POLIO [to 7 March 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 4 March 2015
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: • On the 27 February the Director General accepted the recommendations made by the Emergency Committee of the International Health Regulations concerning the international spread of wild poliovirus. The statement of the recommendations from this fourth meeting can be found here.
• The polio legacy is being demonstrated in action through the work of 26 surveillance experts from the National Polio Surveillance Programme in India who have been deployed to Sierra Leone to support the Ebola outbreak response. Read more.
Selected country report content:
Afghanistan
:: One new case of wild poliovirus type 1 (WPV1) has been reported in the past week in Reg district, Hilmand province. This was the first case reported in 2015, with onset of paralysis on 21 January. The total number of WPV1 cases for 2014 remains 28. Most of the cases from 2014 were linked to cross-border transmission with neighbouring Pakistan.
Pakistan
:: Four new wild poliovirus type 1 (WPV1) cases were reported in the past week. Two cases were reported in Khyber agency, in the Federally Administered Tribal Areas, 1 in Killa Abdullah district of Balochistan province (previously uninfected in 2015) and 1 in Tank district, in Khyber Pakhtunkhwa. The total number of WPV1 cases in 2014 remains 306, and 13 for 2015. The most recent case had onset of paralysis on 3 February in Balochistan.
Statement on the 4th IHR Emergency Committee meeting regarding the international spread of wild poliovirus
WHO statement
27 February 2015
[Editor’s text bolding]
The fourth meeting of the Emergency Committee under the International Health Regulations (IHR) (2005) regarding the international spread of wild poliovirus in 2014 – 15 was convened via teleconference by the Director-General on 17 February 2015. The following IHR States Parties submitted an update on the implementation of the Temporary Recommendations since the Committee last met on 13 November 2014: Cameroon, Equatorial Guinea, Pakistan and the Syrian Arab Republic.

The Committee noted that the international spread of wild poliovirus has continued with one new exportation from Pakistan into neighbouring Afghanistan documented after 13 November 2014. Although there is seasonal decline in the number of reported cases in Pakistan, transmission is ongoing in each of the four provinces and the Federally Administered Tribal Areas. The Committee assessed the risk of international spread from Pakistan to be sustained. The Committee appreciated that Pakistan has prepared a new robust ‘low season’ vaccination plan, established national and provincial emergency operations centres, and resumed campaigns in South and North Waziristan. Nonetheless, the principal factors underpinning the international spread of wild poliovirus from Pakistan have not yet changed sufficiently since the date of the third meeting of the Emergency Committee on 13 November 2014.

There has been no other documented international spread of wild poliovirus since March 2014. Although the risk of new international spread from the nine other infected Member States appears to have declined, the possibility of international spread still remains a global threat worsened by the expansion of conflict-affected areas, particularly in the Middle East and Central Africa. Furthermore, countries affected by conflict inevitably experience a decline in health service delivery that leads to deterioration of immunization systems in a number of such at-risk countries.

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

The committee considered the following factors in reaching this unanimous conclusion:
1. The continued international spread of wild poliovirus through 2014;

2. The risk and consequent costs of failure to eradicate globally one of the world’s most serious vaccine preventable diseases;

3. The continued necessity of a coordinated international response to stop the international spread of wild poliovirus and to prevent new spread with the onset of the high transmission season in May/June 2015;

4. The serious consequences of further international spread for the increasing number of countries in which immunization systems have been disrupted by armed conflict and complex emergencies. Populations in these fragile states are vulnerable to infection and outbreaks of polio which are exceedingly difficult to control;

5. The importance of a regional approach and cooperation as much international spread of polio occurs over land borders.

The Committee sincerely appreciated the efforts that all countries have made in response to the temporary recommendations and reviewed the progress against the criteria previously established by the Committee for countries to respond to under the IHR. The Committee remains concerned that implementation of the Temporary Recommendations is incomplete in all affected countries, many of whom are affected by regional conflicts.

The Committee provided the Director-General with the following advice aimed at reducing the risk of international spread of wild poliovirus, based on an updated risk stratification of the 10 countries that had earlier met the criteria for ‘States currently exporting wild poliovirus’ or ‘States infected with wild poliovirus but not currently exporting ‘. A third risk category has been added by the Committee for ‘States no longer infected by wild poliovirus, but which remain vulnerable to international spread’. The committee also noted the feedback from the four exporting countries that highlighted the challenges of implementing polio eradication measures in situations where there is significant cross-border population movement, often across long borders and common epidemiological blocks. The committee therefore recommended that countries apply a regional approach and develop joint immunisation strategies with neighbouring countries.
[Specific recommendation for States continue…]

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Pakistani Officials Issue Arrest Warrants Over Refusals of Polio Vaccine
By ISMAIL KHAN
New York Times, FEB. 27, 2015
PESHAWAR, Pakistan — Determined to curb Pakistan’s polio crisis, police officials in the northwestern province of Khyber-Pakhtunkhwa said Friday that they had issued hundreds of arrest warrants for parents for refusing to vaccinate their children.

“We had 13,000 to 16,000 refusal cases,” the deputy police commissioner for Peshawar, Riaz Khan Mahsud, said in an interview. “There is total determination on our part. We shall convince parents of the good of vaccinating their children, but if they refuse, we shall detain them. There is no leniency.”

The police in other districts of the province also reported issuing warrants, though no official total was released.

“The number keeps fluctuating,” said a senior government official, speaking on the condition of anonymity because he was not authorized to brief the news media. “We are applying different laws. You have to resort to coercive measures when persuasion fails.”

The official added: “The application of laws is working. Some parents readily agree to vaccinate children to avoid detention. Others take a few days behind the bars to see reason. We take an affidavit from them and let them go if they bring kids for vaccination.”…