Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2016–2018* Chart 2. Adequate specimen collection rate, 2016–2018 Expansion of outbreak response in Papua New Guinea On 9 August 2018, the Victorian Infectious Diseases Reference Laboratory in Australia confirmed isolation of vaccine-derived poliovirus type 1 (VDPV1) virus in a 22 months old girl. The child presented to Goroka Provincial Hospital in Eastern Highlands Province on 10 July with symptoms of acute flaccid paralysis. The onset of the child's paralysis occurred on 8 July. With this most recent confirmation, the total number of circulating vaccine-derived poliovirus type 1 (cVDPV1) cases now is four and the number of cVDPV1-positive community contacts remains two. Considering recent finding of the virus in new provinces, Enga and Eastern Highlands, the outbreak response will expand starting from August. The second round of polio vaccination is planned from 20 August to 9 September. During this round, around 700,100 children under five years of age will be targeted in nine provinces, including six provinces in the Highlands Region. Polio Bulletin 2018 Issue No. 16 - Week 32 (as of 15 August 2018) Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2018 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2018 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). Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: wproepidata@who.int Web: www.wpro.who.int/immunization CONTACT US HIGHLIGHTS * AFP rate annualized as of week 32 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 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 10.7% 27.0% 15.5% 10.9% 0.0% 0.0% 12.1% 0% 5% 10% 15% 20% 25% 30% VNM PNG PHL MYS LAO KHM CHN Table 1. Classification of AFP cases with onset in 2018 and key surveillance indicators Polio Bulletin 2 2017 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 60 46 38 0 0 0 15 23 6 (15.8%) 1.34 39% 82% 03-Aug-18 12 Brunei Darrusalam 1 1 1 0 0 0 0 1 0 (0.0%) 1.63 100% 100% 07-Jul-18 39 Cambodia 57 44 48 0 0 0 42 6 0 (0.0%) 1.77 88% 85% 14-Aug-18 1 China 5278 2256 2408 0 1 0 1360 1047 291 (12.1%) 1.73 91% 100% 08-Aug-18 7 China, Hong Kong SAR 15 9 5 0 0 0 5 0 0 (0.0%) 0.90 100% 100% 03-Aug-18 12 China, Macao SAR 2 1 1 0 0 0 1 0 0 (0.0%) 1.63 100% 100% 13-Aug-18 2 Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 103 21 32 0 0 0 22 10 0 (0.0%) 2.48 91% 72% 18-Jun-18 58 Malaysia 154 77 101 0 0 0 58 43 11 (10.9%) 2.13 77% 79% 06-Aug-18 9 Mongolia 6 9 5 0 0 0 3 2 0 (0.0%) 0.90 100% 80% 01-Aug-18 14 New Zealand 13 9 4 0 0 0 0 4 2 (50.0%) 0.72 50% 100% 26-Jun-18 50 Papua New Guinea 29 34 63 0 4 0 7 52 17 (27.0%) 2.82 35% 67% 15-Aug-18 0 Philippines 462 338 155 0 0 0 108 47 24 (15.5%) 0.75 54% 99% 24-Jul-18 22 Republic of Korea 68 67 34 0 0 0 24 10 0 (0.0%) 0.82 91% 100% 10-Aug-18 5 Singapore 7 6 5 0 0 0 4 1 0 (0.0%) 1.35 80% 100% 10-Aug-18 5 Viet Nam 385 234 84 0 0 0 22 62 9 (10.7%) 0.58 99% 86% 13-Jun-18 63 Pacific island countries and areas 16 11 1 0 0 0 1 0 0 (0.0%) 0.15 0% 100% 16-May-18 91 Total 6656 3324 2985 0 5 0 1672 1308 360 (12.1%) 1.46 87% 97% 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 o ther 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) 2018 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 2. Laboratory investigation of stool samples from AFP cases with onset in 2018 and key laboratory indicators Polio Bulletin 3 ≥ 80% ≥ 80% Australia VIDRL 21 0 0 0 18 0 3 97% 3% 13-Jul-18 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 