Week 20, 2013, ending 19 May 2013 (as of 21 May 2013) HIGHLIGHTS Dear Reader, This week, we are pleased to share with you the new format of the WPRO Weekly Polio Bulletin. After 11 years, it was appropriate to revisit it in order to include latest elements related to feedback on the laboratory new algorithms’ results, the vaccine-derived polio virus (VDPV) classification, key country AFP surveillance indicators trend analysis and performance and information sharing. Although the Western Pacific Region has been certified polio-free for more than a decade, outbreak events such as the 2011 China importation remind us how fragile this status is — unless regular, accurate and timely surveillance data is shared and analysed for information and action. As we are now entering the “end-game strategic plan”, which ultimate goal is to eradicate polio, this reporting system will be central in the country, regional and global monitoring and evaluation process towards final eradication. We would like to seize this opportunity to acknowledge and pay tribute to all countries’ surveillance and laboratory networks who are regularly sharing their data with WHO all these years. This weekly feedback bulletin is yours — please share with us ideas for improvement, as well as any other information that you would like to share with other countries. Thank you. Chart 1. Non-polio AFP rate and adequate specimen collection rate, 2011–2013 3.0 2.5 Non-polio AFP rate
Polio Bulletin 100% Cases with adequate specimens (%)
Chart 2. Percent cases with pending classification > 90 days after onset, 2013 CHN KHM LAO MYS PHL PNG VNM 0% 5% 10% 11.9% 15% 20% 25% 30% 35% 40% 20.4% 37.5% 0.0%
90% 80% 70% 60% 1.5 1.0 0.5 0.0 11 12 13 CHN 11 12 13 KHM 11 12 13 LAO 11 12 13 MYS 11 12 13 PHL 11 12 13 PNG 11 12 13 VNM
7.7% 10.3%
2.0
50% 40% 30% 20% 10% 0%
Chart 3. Polio immunization status of reported AFP cases, 2013 100%
Chart 4. Percentage of samples received at the lab ≤ 3 days of collection, 2013 100%
80%
80% 69% 60% 52% 39% 23% 20% 0% CHN KHM 0% LAO MYS PHL 0% PNG VNM
60%
40%
40%
20%
0% CHN KHM LAO MYS 1-2 doses
CONTACT US Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: WPR_EPIdata@wpro.who.int Web: www.wpro.who.int/immunization
PHL 0 doses
PNG Unknown
VNM
0%
≥ 3 doses
NOTES: 1. Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam). 2. Non-polio AFP rate for 2013 is annualized as of polio week 20.
Table 1. Classification of AFP cases with onset in 2013 and key surveillance indicators 2012 Classification Total reported cases Annual expected cases <15 years of age Pending Total reported cases Vaccinederived polio virus (VDPV) Non-polio AFP rate 2 % % with % with % with any investigated Latest report Days since 60-day adequate 4 ≤ 2 days of specimen 6 date last report 7 specimens 3 5 follow-up notification ≥ 80% ≥ 80% ≥ 80%
2013 Indicators
Confirmed wild polio
Poliocompatible
Discarded (Non-polio)
Total
> 90 days 1 # (%)
≥1
Australia Brunei Darussalam Cambodia China Hong Kong (China) Japan Lao People's Democratic Republic Macao (China) Malaysia Mongolia New Zealand Papua New Guinea Philippines Republic of Korea Singapore Viet Nam Pacific island countries Total 1. 2. 3. 4. 5. 6. 7.
