2014 Issue No. 22 - Week 43 (as of 28 October 2014) HIGHLIGHTS Philippines Introduces Supplemental Inactivated Polio Vaccine (IPV) in its Routine Immunization Program. The Philippines announced on 6 October 2014, the introduction of a supplemental dose of the injectable inactivated polio vaccine (IPV) into its routine immunization programme. The launch for the National Capital Region (NCR) took place on 6 October 2014 in the city of Paranaque, part of Manila’s metropolitan area and will gradually expand nationwide. This major step, which is part of a worldwide rollout of the vaccine across 126 countries by the end of 2015, puts the Philippines at the forefront of the fight against Polio by becoming the first non-GAVI country in Asia using a schedule with only oral polio vaccine (OPV) to add IPV to its routine immunization programme. This national launch was followed by a regional event on 24 October, during World Polio Day, in the city of Iloilo for Region 6 situated in the Visayas. The universal introduction of IPV is part of a global plan to eradicate polio and secure the gains made against the disease through stronger immunization systems, so that all children in all countries have access to vaccines. The plan also calls for the eventual removal of OPV following the eradication of the remaining strains of poliovirus transmission, due to the very low risk of potential vaccine-associated cases. Chart 3. Polio immunization status of reported AFP cases, 2014 100% 100%
Polio Bulletin 90% 80% 70% 60%
Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age) and adequate specimen collection rate, 2012–2014* 3.0 2.5 100%
Chart 2. Percentage of cases with pending classification > 90 days after onset, 2014 CHN 6.5% 9.1% 3.8% 9.8% 5.6% 72.7% 16.2% 0% 20% 40% 60% 80% 100%
Cases with adequate specimens
KHM LAO MYS PHL PNG VNM
Non-polio AFP rate
2.0 1.5 1.0 0.5 0.0 12 13 14 CHN 12 13 14 KHM 12 13 14 LAO 12 13 14 MYS 12 13 14 PHL 12 13 14 PNG 12 13 14 VNM
50% 40% 30% 20% 10% 0%
* AFP rate annualized as of week 43
Chart 4. Percentage of samples received at the lab ≤ 3 days of collection, 2014
80%
80%
60%
60%
53%
58%
40% 40%
37% 27%
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
20% 20%
0% CHN KHM LAO MYS 1-2 doses
PHL 0 doses
PNG Unknown
VNM
0% CHN
0% KHM
0% LAO MYS PHL
0% PNG VNM
≥ 3 doses
Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People’s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam).
Table 1. Classification of AFP cases with onset in 2014 and key surveillance indicators 2013 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 6 specimens 3 5 follow-up notification ≥ 80% ≥ 80% ≥ 80% Latest report date Days since last report 7
2014 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.
62 1 73 5623 12 0 48 1 155 7 12 18 277 84 7 459 8 6847
44 1 46 2225 8 167 25 1 77 8 9 30 378 72 6 231 10 3338
45 2 55 4038 15 0 26 1 133 4 5 11 179 73 7 271 10 4875
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 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 2 17 3013 15 22 1 105 3 4 0 142 69 7 165 6 3609
7 0 38 1025 0 4 0 28 1 1 11 37 4 0 106 4 1266
1 (2.2%) 0 (0.0%) 5 (9.1%) 263 (6.5%) 0 (0.0%) 1 (3.8%) 0 (0.0%) 13 (9.8%) 0 (0.0%) 1 (20.0%) 8 (72.7%) 10 (5.6%) 0 (0.0%) 0 (0.0%) 44 (16.2%) 4 (40.0%) 350 (7.2%) Green Yellow Red
1.24 2.42 1.45 2.19 2.27 1.26 1.21 2.09 0.60 0.67 0.44 0.57 1.23 1.41 1.42 1.21 1.77
47% 50% 96% 92% 93% 54% 0% 74% 75% 40% 36% 64% 82% 71% 95% 60% 90%
76% 50% 100% 99% 100% 85% 100% 98% 100% 80% 91% 91% 100% 100% 98% 80% 98%
84% 100% 91% 100% 100% 92% 100% 64% 100% 100% 73% 97% 97% 100% 92% 90% 98%
0% 100% 100% 83% 100% 100% 100% 56% 0% 33% 0% 8% 100% 100% 50% 25% 66%
20-Oct-14 30-Sep-14 05-Oct-14 22-Oct-14 07-Oct-14 02-Oct-14 14-Oct-14 27-Oct-14 09-Oct-14 28-Oct-14 22-Oct-14 12-Sep-14 16-Oct-14 08-Oct-14 27-Oct-14 28-Oct-14
8 28 23 6 21 26 14 1 19 0 6 46 12 20 1 0
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 for which the 60-day follow-up evaluation has been completed 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 2014 and key laboratory indicators Virus isolation results Country National polio laboratory Total no. of AFP L20B cases with specimens positive L20B positive + NPEV NPEV only Pending ≤ 14 Negative 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 Intratypic differentiation (ITD) results Type 3 VDPV Wild Sabin VDPV NPEV 3
