POLIO [to 22 November 2014]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 19 November 2014
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: On 13 November, the Director-General of WHO accepted the recommendation of an International Health Regulations (IHR) Emergency Committee of Experts on polio that the international spread of polio continues to constitute a Public Health Emergency of International Concern (PHEIC) under the IHR, and extended the existing Temporary Recommendations to prevent the international spread of polio for countries affected by the disease for another 3 months. Recognizing the escalating wild poliovirus (WPV) transmission in Pakistan, additional Temporary Recommendations were provided to further reduce the risk of international spread from Pakistan. Read more below
:: In response to the recent outbreak of circulating vaccine-derived poliovirus (cVDPV) in Madagascar, supplementary immunization activities are scheduled in December in high risk areas and across the entire country in January to stop transmission of the virus.
:: This week, the Centers for Disease Control and Prevention (CDC), USA, released a report marking 2 years during which type 3 wild poliovirus has not been detected anywhere in the world. While the CDC report concludes that WPV3 transmission has possibly been interrupted, continued sensitive surveillance is needed before a final conclusion on WPV3 eradication can be made.
Afghanistan
:: Two new wild poliovirus type 1 (WPV1) cases were reported in the past week in Afghanistan. One was found in Nahr-E-Saraj district of Hilmand province, and the second was reported from Zheray district of Kandahar province. Both areas had not reported WPV1 previously during 2014. The total number of WPV1 cases for 2014 in Afghanistan is now 20. The most recent WPV1 case had onset of paralysis on 20 October, from Kandahar province.
Nigeria
:: Five new type 2 circulating vaccine-derived poliovirus (cVDPV2) cases were reported in the past week, all in districts or states that had not reported cVDPV2 during 2014 to date. One case was in Guzamala district, Borno; 1 in Kura district, Kano; 1 in Barde district, Yobe; and 1 in each Dutse and Kiyawa districts, Jigawa. The total number of cVDPV2 cases for 2014 in Nigeria is now 26. The most recent cVDPV2 case had onset of paralysis on 16 October, in Barde district, Yobe state.
:: In selected high risk areas of Kano state, supplementary immunization activities (SIAs) using both inactivated polio vaccine (IPV) and oral polio vaccine (OPV) are taking place from 15 – 20 November. Large-scale Subnational Immunization Days (SNIDs) are planned for 13 – 16 December across northern Nigeria. The aim is to boost immunity to all strains of poliovirus, to rapidly interrupt circulation of both WPV1 and cVDPV2.
Pakistan
:: Ten new wild poliovirus type 1 (WPV1) cases were reported in the past week. Six were from the Federally Administered Tribal Areas (FATA), with 1 in South Waziristan, and 5 in Khyber Agency; 1 from Killa Abdullah district in Balochistan province; 1 from Mardin district in Khyber Pakhtunkhwa province; and 2 from Sindh province (1 in Bin Qasim town of Karachi city and 1 in Badin district, southern Sindh province). The total number of WPV1 cases in Pakistan in 2014 is now 246, compared to 63 at this time last year. The most recent WPV1 case had onset of paralysis on 1 November, from Khyber
:: Immunization activities are continuing with particular focus on known high-risk areas, in particular newly opened previously inaccessible areas of FATA. At exit and entry points of conflict-affected areas that are still inaccessible during polio campaigns, 100 permanent vaccination points are being used to reach internally displaced families as they move in and out of the inaccessible area. Over 1 million people have been vaccinated in the past few months at transit points and in host communities, including over 850,000 children under 10 years old.
Horn of Africa
:: Following confirmation of two cases of circulating vaccine derived poliovirus type 2 (cVDPV2) in a refugee camp area of Unity state, South Sudan, two weeks ago, preparations for outbreak response immunization activities are being finalized in the country. National Immunization Days (NIDs) were implemented on 4–7 November, with further campaigns planned for December and January. The objective is to rapidly stop the cVDPV2 in the infected area, while further boosting immunity to type 1 polio and to minimize the risk of renewed outbreaks following virus re-introduction from infected countries and areas.

WHO statement on the third meeting of the International Health Regulations Emergency Committee regarding the international spread of wild poliovirus
WHO statement
14 November 2014
[Excerpts]
The third meeting of the Emergency Committee under the IHR (2005) regarding the international spread of wild poliovirus in 2014 was convened by the Director-General through electronic correspondence from 2 through 7 November 2014.1 The following IHR States Parties submitted an update on the implementation of the Temporary Recommendations since the Committee last met on 31 July 2014: Cameroon, Equatorial Guinea, Pakistan and the Syrian Arab Republic.

The Committee noted that the international spread of wild poliovirus has continued since 31 July 2014, with at least 3 new exportations from Pakistan into neighbouring Afghanistan. There has been no other documented international spread of wild poliovirus since March 2014.

The risk of new international spread from Pakistan was assessed to have increased substantively since 31 July 2014, as cases have escalated during the current high transmission season and there has been no significant improvement in the underlying factors that are driving transmission in the country. The risk of new international spread from the other 9 currently infected States appears to have declined, with only 2 of those States having reported new cases since 31 July: Somalia (1 case) and Afghanistan (7 cases, most of which were due to imported virus).

The Committee remains concerned that implementation of the Temporary Recommendations is still incomplete, especially as immunization systems have continued to deteriorate in a number of the countries at greatest risk of new importations, particularly those affected by conflict…

…The Committee assessed that the event still constitutes a Public Health Emergency of International Concern and recommended the extension of the Temporary Recommendations for a further 3 months.

Recognizing the escalating wild poliovirus transmission in Pakistan, with more reported cases than at any time in the past 14 years and ongoing cross-border exportation of the virus, the Committee provided the following additional advice to the Director-General for her consideration to reduce further the risk of international spread of wild poliovirus:
– Pakistan should restrict at the point of departure the international travel of any resident lacking documentation of appropriate polio vaccination. These recommendations apply to international travellers from all points of departure, irrespective of the means of conveyance (e.g. road, air, sea);
– Pakistan should note that the recommendation stated previously for urgent travel remains valid (i.e. those undertaking urgent travel who have not received appropriate polio vaccination must receive a dose of polio vaccine at least by the time of departure and be provided with appropriate documentation of that dose);
– in advance of the next meeting of the Committee, Pakistan should provide to the Director-General a report on the implementation by month of the Temporary Recommendations on international travel, including the number of residents whose travel was restricted and the number of travellers who were vaccinated and provided appropriate documentation at the point of departure.

If the existing and additional Temporary Recommendations for the vaccination of travellers from Pakistan cannot be fully implemented by the time the Committee next meets, the Committee will consider additional measures such as entry screening to reduce the risk of international spread.

The Director-General accepted the Committee’s assessment and declared that the international spread of wild poliovirus continued to constitute a PHEIC. The Director-General endorsed the Committee’s additional advice on reducing the risk of international spread from Pakistan…