2017 Issue No. 14 - Week 28 (as of 18 July 2017) HIGHLIGHTS Polio eradication efforts acknowledged by G20 heads of state At their Summit in Hamburg, Germany, the Heads of State of the Group of Twenty (G20) acknowledged the global effort to eradicate polio and the need to finish the job in their 2017 Summit Statement, committing to “strive to fully eradicate polio”. In May 2017, Ministers of Health from G20 countries issued their first ever declaration on global health, recognizing the historic opportunity that the world faces to eradicate polio. This high level political commitment will be key to success in countries such as Nigeria, Afghanistan and Pakistan, where the wild poliovirus remains endemic, and to ensure that the programme is fully funded to achieve its goals. The eradication of polio is projected to lead to savings of US$ 20 – 30 billion by 2035, making it an example of the economic impact that can be achieved through a focus on health. For more information please visit: http://polioeradication.org/news-post/polio-eradicationefforts-acknowledged-by-g20-heads-of-state/ Chart 3. Percentage of reported AFP cases by number of polio vaccination doses, 2017 100% CHN 12.4% 0.0% 0.0% 12.1% 8.7% 69.2% 14.8% 0% 10% 20% 30% 40% 50% 60% 70% 80% 5.5 5.0 4.5 4.0 3.5 3.0 2.5 40% 60% 80%
Polio Bulletin
Chart 1. Non-polio AFP rate (per 100 000 persons < 15 years of age), 2015–2017* 100%
Chart 2. Adequate specimen collection rate, 2015–2017
2.0 1.5 1.0 0.5 0.0 15 16 CHN 17 15 16 KHM 17 15 16 LAO 17 15 16 MYS 17 15 16 PHL 17 15 16 PNG 17 15 16 VNM 17 0% 15 16 CHN 17 15 16 KHM 17 15 16 LAO 17 15 16 MYS 17 15 16 PHL 17 15 16 PNG 17 15 16 VNM 17 20%
* AFP rate annualized as of week 28
Chart 4. Percentage of reported AFP cases with pending classification > 90 days after onset, 2017
80%
KHM LAO MYS
60%
40%
PHL PNG VNM
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: wproepidata@who.int Web: www.wpro.who.int/immunization 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 2017 and key surveillance indicators 2016 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 investigated adequate ≤ 2 days of specimens 3 notification 4 ≥ 80% ≥ 80% Latest report date Days since last report 5
2017 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.
62 1 51 5691 10 1 133 143 7 12 23 417 70 7 382 20 7030
45 1 45 2256 8 1 161 21 77 9 9 31 394 68 6 234 11 3377
23 0 11 2205 5 1 36 66 4 5 13 184 24 3 142 8 2730
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 1
1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1
13 10 1104 4 0 23 42 4 0 2 151 19 3 35 8 1418
9 1 1100 1 1 13 24 0 5 11 33 5 0 107 0 1310
4 (17.4%) 0 (0.0%) 274 (12.4%) 0 (0.0%) 0 (0.0%) 0 (0.0%) 8 (12.1%) 0 (0.0%) 4 (80.0%) 9 (69.2%) 16 (8.7%) 0 (0.0%) 0 (0.0%) 21 (14.8%) 0 (0.0%) 336 (12.3%) Green Yellow Red
0.95 0.45 1.81 1.16 1.86 3.18 1.59 0.83 1.03 0.78 0.87 0.66 0.93 1.13 1.35 1.50
35% 91% 92% 80% 0% 83% 76% 75% 20% 46% 63% 88% 100% 95% 63% 88%
96% 91% 100% 100% 100% 81% 79% 100% 100% 92% 98% 100% 100% 93% 100% 98%
14-Jul-17 10-Apr-17 20-Jun-17 13-Jul-17 07-Jul-17 14-Jun-17 07-Jun-17 10-Jul-17 08-Jul-17 23-Jun-17 07-Jul-17 14-Jul-17 16-Jun-17 10-Jul-17 23-Jun-17 20-Jun-17
4 99 28 5 11 34 41 8 10 25 11 4 32 8 25 28
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 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 stool samples from AFP cases with onset in 2017 and key laboratory indicators Results of virus isolation for AFP cases Country/area Polio laboratory Total no. of AFP cases w ith specimens L20B positive L20B positive + NPEV only NPEV % results % reported specimens Pending Latest Pending 14 days ≤ positive for report date ≤ 14 days > 14 days NPEV ≥ 80% Intratypic differentiation/ Sequencing 1 laboratory No. of isolates received Type 1 W ild Sabin VDPV Results of intratypic differentiation (ITD)/sequencing for virus isolates Type 3 Type 2 W ild Sabin VDPV W ild 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, Chongqing China, Fujian China, Gansu China, Guangdong China, Guangxi China, Guizhou China, Hebei China, Heilongjiang China, Henan China, Hubei China, Hunan China, Jiangsu China, Jiangxi China, Jilin China, Neimongol China, Ningxia China, Shaanxi China, Shandong China, Shanghai China, Shanxi China, Sichuan China, Tianjin China, Xinjiang China, Yunnan China, Zhejiang China, Hainan China, Liaoning 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