56 1 107 6,173 14 0 55 0 141 9 8 10 403 94 10 514 4 7,599
43 1 45 2,225 8 167 25 1 76 7 9 30 371 76 6 241 10 3,341
6 0 29 1,323 4 0 8 1 0 1 0 8 108 16 4 101 0 1,609
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
6 10 596 4 5 0 0 2 43 7 4 32 709
0 19 727 0 3 1 1 6 65 9 0 69 900
0 (0.0%) 3 (10.3%) 102 (7.7%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 3 (37.5%) 22 (20.4%) 3 (18.8%) 0 (0.0%) 12 (11.9%) 145 (9.0%) Green Yellow Red
0.36 1.68 1.55 1.30 0.83 2.60 0.37 0.69 0.76 0.55 1.73 1.09 1.25
50% 69% 93% 100% 88% 100% 100% 38% 66% 94% 100% 89% 90%
67% 90% 99% 100% 100% 100% 100% 75% 89% 100% 100% 97% 98%
100% 83% 99% 100% 100% 100% 100% 100% 100% 100% 100% 92% 98%
0% 56% 60% 100% 40% 0% 0% 27% 42%
15-Apr-13 09-May-13 15-May-13 02-May-13 24-Apr-13 15-May-13 09-May-13 09-May-13 10-May-13 16-May-13 06-May-13 17-May-13 -
36 12 6 19 27 6 12 12 11 5 15 4 -
Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Annualized non-polio AFP rate per 100 000 population under 15 years of age Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Percentage of reported cases with at least one specimen Percentage of reported cases investigated within two days of notification Percentage of reported cases with inadequate specimens followed-up within 60 days of onset of paralysis Countries are expected to submit data at least once per month to WPRO
Reached or surpassed target Nearly reached target: 0.5–0.99 for non-polio AFP rate; 60–79% for other indicators Substantially below target
2
Polio Bulletin
Table 2. Laboratory investigation of AFP cases with onset in 2013 and key laboratory indicators Virus isolation results Country National polio laboratory Total no. of AFP L20B cases w ith positive specimens L20B positive + NPEV NPEV only Pending Negative ≤ 14 days Intratypic % % results differentiation Latest Pending reported specimens / Sequencing report date positive > 14 2 ≤ 14 days for NPEV 1 lab days ≥ 80% No. of isolates referred Type 1 W ild Sabin VDPV W ild Type 2 Sabin VDPV Wild Intratypic differentiation (ITD) results Type 3 Sabin VDPV NPEV 3
1
Non-EV
Pending ITD -
% ITD results Discordant reported ≤ 7 pending days of sequencing receipt ≥ 80% -
Australia Brunei Darussalam Papua New Guinea Pacific island countries Japan Cambodia Lao People's Democratic Republic Malaysia Mongolia New Zealand Philippines Republic of Korea Singapore Viet Nam, North Viet Nam, South China China (total) 4
VIDRL VIDRL VIDRL VIDRL NIID NIID NIID IMR PHI IESR RITM NIH SGH NIHE PI CCDC
4 1 5 1 0 19 8 60 1 0 129 16 4 59 60 1242
0 0 0 0 0 0 0 0 0 0 0 0 0 27 1 0 0 3 0 1 2 0 7 1 1 0 0 0 3 0 2 0 1 2 1 0 0 0 2 0 0 0 0 0 0 27
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 0 0 0 5 3 0 0 18 0 0 8 8 57 2 1 1 0 6 6 7 2 11 4 0 3 0 0 3 0 0 3 0 0 0 3 1 0 3 1 0 0 0 0 0 100
3 1 5 1 14 5 55 1 107 14 4 41 49 1119 57 11 42 21 70 50 68 29 143 58 63 35 20 21 62 10 43 70 4 17 32 30 55 5 54 18 16 10 1 4 4 1,423
0 0 0 0 0 0 1 0 1 2 0 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 11
0 0 0 0 0 0 4 0 6 0 0 3 3 39 1 0 2 0 0 0 0 0 3 1 1 5 0 1 14 0 1 5 0 0 1 0 0 0 3 0 0 0 0 1 0 55
100% 100% 100% 100% 84% 94% 97% 100% 99% 100% 100% 76% 92% 53% 48% 75% 57% 62% 48% 21% 71% 90% 48% 90% 8% 38% 78% 63% 71% 100% 47% 34% 100% 92% 35% 85% 80% 100% 5% 55% 63% 50% 0% 25% 88% 61% 61%
29% 0% 0% 0% 27% 25% 0% 0% 12% 0% 0% 15% 12% 4% 3% 8% 1% 0% 6% 9% 6% 5% 5% 6% 0% 5% 0% 0% 3% 0% 0% 3% 0% 0% 0% 6% 1% 0% 5% 5% 0% 0% 0% 0% 0% 6% 6%
12-Apr-13 15-May-13 29-Apr-13 23-Apr-13 30-Apr-13 22-Apr-13 16-May-13 09-May-13 06-May-13 16-May-13 16-May-13 03-May-13 12-May-13 12-May-13 15-May-13
VIDRL VIDRL VIDRL VIDRL NIID NIID IMR NIID IESR VIDRL NIID SGH NIID NIID
0 0 0 0 0 0 0 0 0 0 0 0 0
-
-
0 77
