2013 Issue No. 13 - Week 43 (as of 28 October 2013) HIGHLIGHTS Polio Outbreaks update Horn of Africa: The total number of WPV cases (all WPV1) for 2013 in the Horn of Africa remains 197 (174 from Somalia, 14 from Kenya, 6 from Ethiopia and 3 from South Sudan). The most recent WPV1 case in the region had onset of paralysis on 19 September. Outbreak response across the Horn of Africa countries continues. Central Africa: In Cameroon, one WPV1 was reported this week from Ouest province. This is the first WPV in Cameroon since 2009 and had onset of paralysis on 1 October 2013. An outbreak response is now being planned. As the country was considered at high-risk of re-infection due to its proximity with Nigeria, five large-scale supplementary immunization activities (SIAs) have already been conducted (in April, May, August, September and October 2013). Syrian Arab Republic: In Syria, a cluster of ‘hot’ AFP cases was detected and reported in early October in Deir Al-Zour province and is currently being investigated. Wild poliovirus was last reported in Syria in 1999. A comprehensive outbreak response plan is urgently being finalized. Multiple large-scale SIAs are needed over the next 6 months (beginning in early November) across Syria and across the region It is recommended that all WPRO countries should increase their AFP surveillance vigilance. WHO’s international travel and health recommendations include that all persons from polioinfected countries be fully vaccinated against polio. 3.0 2.5
Polio Bulletin 100% 80% 70% 60%
Chart 1. Non-polio AFP rate and adequate specimen collection rate, 2011–2013
Chart 2. Percent cases with pending classification > 90 days after onset, 2013 CHN Cases with adequate specimens (%)
90%
5.0% 0.0% 6.0% 5.0% 32.0% 53.0% 27.0% 0% 10% 20% 30% 40% 50% 60%
KHM LAO MYS PHL PNG VNM
Non-polio AFP rate
2.0 1.5 1.0 0.5 0.0 11 12 13 CHN 11 12 13 KHM 11 12 13 LAO 11 12 13 MYS 11 12 13 PHL 11 12 13 PNG 11 12 13 VNM
50% 40% 30% 20% 10% 0%
Chart 3. Polio immunization status of reported AFP cases, 2013 100%
Chart 4. Percentage of samples received at the lab ≤ 3 days of collection, 2013 100%
80%
80%
60%
60%
54%
58%
40%
40% 21% 20%
40%
20%
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
0% CHN KHM ≥ 3 doses
LAO
MYS
PHL 0 doses
PNG Unknown
VNM
0% CHN
0% KHM
2% LAO MYS PHL
0% PNG VNM
1-2 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 43.
Table 1. Classification of AFP cases with onset in 2013 and key surveillance indicators 2012 Classification Total reported cases Annual expected cases <15 years of age Pending Total reported cases Confirmed wild poliovirus Vaccinederived poliovirus (VDPV) Non-polio AFP rate 2 % % with % with % with any investigated adequate 60-day 4 ≤ 2 days of specimen specimens 3 follow-up 6 notification 5 ≥ 80% ≥ 80% ≥ 80% Latest report date Days since last report 7
2013 Indicators
Poliocompatible
Discarded (Non-polio)
Total
> 90 days 1 # (%)
≥1
Australia Brunei Darussalam Cambodia China Hong Kong (China) Japan Lao People's Democratic Republic Macao (China) Malaysia Mongolia New Zealand Papua New Guinea Philippines Republic of Korea Singapore Viet Nam Pacific island countries Total 1. 2. 3. 4. 5. 6. 7.
