2016 Issue No. 3 - Week 5 (as of 1 February 2016) HIGHLIGHTS Outbreak response assessment in the Lao People’s Democratic Republic 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
On 25-29 January 2016, the first outbreak response assessment in the Lao People's Democratic Republic was jointly conducted by WHO/UNICEF/US CDC team. The main objectives of the assessment were to assess quality and adequacy of outbreak response activities and to produce recommendations to assist the country to interrupt poliovirus transmission as soon as possible. Based on the findings of the assessment the team concluded that the Lao People’s Democratic Republic is possibly on track to interrupt transmission according to global guidelines. The main strengths of the response activities included the following: ・Response activities have been timely and comprehensive (in compliance with the global guidelines). ・Good local government support and inter-sectoral involvement (at the provincial/district level). ・Round-by-round comparisons of supplementary immunization activities (SIAs) revealed improvements in the quality and coverage of vaccination. ・Effective surveillance for acute flaccid paralysis (AFP) in place in the three high risk provinces. ・Engagement of leaders of local communities in social mobilization and communication activities. The assessment team recommended to the Ministry of Health of the Lao People's Democratic Republic the following: ・Continue close cooperation/coordination with community leaders to assure completeness of the lists of the population to be targeted for vaccination. ・Conduct training on AFP surveillance for public health staff. ・Increase AFP awareness among clinicians and health workers. ・Initiate active surveillance at priority hospitals. ・Integrate communications activities into campaign plans and microplans. ・Continue using the opportunities of local cultural events and other creative ways of expanding the reach to different ethnic groups.
3.0 80%
2.5 60%
2.0
1.5
40%
1.0 20%
0.5
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
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
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 5.0% 0.0% 22.9% 20.9% 9.3% 15.4% 6.8% 0% 5% 10% 15% 20% 25%
80%
KHM LAO MYS PHL
60%
40%
20%
PNG VNM 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
0% 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 4 Days since last report 5
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. 5. 6.
60 4 72 5758 19 1 0 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
57 3 84 5268 10 1 0 83 139 9 7 26 418 82 8 367 14 6576
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 7 0 0 0 0 0 0 0 0 0 7 6
0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1
41 2 84 4245 10 1 40 101 7 5 16 355 78 8 271 10 5274
16 1 0 1022 0 0 36 38 2 2 10 63 4 0 96 4 1294
4 (7.0%) 0 (0.0%) 0 (0.0%) 266 (5.0%) 0 (0.0%) 0 (0.0%) 19 (22.9%) 29 (20.9%) 0 (0.0%) 2 (28.6%) 4 (15.4%) 39 (9.3%) 0 (0.0%) 0 (0.0%) 25 (6.8%) 3 (21.4%) 391 (5.9%) Green Yellow Red
1.30 3.00 1.83 2.36 1.25 1.00 3.46 1.81 1.00 0.78 0.76 1.08 1.17 1.33 1.59 1.40 1.96
25% 100% 99% 92% 60% 100% 53% 76% 100% 29% 31% 63% 85% 100% 96% 71% 89%
98% 100% 100% 100% 100% 100% 98% 57% 100% 100% 77% 97% 87% 88% 96% 100% 98%
29-Jan-16 06-Jan-16 01-Feb-16 27-Jan-16 06-Jan-16 15-Jan-16 19-Jan-16 26-Jan-16 04-Jan-16 06-Jan-16 11-Dec-15 12-Jan-16 15-Jan-16 05-Jan-16 06-Jan-16 26-Jan-16
3 26 5 13 6 28 26 52 20 17 26 6
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 Report date is fixed as soon as all cases for the year have been classified Countries are expected to submit data at least once per month to WPRO Includes two cases that are 15 years old or older
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 stool samples from 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 W ild Sabin VDPV W ild Intratypic differentiation (ITD)/sequencing results Type 2 Sabin VDPV W ild Type 3 Sabin VDPV NPEV 2 1
Negative
Pending ITD
% ITD results Discordant reported ≤ 7 days of pending receipt sequencing ≥ 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
45 3 84 5211 302 31 156 100 358 277 299 129 496 292 232 175 51 98 367 39 140 362 42 118 225 185 80 215 39 180 88 90 24 19 2 10 0 0 72 140 9 4 25 465 82 8 211 175 15 6559
0 0 1 68 2 3 4 0 9 3 6 1 8 1 4 6 0 1 1 0 0 1 1 3 7 3 1 0 0 1 0 2 0 0 0 0 10 0 0 0 1 4 0 0 3 0 1 88
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
4 0 10 464 18 0 24 12 13 39 58 5 48 31 4 4 5 5 34 1 12 25 0 16 24 18 8 25 3 21 5 3 1 2 0 0 7 11 2 0 6 59 8 1 20 17 3 612
40 2 73 4610 259 28 128 87 331 222 232 123 437 258 223 165 46 89 329 38 127 331 40 98 194 164 69 188 36 158 83 85 23 17 2 9 54 129 7 4 16 395 72 7 188 156 11 5773
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 1 0 0 0 0 2 7 2 0 0 2 0 15
0 1 0 68 23 0 0 1 5 13 2 0 3 2 1 0 0 3 3 0 1 5 1 1 0 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 69
95% 100% 96% 96% 97% 98% 99% 97% 96% 99% 98% 100% 89% 98% 99% 100% 98% 96% 98% 100% 91% 94% 100% 97% 93% 95% 99% 99% 90% 96% 97% 98% 98% 100% 100% 87% 99% 98% 94% 100% 95% 89% 89% 100% 99% 98% 93% 95%
5% 0% 11% 8% 6% 0% 14% 10% 3% 12% 15% 4% 8% 9% 2% 2% 7% 4% 7% 3% 8% 6% 0% 13% 9% 8% 7% 11% 6% 12% 5% 2% 2% 11% 0% 0% 10% 6% 22% 0% 24% 10% 9% 6% 9% 10% 18% 8%
22-Jan-16 22-Jan-16 14-Jan-16 27-Jan-16
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 0 175 4 10 11 0 31 6 10 0 16 2 6 12 0 2 1 4 0 5 2 6 15 10 3 2 2 4 2 5 4 0 0 0 0 18 0 0 0 1 9 0 0 7 0 2 212
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
51 1 3 0 4 0 6 11 0 2 6 2 0 2 0 0 2 6 2 0 2 0 2 0 0 0 5 1 1 4 0 62
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 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 0
60 1 4 7 14 2 3 1 2 2 4 0 1 2 2 0 4 3 4 0 0 2 0 0 2 0 2 0 2 2 0 66
7 0 0 0 5 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 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
53 2 3 4 8 4 0 4 0 2 2 0 0 0 3 2 0 6 1 3 0 0 2 0 3 4 5 0 6 0 2 66
0 0 0 0 0 0 0 0 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 1 0 3
1 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 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
98% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 86% 100% 67% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 98%
15-Dec-15 15-Dec-15 25-Jan-16 08-Jan-16 11-Jan-16 20-Jan-16 22-Jan-16 11-Jan-16 15-Jan-16 15-Jan-16 12-Jan-16 14-Jan-16 22-Jan-16
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 2006 - 1 Total - 2 2009 - 1 Total - 27
3
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 (7 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