2016 Issue No. 1 - Week 1 (as of 5 January 2016) HIGHLIGHTS Summary of the progress on the Polio Endgame Plan Report by the WHO Secretariat 138th session of the WHO Executive Board Strong progress continues to be made towards objectives of the Polio Eradication and Endgame Strategic Plan 2013– 2018. In 2015 transmission of wild poliovirus was at the lowest levels in history with the fewest ever reported cases from the fewest ever affected countries. As of 15 December 2015, only 66 cases of wild poliovirus were reported for the year from only two countries: Afghanistan (17) and Pakistan (49). On 20 September 2015, the Global Commission for the Certification of Poliomyelitis Eradication declared that wild poliovirus type 2 has been eradicated. In October 2015 the Strategic Advisory Group of Experts on immunization recommended that all countries still using trivalent oral polio vaccine (tOPV) the global synchronized withdrawal of the type 2 component of OPV should occur between 17 April and 1 May 2016. However, the challenges still exist. Outbreaks of circulating vaccine derived poliovirus (cVDPV) in four WHO regions (AFRO, EURO, SEARO, WPRO) illustrate serious gaps in routine immunization programmes of affected countries leading to large pockets of poliovirus susceptibility. To minimize accidental facility-associated risk of poliovirus exposure, all Member States should accelerate implementation of the WHO Global Action Plan by establishing an inventory of facilities holding poliovirus materials by end 2015 and destroying or containing all Sabin type 2 poliovirus materials by July 2016. Polio legacy planning should be accelerated at the national level. See more at: http://apps.who.int/gb/ebwha/pdf_files/EB138/ B138_25-en.pdf 3.5
Polio Bulletin
Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2013–2015 100%
Chart 2. Adequate specimen collection rate, 2013–2015
3.0 80%
2.5 60%
2.0
1.5
40%
1.0 20%
0.5 0%
0.0 13 14 CHN 15 13 14 KHM 15 13 14 LAO 15 13 14 MYS 15 13 14 PHL 15 13 14 PNG 15 13 14 VNM 15
13
14 CHN
15
13
14 KHM
15
13
14 LAO
15
13
14 MYS
15
13
14 PHL
15
13
14 PNG
15
13
14 VNM
15
Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2015 100%
Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2015 CHN 7.3% 0.0% 16.9% 20.3% 7.2% 15.4% 28.7% 0% 5% 10% 15% 20% 25% 30% 35%
80%
KHM LAO MYS
60%
40%
PHL PNG VNM
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%
0% CHN KHM LAO MYS 1-2 doses
PHL 0 doses
PNG Unknown
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 2015 and key surveillance indicators 2014 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 % % with investigated adequate ≤ 2 days of specimens 2 notification 3 ≥ 80% ≥ 80% Latest report date Days since last report 4
2015 Indicators
Country/area
Poliocompatible
Discarded (Non-polio)
Total
> 90 days 1 # (%)
≥1
≤ 30
Australia Brunei Darussalam Cambodia China China, Hong Kong SAR China, Macao SAR Japan Lao People's Democratic Republic Malaysia Mongolia New Zealand Papua New Guinea Philippines Republic of Korea Singapore Viet Nam Pacific island countries and areas Total 1. 2. 3. 4.