56 1 107 6173 14 0 55 0 141 9 8 10 403 95 10 514 4 7600
43 1 45 2225 8 167 25 1 76 7 9 30 371 76 6 241 10 3341
37 1 57 3970 9 0 34 1 124 3 7 19 208 54 7 266 5 4802
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 2
37 1 51 2970 6 24 1 99 3 4 8 135 23 7 165 4 3538
0 0 6 999 3 10 0 25 0 3 11 72 31 0 101 1 1262
0 (0.0%) 0 (0.0%) 0 (0.0%) 153 (3.9%) 0 (0.0%) 2 (5.9%) 0 (0.0%) 4 (3.2%) 0 (0.0%) 0 (0.0%) 10 (52.6%) 44 (21.2%) 19 (35.2%) 0 (0.0%) 41 (15.4%) 1 (20.0%) 274 (5.7%) Green Yellow Red
1.04 1.21 1.53 2.16 1.36 1.64 1.21 1.97 0.52 0.94 0.77 0.68 0.86 1.41 1.33 0.60 1.74
38% 100% 77% 93% 78% 68% 100% 85% 67% 29% 16% 67% 94% 71% 97% 80% 90%
73% 100% 95% 99% 89% 85% 100% 100% 100% 71% 63% 93% 100% 100% 99% 100% 98%
100% 100% 84% 100% 100% 100% 100% 79% 100% 100% 74% 98% 98% 86% 89% 100% 98%
0% 77% 77% 0% 27% 53% 100% 40% 25% 59% 67% 100% 67% 0% 66%
22-Oct-13 17-Aug-13 14-Oct-13 23-Oct-13 07-Oct-13 30-Sep-13 11-Sep-13 14-Oct-13 09-Oct-13 16-Oct-13 09-Oct-13 13-Sep-13 17-Sep-13 03-Oct-13 26-Sep-13 07-Oct-13
6 72 14 5 21 28 47 14 19 12 19 45 41 25 32 21
Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Annualized non-polio AFP rate per 100 000 population under 15 years of age Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Percentage of reported cases with at least one specimen Percentage of reported cases investigated within two days of notification Percentage of reported cases with inadequate specimens followed-up within 60 days of onset of paralysis Countries are expected to submit data at least once per month to WPRO
Reached or surpassed target Nearly reached target: 0.5–0.99 for non-polio AFP rate; 60–79% for other indicators Substantially below target
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Polio Bulletin
Table 2. Laboratory investigation of AFP cases with onset in 2013 and key laboratory indicators Virus isolation results Country National polio laboratory Total no. of AFP L20B cases with positive specimens L20B positive + NPEV NPEV only Pending Negative ≤ 14 days Intratypic % % results differentiation Latest Pending reported specimens / Sequencing positive report date > 14 2 ≤ 14 days for NPEV 1 lab days ≥ 80% No. of isolates referred Type 1 Wild Sabin VDPV Wild 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 days of pending receipt sequencing ≥ 80%
Australia Brunei Darussalam Papua New Guinea Pacific island countries Japan Cambodia Lao People's Democratic Republic Malaysia Mongolia New Zealand Philippines Republic of Korea Singapore Viet Nam, North Viet Nam, South China (total) China, Anhui China, Beijing China, Fujian China, Gansu China, Guangdong China, Guangxi China, Hebei China, Heilongjiang China, Henan China, Hunan China, Jiangsu China, Jiangxi China, Jilin China, Shaanxi China, Shandong China, Shanghai China, Shanxi China, Sichuan China, Tianjin China, Xinjiang China, Yunnan China, Zhejiang China, Chongqing China, Guizhou China, Hainan China, Hubei China, Liaoning China, Neimongol China, Ningxia China, Qinghai China, Tibet Hong Kong (China) Macao (China) Total
VIDRL VIDRL VIDRL VIDRL NIID NIID NIID IMR PHI IESR RITM NIH SGH NIHE PI CCDC 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
33 1 15 5 0 48 28 24 0 4 304 54 7 157 147 3924 167 28 109 104 239 165 264 100 388 218 215 131 52 70 263 18 144 249 22 72 177 88 63 192 25 163 91 58 32 8 9 10 0 4761
0 0 0 0 0 0 0 0 0 0 1 1 1 64 1 1 2 6 2 2 6 1 6 2 8 2 0 1 6 0 3 0 1 3 3 3 0 0 0 3 0 2 0 0 0 0 67
0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
8 0 2 3 16 7 0 1 35 17 0 21 14 53 2 0 1 1 16 12 1 0 9 0 0 0 0 0 0 0 0 3 0 0 0 1 3 1 0 0 2 0 0 1 0 0 177
25 1 12 2 32 21 24 3 263 32 6 128 132 3717 147 27 104 95 221 150 251 97 371 211 206 129 52 69 248 18 131 233 21 61 174 82 59 185 25 159 87 56 32 7 9 5 4403
0 0 0 0 0 0 0 0 3 0 0 0 0 6 3 0 0 0 0 0 1 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 9
0 0 1 0 0 0 0 0 2 5 0 7 3 84 14 0 2 2 0 1 5 2 1 4 1 0 0 0 9 0 10 13 0 8 0 2 1 6 0 1 2 0 0 0 0 5 107
100% 100% 100% 100% 93% 95% 100% 100% 98% 100% 100% 91% 97% 59% 59% 75% 71% 71% 56% 24% 61% 88% 57% 91% 32% 72% 69% 87% 69% 100% 34% 30% 86% 87% 73% 38% 79% 76% 62% 25% 72% 63% 55% 38% 11% 95% 65%
23% 0% 12% 60% 28% 21% 0% 29% 10% 2% 0% 13% 9% 1% 1% 0% 0% 1% 5% 6% 0% 0% 2% 0% 0% 0% 0% 0% 0% 0% 0% 1% 0% 0% 0% 1% 3% 0% 0% 0% 2% 0% 0% 6% 0% 0% 3%