16-Jul-18 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 42 0 0 8 34 0 0 98% 18% 08-Aug-18 NIID 0 - - - - - - - - - - - - - China (total) 2363 16 0 174 2097 0 76 97% 6% 08-Aug-18 45 0 7 0 0 0 0 0 35 3 0 0 0 100% China, Anhui Prov. Lab 139 1 0 9 122 0 7 100% 6% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Beijing Prov. Lab 18 0 0 0 18 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 16 0 0 1 13 0 2 86% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 89 1 0 1 82 0 5 99% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Gansu Prov. Lab 47 0 0 2 42 0 3 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 189 1 0 12 174 0 2 91% 5% Prov. Lab/CCDC 4 0 0 0 0 0 0 0 4 0 0 0 0 100% China, Guangxi Prov. Lab 101 1 0 10 89 0 1 97% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 79 0 0 6 71 0 2 99% 7% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 129 0 0 17 111 0 1 100% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 48 0 0 2 46 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 268 1 0 36 229 0 2 100% 12% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Hubei Prov. Lab 80 0 0 5 72 0 3 99% 6% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Hunan Prov. Lab 99 0 0 14 84 0 1 98% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 86 5 0 5 69 0 7 100% 6% Prov. Lab/CCDC 10 0 0 0 0 0 0 0 7 3 0 0 0 100% China, Jiangxi Prov. Lab 67 0 0 4 60 0 3 95% 4% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Jilin Prov. Lab 31 1 0 3 27 0 0 100% 6% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Neimongol Prov. Lab 44 2 0 2 40 0 0 98% 3% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 100% China, Ningxia Prov. Lab 15 0 0 1 14 0 0 100% 7% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 49 0 0 0 44 0 5 89% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 196 1 0 12 175 0 8 100% 5% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 100% China, Shanghai Prov. Lab 11 0 0 0 11 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 86 0 0 0 86 0 0 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 139 0 0 4 121 0 14 98% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 13 0 0 0 13 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 61 1 0 4 56 0 0 89% 7% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 120 0 0 14 103 0 3 90% 9% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Zhejiang Prov. Lab 70 1 0 5 63 0 1 100% 7% Prov. Lab/CCDC 5 0 0 0 0 0 0 0 5 0 0 0 0 100% China, Hainan Prov. Lab 21 0 0 4 17 0 0 100% 17% CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 35 0 0 0 32 0 3 100% 0% CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 15 0 0 0 12 0 3 100% 0% CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 2 0 0 1 1 0 0 100% 33% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 5 0 0 0 5 0 0 100% 0% 10-Aug-18 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 1 0 0 0 1 0 0 100% 0% 13-Apr-18 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 50 1 0 4 45 0 0 99% 5% 17-Jul-18 NIID 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Malaysia IMR 87 0 0 7 80 0 0 89% 6% 09-Jul-18 IMR 0 - - - - - - - - - - - - - Mongolia PHI 5 0 0 2 3 0 0 100% 40% 13-Aug-18 NIID 0 - - - - - - - - - - - - - New Zealand IESR 6 0 0 0 4 2 0 88% 0% 13-Aug-18 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 44 3 0 2 25 14 0 96% 7% 15-Aug-18 VIDRL 12 0 2 7 0 0 0 0 2 0 0 1 0 175% Philippines RITM 235 2 1 10 208 14 0 94% 4% 14-Aug-18 RITM 7 0 2 0 0 0 0 0 5 0 0 0 0 100% Republic of Korea NIH 34 0 0 2 30 