60 4 72 5758 19 1 28 161 9 8 12 272 88 8 361 15 6876
44 1 46 2234 8 1 163 24 77 9 9 34 387 70 6 231 10 3354
54 3 84 4884 10 1 77 133 9 7 26 391 78 7 289 13 6066
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 5 0 0 0 0 0 0 0 0 0 5
0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1
41 2 74 3704 9 1 38 90 7 5 16 341 67 7 168 7 4577
13 1 10 1179 1 0 34 43 2 2 10 50 11 0 121 6 1483
3 (5.6%) 0 (0.0%) 0 (0.0%) 357 (7.3%) 0 (0.0%) 0 (0.0%) 13 (16.9%) 27 (20.3%) 0 (0.0%) 2 (28.6%) 4 (15.4%) 28 (7.2%) 0 (0.0%) 0 (0.0%) 83 (28.7%) 1 (7.7%) 518 (8.5%) Green Yellow Red
1.23 3.00 1.83 2.19 1.25 1.00 3.21 1.73 1.00 0.78 0.76 1.01 1.11 1.17 1.25 1.30 1.81
24% 100% 99% 92% 80% 100% 56% 77% 100% 29% 31% 63% 86% 100% 96% 69% 89%
94% 100% 100% 100% 100% 100% 97% 59% 100% 100% 77% 97% 88% 86% 94% 100% 98%
24-Dec-15 26-Nov-15 01-Jan-16 30-Dec-15 07-Dec-15 15-Dec-15 04-Jan-16 29-Dec-15 04-Jan-16 09-Nov-15 11-Dec-15 11-Dec-15 18-Dec-15 07-Dec-15 04-Dec-15 29-Dec-15
12 40 4 6 29 21 1 7 1 57 25 25 18 29 32 7
Number (%) of reported cases pending classification more than 90 days from date of onset of paralysis to date of last report Percentage of reported cases with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Percentage of reported cases investigated within two days of notification Countries are expected to submit data at least once per month to WPRO
Reached o r surpassed target Nearly reached target: 0.5–0.99 fo r no n-po lio A FP rate; 60–79% fo r o ther indicato rs Substantially belo w target
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Polio Bulletin
Table 2. Laboratory investigation of AFP cases with onset in 2015 and key laboratory indicators Virus isolation results Country/area Polio laboratory Total no. of AFP cases with specimens L20B positive L20B positive + NPEV only NPEV % % results Latest specimens reported Pending Pending positive for report date 14 days ≤ ≤ 14 days > 14 days NPEV ≥ 80% Intratypic differentiation/ Sequencing 1 laboratory No. of isolates received Type 1 Wild Sabin VDPV Wild Intratypic differentiation (ITD)/sequencing results Type 2 Type 3 Sabin VDPV Wild Sabin VDPV NPEV 2 1
Negative
Pending ITD
% ITD results Discordant reported ≤ 7 pending days of sequencing receipt ≥ 80%
Australia Brunei Darussalam Cambodia 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 China, Hong Kong SAR China, Macao SAR Japan Lao People's Democratic Republic Malaysia Mongolia New Zealand Papua New Guinea Philippines Republic of Korea Singapore Viet Nam (North) Viet Nam (South) Pacific island countries and areas Total
VIDRL VIDRL 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 Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab Prov. Lab PHLC PHLC NIID NIID IMR PHI IESR VIDRL RITM NIH SGH NIHE PI VIDRL
42 3 76 4826 278 30 135 93 323 268 279 125 469 272 211 161 48 94 335 38 132 340 39 106 201 172 78 194 33 166 80 82 23 19 2 10 0 64 131 9 4 23 459 78 7 210 150 14 6106
0 0 1 58 2 3 3 0 8 3 4 0 8 1 4 6 0 1 1 0 0 1 1 3 3 3 1 0 0 0 0 2 0 0 0 0 9 0 0 0 1 4 0 0 3 0 1 77
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 1 0 0 0 0 0 0 0 0 0 0 2
3 0 8 445 17 0 24 12 12 38 55 4 44 30 4 4 5 5 32 1 12 25 0 16 22 18 8 23 2 21 5 3 1 2 0 0 6 11 2 0 5 59 8 1 20 16 3 587
35 2 67 4229 245 27 107 80 298 209 218 118 414 240 179 151 42 86 300 37 120 306 38 85 175 151 67 170 31 145 73 76 22 17 2 9 48 120 7 4 14 392 67 6 182 129 10 5321
4 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 1 0 0 0 0 4 3 3 0 4 5 0 25
0 0 0 93 14 0 1 1 5 18 1 3 3 1 24 0 1 2 2 0 0 8 0 2 1 0 2 1 0 0 2 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 95
94% 100% 96% 96% 97% 100% 99% 97% 96% 99% 99% 100% 90% 98% 98% 100% 98% 96% 98% 100% 90% 94% 100% 98% 92% 95% 99% 98% 88% 96% 96% 99% 98% 100% 100% 87% 98% 98% 94% 100% 93% 89% 89% 100% 99% 98% 92% 96%
5% 0% 10% 8% 5% 0% 17% 10% 3% 12% 16% 3% 7% 10% 2% 2% 8% 4% 8% 3% 8% 7% 0% 15% 9% 8% 7% 11% 6% 13% 5% 2% 2% 11% 0% 0% 10% 6% 22% 0% 23% 10% 9% 7% 9% 11% 19% 8%
24-Dec-15 24-Dec-15 04-Jan-16 30-Dec-15
