 Philippines 883 330 757 0 0 0 690 67 33 (4.4%) 2.54 76% 98% 16-Nov-21 6 Republic of Korea 48 62 28 0 0 0 24 4 0 (0.0%) 0.50 79% 96% 05-Nov-21 17 Singapore 3 6 3 0 0 0 3 0 0 (0.0%) 0.55 100% 100% 23-Oct-21 30 Viet Nam 430 274 101 0 0 0 24 77 73 (72.3%) 0.41 54% 78% 30-Sep-21 53 Pacific island countries and areas 12 11 11 0 0 0 5 6 3 (27.3%) 1.11 55% 36% 19-Oct-21 34 Total 6110 3471 4610 0 0 0 2277 2333 1109 (24.2%) 1.47 82% 92% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) 2021 Non-polio AFP rate 2 Total % with adequate specimens 3 Table 1B. Classification of AFP cases with onset in 2021 and key surveillance indicators 3 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 44 0 0 0 44 0 0 96% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 38 0 0 7 31 0 0 100% 14% 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 4265 0 21 104 4130 0 10 96% 2% 24-Oct-21 56 0 25 1 0 0 0 0 29 1 0 0 0 100% China, Anhui Prov. Lab 237 0 0 2 233 0 2 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 0 1 0 0 0 100% China, Beijing Prov. Lab 69 0 1 2 66 0 0 100% 4% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Chongqing Prov. Lab 70 0 0 2 68 0 0 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 130 0 0 2 128 0 0 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 66 0 0 1 65 0 0 100% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 437 0 1 3 432 0 1 82% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Guangxi Prov. Lab 215 0 0 6 209 0 0 100% 2% Prov. Lab/CCDC 0 0 0 0 0 0 0 0 0 0 0 0 0 100% China, Guizhou Prov. Lab 136 0 2 2 132 0 0 99% 3% Prov. Lab/CCDC 4 0 4 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 26 0 0 1 25 0 0 96% 4% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 211 0 1 17 193 0 0 100% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Heilongjiang Prov. Lab 49 0 0 0 49 0 0 87% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 492 0 3 7 482 0 0 99% 2% Prov. Lab/CCDC 10 0 4 0 0 0 0 0 6 0 0 0 0 100% China, Hubei Prov. Lab 119 0 0 5 111 0 3 97% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 220 0 2 14 203 0 1 100% 6% Prov. Lab/CCDC 5 0 2 0 0 0 0 0 3 0 0 0 0 100% China, Jiangsu Prov. Lab 200 0 3 0 197 0 0 100% 2% Prov. Lab/CCDC 6 0 0 0 0 0 0 0 6 0 0 0 0 100% China, Jiangxi Prov. Lab 141 0 0 3 138 0 0 98% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 46 0 0 6 40 0 0 95% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 66 0 0 1 65 0 0 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Neimongol Prov. Lab 60 0 4 0 56 0 0 92% 6% Prov. Lab/CCDC 11 0 4 1 0 0 0 0 6 0 0 0 0 100% China, Ningxia Prov. Lab 24 0 0 1 23 0 0 96% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 19 0 0 0 19 0 0 84% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 109 0 0 0 109 0 0 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 237 0 0 0 236 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 54 0 0 0 54 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 69 0 0 0 69 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 295 0 2 12 281 0 0 95% 4% Prov. Lab/CCDC 7 0 2 0 0 0 0 0 5 0 0 0 0 100% China, Tianjin Prov. Lab 42 0 0 0 42 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 83 0 0 1 80 0 2 72% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 174 0 0 14 160 0 0 95% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 153 0 1 2 150 0 0 100% 2% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Tibet Prov. Lab 16 0 1 0 15 0 0 32% 6% - CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hong Kong SAR PHLC 13 0 0 0 13 0 0 100% 0% 04-Jun-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 43 3 0 9 31 0 0 63% 19% 18-Aug-21 NIID 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Malaysia IMR 175 5 0 0 170 0 0 100% 0% 14-Apr-21 IMR/VIDRL 22 0 4 4 0 2 0 0 12 0 0 0 0 100% Mongolia PHI 1 0 0 1 0 0 0 100% 100% 06-Mar-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 7 0 0 0 7 0 0 100% 0% 22-Mar-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 70 5 0 12 53 0 0 98% 16% 19-Apr-21 VIDRL 28 0 10 0 0 0 0 0 11 0 7 0 0 100% Philippines RITM 853 32 0 34 787 0 0 98% 4% 02-Mar-21 RITM/NIID 68 0 12 0 0 33 2 0 21 0 0 0 0 100% Republic of Korea KDCA 48 0 0 0 48 0 0 99% 0% 14-Apr-21 KDCA 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 08-Jan-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 234 1 0 31 202 0 0 99% 13% 22-Jan-21 NIHE/NIID 0 - - - - - - - - - - - - - Viet Nam (South) PI 225 0 0 22 203 0 0 100% 10% 13-Apr-21 PI/NIID 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 12 0 0 0 12 0 0 100% 0% 09-Mar-21 VIDRL 0 - - - - - - - - - - - - - Total 6034 46 21 220 5737 0 10 96% 4% 182 0 53 5 0 35 2 0 79 1 7 0 0 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPVNegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2020 and key laboratory indicators 4 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 47 0 0 1 46 0 0 94% 1% 22-Nov-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 09-Aug-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 0 - - - - - - - - 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 3255 11 0 173 3071 0 0 97% 6% 25-Oct-21 35 0 17 6 0 0 0 0 12 0 0 0 0 100% China, Anhui Prov. Lab 178 0 0 7 171 0 0 99% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Beijing Prov. Lab 39 0 0 2 37 0 0 95% 4% Prov. Lab/CCDC 2 0 1 0 0 0 0 0 1 0 0 0 0 100% China, Chongqing Prov. Lab 38 0 0 1 37 0 0 92% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 78 0 0 4 74 0 0 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 108 1 0 2 105 0 0 98% 1% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Guangdong Prov. Lab 319 0 0 22 297 0 0 88% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangxi Prov. Lab 140 0 0 16 124 0 0 99% 10% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 149 0 0 8 141 0 0 99% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 14 0 0 1 13 0 0 100% 7% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 185 1 0 20 164 0 0 100% 8% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 35 1 0 0 34 0 0 94% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Henan Prov. Lab 405 4 0 27 374 0 0 100% 6% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Hubei Prov. Lab 79 0 0 6 73 0 0 95% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 137 0 0 7 130 0 0 99% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 126 0 0 1 125 0 0 100% 0.4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 94 0 0 5 89 0 0 95% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 32 0 0 5 27 0 0 97% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 55 0 0 1 54 0 0 100% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 74 1 0 0 73 0 0 99% 0% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Ningxia Prov. Lab 25 0 0 1 24 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 10 0 0 0 10 0 0 40% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 82 0 0 1 81 0 0 90% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 162 0 0 7 155 0 0 99% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 21 0 0 0 21 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 70 0 0 3 67 0 0 96% 4% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Sichuan Prov. Lab 256 0 0 6 250 0 0 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 16 1 0 0 15 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 60 1 0 2 57 0 0 98% 2% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 123 0 0 8 115 0 0 94% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 138 1 0 9 128 0 0 95% 5% Prov. Lab/CCDC 9 0 1 6 0 0 0 0 2 0 0 0 0 100% China, Tibet Prov. Lab 7 0 0 1 6 0 0 43% 7% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 7 0 0 0 7 0 0 100% 0% 11-Nov-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 1 0 0 0 1 0 0 100% 0% 20-Oct-21 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 0 - - - - - - - - 14-Apr-21 NIID 0 - - - - - - - - - - - - - Malaysia IMR 89 0 0 0 89 0 0 95% 0% 18-Nov-21 IMR/VIDRL 0 - - - - - - - - - - - - - Mongolia PHI 1 0 0 0 1 0 0 100% 0% 19-Nov-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 7 0 0 0 7 0 0 100% 0% 15-Nov-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 28 2 0 5 21 0 0 100% 13% 16-Nov-21 VIDRL 3 0 0 0 0 0 0 0 3 0 2 0 0 100% Philippines RITM 774 6 0 27 720 17 4 99% 3% 22-Nov-21 RITM/NIID 18 0 10 0 0 0 0 0 8 0 0 0 0 100% Republic of Korea KDCA 28 0 0 0 26 0 2 100% 0% 05-Nov-21 KDCA 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 19-Nov-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 29 0 0 3 26 0 0 100% 10% 25-Aug-21 NIHE/NIID 0 - - - - - - - - - - - - - Viet Nam (South) PI 80 0 0 22 55 0 3 100% 29% 07-Sep-21 PI/NIID 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 13 0 0 0 13 0 0 100% 0% 22-Nov-21 VIDRL 0 - - - - - - - - - - - - - Total 4363 19 0 231 4087 17 9 97% 3% 56 0 27 6 0 0 0 0 23 0 2 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2021 and key laboratory indicators 5 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 16 1 0 0 0 0 0 0 0 1 0 2 0 0 10 0 0 0 0 0 0 0 0 0 0 9 0 0 China (total) 364 193 0 123 1 0 0 0 0 390 0 567 0 0 229 78 0 47 0 0 0 0 0 158 1 754 0 0 China, Fujian Prov. Lab/CCDC 65 34 0 9 0 0 0 0 0 54 0 68 0 0 36 4 0 4 0 0 0 0 0 3 0 212 0 0 China, Gansu Prov. Lab/CCDC 39 26 0 16 0 0 0 0 0 72 0 38 0 0 35 9 0 3 0 0 0 0 0 16 0 78 0 0 China, Guangdong Prov. Lab/CCDC 48 25 0 16 0 0 0 0 0 19 0 26 0 0 32 17 0 4 0 0 0 0 0 29 0 71 0 0 China, Guangxi Prov. Lab/CCDC 12 3 0 0 0 0 0 0 0 11 0 9 0 0 7 1 0 0 0 0 0 0 0 1 0 26 0 0 China, Heilongjiang Prov. Lab/CCDC 40 21 0 7 0 0 0 0 0 44 0 111 0 0 8 3 0 1 0 0 0 0 0 3 0 8 0 0 China, Jiangxi Prov. Lab/CCDC 12 8 0 1 0 0 0 0 0 13 0 24 0 0 7 3 0 2 0 0 0 0 0 2 0 33 0 0 China, Neimongol Prov. Lab/CCDC 3 3 0 4 0 0 0 0 0 3 0 1 0 0 4 4 0 3 0 0 0 0 0 11 0 0 0 0 China, Qinghai Prov. Lab/CCDC 11 7 0 3 0 0 0 0 0 11 0 5 0 0 7 1 0 0 0 0 0 0 0 3 0 5 0 0 China, Shandong Prov. Lab/CCDC 32 20 0 14 0 0 0 0 0 25 0 107 0 0 18 7 0 4 0 0 0 0 0 15 0 158 0 0 China, Shanghai Prov. Lab/CCDC 24 14 0 9 0 0 0 0 0 18 0 7 0 0 33 3 0 1 0 0 0 0 0 1 1 52 0 0 China, Sichuan Prov. Lab/CCDC 30 13 0 6 0 0 0 0 0 36 0 70 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 China, Xinjiang Prov. Lab/CCDC 24 19 0 38 1 0 0 0 0 84 0 29 0 0 27 19 0 16 0 0 0 0 0 64 0 58 0 0 China, Yunnan Prov. Lab/CCDC 24 0 0 0 0 0 0 0 0 0 0 72 0 0 15 7 0 9 0 0 0 0 0 10 0 53 0 0 Malaysia IMR/VIDRL 700 97 0 33 9 0 11 7 0 74 1 29 0 0 449 0 0 0 0 0 0 0 0 0 0 21 27 0 Philippines RITM 388 77 0 20 0 0 95 8 0 63 0 97 0 0 591 80 0 27 0 0 0 0 0 123 0 216 75 0 Vietnam NIHE 0 - - - - - - - - - - - - - 48 0 0 0 0 0 0 0 0 0 0 6 6 0 Total 1468 368 0 176 10 0 106 15 0 528 1 695 0 0 1327 158 0 74 0 0 0 0 0 281 1 1006 108 0 2020 2021 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed Table 3. Laboratory confirmation of polio isolates from environmental samples in 2020–20211 6 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2021 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 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) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP)iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) aVDPV3 (1 AFP) aVDPV1 (1 AFP + 1 env) aVDPV3 (1 AFP) cVDPV3 (1 non-AFP) aVDPV3 (1 contact) 5 ?VDPV1 (1 AFP) + cVDPV3 (1 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Malaysia cVDPV1 (3 AFP + 12 env)cVDPV2 (3 env) cVDPV1 (1 AFP + 1 non-AFP + 9 env) cVDPV2 (5 env) aVDPV2 (1 env) ?VDPV3 (1 env) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (2 AFP + 1 contact + 14 env) cVDPV2 (12 AFP + 5 non-AFP + 2 contact + 19 env) iVDPV2 (1 AFP) aVDPV2 (1 AFP) cVDPV2 (1 AFP + 4 env) aVDPV2 (1 AFP + 6 non-AFP + 3 env) Viet Nam aVDPV2 (2 AFP) 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 5. Contact of a different AFP case.

Polio Bulletin 2021 Issue No. 1 - Week 1 (as of 4 January 2021) Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific UK steps up for polio eradication during COVID-19 pandemic The United Kingdom’s Foreign, Commonwealth and Development Office (FCDO) agreed a £30 million increase in the first payment to the World Health Organization of their 2019 – 2023 pledge. Throughout the COVID-19 pandemic, the Global Polio Eradication Initiative has played an integral role in the global response, contributing physical assets, outbreak response expertise and a trained workforce to slow the spread of the novel coronavirus. This support was largely made possible thank to donors like the United Kingdom. Widespread polio vaccination efforts over the past 30 years have led to a 99.9% decrease in global polio cases. The increased payment by the UK will ensure that this progress against polio is not lost due to disruptions by the COVID-19 pandemic, and that the polio programme can continue to play an essential role in supporting pandemic response efforts around the world. Full text is available at the following link: http:// polioeradication.org/news-post/uk-steps-up-for- polio-eradication-during-covid-19-pandemic/ CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2018–2020 Chart 2. Adequate specimen collection rate, 2018–2020 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2020 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2020 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 10.2% 52.5% 7.8% 0.0% 55.8% 37.5% 19.4% 0% 10% 20% 30% 40% 50% 60% VNM PNG PHL MYS LAO KHM CHN 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). 2019 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 63 47 50 0 0 0 41 9 0 (0.0%) 1.06 62% 100% 04-Jan-21 0 Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.00 100% 100% 31-Oct-20 65 Cambodia 55 47 72 0 0 0 14 58 27 (37.5%) 1.53 92% 93% 23-Dec-20 12 China 5183 2370 4029 0 0 0 2220 1809 780 (19.4%) 1.70 93% 100% 02-Jan-21 2 China, Hong Kong SAR 14 9 13 0 0 0 11 2 1 (7.7%) 1.44 85% 100% 16-Dec-20 19 China, Macao SAR 1 1 2 0 0 0 1 1 0 (0.0%) 2.00 100% 100% 15-Dec-20 20 Japan - 152 - - - - - - - - - - - - Lao People's Democratic Republic 65 23 43 0 0 0 5 38 24 (55.8%) 1.87 79% 100% 04-Jan-21 0 Malaysia 194 78 156 0 1 2 146 7 0 (0.0%) 1.99 83% 74% 31-Dec-20 4 Mongolia 5 10 0 - - - - - - - - - 09-Nov-20 56 New Zealand 8 9 10 0 0 0 5 5 2 (20.0%) 1.11 60% 70% 21-Oct-20 75 Papua New Guinea 222 36 59 0 0 0 24 35 31 (52.5%) 1.64 53% 81% 04-Jan-21 0 Philippines 872 330 838 0 3 2 718 115 65 (7.8%) 2.53 63% 97% 23-Dec-20 12 Republic of Korea 81 63 44 0 0 0 31 13 3 (6.8%) 0.70 70% 84% 17-Dec-20 18 Singapore 5 6 3 0 0 0 3 0 0 (0.0%) 0.50 100% 67% 09-Dec-20 26 Viet Nam 353 241 412 0 0 0 276 136 42 (10.2%) 1.71 94% 61% 31-Dec-20 4 Pacific island countries and areas 21 10 7 0 0 0 1 6 4 (57.1%) 0.70 57% 86% 21-Oct-20 75 Total 7144 3433 5739 0 4 4 3497 2234 979 (17.1%) 1.67 87% 95% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Discarded (Non-polio) 2020 Non-polio AFP rate Total % with adequate specimens 2 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Table 1. Classification of AFP cases with onset in 2020 and key surveillance indicators 3 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 42 0 0 0 39 3 0 96% 0% 04-Jan-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 0 - - - - - - - - 30-Nov-20 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 38 0 0 7 31 0 0 100% 14% 10-Nov-20 NIID 0 - - - - - - - - - - - - - China (total) 3977 20 0 89 3776 2 90 96% 2% 02-Jan-21 52 0 24 1 0 0 0 0 26 1 0 0 0 100% China, Anhui Prov. Lab 247 1 0 0 238 0 8 100% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 0 1 0 0 0 100% China, Beijing Prov. Lab 28 1 0 0 27 0 0 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Chongqing Prov. Lab 49 0 0 1 45 0 3 100% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 113 0 0 3 103 0 7 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 95 0 0 0 94 0 1 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 389 1 0 4 380 0 4 82% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Guangxi Prov. Lab 193 0 0 5 188 0 0 100% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 155 2 0 2 141 0 10 98% 1% Prov. Lab/CCDC 4 0 4 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 27 0 0 1 25 0 1 96% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 219 1 0 16 200 0 2 100% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Heilongjiang Prov. Lab 38 0 0 0 36 0 2 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 463 2 0 5 451 1 4 99% 1% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Hubei Prov. Lab 98 0 0 5 85 0 8 96% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 201 1 0 15 183 0 2 100% 6% Prov. Lab/CCDC 5 0 2 0 0 0 0 0 3 0 0 0 0 100% China, Jiangsu Prov. Lab 174 3 0 0 170 0 1 100% 0% Prov. Lab/CCDC 6 0 0 0 0 0 0 0 6 0 0 0 0 100% China, Jiangxi Prov. Lab 138 0 0 3 135 0 0 99% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 36 0 0 6 30 0 0 97% 10% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 55 1 0 1 50 0 3 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Neimongol Prov. Lab 78 4 0 0 68 0 6 96% 0% Prov. Lab/CCDC 11 0 4 1 0 0 0 0 6 0 0 0 0 100% China, Ningxia Prov. Lab 19 0 0 0 13 0 6 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 20 0 0 0 20 0 0 90% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 89 0 0 0 88 0 1 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 241 0 0 0 235 1 5 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 24 0 0 0 24 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 78 0 0 0 75 0 3 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 276 2 0 9 261 0 4 94% 3% Prov. Lab/CCDC 6 0 2 0 0 0 0 0 4 0 0 0 0 100% China, Tianjin Prov. Lab 28 0 0 0 28 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 81 0 0 1 77 0 3 68% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 180 0 0 12 164 0 4 97% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 129 0 0 0 128 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 16 1 0 0 14 0 1 14% 0% CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hong Kong SAR PHLC 13 0 0 0 13 0 0 100% 0% 04-Jan-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID 0 - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 5 0 0 1 4 0 0 100% 20% 13-Apr-20 NIID 0 - - - - - - - - - - - - - Malaysia IMR 164 5 0 0 156 0 3 100% - 31-Dec-20 IMR 20 0 4 4 0 2 0 0 10 0 0 0 0 100% Mongolia PHI 0 - - - - - - - - 31-Dec-20 NIID 0 - - - - - - - - - - - - - New Zealand IESR 8 0 0 0 8 0 0 100% 0% 30-Nov-20 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 62 5 0 11 46 0 0 97% 16% 14-Dec-20 VIDRL 24 0 6 0 0 0 0 0 11 0 7 0 0 100% Philippines RITM 733 32 0 28 647 0 26 98% 3% 03-Dec-20 RITM/NIID 68 0 12 0 0 33 2 0 21 0 0 0 0 100% Republic of Korea KCDC 40 0 0 0 40 0 0 99% 0% 23-Nov-20 KCDC 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 31-Dec-20 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 210 1 0 29 170 10 0 99% 14% 04-Dec-20 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 220 0 0 22 183 15 0 100% 10% 23-Dec-20 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 7 0 0 0 7 0 0 100% 0% 16-Nov-20 VIDRL 0 - - - - - - - - - - - - - Total 5524 63 0 187 5125 30 119 96% 2% 164 0 46 5 0 35 2 0 68 1 7 0 0 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPVNegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Table 2. Laboratory investigation of stool samples from AFP cases with onset in 2020 and key laboratory indicators 5 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 9 1 0 0 0 0 0 0 0 1 0 8 0 0 13 1 0 0 0 0 0 0 0 1 0 1 0 0 China (total) 379 226 0 174 0 0 0 0 0 599 0 1552 0 0 249 141 0 104 1 0 0 0 0 314 0 372 0 0 China, Fujian Prov. Lab/CCDC 70 43 0 17 0 0 0 0 0 85 0 427 0 0 26 16 0 3 0 0 0 0 0 27 0 21 0 0 China, Gansu Prov. Lab/CCDC 32 25 0 31 0 0 0 0 0 111 0 82 0 0 34 23 0 14 0 0 0 0 0 69 0 32 0 0 China, Guangdong Prov. Lab/CCDC 47 34 0 32 0 0 0 0 0 60 0 188 0 0 36 20 0 13 0 0 0 0 0 16 0 10 0 0 China, Guangxi Prov. Lab/CCDC 12 9 0 6 0 0 0 0 0 27 0 47 0 0 6 2 0 0 0 0 0 0 0 10 0 2 0 0 China, Heilongjiang Prov. Lab/CCDC 42 21 0 7 0 0 0 0 0 48 0 111 0 0 34 18 0 6 0 0 0 0 0 36 0 101 0 0 China, Jiangxi Prov. Lab/CCDC 12 11 0 3 0 0 0 0 0 22 0 112 0 0 9 6 0 1 0 0 0 0 0 10 0 18 0 0 China, Neimongol Prov. Lab/CCDC 3 2 0 0 0 0 0 0 0 7 0 2 0 0 3 3 0 4 0 0 0 0 0 3 0 1 0 0 China, Qinghai Prov. Lab/CCDC 9 6 0 1 0 0 0 0 0 14 0 21 0 0 10 7 0 3 0 0 0 0 0 11 0 5 0 0 China, Shandong Prov. Lab/CCDC 33 15 0 5 0 0 0 0 0 30 0 280 0 0 19 12 0 12 0 0 0 0 0 11 0 39 0 0 China, Shanghai Prov. Lab/CCDC 12 7 0 9 0 0 0 0 0 24 0 25 0 0 12 7 0 4 0 0 0 0 0 11 0 2 0 0 China, Sichuan Prov. Lab/CCDC 40 23 0 3 0 0 0 0 0 31 0 46 0 0 30 13 0 6 0 0 0 0 0 36 0 70 0 0 China, Xinjiang Prov. Lab/CCDC 36 28 0 57 0 0 0 0 0 138 0 107 0 0 16 14 0 38 1 0 0 0 0 74 0 28 0 0 China, Yunnan Prov. Lab/CCDC 31 2 0 3 0 0 0 0 0 2 0 104 0 0 14 0 - - - - - - - - - 43 - - Malaysia IMR/VIDRL 60 12 0 0 12 0 0 3 0 0 0 37 0 0 540 78 0 29 9 0 0 7 0 61 0 14 120 0 Philippines RITM 212 93 0 85 33 0 7 60 0 172 0 81 0 0 303 77 0 9 0 0 98 7 0 41 0 68 0 0 Papua New Guinea RITM 75 58 0 33 0 0 0 0 0 44 0 54 0 0 0 - - - - - - - - - - - - - Total 735 390 0 292 45 0 7 63 0 816 0 1732 0 0 1105 297 0 142 10 0 98 14 0 417 0 455 120 0 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV 2019 2020 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD Discordant pending sequencing Polio isolates 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Type 3 Total number of samples processed Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 Table 3. Laboratory confirmation of polio isolates from environmental samples in 2019–20201 6 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2020 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 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) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) aVDPV3 (1 AFP) aVDPV1 (1 AFP + 1 env) aVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (1 contact) 5 China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Malaysia cVDPV1 (3 AFP + 12 env)cVDPV2 (3 env) cVDPV1 (1 AFP + 1 non-AFP + 9 env) cVDPV2 (5 env) aVDPV2 (1 env) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (2 AFP + 1 contact + 14 env) cVDPV2 (12 AFP + 5 non-AFP + 2 contact + 19 env) iVDPV2 (1 AFP) aVDPV2 (1 AFP) cVDPV2 (1 AFP + 4 env) aVDPV2 (1 AFP + 6 non-AFP + 3 env) Viet Nam aVDPV2 (2 AFP) 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 5. Contact of a different AFP case.

Polio Bulletin 2021 Issue No. 2 - Week 3 (as of 18 January 2021) Aidan O’Leary - New GPEI Director On 1 January 2021 O’Leary took over as Director for Polio Eradication at WHO from Michel Zaffran, who will enter a well-deserved retirement end-February. O’Leary brings with him a vast array of experience in both polio eradication and emergencies, including through the United Nations Office for the Coordination of Humanitarian Affairs (OCHA). “Emergency is precisely what we are facing with polio, whether it’s wild or vaccine-derived. I believe my experience working in emergency settings can help us achieve our goal, including by linking polio operations more closely to other emergency efforts” - emphasized O’Leary in his interview to “PolioNews”. Full story is available at the following link: http:// polioeradication.org/news-post/new-gpei-director- aidan-oleary-takes-helm-of-global-polio-effort/ Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2018–2020 Chart 2. Adequate specimen collection rate, 2018–2020 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2020 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2020 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 10.2% 46.7% 7.7% 0.0% 55.8% 37.5% 19.4% 0% 10% 20% 30% 40% 50% 60% VNM PNG PHL MYS LAO KHM CHN 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). 2019 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 63 47 51 0 0 0 41 10 0 (0.0%) 1.09 61% 100% 11-Jan-21 7 Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.00 100% 100% 11-Jan-21 - Cambodia 55 47 72 0 0 0 14 58 27 (37.5%) 1.53 92% 93% 23-Dec-20 26 China 5183 2370 4029 0 0 0 2220 1809 780 (19.4%) 1.70 93% 100% 02-Jan-21 16 China, Hong Kong SAR 14 9 13 0 0 0 11 2 1 (7.7%) 1.44 85% 100% 16-Dec-20 33 China, Macao SAR 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 13-Jan-21 - Japan - 152 - - - - - - - - - - - - Lao People's Democratic Republic 65 23 43 0 0 0 5 38 24 (55.8%) 1.87 79% 100% 04-Jan-21 14 Malaysia 194 78 156 0 1 2 146 7 0 (0.0%) 1.99 83% 74% 31-Dec-20 18 Mongolia 5 10 1 0 0 0 1 0 0 (0.0%) 0.10 100% 100% 16-Jan-21 - New Zealand 8 9 10 0 0 0 5 5 2 (20.0%) 1.11 60% 70% 21-Oct-20 89 Papua New Guinea 222 36 60 0 0 0 30 30 28 (46.7%) 1.67 52% 80% 12-Jan-21 6 Philippines 872 330 871 0 2 2 756 111 67 (7.7%) 2.63 62% 97% 15-Jan-21 3 Republic of Korea 81 63 48 0 0 0 43 5 0 (0.0%) 0.76 85% 100% 07-Jan-21 11 Singapore 5 6 3 0 0 0 3 0 0 (0.0%) 0.50 100% 67% 07-Jan-21 - Viet Nam 353 241 412 0 0 0 276 136 42 (10.2%) 1.71 94% 61% 31-Dec-20 18 Pacific island countries and areas 21 10 8 0 0 0 1 7 6 (75.0%) 0.80 63% 88% 13-Jan-21 5 Total 7144 3433 5780 0 3 4 3555 2218 977 (16.9%) 1.68 87% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 2020 Non-polio AFP rate Total % with adequate specimens 2> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Table 1. Classification of AFP cases with onset in 2020 and key surveillance indicators 3 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 42 0 0 0 42 0 0 96% 0% 11-Jan-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 0 - - - - - - - - 30-Nov-20 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 38 0 0 7 31 0 0 100% 14% 06-Jan-21 NIID 0 - - - - - - - - - - - - - China (total) 3977 20 0 89 3776 0 92 96% 2% 02-Jan-21 52 0 24 1 0 0 0 0 26 1 0 0 0 100% China, Anhui Prov. Lab 247 1 0 0 238 0 8 100% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 0 1 0 0 0 100% China, Beijing Prov. Lab 28 1 0 0 27 0 0 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Chongqing Prov. Lab 49 0 0 1 45 0 3 100% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 113 0 0 3 103 0 7 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 95 0 0 0 94 0 1 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 389 1 0 4 380 0 4 82% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Guangxi Prov. Lab 193 0 0 5 188 0 0 100% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 155 2 0 2 141 0 10 98% 1% Prov. Lab/CCDC 4 0 4 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 27 0 0 1 25 0 1 96% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 219 1 0 16 200 0 2 100% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Heilongjiang Prov. Lab 38 0 0 0 36 0 2 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 463 2 0 5 451 0 5 99% 1% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Hubei Prov. Lab 98 0 0 5 85 0 8 96% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 201 1 0 15 183 0 2 100% 6% Prov. Lab/CCDC 5 0 2 0 0 0 0 0 3 0 0 0 0 100% China, Jiangsu Prov. Lab 174 3 0 0 170 0 1 100% 0% Prov. Lab/CCDC 6 0 0 0 0 0 0 0 6 0 0 0 0 100% China, Jiangxi Prov. Lab 138 0 0 3 135 0 0 99% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 36 0 0 6 30 0 0 97% 10% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 55 1 0 1 50 0 3 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Neimongol Prov. Lab 78 4 0 0 68 0 6 96% 0% Prov. Lab/CCDC 11 0 4 1 0 0 0 0 6 0 0 0 0 100% China, Ningxia Prov. Lab 19 0 0 0 13 0 6 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 20 0 0 0 20 0 0 90% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 89 0 0 0 88 0 1 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 241 0 0 0 235 0 6 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 24 0 0 0 24 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 78 0 0 0 75 0 3 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 276 2 0 9 261 0 4 94% 3% Prov. Lab/CCDC 6 0 2 0 0 0 0 0 4 0 0 0 0 100% China, Tianjin Prov. Lab 28 0 0 0 28 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 81 0 0 1 77 0 3 68% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 180 0 0 12 164 0 4 97% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 129 0 0 0 128 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 16 1 0 0 14 0 1 14% 0% CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hong Kong SAR PHLC 13 0 0 0 13 0 0 100% 0% 04-Jan-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 5 0 0 1 4 0 0 100% 20% 13-Apr-20 NIID 0 - - - - - - - - - - - - - Malaysia IMR 169 5 0 0 161 0 3 82% 0% 17-Jan-21 IMR 22 0 4 4 0 2 0 0 12 0 0 0 0 100% Mongolia PHI 1 0 0 1 0 0 0 100% 50% 15-Jan-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 8 0 0 0 8 0 0 100% 0% 11-Jan-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 62 5 0 11 46 0 0 97% 18% 14-Dec-20 VIDRL 28 0 10 0 0 0 0 0 11 0 7 0 0 100% Philippines RITM 813 32 0 31 748 0 2 98% 4% 13-Jan-21 RITM/NIID 68 0 12 0 0 33 2 0 21 0 0 0 0 100% Republic of Korea KCDC 48 0 0 0 47 1 0 99% 0% 07-Jan-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 08-Jan-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 210 1 0 29 170 10 0 99% 14% 04-Dec-20 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 225 1 0 23 198 3 0 100% 10% 06-Jan-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 9 0 0 0 9 0 0 100% 0% 29-Dec-20 VIDRL 0 - - - - - - - - - - - - - Total 5625 64 0 192 5258 14 97 96% 2% 170 0 50 5 0 35 2 0 70 1 7 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2. Laboratory investigation of stool samples from AFP cases with onset in 2020 and key laboratory indicators 5 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 9 1 0 0 0 0 0 0 0 1 0 8 0 0 13 1 0 0 0 0 0 0 0 1 0 1 0 0 China (total) 379 226 0 174 0 0 0 0 0 599 0 1552 0 0 249 141 0 104 1 0 0 0 0 314 0 372 0 0 China, Fujian Prov. Lab/CCDC 70 43 0 17 0 0 0 0 0 85 0 427 0 0 26 16 0 3 0 0 0 0 0 27 0 21 0 0 China, Gansu Prov. Lab/CCDC 32 25 0 31 0 0 0 0 0 111 0 82 0 0 34 23 0 14 0 0 0 0 0 69 0 32 0 0 China, Guangdong Prov. Lab/CCDC 47 34 0 32 0 0 0 0 0 60 0 188 0 0 36 20 0 13 0 0 0 0 0 16 0 10 0 0 China, Guangxi Prov. Lab/CCDC 12 9 0 6 0 0 0 0 0 27 0 47 0 0 6 2 0 0 0 0 0 0 0 10 0 2 0 0 China, Heilongjiang Prov. Lab/CCDC 42 21 0 7 0 0 0 0 0 48 0 111 0 0 34 18 0 6 0 0 0 0 0 36 0 101 0 0 China, Jiangxi Prov. Lab/CCDC 12 11 0 3 0 0 0 0 0 22 0 112 0 0 9 6 0 1 0 0 0 0 0 10 0 18 0 0 China, Neimongol Prov. Lab/CCDC 3 2 0 0 0 0 0 0 0 7 0 2 0 0 3 3 0 4 0 0 0 0 0 3 0 1 0 0 China, Qinghai Prov. Lab/CCDC 9 6 0 1 0 0 0 0 0 14 0 21 0 0 10 7 0 3 0 0 0 0 0 11 0 5 0 0 China, Shandong Prov. Lab/CCDC 33 15 0 5 0 0 0 0 0 30 0 280 0 0 19 12 0 12 0 0 0 0 0 11 0 39 0 0 China, Shanghai Prov. Lab/CCDC 12 7 0 9 0 0 0 0 0 24 0 25 0 0 12 7 0 4 0 0 0 0 0 11 0 2 0 0 China, Sichuan Prov. Lab/CCDC 40 23 0 3 0 0 0 0 0 31 0 46 0 0 30 13 0 6 0 0 0 0 0 36 0 70 0 0 China, Xinjiang Prov. Lab/CCDC 36 28 0 57 0 0 0 0 0 138 0 107 0 0 16 14 0 38 1 0 0 0 0 74 0 28 0 0 China, Yunnan Prov. Lab/CCDC 31 2 0 3 0 0 0 0 0 2 0 104 0 0 14 0 - - - - - - - - - 43 - - Malaysia IMR/VIDRL 60 12 0 0 12 0 0 3 0 0 0 37 0 0 540 78 0 29 9 0 0 7 0 61 0 14 120 0 Philippines RITM 212 93 0 85 33 0 7 60 0 172 0 81 0 0 373 86 0 20 0 0 98 7 0 60 0 95 0 0 Papua New Guinea RITM 75 58 0 33 0 0 0 0 0 44 0 54 0 0 0 - - - - - - - - - - - - - Total 735 390 0 292 45 0 7 63 0 816 0 1732 0 0 1175 306 0 153 10 0 98 14 0 436 0 482 120 0 2019 2020 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed Table 3. Laboratory confirmation of polio isolates from environmental samples in 2019–20201 6 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2020 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 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) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) aVDPV3 (1 AFP) aVDPV1 (1 AFP + 1 env) aVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (1 contact) 5 China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Malaysia cVDPV1 (3 AFP + 12 env)cVDPV2 (3 env) cVDPV1 (1 AFP + 1 non-AFP + 9 env) cVDPV2 (5 env) aVDPV2 (1 env) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (2 AFP + 1 contact + 14 env) cVDPV2 (12 AFP + 5 non-AFP + 2 contact + 19 env) iVDPV2 (1 AFP) aVDPV2 (1 AFP) cVDPV2 (1 AFP + 4 env) aVDPV2 (1 AFP + 6 non-AFP + 3 env) Viet Nam aVDPV2 (2 AFP) 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 5. Contact of a different AFP case.