2 0 100% 6% 10-Aug-18 NIH 0 - - - - - - - - - - - - - Singapore SGH 5 0 0 1 3 1 0 100% 14% 10-Aug-18 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 95 2 0 12 77 4 0 100% 12% 24-Jul-18 NIHE 3 0 1 0 0 0 0 0 2 0 0 0 0 100% Viet Nam (South) PI 72 3 0 4 65 0 0 100% 6% 06-Aug-18 PI 6 0 0 0 0 0 0 0 6 0 0 0 0 100% Pacific island countries and areas VIDRL 1 0 0 0 1 0 0 100% 0% 02-May-18 VIDRL 0 - - - - - - - - - - - - - Total 3067 27 1 226 2697 37 79 97% 7% 74 0 12 7 0 0 0 0 51 3 0 1 0 105%6% 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2 VDPV Pending ITDVDPV NegativeNPEV 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); NIH (National Institute of Health, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) 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 posit ive for NPEV Latest report date Discordant pending sequencing Polio Bulletin 4 Table 3. Laboratory confirmation of polio isolates from environmental samples in 2017–2018 1 Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2018 Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 6 2 0 0 0 0 0 1 0 1 0 4 0 0 17 2 0 2 0 0 0 0 0 0 0 12 0 0 China (total) 325 188 0 213 0 0 0 0 0 650 0 1158 0 0 132 97 0 134 0 0 0 1 0 357 1 542 0 0 China, Fujian Prov. Lab/CCDC 53 22 0 8 0 0 0 0 0 42 0 331 0 0 40 29 0 7 0 0 0 0 0 72 1 289 0 0 China, Gansu Prov. Lab/CCDC 12 10 0 10 0 0 0 0 0 29 0 18 0 0 6 4 0 2 0 0 0 0 0 5 0 14 0 0 China, Guangdong Prov. Lab/CCDC 48 39 0 18 0 0 0 0 0 87 0 108 0 0 28 25 0 15 0 0 0 0 0 63 0 124 0 0 China, Guangxi Prov. Lab/CCDC 36 20 0 22 0 0 0 0 0 36 0 94 0 0 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab/CCDC 42 17 0 12 0 0 0 0 0 34 0 112 0 0 9 7 0 1 0 0 0 0 0 16 0 3 0 0 China, Shandong Prov. Lab/CCDC 48 28 0 18 0 0 0 0 0 90 0 272 0 0 23 8 0 13 0 0 0 0 0 36 0 61 0 0 China, Shanghai Prov. Lab/CCDC 22 18 0 17 0 0 0 0 0 65 0 51 0 0 5 3 0 2 0 0 0 0 0 6 0 7 0 0 China, Xinjiang Prov. Lab/CCDC 36 34 0 108 0 0 0 0 0 267 0 115 0 0 21 21 0 94 0 0 0 1 0 159 0 44 0 0 China, Yunnan Prov. Lab/CCDC 28 0 - - - - - - - - - 57 0 0 0 - - - - - - - - - - - - - Malaysia IMR 24 0 - - - - - - - - - 22 0 0 0 - - - - - - - - - - - - - Philippines RITM 40 8 0 1 0 0 0 0 0 7 0 21 0 0 43 3 0 2 0 0 0 0 0 1 0 14 0 0 Total 395 198 0 214 0 0 0 1 0 658 0 1205 0 0 192 102 0 138 0 0 0 1 0 358 1 568 0 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); IMR (Institute of Medical Research, Malaysia); 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 2017 2018 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 Australia aVDPV2 (1 env) Cambodia 2006 - 1 Total - 2 China 2009 - 1 Total - 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 ?VDPV2 (1 env) iVDPV3 (2 AFP) aVDPV3 (1 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1 Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (4 AFP + 2 contacts) Philippines 2001 - 3 aVDPV2 (1 AFP) Viet Nam aVDPV2 (2 AFP) 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. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3).
Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2016–2018* Chart 2. Adequate specimen collection rate, 2016–2018 Expansion of outbreak response in Papua New Guinea On 9 August 2018, the Victorian Infectious Diseases Reference Laboratory in Australia confirmed isolation of vaccine-derived poliovirus type 1 (VDPV1) virus in a 22 months old girl. The child presented to Goroka Provincial Hospital in Eastern Highlands Province on 10 July with symptoms of acute flaccid paralysis. The onset of the child's paralysis occurred on 8 July. With this most recent confirmation, the total number of circulating vaccine-derived poliovirus type 1 (cVDPV1) cases now is four and the number of cVDPV1-positive community contacts remains two. Considering recent finding of the virus in new provinces, Enga and Eastern Highlands, the outbreak response will expand starting from August. The second round of polio vaccination is planned from 20 August to 9 September. During this round, around 700,100 children under five years of age will be targeted in nine provinces, including six provinces in the Highlands Region. Polio Bulletin 2018 Issue No. 16 - Week 32 (as of 15 August 2018) Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2018 Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2018 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). Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: +63 2 5288001 Fax: +63 2 5211036, 5260279 Email: wproepidata@who.int Web: www.wpro.who.int/immunization CONTACT US HIGHLIGHTS * AFP rate annualized as of week 32 0.0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 4.0 4.5 5.0 5.5 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 CHN KHM LAO MYS PHL PNG VNM 0% 20% 40% 60% 80% 100% 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 16 17 18 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 10.7% 27.0% 15.5% 10.9% 0.0% 0.0% 12.1% 0% 5% 10% 15% 20% 25% 30% VNM PNG PHL MYS LAO KHM CHN Table 1. Classification of AFP cases with onset in 2018 and key surveillance indicators Polio Bulletin 2 2017 ≥ 1 ≥ 80% ≥ 80% ≤ 30 Australia 60 46 38 0 0 0 15 23 6 (15.8%) 1.34 39% 82% 03-Aug-18 12 Brunei Darrusalam 1 1 1 0 0 0 0 1 0 (0.0%) 1.63 100% 100% 07-Jul-18 39 Cambodia 57 44 48 0 0 0 42 6 0 (0.0%) 1.77 88% 85% 14-Aug-18 1 China 5278 2256 2408 0 1 0 1360 1047 291 (12.1%) 1.73 91% 100% 08-Aug-18 7 China, Hong Kong SAR 15 9 5 0 0 0 5 0 0 (0.0%) 0.90 100% 100% 03-Aug-18 12 China, Macao SAR 2 1 1 0 0 0 1 0 0 (0.0%) 1.63 100% 100% 13-Aug-18 2 Japan - 161 - - - - - - - - - - - - Lao People's Democratic Republic 103 21 32 0 0 0 22 10 0 (0.0%) 2.48 91% 72% 18-Jun-18 58 Malaysia 154 77 101 0 0 0 58 43 11 (10.9%) 2.13 77% 79% 06-Aug-18 9 Mongolia 6 9 5 0 0 0 3 2 0 (0.0%) 0.90 100% 80% 01-Aug-18 14 New Zealand 13 9 4 0 0 0 0 4 2 (50.0%) 0.72 50% 100% 26-Jun-18 50 Papua New Guinea 29 34 63 0 4 0 7 52 17 (27.0%) 2.82 35% 67% 15-Aug-18 0 Philippines 462 338 155 0 0 0 108 47 24 (15.5%) 0.75 54% 99% 24-Jul-18 22 Republic of Korea 68 67 34 0 0 0 24 10 0 (0.0%) 0.82 91% 100% 10-Aug-18 5 Singapore 7 6 5 0 0 0 4 1 0 (0.0%) 1.35 80% 100% 10-Aug-18 5 Viet Nam 385 234 84 0 0 0 22 62 9 (10.7%) 0.58 99% 86% 13-Jun-18 63 Pacific island countries and areas 16 11 1 0 0 0 1 0 0 (0.0%) 0.15 0% 100% 16-May-18 91 Total 6656 3324 2985 0 5 0 1672 1308 360 (12.1%) 1.46 87% 97% 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 o ther 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) 2018 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 2. Laboratory investigation of stool samples from AFP cases with onset in 2018 and key laboratory indicators Polio Bulletin 3 ≥ 80% ≥ 80% Australia VIDRL 21 0 0 0 18 0 3 97% 3% 13-Jul-18 VIDRL 0 - - - - - - - - - - - - - Brunei Darussalam VIDRL 1 0 0 0 1 0 0 100% 0% 16-Jul-18 VIDRL 0 - - - - - - - - - - - - - Cambodia NIID 42 0 0 8 34 0 0 98% 18% 08-Aug-18 NIID 0 - - - - - - - - - - - - - China (total) 2363 16 0 174 2097 0 76 97% 6% 08-Aug-18 45 0 7 0 0 0 0 0 35 3 0 0 0 100% China, Anhui Prov. Lab 139 1 0 9 122 0 7 100% 6% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Beijing Prov. Lab 18 0 0 0 18 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Chongqing Prov. Lab 16 0 0 1 13 0 2 86% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Fujian Prov. Lab 89 1 0 1 82 0 5 99% 1% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Gansu Prov. Lab 47 0 0 2 42 0 3 100% 5% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guangdong Prov. Lab 189 1 0 12 174 0 2 91% 5% Prov. Lab/CCDC 4 0 0 0 0 0 0 0 4 0 0 0 0 100% China, Guangxi Prov. Lab 101 1 0 10 89 0 1 97% 9% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Guizhou Prov. Lab 79 0 0 6 71 0 2 99% 7% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Hebei Prov. Lab 129 0 0 17 111 0 1 100% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab 48 0 0 2 46 0 0 100% 4% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Henan Prov. Lab 268 1 0 36 229 0 2 100% 12% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Hubei Prov. Lab 80 0 0 5 72 0 3 99% 6% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Hunan Prov. Lab 99 0 0 14 84 0 1 98% 11% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Jiangsu Prov. Lab 86 5 0 5 69 0 7 100% 6% Prov. Lab/CCDC 10 0 0 0 0 0 0 0 7 3 0 0 0 100% China, Jiangxi Prov. Lab 67 0 0 4 60 0 3 95% 4% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Jilin Prov. Lab 31 1 0 3 27 0 0 100% 6% Prov. Lab/CCDC 4 0 2 0 0 0 0 0 2 0 0 0 0 100% China, Neimongol Prov. Lab 44 2 0 2 40 0 0 98% 3% Prov. Lab/CCDC 4 0 1 0 0 0 0 0 3 0 0 0 0 100% China, Ningxia Prov. Lab 15 0 0 1 14 0 0 100% 7% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shaanxi Prov. Lab 49 0 0 0 44 0 5 89% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shandong Prov. Lab 196 1 0 12 175 0 8 100% 5% Prov. Lab/CCDC 3 0 0 0 0 0 0 0 3 0 0 0 0 100% China, Shanghai Prov. Lab 11 0 0 0 11 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Shanxi Prov. Lab 86 0 0 0 86 0 0 96% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Sichuan Prov. Lab 139 0 0 4 121 0 14 98% 3% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Tianjin Prov. Lab 13 0 0 0 13 0 0 100% 0% Prov. Lab/CCDC 0 - - - - - - - - - - - - - China, Xinjiang Prov. Lab 61 1 0 4 56 0 0 89% 7% Prov. Lab/CCDC 2 0 0 0 0 0 0 0 2 0 0 0 0 100% China, Yunnan Prov. Lab 120 0 0 14 103 0 3 90% 9% Prov. Lab/CCDC 1 0 0 0 0 0 0 0 1 0 0 0 0 100% China, Zhejiang Prov. Lab 70 1 0 5 63 0 1 100% 7% Prov. Lab/CCDC 5 0 0 0 0 0 0 0 5 0 0 0 0 100% China, Hainan Prov. Lab 21 0 0 4 17 0 0 100% 17% CCDC 0 - - - - - - - - - - - - - China, Liaoning Prov. Lab 35 0 0 0 32 0 3 100% 0% CCDC 0 - - - - - - - - - - - - - China, Qinghai Prov. Lab 15 0 0 0 12 0 3 100% 0% CCDC 0 - - - - - - - - - - - - - China, Tibet Prov. Lab 2 0 0 1 1 0 0 100% 33% CCDC 0 - - - - - - - - - - - - - China, Hong Kong SAR PHLC 5 0 0 0 5 0 0 100% 0% 10-Aug-18 PHLC 0 - - - - - - - - - - - - - China, Macao SAR PHLC 1 0 0 0 1 0 0 100% 0% 13-Apr-18 PHLC 0 - - - - - - - - - - - - - Japan NIID - - - - - - - - - - NIID - - - - - - - - - - - - - - Lao People's Democratic Republic NIID 50 1 0 4 45 0 0 99% 5% 17-Jul-18 NIID 1 0 0 0 0 0 0 0 1 0 0 0 0 100% Malaysia IMR 87 0 0 7 80 0 0 89% 6% 09-Jul-18 IMR 0 - - - - - - - - - - - - - Mongolia PHI 5 0 0 2 3 0 0 100% 40% 13-Aug-18 NIID 0 - - - - - - - - - - - - - New Zealand IESR 6 0 0 0 4 2 0 88% 0% 13-Aug-18 IESR 0 - - - - - - - - - - - - - Papua New Guinea VIDRL 44 3 0 2 25 14 0 96% 7% 15-Aug-18 VIDRL 12 0 2 7 0 0 0 0 2 0 0 1 0 175% Philippines RITM 235 2 1 10 208 14 0 94% 4% 14-Aug-18 