06-Oct-13 06-Oct-13 06-Oct-13 06-Oct-13 11-Sep-13 08-Oct-13 10-Apr-13 09-Oct-13 22-Oct-13 17-Sep-13 26-Aug-13 07-Oct-13 07-Oct-13 23-Oct-13
VIDRL VIDRL VIDRL VIDRL NIID NIID NIID IMR NIID IESR VIDRL NIID SGH NIID NIID Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab CCDC CCDC CCDC CCDC CCDC CCDC CCDC CCDC CCDC
0 0 0 0 0 0 0 0 0 0 3 0 2 2 2 153 8 11 5 11 8 6 2 1 13 4 11 20 0 0 14 4 4 0 2 7 5 7 0 0 1 6 0 1 2 0 0 0 0 162
0 0 0 0 0 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 40 3 3 2 0 2 0 0 1 5 0 9 0 6 2 2 0 0 1 1 0 3 0 0 41
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 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 2 2 0 62 3 6 3 6 5 2 1 0 7 2 1 7 2 2 2 2 6 0 2 0 1 0 2 67
0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
1 0 0 2 42 2 2 0 5 1 4 1 0 1 2 1 4 6 0 0 0 1 4 4 1 2 1 0 45
0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 0 0 0 0 0 0 0 8
0 0 0 0 9 0 0 0 2 0 6 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 9
0 0 0 0 2 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 2
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%
17-Oct-13 17-Oct-13
PHLC PHLC
1. IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); NIH (National Institute of Health, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, Hong Kong); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) 2. The target of 14 days for the timeliness of virus isolation will be used for all polio laboratories 3. NPEV growing in L20B cells 4. Twenty-two provincial laboratories in China perform ITD from 2013
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Polio Bulletin
Table 3. Laboratory confirmation of polio isolates from other sources in 2013 Non-AFP cases Country Intratypic Total number Total number differentiation of non-AFP of non-AFP lab 2 cases tested cases with for polio polio isolates Type 1 Wild Sabin VDPV Wild Type 2 Sabin VDPV Wild Type 3 Sabin NPEV Discordant Total number Pending of samples grown Non-EV pending ITD processed sequencing VDPV in L20B Total number of samples with polio isolates Type 1 Wild Sabin VDPV
1 Environmental samples Type 2 Type 3 VDPV Wild Sabin Discordant NPEV Pending pending grown Non-EV ITD sequencing VDPV in L20B
Wild
Sabin
Australia Japan Malaysia Mongolia New Zealand Philippines Republic of Korea Singapore Viet Nam, North Viet Nam, South China (total) China, Anhui China, Beijing China, Fujian China, Gansu China, Guangdong China, Guangxi China, Hebei China, Heilongjiang China, Henan China, Hunan China, Jiangsu China, Jiangxi China, Jilin China, Shaanxi China, Shandong China, Shanghai China, Shanxi China, Sichuan China, Tianjin China, Xinjiang China, Yunnan China, Zhejiang China, Chongqing China, Guizhou China, Hainan China, Hubei China, Liaoning China, Neimongol China, Ningxia China, Qinghai China, Tibet Hong Kong (China) Total
VIDRL NIID IMR PHI IESR VIDRL NIID SGH NIID NIID Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab CCDC CCDC CCDC CCDC CCDC CCDC CCDC CCDC CCDC PHLC
222 0 0 127 0 6 0 0 0 0 16 0 0 0 7 4 0 0 0 0 0 0 2 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 372
1 0 0 0 0 6 0 0 0 0 13 0 0 0 7 1 0 0 0 0 0 0 2 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 21
0 0 0 0 0 0 0 0 0 0 0 0
0 0 5 9 7 0 0 1 0 1 1 15
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 1 5 4 0 1 0 0 0 0 7
0 0 0 1 0 1 0 0 0 0 0 1
0 0 0 0 0 0 0 0 0 0 0 0
0 0 1 7 4 0 1 0 1 1 0 8
0 0 0 0 0 0 0 0 0 0 0 0
0 43 0 0 0 0 0 0 0 0 0 43
0 0 0 3 0 3 0 0 0 0 0 3
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 0 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9
0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
0 0
0 0
0 0
0 0
0 0
0 0
0 0
1 1
0 0
7 7
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); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, Hong Kong); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia)
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Polio Bulletin
Table 4. Vaccine-derived poliovirus, 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 (1 case) aVDPV2 (5 cases) aVDPV2 (1 case) cVDPV2 (2 cases) cVDPV2 (3 cases) iVDPV2 (1 case) aVDPV3 (2 cases) iVDPV2 (2 cases) iVDPV2 (1 case) iVDPV3 (1 case) iVDPV3 (1 case) iVDPV3 (1 case)
Hong Kong (China) Japan Lao People's Democratic Republic Mongolia Philippines Viet Nam cVDPV1 (3 cases)
aVDPV2 (2 cases)
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Polio Bulletin