Polio Bulletin 2021 Issue No. 3 - Week 5 (as of 1 February 2021) Polio eradication in the agenda of the WHO Executive Board Global health leaders and ministers of health meeting virtually at 148th session of the WHO Executive Board (EB) on 18-26 January 2021, urged for concerted and emergency efforts to finally rid the world of polio. Recognizing that successful polio transition and polio eradication are twin goals, delegates reiterated their support for the sustainable transitioning of polio assets. The WHO Director-General, Dr Tedros Adhanom Ghebreyesus, commented, “We share the understanding that polio eradication and transition are equally important targets: as we work towards eradication we must think about the future.” “If we did not know it before, we certainly know now how quickly infectious diseases can spread across the world and wild polio is one such infectious disease,” said Aidan O’Leary, newly-appointed Director of the Global Polio Eradication Initiative at WHO. Full story is available at the following link: https:// polioeradication.org/news-post/who-executive-board- keeps-polio-eradication-in-its-sights/ Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2018–2020 Chart 2. Adequate specimen collection rate, 2018–2020 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2020 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2020 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 10.2% 46.7% 7.7% 0.0% 55.8% 37.5% 19.4% 0% 10% 20% 30% 40% 50% 60% VNM PNG PHL MYS LAO KHM CHN 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). 2019 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 63 47 51 0 0 0 41 10 0 (0.0%) 1.09 63% 100% 20-Jan-21 12 Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.00 100% 100% 11-Jan-21 - Cambodia 55 47 72 0 0 0 14 58 27 (37.5%) 1.53 92% 93% 23-Dec-20 40 China 5183 2370 4029 0 0 0 2220 1809 780 (19.4%) 1.70 93% 100% 02-Jan-21 30 China, Hong Kong SAR 14 9 13 0 0 0 12 1 1 (7.7%) 1.44 85% 100% 20-Jan-21 12 China, Macao SAR 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 13-Jan-21 - Japan - 152 - - - - - - - - - - - - Lao People's Democratic Republic 65 23 43 0 0 0 5 38 24 (55.8%) 1.87 79% 100% 04-Jan-21 28 Malaysia 194 78 159 0 1 2 151 5 0 (0.0%) 2.03 83% 76% 18-Jan-21 14 Mongolia 5 10 1 0 0 0 1 0 0 (0.0%) 0.10 100% 100% 16-Jan-21 - New Zealand 8 9 10 0 0 0 10 0 0 (0.0%) 1.11 60% 70% 29-Jan-21 - Papua New Guinea 222 36 60 0 0 0 30 30 28 (46.7%) 1.67 52% 80% 12-Jan-21 20 Philippines 872 330 871 0 2 2 756 111 67 (7.7%) 2.63 62% 97% 15-Jan-21 17 Republic of Korea 81 63 48 0 0 0 43 5 0 (0.0%) 0.76 85% 100% 07-Jan-21 25 Singapore 5 6 3 0 0 0 3 0 0 (0.0%) 0.50 100% 67% 07-Jan-21 - Viet Nam 353 241 412 0 0 0 276 136 42 (10.2%) 1.71 94% 61% 31-Dec-20 32 Pacific island countries and areas 21 10 8 0 0 0 1 7 6 (75.0%) 0.80 63% 88% 13-Jan-21 19 Total 7144 3433 5783 0 3 4 3566 2210 975 (16.9%) 1.68 87% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) 2020 Non-polio AFP rate Total % with adequate specimens 2 Table 1. Classification of AFP cases with onset in 2020 and key surveillance indicators 3 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 43 0 0 0 42 0 1 96% 0% 20-Jan-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 03-Feb-20 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 38 0 0 7 31 0 0 100% 14% 06-Jan-21 NIID 0 - - - - - - - - - - - - - China (total) 3977 20 0 89 3776 0 92 96% 2% 02-Jan-21 56 0 25 1 0 0 0 0 29 1 0 0 0 100% China, Anhui Prov. Lab 247 1 0 0 238 0 8 100% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 0 1 0 0 0 100% China, Beijing Prov. Lab 28 1 0 0 27 0 0 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Chongqing Prov. Lab 49 0 0 1 45 0 3 100% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 113 0 0 3 103 0 7 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 95 0 0 0 94 0 1 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 389 1 0 4 380 0 4 82% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Guangxi Prov. Lab 193 0 0 5 188 0 0 100% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 155 2 0 2 141 0 10 98% 1% Prov. Lab/CCDC 4 0 4 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 27 0 0 1 25 0 1 96% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 219 1 0 16 200 0 2 100% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Heilongjiang Prov. Lab 38 0 0 0 36 0 2 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 463 2 0 5 451 0 5 99% 1% Prov. Lab/CCDC 10 0 4 0 0 0 0 0 6 0 0 0 0 100% China, Hubei Prov. Lab 98 0 0 5 85 0 8 96% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 201 1 0 15 183 0 2 100% 6% Prov. Lab/CCDC 5 0 2 0 0 0 0 0 3 0 0 0 0 100% China, Jiangsu Prov. Lab 174 3 0 0 170 0 1 100% 0% Prov. Lab/CCDC 6 0 0 0 0 0 0 0 6 0 0 0 0 100% China, Jiangxi Prov. Lab 138 0 0 3 135 0 0 99% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 36 0 0 6 30 0 0 97% 10% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 55 1 0 1 50 0 3 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Neimongol Prov. Lab 78 4 0 0 68 0 6 96% 0% Prov. Lab/CCDC 11 0 4 1 0 0 0 0 6 0 0 0 0 100% China, Ningxia Prov. Lab 19 0 0 0 13 0 6 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 20 0 0 0 20 0 0 90% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 89 0 0 0 88 0 1 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 241 0 0 0 235 0 6 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 24 0 0 0 24 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 78 0 0 0 75 0 3 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 276 2 0 9 261 0 4 94% 3% Prov. Lab/CCDC 7 0 2 0 0 0 0 0 5 0 0 0 0 100% China, Tianjin Prov. Lab 28 0 0 0 28 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 81 0 0 1 77 0 3 68% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 180 0 0 12 164 0 4 97% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 129 0 0 0 128 0 1 100% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Tibet Prov. Lab 16 1 0 0 14 0 1 14% 0% CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hong Kong SAR PHLC 13 0 0 0 13 0 0 100% 0% 04-Jan-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 5 0 0 1 4 0 0 100% 20% 18-Jan-21 NIID 0 - - - - - - - - - - - - - Malaysia IMR 172 5 0 0 164 0 3 82% 0% 31-Jan-21 IMR 22 0 4 4 0 2 0 0 12 0 0 0 0 100% Mongolia PHI 1 0 0 1 0 0 0 100% 100% 31-Jan-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 7 0 0 0 7 0 0 100% 0% 28-Jan-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 62 5 0 11 46 0 0 97% 16% 14-Dec-20 VIDRL 28 0 10 0 0 0 0 0 11 0 7 0 0 100% Philippines RITM 813 32 0 31 748 0 2 98% 4% 13-Jan-21 RITM/NIID 68 0 12 0 0 33 2 0 21 0 0 0 0 100% Republic of Korea KCDC 48 0 0 0 47 0 1 99% 0% 07-Jan-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 08-Jan-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 234 1 0 31 202 0 0 99% 13% 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 225 1 0 23 198 3 0 100% 10% 06-Jan-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 11 0 0 0 11 0 0 100% 0% 01-Feb-21 VIDRL 0 - - - - - - - - - - - - - Total 5655 64 0 194 5295 3 99 96% 2% 174 0 51 5 0 35 2 0 73 1 7 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2. Laboratory investigation of stool samples from AFP cases with onset in 2020 and key laboratory indicators 5 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 9 1 0 0 0 0 0 0 0 1 0 8 0 0 16 1 0 0 0 0 0 0 0 1 0 2 0 0 China (total) 379 226 0 174 0 0 0 0 0 599 0 1552 0 0 343 187 0 121 1 0 0 0 0 379 0 512 0 0 China, Fujian Prov. Lab/CCDC 70 43 0 17 0 0 0 0 0 85 0 427 0 0 63 33 0 8 0 0 0 0 0 54 0 58 0 0 China, Gansu Prov. Lab/CCDC 32 25 0 31 0 0 0 0 0 111 0 82 0 0 39 26 0 16 0 0 0 0 0 72 0 38 0 0 China, Guangdong Prov. Lab/CCDC 47 34 0 32 0 0 0 0 0 60 0 188 0 0 48 25 0 16 0 0 0 0 0 19 0 26 0 0 China, Guangxi Prov. Lab/CCDC 12 9 0 6 0 0 0 0 0 27 0 47 0 0 12 3 0 0 0 0 0 0 0 11 0 9 0 0 China, Heilongjiang Prov. Lab/CCDC 42 21 0 7 0 0 0 0 0 48 0 111 0 0 34 18 0 6 0 0 0 0 0 36 0 101 0 0 China, Jiangxi Prov. Lab/CCDC 12 11 0 3 0 0 0 0 0 22 0 112 0 0 9 6 0 1 0 0 0 0 0 10 0 18 0 0 China, Neimongol Prov. Lab/CCDC 3 2 0 0 0 0 0 0 0 7 0 2 0 0 3 3 0 4 0 0 0 0 0 3 0 1 0 0 China, Qinghai Prov. Lab/CCDC 9 6 0 1 0 0 0 0 0 14 0 21 0 0 11 7 0 3 0 0 0 0 0 11 0 5 0 0 China, Shandong Prov. Lab/CCDC 33 15 0 5 0 0 0 0 0 30 0 280 0 0 32 20 0 14 0 0 0 0 0 25 0 107 0 0 China, Shanghai Prov. Lab/CCDC 12 7 0 9 0 0 0 0 0 24 0 25 0 0 24 14 0 9 0 0 0 0 0 18 0 7 0 0 China, Sichuan Prov. Lab/CCDC 40 23 0 3 0 0 0 0 0 31 0 46 0 0 30 13 0 6 0 0 0 0 0 36 0 70 0 0 China, Xinjiang Prov. Lab/CCDC 36 28 0 57 0 0 0 0 0 138 0 107 0 0 24 19 0 38 1 0 0 0 0 84 0 29 0 0 China, Yunnan Prov. Lab/CCDC 31 2 0 3 0 0 0 0 0 2 0 104 0 0 14 0 - - - - - - - - - 43 - - Malaysia IMR/VIDRL 60 12 0 0 12 0 0 3 0 0 0 37 0 0 540 78 0 29 9 0 0 7 0 61 0 14 120 0 Philippines RITM 212 93 0 85 33 0 7 60 0 172 0 81 0 0 373 86 0 20 0 0 98 7 0 60 0 95 0 0 Papua New Guinea RITM 75 58 0 33 0 0 0 0 0 44 0 54 0 0 0 - - - - - - - - - - - - - Total 735 390 0 292 45 0 7 63 0 816 0 1732 0 0 1272 352 0 170 10 0 98 14 0 501 0 623 120 0 2019 2020 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed Table 3. Laboratory confirmation of polio isolates from environmental samples in 2019–20201 6 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2020 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 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) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) aVDPV3 (1 AFP) aVDPV1 (1 AFP + 1 env) aVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (1 contact) 5 China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Malaysia cVDPV1 (3 AFP + 12 env)cVDPV2 (3 env) cVDPV1 (1 AFP + 1 non-AFP + 9 env) cVDPV2 (5 env) aVDPV2 (1 env) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (2 AFP + 1 contact + 14 env) cVDPV2 (12 AFP + 5 non-AFP + 2 contact + 19 env) iVDPV2 (1 AFP) aVDPV2 (1 AFP) cVDPV2 (1 AFP + 4 env) aVDPV2 (1 AFP + 6 non-AFP + 3 env) Viet Nam aVDPV2 (2 AFP) 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 5. Contact of a different AFP case.

Polio Bulletin 2021 Issue No. 4 - Week 7 (as of 15 February 2021) Polio Outbreak Response Review in Malaysia On 6th December 2019, the Ministry of Health Malaysia declared Polio outbreak due to cVDPV1 and cVDPV2 and initiated the outbreak response activities. Due to the COVID-19 pandemic and travel restrictions, the first review of progress in conducting outbreak response was organized as a virtual activity from 2nd to 9th of February 2021. The aim was to assess the progress made so far and advise the Ministry of Health and state health departments (Sabah and Labuan) on the way forward to address the remaining challenges. The GPEI team of international experts engaged in detailed virtual discussions with the national and state level health teams around following key areas of work: planning and coordination, implementation of SIAs, AFP and environmental surveillance, laboratory testing, routine immunization, vaccine management, and advocacy and communication. The review team concluded that the response in Malaysia has been timely and comprehensive. Substantial progress has been made towards stopping the poliovirus transmission. Specific recommendations were made in all key areas of work, with greater emphasis on ensuring sensitive AFP and environmental surveillance by clearing the back log of AFP and environmental samples pending testing. The review team also highlighted that the risk of break- through detection or new emergence (particularly cVDPV2 after the use of mOPV2) remains high and that Malaysia should remain ready to respond to any new outbreak requiring vaccination response with type 2 vaccine (novel OPV2 versus mOPV2). Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2018–2020 Chart 2. Adequate specimen collection rate, 2018–2020 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2020 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2020 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 10.2% 3.1% 7.7% 0.0% 72.1% 37.5% 19.4% 0% 10% 20% 30% 40% 50% 60% 70% 80% VNM PNG PHL MYS LAO KHM CHN 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). 2019 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 63 47 51 0 0 0 41 10 1 (2.0%) 1.09 63% 100% 05-Feb-21 10 Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.00 100% 100% 11-Jan-21 - Cambodia 55 47 72 0 0 0 14 58 27 (37.5%) 1.53 92% 93% 23-Dec-20 54 China 5183 2370 4029 0 0 0 2220 1809 780 (19.4%) 1.70 93% 100% 02-Jan-21 44 China, Hong Kong SAR 14 9 13 0 0 0 12 1 1 (7.7%) 1.44 85% 100% 01-Feb-21 14 China, Macao SAR 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 13-Jan-21 - Japan 0 152 0 - - - - - - - - - - - Lao People's Democratic Republic 65 23 43 0 0 0 5 38 31 (72.1%) 1.87 79% 63% 09-Feb-21 6 Malaysia 194 78 159 0 1 2 151 5 0 (0.0%) 2.03 83% 76% 18-Jan-21 28 Mongolia 5 10 1 0 0 0 1 0 0 (0.0%) 0.10 100% 100% 16-Jan-21 - New Zealand 8 9 10 0 0 0 10 0 0 (0.0%) 1.11 60% 70% 29-Jan-21 - Papua New Guinea 222 36 65 0 0 0 61 4 2 (3.1%) 1.81 54% 80% 10-Feb-21 5 Philippines 872 330 871 0 2 2 756 111 67 (7.7%) 2.63 62% 97% 15-Jan-21 31 Republic of Korea 81 63 48 0 0 0 46 2 0 (0.0%) 0.76 85% 100% 15-Feb-21 0 Singapore 5 6 3 0 0 0 3 0 0 (0.0%) 0.50 100% 67% 07-Jan-21 - Viet Nam 353 241 412 0 0 0 276 136 42 (10.2%) 1.71 94% 61% 31-Dec-20 46 Pacific island countries and areas 21 10 8 0 0 0 1 7 6 (75.0%) 0.80 63% 88% 13-Jan-21 33 Total 7144 3433 5788 0 3 4 3600 2181 957 (16.5%) 1.69 87% 95% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO 2020 Non-polio AFP rate Total % with adequate specimens 2> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Table 1. Classification of AFP cases with onset in 2020 and key surveillance indicators 3 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 44 0 0 0 42 1 1 78% 0% 05-Feb-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 03-Feb-20 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 38 0 0 7 31 0 0 100% 14% 06-Jan-21 NIID 0 - - - - - - - - - - - - - China (total) 3977 20 0 89 3776 0 92 96% 2% 09-Feb-21 56 0 25 1 0 0 0 0 29 1 0 0 0 100% China, Anhui Prov. Lab 247 1 0 0 238 0 8 100% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 0 1 0 0 0 100% China, Beijing Prov. Lab 28 1 0 0 27 0 0 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Chongqing Prov. Lab 49 0 0 1 45 0 3 100% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 113 0 0 3 103 0 7 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 95 0 0 0 94 0 1 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 389 1 0 4 380 0 4 82% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Guangxi Prov. Lab 193 0 0 5 188 0 0 100% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 155 2 0 2 141 0 10 98% 1% Prov. Lab/CCDC 4 0 4 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 27 0 0 1 25 0 1 96% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 219 1 0 16 200 0 2 100% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Heilongjiang Prov. Lab 38 0 0 0 36 0 2 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 463 2 0 5 451 0 5 99% 1% Prov. Lab/CCDC 10 0 4 0 0 0 0 0 6 0 0 0 0 100% China, Hubei Prov. Lab 98 0 0 5 85 0 8 96% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 201 1 0 15 183 0 2 100% 6% Prov. Lab/CCDC 5 0 2 0 0 0 0 0 3 0 0 0 0 100% China, Jiangsu Prov. Lab 174 3 0 0 170 0 1 100% 0% Prov. Lab/CCDC 6 0 0 0 0 0 0 0 6 0 0 0 0 100% China, Jiangxi Prov. Lab 138 0 0 3 135 0 0 99% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 36 0 0 6 30 0 0 97% 10% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 55 1 0 1 50 0 3 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Neimongol Prov. Lab 78 4 0 0 68 0 6 96% 0% Prov. Lab/CCDC 11 0 4 1 0 0 0 0 6 0 0 0 0 100% China, Ningxia Prov. Lab 19 0 0 0 13 0 6 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 20 0 0 0 20 0 0 90% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 89 0 0 0 88 0 1 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 241 0 0 0 235 0 6 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 24 0 0 0 24 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 78 0 0 0 75 0 3 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 276 2 0 9 261 0 4 94% 3% Prov. Lab/CCDC 7 0 2 0 0 0 0 0 5 0 0 0 0 100% China, Tianjin Prov. Lab 28 0 0 0 28 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 81 0 0 1 77 0 3 68% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 180 0 0 12 164 0 4 97% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 129 0 0 0 128 0 1 100% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Tibet Prov. Lab 16 1 0 0 14 0 1 14% 0% CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hong Kong SAR PHLC 13 0 0 0 13 0 0 100% 0% 08-Feb-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 5 0 0 1 4 0 0 100% 20% 18-Jan-21 NIID 0 - - - - - - - - - - - - - Malaysia IMR 173 5 0 0 165 0 3 82% 0% 11-Feb-21 IMR 22 0 4 4 0 2 0 0 12 0 0 0 0 100% Mongolia PHI 1 0 0 1 0 0 0 100% 100% 07-Feb-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 7 0 0 0 7 0 0 100% 0% 15-Feb-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 64 5 0 11 48 0 0 98% 15% 11-Feb-21 VIDRL 28 0 10 0 0 0 0 0 11 0 7 0 0 100% Philippines RITM 813 32 0 31 748 0 2 98% 4% 13-Jan-21 RITM/NIID 68 0 12 0 0 33 2 0 21 0 0 0 0 100% Republic of Korea KCDC 48 0 0 0 47 0 1 99% 0% 07-Jan-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 11-Feb-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 234 1 0 31 202 0 0 99% 13% 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 225 1 0 23 198 3 0 100% 10% 06-Jan-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 11 0 0 0 11 0 0 100% 0% 01-Feb-21 VIDRL 0 - - - - - - - - - - - - - Total 5659 64 0 194 5298 4 99 96% 2% 174 0 51 5 0 35 2 0 73 1 7 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2. Laboratory investigation of stool samples from AFP cases with onset in 2020 and key laboratory indicators 5 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 9 1 0 0 0 0 0 0 0 1 0 8 0 0 16 1 0 0 0 0 0 0 0 1 0 2 0 0 China (total) 379 226 0 174 0 0 0 0 0 599 0 1552 0 0 343 187 0 121 1 0 0 0 0 379 0 512 0 0 China, Fujian Prov. Lab/CCDC 70 43 0 17 0 0 0 0 0 85 0 427 0 0 63 33 0 8 0 0 0 0 0 54 0 58 0 0 China, Gansu Prov. Lab/CCDC 32 25 0 31 0 0 0 0 0 111 0 82 0 0 39 26 0 16 0 0 0 0 0 72 0 38 0 0 China, Guangdong Prov. Lab/CCDC 47 34 0 32 0 0 0 0 0 60 0 188 0 0 48 25 0 16 0 0 0 0 0 19 0 26 0 0 China, Guangxi Prov. Lab/CCDC 12 9 0 6 0 0 0 0 0 27 0 47 0 0 12 3 0 0 0 0 0 0 0 11 0 9 0 0 China, Heilongjiang Prov. Lab/CCDC 42 21 0 7 0 0 0 0 0 48 0 111 0 0 34 18 0 6 0 0 0 0 0 36 0 101 0 0 China, Jiangxi Prov. Lab/CCDC 12 11 0 3 0 0 0 0 0 22 0 112 0 0 9 6 0 1 0 0 0 0 0 10 0 18 0 0 China, Neimongol Prov. Lab/CCDC 3 2 0 0 0 0 0 0 0 7 0 2 0 0 3 3 0 4 0 0 0 0 0 3 0 1 0 0 China, Qinghai Prov. Lab/CCDC 9 6 0 1 0 0 0 0 0 14 0 21 0 0 11 7 0 3 0 0 0 0 0 11 0 5 0 0 China, Shandong Prov. Lab/CCDC 33 15 0 5 0 0 0 0 0 30 0 280 0 0 32 20 0 14 0 0 0 0 0 25 0 107 0 0 China, Shanghai Prov. Lab/CCDC 12 7 0 9 0 0 0 0 0 24 0 25 0 0 24 14 0 9 0 0 0 0 0 18 0 7 0 0 China, Sichuan Prov. Lab/CCDC 40 23 0 3 0 0 0 0 0 31 0 46 0 0 30 13 0 6 0 0 0 0 0 36 0 70 0 0 China, Xinjiang Prov. Lab/CCDC 36 28 0 57 0 0 0 0 0 138 0 107 0 0 24 19 0 38 1 0 0 0 0 84 0 29 0 0 China, Yunnan Prov. Lab/CCDC 31 2 0 3 0 0 0 0 0 2 0 104 0 0 14 0 - - - - - - - - - 43 - - Malaysia IMR/VIDRL 60 12 0 0 12 0 0 3 0 0 0 37 0 0 700 77 0 28 9 0 0 7 0 64 0 21 113 0 Philippines RITM 212 93 0 85 33 0 7 60 0 172 0 81 0 0 373 86 0 20 0 0 98 7 0 60 0 95 0 0 Papua New Guinea RITM 75 58 0 33 0 0 0 0 0 44 0 54 0 0 0 - - - - - - - - - - - - - Total 735 390 0 292 45 0 7 63 0 816 0 1732 0 0 1432 351 0 169 10 0 98 14 0 504 0 630 113 0 2019 2020 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed Table 3. Laboratory confirmation of polio isolates from environmental samples in 2019–20201 6 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2020 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 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) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) aVDPV3 (1 AFP) aVDPV1 (1 AFP + 1 env) aVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (1 contact) 5 China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Malaysia cVDPV1 (3 AFP + 12 env)cVDPV2 (3 env) cVDPV1 (1 AFP + 1 non-AFP + 9 env) cVDPV2 (5 env) aVDPV2 (1 env) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (2 AFP + 1 contact + 14 env) cVDPV2 (12 AFP + 5 non-AFP + 2 contact + 19 env) iVDPV2 (1 AFP) aVDPV2 (1 AFP) cVDPV2 (1 AFP + 4 env) aVDPV2 (1 AFP + 6 non-AFP + 3 env) Viet Nam aVDPV2 (2 AFP) 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 5. Contact of a different AFP case.

Polio preventive SIAs close the immunity gaps among children in Laos and Papua New Guinea Lao People’s Democratic Republic and Papua New Guinea continue with their efforts to close the widening immunity gaps amid pandemic and conducted preventive bOPV SIAs towards end of 2020. PNG conducted nationwide bOPV SIA from November 2-30, 2020. Vitamin A and deworming medicine administration were also integrated. Overall, the country achieved 91% coverage among children under the age of 5 years with bOPV, Vitamin A and deworming medicine. Lao PDR implemented the MR-bOPV SIA in all sixty-one districts of the nine high risk provinces (Attapu, Bolikhamxai, Champasak, Louangnamtha, Phongsali, Vientiane, Xaisomboun, Xekong, and Xiangkhouang) during the last quarter of 2020, achieving 92% coverage for bOPV among all children below 5 years of age, and 93% coverage for MR among children aged 9 to 59 months. MR-bOPV SIA implementation for nursery school children in, Khong District, Lao PDR The outreach team of West New Britain going to vaccinate children in hard to reach village Polio Bulletin 2021 Issue No. 5 - Week 9 (as of 2 March 2021) Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2018–2020 Chart 2. Adequate specimen collection rate, 2018–2020 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2020 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2020 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 10.2% 3.1% 7.7% 0.0% 72.1% 37.5% 19.4% 0% 10% 20% 30% 40% 50% 60% 70% 80% VNM PNG PHL MYS LAO KHM CHN 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). 2019 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 63 47 51 0 0 0 51 0 0 (0.0%) 1.09 63% 100% 24-Feb-21 - Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.00 100% 100% 11-Jan-21 - Cambodia 55 47 72 0 0 0 14 58 27 (37.5%) 1.53 92% 93% 23-Dec-20 69 China 5183 2370 4029 0 0 0 2220 1809 780 (19.4%) 1.70 93% 100% 02-Jan-21 59 China, Hong Kong SAR 14 9 13 0 0 0 12 1 1 (7.7%) 1.44 85% 100% 01-Feb-21 29 China, Macao SAR 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 13-Jan-21 - Japan 0 152 0 - - - - - - - - - - - Lao People's Democratic Republic 65 23 43 0 0 0 5 38 31 (72.1%) 1.87 79% 63% 09-Feb-21 21 Malaysia 194 78 159 0 1 2 151 5 0 (0.0%) 2.03 83% 76% 18-Jan-21 43 Mongolia 5 10 1 0 0 0 1 0 0 (0.0%) 0.10 100% 100% 16-Jan-21 - New Zealand 8 9 10 0 0 0 10 0 0 (0.0%) 1.11 60% 70% 29-Jan-21 - Papua New Guinea 222 36 65 0 0 0 61 4 2 (3.1%) 1.81 54% 80% 10-Feb-21 20 Philippines 872 330 871 0 2 2 756 111 67 (7.7%) 2.63 62% 97% 15-Jan-21 46 Republic of Korea 81 63 48 0 0 0 46 2 0 (0.0%) 0.76 85% 100% 15-Feb-21 15 Singapore 5 6 3 0 0 0 3 0 0 (0.0%) 0.50 100% 67% 07-Jan-21 - Viet Nam 353 241 412 0 0 0 276 136 42 (10.2%) 1.71 94% 61% 31-Dec-20 61 Pacific island countries and areas 21 10 8 0 0 0 1 7 6 (75.0%) 0.80 63% 88% 13-Jan-21 48 Total 7144 3433 5788 0 3 4 3600 2181 957 (16.5%) 1.69 87% 95% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 2020 Non-polio AFP rate Total % with adequate specimens 2> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Table 1. Classification of AFP cases with onset in 2020 and key surveillance indicators 3 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 44 0 0 0 42 1 1 96% 0% 05-Feb-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 03-Feb-20 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 38 0 0 7 31 0 0 100% 14% 06-Jan-21 NIID 0 - - - - - - - - - - - - - China (total) 3977 20 0 89 3776 0 92 96% 2% 02-Jan-21 56 0 25 1 0 0 0 0 29 1 0 0 0 100% China, Anhui Prov. Lab 247 1 0 0 238 0 8 100% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 0 1 0 0 0 100% China, Beijing Prov. Lab 28 1 0 0 27 0 0 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Chongqing Prov. Lab 49 0 0 1 45 0 3 100% 1% Prov. Lab/CCDC 0 - - - China, Fujian Prov. Lab 113 0 0 3 103 0 7 99% 2% Prov. Lab/CCDC 0 - - - China, Gansu Prov. Lab 95 0 0 0 94 0 1 99% 0% Prov. Lab/CCDC 0 - - - China, Guangdong Prov. Lab 389 1 0 4 380 0 4 82% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Guangxi Prov. Lab 193 0 0 5 188 0 0 100% 2% Prov. Lab/CCDC 0 0 0 0 0 0 0 0 0 0 0 - - - China, Guizhou Prov. Lab 155 2 0 2 141 0 10 98% 1% Prov. Lab/CCDC 4 0 4 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 27 0 0 1 25 0 1 96% 4% Prov. Lab/CCDC 0 - - - China, Hebei Prov. Lab 219 1 0 16 200 0 2 100% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Heilongjiang Prov. Lab 38 0 0 0 36 0 2 100% 0% Prov. Lab/CCDC 0 - - - China, Henan Prov. Lab 463 2 0 5 451 0 5 99% 1% Prov. Lab/CCDC 10 0 4 0 0 0 0 0 6 0 0 0 0 100% China, Hubei Prov. Lab 98 0 0 5 85 0 8 96% 5% Prov. Lab/CCDC 0 - - - China, Hunan Prov. Lab 201 1 0 15 183 0 2 100% 6% Prov. Lab/CCDC 5 0 2 0 0 0 0 0 3 0 0 0 0 100% China, Jiangsu Prov. Lab 174 3 0 0 170 0 1 100% 0% Prov. Lab/CCDC 6 0 0 0 0 0 0 0 6 0 0 0 0 100% China, Jiangxi Prov. Lab 138 0 0 3 135 0 0 99% 1% Prov. Lab/CCDC 0 - - - China, Jilin Prov. Lab 36 0 0 6 30 0 0 97% 10% Prov. Lab/CCDC 0 - - - China, Liaoning Prov. Lab 55 1 0 1 50 0 3 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 - - 100% China, Neimongol Prov. Lab 78 4 0 0 68 0 6 96% 0% Prov. Lab/CCDC 11 0 4 1 0 0 0 0 6 0 0 0 0 100% China, Ningxia Prov. Lab 19 0 0 0 13 0 6 100% 0% Prov. Lab/CCDC 0 - - - China, Qinghai Prov. Lab 20 0 0 0 20 0 0 90% 0% Prov. Lab/CCDC 0 - - - China, Shaanxi Prov. Lab 89 0 0 0 88 0 1 96% 0% Prov. Lab/CCDC 0 - - - China, Shandong Prov. Lab 241 0 0 0 235 0 6 99% 0% Prov. Lab/CCDC 0 - - - China, Shanghai Prov. Lab 24 0 0 0 24 0 0 100% 0% Prov. Lab/CCDC 0 - - - China, Shanxi Prov. Lab 78 0 0 0 75 0 3 100% 0% Prov. Lab/CCDC 0 - - - China, Sichuan Prov. Lab 276 2 0 9 261 0 4 94% 3% Prov. Lab/CCDC 7 0 2 0 0 0 0 0 5 0 0 0 0 100% China, Tianjin Prov. Lab 28 0 0 0 28 0 0 100% 0% Prov. Lab/CCDC 0 - - - China, Xinjiang Prov. Lab 81 0 0 1 77 0 3 68% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 - - 100% China, Yunnan Prov. Lab 180 0 0 12 164 0 4 97% 5% Prov. Lab/CCDC 0 - - - China, Zhejiang Prov. Lab 129 0 0 0 128 0 1 100% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 - - 100% China, Tibet Prov. Lab 16 1 0 0 14 0 1 14% 0% CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hong Kong SAR PHLC 13 0 0 0 13 0 0 100% 0% 04-Jan-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID 0 - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 5 0 0 1 4 0 0 100% 20% 18-Jan-21 NIID 0 - - - - - - - - - - - - - Malaysia IMR 173 5 0 0 165 0 3 82% 0% 11-Feb-21 IMR 22 0 4 4 0 2 0 0 12 0 0 0 0 100% Mongolia PHI 1 0 0 1 0 0 0 100% 100% 07-Feb-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 7 0 0 0 7 0 0 100% 0% 15-Feb-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 64 5 0 11 48 0 0 98% 15% 11-Feb-21 VIDRL 28 0 10 0 0 0 0 0 11 0 7 0 0 100% Philippines RITM 813 32 0 31 748 0 2 98% 4% 13-Jan-21 RITM/NIID 68 0 12 0 0 33 2 0 21 0 0 0 0 100% Republic of Korea KCDC 48 0 0 0 47 0 1 99% 0% 07-Jan-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 08-Jan-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 234 1 0 31 202 0 0 99% 13% 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 225 1 0 23 198 3 0 100% 10% 06-Jan-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 11 0 0 0 11 0 0 100% 0% 01-Feb-21 VIDRL 0 - - - - - - - - - - - - - Total 5659 64 0 194 5298 4 99 96% 2% 174 0 51 5 0 35 2 0 73 1 7 0 0 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPVNegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Table 2. Laboratory investigation of stool samples from AFP cases with onset in 2020 and key laboratory indicators 5 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 9 1 0 0 0 0 0 0 0 1 0 8 0 0 16 1 0 0 0 0 0 0 0 1 0 2 0 0 China (total) 379 226 0 174 0 0 0 0 0 599 0 1552 0 0 343 187 0 121 1 0 0 0 0 379 0 512 0 0 China, Fujian Prov. Lab/CCDC 70 43 0 17 0 0 0 0 0 85 0 427 0 0 63 33 0 8 0 0 0 0 0 54 0 58 0 0 China, Gansu Prov. Lab/CCDC 32 25 0 31 0 0 0 0 0 111 0 82 0 0 39 26 0 16 0 0 0 0 0 72 0 38 0 0 China, Guangdong Prov. Lab/CCDC 47 34 0 32 0 0 0 0 0 60 0 188 0 0 48 25 0 16 0 0 0 0 0 19 0 26 0 0 China, Guangxi Prov. Lab/CCDC 12 9 0 6 0 0 0 0 0 27 0 47 0 0 12 3 0 0 0 0 0 0 0 11 0 9 0 0 China, Heilongjiang Prov. Lab/CCDC 42 21 0 7 0 0 0 0 0 48 0 111 0 0 34 18 0 6 0 0 0 0 0 36 0 101 0 0 China, Jiangxi Prov. Lab/CCDC 12 11 0 3 0 0 0 0 0 22 0 112 0 0 9 6 0 1 0 0 0 0 0 10 0 18 0 0 China, Neimongol Prov. Lab/CCDC 3 2 0 0 0 0 0 0 0 7 0 2 0 0 3 3 0 4 0 0 0 0 0 3 0 1 0 0 China, Qinghai Prov. Lab/CCDC 9 6 0 1 0 0 0 0 0 14 0 21 0 0 11 7 0 3 0 0 0 0 0 11 0 5 0 0 China, Shandong Prov. Lab/CCDC 33 15 0 5 0 0 0 0 0 30 0 280 0 0 32 20 0 14 0 0 0 0 0 25 0 107 0 0 China, Shanghai Prov. Lab/CCDC 12 7 0 9 0 0 0 0 0 24 0 25 0 0 24 14 0 9 0 0 0 0 0 18 0 7 0 0 China, Sichuan Prov. Lab/CCDC 40 23 0 3 0 0 0 0 0 31 0 46 0 0 30 13 0 6 0 0 0 0 0 36 0 70 0 0 China, Xinjiang Prov. Lab/CCDC 36 28 0 57 0 0 0 0 0 138 0 107 0 0 24 19 0 38 1 0 0 0 0 84 0 29 0 0 China, Yunnan Prov. Lab/CCDC 31 2 0 3 0 0 0 0 0 2 0 104 0 0 14 0 - - - - - - - - - 43 - - Malaysia IMR/VIDRL 60 12 0 0 12 0 0 3 0 0 0 37 0 0 700 77 0 28 9 0 0 7 0 64 0 21 113 0 Philippines RITM 212 93 0 85 33 0 7 60 0 172 0 81 0 0 373 86 0 20 0 0 98 7 0 60 0 95 0 0 Papua New Guinea RITM 75 58 0 33 0 0 0 0 0 44 0 54 0 0 0 - - - - - - - - - - - - - Total 735 390 0 292 45 0 7 63 0 816 0 1732 0 0 1432 351 0 169 10 0 98 14 0 504 0 630 113 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2019 2020 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD Table 3. Laboratory confirmation of polio isolates from environmental samples in 2019–20201 6 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2020 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 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) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) aVDPV3 (1 AFP) aVDPV1 (1 AFP + 1 env) aVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (1 contact) 5 China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Malaysia cVDPV1 (3 AFP + 12 env)cVDPV2 (3 env) cVDPV1 (1 AFP + 1 non-AFP + 9 env) cVDPV2 (5 env) aVDPV2 (1 env) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (2 AFP + 1 contact + 14 env) cVDPV2 (12 AFP + 5 non-AFP + 2 contact + 19 env) iVDPV2 (1 AFP) aVDPV2 (1 AFP) cVDPV2 (1 AFP + 4 env) aVDPV2 (1 AFP + 6 non-AFP + 3 env) Viet Nam aVDPV2 (2 AFP) 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 5. Contact of a different AFP case.

