POLIO [to 9 May 2015]

POLIO [to 9 May 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 29 April 2015
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: Polio spread remains public health emergency: The WHO Director-General has accepted the assessment of the 5th meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) that the spread of polio still constitutes a public health emergency of international concern and recommended the extension of revised Temporary Recommendations.
:: Global Polio Eradication Initiative (GPEI) report to upcoming World Health Assembly (WHA) now available: The report and an accompanying resolution are expected to inform discussions at the WHA, 18-26 May in Geneva, Switzerland.
:: Latest semi-annual status report covers second half of 2014: details on the situation in endemic, re-infected and high-risk countries.
:: Independent Monitoring Board (IMB) meeting: the IMB met last week in Abu Dhabi, United Arab Emirates, to review the current status of the global polio eradication effort and is expected to publish its report here over the coming weeks.
Selected excerpts from Country-specific Reports [No new polio cases reported]

Statement on the 5th IHR Emergency Committee meeting regarding the international spread of wild poliovirus
WHO statement
5 May 2015
[Initial text; Editor’s text bolding]
The fifth meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of wild poliovirus in 2014 – 15 was convened via teleconference by the Director-General on 24 April 2015. The following IHR States Parties submitted an update on the implementation of the Temporary Recommendations since the Committee last met on 17 February 2015: Afghanistan and Pakistan.

The Committee noted that after nearly one year since the declaration that the international spread of polio constituted a Public Health Emergency of International Concern (PHEIC), strong progress has been made by countries in response to the Temporary Recommendations issued by the Director-General, and that this was a commendable achievement. No cases of wild poliovirus have been reported in Africa for eight months; in 2015, Pakistan and Afghanistan have reported less than half the number of cases that were reported during the same period in 2014; there has been no exportation from Pakistan since October 2014; and the number of persistently missed and inaccessible children is declining in Pakistan. The number of inaccessible children has declined from an estimated 300,000 to 50,000 in Federally Administered Tribal Areas. Pakistan continued to implement the Temporary Recommendations; since November, an average of 370,000 international travellers per month were vaccinated pre-departure at health facilities and points of exit.

The Committee noted, however, that the international spread of wild poliovirus has continued with three new documented exportations from Afghanistan into neighbouring Pakistan which occurred in late 2014. The poliovirus isolates found in the three cases in Pakistan were more closely related to strains recently circulating in Afghanistan than to those currently found in Pakistan. While two of these virus strains circulated in bordering areas of Afghanistan following recent exportation from Pakistan (September 2014), the third virus was related to a strain that had circulated only in Afghanistan for a period of more than one year, thus demonstrating the strongest evidence of exportation into Pakistan of a strain of poliovirus that has established transmission in Afghanistan.

The Committee agreed that Pakistan and Afghanistan formed a single epidemiological block with frequent cross-border population movement, which accounts for the ebb and flow of poliovirus in both directions. Much stronger coordination and quality of cross-border vaccination and surveillance activities will be essential to reduce the risk of this international spread. In addition, both countries must achieve interruption of poliovirus transmission simultaneously in order to prevent such international spread from repeatedly setting back progress in both countries.

In Pakistan, a reduction of cases occurred during the low season and the performance of the eradication program has improved. Nevertheless, 21 of 22 reported cases in 2015 to date (or 95% of global cases in 2015) were reported from Pakistan, and the key factors that contribute to international spread of wild poliovirus from Pakistan, although improving, have not changed sufficiently since the fourth meeting of the Emergency Committee on 17 February. The risk of new exportations from Pakistan remains with the ongoing transmission in the country during the low transmission season, nearly 50,000 children still inaccessible in infected areas of the Federally Administered Tribal Areas and the imminent high transmission season that commences in May. In Afghanistan, the number of cases reported has declined and cross-border transit vaccination activities have been strengthened, particularly in the Southeast Region. However, areas with chronically missed or inaccessible populations remain in parts of Southern and Eastern Regions.

Despite the commendable progress, the implications of the continued risk of international spread from Pakistan and Afghanistan remain of concern. This is a critical stage for global polio eradication during which the hard-earned gains can be quickly lost given fragility of progress and continued disruption of immunization systems in settings of conflict and complex humanitarian emergencies.

Although the risk of new international spread from other infected Member States appears to have declined, the possibility of international spread still remains a global threat worsened by expansion of conflict-affected areas, particularly in the Middle East and Central Africa. Countries affected by conflict are vulnerable to outbreaks of polio that can be difficult to detect and are very challenging and costly to control.

The Committee unanimously agreed that the spread of polio still constitutes a PHEIC and recommended the extension of the Temporary Recommendations, as revised, for a further three months…

May 2015 :: 50 pages
Objective 1: Poliovirus detection and interruption
:: Endemic countries: Strong progress has been made in Nigeria towards eradicating the disease, but polio cases are on the rise in Pakistan, affecting Afghanistan.
:: Outbreaks: In the Horn of Africa and central Africa, outbreaks appear close to being stopped. The response is strong in the Middle East, despite ongoing security challenges.
:: Wild poliovirus type 3 (WPV3): November marked two years since the most recent case of WPV3 and onset of paralysis in Nigeria. With no reported cases of wild poliovirus type 2 (WPV2) since 1999, potentially just one of the three strains of wild poliovirus remains.
:: PHEIC: In May 2014, WHO Director-General declared the international spread of wild poliovirus a “public health emergency of international concern” (PHEIC) and issued Temporary Recommendations under the International Health Regulations (2005) to minimize the risk of further global spread. Countries’ implementation of the recommendations varied in the second half of 2014.

Objective 2: Immunization systems strengthening and OPV withdrawal
:: The Strategic Advisory Group of Experts on immunization (SAGE) concludes global preparations are on track to switch from trivalent oral polio vaccine (OPV) to bivalent OPV in April 2016.
:: The SAGE notes progress achieved with regard to inactivated polio vaccine (IPV) introduction worldwide.
:: Efforts intensify in 10 priority countries (with the bulk of Global Polio Eradication Initiative infrastructure) to use the infrastructure in support of routine immunization systems strengthening.

Objective 3: Containment and certification
:: Certification: The WHO South-East Asia Region was certified polio-free on 27 March 2014; certification of the conclusive global eradication of WPV2 is on track for 2015.
:: Containment: In 2014, the Global Action Plan (GAP) to minimize post-eradication poliovirus facility-associated risks (GAPIII) was updated and aligned with Polio Eradication & Endgame Strategic Plan timelines, particularly with regard to the phased removal of OPVs.

Objective 4: Legacy planning
:: A draft Global Legacy Framework is under development by a legacy planning working
group, following outcomes from a Boston Consultancy Group evaluation. The draft plan was approved by the Polio Oversight Board. Legacy planning is to be guided by national priorities at the country level, with strong linkages to global priorities. Planning missions were conducted in the Democratic Republic of the Congo and Nepal. A practical example of legacy in action is support to the Ebola outbreak in west Africa.