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
21 2 0 5 0 0 5 0 0 3 0 2 0 0 1 1 2 0 21
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
34 2 2 6 2 1 5 2 1 2 1 2 2 4 0 0 0 2 34
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
22 2 0 6 2 0 1 0 1 4 0 0 0 2 2 2 0 0 22
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
38% 0% 0% 100% 0% 0% 20% 0% 0% 0% 0% 0% 100% 50% 0% 0% 100% 100% 38%
China, Anhui China, Beijing China, Fujian China, Gansu China, Guangdong China, Guangxi China, Hebei China, Heilongjiang China, Henan China, Hunan China, Jiangsu China, Jiangxi China, Jilin China, Shaanxi China, Shandong China, Shanghai China, Shanxi China, Sichuan China, Tianjin China, Xinjiang China, Yunnan China, Zhejiang China, Chongqing China, Guizhou China, Hainan China, Hubei China, Liaoning China, Neimongol China, Ningxia China, Qinghai China, Tibet Hong Kong (China) Macao (China) Total
Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab PHLC PHLC
61 12 45 24 76 57 77 31 164 64 65 43 20 22 82 10 46 78 5 19 0 34 33 56 5 62 19 16 10 1 5 4 0 1,613
Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab CCDC CCDC CCDC CCDC CCDC CCDC CCDC CCDC 15-May-13 15-May-13 CCDC PHLC PHLC
6 2 0 17 0 4 1 0 11 2 2 0 0 0 9 1 4 0 2 6 3 3 0 0 0 2 0 0 2 0 0 0 0 77
1. IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); NIH (National Institute of Health, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, Hong Kong); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) 2. The target of 14 days for the timeliness of virus isolation will be used for all polio laboratories 3. NPEV growing in L20B cell 4. Twenty two provincial laboratories in China perform ITD from 2013
3
Polio Bulletin
Table 3. Laboratory confirmation of polio isolates from other sources in 2013 Non-AFP cases Country Intratypic Total number differentiation of non-AFP lab 2 cases with polio isolates Type 1 Wild Sabin VDPV Wild Type 2 Sabin VDPV Wild Type 3 Sabin Discordant NPEV Pending pending grown Non-EV ITD sequencing VDPV in L20B Total number of samples with polio isolates Type 1 Wild Sabin VDPV
1
Environmental samples Type 2 Wild Sabin VDPV Wild Type 3 Sabin Discordant NPEV Pending pending grown Non-EV ITD sequencing VDPV in L20B
China Hong Kong (China) Malaysia New Zealand Singapore Australia Philippines Japan Republic of Korea Viet Nam, North Viet Nam, South Pacific island countries Total
CCDC PHLC IMR IESR SGH VIDRL VIDRL NIID NIID NIID NIID VIDRL
0 1 0 0 0 0 6 0 0 0 0 0 7
0 0 0
1 5 6
0 0 0
0 0 0
0 1 1
0 0 0
0 0 0
0 1 1
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
0
0
0
0
0
0
0
0
0
0
0
0
0
1. Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. 2. CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); NIID (National Institute of Infectious Diseases, Japan); PHLC (Public Health Laboratory Center, Hong Kong); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia)
Table 4. Vaccine-derived polio virus, 2000–2013 Country Cambodia iVDPV1 (1 case) aVDPV1 (1 case) aVDPV1 (1 case) aVDPV3 (1 case) aVDPV3 (1 case)
2000
2001
2002
2003
2004
2005 cVDPV3 (1 case)
2006 cVDPV3 (1 case)
2007
2008
2009
2010
2011
2012
2013
China
cVDPV1 (2 cases) aVDPV1 (1 case) aVDPV1 (3 cases) ?VDPV1 (4 cases) iVDPV2 (1 case) ?VDPV1 (7 cases) ?VDPV1 (1 case) ?VDPV2 (1 case) VDPV3 (1 case) ?VDPV? (3 cases) ?VDPV? (1 case) aVDPV2 (1 case) ?VDPV? (2 cases) ?VDPV? (1 case) ?VDPV3 (1 case)
aVDPV1 (1 case) aVDPV1 (1 case) aVDPV2 (3 cases) aVDPV2 (2 cases) aVDPV2 (5 cases) aVDPV2 (1 case) cVDPV2 (2 cases) cVDPV2 (3 cases) aVDPV3 (2 cases) iVDPV2 (2 cases) iVDPV2 (1 case) iVDPV3 (1 case) iVDPV3 (1 case)
Hong Kong (China) Japan Lao People's Democratic Republic Mongolia Philippines Viet Nam cVDPV1 (3 cases)
aVDPV2 (2 cases)
4
Polio Bulletin