1
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 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 10 8 0 58 23 137 4 5 268 73 8 160 103 3989 212 29 159 79 270 192 207 112 353 166 225 133 45 75 273 20 184 263 19 69 199 124 55 157 22 130 101 71 27 17 1 15 0 4895
0 0 0 0 4 0 0 0 0 3 0 0 0 0 68 5 1 1 0 3 5 7 0 3 2 11 2 0 1 2 2 3 4 0 1 11 2 0 1 0 0 0 0 1 0 0 0 75
0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 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 3
2 0 4 0 10 5 3 1 1 9 7 0 20 11 436 20 0 22 8 39 36 22 6 38 24 2 21 6 4 27 0 2 25 3 4 34 19 10 23 5 16 12 3 2 3 0 4 513
26 1 5 7 44 18 134 3 4 241 64 8 136 92 3425 187 27 135 71 228 149 176 104 308 133 210 109 39 59 241 17 176 233 15 62 152 103 40 127 17 114 87 68 23 14 1 11 4219
5 0 0 0 0 0 0 0 0 15 1 0 4 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 1 0 0 0 0 0 0 0 0 26
0 0 0 1 0 0 0 0 0 0 0 0 0 0 58 0 1 1 0 0 2 1 2 4 7 2 1 0 11 3 1 3 1 1 2 2 0 5 5 0 0 2 0 1 0 0 0 59
94% 0% 100% 100% 95% 100% 100% 100% 91% 89% 96% 100% 100% 92% 69% 76% 79% 91% 66% 79% 50% 57% 87% 78% 83% 71% 91% 59% 82% 77% 97% 42% 33% 89% 94% 49% 60% 68% 90% 59% 56% 82% 65% 60% 91% 0% 91% 71%
4% 0% 50% 0% 15% 20% 2% 25% 18% 3% 10% 0% 11% 10% 9% 9% 0% 9% 8% 12% 16% 8% 5% 9% 14% 1% 14% 11% 6% 7% 0% 1% 8% 14% 4% 14% 12% 15% 14% 18% 12% 10% 3% 6% 18% 0% 13% 9%
25-Sep-14 25-Sep-14 25-Sep-14 25-Sep-14 27-Oct-14 20-Oct-14 14-Oct-14 09-Oct-14 07-Oct-14 27-Oct-14 16-Oct-14 27-Oct-14 15-Oct-14 22-Oct-14 22-Oct-14
VIDRL VIDRL VIDRL VIDRL NIID NIID NIID IMR NIID IESR RITM NIH SGH NIHE PI 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 4 0 0 8 0 0 0 0 9 2 0 0 0 176 12 6 3 6 7 11 9 1 5 2 29 2 0 2 4 6 10 10 2 4 24 8 4 5 0 2 2 0 0 0 0 0 0 199
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 2 0 40 2 2 0 2 2 0 2 0 1 2 7 1 0 2 0 2 4 0 2 7 0 0 0 2 0 42
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 8 6 0 64 5 0 0 2 3 6 4 0 1 0 15 0 2 0 2 4 4 0 2 7 2 2 3 0 0 78
0 0 0 0 4 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 4
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 0 0 0 65 5 4 3 2 2 5 1 0 3 0 7 1 0 2 4 2 2 2 0 10 4 2 2 0 2 67
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
2 0 0 2 3 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 7
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 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
100% 100% 100% 100% 96% 100% 100% 100% 100% 71% 100% 100% 100% 100% 100% 95% 100% 100% 100% 100% 88% 100% 100% 100% 93% 100% 100% 80% 100% 100% 96%
20-Oct-14 20-Oct-14
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
3
Polio Bulletin
Table 3. Laboratory confirmation of polio isolates from other sources in 2014 Non-AFP cases Country Intratypic Total number Total number differentiation of non-AFP of non-AFP lab 2 cases tested cases with polio isolates for polio Type 1 Wild Sabin VDPV Wild Type 2 Sabin VDPV Wild Type 3 Sabin NPEV Discordant Total number Pending grown pending of samples ITD sequencing processed 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 NPEV Discordant Pending grown pending ITD sequencing VDPV in L20B
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
43 0 0 140 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 1 0 0 0 0 0 0 0 0 0 0 0 185
0 0 0 1 1 1
0 0 0 0 0 0
0 0 0 1 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 0
0 17 0 0 0 17
0 0 0 0 0 0
0 0 0 0 0 0
0 0 9 0 0 0 0 0 0 0 78 0 0 0 0 24 0 0 10 0 0 0 0 0 0 24 8 0 0 0 12 0 0 0 0 0 0 0 0 0 0 0 0 87
6 78 24 10 24 8 12 84
0 0 0 0 0 0 0 0
1 43 12 7 5 5 14 44
0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
1 69 15 19 6 8 21 70
0 2 0 1 0 0 1 2
0 0 0 0 0 0 0 0
4 50 6 13 15 2 14 54
0 0 0 0 0 0 0 0
6 0 0 0 0 0 0 6
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); 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, 2000–2014 Country Cambodia iVDPV1 (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
2014
China
aVDPV1 (1 case)
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)
aVDPV2 (1 case)
aVDPV1 (1 case) aVDPV1 (1 case) aVDPV2 (3 cases) aVDPV2 (5 cases) aVDPV2 (2 cases) aVDPV2 (1 case) cVDPV2 (2 cases) aVDPV2 (1 case) aVDPV3 (2 cases) cVDPV2 (3 cases) iVDPV2 + iVDPV3 (1 case) iVDPV2 (2 cases) iVDPV2 + 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