VIDRL VIDRL NIID Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC CCDC CCDC CCDC CCDC CCDC CCDC CCDC CCDC CCDC
0 0 0 160 4 10 9 0 31 6 9 0 16 2 6 12 0 2 1 4 0 5 2 6 7 10 3 2 2 0 2 5 4 0 0 0 0 18 0 0 0 1 9 0 0 5 0 2 195
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
45 1 3 0 4 0 6 11 0 2 6 2 0 2 0 0 2 2 2 0 2 0 0 0 0 5 1 1 3 0 55
1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 6 0 0 0 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
57 1 4 5 14 2 3 1 2 2 4 0 1 2 2 0 4 2 4 0 0 2 0 2 0 2 0 2 1 0 62
7 0 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 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
48 2 3 4 8 4 0 4 0 2 2 0 0 0 3 2 0 3 1 3 0 0 0 3 4 5 0 6 0 2 61
0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 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 1 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
98% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 71% 100% 67% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98%
15-Dec-15 15-Dec-15 04-Jan-16 10-Dec-15 21-Dec-15 01-Dec-15 24-Dec-15 04-Jan-16 18-Dec-15 27-Nov-15 30-Dec-15 11-Dec-15 24-Dec-15
PHLC PHLC NIID NIID IMR NIID IESR VIDRL RITM NIH SGH NIHE PI VIDRL
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) 2. NPEV growing in L20B cells
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Polio Bulletin
Table 3. Laboratory confirmation of polio isolates from environmental samples in 2014–2015 1 2014 Country/area Intratypic differentiation lab 2 Total number of samples processed Total number of samples with polio isolates Type 1 Wild Sabin VDPV Wild Type 2 Sabin VDPV Wild Type 3 Sabin VDPV Discordant Total number Pending pending NPEV of samples ITD sequencing processed Total number of samples with polio isolates Type 1 Wild Sabin VDPV Wild
2015 Type 2 Sabin VDPV Wild Type 3 NPEV Sabin VDPV Pending ITD Discordant pending sequencing
Australia China (total) 3
VIDRL Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC IMR
3 167 14 0 48 0 18 48 12 27 0 21 191
0 167 14 0 48 0 18 48 12 27 0 7 174
0 0 0 0 0 0 0 0 0
79 1 21 11 13 6 27 1 80
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
129 4 22 37 16 12 38 1 130
2 0 0 1 0 0 1 0 2
0 0 0 0 0 0 0 0 0
115 0 15 47 23 10 20 5 120
0 0 0 0 0 0 0 0 0
3 0 0 0 0 0 0 0 7 10
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
29 186 15 8 16 29 6 18 4 18 72 0 215
2 68 7 5 7 8 4 15 4 18 0 70
0 0 0 0 0 0 0 0 0 0 0 0
0 121 0 3 6 6 1 28 0 77 0 121
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
1 122 7 0 5 3 5 9 3 90 0 123
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
1 116 0 6 2 23 1 27 1 56 0 117
0 0 0 0 0 0 0 0 0 0 0 0
26 287 2 8 10 60 5 73 13 116 0 313
0 0 0 0 0 0 0 0 0 0 0 0
0 7 0 0 0 0 0 0 0 7 0 7
China, Fujian China, Gansu China, Guangdong China, Guangxi China, Heilongjiang China, Shandong China, Shanghai China, Xinjiang China, Yunnan Malaysia Total
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); IMR (Institute of Medical Research, Malaysia); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) 3. Reported data from China are currently being verified and may be amended in the next issue of the bulletin.
Table 4. Vaccine-derived poliovirus identified from laboratory testing2, 2000-2015 Country/area Cambodia
2000–2009 3 2006 - 1 Total - 2 2009 - 1 Total - 27
2010
2011
2012
2013
2014
2015
China
aVDPV2 (3 AFP + 1 contact + 1 non-AFP) aVDPV3 (1 AFP + 1 non-AFP)
aVDPV1 (1 AFP) aVDPV2 (2 AFP + 1 contact) cVDPV2 (1 AFP + 1 non-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)
China, Hong Kong SAR Japan Lao People's Democratic Republic Mongolia Philippines Viet Nam
2005 - 3 2005 - 1 Total - 2 2004 - 3 2003 - 1 2001 - 3 aVDPV2 (2 AFP) aVDPV2 (1 AFP) cVDPV1 (5 AFP + 20 contacts)
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). 2. Source of specimens could be AFP cases, contacts, or non-AFP cases 3. Refers to year of last VDPV case, and aggregate total of VDPV cases for 2000-2009
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Polio Bulletin