RITM 7 0 2 0 0 0 0 0 5 0 0 0 0 100% Republic of Korea NIH 34 0 0 2 30 2 0 100% 6% 10-Aug-18 NIH 0 - - - - - - - - - - - - - Singapore SGH 5 0 0 1 3 1 0 100% 14% 10-Aug-18 SGH 0 - - - - - - - - - - - - - Viet Nam (North) NIHE 95 2 0 12 77 4 0 100% 12% 24-Jul-18 NIHE 3 0 1 0 0 0 0 0 2 0 0 0 0 100% Viet Nam (South) PI 72 3 0 4 65 0 0 100% 6% 06-Aug-18 PI 6 0 0 0 0 0 0 0 6 0 0 0 0 100% Pacific island countries and areas VIDRL 1 0 0 0 1 0 0 100% 0% 02-May-18 VIDRL 0 - - - - - - - - - - - - - Total 3067 27 1 226 2697 37 79 97% 7% 74 0 12 7 0 0 0 0 51 3 0 1 0 105%6% 100% 2. NPEV growing in L20B cells L20B positive Pending ≤ 14 days VDPV Type 2 L20B positive + NPEV NPEV 2 VDPV Pending ITDVDPV NegativeNPEV 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); NIH (National Institute of Health, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) 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 posit ive for NPEV Latest report date Discordant pending sequencing Polio Bulletin 4 Table 3. Laboratory confirmation of polio isolates from environmental samples in 2017–2018 1 Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2018 Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV Australia VIDRL 6 2 0 0 0 0 0 1 0 1 0 4 0 0 17 2 0 2 0 0 0 0 0 0 0 12 0 0 China (total) 325 188 0 213 0 0 0 0 0 650 0 1158 0 0 132 97 0 134 0 0 0 1 0 357 1 542 0 0 China, Fujian Prov. Lab/CCDC 53 22 0 8 0 0 0 0 0 42 0 331 0 0 40 29 0 7 0 0 0 0 0 72 1 289 0 0 China, Gansu Prov. Lab/CCDC 12 10 0 10 0 0 0 0 0 29 0 18 0 0 6 4 0 2 0 0 0 0 0 5 0 14 0 0 China, Guangdong Prov. Lab/CCDC 48 39 0 18 0 0 0 0 0 87 0 108 0 0 28 25 0 15 0 0 0 0 0 63 0 124 0 0 China, Guangxi Prov. Lab/CCDC 36 20 0 22 0 0 0 0 0 36 0 94 0 0 0 - - - - - - - - - - - - - China, Heilongjiang Prov. Lab/CCDC 42 17 0 12 0 0 0 0 0 34 0 112 0 0 9 7 0 1 0 0 0 0 0 16 0 3 0 0 China, Shandong Prov. Lab/CCDC 48 28 0 18 0 0 0 0 0 90 0 272 0 0 23 8 0 13 0 0 0 0 0 36 0 61 0 0 China, Shanghai Prov. Lab/CCDC 22 18 0 17 0 0 0 0 0 65 0 51 0 0 5 3 0 2 0 0 0 0 0 6 0 7 0 0 China, Xinjiang Prov. Lab/CCDC 36 34 0 108 0 0 0 0 0 267 0 115 0 0 21 21 0 94 0 0 0 1 0 159 0 44 0 0 China, Yunnan Prov. Lab/CCDC 28 0 - - - - - - - - - 57 0 0 0 - - - - - - - - - - - - - Malaysia IMR 24 0 - - - - - - - - - 22 0 0 0 - - - - - - - - - - - - - Philippines RITM 40 8 0 1 0 0 0 0 0 7 0 21 0 0 43 3 0 2 0 0 0 0 0 1 0 14 0 0 Total 395 198 0 214 0 0 0 1 0 658 0 1205 0 0 192 102 0 138 0 0 0 1 0 358 1 568 0 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); IMR (Institute of Medical Research, Malaysia); 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 2017 2018 Total number of samples processed Total number of samples with polio isolates NPEV Pending ITD Country/area 2000–2009 3 2010 2011 2012 2013 2014 2015 2016 2017 2018 Australia aVDPV2 (1 env) Cambodia 2006 - 1 Total - 2 China 2009 - 1 Total - 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 ?VDPV2 (1 env) iVDPV3 (2 AFP) aVDPV3 (1 env) China, Hong Kong SAR 2005 - 3 Japan 2005 - 1 Total - 2 Lao People's Democratic Republic 2004 - 3 cVDPV1 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 contacts) Mongolia 2003 - 1 Papua New Guinea cVDPV1 (4 AFP + 2 contacts) Philippines 2001 - 3 aVDPV2 (1 AFP) Viet Nam aVDPV2 (2 AFP) 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. 1. Prefix letter refers to the VDPV category: "cVDPV" = circulating VDPV, "iVDPV" = immunodeficiency-associated VDPV, "aVDPV" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the poliovirus serotype (types 1, 2 or 3).