African countries gear up to rapidly and sustainably stop outbreaks of cVDPV2, nOPV2 is now being rolled out Although Africa is free of wild poliovirus, countries continue to be affected by cVDPV2 outbreaks. Twenty countries have been affected by cVDPV2 outbreaks since 2018. Soon after the issuance of the EUL for nOPV2, the WHO Regional Director for Africa, Dr Matshidiso Moeti, advocated to countries to use this additional tool to stop all forms of polio in Africa. With WHO’s support they are developing supply, demand and deployment plans; ensuring expedited pathways for national regulatory approvals; enhancing surveillance and laboratory capacity; investing in meeting cold-chain capacity and vaccine management requirements; ensuring vaccine safety monitoring; and developing communication plans. These preparations continue even amidst the COVID-19 pandemic, and the existing polio eradication infrastructure has been instrumental in preparing for the nOPV2 vaccine as well as more broadly supporting COVID-19 response efforts across the continent. “This is tremendous news for Africa’s polio eradication effort, and in particular for Africa’s children who are currently at risk of lifelong paralysis due to circulating vaccine-derived poliovirus,” said Dr Moeti. More details here Polio Bulletin 2021 Issue No. 6 - Week 11 (as of 15 March 2021) Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2018–2020 Chart 2. Adequate specimen collection rate, 2018–2020 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2020 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2020 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 10.2% 3.1% 7.7% 0.0% 73.3% 37.5% 19.4% 0% 10% 20% 30% 40% 50% 60% 70% 80% VNM PNG PHL MYS LAO KHM CHN 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). Little girl receiving polio drops © WHO/AFRO 2019 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 63 47 51 0 0 0 51 0 0 (0.0%) 1.09 63% 100% 24-Feb-21 - Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.00 100% 100% 11-Jan-21 - Cambodia 55 47 72 0 0 0 14 58 27 (37.5%) 1.53 92% 93% 23-Dec-20 82 China 5183 2370 4029 0 0 0 2220 1809 780 (19.4%) 1.70 93% 100% 02-Jan-21 72 China, Hong Kong SAR 14 9 13 0 0 0 12 1 1 (7.7%) 1.44 85% 100% 04-Mar-21 11 China, Macao SAR 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 17-Feb-21 - Japan 0 152 0 - - - - - - - - - - - Lao People's Democratic Republic 65 23 86 0 0 0 10 76 63 (73.3%) 3.74 77% 81% 23-Feb-21 20 Malaysia 194 78 161 0 1 2 157 1 0 (0.0%) 2.05 83% 77% 10-Mar-21 5 Mongolia 5 10 1 0 0 0 1 0 0 (0.0%) 0.10 100% 100% 16-Jan-21 - New Zealand 8 9 10 0 0 0 10 0 0 (0.0%) 1.11 60% 70% 29-Jan-21 - Papua New Guinea 222 36 65 0 0 0 61 4 2 (3.1%) 1.81 54% 80% 10-Feb-21 33 Philippines 872 330 871 0 2 2 756 111 67 (7.7%) 2.63 62% 97% 15-Jan-21 59 Republic of Korea 81 63 48 0 0 0 46 2 0 (0.0%) 0.76 85% 100% 15-Feb-21 28 Singapore 5 6 3 0 0 0 3 0 0 (0.0%) 0.50 100% 67% 07-Jan-21 - Viet Nam 353 241 412 0 0 0 276 136 42 (10.2%) 1.71 94% 61% 31-Dec-20 74 Pacific island countries and areas 21 9 11 0 0 0 6 5 4 (36.4%) 1.22 73% 91% 10-Mar-21 5 Total 7144 3432 5836 0 3 4 3626 2203 986 (16.9%) 1.70 87% 95% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 2020 Non-polio AFP rate Total % with adequate specimens 2> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Table 1. Classification of AFP cases with onset in 2020 and key surveillance indicators 3 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 44 0 0 0 44 0 0 96% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 03-Feb-20 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 38 0 0 7 31 0 0 100% 14% 06-Jan-21 NIID 0 - - - - - - - - - - - - - China (total) 3977 20 0 89 3776 0 92 96% 2% 02-Jan-21 56 0 25 1 0 0 0 0 29 1 0 0 0 100% China, Anhui Prov. Lab 247 1 0 0 238 0 8 100% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 0 1 0 0 0 100% China, Beijing Prov. Lab 28 1 0 0 27 0 0 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Chongqing Prov. Lab 49 0 0 1 45 0 3 100% 1% Prov. Lab/CCDC 0 - - - China, Fujian Prov. Lab 113 0 0 3 103 0 7 99% 2% Prov. Lab/CCDC 0 - - - China, Gansu Prov. Lab 95 0 0 0 94 0 1 99% 0% Prov. Lab/CCDC 0 - - - China, Guangdong Prov. Lab 389 1 0 4 380 0 4 82% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Guangxi Prov. Lab 193 0 0 5 188 0 0 100% 2% Prov. Lab/CCDC 0 0 0 0 0 0 0 0 0 0 0 - - - China, Guizhou Prov. Lab 155 2 0 2 141 0 10 98% 1% Prov. Lab/CCDC 4 0 4 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 27 0 0 1 25 0 1 96% 4% Prov. Lab/CCDC 0 - - - China, Hebei Prov. Lab 219 1 0 16 200 0 2 100% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Heilongjiang Prov. Lab 38 0 0 0 36 0 2 100% 0% Prov. Lab/CCDC 0 - - - China, Henan Prov. Lab 463 2 0 5 451 0 5 99% 1% Prov. Lab/CCDC 10 0 4 0 0 0 0 0 6 0 0 0 0 100% China, Hubei Prov. Lab 98 0 0 5 85 0 8 96% 5% Prov. Lab/CCDC 0 - - - China, Hunan Prov. Lab 201 1 0 15 183 0 2 100% 6% Prov. Lab/CCDC 5 0 2 0 0 0 0 0 3 0 0 0 0 100% China, Jiangsu Prov. Lab 174 3 0 0 170 0 1 100% 0% Prov. Lab/CCDC 6 0 0 0 0 0 0 0 6 0 0 0 0 100% China, Jiangxi Prov. Lab 138 0 0 3 135 0 0 99% 1% Prov. Lab/CCDC 0 - - - China, Jilin Prov. Lab 36 0 0 6 30 0 0 97% 10% Prov. Lab/CCDC 0 - - - China, Liaoning Prov. Lab 55 1 0 1 50 0 3 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 - - 100% China, Neimongol Prov. Lab 78 4 0 0 68 0 6 96% 0% Prov. Lab/CCDC 11 0 4 1 0 0 0 0 6 0 0 0 0 100% China, Ningxia Prov. Lab 19 0 0 0 13 0 6 100% 0% Prov. Lab/CCDC 0 - - - China, Qinghai Prov. Lab 20 0 0 0 20 0 0 90% 0% Prov. Lab/CCDC 0 - - - China, Shaanxi Prov. Lab 89 0 0 0 88 0 1 96% 0% Prov. Lab/CCDC 0 - - - China, Shandong Prov. Lab 241 0 0 0 235 0 6 99% 0% Prov. Lab/CCDC 0 - - - China, Shanghai Prov. Lab 24 0 0 0 24 0 0 100% 0% Prov. Lab/CCDC 0 - - - China, Shanxi Prov. Lab 78 0 0 0 75 0 3 100% 0% Prov. Lab/CCDC 0 - - - China, Sichuan Prov. Lab 276 2 0 9 261 0 4 94% 3% Prov. Lab/CCDC 7 0 2 0 0 0 0 0 5 0 0 0 0 100% China, Tianjin Prov. Lab 28 0 0 0 28 0 0 100% 0% Prov. Lab/CCDC 0 - - - China, Xinjiang Prov. Lab 81 0 0 1 77 0 3 68% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 - - 100% China, Yunnan Prov. Lab 180 0 0 12 164 0 4 97% 5% Prov. Lab/CCDC 0 - - - China, Zhejiang Prov. Lab 129 0 0 0 128 0 1 100% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 - - 100% China, Tibet Prov. Lab 16 1 0 0 14 0 1 14% 0% CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hong Kong SAR PHLC 13 0 0 0 13 0 0 100% 0% 04-Jan-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 5 0 0 1 4 0 0 100% 20% 18-Jan-21 NIID 0 - - - - - - - - - - - - - Malaysia IMR 173 5 0 0 165 0 3 82% 0% 11-Feb-21 IMR 22 0 4 4 0 2 0 0 12 0 0 0 0 100% Mongolia PHI 1 0 0 1 0 0 0 100% 100% 06-Mar-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 10 0 0 0 10 0 0 100% 0% 08-Mar-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 70 5 0 12 53 0 0 98% 16% 22-Feb-21 VIDRL 28 0 10 0 0 0 0 0 11 0 7 0 0 100% Philippines RITM 853 32 0 34 787 0 0 98% 4% 02-Mar-21 RITM/NIID 68 0 12 0 0 33 2 0 21 0 0 0 0 100% Republic of Korea KCDC 48 0 0 0 47 0 1 99% 0% 07-Jan-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 08-Jan-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 234 1 0 31 202 0 0 99% 13% 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 225 1 0 23 198 3 0 100% 10% 06-Jan-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 13 0 0 0 13 0 0 100% 0% 09-Mar-21 VIDRL 0 - - - - - - - - - - - - - Total 5710 64 0 198 5349 3 96 96% 2% 174 0 51 5 0 35 2 0 73 1 7 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2. Laboratory investigation of stool samples from AFP cases with onset in 2020 and key laboratory indicators 5 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 9 1 0 0 0 0 0 0 0 1 0 8 0 0 16 1 0 0 0 0 0 0 0 1 0 2 0 0 China (total) 379 226 0 174 0 0 0 0 0 599 0 1552 0 0 364 193 0 123 1 0 0 0 0 390 0 567 0 0 China, Fujian Prov. Lab/CCDC 70 43 0 17 0 0 0 0 0 85 0 427 0 0 65 34 0 9 0 0 0 0 0 54 0 68 0 0 China, Gansu Prov. Lab/CCDC 32 25 0 31 0 0 0 0 0 111 0 82 0 0 39 26 0 16 0 0 0 0 0 72 0 38 0 0 China, Guangdong Prov. Lab/CCDC 47 34 0 32 0 0 0 0 0 60 0 188 0 0 48 25 0 16 0 0 0 0 0 19 0 26 0 0 China, Guangxi Prov. Lab/CCDC 12 9 0 6 0 0 0 0 0 27 0 47 0 0 12 3 0 0 0 0 0 0 0 11 0 9 0 0 China, Heilongjiang Prov. Lab/CCDC 42 21 0 7 0 0 0 0 0 48 0 111 0 0 40 21 0 7 0 0 0 0 0 44 0 111 0 0 China, Jiangxi Prov. Lab/CCDC 12 11 0 3 0 0 0 0 0 22 0 112 0 0 12 8 0 1 0 0 0 0 0 13 0 24 0 0 China, Neimongol Prov. Lab/CCDC 3 2 0 0 0 0 0 0 0 7 0 2 0 0 3 3 0 4 0 0 0 0 0 3 0 1 0 0 China, Qinghai Prov. Lab/CCDC 9 6 0 1 0 0 0 0 0 14 0 21 0 0 11 7 0 3 0 0 0 0 0 11 0 5 0 0 China, Shandong Prov. Lab/CCDC 33 15 0 5 0 0 0 0 0 30 0 280 0 0 32 20 0 14 0 0 0 0 0 25 0 107 0 0 China, Shanghai Prov. Lab/CCDC 12 7 0 9 0 0 0 0 0 24 0 25 0 0 24 14 0 9 0 0 0 0 0 18 0 7 0 0 China, Sichuan Prov. Lab/CCDC 40 23 0 3 0 0 0 0 0 31 0 46 0 0 30 13 0 6 0 0 0 0 0 36 0 70 0 0 China, Xinjiang Prov. Lab/CCDC 36 28 0 57 0 0 0 0 0 138 0 107 0 0 24 19 0 38 1 0 0 0 0 84 0 29 0 0 China, Yunnan Prov. Lab/CCDC 31 2 0 3 0 0 0 0 0 2 0 104 0 0 24 0 - - - - - - - - - 72 - - Malaysia IMR/VIDRL 60 12 0 0 12 0 0 3 0 0 0 37 0 0 700 77 0 28 9 0 0 7 0 64 0 21 113 0 Philippines RITM 212 93 0 85 33 0 7 60 0 172 0 81 0 0 373 86 0 20 0 0 98 7 0 60 0 95 0 0 Papua New Guinea RITM 75 58 0 33 0 0 0 0 0 44 0 54 0 0 0 - - - - - - - - - - - - - Total 735 390 0 292 45 0 7 63 0 816 0 1732 0 0 1453 357 0 171 10 0 98 14 0 515 0 685 113 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2019 2020 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD Table 3. Laboratory confirmation of polio isolates from environmental samples in 2019–20201 6 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2020 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 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) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) aVDPV3 (1 AFP) aVDPV1 (1 AFP + 1 env) aVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (1 contact) 5 China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Malaysia cVDPV1 (3 AFP + 12 env)cVDPV2 (3 env) cVDPV1 (1 AFP + 1 non-AFP + 9 env) cVDPV2 (5 env) aVDPV2 (1 env) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (2 AFP + 1 contact + 14 env) cVDPV2 (12 AFP + 5 non-AFP + 2 contact + 19 env) iVDPV2 (1 AFP) aVDPV2 (1 AFP) cVDPV2 (1 AFP + 4 env) aVDPV2 (1 AFP + 6 non-AFP + 3 env) Viet Nam aVDPV2 (2 AFP) 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 5. Contact of a different AFP case.

Polio Bulletin 2021 Issue No. 7 - Week 13 (as of 29 March 2021) Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific Philippines concluded the phase 2 of preventive MR-bOPV SIA on 31 March 2021 amid COVID-19 pandemic The Department of Health, Philippines rolled out the second phase of MR-bOPV SIA from 1 February 2021. During this two-month long campaign more than 5 million children were targeted with bOPV and MR vaccines in National Capital Region, and Regions III, IVa, VI, VII, and VIII. The reported administrative coverage as of 1 April 2021 on the national MR-bOPV SIA tracker stands at 87.4% for MR (among children aged 9 to 59 months) and 86.6% for bOPV (among children aged 0 to 59 months). The SIA was part of the national efforts to fill the widening immunity gaps against Polio, Measles, and Rubella while the health workforce was simultaneously battling against the ongoing COVID-19 pandemic. The first phase of MR-bOPV SIA was completed in the last quarter of 2020 reaching nearly 2 million children with bOPV and 4 million children with MR vaccine. Picture courtesy: Department of Health and WHO, Philippines CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2018–2020 Chart 2. Adequate specimen collection rate, 2018–2020 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2020 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2020 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 18 19 20 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 10.2% 4.4% 7.7% 0.0% 73.3% 37.5% 14.7% 0% 10% 20% 30% 40% 50% 60% 70% 80% VNM PNG PHL MYS LAO KHM CHN 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). 2019 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 63 47 51 0 0 0 51 0 0 (0.0%) 1.09 63% 100% 24-Feb-21 - Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.00 100% 100% 11-Jan-21 - Cambodia 55 47 72 0 0 0 14 58 27 (37.5%) 1.53 92% 93% 23-Dec-20 96 China 5183 2370 4470 0 0 0 3677 793 659 (14.7%) 1.89 93% 100% 17-Mar-21 12 China, Hong Kong SAR 14 9 13 0 0 0 12 1 1 (7.7%) 1.44 85% 100% 04-Mar-21 25 China, Macao SAR 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 17-Feb-21 - Japan 0 152 0 - - - - - - - - - - - Lao People's Democratic Republic 65 23 43 0 0 0 5 38 32 (74.4%) 1.87 74% 100% 23-Feb-21 34 Malaysia 194 78 161 0 1 2 158 0 0 (0.0%) 2.05 83% 77% 25-Mar-21 - Mongolia 5 10 1 0 0 0 1 0 0 (0.0%) 0.10 100% 100% 16-Jan-21 - New Zealand 8 9 11 0 0 0 10 1 1 (9.1%) 1.22 55% 73% 17-Mar-21 12 Papua New Guinea 222 36 68 0 0 0 64 4 3 (4.4%) 1.89 53% 81% 17-Mar-21 12 Philippines 872 330 871 0 2 2 756 111 67 (7.7%) 2.63 62% 97% 15-Jan-21 73 Republic of Korea 81 63 48 0 0 0 48 0 0 (0.0%) 0.76 85% 100% 11-Mar-21 - Singapore 5 6 3 0 0 0 3 0 0 (0.0%) 0.50 100% 67% 07-Jan-21 - Viet Nam 353 241 412 0 0 0 276 136 42 (10.2%) 1.71 94% 61% 31-Dec-20 88 Pacific island countries and areas 21 9 11 0 0 0 6 5 4 (36.4%) 1.22 73% 91% 10-Mar-21 19 Total 7144 3432 6284 0 3 4 5089 1185 867 (13.8%) 1.83 87% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO 2020 Non-polio AFP rate Total % with adequate specimens 2> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Table 1A. Classification of AFP cases with onset in 2020 and key surveillance indicators 2 Polio Bulletin 2020 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 51 48 16 0 0 0 7 9 0 (0.0%) 1.33 44% 94% 29-Mar-21 0 Brunei Darussalam 1 1 0 - - - - - - - - - 11-Jan-21 77 Cambodia 72 48 5 0 0 0 0 5 0 (0.0%) 0.42 100% 80% 01-Mar-21 28 China 4470 2370 375 0 0 0 8 367 0 (0.0%) 0.63 89% 99% 20-Mar-21 9 China, Hong Kong SAR 13 9 3 0 0 0 1 2 0 (0.0%) 1.33 100% 67% 27-Feb-21 30 China, Macao SAR 2 1 0 - - - - - - - - - 17-Feb-21 40 Japan - 152 - - - - - - - - - - - - Lao People's Democratic Republic 86 23 7 0 0 0 0 7 0 (0.0%) 1.22 86% 57% 18-Mar-21 11 Malaysia 161 80 21 0 0 0 18 3 0 (0.0%) 1.05 81% 43% 25-Mar-21 4 Mongolia 1 10 1 0 0 0 0 1 0 (0.0%) 0.40 100% 100% 24-Feb-21 33 New Zealand 11 9 0 - - - - - - - - - 17-Mar-21 12 Papua New Guinea 68 36 2 0 0 0 0 2 0 (0.0%) 0.22 0% 100% 17-Mar-21 12 Philippines 874 330 106 0 0 0 57 49 0 (0.0%) 1.28 81% 97% 23-Mar-21 6 Republic of Korea 48 62 4 0 0 0 3 1 0 (0.0%) 0.26 0% 100% 11-Mar-21 18 Singapore 3 6 0 - - - - - - - - - 07-Jan-21 81 Viet Nam 412 274 0 - - - - - - - - - 31-Dec-20 88 Pacific island countries and areas 11 6 4 0 0 0 0 4 1 (25.0%) 2.67 50% 75% 10-Mar-21 19 Total 6284 3464 544 0 0 0 94 450 1 (0.2%) 0.63 85% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO 2021 Non-polio AFP rate 2 Total % with adequate specimens 3> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Table 1B. Classification of AFP cases with onset in 2021 and key surveillance indicators 3 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 44 0 0 0 44 0 0 96% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 38 0 0 7 31 0 0 100% 14% 06-Jan-21 NIID 0 - - - - - - - - - - - - - China (total) 3977 20 0 89 3776 0 92 96% 2% 02-Jan-21 56 0 25 1 0 0 0 0 29 1 0 0 0 100% China, Anhui Prov. Lab 281 1 0 1 277 0 2 100% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 0 1 0 0 0 100% China, Beijing Prov. Lab 27 1 0 0 26 0 0 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Chongqing Prov. Lab 55 0 0 2 53 0 0 100% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 133 0 0 2 131 0 0 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 88 0 0 0 88 0 0 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 441 1 0 5 435 0 0 82% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Guangxi Prov. Lab 224 0 0 5 219 0 0 100% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 154 2 0 2 150 0 0 99% 1% Prov. Lab/CCDC 4 0 4 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 31 0 0 1 29 0 1 97% 3% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 247 1 0 19 227 0 0 100% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Heilongjiang Prov. Lab 44 0 0 0 44 0 0 86% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 515 3 0 8 501 0 3 99% 2% Prov. Lab/CCDC 10 0 4 0 0 0 0 0 6 0 0 0 0 100% China, Hubei Prov. Lab 122 0 0 6 111 0 5 97% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 220 2 0 15 203 0 0 100% 5% Prov. Lab/CCDC 5 0 2 0 0 0 0 0 3 0 0 0 0 100% China, Jiangsu Prov. Lab 193 3 0 0 189 0 1 100% 0% Prov. Lab/CCDC 6 0 0 0 0 0 0 0 6 0 0 0 0 100% China, Jiangxi Prov. Lab 160 0 0 4 156 0 0 98% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 44 0 0 6 38 0 0 95% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 66 1 0 1 64 0 0 100% 1% Prov. Lab/CCDC 1 - - - - - - - 1 - - - - - China, Neimongol Prov. Lab 82 4 0 0 72 0 6 95% 0% Prov. Lab/CCDC 11 0 4 1 0 0 0 0 6 0 0 0 0 100% China, Ningxia Prov. Lab 21 0 0 0 20 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 22 0 0 0 22 0 0 82% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 99 0 0 0 99 0 0 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 257 0 0 1 255 0 1 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 28 0 0 0 28 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 83 0 0 0 83 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 306 2 0 13 289 0 2 94% 4% Prov. Lab/CCDC 7 0 2 0 0 0 0 0 5 0 0 0 0 100% China, Tianjin Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 92 0 0 1 89 0 2 72% 1% Prov. Lab/CCDC 1 - 1 - - - - - - - - - - - China, Yunnan Prov. Lab 184 0 0 15 166 0 3 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 152 1 0 2 149 0 0 100% 1% Prov. Lab/CCDC 1 - 1 - - - - - - - - - - - China, Tibet Prov. Lab 19 1 0 0 17 0 1 29% 0% - CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hong Kong SAR PHLC 13 0 0 0 13 0 0 100% 0% 04-Jan-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 5 0 0 1 4 0 0 100% 20% 18-Jan-21 NIID 0 - - - - - - - - - - - - - Malaysia IMR 173 5 0 0 165 0 3 82% 0% 11-Feb-21 IMR 22 0 4 4 0 2 0 0 12 0 0 0 0 100% Mongolia PHI 1 0 0 1 0 0 0 100% 100% 06-Mar-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 7 0 0 0 7 0 0 100% 0% 22-Mar-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 70 5 0 12 53 0 0 98% 16% 22-Feb-21 VIDRL 28 0 10 0 0 0 0 0 11 0 7 0 0 100% Philippines RITM 853 32 0 34 787 0 0 98% 4% 02-Mar-21 RITM/NIID 68 0 12 0 0 33 2 0 21 0 0 0 0 100% Republic of Korea KCDC 48 0 0 0 47 0 1 99% 0% 07-Jan-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 08-Jan-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 234 1 0 31 202 0 0 99% 13% 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 225 1 0 23 198 3 0 100% 10% 06-Jan-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 13 0 0 0 13 0 0 100% 0% 09-Mar-21 VIDRL 0 - - - - - - - - - - - - - Total 5707 64 0 198 5346 3 96 96% 2% 174 0 51 5 0 35 2 0 73 1 7 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2020 and key laboratory indicators 4 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 11 0 0 1 9 1 0 94% 6% 22-Mar-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 0 - - - - - - - - 03-Feb-20 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 0 - - - - - - - - 19-Jan-21 NIID 0 - - - - - - - - - - - - - China (total) 363 0 0 13 326 0 24 94% 3% 20-Mar-21 0 - - - - - - - - - - - - - China, Anhui Prov. Lab 17 0 0 1 16 0 0 100% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Beijing Prov. Lab 6 0 0 2 4 0 0 67% 25% Prov. Lab/CCDC 0 - - - - - - - - - - - - China, Chongqing Prov. Lab 9 0 0 0 7 0 2 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 10 0 0 0 10 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 4 0 0 0 4 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 43 0 0 0 42 0 1 79% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - China, Guangxi Prov. Lab 23 0 0 2 21 0 0 96% 7% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 15 0 0 0 15 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - China, Hainan Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 13 0 0 1 10 0 2 100% 10% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 4 0 0 0 2 0 2 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 41 0 0 0 41 0 0 98% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hubei Prov. Lab 14 0 0 1 10 0 3 73% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 10 0 0 1 7 0 2 100% 13% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 13 0 0 0 12 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 10 0 0 0 10 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 7 0 0 1 6 0 0 86% 7% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 5 0 0 0 3 0 2 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 8 0 0 0 7 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Ningxia Prov. Lab 1 0 0 0 0 0 1 - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 0 - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 7 0 0 0 7 0 0 86% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 23 0 0 1 22 0 0 100% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 3 0 0 0 3 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 10 0 0 0 10 0 0 90% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 26 0 0 1 22 0 3 96% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 1 0 0 0 1 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 8 0 0 0 8 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Yunnan Prov. Lab 12 0 0 2 6 0 4 100% 27% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 20 0 0 0 20 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 0 - - - - - - - - CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 3 0 0 0 3 0 0 100% 0% 19-Mar-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 0 - - - - - - - - 18-Jan-21 NIID 0 - - - - - - - - - - - - - Malaysia IMR 19 0 0 0 19 0 0 100% 0% 28-Mar-21 IMR 0 - - - - - - - - - - - - - Mongolia PHI 1 0 0 0 1 0 0 100% 0% 27-Mar-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 0 - - - - - - - - 06-Mar-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 1 0 0 0 1 0 0 100% 0% 11-Feb-21 VIDRL 0 - - - - - - - - - - - - - Philippines RITM 97 0 0 4 64 28 1 98% 6% 13-Mar-21 RITM/NIID 0 - - - - - - - - - - - - - Republic of Korea KCDC 4 0 0 0 4 0 0 100% 0% 09-Mar-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 0 - - - - - - - - 26-Mar-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 0 - - - - - - - - 22-Mar-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 42 0 0 13 20 6 3 100% 39% 29-Mar-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 0 - - - - - - - - 09-Mar-21 VIDRL 0 - - - - - - - - - - - - - Total 541 0 0 31 447 35 28 94% 3% 0 - - - - - - - - - - - - - 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPVNegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2021 and key laboratory indicators 5 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 16 1 0 0 0 0 0 0 0 1 0 2 0 0 2 0 0 0 0 0 0 0 0 0 0 2 0 0 China (total) 364 193 0 123 1 0 0 0 0 390 0 567 0 0 23 13 0 6 0 0 0 0 0 20 0 28 0 0 China, Fujian Prov. Lab/CCDC 65 34 0 9 0 0 0 0 0 54 0 68 0 0 4 2 0 3 0 0 0 0 0 1 0 13 0 0 China, Gansu Prov. Lab/CCDC 39 26 0 16 0 0 0 0 0 72 0 38 0 0 5 1 0 0 0 0 0 0 0 3 0 4 0 0 China, Guangdong Prov. Lab/CCDC 48 25 0 16 0 0 0 0 0 19 0 26 0 0 8 7 0 2 0 0 0 0 0 14 0 5 0 0 China, Guangxi Prov. Lab/CCDC 12 3 0 0 0 0 0 0 0 11 0 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 China, Heilongjiang Prov. Lab/CCDC 40 21 0 7 0 0 0 0 0 44 0 111 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 China, Jiangxi Prov. Lab/CCDC 12 8 0 1 0 0 0 0 0 13 0 24 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 China, Neimongol Prov. Lab/CCDC 3 3 0 4 0 0 0 0 0 3 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 China, Qinghai Prov. Lab/CCDC 11 7 0 3 0 0 0 0 0 11 0 5 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 China, Shandong Prov. Lab/CCDC 32 20 0 14 0 0 0 0 0 25 0 107 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 China, Shanghai Prov. Lab/CCDC 24 14 0 9 0 0 0 0 0 18 0 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 China, Sichuan Prov. Lab/CCDC 30 13 0 6 0 0 0 0 0 36 0 70 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 China, Xinjiang Prov. Lab/CCDC 24 19 0 38 1 0 0 0 0 84 0 29 0 0 4 2 0 0 0 0 0 0 0 2 0 5 0 0 China, Yunnan Prov. Lab/CCDC 24 0 - - - - - - - - - 72 - - 0 - - - - - - - - - - - - - Malaysia IMR/VIDRL 700 78 0 28 9 0 11 7 0 71 1 31 5 0 112 0 0 0 0 0 0 0 0 0 0 6 45 0 Philippines RITM 373 86 0 20 0 0 98 7 0 60 0 95 0 0 80 0 0 0 0 0 0 0 0 0 0 0 80 0 Papua New Guinea RITM 0 - - - - - - - - - - - - - 0 - - - - - - - - - - - - - Vietnam NIHE - - - - - - - - - - - - - - 13 0 0 0 0 0 0 0 0 0 0 0 0 0 Total 1453 358 0 171 10 0 109 14 0 522 1 695 5 0 230 13 0 6 0 0 0 0 0 20 0 36 125 0 2020 2021 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed Table 3. Laboratory confirmation of polio isolates from environmental samples in 2019–20201 6 Polio Bulletin Table 4. Vaccine-d rived oliovirus1 identified from laborat ry tes ing2, 2000–2020 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 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) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) aVDPV3 (1 AFP) aVDPV1 (1 AFP + 1 env) aVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (1 contact) 5 China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Malaysia cVDPV1 (3 AFP + 12 env)cVDPV2 (3 env) cVDPV1 (1 AFP + 1 non-AFP + 9 env) cVDPV2 (5 env) aVDPV2 (1 env) ?VDPV3 (1 env) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (2 AFP + 1 contact + 14 env) cVDPV2 (12 AFP + 5 non-AFP + 2 contact + 19 env) iVDPV2 (1 AFP) aVDPV2 (1 AFP) cVDPV2 (1 AFP + 4 env) aVDPV2 (1 AFP + 6 non-AFP + 3 env) Viet Nam aVDPV2 (2 AFP) 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 5. Contact of a different AFP case.

Polio Bulletin 2021 Issue No. 8 - Week 15 (as of 12 April 2021) Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific Closure of the outbreak of circulating vaccine-derived poliovirus type 3 (cVDPV3) in Somalia Dr Hamid Jafari, Director of Polio Eradication for WHO’s Eastern Mediterranean Region, declared Somalia’s outbreak of circulating vaccine-derived poliovirus type 3 (cVDPV3) closed. Seven children were paralysed by the type 3 strain in the outbreak beginning March 2018. The 2018 cVDPV3 outbreak was part of a 2-strain polio outbreak in Somalia at that time, along with circulating vaccine- derived poliovirus type 2. The cVDPV2 outbreak continues to paralyse children, and environmental samples consistently show that virus moving through Somali communities. Despite extensive disease surveillance measures, no cVDPV3 has been identified since 7 September 2018, when the last child developed paralysis. For the polio programme, the presence of cVDPV2 samples and the absence of cVDPV3 samples demonstrates the sensitivity of testing, so that the program can be confident that cVDPV3 is no longer a threat to Somali children – but the threat of paralytic polio still looms. Children wait to be vaccinated as part of national polio vaccination campaign in Mogadishu. © Siyaad Mohamed /Ildoog/ WHO SOMALIA CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2019–2021 Chart 2. Adequate specimen collection rate, 2019–2021 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2021 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2021 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 0.0% 0.0% 4.1% 4.2% 37.5% 0.0% 10.7% 0% 5% 10% 15% 20% 25% 30% 35% 40% VNM PNG PHL MYS LAO KHM CHN 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). 2019 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 63 47 51 0 0 0 51 0 0 (0.0%) 1.09 63% 100% 24-Feb-21 - Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.00 100% 100% 11-Jan-21 - Cambodia 55 47 72 0 0 0 14 58 27 (37.5%) 1.53 92% 93% 23-Dec-20 110 China 5183 2370 4443 0 0 0 3952 491 491 (11.1%) 1.87 93% 100% 08-Apr-21 4 China, Hong Kong SAR 14 9 13 0 0 0 12 1 1 (7.7%) 1.44 85% 100% 07-Apr-21 5 China, Macao SAR 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 17-Feb-21 - Japan 0 152 0 - - - - - - - - - - - Lao People's Democratic Republic 65 23 43 0 0 0 5 38 38 (88.4%) 1.87 74% 100% 30-Mar-21 13 Malaysia 194 78 161 0 1 2 158 0 0 (0.0%) 2.05 83% 77% 25-Mar-21 - Mongolia 5 10 1 0 0 0 1 0 0 (0.0%) 0.10 100% 100% 16-Jan-21 - New Zealand 8 9 11 0 0 0 10 1 1 (9.1%) 1.22 55% 73% 12-Apr-21 0 Papua New Guinea 222 36 70 0 0 0 64 6 6 (8.6%) 1.94 53% 80% 08-Apr-21 4 Philippines 872 330 871 0 2 2 756 111 67 (7.7%) 2.63 62% 97% 15-Jan-21 87 Republic of Korea 81 63 48 0 0 0 48 0 0 (0.0%) 0.76 85% 100% 11-Mar-21 - Singapore 5 6 3 0 0 0 3 0 0 (0.0%) 0.50 100% 67% 07-Jan-21 - Viet Nam 353 241 430 0 0 0 376 54 54 (12.6%) 1.78 94% 62% 01-Apr-21 11 Pacific island countries and areas 21 9 12 0 0 0 10 2 2 (16.7%) 1.33 67% 92% 08-Apr-21 4 Total 7144 3432 6284 0 3 4 5089 1185 867 (13.8%) 1.83 87% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Discarded (Non-polio) 2020 Non-polio AFP rate Total % with adequate specimens 2 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Table 1A. Classification of AFP cases with onset in 2020 and key surveillance indicators 2 Polio Bulletin 2020 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 51 48 16 0 0 0 12 4 0 (0.0%) 1.16 63% 100% 08-Apr-21 4 Brunei Darussalam 1 1 0 - - - - - - - - - 11-Jan-21 91 Cambodia 72 48 5 0 0 0 0 5 0 (0.0%) 0.36 100% 80% 01-Mar-21 42 China 4443 2370 582 0 0 0 24 558 62 (10.7%) 0.85 89% 99% 08-Apr-21 4 China, Hong Kong SAR 13 9 3 0 0 0 3 0 0 (0.0%) 1.16 100% 100% 07-Apr-21 5 China, Macao SAR 2 1 0 - - - - - - - - - 12-Apr-21 0 Japan 0 152 0 - - - - - - - - - - - Lao People's Democratic Republic 43 23 8 0 0 0 0 8 3 (37.5%) 1.21 88% 63% 30-Mar-21 13 Malaysia 161 80 24 0 0 0 20 4 1 (4.2%) 1.04 79% 63% 09-Apr-21 3 Mongolia 1 10 1 0 0 0 0 1 0 (0.0%) 0.35 100% 100% 24-Feb-21 47 New Zealand 11 9 1 0 0 0 0 1 0 (0.0%) 0.39 0% 100% 12-Apr-21 0 Papua New Guinea 70 36 2 0 0 0 0 2 0 (0.0%) 0.19 50% 100% 08-Apr-21 4 Philippines 871 330 145 0 0 0 77 68 6 (4.1%) 1.52 75% 99% 12-Apr-21 0 Republic of Korea 48 62 6 0 0 0 4 2 0 (0.0%) 0.34 0% 100% 02-Apr-21 10 Singapore 3 6 0 - - - - - - - - - 05-Apr-21 7 Viet Nam 430 274 29 0 0 0 0 29 0 (0.0%) 0.37 93% 34% 01-Apr-21 11 Pacific island countries and areas 12 6 5 0 0 0 0 5 0 (0.0%) 2.89 80% 60% 08-Apr-21 4 Total 6284 3464 544 0 0 0 94 450 1 (0.2%) 0.63 85% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) 2021 Non-polio AFP rate 2 Total % with adequate specimens 3 Table 1B. Classification of AFP cases with onset in 2021 and key surveillance indicators 3 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 44 0 0 0 44 0 0 96% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 38 0 0 7 31 0 0 100% 14% 06-Jan-21 NIID 0 - - - - - - - - - - - - - China (total) 4397 23 0 109 4246 0 19 96% 2% 08-Apr-21 56 0 25 1 0 0 0 0 29 1 0 0 0 100% China, Anhui Prov. Lab 281 1 0 1 277 0 2 100% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 0 1 0 0 0 100% China, Beijing Prov. Lab 27 1 0 0 26 0 0 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Chongqing Prov. Lab 51 0 0 2 49 0 0 100% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 133 0 0 2 131 0 0 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 75 0 0 0 75 0 0 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 442 1 0 5 436 0 0 82% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Guangxi Prov. Lab 219 0 0 5 214 0 0 100% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 151 2 0 2 147 0 0 99% 1% Prov. Lab/CCDC 4 0 4 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 31 0 0 1 29 0 1 97% 3% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 247 1 0 19 227 0 0 100% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Heilongjiang Prov. Lab 44 0 0 0 44 0 0 86% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 513 3 0 8 502 0 0 99% 2% Prov. Lab/CCDC 10 0 4 0 0 0 0 0 6 0 0 0 0 100% China, Hubei Prov. Lab 122 0 0 6 113 0 3 97% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 220 2 0 15 203 0 0 100% 5% Prov. Lab/CCDC 5 0 2 0 0 0 0 0 3 0 0 0 0 100% China, Jiangsu Prov. Lab 194 3 0 0 190 0 1 100% 0% Prov. Lab/CCDC 6 0 0 0 0 0 0 0 6 0 0 0 0 100% China, Jiangxi Prov. Lab 160 0 0 4 156 0 0 98% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 44 0 0 6 38 0 0 95% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 68 1 0 1 66 0 0 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Neimongol Prov. Lab 82 4 0 0 72 0 6 95% 0% Prov. Lab/CCDC 11 0 4 1 0 0 0 0 6 0 0 0 0 100% China, Ningxia Prov. Lab 21 0 0 0 20 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 22 0 0 0 22 0 0 82% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 99 0 0 0 99 0 0 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 256 0 0 1 254 0 1 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 28 0 0 0 28 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 83 0 0 0 83 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 306 2 0 13 290 0 1 94% 4% Prov. Lab/CCDC 7 0 2 0 0 0 0 0 5 0 0 0 0 100% China, Tianjin Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 92 0 0 1 89 0 2 72% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 183 0 0 15 168 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 152 1 0 2 149 0 0 100% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Tibet Prov. Lab 19 1 0 0 17 0 1 29% 0% - CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hong Kong SAR PHLC 13 0 0 0 13 0 0 100% 0% 04-Jan-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 5 0 0 1 4 0 0 100% 20% 18-Jan-21 NIID 0 - - - - - - - - - - - - - Malaysia IMR 173 5 0 0 165 0 3 82% 0% 11-Feb-21 IMR 22 0 4 4 0 2 0 0 12 0 0 0 0 100% Mongolia PHI 1 0 0 1 0 0 0 100% 100% 06-Mar-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 7 0 0 0 7 0 0 100% 0% 22-Mar-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 70 5 0 12 53 0 0 98% 16% 22-Feb-21 VIDRL 28 0 10 0 0 0 0 0 11 0 7 0 0 100% Philippines RITM 853 32 0 34 787 0 0 98% 4% 02-Mar-21 RITM/NIID 68 0 12 0 0 33 2 0 21 0 0 0 0 100% Republic of Korea KCDC 48 0 0 0 47 0 1 99% 0% 07-Jan-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 08-Jan-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 234 1 0 31 202 0 0 99% 13% 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 225 1 0 23 198 3 0 100% 10% 06-Jan-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 12 0 0 0 12 0 0 100% 0% 09-Mar-21 VIDRL 0 - - - - - - - - - - - - - Total 6126 67 0 218 5815 3 23 96% 2% 174 0 51 5 0 35 2 0 73 1 7 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2020 and key laboratory indicators 4 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 14 0 0 1 10 3 0 89% 5% 08-Apr-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 0 - - - - - - - - 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 0 - - - - - - - - 19-Jan-21 NIID 0 - - - - - - - - - - - - - China (total) 568 3 0 20 515 0 30 94% 3% 20-Mar-21 0 - - - - - - - - - - - - - China, Anhui Prov. Lab 27 0 0 1 26 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Beijing Prov. Lab 9 0 0 2 7 0 0 78% 17% Prov. Lab/CCDC 0 - - - - - - - - - - - - China, Chongqing Prov. Lab 12 0 0 0 10 0 2 89% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 12 0 0 0 12 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 13 1 0 0 12 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 62 0 0 0 61 0 1 79% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - China, Guangxi Prov. Lab 31 0 0 2 29 0 0 97% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 21 0 0 0 21 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - China, Hainan Prov. Lab 2 0 0 1 1 0 0 100% 50% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 20 0 0 2 18 0 0 100% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 7 1 0 0 5 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 80 1 0 1 78 0 0 99% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hubei Prov. Lab 21 0 0 2 13 0 6 80% 13% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 16 0 0 1 13 0 2 100% 7% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 20 0 0 0 19 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 16 0 0 0 16 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 10 0 0 1 9 0 0 90% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 7 0 0 0 7 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 15 0 0 0 11 0 4 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Ningxia Prov. Lab 4 0 0 0 1 0 3 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 12 0 0 0 12 0 0 92% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 35 0 0 1 31 0 3 100% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 4 0 0 0 4 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 13 0 0 0 12 0 1 92% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 43 0 0 2 39 0 2 98% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 2 0 0 0 2 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 13 0 0 0 12 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Yunnan Prov. Lab 17 0 0 3 13 0 1 100% 16% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 24 0 0 1 21 0 2 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 0 - - - - - - - - - CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 3 0 0 0 3 0 0 100% 0% 30-Mar-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - 11-Dec-21 PHLC 0 - - - - - - - - - - - - - Japan NIID 0 - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 0 - - - - - - - - 18-Jan-21 NIID 0 - - - - - - - - - - - - - Malaysia IMR 24 0 0 0 24 0 0 100% 0% 10-Apr-21 IMR 0 - - - - - - - - - - - - - Mongolia PHI 1 0 0 0 1 0 0 100% 0% 09-Apr-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 1 0 0 0 0 1 0 100% 0% 07-Apr-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 2 0 0 0 0 2 0 100% 0% 08-Apr-21 VIDRL 0 - - - - - - - - - - - - - Philippines RITM 145 0 0 4 113 28 0 99% 6% 13-Mar-21 RITM/NIID 0 - - - - - - - - - - - - - Republic of Korea KCDC 4 0 0 0 4 0 0 100% 0% 02-Apr-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 0 - - - - - - - - 09-Apr-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 0 - - - - - - - - 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 48 0 0 15 26 4 3 100% 37% 12-Apr-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 3 0 0 0 3 0 0 100% 0% 12-Apr-21 VIDRL 0 - - - - - - - - - - - - - Total 813 3 0 40 699 38 33 94% 3% 0 - - - - - - - - - - - - - 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPVNegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2021 and key laboratory indicators 5 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 16 1 0 0 0 0 0 0 0 1 0 2 0 0 3 0 0 0 0 0 0 0 0 0 0 3 0 0 China (total) 364 193 0 123 1 0 0 0 0 390 0 567 0 0 23 13 0 6 0 0 0 0 0 20 0 28 0 0 China, Fujian Prov. Lab/CCDC 65 34 0 9 0 0 0 0 0 54 0 68 0 0 4 2 0 3 0 0 0 0 0 1 0 13 0 0 China, Gansu Prov. Lab/CCDC 39 26 0 16 0 0 0 0 0 72 0 38 0 0 5 1 0 0 0 0 0 0 0 3 0 4 0 0 China, Guangdong Prov. Lab/CCDC 48 25 0 16 0 0 0 0 0 19 0 26 0 0 8 7 0 2 0 0 0 0 0 14 0 5 0 0 China, Guangxi Prov. Lab/CCDC 12 3 0 0 0 0 0 0 0 11 0 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 China, Heilongjiang Prov. Lab/CCDC 40 21 0 7 0 0 0 0 0 44 0 111 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 China, Jiangxi Prov. Lab/CCDC 12 8 0 1 0 0 0 0 0 13 0 24 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 China, Neimongol Prov. Lab/CCDC 3 3 0 4 0 0 0 0 0 3 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 China, Qinghai Prov. Lab/CCDC 11 7 0 3 0 0 0 0 0 11 0 5 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 China, Shandong Prov. Lab/CCDC 32 20 0 14 0 0 0 0 0 25 0 107 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 China, Shanghai Prov. Lab/CCDC 24 14 0 9 0 0 0 0 0 18 0 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 China, Sichuan Prov. Lab/CCDC 30 13 0 6 0 0 0 0 0 36 0 70 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 China, Xinjiang Prov. Lab/CCDC 24 19 0 38 1 0 0 0 0 84 0 29 0 0 4 2 0 0 0 0 0 0 0 2 0 5 0 0 China, Yunnan Prov. Lab/CCDC 24 0 - - - - - - - - - 72 - - 0 - - - - - - - - - - - - - Malaysia IMR/VIDRL 700 78 0 28 9 0 11 7 0 71 1 31 5 0 145 0 0 0 0 0 0 0 0 0 0 6 49 0 Philippines RITM 373 86 0 20 0 0 98 7 0 60 0 95 0 0 80 0 0 0 0 0 0 0 0 0 0 0 80 0 Vietnam NIHE - - - - - - - - - - - - - - 13 0 0 0 0 0 0 0 0 0 0 0 0 0 Total 1453 358 0 171 10 0 109 14 0 522 1 695 5 0 264 13 0 6 0 0 0 0 0 20 0 37 129 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2020 2021 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD Table 3. Laboratory confirmation of polio isolates from environmental samples in 2019–20201 6 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2020 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 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) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) aVDPV3 (1 AFP) aVDPV1 (1 AFP + 1 env) aVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (1 contact) 5 China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Malaysia cVDPV1 (3 AFP + 12 env)cVDPV2 (3 env) cVDPV1 (1 AFP + 1 non-AFP + 9 env) cVDPV2 (5 env) aVDPV2 (1 env) ?VDPV3 (1 env) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (2 AFP + 1 contact + 14 env) cVDPV2 (12 AFP + 5 non-AFP + 2 contact + 19 env) iVDPV2 (1 AFP) aVDPV2 (1 AFP) cVDPV2 (1 AFP + 4 env) aVDPV2 (1 AFP + 6 non-AFP + 3 env) Viet Nam aVDPV2 (2 AFP) 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 5. Contact of a different AFP case.