16 0 19 2162 148 21 35 79 30 164 109 84 122 44 210 77 80 97 59 27 33 9 49 153 16 75 134 16 55 98 82 7 36 9 4 5 0 67 92 4 2 13 239 24 3 87 90 8 2831
0 0 25 3 1 0 1 0 1 3 0 2 0 2 0 1 2 1 0 0 0 1 3 0 0 1 0 2 0 1 0 0 0 0 0 1 0 0 0 0 3 0 0 0 0 0 29
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 2 112 4 0 2 2 0 16 14 2 5 1 26 7 5 0 4 0 1 0 2 1 0 1 6 0 4 6 1 1 1 0 0 0 5 6 0 0 5 12 2 0 18 13 3 181
11 17 1977 139 20 33 72 29 144 92 75 115 43 182 64 72 92 52 25 32 9 44 149 15 73 123 16 47 89 80 6 33 8 4 5 61 85 4 2 8 214 19 3 65 74 5 2550
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 10 3 0 4 3 0 22
0 0 48 2 0 0 4 1 3 0 7 0 0 0 6 2 3 2 2 0 0 2 0 1 1 4 0 2 3 0 0 2 1 0 0 0 1 0 0 0 0 0 0 0 0 0 49
96% 100% 94% 99% 95% 94% 87% 97% 96% 96% 98% 99% 100% 83% 94% 97% 100% 98% 100% 97% 89% 87% 90% 100% 95% 92% 100% 96% 89% 100% 86% 100% 100% 100% 100% 100% 98% 100% 100% 100% 100% 100% 100% 99% 100% 100% 94%
21% 11% 4% 2% 0% 4% 1% 0% 9% 12% 3% 3% 2% 10% 9% 6% 0% 5% 0% 2% 0% 4% 0% 0% 1% 3% 0% 7% 5% 1% 7% 2% 0% 0% 0% 7% 6% 0% 0% 29% 4% 5% 0% 20% 15% 33% 4%
15-Jul-17 15-Jul-17 14-Jul-17 13-Jul-17
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 Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC Prov. Lab/CCDC CCDC CCDC CCDC CCDC
0 0 0 57 7 1 2 1 0 4 6 0 3 0 9 0 4 4 1 0 0 0 1 4 0 0 2 0 6 0 2 0 0 0 0 0 0 0 0 0 0 0 9 0 0 0 0 0 66
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
24 6 0 0 0 4 2 0 2 3 0 0 0 1 2 4 0 3 27
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
28 1 1 2 1 0 4 3 2 1 4 1 1 3 0 2 2 4 32
1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1
4 0 0 0 0 0 0 0 4 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 2 2
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
96% 86% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 0% 100% 100% 100% 100% 100% 96%
07-Jul-17 07-Jul-17 11-Jul-17 13-Jul-17 04-May-17 17-Jul-17 15-Jul-17 11-Jul-17 16-Jun-17 14-Jul-17 17-Jul-17 04-Jul-17 15-Jul-17
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 2016–2017 1 2016 Country/area Intratypic differentiation lab 2 Total number of samples processed Total number of samples with polio isolates Polio isolates Type 1 Wild Sabin VDPV Wild Type 2 Sabin VDPV Wild Type 3 Sabin VDPV NPEV Pending ITD Discordant Total number pending of samples sequencing processed Total number of samples with polio isolates Type 1 Wild Sabin VDPV Wild
2017 Polio isolates Type 2 Sabin VDPV Wild Type 3 Sabin VDPV NPEV Pending ITD Discordant pending sequencing
Australia China (total) China, Fujian China, Gansu China, Guangdong China, Guangxi China, Heilongjiang China, Shandong China, Shanghai China, Xinjiang China, Yunnan Malaysia Philippines Total
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 RITM
0 345 60 13 48 36 45 45 24 36 38 10 0 355
171 12 8 35 13 21 28 18 36 0 0 171
0 0 0 0 0 0 0 0 0 0
179 3 5 19 1 0 25 17 109 179
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
174 1 5 4 4 5 15 4 136 174
0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0
507 11 13 62 52 46 42 34 247 507
0 0 0 0 0 0 0 0 0 0
229 42 2 39 23 32 40 18 25 8 6 235
0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0
0 131 16 6 24 15 12 20 8 15 15 2 6 139
76 3 4 21 7 5 14 7 15 0 0 3 79
0 0 0 0 0 0 0 0 0 0 0
127 1 4 11 3 1 15 11 81 0 127
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0
342 5 13 55 15 15 60 19 160 3 345
0 0 0 0 0 0 0 0 0 0 0
266 63 2 42 23 22 67 7 29 11 0 2 268
1 0 0 0 1 0 0 0 0 0 0 0 1
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); IMR (Institute of Medical Research, Malaysia); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia)
Table 4. Vaccine-derived poliovirus1 identified from laboratory testing2, 2000–2017 Country/area Cambodia
2000–2009 3 2006 - 1 Total - 2 2009 - 1 Total - 27
2010
2011
2012
2013
2014
2015
2016
2017
China
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)
aVDPV3 (1 AFP)
aVDPV3 (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 (8 AFP + 21 contacts) cVDPV1 (3 AFP + 4 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