Polio Bulletin 2021 Issue No. 9 - Week 17 (as of 26 April 2021) Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific Immunization services begin slow recovery from COVID-19 disruptions, though millions of children remain at risk from deadly diseases – WHO, UNICEF, Gavi While immunization services have started to recover from disruptions caused by COVID-19, millions of children remain vulnerable to deadly diseases, the World Health Organization (WHO), UNICEF and Gavi, the Vaccine Alliance warned during World Immunization Week. WHO survey has found that, despite progress when compared to the situation in 2020, more than one third of respondent countries still report experiencing disruptions to their routine immunization services. Mass immunization campaigns are also disrupted. According to new data, 60 of these lifesaving campaigns are currently postponed in 50 countries, putting around 228 million people - mostly children - at risk for diseases such as measles, yellow fever and polio. “Vaccines will help us end the COVID-19 pandemic but only if we ensure fair access for all countries, and build strong systems to deliver them,” said Dr Tedros Adhanom Ghebreyesus, WHO’s Director-General. “And if we’re to avoid multiple outbreaks of life-threatening diseases like measles, yellow fever and diphtheria, we must ensure routine vaccination services are protected in every country in the world.” Fiji starts COVID-19 vaccination. @Jin Ni/WHO CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2019–2021 Chart 2. Adequate specimen collection rate, 2019–2021 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2021 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2021 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 0.0% 0.0% 7.3% 0.0% 0.0% 0.0% 10.7% 0% 2% 4% 6% 8% 10% 12% VNM PNG PHL MYS LAO KHM CHN 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). 2019 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 63 47 51 0 0 0 51 0 0 (0.0%) 1.09 63% 100% 24-Feb-21 - Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.00 100% 100% 11-Jan-21 - Cambodia 55 47 72 0 0 0 14 58 27 (37.5%) 1.53 92% 93% 23-Dec-20 124 China 5183 2370 4443 0 0 0 3952 491 491 (11.1%) 1.87 93% 100% 08-Apr-21 18 China, Hong Kong SAR 14 9 13 0 0 0 13 0 0 (0.0%) 1.44 85% 100% 14-Apr-21 - China, Macao SAR 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 17-Feb-21 - Japan 0 152 0 - - - - - - - - - - - Lao People's Democratic Republic 65 23 43 0 0 0 33 10 10 (23.3%) 1.87 74% 100% 23-Apr-21 3 Malaysia 194 78 161 0 1 2 158 0 0 (0.0%) 2.05 83% 77% 25-Mar-21 - Mongolia 5 10 1 0 0 0 1 0 0 (0.0%) 0.10 100% 100% 16-Jan-21 - New Zealand 8 9 11 0 0 0 10 1 1 (9.1%) 1.22 55% 73% 12-Apr-21 14 Papua New Guinea 222 36 70 0 0 0 64 6 6 (8.6%) 1.94 53% 80% 08-Apr-21 18 Philippines 872 330 871 0 2 2 756 111 67 (7.7%) 2.63 62% 97% 15-Jan-21 101 Republic of Korea 81 63 48 0 0 0 48 0 0 (0.0%) 0.76 85% 100% 14-Apr-21 - Singapore 5 6 3 0 0 0 3 0 0 (0.0%) 0.50 100% 67% 07-Jan-21 - Viet Nam 353 241 430 0 0 0 376 54 54 (12.6%) 1.78 94% 62% 01-Apr-21 25 Pacific island countries and areas 21 9 12 0 0 0 10 2 2 (16.7%) 1.33 67% 92% 08-Apr-21 18 Total 7144 3432 6232 0 3 4 5492 733 658 (10.6%) 1.81 88% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO 2020 Non-polio AFP rate Total % with adequate specimens 2> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Table 1A. Classification of AFP cases with onset in 2020 and key surveillance indicators 2 Polio Bulletin 2020 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 51 48 19 0 0 0 12 5 0 (0.0%) 1.21 53% 100% 23-Apr-21 3 Brunei Darussalam 1 1 0 - - - - - - - - - 11-Jan-21 105 Cambodia 72 48 5 0 0 0 0 5 0 (0.0%) 0.32 100% 80% 01-Mar-21 56 China 4443 2370 582 0 0 0 24 558 62 (10.7%) 0.75 89% 99% 08-Apr-21 18 China, Hong Kong SAR 13 9 3 0 0 0 3 0 0 (0.0%) 1.02 100% 100% 07-Apr-21 19 China, Macao SAR 2 1 0 - - - - - - - - - 12-Apr-21 14 Japan 0 152 0 - - - - - - - - - - - Lao People's Democratic Republic 43 23 8 0 0 0 0 8 0 (0.0%) 1.06 88% 63% 30-Mar-21 27 Malaysia 161 80 33 0 0 0 29 4 0 (0.0%) 1.26 82% 70% 23-Apr-21 3 Mongolia 1 10 1 0 0 0 1 0 0 (0.0%) 0.31 100% 100% 14-Apr-21 12 New Zealand 11 9 1 0 0 0 0 1 0 (0.0%) 0.34 0% 100% 20-Apr-21 6 Papua New Guinea 70 36 2 0 0 0 0 2 0 (0.0%) 0.17 50% 100% 08-Apr-21 18 Philippines 871 330 164 0 0 0 88 76 12 (7.3%) 1.52 64% 99% 20-Apr-21 6 Republic of Korea 48 62 6 0 0 0 4 2 0 (0.0%) 0.30 83% 100% 14-Apr-21 12 Singapore 3 6 1 0 0 0 0 1 0 (0.0%) 0.51 100% 100% 22-Apr-21 4 Viet Nam 430 274 29 0 0 0 0 29 0 (0.0%) 0.32 93% 34% 01-Apr-21 25 Pacific island countries and areas 12 6 5 0 0 0 0 5 0 (0.0%) 2.55 80% 60% 08-Apr-21 18 Total 6232 3464 859 0 0 0 161 696 74 (8.6%) 0.76 83% 95% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO Discarded (Non-polio) 2021 Non-polio AFP rate 2 Total % with adequate specimens 3 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date Table 1B. Classification of AFP cases with onset in 2021 and key surveillance indicators 3 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 44 0 0 0 44 0 0 96% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 38 0 0 7 31 0 0 100% 14% 06-Jan-21 NIID 0 - - - - - - - - - - - - - China (total) 4397 23 0 109 4246 0 19 96% 2% 08-Apr-21 56 0 25 1 0 0 0 0 29 1 0 0 0 100% China, Anhui Prov. Lab 281 1 0 1 277 0 2 100% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 0 1 0 0 0 100% China, Beijing Prov. Lab 27 1 0 0 26 0 0 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Chongqing Prov. Lab 51 0 0 2 49 0 0 100% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 133 0 0 2 131 0 0 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 75 0 0 0 75 0 0 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 442 1 0 5 436 0 0 82% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Guangxi Prov. Lab 219 0 0 5 214 0 0 100% 2% Prov. Lab/CCDC 0 0 0 0 0 0 0 0 0 0 0 0 0 100% China, Guizhou Prov. Lab 151 2 0 2 147 0 0 99% 1% Prov. Lab/CCDC 4 0 4 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 31 0 0 1 29 0 1 97% 3% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 247 1 0 19 227 0 0 100% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Heilongjiang Prov. Lab 44 0 0 0 44 0 0 86% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 513 3 0 8 502 0 0 99% 2% Prov. Lab/CCDC 10 0 4 0 0 0 0 0 6 0 0 0 0 100% China, Hubei Prov. Lab 122 0 0 6 113 0 3 97% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 220 2 0 15 203 0 0 100% 5% Prov. Lab/CCDC 5 0 2 0 0 0 0 0 3 0 0 0 0 100% China, Jiangsu Prov. Lab 194 3 0 0 190 0 1 100% 0% Prov. Lab/CCDC 6 0 0 0 0 0 0 0 6 0 0 0 0 100% China, Jiangxi Prov. Lab 160 0 0 4 156 0 0 98% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 44 0 0 6 38 0 0 95% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 68 1 0 1 66 0 0 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Neimongol Prov. Lab 82 4 0 0 72 0 6 95% 0% Prov. Lab/CCDC 11 0 4 1 0 0 0 0 6 0 0 0 0 100% China, Ningxia Prov. Lab 21 0 0 0 20 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 22 0 0 0 22 0 0 82% 0% - Prov. Lab/CCDC 0 - China, Shaanxi Prov. Lab 99 0 0 0 99 0 0 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 256 0 0 1 254 0 1 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 28 0 0 0 28 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 83 0 0 0 83 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 306 2 0 13 290 0 1 94% 4% Prov. Lab/CCDC 7 0 2 0 0 0 0 0 5 0 0 0 0 100% China, Tianjin Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 92 0 0 1 89 0 2 72% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 183 0 0 15 168 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 152 1 0 2 149 0 0 100% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Tibet Prov. Lab 19 1 0 0 17 0 1 29% 0% - CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hong Kong SAR PHLC 13 0 0 0 13 0 0 100% 0% 04-Jan-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 43 3 0 9 31 0 0 63% 19% 22-Apr-21 NIID 4 0 1 0 0 0 0 0 3 0 0 0 0 0% Malaysia IMR 175 5 0 0 170 0 0 100% 0% 14-Apr-21 IMR 22 0 4 4 0 2 0 0 12 0 0 0 0 100% Mongolia PHI 1 0 0 1 0 0 0 100% 100% 06-Mar-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 7 0 0 0 7 0 0 100% 0% 22-Mar-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 70 5 0 12 53 0 0 98% 16% 19-Apr-21 VIDRL 28 0 10 0 0 0 0 0 11 0 7 0 0 100% Philippines RITM 853 32 0 34 787 0 0 98% 4% 02-Mar-21 RITM/NIID 68 0 12 0 0 33 2 0 21 0 0 0 0 100% Republic of Korea KCDC 48 0 0 0 48 0 0 99% 0% 14-Apr-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 08-Jan-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 234 1 0 31 202 0 0 99% 13% 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 225 0 0 22 203 0 0 100% 0% 13-Apr-21 PI 0 - Pacific island countries and areas VIDRL 12 0 0 0 12 0 0 100% 0% 09-Mar-21 VIDRL 0 - - - - - - - - - - - - - Total 6166 69 0 225 5853 0 19 96% 2% 178 0 52 5 0 35 2 0 76 1 7 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2020 and key laboratory indicators 4 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 17 0 0 1 14 2 0 88% 4% 22-Apr-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 0 - - - - - - - - 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 0 - - - - - - - - 19-Jan-21 NIID 0 - - - - - - - - - - - - - China (total) 568 3 0 20 515 0 30 95% 3% 08-Apr-21 10 0 6 0 0 0 0 1 3 0 0 0 0 100% China, Anhui Prov. Lab 27 0 0 1 26 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Beijing Prov. Lab 9 0 0 2 7 0 0 78% 17% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 12 0 0 0 10 0 2 89% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 12 0 0 0 12 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 13 1 0 0 12 0 0 100% 0% Prov. Lab/CCDC 3 0 2 0 0 0 0 1 0 0 0 0 0 100% China, Guangdong Prov. Lab 62 0 0 0 61 0 1 79% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangxi Prov. Lab 31 0 0 2 29 0 0 97% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 21 0 0 0 21 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 2 0 0 1 1 0 0 100% 50% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 20 0 0 2 18 0 0 100% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 7 1 0 0 5 0 1 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Henan Prov. Lab 80 1 0 1 78 0 0 99% 1% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Hubei Prov. Lab 21 0 0 2 13 0 6 80% 13% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 16 0 0 1 13 0 2 100% 7% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 20 0 0 0 19 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 16 0 0 0 16 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 10 0 0 1 9 0 0 90% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 7 0 0 0 7 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 15 0 0 0 11 0 4 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Ningxia Prov. Lab 4 0 0 0 1 0 3 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 12 0 0 0 12 0 0 92% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 35 0 0 1 31 0 3 100% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 4 0 0 0 4 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 13 0 0 0 12 0 1 92% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 43 0 0 2 39 0 2 98% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 2 0 0 0 2 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 13 0 0 0 12 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Yunnan Prov. Lab 17 0 0 3 13 0 1 100% 16% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 24 0 0 1 21 0 2 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 0 - - - - - - - - - CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 3 0 0 0 3 0 0 100% 0% 12-Apr-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - 23-Apr-21 PHLC 0 - - - - - - - - - - - - - Japan NIID 0 - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 0 - - - - - - - - 18-Jan-21 NIID 0 - Malaysia IMR 33 0 0 0 33 0 0 100% 0% 14-Apr-21 IMR 0 - - - - - - - - - - - - - Mongolia PHI 1 0 0 0 1 0 0 100% 0% 23-Apr-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 1 0 0 0 1 0 0 100% 0% 21-Apr-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 2 0 0 1 1 0 0 100% 25% 19-Apr-21 VIDRL 0 - - - - - - - - - - - - - Philippines RITM 204 1 0 9 175 4 15 99% 4% 26-Apr-21 RITM/NIID 0 - - - - - - - - - - - - - Republic of Korea KCDC 4 0 0 0 4 0 0 100% 0% 02-Apr-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 0 - - - - - - - - 23-Apr-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 0 - - - - - - - - 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 48 0 0 15 - 4 3 85% 31% 12-Apr-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 4 0 0 0 5 0 0 96% 3% 19-Apr-21 VIDRL 0 - - - - - - - - - - - - - Total 885 4 0 46 752 10 48 94% 3% 10 0 6 0 0 0 0 1 3 0 0 0 0 1 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPVNegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2021 and key laboratory indicators 5 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 16 1 0 0 0 0 0 0 0 1 0 2 0 0 3 0 0 0 0 0 0 0 0 0 0 3 0 0 China (total) 364 193 0 123 1 0 0 0 0 390 0 567 0 0 50 21 0 8 0 0 0 0 0 36 0 51 2 0 China, Fujian Prov. Lab/CCDC 65 34 0 9 0 0 0 0 0 54 0 68 0 0 14 3 0 3 0 0 0 0 0 1 0 19 2 0 China, Gansu Prov. Lab/CCDC 39 26 0 16 0 0 0 0 0 72 0 38 0 0 15 3 0 1 0 0 0 0 0 9 0 12 0 0 China, Guangdong Prov. Lab/CCDC 48 25 0 16 0 0 0 0 0 19 0 26 0 0 12 10 0 2 0 0 0 0 0 20 0 10 0 0 China, Guangxi Prov. Lab/CCDC 12 3 0 0 0 0 0 0 0 11 0 9 0 0 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab/CCDC 40 21 0 7 0 0 0 0 0 44 0 111 0 0 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab/CCDC 12 8 0 1 0 0 0 0 0 13 0 24 0 0 3 2 0 2 0 0 0 0 0 1 0 3 0 0 China, Neimongol Prov. Lab/CCDC 3 3 0 4 0 0 0 0 0 3 0 1 0 0 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab/CCDC 11 7 0 3 0 0 0 0 0 11 0 5 0 0 2 1 0 0 0 0 0 0 0 3 0 2 0 0 China, Shandong Prov. Lab/CCDC 32 20 0 14 0 0 0 0 0 25 0 107 0 0 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab/CCDC 24 14 0 9 0 0 0 0 0 18 0 7 0 0 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab/CCDC 30 13 0 6 0 0 0 0 0 36 0 70 0 0 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab/CCDC 24 19 0 38 1 0 0 0 0 84 0 29 0 0 4 2 0 0 0 0 0 0 0 2 0 5 0 0 China, Yunnan Prov. Lab/CCDC 24 0 - - - - - - - - - 72 - - 0 - - - - - - - - - - - - - Malaysia IMR/VIDRL 700 97 0 33 9 0 11 7 0 74 1 29 0 0 173 0 0 0 0 0 0 0 0 0 0 10 46 0 Philippines RITM 372 75 0 12 1 0 39 5 0 33 0 95 0 0 199 40 0 3 0 0 0 0 0 15 0 9 80 0 Vietnam NIHE 0 - - - - - - - - - - - - - 13 0 0 0 0 0 0 0 0 0 0 0 0 0 Total 1452 366 0 168 11 0 50 12 0 498 1 693 0 0 438 61 0 11 0 0 0 0 0 51 0 73 128 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2020 2021 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD Table 3. Laboratory confirmation of polio isolates from environmental samples in 2019–20201 6 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2020 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 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) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP) iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) aVDPV3 (1 AFP) aVDPV1 (1 AFP + 1 env) aVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (1 contact) 5 China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Malaysia cVDPV1 (3 AFP + 12 env)cVDPV2 (3 env) cVDPV1 (1 AFP + 1 non-AFP + 9 env) cVDPV2 (5 env) aVDPV2 (1 env) ?VDPV3 (1 env) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (2 AFP + 1 contact + 14 env) cVDPV2 (12 AFP + 5 non-AFP + 2 contact + 19 env) iVDPV2 (1 AFP) aVDPV2 (1 AFP) cVDPV2 (1 AFP + 4 env) aVDPV2 (1 AFP + 6 non-AFP + 3 env) Viet Nam aVDPV2 (2 AFP) 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 5. Contact of a different AFP case.

Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific GPEI statement on proposed UK aid cuts The Global Polio Eradication Initiative (GPEI) is greatly concerned by the United Kingdom’s proposed 95% cuts to contributions toward polio eradication in 2021. The GPEI values the UK government’s steadfast partnership and shared commitment to eradicating polio. In 2019, the UK government pledged to help vaccinate more than 400 million children a year against polio and to support 20 million health workers and volunteers in this vital work. In addition to their life-saving work to end polio, these health workers have been in the frontline of the fight against COVID-19 and have helped some of the world’s most vulnerable countries protect their citizens. The GPEI recognises the challenging economic circumstances faced by the UK government. Cutting the UK government’s contributions by 95% will, however, put millions of children at increased risk of polio and other infectious diseases, including COVID-19. GPEI looks forward to working with the UK and the broader global community to address these urgent issues, which jeopardize the collective investment and progress toward a polio free world. Polio Bulletin 2021 Issue No. 10 - Week 19 (as of 10 May 2021) CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2019–2021 Chart 2. Adequate specimen collection rate, 2019–2021 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2021 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2021 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 0.0% 0.0% 8.1% 0.0% 0.0% 0.0% 10.7% 0% 2% 4% 6% 8% 10% 12% VNM PNG PHL MYS LAO KHM CHN 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). 2019 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 63 47 51 0 0 0 51 0 0 (0.0%) 1.09 63% 100% 24-Feb-21 - Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.00 100% 100% 11-Jan-21 - Cambodia 55 47 72 0 0 0 14 58 27 (37.5%) 1.53 92% 93% 23-Dec-20 138 China 5183 2370 4443 0 0 0 3952 491 491 (11.1%) 1.87 93% 100% 08-Apr-21 32 China, Hong Kong SAR 14 9 13 0 0 0 13 0 0 (0.0%) 1.44 85% 100% 14-Apr-21 - China, Macao SAR 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 17-Feb-21 - Japan 0 152 0 - - - - - - - - - - - Lao People's Democratic Republic 65 23 43 0 0 0 33 10 10 (23.3%) 1.87 74% 100% 23-Apr-21 17 Malaysia 194 78 161 0 1 2 158 0 0 (0.0%) 2.05 83% 77% 25-Mar-21 - Mongolia 5 10 1 0 0 0 1 0 0 (0.0%) 0.10 100% 100% 10-Mar-21 - New Zealand 8 9 11 0 0 0 10 1 1 (9.1%) 1.22 55% 73% 12-Apr-21 28 Papua New Guinea 222 36 70 0 0 0 64 6 6 (8.6%) 1.94 53% 80% 08-Apr-21 32 Philippines 872 330 871 0 2 2 756 111 67 (7.7%) 2.63 62% 97% 15-Jan-21 115 Republic of Korea 81 63 48 0 0 0 48 0 0 (0.0%) 0.76 85% 100% 14-Apr-21 - Singapore 5 6 3 0 0 0 3 0 0 (0.0%) 0.50 100% 67% 07-Jan-21 - Viet Nam 353 241 430 0 0 0 376 54 54 (12.6%) 1.78 94% 62% 01-Apr-21 39 Pacific island countries and areas 21 9 12 0 0 0 10 2 2 (16.7%) 1.33 67% 92% 08-Apr-21 32 Total 7144 3432 6232 0 3 4 5492 733 658 (10.6%) 1.81 88% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 2020 Non-polio AFP rate Total % with adequate specimens 2> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Table 1A. Classification of AFP cases with onset in 2020 and key surveillance indicators 2 Polio Bulletin 2020 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 51 48 22 0 0 0 12 10 0 (0.0%) 1.25 59% 100% 10-May-21 0 Brunei Darussalam 1 1 0 - - - - - - - - - 11-Jan-21 119 Cambodia 72 48 5 0 0 0 0 5 0 (0.0%) 0.29 100% 80% 01-Mar-21 70 China 4443 2370 582 0 0 0 24 558 62 (10.7%) 0.67 89% 99% 08-Apr-21 32 China, Hong Kong SAR 13 9 3 0 0 0 2 1 0 (0.0%) 0.91 67% 100% 10-May-21 0 China, Macao SAR 2 1 0 - - - - - - - - - 10-May-21 0 Japan 0 152 0 - - - - - - - - - - - Lao People's Democratic Republic 43 23 8 0 0 0 0 8 0 (0.0%) 0.95 88% 63% 30-Mar-21 41 Malaysia 161 80 34 0 0 0 31 3 0 (0.0%) 1.16 85% 68% 03-May-21 7 Mongolia 1 10 1 0 0 0 1 0 0 (0.0%) 0.27 100% 100% 14-Apr-21 26 New Zealand 11 9 2 0 0 0 0 2 0 (0.0%) 0.61 0% 100% 03-May-21 7 Papua New Guinea 70 36 2 0 0 0 0 2 0 (0.0%) 0.15 50% 100% 08-Apr-21 32 Philippines 871 330 209 0 0 0 125 84 17 (8.1%) 1.73 73% 99% 08-May-21 2 Republic of Korea 48 62 8 0 0 0 6 2 0 (0.0%) 0.35 88% 100% 04-May-21 6 Singapore 3 6 1 0 0 0 1 0 0 (0.0%) 0.46 100% 100% 04-May-21 6 Viet Nam 430 274 29 0 0 0 0 29 0 (0.0%) 0.29 93% 34% 01-Apr-21 39 Pacific island countries and areas 12 6 5 0 0 0 0 5 0 (0.0%) 2.28 80% 60% 08-Apr-21 32 Total 6232 3464 911 0 0 0 202 709 79 (8.7%) 0.72 84% 95% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date 2021 Non-polio AFP rate 2 Total % with adequate specimens 3> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Table 1B. Classification of AFP cases with onset in 2021 and key surveillance indicators 3 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 44 0 0 0 44 0 0 96% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 38 0 0 7 31 0 0 100% 14% 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 4397 23 0 109 4246 0 19 96% 2% 08-Apr-21 56 0 25 1 0 0 0 0 29 1 0 0 0 100% China, Anhui Prov. Lab 281 1 0 1 277 0 2 100% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 0 1 0 0 0 100% China, Beijing Prov. Lab 27 1 0 0 26 0 0 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Chongqing Prov. Lab 51 0 0 2 49 0 0 100% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 133 0 0 2 131 0 0 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 75 0 0 0 75 0 0 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 442 1 0 5 436 0 0 82% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Guangxi Prov. Lab 219 0 0 5 214 0 0 100% 2% Prov. Lab/CCDC 0 0 0 0 0 0 0 0 0 0 0 0 0 100% China, Guizhou Prov. Lab 151 2 0 2 147 0 0 99% 1% Prov. Lab/CCDC 4 0 4 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 31 0 0 1 29 0 1 97% 3% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 247 1 0 19 227 0 0 100% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Heilongjiang Prov. Lab 44 0 0 0 44 0 0 86% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 513 3 0 8 502 0 0 99% 2% Prov. Lab/CCDC 10 0 4 0 0 0 0 0 6 0 0 0 0 100% China, Hubei Prov. Lab 122 0 0 6 113 0 3 97% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 220 2 0 15 203 0 0 100% 5% Prov. Lab/CCDC 5 0 2 0 0 0 0 0 3 0 0 0 0 100% China, Jiangsu Prov. Lab 194 3 0 0 190 0 1 100% 0% Prov. Lab/CCDC 6 0 0 0 0 0 0 0 6 0 0 0 0 100% China, Jiangxi Prov. Lab 160 0 0 4 156 0 0 98% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 44 0 0 6 38 0 0 95% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 68 1 0 1 66 0 0 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Neimongol Prov. Lab 82 4 0 0 72 0 6 95% 0% Prov. Lab/CCDC 11 0 4 1 0 0 0 0 6 0 0 0 0 100% China, Ningxia Prov. Lab 21 0 0 0 20 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 22 0 0 0 22 0 0 82% 0% - Prov. Lab/CCDC 0 - China, Shaanxi Prov. Lab 99 0 0 0 99 0 0 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 256 0 0 1 254 0 1 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 28 0 0 0 28 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 83 0 0 0 83 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 306 2 0 13 290 0 1 94% 4% Prov. Lab/CCDC 7 0 2 0 0 0 0 0 5 0 0 0 0 100% China, Tianjin Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 92 0 0 1 89 0 2 72% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 183 0 0 15 168 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 152 1 0 2 149 0 0 100% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Tibet Prov. Lab 19 1 0 0 17 0 1 29% 0% - CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hong Kong SAR PHLC 13 0 0 0 13 0 0 100% 0% 04-Jan-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 43 3 0 9 31 0 0 63% 19% 21-Apr-21 NIID 4 0 1 0 0 0 0 0 3 0 0 0 0 0% Malaysia IMR 175 5 0 0 170 0 0 100% 0% 14-Apr-21 IMR 22 0 4 4 0 2 0 0 12 0 0 0 0 100% Mongolia PHI 1 0 0 1 0 0 0 100% 100% 06-Mar-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 7 0 0 0 7 0 0 100% 0% 22-Mar-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 70 5 0 12 53 0 0 98% 16% 19-Apr-21 VIDRL 28 0 10 0 0 0 0 0 11 0 7 0 0 100% Philippines RITM 853 32 0 34 787 0 0 98% 4% 02-Mar-21 RITM/NIID 68 0 12 0 0 33 2 0 21 0 0 0 0 100% Republic of Korea KCDC 48 0 0 0 48 0 0 99% 0% 14-Apr-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 08-Jan-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 234 1 0 31 202 0 0 99% 13% 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 225 0 0 22 203 0 0 100% 0% 13-Apr-21 PI 0 - Pacific island countries and areas VIDRL 12 0 0 0 12 0 0 100% 0% 09-Mar-21 VIDRL 0 - - - - - - - - - - - - - Total 6166 69 0 225 5853 0 19 96% 2% 178 0 52 5 0 35 2 0 76 1 7 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2020 and key laboratory indicators 4 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 19 0 0 1 17 1 0 91% 3% 10-May-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 0 - - - - - - - - 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 0 - - - - - - - - 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 569 4 0 20 515 0 30 95% 3% 08-Apr-21 13 0 7 2 0 0 0 0 4 0 0 0 0 100% China, Anhui Prov. Lab 27 0 0 1 26 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Beijing Prov. Lab 9 0 0 2 7 0 0 78% 17% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 12 0 0 0 10 0 2 89% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 12 0 0 0 12 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 13 1 0 0 12 0 0 100% 0% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Guangdong Prov. Lab 62 0 0 0 61 0 1 79% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangxi Prov. Lab 31 0 0 2 29 0 0 97% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 21 0 0 0 21 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 2 0 0 1 1 0 0 100% 50% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 20 0 0 2 18 0 0 100% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 7 1 0 0 5 0 1 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Henan Prov. Lab 80 1 0 1 78 0 0 99% 1% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Hubei Prov. Lab 21 0 0 2 13 0 6 80% 13% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 16 0 0 1 13 0 2 100% 7% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 20 0 0 0 19 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 16 0 0 0 16 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 10 0 0 1 9 0 0 90% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 7 0 0 0 7 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 15 0 0 0 11 0 4 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Ningxia Prov. Lab 4 0 0 0 1 0 3 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 0 - - - - - - - - - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 12 0 0 0 12 0 0 92% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 35 0 0 1 31 0 3 100% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 5 1 0 0 4 0 0 100% 0% Prov. Lab/CCDC 2 0 0 2 0 0 0 0 0 0 0 0 0 100% China, Shanxi Prov. Lab 13 0 0 0 12 0 1 92% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Sichuan Prov. Lab 43 0 0 2 39 0 2 98% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 2 0 0 0 2 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 13 0 0 0 12 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Yunnan Prov. Lab 17 0 0 3 13 0 1 100% 16% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 24 0 0 1 21 0 2 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 0 - - - - - - - - - CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 2 0 0 0 2 0 0 100% 0% 05-May-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - 23-Apr-21 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 0 - - - - - - - - 14-Apr-21 NIID 0 - Malaysia IMR 34 0 0 0 34 0 0 100% 0% 08-May-21 IMR 0 - - - - - - - - - - - - - Mongolia PHI 1 0 0 0 1 0 0 100% 0% 10-May-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 1 0 0 0 1 0 0 100% 0% 10-May-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 2 0 0 1 1 0 0 100% 25% 19-Apr-21 VIDRL 0 - - - - - - - - - - - - - Philippines RITM 218 3 0 10 187 3 15 99% 4% 10-May-21 RITM/NIID 0 - - - - - - - - - - - - - Republic of Korea KCDC 4 0 0 0 4 0 0 100% 0% 04-May-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 1 0 0 0 1 0 0 100% 0% 07-May-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 0 - - - - - - - - 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 57 0 0 36 18 0 3 100% 63% 06-May-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 4 0 0 0 5 0 0 100% 0% 19-Apr-21 VIDRL 0 - - - - - - - - - - - - - Total 912 7 0 68 786 4 48 94% 3% 13 0 7 2 0 0 0 0 4 0 0 0 0 1 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2021 and key laboratory indicators 5 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 16 1 0 0 0 0 0 0 0 1 0 2 0 0 4 1 0 0 0 0 0 0 0 0 0 3 1 0 China (total) 364 193 0 123 1 0 0 0 0 390 0 567 0 0 50 21 0 8 0 0 0 0 0 36 0 51 2 0 China, Fujian Prov. Lab/CCDC 65 34 0 9 0 0 0 0 0 54 0 68 0 0 14 3 0 3 0 0 0 0 0 1 0 19 2 0 China, Gansu Prov. Lab/CCDC 39 26 0 16 0 0 0 0 0 72 0 38 0 0 15 3 0 1 0 0 0 0 0 9 0 12 0 0 China, Guangdong Prov. Lab/CCDC 48 25 0 16 0 0 0 0 0 19 0 26 0 0 12 10 0 2 0 0 0 0 0 20 0 10 0 0 China, Guangxi Prov. Lab/CCDC 12 3 0 0 0 0 0 0 0 11 0 9 0 0 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab/CCDC 40 21 0 7 0 0 0 0 0 44 0 111 0 0 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab/CCDC 12 8 0 1 0 0 0 0 0 13 0 24 0 0 3 2 0 2 0 0 0 0 0 1 0 3 0 0 China, Neimongol Prov. Lab/CCDC 3 3 0 4 0 0 0 0 0 3 0 1 0 0 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab/CCDC 11 7 0 3 0 0 0 0 0 11 0 5 0 0 2 1 0 0 0 0 0 0 0 3 0 2 0 0 China, Shandong Prov. Lab/CCDC 32 20 0 14 0 0 0 0 0 25 0 107 0 0 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab/CCDC 24 14 0 9 0 0 0 0 0 18 0 7 0 0 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab/CCDC 30 13 0 6 0 0 0 0 0 36 0 70 0 0 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab/CCDC 24 19 0 38 1 0 0 0 0 84 0 29 0 0 4 2 0 0 0 0 0 0 0 2 0 5 0 0 China, Yunnan Prov. Lab/CCDC 24 0 - - - - - - - - - 72 - - 0 - - - - - - - - - - - - - Malaysia IMR/VIDRL 700 97 0 33 9 0 11 7 0 74 1 29 0 0 193 0 0 0 0 0 0 0 0 0 0 17 29 0 Philippines RITM 372 75 0 12 1 0 39 5 0 33 0 95 0 0 214 36 0 3 0 0 0 0 0 13 0 8 21 0 Vietnam NIHE 0 - - - - - - - - - - - - - 13 0 0 0 0 0 0 0 0 0 0 0 0 0 Total 1452 366 0 168 11 0 50 12 0 498 1 693 0 0 474 58 0 11 0 0 0 0 0 49 0 79 53 0 2020 2021 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed Table 3. Laboratory confirmation of polio isolates from environmental samples in 2019–20201 6 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2020 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 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) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP)iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) aVDPV3 (1 AFP) aVDPV1 (1 AFP + 1 env) aVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (1 contact) 5 ?VDPV1 (1 AFP) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Malaysia cVDPV1 (3 AFP + 12 env)cVDPV2 (3 env) cVDPV1 (1 AFP + 1 non-AFP + 9 env) cVDPV2 (5 env) aVDPV2 (1 env) ?VDPV3 (1 env) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (2 AFP + 1 contact + 14 env) cVDPV2 (12 AFP + 5 non-AFP + 2 contact + 19 env) iVDPV2 (1 AFP) aVDPV2 (1 AFP) cVDPV2 (1 AFP + 4 env) aVDPV2 (1 AFP + 6 non-AFP + 3 env) Viet Nam aVDPV2 (2 AFP) 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 5. Contact of a different AFP case.

Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific Delivering on the promise of a polio-free world In 2020, the GPEI launched a revision of the strategy for polio eradication. Partners and stakeholders collectively identified remaining obstacles to polio eradication, in order to inform a revised and strengthened plan. They then developed optimal approaches to reaching the goal, adapted to the global health context and based on lessons learned. The strengthened plan aims to achieve and sustain a polio-free world through a focus on implementation and accountability. Emphasis will be on cutting outbreak response times; increasing vaccine demand; transforming campaign effectiveness; working systematically through integration; increasing access in inaccessible areas; transitioning towards government ownership; and improving decision-making and accountability. Many of the new tactics and strengthened approaches outlined in this plan are already operational, and the plan will officially replace the current Polio Endgame Strategy in January 2022. Come and join the virtual launch of the Polio Eradication Strategy 2022-2026, at an online event on Thursday 10 June 2021 (at 2pm, Central European Summer Time). Come and join the virtual launch of the Polio Eradication Strategy 2022-2026, at an online event on Thursday 10 June 2021 (at 2pm, Central European Summer Time). More information, including registration details, are available here, where you will find the ‘Save the Date’. Polio Bulletin 2021 Issue No. 11 - Week 21 (as of 24 May 2021) CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2019–2021 Chart 2. Adequate specimen collection rate, 2019–2021 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2021 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2021 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 0.0% 40.0% 9.9% 0.0% 0.0% 0.0% 29.6% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% VNM PNG PHL MYS LAO KHM CHN 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). 2019 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 63 47 51 0 0 0 51 0 0 (0.0%) 1.09 63% 100% 24-Feb-21 - Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.00 100% 100% 11-Jan-21 - Cambodia 55 47 72 0 0 0 14 58 27 (37.5%) 1.53 92% 93% 23-Dec-20 152 China 5183 2370 4427 0 0 0 4222 205 205 (4.6%) 1.87 93% 100% 14-May-21 10 China, Hong Kong SAR 14 9 13 0 0 0 13 0 0 (0.0%) 1.44 85% 100% 14-Apr-21 - China, Macao SAR 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 17-Feb-21 - Japan - 152 - - - - - - - - - - - - Lao People's Democratic Republic 65 23 43 0 0 0 33 10 10 (23.3%) 1.87 74% 100% 23-Apr-21 31 Malaysia 194 78 161 0 1 2 158 0 0 (0.0%) 2.05 83% 77% 25-Mar-21 - Mongolia 5 10 1 0 0 0 1 0 0 (0.0%) 0.10 100% 100% 10-Mar-21 - New Zealand 8 9 11 0 0 0 10 1 1 (9.1%) 1.22 55% 73% 12-Apr-21 42 Papua New Guinea 222 36 70 0 0 0 64 6 6 (8.6%) 1.94 53% 80% 08-Apr-21 46 Philippines 872 330 871 0 2 2 756 111 67 (7.7%) 2.63 62% 97% 15-Jan-21 129 Republic of Korea 81 63 48 0 0 0 48 0 0 (0.0%) 0.76 85% 100% 14-Apr-21 - Singapore 5 6 3 0 0 0 3 0 0 (0.0%) 0.50 100% 67% 07-Jan-21 - Viet Nam 353 241 430 0 0 0 430 0 0 (0.0%) 1.78 95% 62% 12-May-21 - Pacific island countries and areas 21 9 12 0 0 0 10 2 2 (16.7%) 1.33 67% 92% 08-Apr-21 46 Total 7144 3432 6216 0 3 4 5816 393 318 (5.1%) 1.81 88% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 2020 Non-polio AFP rate Total % with adequate specimens 2> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Table 1A. Classification of AFP cases with onset in 2020 and key surveillance indicators 2 Polio Bulletin 2020 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 51 48 24 0 0 0 12 12 1 (4.2%) 1.24 67% 100% 21-May-21 3 Brunei Darussalam 1 1 0 - - - - - - - - - 11-Jan-21 133 Cambodia 72 48 5 0 0 0 0 5 0 (0.0%) 0.26 100% 80% 01-Mar-21 84 China 4443 2370 1037 0 0 0 60 977 307 (29.6%) 1.08 91% 100% 14-May-21 10 China, Hong Kong SAR 13 9 3 0 0 0 2 1 0 (0.0%) 0.83 100% 100% 11-May-21 13 China, Macao SAR 2 1 0 - - - - - - - - - 10-May-21 14 Japan - 152 - - - - - - - - - - - - Lao People's Democratic Republic 43 23 8 0 0 0 0 8 0 (0.0%) 0.86 88% 63% 30-Mar-21 55 Malaysia 161 80 34 0 0 0 31 3 0 (0.0%) 1.05 85% 68% 03-May-21 21 Mongolia 1 10 1 0 0 0 1 0 0 (0.0%) 0.25 100% 100% 10-May-21 14 New Zealand 11 9 2 0 0 0 0 2 0 (0.0%) 0.55 0% 100% 18-May-21 6 Papua New Guinea 70 36 5 0 0 0 0 5 2 (40.0%) 0.34 40% 100% 24-May-21 0 Philippines 871 330 223 0 0 0 153 70 22 (9.9%) 1.67 74% 99% 18-May-21 6 Republic of Korea 48 62 8 0 0 0 6 2 0 (0.0%) 0.32 88% 100% 04-May-21 20 Singapore 3 6 1 0 0 0 1 0 0 (0.0%) 0.41 100% 100% 04-May-21 20 Viet Nam 430 274 29 0 0 0 0 29 0 (0.0%) 0.32 93% 34% 01-Apr-21 53 Pacific island countries and areas 12 6 5 0 0 0 0 5 0 (0.0%) 2.06 80% 60% 08-Apr-21 46 Total 6232 3465 1385 0 0 0 266 1119 332 (18.6%) 1.28 89% 90% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date 2021 Non-polio AFP rate 2 Total % with adequate specimens 3> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Table 1B. Classification of AFP cases with onset in 2021 and key surveillance indicators 3 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 44 0 0 0 44 0 0 96% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 38 0 0 7 31 0 0 100% 14% 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 4383 23 0 110 4240 0 10 96% 2% 08-Apr-21 56 0 25 1 0 0 0 0 29 1 0 0 0 100% China, Anhui Prov. Lab 271 1 0 1 267 0 2 100% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 0 1 0 0 0 100% China, Beijing Prov. Lab 27 1 0 0 26 0 0 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Chongqing Prov. Lab 52 0 0 2 50 0 0 100% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 133 0 0 2 131 0 0 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 75 0 0 0 75 0 0 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 442 1 0 5 436 0 0 82% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Guangxi Prov. Lab 219 0 0 5 214 0 0 100% 2% Prov. Lab/CCDC 0 0 0 0 0 0 0 0 0 0 0 0 0 100% China, Guizhou Prov. Lab 152 2 0 2 148 0 0 99% 1% Prov. Lab/CCDC 4 0 4 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 31 0 0 1 29 0 1 97% 3% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 247 1 0 19 227 0 0 100% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Heilongjiang Prov. Lab 44 0 0 0 44 0 0 86% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 513 3 0 8 502 0 0 99% 2% Prov. Lab/CCDC 10 0 4 0 0 0 0 0 6 0 0 0 0 100% China, Hubei Prov. Lab 122 0 0 6 113 0 3 97% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 220 2 0 15 203 0 0 100% 5% Prov. Lab/CCDC 5 0 2 0 0 0 0 0 3 0 0 0 0 100% China, Jiangsu Prov. Lab 194 3 0 0 191 0 0 100% 0% Prov. Lab/CCDC 6 0 0 0 0 0 0 0 6 0 0 0 0 100% China, Jiangxi Prov. Lab 160 0 0 4 156 0 0 98% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 44 0 0 6 38 0 0 95% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 68 1 0 1 66 0 0 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Neimongol Prov. Lab 81 4 0 0 77 0 0 91% 0% Prov. Lab/CCDC 11 0 4 1 0 0 0 0 6 0 0 0 0 100% China, Ningxia Prov. Lab 21 0 0 1 20 0 0 95% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 22 0 0 0 22 0 0 82% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 99 0 0 0 99 0 0 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 258 0 0 1 256 0 1 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 28 0 0 0 28 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 76 0 0 0 76 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 306 2 0 13 291 0 0 94% 4% Prov. Lab/CCDC 7 0 2 0 0 0 0 0 5 0 0 0 0 100% China, Tianjin Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 92 0 0 1 89 0 2 72% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 183 0 0 15 168 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 152 1 0 2 149 0 0 100% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Tibet Prov. Lab 19 1 0 0 17 0 1 29% 0% - CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hong Kong SAR PHLC 13 0 0 0 13 0 0 100% 0% 04-Jan-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 43 3 0 9 31 0 0 63% 19% 22-Apr-21 NIID 4 0 1 0 0 0 0 0 3 0 0 0 0 0% Malaysia IMR 175 5 0 0 170 0 0 100% 0% 14-Apr-21 IMR 22 0 4 4 0 2 0 0 12 0 0 0 0 100% Mongolia PHI 1 0 0 1 0 0 0 100% 100% 06-Mar-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 7 0 0 0 7 0 0 100% 0% 22-Mar-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 70 5 0 12 53 0 0 98% 16% 19-Apr-21 VIDRL 28 0 10 0 0 0 0 0 11 0 7 0 0 100% Philippines RITM 853 32 0 34 787 0 0 98% 4% 02-Mar-21 RITM/NIID 68 0 12 0 0 33 2 0 21 0 0 0 0 100% Republic of Korea KCDC 48 0 0 0 48 0 0 99% 0% 14-Apr-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 08-Jan-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 234 1 0 31 202 0 0 99% 13% 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 225 0 0 22 203 0 0 100% 0% 13-Apr-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 12 0 0 0 12 0 0 100% 0% 09-Mar-21 VIDRL 0 - - - - - - - - - - - - - Total 6152 69 0 226 5847 0 10 96% 3% 178 0 52 5 0 35 2 0 76 1 7 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2020 and key laboratory indicators 4 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 22 0 0 1 18 3 0 91% 3% 21-May-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 0 - - - - - - - - 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 0 - - - - - - - - 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 1018 6 0 38 884 0 90 95% 3% 14-May-21 17 0 9 4 0 0 0 0 4 0 0 0 0 100% China, Anhui Prov. Lab 45 0 0 2 43 0 0 98% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Beijing Prov. Lab 16 0 0 2 12 0 2 86% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 16 0 0 0 16 0 0 94% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 21 0 0 0 15 0 6 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 27 1 0 0 25 0 1 100% 0% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Guangdong Prov. Lab 121 0 0 4 115 0 2 78% 3% Prov. Lab/CCDC 0 - China, Guangxi Prov. Lab 49 0 0 2 39 0 8 95% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 34 0 0 0 27 0 7 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 4 0 0 1 3 0 0 100% 25% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 49 0 0 4 44 0 1 100% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 14 1 0 0 6 0 7 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Henan Prov. Lab 147 1 0 3 143 0 0 99% 2% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Hubei Prov. Lab 24 0 0 3 19 0 2 86% 14% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 48 0 0 1 21 0 26 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 36 0 0 0 34 0 2 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 34 0 0 2 32 0 0 94% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 13 0 0 1 12 0 0 92% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 19 0 0 0 19 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 28 0 0 0 12 0 16 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Ningxia Prov. Lab 5 0 0 0 5 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 2 0 0 0 2 0 0 0% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 18 0 0 0 16 0 2 94% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 57 0 0 1 54 0 2 100% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 7 0 0 0 7 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 19 1 0 0 18 0 0 89% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Sichuan Prov. Lab 73 0 0 6 64 0 3 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 3 0 0 0 3 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 18 1 0 0 16 0 1 94% 0% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 32 0 0 3 28 0 1 100% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 39 1 0 3 34 0 1 100% 5% Prov. Lab/CCDC 4 0 0 4 0 0 0 0 0 0 0 0 0 100% China, Tibet Prov. Lab 0 - - - - - - - - - CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 3 0 0 0 2 0 1 100% 0% 20-May-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - 23-Apr-21 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - 18-Jan-21 NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 0 - - - - - - - - 14-Apr-21 NIID 0 - - - - - - - - - - - - - Malaysia IMR 49 0 0 0 49 0 0 100% 0% 23-May-21 IMR 0 - - - - - - - - - - - - - Mongolia PHI 1 0 0 0 1 0 0 100% 0% 21-May-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 2 0 0 0 1 1 0 100% 0% 18-May-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 2 0 0 1 1 0 0 100% 50% 19-Apr-21 VIDRL 0 - - - - - - - - - - - - - Philippines RITM 239 4 0 10 201 9 15 99% 4% 24-May-21 RITM/NIID 0 - - - - - - - - - - - - - Republic of Korea KCDC 4 0 0 0 4 0 0 100% 0% 04-May-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 1 0 0 0 1 0 0 100% 0% 21-May-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 0 - - - - - - - - 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 71 0 0 22 46 0 3 100% 31% 24-May-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 4 0 0 0 4 0 0 100% 0% 19-Apr-21 VIDRL 0 - - - - - - - - - - - - - Total 1416 10 0 72 1212 13 109 96% 3% 17 0 9 4 0 0 0 0 4 0 0 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2021 and key laboratory indicators 5 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 16 1 0 0 0 0 0 0 0 1 0 2 0 0 4 0 0 0 0 0 0 0 0 0 0 4 0 0 China (total) 364 193 0 123 1 0 0 0 0 390 0 567 0 0 77 35 0 13 0 0 0 0 0 75 1 85 2 0 China, Fujian Prov. Lab/CCDC 65 34 0 9 0 0 0 0 0 54 0 68 0 0 14 3 0 3 0 0 0 0 0 1 0 19 2 0 China, Gansu Prov. Lab/CCDC 39 26 0 16 0 0 0 0 0 72 0 38 0 0 15 3 0 1 0 0 0 0 0 9 0 12 0 0 China, Guangdong Prov. Lab/CCDC 48 25 0 16 0 0 0 0 0 19 0 26 0 0 16 14 0 2 0 0 0 0 0 27 0 20 0 0 China, Guangxi Prov. Lab/CCDC 12 3 0 0 0 0 0 0 0 11 0 9 0 0 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab/CCDC 40 21 0 7 0 0 0 0 0 44 0 111 0 0 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab/CCDC 12 8 0 1 0 0 0 0 0 13 0 24 0 0 3 2 0 2 0 0 0 0 0 1 0 3 0 0 China, Neimongol Prov. Lab/CCDC 3 3 0 4 0 0 0 0 0 3 0 1 0 0 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab/CCDC 11 7 0 3 0 0 0 0 0 11 0 5 0 0 3 1 0 0 0 0 0 0 0 3 0 4 0 0 China, Shandong Prov. Lab/CCDC 32 20 0 14 0 0 0 0 0 25 0 107 0 0 8 3 0 3 0 0 0 0 0 11 0 12 0 0 China, Shanghai Prov. Lab/CCDC 24 14 0 9 0 0 0 0 0 18 0 7 0 0 6 1 0 0 0 0 0 0 0 0 1 8 0 0 China, Sichuan Prov. Lab/CCDC 30 13 0 6 0 0 0 0 0 36 0 70 0 0 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab/CCDC 24 19 0 38 1 0 0 0 0 84 0 29 0 0 12 8 0 2 0 0 0 0 0 23 0 7 0 0 China, Yunnan Prov. Lab/CCDC 24 0 0 0 0 0 0 0 0 0 0 72 0 0 0 - - - - - - - - - - - - - Malaysia IMR/VIDRL 700 97 0 33 9 0 11 7 0 74 1 29 0 0 193 0 0 0 0 0 0 0 0 0 0 17 29 0 Philippines RITM 372 75 0 12 1 0 39 5 0 33 0 95 0 0 261 42 0 3 0 0 0 0 0 15 0 14 25 0 Vietnam NIHE 0 - - - - - - - - - - - - - 13 0 0 0 0 0 0 0 0 0 0 0 0 0 Total 1452 366 0 168 11 0 50 12 0 498 1 693 0 0 548 77 0 16 0 0 0 0 0 90 1 120 56 0 2020 2021 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed Table 3. Laboratory confirmation of polio isolates from environmental samples in 2020–20211 6 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2021 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 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) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP)iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) aVDPV3 (1 AFP) aVDPV1 (1 AFP + 1 env) aVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (1 contact) 5 ?VDPV1 (1 AFP) + cVDPV3 (1 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Malaysia cVDPV1 (3 AFP + 12 env)cVDPV2 (3 env) cVDPV1 (1 AFP + 1 non-AFP + 9 env) cVDPV2 (5 env) aVDPV2 (1 env) ?VDPV3 (1 env) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (2 AFP + 1 contact + 14 env) cVDPV2 (12 AFP + 5 non-AFP + 2 contact + 19 env) iVDPV2 (1 AFP) aVDPV2 (1 AFP) cVDPV2 (1 AFP + 4 env) aVDPV2 (1 AFP + 6 non-AFP + 3 env) Viet Nam aVDPV2 (2 AFP) 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 5. Contact of a different AFP case.

Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific Ninth Meeting of the Combined Sub- regional Committees for the Certification of Poliomyelitis Eradication and Verification of Measles and Rubella Elimination in Pacific Island Countries and Areas The ninth meeting of the combined sub-regional committees for the certification of poliomyelitis eradication and verification of measles and rubella elimination in Pacific island countries and areas (SRCC/SRVC) convened remotely on 25-27 May 2021. The SRCC/SRVC reviewed the impact of the COVID-19 pandemic on the performance of the national immunization programmes, progress in maintaining polio-free status and elimination of measles and rubella in Pacific island countries and areas. The SRCC/SRVC concluded that Pacific island countries and areas have continued to maintain wild polio-free status. The SRCC/SRVC commended the efforts of the countries and areas for continuing provision of immunization services resuming activities as soon as conditions became favourable. The Committee also developed general and country specific recommendations for the Pacific island countries and areas. Polio Bulletin 2021 Issue No. 12 - Week 23 (as of 8 June 2021) CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2019–2021 Chart 2. Adequate specimen collection rate, 2019–2021 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2021 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2021 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 0.0% 40.0% 9.1% 2.1% 77.8% 100.0% 29.6% 0% 20% 40% 60% 80% 100% 120% VNM PNG PHL MYS LAO KHM CHN 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). 2019 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 63 47 51 0 0 0 51 0 0 (0.0%) 1.09 63% 100% 24-Feb-21 - Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.00 100% 100% 11-Jan-21 - Cambodia 55 47 72 0 0 0 14 58 27 (37.5%) 1.53 92% 93% 23-Dec-20 167 China 5183 2370 4427 0 0 0 4222 205 205 (4.6%) 1.87 93% 100% 14-May-21 25 China, Hong Kong SAR 14 9 13 0 0 0 13 0 0 (0.0%) 1.44 85% 100% 01-Jun-21 - China, Macao SAR 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 17-Feb-21 - Japan - 152 - - - - - - - - - - - - Lao People's Democratic Republic 65 23 43 0 0 0 33 10 10 (23.3%) 1.87 74% 100% 23-Apr-21 46 Malaysia 194 78 161 0 1 2 158 0 0 (0.0%) 2.05 83% 77% 25-Mar-21 - Mongolia 5 10 1 0 0 0 1 0 0 (0.0%) 0.10 100% 100% 10-Mar-21 - New Zealand 8 9 11 0 0 0 10 1 1 (9.1%) 1.22 55% 73% 12-Apr-21 57 Papua New Guinea 222 36 70 0 0 0 64 6 6 (8.6%) 1.94 53% 80% 08-Apr-21 61 Philippines 872 330 871 0 2 2 756 111 67 (7.7%) 2.63 62% 97% 15-Jan-21 144 Republic of Korea 81 63 48 0 0 0 48 0 0 (0.0%) 0.76 85% 100% 14-Apr-21 - Singapore 5 6 3 0 0 0 3 0 0 (0.0%) 0.50 100% 67% 07-Jan-21 - Viet Nam 353 241 430 0 0 0 430 0 0 (0.0%) 1.78 95% 62% 12-May-21 - Pacific island countries and areas 21 9 12 0 0 0 10 2 2 (16.7%) 1.33 67% 92% 08-Apr-21 61 Total 7144 3432 6216 0 3 4 5816 393 318 (5.1%) 1.81 88% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO 2020 Non-polio AFP rate Total % with adequate specimens 2> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Table 1A. Classification of AFP cases with onset in 2020 and key surveillance indicators 2 Polio Bulletin 2020 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 51 48 25 0 0 0 12 13 1 (4.0%) 1.18 68% 100% 07-Jun-21 1 Brunei Darussalam 1 1 0 - - - - - - - - - 01-Jun-21 7 Cambodia 72 48 5 0 0 0 0 5 5 (100.0%) 0.24 100% 80% 01-Mar-21 99 China 4427 2370 1037 0 0 0 60 977 307 (29.6%) 0.99 91% 100% 14-May-21 25 China, Hong Kong SAR 13 9 4 0 0 0 2 2 0 (0.0%) 1.00 75% 75% 07-Jun-21 1 China, Macao SAR 2 1 0 - - - - - - - - - 10-May-21 29 Japan - 152 - - - - - - - - - - - - Lao People's Democratic Republic 43 23 9 0 0 0 0 9 7 (77.8%) 0.88 89% 67% 01-Jun-21 7 Malaysia 161 80 48 0 0 0 35 13 1 (2.1%) 1.36 77% 52% 28-May-21 11 Mongolia 1 10 1 0 0 0 1 0 0 (0.0%) 0.23 100% 100% 10-May-21 29 New Zealand 11 9 3 0 0 0 0 3 0 (0.0%) 0.75 0% 100% 03-Jun-21 5 Papua New Guinea 70 36 5 0 0 0 0 5 2 (40.0%) 0.31 40% 100% 24-May-21 15 Philippines 871 330 243 0 0 0 171 72 22 (9.1%) 1.66 77% 98% 01-Jun-21 7 Republic of Korea 48 62 8 0 0 0 6 2 0 (0.0%) 0.29 88% 100% 04-May-21 35 Singapore 3 6 1 0 0 0 1 0 0 (0.0%) 0.38 100% 100% 03-Jun-21 5 Viet Nam 430 274 29 0 0 0 0 29 0 (0.0%) 0.32 93% 34% 01-Apr-21 68 Pacific island countries and areas 12 6 5 0 0 0 0 5 0 (0.0%) 1.88 80% 60% 08-Apr-21 61 Total 6216 3465 1423 0 0 0 288 1135 340 (18.6%) 1.19 89% 89% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date 2021 Non-polio AFP rate 2 Total % with adequate specimens 3> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Table 1B. Classification of AFP cases with onset in 2021 and key surveillance indicators 3 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 44 0 0 0 44 0 0 96% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 38 0 0 7 31 0 0 100% 14% 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 4383 23 0 110 4240 0 10 96% 2% 14-May-21 56 0 25 1 0 0 0 0 29 1 0 0 0 100% China, Anhui Prov. Lab 271 1 0 1 267 0 2 100% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 0 1 0 0 0 100% China, Beijing Prov. Lab 27 1 0 0 26 0 0 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Chongqing Prov. Lab 52 0 0 2 50 0 0 100% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 133 0 0 2 131 0 0 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 75 0 0 0 75 0 0 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 442 1 0 5 436 0 0 82% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Guangxi Prov. Lab 219 0 0 5 214 0 0 100% 2% Prov. Lab/CCDC 0 0 0 0 0 0 0 0 0 0 0 0 0 100% China, Guizhou Prov. Lab 152 2 0 2 148 0 0 99% 1% Prov. Lab/CCDC 4 0 4 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 31 0 0 1 29 0 1 97% 3% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 247 1 0 19 227 0 0 100% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Heilongjiang Prov. Lab 44 0 0 0 44 0 0 86% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 513 3 0 8 502 0 0 99% 2% Prov. Lab/CCDC 10 0 4 0 0 0 0 0 6 0 0 0 0 100% China, Hubei Prov. Lab 122 0 0 6 113 0 3 97% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 220 2 0 15 203 0 0 100% 5% Prov. Lab/CCDC 5 0 2 0 0 0 0 0 3 0 0 0 0 100% China, Jiangsu Prov. Lab 194 3 0 0 191 0 0 100% 0% Prov. Lab/CCDC 6 0 0 0 0 0 0 0 6 0 0 0 0 100% China, Jiangxi Prov. Lab 160 0 0 4 156 0 0 98% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 44 0 0 6 38 0 0 95% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 68 1 0 1 66 0 0 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Neimongol Prov. Lab 81 4 0 0 77 0 0 91% 0% Prov. Lab/CCDC 11 0 4 1 0 0 0 0 6 0 0 0 0 100% China, Ningxia Prov. Lab 21 0 0 1 20 0 0 95% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 22 0 0 0 22 0 0 82% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 99 0 0 0 99 0 0 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 258 0 0 1 256 0 1 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 28 0 0 0 28 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 76 0 0 0 76 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 306 2 0 13 291 0 0 94% 4% Prov. Lab/CCDC 7 0 2 0 0 0 0 0 5 0 0 0 0 100% China, Tianjin Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 92 0 0 1 89 0 2 72% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 183 0 0 15 168 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 152 1 0 2 149 0 0 100% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Tibet Prov. Lab 19 1 0 0 17 0 1 29% 0% - CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hong Kong SAR PHLC 13 0 0 0 13 0 0 100% 0% 04-Jan-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 43 3 0 9 31 0 0 63% 19% 22-Apr-21 NIID 4 0 1 0 0 0 0 0 3 0 0 0 0 0% Malaysia IMR 175 5 0 0 170 0 0 100% 0% 14-Apr-21 IMR 22 0 4 4 0 2 0 0 12 0 0 0 0 100% Mongolia PHI 1 0 0 1 0 0 0 100% 100% 06-Mar-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 7 0 0 0 7 0 0 100% 0% 22-Mar-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 70 5 0 12 53 0 0 98% 16% 19-Apr-21 VIDRL 28 0 10 0 0 0 0 0 11 0 7 0 0 100% Philippines RITM 853 32 0 34 787 0 0 98% 4% 02-Mar-21 RITM/NIID 68 0 12 0 0 33 2 0 21 0 0 0 0 100% Republic of Korea KCDC 48 0 0 0 48 0 0 99% 0% 14-Apr-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 08-Jan-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 234 1 0 31 202 0 0 99% 13% 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 225 0 0 22 203 0 0 100% 0% 13-Apr-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 12 0 0 0 12 0 0 100% 0% 09-Mar-21 VIDRL 0 - - - - - - - - - - - - - Total 6152 69 0 226 5847 0 10 96% 3% 178 0 52 5 0 35 2 0 76 1 7 0 0 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPVNegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2020 and key laboratory indicators 4 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 24 0 0 1 22 1 0 93% 2% 07-Jun-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 0 - - - - - - - - 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 0 - - - - - - - - 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 1018 6 0 38 884 0 90 95% 3% 14-May-21 20 0 9 6 0 0 0 0 5 0 0 0 0 98% China, Anhui Prov. Lab 45 0 0 2 43 0 0 98% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Beijing Prov. Lab 16 0 0 2 12 0 2 86% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 16 0 0 0 16 0 0 94% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 21 0 0 0 15 0 6 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 27 1 0 0 25 0 1 100% 0% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Guangdong Prov. Lab 121 0 0 4 115 0 2 78% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangxi Prov. Lab 49 0 0 2 39 0 8 95% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 34 0 0 0 27 0 7 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 4 0 0 1 3 0 0 100% 25% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 49 0 0 4 44 0 1 100% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 14 1 0 0 6 0 7 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Henan Prov. Lab 147 1 0 3 143 0 0 99% 2% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Hubei Prov. Lab 24 0 0 3 19 0 2 86% 14% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 48 0 0 1 21 0 26 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 36 0 0 0 34 0 2 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 34 0 0 2 32 0 0 94% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 13 0 0 1 12 0 0 92% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 19 0 0 0 19 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 28 0 0 0 12 0 16 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Ningxia Prov. Lab 5 0 0 0 5 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 2 0 0 0 2 0 0 0% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 18 0 0 0 16 0 2 94% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 57 0 0 1 54 0 2 100% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 7 0 0 0 7 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 19 1 0 0 18 0 0 89% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Sichuan Prov. Lab 73 0 0 6 64 0 3 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 3 0 0 0 3 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 18 1 0 0 16 0 1 94% 0% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 32 0 0 3 28 0 1 100% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 39 1 0 3 34 0 1 100% 5% Prov. Lab/CCDC 6 0 0 6 0 0 0 0 0 0 0 0 0 83% China, Tibet Prov. Lab 0 - - - - - - - - CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 3 0 0 0 3 0 0 100% 0% 02-Jun-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - 01-Jun-21 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 0 - - - - - - - - 14-Apr-21 NIID 0 - - - - - - - - - - - - - Malaysia IMR 49 0 0 0 49 0 0 99% 0% 07-Jun-21 IMR 0 - - - - - - - - - - - - - Mongolia PHI 1 0 0 0 1 0 0 100% 0% 08-Jun-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 2 0 0 0 2 0 0 100% 0% 31-May-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 4 0 0 1 3 0 0 100% 13% 01-Jun-21 VIDRL 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Philippines RITM 298 4 0 11 271 12 0 99% 4% 07-Jun-21 RITM/NIID 13 0 5 0 0 0 0 0 8 0 0 0 0 100% Republic of Korea KCDC 4 0 0 0 4 0 0 100% 0% 04-May-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 1 0 0 0 1 0 0 100% 0% 03-Jun-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 14 0 0 1 12 1 0 96% 7% 31-May-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 71 0 0 22 46 0 3 100% 31% 24-May-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 4 0 0 0 5 0 0 100% 0% 19-Apr-21 VIDRL 0 - - - - - - - - - - - - - Total 1493 10 0 74 1303 14 93 96% 3% 34 0 14 6 0 0 0 0 14 0 0 0 0 96% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPVNegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2021 and key laboratory indicators 5 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 16 1 0 0 0 0 0 0 0 1 0 2 0 0 5 0 0 0 0 0 0 0 0 0 0 5 0 0 China (total) 364 193 0 123 1 0 0 0 0 390 0 567 0 0 77 35 0 13 0 0 0 0 0 75 1 85 2 0 China, Fujian Prov. Lab/CCDC 65 34 0 9 0 0 0 0 0 54 0 68 0 0 14 3 0 3 0 0 0 0 0 1 0 19 2 0 China, Gansu Prov. Lab/CCDC 39 26 0 16 0 0 0 0 0 72 0 38 0 0 15 3 0 1 0 0 0 0 0 9 0 12 0 0 China, Guangdong Prov. Lab/CCDC 48 25 0 16 0 0 0 0 0 19 0 26 0 0 16 14 0 2 0 0 0 0 0 27 0 20 0 0 China, Guangxi Prov. Lab/CCDC 12 3 0 0 0 0 0 0 0 11 0 9 0 0 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab/CCDC 40 21 0 7 0 0 0 0 0 44 0 111 0 0 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab/CCDC 12 8 0 1 0 0 0 0 0 13 0 24 0 0 3 2 0 2 0 0 0 0 0 1 0 3 0 0 China, Neimongol Prov. Lab/CCDC 3 3 0 4 0 0 0 0 0 3 0 1 0 0 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab/CCDC 11 7 0 3 0 0 0 0 0 11 0 5 0 0 3 1 0 0 0 0 0 0 0 3 0 4 0 0 China, Shandong Prov. Lab/CCDC 32 20 0 14 0 0 0 0 0 25 0 107 0 0 8 3 0 3 0 0 0 0 0 11 0 12 0 0 China, Shanghai Prov. Lab/CCDC 24 14 0 9 0 0 0 0 0 18 0 7 0 0 6 1 0 0 0 0 0 0 0 0 1 8 0 0 China, Sichuan Prov. Lab/CCDC 30 13 0 6 0 0 0 0 0 36 0 70 0 0 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab/CCDC 24 19 0 38 1 0 0 0 0 84 0 29 0 0 12 8 0 2 0 0 0 0 0 23 0 7 0 0 China, Yunnan Prov. Lab/CCDC 24 0 0 0 0 0 0 0 0 0 0 72 0 0 0 - - - - - - - - - - - - - Malaysia IMR/VIDRL 700 97 0 33 9 0 11 7 0 74 1 29 0 0 226 0 0 0 0 0 0 0 0 0 0 17 33 0 Philippines RITM 384 77 0 20 0 0 95 8 0 62 0 95 0 0 286 44 0 19 0 0 0 0 0 74 0 22 4 0 Vietnam NIHE 0 - - - - - - - - - - - - - 23 0 0 0 0 0 0 0 0 0 0 4 1 0 Total 1464 368 0 176 10 0 106 15 0 527 1 693 0 0 617 79 0 32 0 0 0 0 0 149 1 133 40 0 2020 2021 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed Table 3. Laboratory confirmation of polio isolates from environmental samples in 2020–20211 6 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2021 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 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) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP)iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) aVDPV3 (1 AFP) aVDPV1 (1 AFP + 1 env) aVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (1 contact) 5 ?VDPV1 (1 AFP) + cVDPV3 (1 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Malaysia cVDPV1 (3 AFP + 12 env)cVDPV2 (3 env) cVDPV1 (1 AFP + 1 non-AFP + 9 env) cVDPV2 (5 env) aVDPV2 (1 env) ?VDPV3 (1 env) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (2 AFP + 1 contact + 14 env) cVDPV2 (12 AFP + 5 non-AFP + 2 contact + 19 env) iVDPV2 (1 AFP) aVDPV2 (1 AFP) cVDPV2 (1 AFP + 4 env) aVDPV2 (1 AFP + 6 non-AFP + 3 env) Viet Nam aVDPV2 (2 AFP) 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 5. Contact of a different AFP case.

Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific WHO, UNICEF laud end of polio outbreak in the Philippines The circulating vaccine-derived poliovirus (cVDPV) types 1 and 2 outbreaks in the Philippines was officially closed on 3 June 2021, as the virus has not been detected in a child or in the environment in the past 16 months as a result of comprehensive outbreak response actions including intensified immunization and surveillance activities in affected areas of the country. WHO and UNICEF commend the DOH for exceptional leadership and for effectively mobilizing all levels of society in coordinating resources for the outbreak response since its announcement on 19 September 2019. Furthermore, the Philippines has effectively rolled out a nationwide and integrated SIA to mitigate risk of measles outbreak, by combining the delivery of Measles-Rubella vaccine and OPV while ensuring the safety of community and health staff during the COVID-19 pandemic. WHO supported the country’s polio outbreak response by providing both technical and operations support on intensifying polio surveillance, planning, preparing for and monitoring of immunization campaigns, infection prevention and control measures and risk communication. WHO also deployed international and national polio experts who provided on-the-ground technical support to the regions and local implementers. Polio Bulletin 2021 Issue No. 13 - Week 25 (as of 21 June 2021) CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2019–2021 Chart 2. Adequate specimen collection rate, 2019–2021 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2021 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2021 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 0.0% 40.0% 5.7% 0.0% 77.8% 0.0% 29.6% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% VNM PNG PHL MYS LAO KHM CHN 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). 2019 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 63 47 51 0 0 0 51 0 0 (0.0%) 1.09 63% 100% 24-Feb-21 - Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.00 100% 100% 11-Jan-21 - Cambodia 55 47 72 0 0 0 14 58 27 (37.5%) 1.53 92% 93% 23-Dec-20 180 China 5183 2370 4427 0 0 0 4222 205 205 (4.6%) 1.87 93% 100% 14-May-21 38 China, Hong Kong SAR 14 9 13 0 0 0 13 0 0 (0.0%) 1.44 85% 100% 01-Jun-21 - China, Macao SAR 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 17-Feb-21 - Japan - 152 - - - - - - - - - - - - Lao People's Democratic Republic 65 23 43 0 0 0 33 10 10 (23.3%) 1.87 74% 100% 23-Apr-21 59 Malaysia 194 78 161 0 1 2 158 0 0 (0.0%) 2.05 83% 77% 25-Mar-21 - Mongolia 5 10 1 0 0 0 1 0 0 (0.0%) 0.10 100% 100% 10-Mar-21 - New Zealand 8 9 11 0 0 0 10 1 1 (9.1%) 1.22 55% 73% 12-Apr-21 70 Papua New Guinea 222 36 70 0 0 0 64 6 6 (8.6%) 1.94 53% 80% 08-Apr-21 74 Philippines 872 330 871 0 2 2 756 111 67 (7.7%) 2.63 62% 97% 15-Jan-21 157 Republic of Korea 81 63 48 0 0 0 48 0 0 (0.0%) 0.76 85% 100% 14-Apr-21 - Singapore 5 6 3 0 0 0 3 0 0 (0.0%) 0.50 100% 67% 07-Jan-21 - Viet Nam 353 241 430 0 0 0 430 0 0 (0.0%) 1.78 95% 62% 12-May-21 - Pacific island countries and areas 21 9 12 0 0 0 10 2 2 (16.7%) 1.33 67% 92% 08-Apr-21 74 Total 7144 3432 6216 0 3 4 5816 393 318 (5.1%) 1.81 88% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Discarded (Non-polio) 2020 Non-polio AFP rate Total % with adequate specimens 2 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Table 1A. Classification of AFP cases with onset in 2020 and key surveillance indicators 2 Polio Bulletin 2020 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 51 48 26 0 0 0 23 3 0 (0.0%) 1.13 62% 100% 18-Jun-21 3 Brunei Darussalam 1 1 0 - - - - - - - - - 01-Jun-21 20 Cambodia 72 48 5 0 0 0 0 5 0 (0.0%) 0.22 100% 80% 01-Mar-21 112 China 4427 2370 1037 0 0 0 60 977 307 (29.6%) 0.91 91% 100% 14-May-21 38 China, Hong Kong SAR 13 9 4 0 0 0 2 2 0 (0.0%) 0.92 75% 75% 15-Jun-21 6 China, Macao SAR 2 1 0 - - - - - - - - - 10-Jun-21 11 Japan - 152 - - - - - - - - - - - - Lao People's Democratic Republic 43 23 9 0 0 0 0 9 7 (77.8%) 0.81 89% 67% 01-Jun-21 20 Malaysia 161 80 50 0 0 0 48 2 0 (0.0%) 1.30 88% 68% 16-Jun-21 5 Mongolia 1 10 1 0 0 0 1 0 0 (0.0%) 0.21 100% 100% 10-May-21 42 New Zealand 11 9 3 0 0 0 0 3 1 (33.3%) 0.69 33% 100% 21-Jun-21 0 Papua New Guinea 70 36 5 0 0 0 0 5 2 (40.0%) 0.29 40% 100% 24-May-21 28 Philippines 871 330 299 0 0 0 224 75 17 (5.7%) 1.88 71% 80% 15-Jun-21 6 Republic of Korea 48 62 8 0 0 0 6 2 0 (0.0%) 0.27 88% 100% 04-May-21 48 Singapore 3 6 1 0 0 0 1 0 0 (0.0%) 0.35 100% 100% 03-Jun-21 18 Viet Nam 430 274 29 0 0 0 0 29 0 (0.0%) 0.22 93% 34% 01-Apr-21 81 Pacific island countries and areas 12 6 5 0 0 0 0 5 0 (0.0%) 1.73 80% 60% 08-Apr-21 74 Total 6216 3464 1482 0 0 0 365 1117 334 (22.5%) 0.89 86% 93% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date 2021 Non-polio AFP rate 2 Total % with adequate specimens 3 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Table 1B. Classification of AFP cases with onset in 2021 and key surveillance indicators 3 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 44 0 0 0 44 0 0 96% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 38 0 0 7 31 0 0 100% 14% 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 4383 23 0 110 4240 0 10 96% 2% 14-May-21 56 0 25 1 0 0 0 0 29 1 0 0 0 100% China, Anhui Prov. Lab 271 1 0 1 267 0 2 100% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 0 1 0 0 0 100% China, Beijing Prov. Lab 27 1 0 0 26 0 0 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Chongqing Prov. Lab 52 0 0 2 50 0 0 100% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 133 0 0 2 131 0 0 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 75 0 0 0 75 0 0 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 442 1 0 5 436 0 0 82% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Guangxi Prov. Lab 219 0 0 5 214 0 0 100% 2% Prov. Lab/CCDC 0 0 0 0 0 0 0 0 0 0 0 0 0 100% China, Guizhou Prov. Lab 152 2 0 2 148 0 0 99% 1% Prov. Lab/CCDC 4 0 4 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 31 0 0 1 29 0 1 97% 3% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 247 1 0 19 227 0 0 100% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Heilongjiang Prov. Lab 44 0 0 0 44 0 0 86% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 513 3 0 8 502 0 0 99% 2% Prov. Lab/CCDC 10 0 4 0 0 0 0 0 6 0 0 0 0 100% China, Hubei Prov. Lab 122 0 0 6 113 0 3 97% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 220 2 0 15 203 0 0 100% 5% Prov. Lab/CCDC 5 0 2 0 0 0 0 0 3 0 0 0 0 100% China, Jiangsu Prov. Lab 194 3 0 0 191 0 0 100% 0% Prov. Lab/CCDC 6 0 0 0 0 0 0 0 6 0 0 0 0 100% China, Jiangxi Prov. Lab 160 0 0 4 156 0 0 98% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 44 0 0 6 38 0 0 95% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 68 1 0 1 66 0 0 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Neimongol Prov. Lab 81 4 0 0 77 0 0 91% 0% Prov. Lab/CCDC 11 0 4 1 0 0 0 0 6 0 0 0 0 100% China, Ningxia Prov. Lab 21 0 0 1 20 0 0 95% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 22 0 0 0 22 0 0 82% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 99 0 0 0 99 0 0 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 258 0 0 1 256 0 1 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 28 0 0 0 28 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 76 0 0 0 76 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 306 2 0 13 291 0 0 94% 4% Prov. Lab/CCDC 7 0 2 0 0 0 0 0 5 0 0 0 0 100% China, Tianjin Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 92 0 0 1 89 0 2 72% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 183 0 0 15 168 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 152 1 0 2 149 0 0 100% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Tibet Prov. Lab 19 1 0 0 17 0 1 29% 0% - CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hong Kong SAR PHLC 13 0 0 0 13 0 0 100% 0% 04-Jun-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 43 3 0 9 31 0 0 63% 19% 22-Apr-21 NIID 4 0 1 0 0 0 0 0 3 0 0 0 0 100% Malaysia IMR 175 5 0 0 170 0 0 100% 0% 14-Apr-21 IMR 22 0 4 4 0 2 0 0 12 0 0 0 0 100% Mongolia PHI 1 0 0 1 0 0 0 100% 100% 06-Mar-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 7 0 0 0 7 0 0 100% 0% 22-Mar-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 70 5 0 12 53 0 0 98% 16% 19-Apr-21 VIDRL 28 0 10 0 0 0 0 0 11 0 7 0 0 100% Philippines RITM 853 32 0 34 787 0 0 98% 4% 02-Mar-21 RITM/NIID 68 0 12 0 0 33 2 0 21 0 0 0 0 100% Republic of Korea KCDC 48 0 0 0 48 0 0 99% 0% 14-Apr-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 08-Jan-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 234 1 0 31 202 0 0 99% 13% 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 225 0 0 22 203 0 0 100% 0% 13-Apr-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 12 0 0 0 12 0 0 100% 0% 09-Mar-21 VIDRL 0 - - - - - - - - - - - - - Total 6152 69 0 226 5847 0 10 96% 3% 178 0 52 5 0 35 2 0 76 1 7 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2020 and key laboratory indicators 4 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 25 0 0 1 23 1 0 93% 2% 16-Jun-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 0 - - - - - - - - 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 0 - - - - - - - - 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 1018 6 0 38 884 0 90 95% 3% 14-May-21 22 0 9 6 0 0 0 0 7 0 0 0 0 95% China, Anhui Prov. Lab 45 0 0 2 43 0 0 98% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Beijing Prov. Lab 16 0 0 2 12 0 2 86% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 16 0 0 0 16 0 0 94% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 21 0 0 0 15 0 6 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 27 1 0 0 25 0 1 100% 0% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Guangdong Prov. Lab 121 0 0 4 115 0 2 78% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangxi Prov. Lab 49 0 0 2 39 0 8 95% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 34 0 0 0 27 0 7 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 4 0 0 1 3 0 0 100% 25% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 49 0 0 4 44 0 1 100% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 14 1 0 0 6 0 7 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Henan Prov. Lab 147 1 0 3 143 0 0 99% 2% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Hubei Prov. Lab 24 0 0 3 19 0 2 86% 14% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 48 0 0 1 21 0 26 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 36 0 0 0 34 0 2 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 34 0 0 2 32 0 0 94% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 13 0 0 1 12 0 0 92% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 19 0 0 0 19 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 28 0 0 0 12 0 16 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Ningxia Prov. Lab 5 0 0 0 5 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 2 0 0 0 2 0 0 0% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 18 0 0 0 16 0 2 94% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 57 0 0 1 54 0 2 100% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 7 0 0 0 7 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 19 1 0 0 18 0 0 89% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Sichuan Prov. Lab 73 0 0 6 64 0 3 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 3 0 0 0 3 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 18 1 0 0 16 0 1 94% 0% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 32 0 0 3 28 0 1 100% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 39 1 0 3 34 0 1 100% 5% Prov. Lab/CCDC 8 0 0 6 0 0 0 0 2 0 0 0 0 88% China, Tibet Prov. Lab 0 - - - - - - - - CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 3 0 0 0 3 0 0 100% 0% 09-Jun-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - 23-Apr-21 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 0 - - - - - - - - 14-Apr-21 NIID 0 - - - - - - - - - - - - - Malaysia IMR 52 0 0 0 52 0 0 99% 0% 18-Jun-21 IMR 0 - - - - - - - - - - - - - Mongolia PHI 1 0 0 0 1 0 0 100% 0% 20-Jun-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 3 0 0 0 2 1 0 100% 0% 16-Jun-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 4 1 0 1 2 0 0 100% 13% 10-Jun-21 VIDRL 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Philippines RITM 334 4 0 12 294 24 0 99% 4% 21-Jun-21 RITM/NIID 12 0 4 0 0 0 0 0 8 0 0 0 0 100% Republic of Korea KCDC 4 0 0 0 4 0 0 100% 0% 04-May-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 1 0 0 0 1 0 0 100% 0% 17-Jun-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 14 0 0 1 12 1 0 96% 7% 31-May-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 79 0 0 22 54 0 3 100% 28% 15-Jun-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 4 0 0 0 4 0 0 100% 0% 19-Apr-21 VIDRL 0 - - - - - - - - - - - - - Total 1542 11 0 75 1336 27 93 96% 3% 35 0 13 6 0 0 0 0 16 0 0 0 0 96% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2021 and key laboratory indicators 5 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 16 1 0 0 0 0 0 0 0 1 0 2 0 0 5 0 0 0 0 0 0 0 0 0 0 5 0 0 China (total) 364 193 0 123 1 0 0 0 0 390 0 567 0 0 139 62 0 43 0 0 0 0 0 139 1 254 0 0 China, Fujian Prov. Lab/CCDC 65 34 0 9 0 0 0 0 0 54 0 68 0 0 20 3 0 4 0 0 0 0 0 2 0 53 0 0 China, Gansu Prov. Lab/CCDC 39 26 0 16 0 0 0 0 0 72 0 38 0 0 25 6 0 1 0 0 0 0 0 12 0 34 0 0 China, Guangdong Prov. Lab/CCDC 48 25 0 16 0 0 0 0 0 19 0 26 0 0 20 16 0 4 0 0 0 0 0 28 0 44 0 0 China, Guangxi Prov. Lab/CCDC 12 3 0 0 0 0 0 0 0 11 0 9 0 0 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab/CCDC 40 21 0 7 0 0 0 0 0 44 0 111 0 0 8 3 0 1 0 0 0 0 0 3 0 8 0 0 China, Jiangxi Prov. Lab/CCDC 12 8 0 1 0 0 0 0 0 13 0 24 0 0 5 2 0 2 0 0 0 0 0 1 0 10 0 0 China, Neimongol Prov. Lab/CCDC 3 3 0 4 0 0 0 0 0 3 0 1 0 0 4 4 0 3 0 0 0 0 0 11 0 0 0 0 China, Qinghai Prov. Lab/CCDC 11 7 0 3 0 0 0 0 0 11 0 5 0 0 5 1 0 0 0 0 0 0 0 3 0 4 0 0 China, Shandong Prov. Lab/CCDC 32 20 0 14 0 0 0 0 0 25 0 107 0 0 8 3 0 3 0 0 0 0 0 11 0 12 0 0 China, Shanghai Prov. Lab/CCDC 24 14 0 9 0 0 0 0 0 18 0 7 0 0 9 1 0 0 0 0 0 0 0 0 1 11 0 0 China, Sichuan Prov. Lab/CCDC 30 13 0 6 0 0 0 0 0 36 0 70 0 0 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab/CCDC 24 19 0 38 1 0 0 0 0 84 0 29 0 0 20 16 0 16 0 0 0 0 0 58 0 25 0 0 China, Yunnan Prov. Lab/CCDC 24 0 0 0 0 0 0 0 0 0 0 72 0 0 15 7 0 9 0 0 0 0 0 10 0 53 0 0 Malaysia IMR/VIDRL 700 97 0 33 9 0 11 7 0 74 1 29 0 0 252 0 0 0 0 0 0 0 0 0 0 17 27 0 Philippines RITM 384 77 0 20 0 0 95 8 0 62 0 95 0 0 305 51 0 22 0 0 0 0 0 93 0 80 124 0 Vietnam NIHE 0 - - - - - - - - - - - - - 23 0 0 0 0 0 0 0 0 0 0 4 1 0 Total 1464 368 0 176 10 0 106 15 0 527 1 693 0 0 724 113 0 65 0 0 0 0 0 232 1 360 152 0 2020 2021 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed Table 3. Laboratory confirmation of polio isolates from environmental samples in 2020–20211 6 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2021 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 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) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP)iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) aVDPV3 (1 AFP) aVDPV1 (1 AFP + 1 env) aVDPV3 (1 AFP) cVDPV3 (1 non-AFP) aVDPV3 (1 contact) 5 ?VDPV1 (1 AFP) + cVDPV3 (1 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Malaysia cVDPV1 (3 AFP + 12 env)cVDPV2 (3 env) cVDPV1 (1 AFP + 1 non-AFP + 9 env) cVDPV2 (5 env) aVDPV2 (1 env) ?VDPV3 (1 env) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (2 AFP + 1 contact + 14 env) cVDPV2 (12 AFP + 5 non-AFP + 2 contact + 19 env) iVDPV2 (1 AFP) aVDPV2 (1 AFP) cVDPV2 (1 AFP + 4 env) aVDPV2 (1 AFP + 6 non-AFP + 3 env) Viet Nam aVDPV2 (2 AFP) 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 5. Contact of a different AFP case.

Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific 30th Meeting of the Technical Advisory Group on Immunization and Vaccine-Preventable Diseases in the Western Pacific Region 22-25 June 2021 The VDI unit virtually convened the 30th Meeting of the Technical Advisory Group (TAG) on Immunization and Vaccine-Preventable Diseases in the Western Pacific Region. The TAG reviewed the impact of COVID-19 pandemic on national immunization programmes and disease elimination initiatives, the progress and challenges in response to COVID-19 pandemic, as well as progress towards achieving regional immunization goals. The TAG commended the efforts of the Member States in maintaining polio essential functions even during the COVID-19 pandemic; congratulated the Philippines on the official closing of the polio outbreak; noted the remaining issues and challenges related to continuous risk of emergence and circulation of vaccine-derived polio viruses (VDPV) and progress in polio virus laboratory containment. The TAG urged Member States to maintain high level of population immunity with all polio vaccines; maintain high quality polio surveillance; and expedite progress in polio laboratory containment. The TAG requested the WHO to continue technical and financial support to the Member States in their efforts to maintain polio-free status and prevent emergence and circulation of VDPVs. Polio Bulletin 2021 Issue No. 14 - Week 27 (as of 6 July 2021) CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2019–2021 Chart 2. Adequate specimen collection rate, 2019–2021 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2021 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2021 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 0.0% 41.7% 4.4% 0.0% 77.8% 0.0% 29.6% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% VNM PNG PHL MYS LAO KHM CHN 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). 2019 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 63 47 51 0 0 0 51 0 0 (0.0%) 1.09 63% 100% 24-Feb-21 - Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.00 100% 100% 11-Jan-21 - Cambodia 55 47 72 0 0 0 14 58 27 (37.5%) 1.53 92% 93% 23-Dec-20 195 China 5183 2370 4427 0 0 0 4222 205 205 (4.6%) 1.87 93% 100% 14-May-21 53 China, Hong Kong SAR 14 9 13 0 0 0 13 0 0 (0.0%) 1.44 85% 100% 01-Jun-21 - China, Macao SAR 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 17-Feb-21 - Japan - 152 0 - - - - - - - - - - - Lao People's Democratic Republic 65 23 43 0 0 0 33 10 10 (23.3%) 1.87 74% 100% 23-Apr-21 74 Malaysia 194 78 161 0 1 2 158 0 0 (0.0%) 2.05 83% 77% 25-Mar-21 - Mongolia 5 10 1 0 0 0 1 0 0 (0.0%) 0.10 100% 100% 10-Mar-21 - New Zealand 8 9 11 0 0 0 10 1 1 (9.1%) 1.22 55% 73% 12-Apr-21 85 Papua New Guinea 222 36 70 0 0 0 64 6 6 (8.6%) 1.94 53% 80% 08-Apr-21 89 Philippines 872 330 871 0 2 2 756 111 67 (7.7%) 2.63 62% 97% 15-Jan-21 172 Republic of Korea 81 63 48 0 0 0 48 0 0 (0.0%) 0.76 85% 100% 14-Apr-21 - Singapore 5 6 3 0 0 0 3 0 0 (0.0%) 0.50 100% 67% 07-Jan-21 - Viet Nam 353 241 430 0 0 0 430 0 0 (0.0%) 1.78 95% 62% 12-May-21 - Pacific island countries and areas 21 9 12 0 0 0 10 2 2 (16.7%) 1.33 67% 92% 08-Apr-21 89 Total 7144 3432 6216 0 3 4 5816 393 318 (5.1%) 1.81 88% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO 2020 Non-polio AFP rate Total % with adequate specimens 2> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Table 1A. Classification of AFP cases with onset in 2020 and key surveillance indicators 2 Polio Bulletin 2020 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 51 48 26 0 0 0 23 3 0 (0.0%) 1.04 62% 100% 28-Jun-21 8 Brunei Darussalam 1 1 0 - - - - - - - - - 01-Jun-21 35 Cambodia 72 48 5 0 0 0 0 5 0 (0.0%) 0.20 100% 80% 01-Mar-21 127 China 4427 2370 1037 0 0 0 60 977 307 (29.6%) 0.84 91% 100% 14-May-21 53 China, Hong Kong SAR 13 9 5 0 0 0 2 3 0 (0.0%) 1.07 80% 80% 25-Jun-21 11 China, Macao SAR 2 1 0 - - - - - - - - - 10-Jun-21 26 Japan - 152 - - - - - - - - - - - - Lao People's Democratic Republic 43 23 9 0 0 0 0 9 7 (77.8%) 0.75 89% 67% 01-Jun-21 35 Malaysia 161 80 50 0 0 0 48 2 0 (0.0%) 1.20 88% 68% 16-Jun-21 20 Mongolia 1 10 1 0 0 0 1 0 0 (0.0%) 0.19 100% 100% 10-May-21 57 New Zealand 11 9 3 0 0 0 0 3 1 (33.3%) 0.64 33% 100% 29-Jun-21 7 Papua New Guinea 70 36 12 0 0 0 0 12 5 (41.7%) 0.64 33% 75% 29-Jun-21 7 Philippines 871 330 365 0 0 0 286 79 16 (4.4%) 2.13 73% 98% 06-Jul-21 0 Republic of Korea 48 62 8 0 0 0 6 2 0 (0.0%) 0.25 88% 100% 04-May-21 63 Singapore 3 6 1 0 0 0 1 0 0 (0.0%) 0.32 100% 100% 06-Jul-21 0 Viet Nam 430 274 29 0 0 0 0 29 0 (0.0%) 0.20 93% 34% 01-Apr-21 96 Pacific island countries and areas 12 6 5 0 0 0 0 5 0 (0.0%) 1.60 80% 60% 08-Apr-21 89 Total 6216 3465 1556 0 0 0 427 1129 336 (21.6%) 0.87 85% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO 2021 Non-polio AFP rate 2 Total % with adequate specimens 3> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Table 1B. Classification of AFP cases with onset in 2021 and key surveillance indicators 3 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 44 0 0 0 44 0 0 96% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 38 0 0 7 31 0 0 100% 14% 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 4383 23 0 110 4240 0 10 96% 2% 14-May-21 56 0 25 1 0 0 0 0 29 1 0 0 0 100% China, Anhui Prov. Lab 271 1 0 1 267 0 2 100% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 0 1 0 0 0 100% China, Beijing Prov. Lab 27 1 0 0 26 0 0 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Chongqing Prov. Lab 52 0 0 2 50 0 0 100% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 133 0 0 2 131 0 0 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 75 0 0 0 75 0 0 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 442 1 0 5 436 0 0 82% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Guangxi Prov. Lab 219 0 0 5 214 0 0 100% 2% Prov. Lab/CCDC 0 0 0 0 0 0 0 0 0 0 0 0 0 100% China, Guizhou Prov. Lab 152 2 0 2 148 0 0 99% 1% Prov. Lab/CCDC 4 0 4 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 31 0 0 1 29 0 1 97% 3% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 247 1 0 19 227 0 0 100% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Heilongjiang Prov. Lab 44 0 0 0 44 0 0 86% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 513 3 0 8 502 0 0 99% 2% Prov. Lab/CCDC 10 0 4 0 0 0 0 0 6 0 0 0 0 100% China, Hubei Prov. Lab 122 0 0 6 113 0 3 97% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 220 2 0 15 203 0 0 100% 5% Prov. Lab/CCDC 5 0 2 0 0 0 0 0 3 0 0 0 0 100% China, Jiangsu Prov. Lab 194 3 0 0 191 0 0 100% 0% Prov. Lab/CCDC 6 0 0 0 0 0 0 0 6 0 0 0 0 100% China, Jiangxi Prov. Lab 160 0 0 4 156 0 0 98% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 44 0 0 6 38 0 0 95% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 68 1 0 1 66 0 0 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Neimongol Prov. Lab 81 4 0 0 77 0 0 91% 0% Prov. Lab/CCDC 11 0 4 1 0 0 0 0 6 0 0 0 0 100% China, Ningxia Prov. Lab 21 0 0 1 20 0 0 95% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 22 0 0 0 22 0 0 82% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 99 0 0 0 99 0 0 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 258 0 0 1 256 0 1 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 28 0 0 0 28 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 76 0 0 0 76 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 306 2 0 13 291 0 0 94% 4% Prov. Lab/CCDC 7 0 2 0 0 0 0 0 5 0 0 0 0 100% China, Tianjin Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 92 0 0 1 89 0 2 72% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 183 0 0 15 168 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 152 1 0 2 149 0 0 100% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Tibet Prov. Lab 19 1 0 0 17 0 1 29% 0% - CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hong Kong SAR PHLC 13 0 0 0 13 0 0 100% 0% 04-Jun-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 43 3 0 9 31 0 0 63% 19% 22-Apr-21 NIID 4 0 1 0 0 0 0 0 3 0 0 0 0 100% Malaysia IMR 175 5 0 0 170 0 0 100% 0% 14-Apr-21 IMR 22 0 4 4 0 2 0 0 12 0 0 0 0 100% Mongolia PHI 1 0 0 1 0 0 0 100% 100% 06-Mar-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 7 0 0 0 7 0 0 100% 0% 22-Mar-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 70 5 0 12 53 0 0 98% 16% 19-Apr-21 VIDRL 28 0 10 0 0 0 0 0 11 0 7 0 0 100% Philippines RITM 853 32 0 34 787 0 0 98% 4% 02-Mar-21 RITM/NIID 68 0 12 0 0 33 2 0 21 0 0 0 0 100% Republic of Korea KCDC 48 0 0 0 48 0 0 99% 0% 14-Apr-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 08-Jan-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 234 1 0 31 202 0 0 99% 13% 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 225 0 0 22 203 0 0 100% 0% 13-Apr-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 12 0 0 0 12 0 0 100% 0% 09-Mar-21 VIDRL 0 - - - - - - - - - - - - - Total 6152 69 0 226 5847 0 10 96% 3% 178 0 52 5 0 35 2 0 76 1 7 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2020 and key laboratory indicators 4 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 25 0 0 1 24 0 0 89% 2% 28-Jun-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 0 - - - - - - - - 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 0 - - - - - - - - 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 1018 6 0 38 884 0 90 95% 3% 14-May-21 25 0 10 6 0 0 0 0 9 0 0 0 0 100% China, Anhui Prov. Lab 45 0 0 2 43 0 0 98% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Beijing Prov. Lab 16 0 0 2 12 0 2 86% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 16 0 0 0 16 0 0 94% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 21 0 0 0 15 0 6 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 27 1 0 0 25 0 1 100% 0% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Guangdong Prov. Lab 121 0 0 4 115 0 2 78% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangxi Prov. Lab 49 0 0 2 39 0 8 95% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 34 0 0 0 27 0 7 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 4 0 0 1 3 0 0 100% 25% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 49 0 0 4 44 0 1 100% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 14 1 0 0 6 0 7 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Henan Prov. Lab 147 1 0 3 143 0 0 99% 2% Prov. Lab/CCDC 6 0 2 0 0 0 0 0 4 0 0 0 0 100% China, Hubei Prov. Lab 24 0 0 3 19 0 2 86% 14% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 48 0 0 1 21 0 26 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 36 0 0 0 34 0 2 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 34 0 0 2 32 0 0 94% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 13 0 0 1 12 0 0 92% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 19 0 0 0 19 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 28 0 0 0 12 0 16 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Ningxia Prov. Lab 5 0 0 0 5 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 2 0 0 0 2 0 0 0% 0% Prov. Lab/CCDC 0 - China, Shaanxi Prov. Lab 18 0 0 0 16 0 2 94% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 57 0 0 1 54 0 2 100% 1% Prov. Lab/CCDC 0 - China, Shanghai Prov. Lab 7 0 0 0 7 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 19 1 0 0 18 0 0 89% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Sichuan Prov. Lab 73 0 0 6 64 0 3 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 3 0 0 0 3 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 18 1 0 0 16 0 1 94% 0% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 32 0 0 3 28 0 1 100% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 39 1 0 3 34 0 1 100% 5% Prov. Lab/CCDC 9 0 1 6 0 0 0 0 2 0 0 0 0 100% China, Tibet Prov. Lab 0 - - - - - - - - CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 4 0 0 0 4 0 0 100% 0% 28-Jun-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - 01-Jul-21 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 0 - - - - - - - - 14-Apr-21 NIID 0 - - - - - - - - - - - - - Malaysia IMR 52 0 0 0 52 0 0 99% 0% 30-Jun-21 IMR 0 - - - - - - - - - - - - - Mongolia PHI 1 0 0 0 1 0 0 100% 0% 04-Jul-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 3 0 0 0 3 0 0 100% 0% 05-Jul-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 7 1 0 1 3 2 0 100% 10% 02-Jul-21 VIDRL 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Philippines RITM 372 4 0 13 344 10 1 99% 4% 06-Jul-21 RITM/NIID 12 0 4 0 0 0 0 0 8 0 0 0 0 100% Republic of Korea KCDC 4 0 0 0 4 0 0 100% 0% 04-May-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 1 0 0 0 1 0 0 100% 0% 01-Jul-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 14 0 0 1 13 1 0 96% 7% 31-May-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 79 0 0 22 54 0 3 100% 28% 15-Jun-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 4 0 0 0 4 0 0 100% 0% 19-Apr-21 VIDRL 0 - - - - - - - - - - - - - Total 1584 11 0 76 1391 13 94 96% 3% 38 0 14 6 0 0 0 0 18 0 0 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2021 and key laboratory indicators 5 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 16 1 0 0 0 0 0 0 0 1 0 2 0 0 5 0 0 0 0 0 0 0 0 0 0 5 0 0 China (total) 364 193 0 123 1 0 0 0 0 390 0 567 0 0 139 62 0 43 0 0 0 0 0 139 1 254 0 0 China, Fujian Prov. Lab/CCDC 65 34 0 9 0 0 0 0 0 54 0 68 0 0 20 3 0 4 0 0 0 0 0 2 0 53 0 0 China, Gansu Prov. Lab/CCDC 39 26 0 16 0 0 0 0 0 72 0 38 0 0 25 6 0 1 0 0 0 0 0 12 0 34 0 0 China, Guangdong Prov. Lab/CCDC 48 25 0 16 0 0 0 0 0 19 0 26 0 0 20 16 0 4 0 0 0 0 0 28 0 44 0 0 China, Guangxi Prov. Lab/CCDC 12 3 0 0 0 0 0 0 0 11 0 9 0 0 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab/CCDC 40 21 0 7 0 0 0 0 0 44 0 111 0 0 8 3 0 1 0 0 0 0 0 3 0 8 0 0 China, Jiangxi Prov. Lab/CCDC 12 8 0 1 0 0 0 0 0 13 0 24 0 0 5 2 0 2 0 0 0 0 0 1 0 10 0 0 China, Neimongol Prov. Lab/CCDC 3 3 0 4 0 0 0 0 0 3 0 1 0 0 4 4 0 3 0 0 0 0 0 11 0 0 0 0 China, Qinghai Prov. Lab/CCDC 11 7 0 3 0 0 0 0 0 11 0 5 0 0 5 1 0 0 0 0 0 0 0 3 0 4 0 0 China, Shandong Prov. Lab/CCDC 32 20 0 14 0 0 0 0 0 25 0 107 0 0 8 3 0 3 0 0 0 0 0 11 0 12 0 0 China, Shanghai Prov. Lab/CCDC 24 14 0 9 0 0 0 0 0 18 0 7 0 0 9 1 0 0 0 0 0 0 0 0 1 11 0 0 China, Sichuan Prov. Lab/CCDC 30 13 0 6 0 0 0 0 0 36 0 70 0 0 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab/CCDC 24 19 0 38 1 0 0 0 0 84 0 29 0 0 20 16 0 16 0 0 0 0 0 58 0 25 0 0 China, Yunnan Prov. Lab/CCDC 24 0 0 0 0 0 0 0 0 0 0 72 0 0 15 7 0 9 0 0 0 0 0 10 0 53 0 0 Malaysia IMR/VIDRL 700 97 0 33 9 0 11 7 0 74 1 29 0 0 275 0 0 0 0 0 0 0 0 0 0 17 48 0 Philippines RITM 384 77 0 20 0 0 95 8 0 62 0 95 0 0 336 53 0 21 0 0 0 0 0 91 0 105 92 0 Vietnam NIHE 0 - - - - - - - - - - - - - 23 0 0 0 0 0 0 0 0 0 0 4 1 0 Total 1464 368 0 176 10 0 106 15 0 527 1 693 0 0 778 115 0 64 0 0 0 0 0 230 1 385 141 0 2020 2021 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed Table 3. Laboratory confirmation of polio isolates from environmental samples in 2020–20211 6 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2021 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 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) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP)iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) aVDPV3 (1 AFP) aVDPV1 (1 AFP + 1 env) aVDPV3 (1 AFP) cVDPV3 (1 non-AFP) aVDPV3 (1 contact) 5 ?VDPV1 (1 AFP) + cVDPV3 (1 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Malaysia cVDPV1 (3 AFP + 12 env)cVDPV2 (3 env) cVDPV1 (1 AFP + 1 non-AFP + 9 env) cVDPV2 (5 env) aVDPV2 (1 env) ?VDPV3 (1 env) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (2 AFP + 1 contact + 14 env) cVDPV2 (12 AFP + 5 non-AFP + 2 contact + 19 env) iVDPV2 (1 AFP) aVDPV2 (1 AFP) cVDPV2 (1 AFP + 4 env) aVDPV2 (1 AFP + 6 non-AFP + 3 env) Viet Nam aVDPV2 (2 AFP) 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 5. Contact of a different AFP case.

Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific Value of polio infrastructure in COVID-19 support continues to be highlighted The Heads of State of the G7 countries, at the annual meeting held in the UK on 11-13 June 2021, highlighted the need for increased global efforts to detect global public health threats, by building international surveillance on existing networks such as polio surveillance. The unique value of the polio infrastructure in supporting COVID-19 response efforts was recently underscored by other global fora, including the World Health Assembly in May, and the G7 health ministers meeting in June. An integral part of the new GPEI Strategy 2022-2026 is to ensure close coordination with broader public health efforts, to not only achieve a lasting world free of all polioviruses, but also one where the polio infrastructure will continue to benefit other public health emergencies long after the disease has been eradicated. Key to success, however, will be the continued support and engagement of the international development community, including by ensuring that previous pledges are fully and rapidly operationalized. Chaudhry Hakim Ali and Muhammad Usman enter data after collecting samples for COVID-19 testing at a laboratory located at the National Institute of Health in Islamabad, Pakistan. © WHO/EMRO Polio Bulletin 2021 Issue No. 15 - Week 29 (as of 20 July 2021) CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2019–2021 Chart 2. Adequate specimen collection rate, 2019–2021 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2021 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2021 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 0.0% 42.9% 4.3% 0.0% 77.8% 0.0% 29.6% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% VNM PNG PHL MYS LAO KHM CHN 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). 2019 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 63 47 51 0 0 0 51 0 0 (0.0%) 1.09 63% 100% 24-Feb-21 - Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.00 100% 100% 11-Jan-21 - Cambodia 55 47 72 0 0 0 14 58 27 (37.5%) 1.53 92% 93% 23-Dec-20 209 China 5183 2370 4427 0 0 0 4222 205 205 (4.6%) 1.87 93% 100% 14-May-21 67 China, Hong Kong SAR 14 9 12 0 0 0 12 0 0 (0.0%) 1.33 92% 100% 07-Jul-21 - China, Macao SAR 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 17-Feb-21 - Japan 0 152 - - - - - - - - - - - - Lao People's Democratic Republic 65 23 43 0 0 0 33 10 10 (23.3%) 1.87 74% 100% 23-Apr-21 88 Malaysia 194 78 161 0 1 2 158 0 0 (0.0%) 2.05 83% 77% 25-Mar-21 - Mongolia 5 10 1 0 0 0 1 0 0 (0.0%) 0.10 100% 100% 10-Mar-21 - New Zealand 8 9 11 0 0 0 10 1 1 (9.1%) 1.22 55% 73% 12-Apr-21 99 Papua New Guinea 222 36 70 0 0 0 64 6 6 (8.6%) 1.94 53% 80% 08-Apr-21 103 Philippines 872 330 871 0 2 2 756 111 67 (7.7%) 2.63 62% 97% 15-Jan-21 186 Republic of Korea 81 63 48 0 0 0 48 0 0 (0.0%) 0.76 85% 100% 14-Apr-21 - Singapore 5 6 3 0 0 0 3 0 0 (0.0%) 0.50 100% 67% 07-Jan-21 - Viet Nam 353 241 430 0 0 0 430 0 0 (0.0%) 1.78 95% 62% 12-May-21 - Pacific island countries and areas 21 9 12 0 0 0 10 2 2 (16.7%) 1.33 67% 92% 08-Apr-21 103 Total 7144 3432 6215 0 3 4 5815 393 318 (5.1%) 1.81 88% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 2020 Non-polio AFP rate Total % with adequate specimens 2 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Table 1A. Classification of AFP cases with onset in 2020 and key surveillance indicators 2 Polio Bulletin 2020 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 51 48 35 0 0 0 23 12 1 (2.9%) 1.31 63% 100% 20-Jul-21 0 Brunei Darussalam 1 1 0 - - - - - - - - - 01-Jun-21 49 Cambodia 72 48 5 0 0 0 0 5 0 (0.0%) 0.19 100% 80% 01-Mar-21 141 China 4427 2370 1037 0 0 0 60 977 307 (29.6%) 0.78 91% 100% 14-May-21 67 China, Hong Kong SAR 12 9 5 0 0 0 4 1 0 (0.0%) 1.00 80% 100% 19-Jul-21 1 China, Macao SAR 2 1 0 - - - - - - - - - 12-Jul-21 8 Japan 0 152 - - - - - - - - - - - - Lao People's Democratic Republic 43 23 9 0 0 0 0 9 7 (77.8%) 0.70 89% 67% 01-Jun-21 49 Malaysia 161 80 50 0 0 0 48 2 0 (0.0%) 1.12 88% 68% 16-Jun-21 34 Mongolia 1 10 1 0 0 0 1 0 0 (0.0%) 0.18 100% 100% 10-May-21 71 New Zealand 11 9 3 0 0 0 0 3 1 (33.3%) 0.60 33% 100% 29-Jun-21 21 Papua New Guinea 70 36 14 0 0 0 1 13 6 (42.9%) 0.70 43% 79% 14-Jul-21 6 Philippines 871 330 391 0 0 0 312 79 17 (4.3%) 2.12 73% 97% 12-Jul-21 8 Republic of Korea 48 62 15 0 0 0 9 6 2 (13.3%) 0.43 80% 93% 08-Jul-21 12 Singapore 3 6 1 0 0 0 1 0 0 (0.0%) 0.30 100% 100% 06-Jul-21 14 Viet Nam 430 274 29 0 0 0 0 29 0 (0.0%) 0.19 93% 34% 01-Apr-21 110 Pacific island countries and areas 12 6 5 0 0 0 0 5 0 (0.0%) 1.49 80% 60% 08-Apr-21 103 Total 6215 3465 1600 0 0 0 459 1141 341 (21.3%) 0.83 85% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO 2021 Non-polio AFP rate 2 Total % with adequate specimens 3> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Table 1B. Classification of AFP cases with onset in 2021 and key surveillance indicators 3 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 44 0 0 0 44 0 0 96% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 38 0 0 7 31 0 0 100% 14% 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 4383 23 0 110 4240 0 10 96% 2% 14-May-21 56 0 25 1 0 0 0 0 29 1 0 0 0 100% China, Anhui Prov. Lab 271 1 0 1 267 0 2 100% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 0 1 0 0 0 100% China, Beijing Prov. Lab 27 1 0 0 26 0 0 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Chongqing Prov. Lab 52 0 0 2 50 0 0 100% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 133 0 0 2 131 0 0 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 75 0 0 0 75 0 0 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 442 1 0 5 436 0 0 82% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Guangxi Prov. Lab 219 0 0 5 214 0 0 100% 2% Prov. Lab/CCDC 0 0 0 0 0 0 0 0 0 0 0 0 0 100% China, Guizhou Prov. Lab 152 2 0 2 148 0 0 99% 1% Prov. Lab/CCDC 4 0 4 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 31 0 0 1 29 0 1 97% 3% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 247 1 0 19 227 0 0 100% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Heilongjiang Prov. Lab 44 0 0 0 44 0 0 86% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 513 3 0 8 502 0 0 99% 2% Prov. Lab/CCDC 10 0 4 0 0 0 0 0 6 0 0 0 0 100% China, Hubei Prov. Lab 122 0 0 6 113 0 3 97% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 220 2 0 15 203 0 0 100% 5% Prov. Lab/CCDC 5 0 2 0 0 0 0 0 3 0 0 0 0 100% China, Jiangsu Prov. Lab 194 3 0 0 191 0 0 100% 0% Prov. Lab/CCDC 6 0 0 0 0 0 0 0 6 0 0 0 0 100% China, Jiangxi Prov. Lab 160 0 0 4 156 0 0 98% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 44 0 0 6 38 0 0 95% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 68 1 0 1 66 0 0 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Neimongol Prov. Lab 81 4 0 0 77 0 0 91% 0% Prov. Lab/CCDC 11 0 4 1 0 0 0 0 6 0 0 0 0 100% China, Ningxia Prov. Lab 21 0 0 1 20 0 0 95% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 22 0 0 0 22 0 0 82% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 99 0 0 0 99 0 0 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 258 0 0 1 256 0 1 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 28 0 0 0 28 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 76 0 0 0 76 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 306 2 0 13 291 0 0 94% 4% Prov. Lab/CCDC 7 0 2 0 0 0 0 0 5 0 0 0 0 100% China, Tianjin Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 92 0 0 1 89 0 2 72% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 183 0 0 15 168 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 152 1 0 2 149 0 0 100% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Tibet Prov. Lab 19 1 0 0 17 0 1 29% 0% CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hong Kong SAR PHLC 13 0 0 0 13 0 0 100% 0% 04-Jun-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 43 3 0 9 31 0 0 63% 19% 22-Apr-21 NIID 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Malaysia IMR 175 5 0 0 170 0 0 100% 0% 14-Apr-21 IMR 22 0 4 4 0 2 0 0 12 0 0 0 0 100% Mongolia PHI 1 0 0 1 0 0 0 100% 100% 06-Mar-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 7 0 0 0 7 0 0 100% 0% 22-Mar-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 70 5 0 12 53 0 0 98% 16% 19-Apr-21 VIDRL 28 0 10 0 0 0 0 0 11 0 7 0 0 100% Philippines RITM 853 32 0 34 787 0 0 98% 4% 02-Mar-21 RITM/NIID 68 0 12 0 0 33 2 0 21 0 0 0 0 100% Republic of Korea KCDC 48 0 0 0 48 0 0 99% 0% 14-Apr-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 08-Jan-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 234 1 0 31 202 0 0 99% 13% 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 225 0 0 22 203 0 0 100% 0% 13-Apr-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 12 0 0 0 12 0 0 100% 0% 09-Mar-21 VIDRL 0 - - - - - - - - - - - - - Total 6152 69 0 226 5847 0 10 96% 3% 182 0 53 5 0 35 2 0 79 1 7 0 0 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPVNegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2020 and key laboratory indicators 4 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 33 0 0 1 28 4 0 90% 2% 20-Jul-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 0 - - - - - - - - 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 0 - - - - - - - - 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 1018 6 0 38 884 0 90 95% 3% 14-May-21 25 0 10 6 0 0 0 0 9 0 0 0 0 100% China, Anhui Prov. Lab 45 0 0 2 43 0 0 98% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Beijing Prov. Lab 16 0 0 2 12 0 2 86% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 16 0 0 0 16 0 0 94% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 21 0 0 0 15 0 6 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 27 1 0 0 25 0 1 100% 0% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Guangdong Prov. Lab 121 0 0 4 115 0 2 78% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangxi Prov. Lab 49 0 0 2 39 0 8 95% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 34 0 0 0 27 0 7 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 4 0 0 1 3 0 0 100% 25% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 49 0 0 4 44 0 1 100% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 14 1 0 0 6 0 7 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Henan Prov. Lab 147 1 0 3 143 0 0 99% 2% Prov. Lab/CCDC 6 0 2 0 0 0 0 0 4 0 0 0 0 100% China, Hubei Prov. Lab 24 0 0 3 19 0 2 86% 14% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 48 0 0 1 21 0 26 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 36 0 0 0 34 0 2 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 34 0 0 2 32 0 0 94% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 13 0 0 1 12 0 0 92% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 19 0 0 0 19 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 28 0 0 0 12 0 16 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Ningxia Prov. Lab 5 0 0 0 5 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 2 0 0 0 2 0 0 0% 0% Prov. Lab/CCDC 0 - China, Shaanxi Prov. Lab 18 0 0 0 16 0 2 94% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 57 0 0 1 54 0 2 100% 1% Prov. Lab/CCDC 0 - China, Shanghai Prov. Lab 7 0 0 0 7 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 19 1 0 0 18 0 0 89% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Sichuan Prov. Lab 73 0 0 6 64 0 3 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 3 0 0 0 3 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 18 1 0 0 16 0 1 94% 0% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 32 0 0 3 28 0 1 100% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 39 1 0 3 34 0 1 100% 5% Prov. Lab/CCDC 9 0 1 6 0 0 0 0 2 0 0 0 0 100% China, Tibet Prov. Lab 0 - - - - - - - - CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 5 0 0 0 4 1 0 100% 0% 19-Jul-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 0 - - - - - - - - 01-Jul-21 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 0 - - - - - - - - 14-Apr-21 NIID 0 - - - - - - - - - - - - - Malaysia IMR 55 0 0 0 55 0 0 99% 0% 17-Jul-21 IMR 0 - - - - - - - - - - - - - Mongolia PHI 1 0 0 0 1 0 0 100% 0% 12-Jul-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 3 0 0 0 3 0 0 100% 0% 12-Jul-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 6 1 0 1 4 0 0 100% 8% 12-Jul-21 VIDRL 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Philippines RITM 431 4 0 13 389 23 2 99% 3% 19-Jul-21 RITM/NIID 12 0 4 0 0 0 0 0 8 0 0 0 0 100% Republic of Korea KCDC 14 0 0 0 13 0 1 100% 0% 08-Jul-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 1 0 0 0 1 0 0 100% 0% 15-Jul-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 14 0 0 1 12 1 0 96% 7% 31-May-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 79 0 0 22 54 0 3 100% 28% 15-Jun-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 4 0 0 0 4 0 0 100% 0% 19-Apr-21 VIDRL 0 - - - - - - - - - - - - - Total 1664 11 0 76 1452 29 96 96% 3% 38 0 14 6 0 0 0 0 18 0 0 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2021 and key laboratory indicators 5 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 16 1 0 0 0 0 0 0 0 1 0 2 0 0 6 0 0 0 0 0 0 0 0 0 0 6 0 0 China (total) 364 193 0 123 1 0 0 0 0 390 0 567 0 0 181 66 0 45 0 0 0 0 0 141 1 431 0 0 China, Fujian Prov. Lab/CCDC 65 34 0 9 0 0 0 0 0 54 0 68 0 0 31 3 0 4 0 0 0 0 0 2 0 148 0 0 China, Gansu Prov. Lab/CCDC 39 26 0 16 0 0 0 0 0 72 0 38 0 0 30 7 0 2 0 0 0 0 0 12 0 55 0 0 China, Guangdong Prov. Lab/CCDC 48 25 0 16 0 0 0 0 0 19 0 26 0 0 20 16 0 4 0 0 0 0 0 28 0 44 0 0 China, Guangxi Prov. Lab/CCDC 12 3 0 0 0 0 0 0 0 11 0 9 0 0 6 1 0 0 0 0 0 0 0 1 0 23 0 - China, Heilongjiang Prov. Lab/CCDC 40 21 0 7 0 0 0 0 0 44 0 111 0 0 8 3 0 1 0 0 0 0 0 3 0 8 0 0 China, Jiangxi Prov. Lab/CCDC 12 8 0 1 0 0 0 0 0 13 0 24 0 0 5 2 0 2 0 0 0 0 0 1 0 10 0 0 China, Neimongol Prov. Lab/CCDC 3 3 0 4 0 0 0 0 0 3 0 1 0 0 4 4 0 3 0 0 0 0 0 11 0 0 0 0 China, Qinghai Prov. Lab/CCDC 11 7 0 3 0 0 0 0 0 11 0 5 0 0 5 1 0 0 0 0 0 0 0 3 0 4 0 0 China, Shandong Prov. Lab/CCDC 32 20 0 14 0 0 0 0 0 25 0 107 0 0 8 3 0 3 0 0 0 0 0 11 0 12 0 0 China, Shanghai Prov. Lab/CCDC 24 14 0 9 0 0 0 0 0 18 0 7 0 0 25 3 0 1 0 0 0 0 0 1 1 24 0 0 China, Sichuan Prov. Lab/CCDC 30 13 0 6 0 0 0 0 0 36 0 70 0 0 0 0 - - - - - - - - - - - - China, Xinjiang Prov. Lab/CCDC 24 19 0 38 1 0 0 0 0 84 0 29 0 0 24 16 0 16 0 0 0 0 0 58 0 50 0 0 China, Yunnan Prov. Lab/CCDC 24 0 0 0 0 0 0 0 0 0 0 72 0 0 15 7 0 9 0 0 0 0 0 10 0 53 0 0 Malaysia IMR/VIDRL 700 97 0 33 9 0 11 7 0 74 1 29 0 0 275 0 0 0 0 0 0 0 0 0 0 17 48 0 Philippines RITM 384 77 0 20 0 0 95 8 0 62 0 95 0 0 354 54 0 21 0 0 0 0 0 92 0 115 59 0 Vietnam NIHE 0 - - - - - - - - - - - - - 23 0 0 0 0 0 0 0 0 0 0 4 1 0 Total 1464 368 0 176 10 0 106 15 0 527 1 693 0 0 839 120 0 66 0 0 0 0 0 233 1 573 108 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2020 2021 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD Table 3. Laboratory confirmation of polio isolates from environmental samples in 2020–20211 6 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2021 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 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) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP)iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) aVDPV3 (1 AFP) aVDPV1 (1 AFP + 1 env) aVDPV3 (1 AFP) cVDPV3 (1 non-AFP) aVDPV3 (1 contact) 5 ?VDPV1 (1 AFP) + cVDPV3 (1 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Malaysia cVDPV1 (3 AFP + 12 env)cVDPV2 (3 env) cVDPV1 (1 AFP + 1 non-AFP + 9 env) cVDPV2 (5 env) aVDPV2 (1 env) ?VDPV3 (1 env) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (2 AFP + 1 contact + 14 env) cVDPV2 (12 AFP + 5 non-AFP + 2 contact + 19 env) iVDPV2 (1 AFP) aVDPV2 (1 AFP) cVDPV2 (1 AFP + 4 env) aVDPV2 (1 AFP + 6 non-AFP + 3 env) Viet Nam aVDPV2 (2 AFP) 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 5. Contact of a different AFP case.

Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific United Arab Emirates re-affirms commitment to ending polio in Pakistan The United Arab Emirates on July 24 announced an additional US$9.5 million support to the Pakistan Polio Eradication Initiative. The funding will be used to vaccinate approximately 16 million children during door-to-door immunization campaigns in 84 highest-risk districts. Only one case of wild poliovirus has been reported in Pakistan in the first six months of the year, a significant decrease from the 59 cases reported during the same period in 2020. In order to be certified polio-free, Pakistan is required to report zero cases of wild poliovirus over a three-year period. Dr Shahzad Baig, National Coordinator of the National Emergency Operations Centre for polio eradication warmly welcomed the contribution as an important boost in ensuring the programme continued door-to-door polio campaigns, the most effective way of immunizing against the virus, and ending polio in Pakistan. For more information visit the following website: https:// polioeradication.org/news-post/united-arab-emirates-re- affirms-commitment-to-ending-polio-in-pakistan/ The Emirates Polio Campaign plays an important role in driving eradication efforts at the frontline of Pakistan’s most vulnerable communities. © UAE Polio Bulletin 2021 Issue No. 16 - Week 31 (as of 2 August 2021) CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2019–2021 Chart 2. Adequate specimen collection rate, 2019–2021 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2021 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2021 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 65.3% 0.0% 4.6% 0.0% 72.7% 0.0% 29.6% 0% 10% 20% 30% 40% 50% 60% 70% 80% VNM PNG PHL MYS LAO KHM CHN 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). 2019 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 63 47 51 0 0 0 51 0 0 (0.0%) 1.09 63% 100% 24-Feb-21 - Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.00 100% 100% 11-Jan-21 - Cambodia 55 47 72 0 0 0 14 58 27 (37.5%) 1.53 92% 93% 23-Dec-20 222 China 5183 2370 4427 0 0 0 4222 205 205 (4.6%) 1.87 93% 100% 14-May-21 80 China, Hong Kong SAR 14 9 12 0 0 0 12 0 0 (0.0%) 1.33 92% 100% 07-Jul-21 - China, Macao SAR 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 17-Feb-21 - Japan 0 152 - - - - - - - - - - - - Lao People's Democratic Republic 65 23 43 0 0 0 33 10 10 (23.3%) 1.87 74% 100% 23-Apr-21 101 Malaysia 194 78 161 0 1 2 158 0 0 (0.0%) 2.05 83% 77% 25-Mar-21 - Mongolia 5 10 1 0 0 0 1 0 0 (0.0%) 0.10 100% 100% 10-Mar-21 - New Zealand 8 9 11 0 0 0 10 1 1 (9.1%) 1.22 55% 73% 12-Apr-21 112 Papua New Guinea 222 36 70 0 0 0 70 0 0 (0.0%) 1.94 50% 74% 02-Aug-21 - Philippines 872 330 871 0 2 2 756 111 67 (7.7%) 2.63 62% 97% 15-Jan-21 199 Republic of Korea 81 63 48 0 0 0 48 0 0 (0.0%) 0.76 85% 100% 14-Apr-21 - Singapore 5 6 3 0 0 0 3 0 0 (0.0%) 0.50 100% 67% 07-Jan-21 - Viet Nam 353 241 430 0 0 0 430 0 0 (0.0%) 1.78 95% 62% 12-May-21 - Pacific island countries and areas 21 9 12 0 0 0 12 0 0 (0.0%) 1.33 67% 92% 26-Jul-21 - Total 7144 3432 6215 0 3 4 5823 385 310 (5.0%) 1.81 88% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 2020 Non-polio AFP rate Total % with adequate specimens 2 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Table 1A. Classification of AFP cases with onset in 2020 and key surveillance indicators 2 Polio Bulletin 2020 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 51 48 37 0 0 0 23 14 1 (2.7%) 1.29 62% 100% 02-Aug-21 0 Brunei Darussalam 1 1 1 0 0 0 0 1 0 (0.0%) 1.68 100% 0% 24-Jul-21 9 Cambodia 72 48 5 0 0 0 0 5 0 (0.0%) 0.17 100% 80% 01-Mar-21 154 China 4427 2370 1037 0 0 0 60 977 307 (29.6%) 0.73 91% 100% 14-May-21 80 China, Hong Kong SAR 12 9 5 0 0 0 4 1 0 (0.0%) 0.93 100% 100% 23-Jul-21 10 China, Macao SAR 2 1 1 0 0 0 0 1 0 (0.0%) 1.68 100% 100% 22-Jul-21 11 Japan 0 152 - - - - - - - - - - - - Lao People's Democratic Republic 43 23 11 0 0 0 0 11 8 (72.7%) 0.80 73% 64% 26-Jul-21 7 Malaysia 161 80 56 0 0 0 54 2 0 (0.0%) 1.17 88% 68% 21-Jul-21 12 Mongolia 1 10 1 0 0 0 1 0 0 (0.0%) 0.17 100% 100% 26-Jul-21 7 New Zealand 11 9 3 0 0 0 0 3 1 (33.3%) 0.56 33% 100% 29-Jun-21 34 Papua New Guinea 70 36 14 0 0 0 14 0 0 (0.0%) 0.70 40% 73% 02-Aug-21 0 Philippines 871 330 454 0 0 0 362 92 21 (4.6%) 2.31 72% 97% 26-Jul-21 7 Republic of Korea 48 62 15 0 0 0 9 6 2 (13.3%) 0.41 80% 93% 08-Jul-21 25 Singapore 3 6 1 0 0 0 1 0 0 (0.0%) 0.28 100% 100% 06-Jul-21 27 Viet Nam 430 274 95 0 0 0 9 86 62 (65.3%) 0.58 94% 85% 28-Jul-21 5 Pacific island countries and areas 12 6 8 0 0 0 5 3 1 (12.5%) 2.24 63% 50% 26-Jul-21 7 Total 6215 3465 1744 0 0 0 542 1202 403 (23.1%) 0.85 84% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO 2021 Non-polio AFP rate 2 Total % with adequate specimens 3> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Table 1B. Classification of AFP cases with onset in 2021 and key surveillance indicators 3 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 44 0 0 0 44 0 0 96% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 38 0 0 7 31 0 0 100% 14% 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 4383 23 0 110 4240 0 10 96% 2% 14-May-21 56 0 25 1 0 0 0 0 29 1 0 0 0 100% China, Anhui Prov. Lab 271 1 0 1 267 0 2 100% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 0 1 0 0 0 100% China, Beijing Prov. Lab 27 1 0 0 26 0 0 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Chongqing Prov. Lab 52 0 0 2 50 0 0 100% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 133 0 0 2 131 0 0 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 75 0 0 0 75 0 0 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 442 1 0 5 436 0 0 82% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Guangxi Prov. Lab 219 0 0 5 214 0 0 100% 2% Prov. Lab/CCDC 0 0 0 0 0 0 0 0 0 0 0 0 0 100% China, Guizhou Prov. Lab 152 2 0 2 148 0 0 99% 1% Prov. Lab/CCDC 4 0 4 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 31 0 0 1 29 0 1 97% 3% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 247 1 0 19 227 0 0 100% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Heilongjiang Prov. Lab 44 0 0 0 44 0 0 86% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 513 3 0 8 502 0 0 99% 2% Prov. Lab/CCDC 10 0 4 0 0 0 0 0 6 0 0 0 0 100% China, Hubei Prov. Lab 122 0 0 6 113 0 3 97% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 220 2 0 15 203 0 0 100% 5% Prov. Lab/CCDC 5 0 2 0 0 0 0 0 3 0 0 0 0 100% China, Jiangsu Prov. Lab 194 3 0 0 191 0 0 100% 0% Prov. Lab/CCDC 6 0 0 0 0 0 0 0 6 0 0 0 0 100% China, Jiangxi Prov. Lab 160 0 0 4 156 0 0 98% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 44 0 0 6 38 0 0 95% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 68 1 0 1 66 0 0 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Neimongol Prov. Lab 81 4 0 0 77 0 0 91% 0% Prov. Lab/CCDC 11 0 4 1 0 0 0 0 6 0 0 0 0 100% China, Ningxia Prov. Lab 21 0 0 1 20 0 0 95% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 22 0 0 0 22 0 0 82% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 99 0 0 0 99 0 0 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 258 0 0 1 256 0 1 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 28 0 0 0 28 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 76 0 0 0 76 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 306 2 0 13 291 0 0 94% 4% Prov. Lab/CCDC 7 0 2 0 0 0 0 0 5 0 0 0 0 100% China, Tianjin Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 92 0 0 1 89 0 2 72% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 183 0 0 15 168 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 152 1 0 2 149 0 0 100% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Tibet Prov. Lab 19 1 0 0 17 0 1 29% 0% CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hong Kong SAR PHLC 13 0 0 0 13 0 0 100% 0% 04-Jun-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 43 3 0 9 31 0 0 63% 19% 22-Apr-21 NIID 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Malaysia IMR 175 5 0 0 170 0 0 100% 0% 14-Apr-21 IMR 22 0 4 4 0 2 0 0 12 0 0 0 0 100% Mongolia PHI 1 0 0 1 0 0 0 100% 100% 06-Mar-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 7 0 0 0 7 0 0 100% 0% 22-Mar-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 70 5 0 12 53 0 0 98% 16% 19-Apr-21 VIDRL 28 0 10 0 0 0 0 0 11 0 7 0 0 100% Philippines RITM 853 32 0 34 787 0 0 98% 4% 02-Mar-21 RITM/NIID 68 0 12 0 0 33 2 0 21 0 0 0 0 100% Republic of Korea KCDC 48 0 0 0 48 0 0 99% 0% 14-Apr-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 08-Jan-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 234 1 0 31 202 0 0 99% 13% 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 225 0 0 22 203 0 0 100% 0% 13-Apr-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 12 0 0 0 12 0 0 100% 0% 09-Mar-21 VIDRL 0 - - - - - - - - - - - - - Total 6152 69 0 226 5847 0 10 96% 3% 182 0 53 5 0 35 2 0 79 1 7 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2020 and key laboratory indicators 4 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 34 0 0 1 32 1 0 92% 2% 02-Aug-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 0 - - - - - - - - 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 0 - - - - - - - - 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 1018 6 0 38 884 0 90 95% 3% 14-May-21 29 0 12 6 0 0 0 0 11 0 0 0 0 100% China, Anhui Prov. Lab 45 0 0 2 43 0 0 98% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Beijing Prov. Lab 16 0 0 2 12 0 2 86% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 16 0 0 0 16 0 0 94% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 21 0 0 0 15 0 6 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 27 1 0 0 25 0 1 100% 0% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Guangdong Prov. Lab 121 0 0 4 115 0 2 78% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangxi Prov. Lab 49 0 0 2 39 0 8 95% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 34 0 0 0 27 0 7 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 4 0 0 1 3 0 0 100% 25% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 49 0 0 4 44 0 1 100% 6% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 - China, Heilongjiang Prov. Lab 14 1 0 0 6 0 7 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Henan Prov. Lab 147 1 0 3 143 0 0 99% 2% Prov. Lab/CCDC 6 0 2 0 0 0 0 0 4 0 0 0 0 100% China, Hubei Prov. Lab 24 0 0 3 19 0 2 86% 14% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 48 0 0 1 21 0 26 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 36 0 0 0 34 0 2 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 34 0 0 2 32 0 0 94% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 13 0 0 1 12 0 0 92% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 19 0 0 0 19 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 28 0 0 0 12 0 16 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Ningxia Prov. Lab 5 0 0 0 5 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 2 0 0 0 2 0 0 0% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 18 0 0 0 16 0 2 94% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 57 0 0 1 54 0 2 100% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 7 0 0 0 7 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 19 1 0 0 18 0 0 89% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Sichuan Prov. Lab 73 0 0 6 64 0 3 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 3 0 0 0 3 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 18 1 0 0 16 0 1 94% 0% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 32 0 0 3 28 0 1 100% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 39 1 0 3 34 0 1 100% 5% Prov. Lab/CCDC 9 0 1 6 0 0 0 0 2 0 0 0 0 100% China, Tibet Prov. Lab 0 - - - - - - - - CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 5 0 0 0 5 0 0 100% 0% 27-Jul-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 1 0 0 0 1 0 0 100% 0% 22-Jul-21 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID 0 - - - - - - - - - - - - - Lao People's Democratic Republic NIID 0 - - - - - - - - 14-Apr-21 NIID 0 - - - - - - - - - - - - - Malaysia IMR 57 0 0 0 57 0 0 99% 0% 31-Jul-21 IMR 0 - - - - - - - - - - - - - Mongolia PHI 1 0 0 0 1 0 0 100% 0% 30-Jul-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 3 0 0 0 3 0 0 100% 0% 26-Jul-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 13 1 0 2 10 0 0 100% 8% 28-Jul-21 VIDRL 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Philippines RITM 471 4 0 15 431 19 2 99% 3% 02-Aug-21 RITM/NIID 12 0 4 0 0 0 0 0 8 0 0 0 0 100% Republic of Korea KCDC 14 0 0 0 13 0 1 100% 0% 08-Jul-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 1 0 0 0 1 0 0 100% 0% 02-Aug-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 14 0 0 1 12 1 0 96% 7% 31-May-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 79 0 0 22 54 0 3 100% 28% 15-Jun-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 4 0 0 0 4 0 0 100% 0% 19-Apr-21 VIDRL 0 - - - - - - - - - - - - - Total 1715 11 0 79 1508 21 96 96% 3% 42 0 16 6 0 0 0 0 20 0 0 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2021 and key laboratory indicators 5 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 16 1 0 0 0 0 0 0 0 1 0 2 0 0 7 0 0 0 0 0 0 0 0 0 0 7 0 0 China (total) 364 193 0 123 1 0 0 0 0 390 0 567 0 0 181 66 0 45 0 0 0 0 0 141 1 431 0 0 China, Fujian Prov. Lab/CCDC 65 34 0 9 0 0 0 0 0 54 0 68 0 0 31 3 0 4 0 0 0 0 0 2 0 148 0 0 China, Gansu Prov. Lab/CCDC 39 26 0 16 0 0 0 0 0 72 0 38 0 0 30 7 0 2 0 0 0 0 0 12 0 55 0 0 China, Guangdong Prov. Lab/CCDC 48 25 0 16 0 0 0 0 0 19 0 26 0 0 20 16 0 4 0 0 0 0 0 28 0 44 0 0 China, Guangxi Prov. Lab/CCDC 12 3 0 0 0 0 0 0 0 11 0 9 0 0 6 1 0 0 0 0 0 0 0 1 0 23 0 - China, Heilongjiang Prov. Lab/CCDC 40 21 0 7 0 0 0 0 0 44 0 111 0 0 8 3 0 1 0 0 0 0 0 3 0 8 0 0 China, Jiangxi Prov. Lab/CCDC 12 8 0 1 0 0 0 0 0 13 0 24 0 0 5 2 0 2 0 0 0 0 0 1 0 10 0 0 China, Neimongol Prov. Lab/CCDC 3 3 0 4 0 0 0 0 0 3 0 1 0 0 4 4 0 3 0 0 0 0 0 11 0 0 0 0 China, Qinghai Prov. Lab/CCDC 11 7 0 3 0 0 0 0 0 11 0 5 0 0 5 1 0 0 0 0 0 0 0 3 0 4 0 0 China, Shandong Prov. Lab/CCDC 32 20 0 14 0 0 0 0 0 25 0 107 0 0 8 3 0 3 0 0 0 0 0 11 0 12 0 0 China, Shanghai Prov. Lab/CCDC 24 14 0 9 0 0 0 0 0 18 0 7 0 0 25 3 0 1 0 0 0 0 0 1 1 24 0 0 China, Sichuan Prov. Lab/CCDC 30 13 0 6 0 0 0 0 0 36 0 70 0 0 0 0 - - - - - - - - - - - - China, Xinjiang Prov. Lab/CCDC 24 19 0 38 1 0 0 0 0 84 0 29 0 0 24 16 0 16 0 0 0 0 0 58 0 50 0 0 China, Yunnan Prov. Lab/CCDC 24 0 0 0 0 0 0 0 0 0 0 72 0 0 15 7 0 9 0 0 0 0 0 10 0 53 0 0 Malaysia IMR/VIDRL 700 97 0 33 9 0 11 7 0 74 1 29 0 0 311 0 0 0 0 0 0 0 0 0 0 17 28 0 Philippines RITM 384 77 0 20 0 0 95 8 0 62 0 95 0 0 375 57 0 22 0 0 0 0 0 95 0 126 60 0 Vietnam NIHE 0 - - - - - - - - - - - - - 31 0 0 0 0 0 0 0 0 0 0 4 0 0 Total 1464 368 0 176 10 0 106 15 0 527 1 693 0 0 905 123 0 67 0 0 0 0 0 236 1 585 88 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2020 2021 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD Table 3. Laboratory confirmation of polio isolates from environmental samples in 2020–20211 6 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2021 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 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) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP)iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) aVDPV3 (1 AFP) aVDPV1 (1 AFP + 1 env) aVDPV3 (1 AFP) cVDPV3 (1 non-AFP) aVDPV3 (1 contact) 5 ?VDPV1 (1 AFP) + cVDPV3 (1 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Malaysia cVDPV1 (3 AFP + 12 env)cVDPV2 (3 env) cVDPV1 (1 AFP + 1 non-AFP + 9 env) cVDPV2 (5 env) aVDPV2 (1 env) ?VDPV3 (1 env) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (2 AFP + 1 contact + 14 env) cVDPV2 (12 AFP + 5 non-AFP + 2 contact + 19 env) iVDPV2 (1 AFP) aVDPV2 (1 AFP) cVDPV2 (1 AFP + 4 env) aVDPV2 (1 AFP + 6 non-AFP + 3 env) Viet Nam aVDPV2 (2 AFP) 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 5. Contact of a different AFP case.

Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific GPEI statement on the UK aid cuts The Global Polio Eradication Initiative (GPEI) was deeply saddened by the UK parliament’s decision to support significant cuts to international aid, which includes a proposed 95% reduction in the contributions made to the GPEI by the UK for 2021. The GPEI will have to plan for significant funding cuts in the future. The polio programme’s importance to global health security cannot be overstated. During the pandemic, the GPEI’s resources and expertise have been deployed extensively to assist the COVID-19 response. The unique value of the polio infrastructure was recently highlighted during the G7 meeting when world leaders called for a global pandemic radar built on the existing surveillance networks of the polio and influenza programme. The GPEI looks forward to working with the UK and its other longstanding partners to protect progress and address the urgent issues that will arise from this shortfall in funding. For more information visit the following website: https://polioeradication.org/news-post/gpei- statement-on-the-uk-aid-cuts/ Polio Bulletin 2021 Issue No. 17 - Week 33 (as of 16 August 2021) CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2019–2021 Chart 2. Adequate specimen collection rate, 2019–2021 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2021 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2021 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 65.3% 0.0% 3.3% 0.0% 72.7% 0.0% 29.6% 0% 10% 20% 30% 40% 50% 60% 70% 80% VNM PNG PHL MYS LAO KHM CHN 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). 2019 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 63 47 51 0 0 0 51 0 0 (0.0%) 1.09 63% 100% 24-Feb-21 - Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.00 100% 100% 11-Jan-21 - Cambodia 55 47 72 0 0 0 14 58 27 (37.5%) 1.53 92% 93% 23-Dec-20 236 China 5183 2370 4427 0 0 0 4222 205 205 (4.6%) 1.87 93% 100% 14-May-21 94 China, Hong Kong SAR 14 9 12 0 0 0 12 0 0 (0.0%) 1.33 92% 100% 07-Jul-21 - China, Macao SAR 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 17-Feb-21 - Japan 0 152 - - - - - - - - - - - - Lao People's Democratic Republic 65 23 43 0 0 0 33 10 10 (23.3%) 1.87 74% 100% 23-Apr-21 115 Malaysia 194 78 161 0 1 2 158 0 0 (0.0%) 2.05 83% 77% 25-Mar-21 - Mongolia 5 10 1 0 0 0 1 0 0 (0.0%) 0.10 100% 100% 10-Mar-21 - New Zealand 8 9 11 0 0 0 10 1 1 (9.1%) 1.22 55% 73% 12-Apr-21 126 Papua New Guinea 222 36 70 0 0 0 70 0 0 (0.0%) 1.94 50% 74% 02-Aug-21 - Philippines 872 330 871 0 2 2 756 111 67 (7.7%) 2.63 62% 97% 15-Jan-21 213 Republic of Korea 81 63 48 0 0 0 48 0 0 (0.0%) 0.76 85% 100% 14-Apr-21 - Singapore 5 6 3 0 0 0 3 0 0 (0.0%) 0.50 100% 67% 07-Jan-21 - Viet Nam 353 241 430 0 0 0 430 0 0 (0.0%) 1.78 95% 62% 12-May-21 - Pacific island countries and areas 21 9 12 0 0 0 12 0 0 (0.0%) 1.33 67% 92% 26-Jul-21 - Total 7144 3432 6215 0 3 4 5823 385 310 (5.0%) 1.81 88% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO 2020 Non-polio AFP rate Total % with adequate specimens 2> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Table 1A. Classification of AFP cases with onset in 2020 and key surveillance indicators 2 Polio Bulletin 2020 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 51 48 38 0 0 0 23 15 2 (5.3%) 1.25 66% 100% 16-Aug-21 0 Brunei Darussalam 1 1 1 0 0 0 0 1 0 (0.0%) 1.58 100% 0% 24-Jul-21 23 Cambodia 72 48 5 0 0 0 0 5 0 (0.0%) 0.16 100% 80% 01-Mar-21 168 China 4427 2370 1037 0 0 0 60 977 307 (29.6%) 0.69 91% 100% 14-May-21 94 China, Hong Kong SAR 12 9 6 0 0 0 4 2 0 (0.0%) 1.05 83% 100% 12-Aug-21 4 China, Macao SAR 2 1 1 0 0 0 0 1 0 (0.0%) 1.58 100% 100% 22-Jul-21 25 Japan 0 152 - - - - - - - - - - - - Lao People's Democratic Republic 43 23 11 0 0 0 0 11 8 (72.7%) 0.75 73% 64% 26-Jul-21 21 Malaysia 161 80 59 0 0 0 54 5 0 (0.0%) 1.16 86% 69% 03-Aug-21 13 Mongolia 1 10 1 0 0 0 1 0 0 (0.0%) 0.16 100% 100% 11-Aug-21 5 New Zealand 11 9 4 0 0 0 0 4 2 (50.0%) 0.70 25% 75% 12-Aug-21 4 Papua New Guinea 70 36 16 0 0 0 14 2 0 (0.0%) 0.70 50% 75% 09-Aug-21 7 Philippines 871 330 482 0 0 0 412 70 16 (3.3%) 2.30 73% 98% 10-Aug-21 6 Republic of Korea 48 62 15 0 0 0 15 0 0 (0.0%) 0.38 80% 93% 06-Aug-21 10 Singapore 3 6 2 0 0 0 2 0 0 (0.0%) 0.53 100% 100% 09-Aug-21 7 Viet Nam 430 274 95 0 0 0 9 86 62 (65.3%) 0.55 94% 85% 28-Jul-21 19 Pacific island countries and areas 12 6 8 0 0 0 5 3 1 (12.5%) 2.10 63% 50% 26-Jul-21 21 Total 6215 3465 1781 0 0 0 599 1182 398 (22.3%) 0.81 85% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) 2021 Non-polio AFP rate 2 Total % with adequate specimens 3 Table 1B. Classification of AFP cases with onset in 2021 and key surveillance indicators 3 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 44 0 0 0 44 0 0 96% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 38 0 0 7 31 0 0 100% 14% 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 4383 23 0 110 4240 0 10 96% 2% 14-May-21 56 0 25 1 0 0 0 0 29 1 0 0 0 100% China, Anhui Prov. Lab 271 1 0 1 267 0 2 100% 0% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 0 1 0 0 0 100% China, Beijing Prov. Lab 27 1 0 0 26 0 0 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Chongqing Prov. Lab 52 0 0 2 50 0 0 100% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 133 0 0 2 131 0 0 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 75 0 0 0 75 0 0 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 442 1 0 5 436 0 0 82% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Guangxi Prov. Lab 219 0 0 5 214 0 0 100% 2% Prov. Lab/CCDC 0 0 0 0 0 0 0 0 0 0 0 0 0 100% China, Guizhou Prov. Lab 152 2 0 2 148 0 0 99% 1% Prov. Lab/CCDC 4 0 4 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 31 0 0 1 29 0 1 97% 3% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 247 1 0 19 227 0 0 100% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Heilongjiang Prov. Lab 44 0 0 0 44 0 0 86% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 513 3 0 8 502 0 0 99% 2% Prov. Lab/CCDC 10 0 4 0 0 0 0 0 6 0 0 0 0 100% China, Hubei Prov. Lab 122 0 0 6 113 0 3 97% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 220 2 0 15 203 0 0 100% 5% Prov. Lab/CCDC 5 0 2 0 0 0 0 0 3 0 0 0 0 100% China, Jiangsu Prov. Lab 194 3 0 0 191 0 0 100% 0% Prov. Lab/CCDC 6 0 0 0 0 0 0 0 6 0 0 0 0 100% China, Jiangxi Prov. Lab 160 0 0 4 156 0 0 98% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 44 0 0 6 38 0 0 95% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 68 1 0 1 66 0 0 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Neimongol Prov. Lab 81 4 0 0 77 0 0 91% 0% Prov. Lab/CCDC 11 0 4 1 0 0 0 0 6 0 0 0 0 100% China, Ningxia Prov. Lab 21 0 0 1 20 0 0 95% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 22 0 0 0 22 0 0 82% 0% - Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 99 0 0 0 99 0 0 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 258 0 0 1 256 0 1 99% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 28 0 0 0 28 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 76 0 0 0 76 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 306 2 0 13 291 0 0 94% 4% Prov. Lab/CCDC 7 0 2 0 0 0 0 0 5 0 0 0 0 100% China, Tianjin Prov. Lab 32 0 0 0 32 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 92 0 0 1 89 0 2 72% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 183 0 0 15 168 0 0 96% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 152 1 0 2 149 0 0 100% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Tibet Prov. Lab 19 1 0 0 17 0 1 29% 0% CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hong Kong SAR PHLC 13 0 0 0 13 0 0 100% 0% 04-Jun-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 43 3 0 9 31 0 0 63% 19% 22-Apr-21 NIID 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Malaysia IMR 175 5 0 0 170 0 0 100% 0% 14-Apr-21 IMR 22 0 4 4 0 2 0 0 12 0 0 0 0 100% Mongolia PHI 1 0 0 1 0 0 0 100% 100% 06-Mar-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 7 0 0 0 7 0 0 100% 0% 22-Mar-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 70 5 0 12 53 0 0 98% 16% 19-Apr-21 VIDRL 28 0 10 0 0 0 0 0 11 0 7 0 0 100% Philippines RITM 853 32 0 34 787 0 0 98% 4% 02-Mar-21 RITM/NIID 68 0 12 0 0 33 2 0 21 0 0 0 0 100% Republic of Korea KCDC 48 0 0 0 48 0 0 99% 0% 14-Apr-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 08-Jan-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 234 1 0 31 202 0 0 99% 13% 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 225 0 0 22 203 0 0 100% 0% 13-Apr-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 12 0 0 0 12 0 0 100% 0% 09-Mar-21 VIDRL 0 - - - - - - - - - - - - - Total 6152 69 0 226 5847 0 10 96% 3% 182 0 53 5 0 35 2 0 79 1 7 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2020 and key laboratory indicators 4 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 37 0 0 1 36 0 0 93% 1% 16-Aug-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 09-Aug-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 0 - - - - - - - - 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 1018 6 0 38 884 0 90 95% 3% 14-May-21 29 0 12 6 0 0 0 0 11 0 0 0 0 100% China, Anhui Prov. Lab 45 0 0 2 43 0 0 98% 3% Prov. Lab/CCDC 0 0 0 0 0 0 0 0 0 0 0 0 0 - China, Beijing Prov. Lab 16 0 0 2 12 0 2 86% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 16 0 0 0 16 0 0 94% 0% Prov. Lab/CCDC 0 0 0 0 0 0 0 0 0 0 0 0 0 - China, Fujian Prov. Lab 21 0 0 0 15 0 6 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 27 1 0 0 25 0 1 100% 0% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Guangdong Prov. Lab 121 0 0 4 115 0 2 78% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangxi Prov. Lab 49 0 0 2 39 0 8 95% 4% Prov. Lab/CCDC 0 0 0 0 0 0 0 0 0 0 0 0 0 - China, Guizhou Prov. Lab 34 0 0 0 27 0 7 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 4 0 0 1 3 0 0 100% 25% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 49 0 0 4 44 0 1 100% 6% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 14 1 0 0 6 0 7 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Henan Prov. Lab 147 1 0 3 143 0 0 99% 2% Prov. Lab/CCDC 6 0 2 0 0 0 0 0 4 0 0 0 0 100% China, Hubei Prov. Lab 24 0 0 3 19 0 2 86% 14% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 48 0 0 1 21 0 26 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 36 0 0 0 34 0 2 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 34 0 0 2 32 0 0 94% 6% Prov. Lab/CCDC 0 - China, Jilin Prov. Lab 13 0 0 1 12 0 0 92% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 19 0 0 0 19 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 28 0 0 0 12 0 16 100% 0% Prov. Lab/CCDC 0 - China, Ningxia Prov. Lab 5 0 0 0 5 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 2 0 0 0 2 0 0 0% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 18 0 0 0 16 0 2 94% 0% Prov. Lab/CCDC 0 - China, Shandong Prov. Lab 57 0 0 1 54 0 2 100% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 7 0 0 0 7 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 19 1 0 0 18 0 0 89% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Sichuan Prov. Lab 73 0 0 6 64 0 3 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 3 0 0 0 3 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 18 1 0 0 16 0 1 94% 0% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 32 0 0 3 28 0 1 100% 8% Prov. Lab/CCDC 0 - China, Zhejiang Prov. Lab 39 1 0 3 34 0 1 100% 5% Prov. Lab/CCDC 9 0 1 6 0 0 0 0 2 0 0 0 0 100% China, Tibet Prov. Lab 0 - - - - - - - - CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 6 0 0 0 5 1 0 100% 0% 12-Aug-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 1 0 0 0 1 0 0 100% 0% 04-Aug-21 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 0 - - - - - - - - 14-Apr-21 NIID 0 - - - - - - - - - - - - - Malaysia IMR 61 0 0 0 61 0 0 93% 0% 15-Aug-21 IMR 0 - - - - - - - - - - - - - Mongolia PHI 1 0 0 0 1 0 0 100% 0% 14-Aug-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 4 0 0 0 3 1 0 100% 0% 13-Aug-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 13 1 0 2 10 0 0 100% 8% 28-Jul-21 VIDRL 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Philippines RITM 534 4 0 18 473 37 2 99% 3% 16-Aug-21 RITM/NIID 12 0 4 0 0 0 0 0 8 0 0 0 0 100% Republic of Korea KCDC 14 0 0 0 13 0 1 100% 0% 08-Jul-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 2 0 0 0 2 0 0 100% 0% 12-Aug-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 14 0 0 1 12 1 0 96% 7% 31-May-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 79 0 0 22 54 0 3 100% 28% 15-Jun-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 4 0 0 0 4 0 0 100% 0% 19-Apr-21 VIDRL 0 - - - - - - - - - - - - - Total 1789 11 0 82 1560 40 96 97% 3% 42 0 16 6 0 0 0 0 20 0 0 0 0 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPVNegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2021 and key laboratory indicators 5 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 16 1 0 0 0 0 0 0 0 1 0 2 0 0 7 0 0 0 0 0 0 0 0 0 0 7 0 0 China (total) 364 193 0 123 1 0 0 0 0 390 0 567 0 0 181 66 0 45 0 0 0 0 0 141 1 431 0 0 China, Fujian Prov. Lab/CCDC 65 34 0 9 0 0 0 0 0 54 0 68 0 0 31 3 0 4 0 0 0 0 0 2 0 148 0 0 China, Gansu Prov. Lab/CCDC 39 26 0 16 0 0 0 0 0 72 0 38 0 0 30 7 0 2 0 0 0 0 0 12 0 55 0 0 China, Guangdong Prov. Lab/CCDC 48 25 0 16 0 0 0 0 0 19 0 26 0 0 20 16 0 4 0 0 0 0 0 28 0 44 0 0 China, Guangxi Prov. Lab/CCDC 12 3 0 0 0 0 0 0 0 11 0 9 0 0 6 1 0 0 0 0 0 0 0 1 0 23 0 - China, Heilongjiang Prov. Lab/CCDC 40 21 0 7 0 0 0 0 0 44 0 111 0 0 8 3 0 1 0 0 0 0 0 3 0 8 0 0 China, Jiangxi Prov. Lab/CCDC 12 8 0 1 0 0 0 0 0 13 0 24 0 0 5 2 0 2 0 0 0 0 0 1 0 10 0 0 China, Neimongol Prov. Lab/CCDC 3 3 0 4 0 0 0 0 0 3 0 1 0 0 4 4 0 3 0 0 0 0 0 11 0 0 0 0 China, Qinghai Prov. Lab/CCDC 11 7 0 3 0 0 0 0 0 11 0 5 0 0 5 1 0 0 0 0 0 0 0 3 0 4 0 0 China, Shandong Prov. Lab/CCDC 32 20 0 14 0 0 0 0 0 25 0 107 0 0 8 3 0 3 0 0 0 0 0 11 0 12 0 0 China, Shanghai Prov. Lab/CCDC 24 14 0 9 0 0 0 0 0 18 0 7 0 0 25 3 0 1 0 0 0 0 0 1 1 24 0 0 China, Sichuan Prov. Lab/CCDC 30 13 0 6 0 0 0 0 0 36 0 70 0 0 0 0 - - - - - - - - - - - - China, Xinjiang Prov. Lab/CCDC 24 19 0 38 1 0 0 0 0 84 0 29 0 0 24 16 0 16 0 0 0 0 0 58 0 50 0 0 China, Yunnan Prov. Lab/CCDC 24 0 0 0 0 0 0 0 0 0 0 72 0 0 15 7 0 9 0 0 0 0 0 10 0 53 0 0 Malaysia IMR/VIDRL 700 97 0 33 9 0 11 7 0 74 1 29 0 0 311 0 0 0 0 0 0 0 0 0 0 17 28 0 Philippines RITM 384 77 0 20 0 0 95 8 0 62 0 95 0 0 416 60 0 32 0 0 0 0 0 99 0 140 72 0 Vietnam NIHE 0 - - - - - - - - - - - - - 31 0 0 0 0 0 0 0 0 0 0 4 0 0 Total 1464 368 0 176 10 0 106 15 0 527 1 693 0 0 946 126 0 77 0 0 0 0 0 240 1 599 100 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2020 2021 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD Table 3. Laboratory confirmation of polio isolates from environmental samples in 2020–20211 6 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2021 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 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) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP)iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) aVDPV3 (1 AFP) aVDPV1 (1 AFP + 1 env) aVDPV3 (1 AFP) cVDPV3 (1 non-AFP) aVDPV3 (1 contact) 5 ?VDPV1 (1 AFP) + cVDPV3 (1 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Malaysia cVDPV1 (3 AFP + 12 env)cVDPV2 (3 env) cVDPV1 (1 AFP + 1 non-AFP + 9 env) cVDPV2 (5 env) aVDPV2 (1 env) ?VDPV3 (1 env) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (2 AFP + 1 contact + 14 env) cVDPV2 (12 AFP + 5 non-AFP + 2 contact + 19 env) iVDPV2 (1 AFP) aVDPV2 (1 AFP) cVDPV2 (1 AFP + 4 env) aVDPV2 (1 AFP + 6 non-AFP + 3 env) Viet Nam aVDPV2 (2 AFP) 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 5. Contact of a different AFP case.

Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific GPEI Statement on Afghanistan The polio programme in Afghanistan has operated for many years amid insecurity and conflict, and will continue working with all actors, agencies and organizations who enable delivery of immunization as well as deliver humanitarian assistance to populations in need across the country. The Global Polio Eradication Initiative remains committed to protecting all children from polio and supporting the provision of other essential immunizations and health services. We strongly believe that the delivery of health care – including polio vaccination – is essential to prevent diseases and safeguard communities. Together with our partners, the people of Afghanistan, national and provincial authorities, we will do everything in our power to continue this critical work. For more information visit the following website: https://polioeradication.org/news- post/gpei-statement-on-afghanistan/ Polio Bulletin 2021 Issue No. 18 - Week 35 (as of 30 August 2021) CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2019–2021 Chart 2. Adequate specimen collection rate, 2019–2021 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2021 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2021 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 65.3% 0.0% 4.8% 0.0% 64.3% 0.0% 29.6% 0% 10% 20% 30% 40% 50% 60% 70% VNM PNG PHL MYS LAO KHM CHN 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). 2019 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 63 47 51 0 0 0 51 0 0 (0.0%) 1.09 63% 100% 24-Feb-21 - Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.00 100% 100% 11-Jan-21 - Cambodia 55 47 72 0 0 0 14 58 27 (37.5%) 1.53 92% 93% 23-Dec-20 250 China 5183 2370 4369 0 0 0 4369 0 0 (0.0%) 1.84 92% 98% 19-Aug-21 - China, Hong Kong SAR 14 9 12 0 0 0 12 0 0 (0.0%) 1.33 92% 100% 07-Jul-21 - China, Macao SAR 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 17-Feb-21 - Japan - 152 - - - - - - - - - - - - Lao People's Democratic Republic 65 23 43 0 0 0 33 10 10 (23.3%) 1.87 74% 100% 23-Apr-21 129 Malaysia 194 78 161 0 1 2 158 0 0 (0.0%) 2.05 83% 77% 25-Mar-21 - Mongolia 5 10 1 0 0 0 1 0 0 (0.0%) 0.10 100% 100% 10-Mar-21 - New Zealand 8 9 11 0 0 0 10 1 1 (9.1%) 1.22 55% 73% 12-Apr-21 140 Papua New Guinea 222 36 65 0 0 0 65 0 0 (0.0%) 1.81 54% 80% 02-Aug-21 - Philippines 872 330 883 0 2 3 878 0 0 (0.0%) 2.67 64% 98% 26-Aug-21 - Republic of Korea 81 63 48 0 0 0 48 0 0 (0.0%) 0.76 85% 100% 14-Apr-21 - Singapore 5 6 3 0 0 0 3 0 0 (0.0%) 0.50 100% 67% 07-Jan-21 - Viet Nam 353 241 430 0 0 0 430 0 0 (0.0%) 1.78 95% 62% 12-May-21 - Pacific island countries and areas 21 9 12 0 0 0 12 0 0 (0.0%) 1.33 67% 92% 26-Jul-21 - Total 7144 3432 6164 0 3 5 6087 69 38 (0.6%) 1.80 87% 95% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) 2020 Non-polio AFP rate Total % with adequate specimens 2 Table 1A. Classification of AFP cases with onset in 2020 and key surveillance indicators 2 Polio Bulletin 2020 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 51 48 39 0 0 0 23 16 3 (7.7%) 1.21 62% 100% 30-Aug-21 0 Brunei Darussalam 1 1 1 0 0 0 0 1 0 (0.0%) 1.49 100% 0% 24-Jul-21 37 Cambodia 72 48 5 0 0 0 0 5 0 (0.0%) 0.15 100% 80% 01-Mar-21 182 China 4369 2370 1037 0 0 0 60 977 307 (29.6%) 0.65 91% 100% 14-May-21 108 China, Hong Kong SAR 12 9 6 0 0 0 4 2 0 (0.0%) 0.99 100% 100% 17-Aug-21 13 China, Macao SAR 2 1 1 0 0 0 0 1 0 (0.0%) 1.49 100% 100% 22-Jul-21 39 Japan - 152 - - - - - - - - - - - - Lao People's Democratic Republic 43 23 14 0 0 0 0 14 9 (64.3%) 0.90 64% 71% 27-Aug-21 3 Malaysia 161 80 68 0 0 0 57 11 0 (0.0%) 1.26 82% 69% 25-Aug-21 5 Mongolia 1 10 1 0 0 0 1 0 0 (0.0%) 0.15 100% 100% 11-Aug-21 19 New Zealand 11 9 5 0 0 0 0 5 2 (40.0%) 0.83 40% 80% 25-Aug-21 5 Papua New Guinea 65 36 16 0 0 0 14 2 0 (0.0%) 0.66 50% 75% 09-Aug-21 21 Philippines 883 330 545 0 0 0 453 92 26 (4.8%) 2.45 72% 98% 24-Aug-21 6 Republic of Korea 48 62 15 0 0 0 15 0 0 (0.0%) 0.36 80% 93% 06-Aug-21 24 Singapore 3 6 2 0 0 0 2 0 0 (0.0%) 0.50 100% 100% 09-Aug-21 21 Viet Nam 430 274 95 0 0 0 9 86 62 (65.3%) 0.52 94% 85% 28-Jul-21 33 Pacific island countries and areas 12 6 8 0 0 0 5 3 1 (12.5%) 1.98 63% 50% 26-Jul-21 35 Total 6164 3465 1858 0 0 0 643 1215 410 (22.1%) 0.80 84% 96% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO 2021 Non-polio AFP rate 2 Total % with adequate specimens 3> 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Table 1B. Classification of AFP cases with onset in 2021 and key surveillance indicators 3 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 44 0 0 0 44 0 0 96% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 38 0 0 7 31 0 0 100% 14% 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 4278 0 21 105 4136 0 16 96% 2% 19-Aug-21 56 0 25 1 0 0 0 0 29 1 0 0 0 100% China, Anhui Prov. Lab 237 0 0 2 233 0 2 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 0 1 0 0 0 100% China, Beijing Prov. Lab 71 0 1 2 68 0 0 100% 4% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Chongqing Prov. Lab 71 0 0 2 69 0 0 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 130 0 0 2 128 0 0 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 66 0 0 1 65 0 0 100% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 437 0 1 3 432 0 1 82% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Guangxi Prov. Lab 215 0 0 6 209 0 0 100% 2% Prov. Lab/CCDC 0 0 0 0 0 0 0 0 0 0 0 0 0 100% China, Guizhou Prov. Lab 138 0 2 2 132 0 2 99% 3% Prov. Lab/CCDC 4 0 4 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 27 0 0 1 26 0 0 96% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 211 0 1 17 193 0 0 100% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Heilongjiang Prov. Lab 49 0 0 0 49 0 0 87% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 492 0 3 7 482 0 0 99% 2% Prov. Lab/CCDC 10 0 4 0 0 0 0 0 6 0 0 0 0 100% China, Hubei Prov. Lab 119 0 0 5 111 0 3 97% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 220 0 2 15 202 0 1 100% 6% Prov. Lab/CCDC 5 0 2 0 0 0 0 0 3 0 0 0 0 100% China, Jiangsu Prov. Lab 200 0 3 0 197 0 0 100% 2% Prov. Lab/CCDC 6 0 0 0 0 0 0 0 6 0 0 0 0 100% China, Jiangxi Prov. Lab 142 0 0 3 139 0 0 98% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 46 0 0 6 40 0 0 95% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 66 0 0 1 65 0 0 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Neimongol Prov. Lab 60 0 4 0 56 0 0 92% 6% Prov. Lab/CCDC 11 0 4 1 0 0 0 0 6 0 0 0 0 100% China, Ningxia Prov. Lab 24 0 0 1 23 0 0 96% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 19 0 0 0 19 0 0 84% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 109 0 0 0 109 0 0 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 237 0 0 0 236 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 55 0 0 0 55 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 70 0 0 0 69 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 295 0 2 12 281 0 0 95% 4% Prov. Lab/CCDC 7 0 2 0 0 0 0 0 5 0 0 0 0 100% China, Tianjin Prov. Lab 42 0 0 0 42 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 84 0 0 1 80 0 3 72% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 175 0 0 14 161 0 0 95% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 155 0 1 2 150 0 2 100% 2% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Tibet Prov. Lab 16 0 1 0 15 0 0 32% 6% CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hong Kong SAR PHLC 13 0 0 0 13 0 0 100% 0% 04-Jun-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 43 3 0 9 31 0 0 63% 19% 18-Aug-21 NIID 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Malaysia IMR 175 5 0 0 170 0 0 100% 0% 14-Apr-21 IMR 22 0 4 4 0 2 0 0 12 0 0 0 0 100% Mongolia PHI 1 0 0 1 0 0 0 100% 100% 06-Mar-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 7 0 0 0 7 0 0 100% 0% 22-Mar-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 70 5 0 12 53 0 0 98% 16% 19-Apr-21 VIDRL 28 0 10 0 0 0 0 0 11 0 7 0 0 100% Philippines RITM 853 32 0 34 787 0 0 98% 4% 02-Mar-21 RITM/NIID 68 0 12 0 0 33 2 0 21 0 0 0 0 100% Republic of Korea KCDC 48 0 0 0 48 0 0 99% 0% 14-Apr-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 08-Jan-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 234 1 0 31 202 0 0 99% 13% 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 225 0 0 22 203 0 0 100% 0% 13-Apr-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 12 0 0 0 12 0 0 100% 0% 09-Mar-21 VIDRL 0 - - - - - - - - - - - - - Total 6047 46 21 221 5743 0 16 96% 4% 182 0 53 5 0 35 2 0 79 1 7 0 0 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPVNegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2020 and key laboratory indicators 4 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 37 0 0 1 36 0 0 93% 1% 16-Aug-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 09-Aug-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 0 - - - - - - - - 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 1018 6 0 38 884 0 90 95% 3% 14-May-21 35 0 17 6 0 0 0 0 12 0 0 0 0 100% China, Anhui Prov. Lab 45 0 0 2 43 0 0 98% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Beijing Prov. Lab 16 0 0 2 12 0 2 86% 11% Prov. Lab/CCDC 2 0 1 0 0 0 0 0 1 0 0 0 0 100% China, Chongqing Prov. Lab 16 0 0 0 16 0 0 94% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 21 0 0 0 15 0 6 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 27 1 0 0 25 0 1 100% 0% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Guangdong Prov. Lab 121 0 0 4 115 0 2 78% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangxi Prov. Lab 49 0 0 2 39 0 8 95% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 34 0 0 0 27 0 7 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 4 0 0 1 3 0 0 100% 25% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 49 0 0 4 44 0 1 100% 6% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 14 1 0 0 6 0 7 100% 0% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Henan Prov. Lab 147 1 0 3 143 0 0 99% 2% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Hubei Prov. Lab 24 0 0 3 19 0 2 86% 14% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 48 0 0 1 21 0 26 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 36 0 0 0 34 0 2 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 34 0 0 2 32 0 0 94% 6% Prov. Lab/CCDC 0 - China, Jilin Prov. Lab 13 0 0 1 12 0 0 92% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 19 0 0 0 19 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 28 0 0 0 12 0 16 100% 0% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Ningxia Prov. Lab 5 0 0 0 5 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 2 0 0 0 2 0 0 0% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 18 0 0 0 16 0 2 94% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 57 0 0 1 54 0 2 100% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 7 0 0 0 7 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 19 1 0 0 18 0 0 89% 0% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Sichuan Prov. Lab 73 0 0 6 64 0 3 99% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 3 0 0 0 3 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 18 1 0 0 16 0 1 94% 0% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 32 0 0 3 28 0 1 100% 8% Prov. Lab/CCDC 0 - China, Zhejiang Prov. Lab 39 1 0 3 34 0 1 100% 5% Prov. Lab/CCDC 9 0 1 6 0 0 0 0 2 0 0 0 0 100% China, Tibet Prov. Lab 0 - - - - - - - - CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 6 0 0 0 6 0 0 100% 0% 26-Aug-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 1 0 0 0 1 0 0 100% 0% 04-Aug-21 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 0 - - - - - - - - 14-Apr-21 NIID 0 - - - - - - - - - - - - - Malaysia IMR 81 0 0 0 81 0 0 94% 0% 28-Aug-21 IMR 0 - - - - - - - - - - - - - Mongolia PHI 1 0 0 0 1 0 0 100% 0% 25-Aug-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 5 0 0 0 3 1 1 100% 0% 26-Aug-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 15 1 0 2 12 0 0 100% 7% 30-Aug-21 VIDRL 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Philippines RITM 569 4 0 18 531 14 2 100% 3% 30-Aug-21 RITM/NIID 12 0 4 0 0 0 0 0 8 0 0 0 0 100% Republic of Korea KCDC 14 0 0 0 13 0 1 100% 0% 08-Jul-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 2 0 0 0 2 0 0 100% 0% 27-Aug-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 29 0 0 3 26 0 0 100% 10% 25-Aug-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 79 0 0 22 54 0 3 100% 29% 15-Jun-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 4 0 0 0 4 0 0 100% 0% 19-Apr-21 VIDRL 0 - - - - - - - - - - - - - Total 1862 11 0 84 1655 15 97 97% 3% 48 0 21 6 0 0 0 0 21 0 0 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2021 and key laboratory indicators 5 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 16 1 0 0 0 0 0 0 0 1 0 2 0 0 8 0 0 0 0 0 0 0 0 0 0 8 0 0 China (total) 364 193 0 123 1 0 0 0 0 390 0 567 0 0 181 66 0 45 0 0 0 0 0 141 1 431 0 0 China, Fujian Prov. Lab/CCDC 65 34 0 9 0 0 0 0 0 54 0 68 0 0 31 3 0 4 0 0 0 0 0 2 0 148 0 0 China, Gansu Prov. Lab/CCDC 39 26 0 16 0 0 0 0 0 72 0 38 0 0 30 7 0 2 0 0 0 0 0 12 0 55 0 0 China, Guangdong Prov. Lab/CCDC 48 25 0 16 0 0 0 0 0 19 0 26 0 0 20 16 0 4 0 0 0 0 0 28 0 44 0 0 China, Guangxi Prov. Lab/CCDC 12 3 0 0 0 0 0 0 0 11 0 9 0 0 6 1 0 0 0 0 0 0 0 1 0 23 0 - China, Heilongjiang Prov. Lab/CCDC 40 21 0 7 0 0 0 0 0 44 0 111 0 0 8 3 0 1 0 0 0 0 0 3 0 8 0 0 China, Jiangxi Prov. Lab/CCDC 12 8 0 1 0 0 0 0 0 13 0 24 0 0 5 2 0 2 0 0 0 0 0 1 0 10 0 0 China, Neimongol Prov. Lab/CCDC 3 3 0 4 0 0 0 0 0 3 0 1 0 0 4 4 0 3 0 0 0 0 0 11 0 0 0 0 China, Qinghai Prov. Lab/CCDC 11 7 0 3 0 0 0 0 0 11 0 5 0 0 5 1 0 0 0 0 0 0 0 3 0 4 0 0 China, Shandong Prov. Lab/CCDC 32 20 0 14 0 0 0 0 0 25 0 107 0 0 8 3 0 3 0 0 0 0 0 11 0 12 0 0 China, Shanghai Prov. Lab/CCDC 24 14 0 9 0 0 0 0 0 18 0 7 0 0 25 3 0 1 0 0 0 0 0 1 1 24 0 0 China, Sichuan Prov. Lab/CCDC 30 13 0 6 0 0 0 0 0 36 0 70 0 0 0 0 - - - - - - - - - - - - China, Xinjiang Prov. Lab/CCDC 24 19 0 38 1 0 0 0 0 84 0 29 0 0 24 16 0 16 0 0 0 0 0 58 0 50 0 0 China, Yunnan Prov. Lab/CCDC 24 0 0 0 0 0 0 0 0 0 0 72 0 0 15 7 0 9 0 0 0 0 0 10 0 53 0 0 Malaysia IMR/VIDRL 700 97 0 33 9 0 11 7 0 74 1 29 0 0 341 0 0 0 0 0 0 0 0 0 0 19 26 0 Philippines RITM 384 77 0 20 0 0 95 8 0 62 0 95 0 0 442 66 0 24 0 0 0 0 0 106 0 154 80 0 Vietnam NIHE 0 - - - - - - - - - - - - - 31 0 0 0 0 0 0 0 0 0 0 4 0 0 Total 1464 368 0 176 10 0 106 15 0 527 1 693 0 0 1003 132 0 69 0 0 0 0 0 247 1 616 106 0 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 2020 2021 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD Table 3. Laboratory confirmation of polio isolates from environmental samples in 2020–20211 6 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2021 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 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) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP)iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) aVDPV3 (1 AFP) aVDPV1 (1 AFP + 1 env) aVDPV3 (1 AFP) cVDPV3 (1 non-AFP) aVDPV3 (1 contact) 5 ?VDPV1 (1 AFP) + cVDPV3 (1 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Malaysia cVDPV1 (3 AFP + 12 env)cVDPV2 (3 env) cVDPV1 (1 AFP + 1 non-AFP + 9 env) cVDPV2 (5 env) aVDPV2 (1 env) ?VDPV3 (1 env) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (2 AFP + 1 contact + 14 env) cVDPV2 (12 AFP + 5 non-AFP + 2 contact + 19 env) iVDPV2 (1 AFP) aVDPV2 (1 AFP) cVDPV2 (1 AFP + 4 env) aVDPV2 (1 AFP + 6 non-AFP + 3 env) Viet Nam aVDPV2 (2 AFP) 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 5. Contact of a different AFP case.

Vaccine-Preventable Diseases and Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 8528 8001 Fax: +63 2 8521 1036, 8526 0279 Email: wproepidata@who.int Web: www.who.int/westernpacific Closure of polio outbreak in Malaysia The twenty-ninth meeting of the Emergency Committee under the International Health Regulations (2005) on the international spread of poliovirus was convened by the WHO Director- General on 4 August 2021. The Committee noted sharp decrease in number of type 1 wild poliovirus (WPV) and type 2 circulating vaccine-derived polio virus (cVDPV) cases but warned that the situation in Afghanistan risked a rapid reversal of progress. The committee removed Malaysia form he list of countries infected with cVDPV which is considered official closure of type 1 and type 2 cVDPV outbreaks affected the country in 2019- 2020. Based on the current situation regarding WPV1 and cVDPV, and the reports provided by affected countries, the WHO Director-General accepted the Committee’s assessment and on 10 August 2021 determined that the situation relating to poliovirus continues to constitute a PHEIC, with respect to WPV1 and cVDPV. For the complete Committee’s statement please visit the WHO official website following this link: https://www.who.int/news/item/20-08- 2021-statement-of-the-twenty-ninth-polio-ihr- emergency-committee Polio Bulletin 2021 Issue No. 19 - Week 37 (as of 14 September 2021) CONTACT US HIGHLIGHTS Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2019–2021 Chart 2. Adequate specimen collection rate, 2019–2021 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2021 Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2021 0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 19 20 21 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% CHN KHM LAO MYS PHL PNG VNM ≥ 3 doses 1-2 doses 0 doses Unknown 68.0% 0.0% 3.8% 0.0% 64.3% 0.0% 32.1% 0% 10% 20% 30% 40% 50% 60% 70% 80% VNM PNG PHL MYS LAO KHM CHN 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). 2019 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 63 47 51 0 0 0 51 0 0 (0.0%) 1.09 63% 100% 24-Feb-21 - Brunei Darussalam 2 1 1 0 0 0 1 0 0 (0.0%) 1.00 100% 100% 11-Jan-21 - Cambodia 55 47 72 0 0 0 14 58 27 (37.5%) 1.53 92% 93% 23-Dec-20 265 China 5183 2370 4369 0 0 0 4369 0 0 (0.0%) 1.84 92% 98% 19-Aug-21 - China, Hong Kong SAR 14 9 12 0 0 0 12 0 0 (0.0%) 1.33 92% 100% 07-Jul-21 - China, Macao SAR 1 1 2 0 0 0 2 0 0 (0.0%) 2.00 100% 100% 17-Feb-21 - Japan - 152 - - - - - - - - - - - - Lao People's Democratic Republic 65 23 43 0 0 0 33 10 10 (23.3%) 1.87 74% 100% 23-Apr-21 144 Malaysia 194 78 161 0 1 2 158 0 0 (0.0%) 2.05 83% 77% 25-Mar-21 - Mongolia 5 10 1 0 0 0 1 0 0 (0.0%) 0.10 100% 100% 10-Mar-21 - New Zealand 8 9 11 0 0 0 10 1 1 (9.1%) 1.22 55% 73% 12-Apr-21 155 Papua New Guinea 222 36 65 0 0 0 65 0 0 (0.0%) 1.81 54% 80% 02-Aug-21 - Philippines 872 330 883 0 2 3 878 0 0 (0.0%) 2.67 64% 98% 26-Aug-21 - Republic of Korea 81 63 48 0 0 0 48 0 0 (0.0%) 0.76 85% 100% 14-Apr-21 - Singapore 5 6 3 0 0 0 3 0 0 (0.0%) 0.50 100% 67% 07-Jan-21 - Viet Nam 353 241 430 0 0 0 430 0 0 (0.0%) 1.78 95% 62% 12-May-21 - Pacific island countries and areas 21 9 12 0 0 0 12 0 0 (0.0%) 1.33 67% 92% 26-Jul-21 - Total 7144 3432 6164 0 3 5 6087 69 38 (0.6%) 1.80 87% 95% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases investigated within two days of notification Substantially below target 4. Report date is fixed as soon as all cases for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Days since last report 5 % investigated ≤ 2 days of notification 3 Indicators Latest report date 4 2020 Non-polio AFP rate Total % with adequate specimens 2 Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus Discarded (Non-polio) Table 1A. Classification of AFP cases with onset in 2020 and key surveillance indicators 2 Polio Bulletin 2020 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 51 48 40 0 0 0 37 3 0 (0.0%) 1.17 63% 100% 13-Sep-21 1 Brunei Darussalam 1 1 1 0 0 0 0 1 0 (0.0%) 1.41 100% 100% 24-Jul-21 52 Cambodia 72 48 5 0 0 0 0 5 0 (0.0%) 0.15 100% 80% 01-Mar-21 197 China 4369 2370 2742 0 0 0 976 1766 880 (32.1%) 1.63 86% 34% 10-Sep-21 4 China, Hong Kong SAR 12 9 6 0 0 0 6 0 0 (0.0%) 0.94 100% 100% 02-Sep-21 12 China, Macao SAR 2 1 1 0 0 0 0 1 0 (0.0%) 1.41 100% 100% 06-Sep-21 8 Japan - 152 - - - - - - - - - - - - Lao People's Democratic Republic 43 23 14 0 0 0 0 14 9 (64.3%) 0.86 64% 71% 27-Aug-21 18 Malaysia 161 80 70 0 0 0 64 6 0 (0.0%) 1.23 83% 70% 01-Sep-21 13 Mongolia 1 10 1 0 0 0 1 0 0 (0.0%) 0.14 100% 100% 11-Aug-21 34 New Zealand 11 9 5 0 0 0 0 5 2 (40.0%) 0.78 40% 80% 25-Aug-21 20 Papua New Guinea 65 36 19 0 0 0 16 3 0 (0.0%) 0.74 47% 79% 06-Sep-21 8 Philippines 883 330 624 0 0 0 541 83 24 (3.8%) 2.66 73% 98% 14-Sep-21 0 Republic of Korea 48 62 15 0 0 0 15 0 0 (0.0%) 0.34 80% 93% 06-Aug-21 39 Singapore 3 6 2 0 0 0 2 0 0 (0.0%) 0.47 100% 100% 08-Sep-21 6 Viet Nam 430 274 100 0 0 0 21 79 68 (68.0%) 0.51 95% 86% 06-Sep-21 8 Pacific island countries and areas 12 6 8 0 0 0 5 3 1 (12.5%) 1.87 63% 50% 26-Jul-21 50 Total 6164 3465 3653 0 0 0 1684 1969 984 (26.9%) 1.48 84% 49% 1. Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Reached or surpass target 2. Annualized non-polio AFP rate per 100 000 population under 15 years of age Nearly reached target 0.5-0.99 for non-polio AFP rate; 60-79% for other indicators 3. Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Substantially below target 4. Percentage of reported cases investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO Days since last report 5 % investigated ≤ 2 days of notification 4 Indicators Latest report date Country/area Total reported cases Annual expected cases <15 years of age Total reported cases Confirmed wild poliovirus > 90 days 1 # (%) Vaccine- derived poliovirus (VDPV) Polio- compatible Classification Pending Discarded (Non-polio) 2021 Non-polio AFP rate 2 Total % with adequate specimens 3 Table 1B. Classification of AFP cases with onset in 2021 and key surveillance indicators 3 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 44 0 0 0 44 0 0 96% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 16-Feb-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 38 0 0 7 31 0 0 100% 14% 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 4278 0 21 105 4136 0 16 96% 2% 19-Aug-21 56 0 25 1 0 0 0 0 29 1 0 0 0 100% China, Anhui Prov. Lab 237 0 0 2 233 0 2 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 0 1 0 0 0 100% China, Beijing Prov. Lab 71 0 1 2 68 0 0 100% 4% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Chongqing Prov. Lab 71 0 0 2 69 0 0 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 130 0 0 2 128 0 0 99% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 66 0 0 1 65 0 0 100% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 437 0 1 3 432 0 1 82% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Guangxi Prov. Lab 215 0 0 6 209 0 0 100% 2% Prov. Lab/CCDC 0 0 0 0 0 0 0 0 0 0 0 0 0 100% China, Guizhou Prov. Lab 138 0 2 2 132 0 2 99% 3% Prov. Lab/CCDC 4 0 4 0 0 0 0 0 0 0 0 0 0 100% China, Hainan Prov. Lab 27 0 0 1 26 0 0 96% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 211 0 1 17 193 0 0 100% 6% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Heilongjiang Prov. Lab 49 0 0 0 49 0 0 87% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 492 0 3 7 482 0 0 99% 2% Prov. Lab/CCDC 10 0 4 0 0 0 0 0 6 0 0 0 0 100% China, Hubei Prov. Lab 119 0 0 5 111 0 3 97% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 220 0 2 15 202 0 1 100% 6% Prov. Lab/CCDC 5 0 2 0 0 0 0 0 3 0 0 0 0 100% China, Jiangsu Prov. Lab 200 0 3 0 197 0 0 100% 2% Prov. Lab/CCDC 6 0 0 0 0 0 0 0 6 0 0 0 0 100% China, Jiangxi Prov. Lab 142 0 0 3 139 0 0 98% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 46 0 0 6 40 0 0 95% 8% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 66 0 0 1 65 0 0 100% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Neimongol Prov. Lab 60 0 4 0 56 0 0 92% 6% Prov. Lab/CCDC 11 0 4 1 0 0 0 0 6 0 0 0 0 100% China, Ningxia Prov. Lab 24 0 0 1 23 0 0 96% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 19 0 0 0 19 0 0 84% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 109 0 0 0 109 0 0 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 237 0 0 0 236 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 55 0 0 0 55 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 70 0 0 0 69 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 295 0 2 12 281 0 0 95% 4% Prov. Lab/CCDC 7 0 2 0 0 0 0 0 5 0 0 0 0 100% China, Tianjin Prov. Lab 42 0 0 0 42 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 84 0 0 1 80 0 3 72% 1% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 175 0 0 14 161 0 0 95% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 155 0 1 2 150 0 2 100% 2% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Tibet Prov. Lab 16 0 1 0 15 0 0 32% 6% CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Hong Kong SAR PHLC 13 0 0 0 13 0 0 100% 0% 04-Jun-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 2 0 0 0 2 0 0 100% 0% 11-Dec-20 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 43 3 0 9 31 0 0 63% 19% 18-Aug-21 NIID 8 0 2 0 0 0 0 0 6 0 0 0 0 100% Malaysia IMR 175 5 0 0 170 0 0 100% 0% 14-Apr-21 IMR 22 0 4 4 0 2 0 0 12 0 0 0 0 100% Mongolia PHI 1 0 0 1 0 0 0 100% 100% 06-Mar-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 7 0 0 0 7 0 0 100% 0% 22-Mar-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 70 5 0 12 53 0 0 98% 16% 19-Apr-21 VIDRL 28 0 10 0 0 0 0 0 11 0 7 0 0 100% Philippines RITM 853 32 0 34 787 0 0 98% 4% 02-Mar-21 RITM/NIID 68 0 12 0 0 33 2 0 21 0 0 0 0 100% Republic of Korea KCDC 48 0 0 0 48 0 0 99% 0% 14-Apr-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 3 0 0 0 3 0 0 100% 0% 08-Jan-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 234 1 0 31 202 0 0 99% 13% 22-Jan-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 225 0 0 22 203 0 0 100% 0% 13-Apr-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 12 0 0 0 12 0 0 100% 0% 09-Mar-21 VIDRL 0 - - - - - - - - - - - - - Total 6047 46 21 221 5743 0 16 96% 3% 182 0 53 5 0 35 2 0 79 1 7 0 0 100% 2. NPEV growing in L20B cells % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area Pending ITDVDPVNegativeNPEV only SabinWild L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Table 2A. Laboratory investigation of stool samples from AFP cases with onset in 2020 and key laboratory indicators 4 Polio Bulletin ≥ 80% ≥ 80% Australia VIDRL 38 0 0 1 37 0 0 93% 1% 13-Sep-21 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 09-Aug-21 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 0 - - - - - - - - 17-Apr-21 NIID 0 - - - - - - - - - - - - - China (total) 2584 0 12 141 2199 0 232 97% 6% 10-Sep-21 35 0 17 6 0 0 0 0 12 0 0 0 0 100% China, Anhui Prov. Lab 124 0 0 5 111 0 8 99% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Beijing Prov. Lab 56 0 1 2 52 0 1 96% 4% Prov. Lab/CCDC 2 0 1 0 0 0 0 0 1 0 0 0 0 100% China, Chongqing Prov. Lab 47 0 0 1 41 0 5 93% 1% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 68 0 0 3 57 0 8 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Gansu Prov. Lab 84 0 1 3 79 0 1 100% 4% Prov. Lab/CCDC 3 0 2 0 0 0 0 0 1 0 0 0 0 100% China, Guangdong Prov. Lab 275 0 0 21 235 0 19 87% 7% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangxi Prov. Lab 117 0 0 14 95 0 8 99% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 100 0 0 6 85 0 9 100% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hainan Prov. Lab 10 0 0 1 9 0 0 100% 10% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 128 0 1 11 108 0 8 100% 8% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Heilongjiang Prov. Lab 31 0 1 0 25 0 5 100% 4% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Henan Prov. Lab 331 0 4 26 287 0 14 99% 8% Prov. Lab/CCDC 8 0 4 0 0 0 0 0 4 0 0 0 0 100% China, Hubei Prov. Lab 60 0 0 5 46 0 9 92% 10% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hunan Prov. Lab 113 0 0 6 96 0 11 99% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 102 0 0 0 88 0 14 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangxi Prov. Lab 75 0 0 4 66 0 5 94% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jilin Prov. Lab 28 0 0 1 25 0 2 96% 2% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 44 0 0 0 34 0 10 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Neimongol Prov. Lab 52 0 1 0 41 0 10 98% 2% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Ningxia Prov. Lab 23 0 0 2 17 0 4 95% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 6 0 0 0 5 0 1 0% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 77 0 0 0 66 0 11 94% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 117 0 0 6 106 0 5 99% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanghai Prov. Lab 52 0 0 3 45 0 4 98% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 48 0 1 2 44 0 1 94% 5% Prov. Lab/CCDC 1 0 1 0 0 0 0 0 0 0 0 0 0 100% China, Sichuan Prov. Lab 172 0 0 6 143 0 23 99% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 11 0 0 0 10 0 1 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 43 0 1 0 41 0 1 98% 2% Prov. Lab/CCDC 2 0 2 0 0 0 0 0 0 0 0 0 0 100% China, Yunnan Prov. Lab 92 0 0 5 59 0 28 94% 6% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Zhejiang Prov. Lab 98 0 1 8 83 0 6 95% 8% Prov. Lab/CCDC 9 0 1 6 0 0 0 0 2 0 0 0 0 100% China, Tibet Prov. Lab 0 - - - - - - - - CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 6 0 0 0 6 0 0 100% 0% 14-Sep-21 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 1 0 0 0 1 0 0 100% 0% 04-Aug-21 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 0 - - - - - - - - 14-Apr-21 NIID 0 - - - - - - - - - - - - - Malaysia IMR 71 0 0 0 71 0 0 94% 0% 13-Sep-21 IMR 0 - - - - - - - - - - - - - Mongolia PHI 1 0 0 0 1 0 0 100% 0% 09-Sep-21 NIID 0 - - - - - - - - - - - - - New Zealand IESR 5 0 0 0 4 0 1 100% 0% 13-Sep-21 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 18 1 0 2 15 0 0 100% 6% 14-Sep-21 VIDRL 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Philippines RITM 594 5 0 20 559 8 2 100% 3% 14-Sep-21 RITM/NIID 18 0 10 0 0 0 0 0 8 0 0 0 0 100% Republic of Korea KCDC 14 0 0 0 13 0 1 100% 0% 04-Sep-21 KCDC 0 - - - - - - - - - - - - - Singapore SGH 2 0 0 0 2 0 0 100% 0% 14-Sep-21 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 29 0 0 3 26 0 0 100% 10% 25-Aug-21 NIHE 0 - - - - - - - - - - - - - Viet Nam (South) PI 80 0 0 22 55 0 3 100% 29% 07-Sep-21 PI 0 - - - - - - - - - - - - - Pacific island countries and areas VIDRL 4 0 0 0 4 0 0 100% 0% 19-Apr-21 VIDRL 0 - - - - - - - - - - - - - Total 3448 6 12 189 2994 8 239 96% 5% 54 0 27 6 0 0 0 0 21 0 0 0 0 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2VDPV Pending ITDVDPVNegativeNPEV only SabinWild 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); KCDC (Korea Centers for Disease Control and Prevention, 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) Intratypic differentiation/ Sequencing laboratory 1 No. of isolates received Wild Sabin Total no. of AFP cases with specimens Results of virus isolation for AFP cases Results of intratypic differentiation (ITD)/sequencing for virus isolates Wild Country/area % ITD results reported ≤ 7 days of receipt Type 3 Polio laboratory 1 Type 1 Sabin Pending > 14 days % results reported ≤ 14 days % specimens positive for NPEV Latest report date Discordant pending sequencing Table 2B. Laboratory investigation of stool samples from AFP cases with onset in 2021 and key laboratory indicators 5 Polio Bulletin Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 16 1 0 0 0 0 0 0 0 1 0 2 0 0 8 0 0 0 0 0 0 0 0 0 0 8 0 0 China (total) 364 193 0 123 1 0 0 0 0 390 0 567 0 0 229 78 0 47 0 0 0 0 0 158 1 754 0 0 China, Fujian Prov. Lab/CCDC 65 34 0 9 0 0 0 0 0 54 0 68 0 0 36 4 0 4 0 0 0 0 0 3 0 212 0 0 China, Gansu Prov. Lab/CCDC 39 26 0 16 0 0 0 0 0 72 0 38 0 0 35 9 0 3 0 0 0 0 0 16 0 78 0 0 China, Guangdong Prov. Lab/CCDC 48 25 0 16 0 0 0 0 0 19 0 26 0 0 32 17 0 4 0 0 0 0 0 29 0 71 0 0 China, Guangxi Prov. Lab/CCDC 12 3 0 0 0 0 0 0 0 11 0 9 0 0 7 1 0 0 0 0 0 0 0 1 0 26 0 0 China, Heilongjiang Prov. Lab/CCDC 40 21 0 7 0 0 0 0 0 44 0 111 0 0 8 3 0 1 0 0 0 0 0 3 0 8 0 0 China, Jiangxi Prov. Lab/CCDC 12 8 0 1 0 0 0 0 0 13 0 24 0 0 7 3 0 2 0 0 0 0 0 2 0 33 0 0 China, Neimongol Prov. Lab/CCDC 3 3 0 4 0 0 0 0 0 3 0 1 0 0 4 4 0 3 0 0 0 0 0 11 0 0 0 0 China, Qinghai Prov. Lab/CCDC 11 7 0 3 0 0 0 0 0 11 0 5 0 0 7 1 0 0 0 0 0 0 0 3 0 5 0 0 China, Shandong Prov. Lab/CCDC 32 20 0 14 0 0 0 0 0 25 0 107 0 0 18 7 0 4 0 0 0 0 0 15 0 158 0 0 China, Shanghai Prov. Lab/CCDC 24 14 0 9 0 0 0 0 0 18 0 7 0 0 33 3 0 1 0 0 0 0 0 1 1 52 0 0 China, Sichuan Prov. Lab/CCDC 30 13 0 6 0 0 0 0 0 36 0 70 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 China, Xinjiang Prov. Lab/CCDC 24 19 0 38 1 0 0 0 0 84 0 29 0 0 27 19 0 16 0 0 0 0 0 64 0 58 0 0 China, Yunnan Prov. Lab/CCDC 24 0 0 0 0 0 0 0 0 0 0 72 0 0 15 7 0 9 0 0 0 0 0 10 0 53 0 0 Malaysia IMR/VIDRL 700 97 0 33 9 0 11 7 0 74 1 29 0 0 364 0 0 0 0 0 0 0 0 0 0 19 31 0 Philippines RITM 384 77 0 20 0 0 95 8 0 62 0 95 0 0 457 69 0 25 0 0 0 0 0 109 0 166 72 0 Vietnam NIHE 0 - - - - - - - - - - - - - 31 0 0 0 0 0 0 0 0 0 0 4 0 0 Total 1464 368 0 176 10 0 106 15 0 527 1 693 0 0 1089 147 0 72 0 0 0 0 0 267 1 951 103 0 2020 2021 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD 2. CCDC (Chinese Center for Disease Control and Prevention, China); RITM (Research Institute for Tropical Medicine, Philippines); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Type 1 Type 2 Type 3 Type 1 NPEV Discordant pending sequencing Country/area Type 2 Intratypic differentiation lab 2 1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. Total number of samples with polio isolates Polio isolates Pending ITD Discordant pending sequencing Polio isolates Type 3 Total number of samples processed Table 3. Laboratory confirmation of polio isolates from environmental samples in 2020–20211 6 Polio Bulletin Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2021 Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Australia aVDPV2 (1 env) Cambodia 2006 - 1Total - 2 China 2009 - 1Total - 27 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) aVDPV2 (1 env) aVDPV3 (1 AFP) aVDPV3 (1 AFP)iVDPV3 (1 AFP) 4 cVDPV2 (1 env) iVDPV3 (1 AFP + 1 non-AFP) aVDPV3 (2 env) cVDPV2 (1 AFP + 2 contacts + 1 non-AFP) aVDPV3 (1 AFP) aVDPV1 (1 AFP + 1 env) aVDPV3 (1 AFP) cVDPV3 (1 non-AFP) aVDPV3 (1 contact) 5 ?VDPV1 (1 AFP) + cVDPV3 (1 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Malaysia cVDPV1 (3 AFP + 12 env)cVDPV2 (3 env) cVDPV1 (1 AFP + 1 non-AFP + 9 env) cVDPV2 (5 env) aVDPV2 (1 env) ?VDPV3 (1 env) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (26 AFP + 8 contacts + 7 env) Philippines 2001 - 3 aVDPV2 (1 AFP) cVDPV1 (2 AFP + 1 contact + 14 env) cVDPV2 (12 AFP + 5 non-AFP + 2 contact + 19 env) iVDPV2 (1 AFP) aVDPV2 (1 AFP) cVDPV2 (1 AFP + 4 env) aVDPV2 (1 AFP + 6 non-AFP + 3 env) Viet Nam aVDPV2 (2 AFP) 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV. Suffix number refers to the poliovirus serotype (types 1, 2 or 3). 2. Source of specimens could be AFP cases, contacts, non-AFP cases or environmental 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009 4. Continuous excretion for 4 months; potential immunodeficient person. 5. Contact of a different AFP case.