POLIO [to 22 August 2015]
Public Health Emergency of International Concern (PHEIC)

Statement on the 6th IHR Emergency Committee meeting regarding the international spread of wild poliovirus
WHO statement
17 August 2015
[Editor’s excerpts and text bolding]
The sixth meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of wild poliovirus was convened via teleconference by the Director-General on 4 August 2015. The following IHR States Parties submitted an update on the implementation of the Temporary Recommendations since the Committee last met on 24 April 2015: Afghanistan and Pakistan.

The Committee noted that 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 toward interruption of wild poliovirus transmission, implementation of Temporary Recommeations issued by the Director-General, and overall decline in occurrence of international spread of wild poliovirus. The Committee appreciated these commendable achievements….

…While the primary measure to prevent international spread remains interruption of wild poliovirus transmission in infected countries, reducing vulnerability and risk of outbreak in vulnerable regions is critically important. Countries or areas affected by conflict are vulnerable to outbreaks of polio because insecurity and inaccessibility can lead to deterioration of public health and immunization. Those vulnerable include the conflict-affected countries in the Middle East, the Horn of Africa and central Africa, particularly the Lake Chad Region. The hard-earned gains can be quickly lost if there is continued disruption of health systems in settings of complex humanitarian emergencies.

The world has reached the critical end stage for global polio eradication and loss of momentum now could reverse or prevent the world achieving this global goal. The Committee unanimously agreed that the international spread of polio remains a PHEIC and recommended the extension of the Temporary Recommendations, as revised, for a further three months.

The Committee considered the following factors in reaching this conclusion:
:: The continued international spread of wild poliovirus in 2015, including during the recent low transmission season in Pakistan and Afghanistan, while recognizing the progress achieved and the decrease in the number of cases.
:: The risk and consequent costs of failure to eradicate globally one of the world’s most serious vaccine preventable diseases.
:: The continued necessity of a coordinated international response to improve immunization and surveillance for wild poliovirus, stop its international spread and reduce the risk of new spread with the onset of the high transmission season in May/June 2015.
:: The serious consequences of further international spread for the increasing number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies. Populations in these fragile states are vulnerable to outbreaks of polio. Outbreaks in fragile states are exceedingly difficult to control and threaten the completion of global polio eradication during its end stage.
:: The importance of a regional approach and strong cross-border cooperation, as much international spread of polio occurs over land borders, while recognizing that the risk of distant international spread remains from zones with active poliovirus transmission.

The Committee provided the Director-General with…advice aimed at reducing the risk of international spread of wild poliovirus, based on the risk stratification as follows:
:: States currently exporting wild poliovirus.
:: States infected with wild poliovirus but not currently exporting.
:: States no longer infected by wild poliovirus, but which remain vulnerable to international spread.
[Full specific recommendations and full text of announcement here]

Note on vaccine-derived poliovirus
While not the specific subject of the PHEIC, the committee also noted that stopping the outbreaks of circulating vaccine derived poliovirus is a critical component of the Polio Endgame Strategy. The Committee recommended that more attention should be paid to the on-going type 1 circulating vaccine derived poliovirus in Madagascar and cautioned that polio eradication could not be completed until all poliovirus transmission is interrupted. The Committee also urged international partners to offer additional support to Madagascar to address the challenge of on-going circulating vaccine derived poliovirus.

Based on the advice concerning wild poliovirus, the reports made by Afghanistan and Pakistan and the currently available information, the Director-General accepted the Committee’s assessment and on 10 August 2015 determined that the events relating to wild poliovirus continue to constitute a PHEIC. The Director-General endorsed the Committee’s recommendations for ‘States currently exporting wild polioviruses’, for ‘States infected with wild poliovirus but not currently exporting’ and for ‘States no longer infected by wild poliovirus, but which remain vulnerable to international spread’ and extended them, as revised by the Committee, as Temporary Recommendations under the IHR to reduce the international spread of wild poliovirus, effective 10 August 2015. The Director-General thanked the Committee Members and Advisors for their advice and requested their reassessment of this situation within the next three months.

With regard to the concerns about on-going circulating vaccine-derived poliovirus, the Director-General emphasized the critical importance of interrupting all poliovirus transmission, including outbreaks of vaccine-derived poliovirus for successful completion of polio eradication.

::::::

GPEI Update: Polio this week – As of 19 August 2015
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: This week, Pakistan will become the second polio-endemic country to introduce the inactivated polio vaccine (IPV) into its routine immunization system. More than half the global birth cohort is now receiving at least one dose of IPV through routine immunization systems as a result of the biggest globally synchronized vaccine introduction in history. Read more on the status of IPV introductions here.
:: The emergency committee of the International Health Regulations (IHR) has met for the sixth time and assessed that the international spread of polio continues to constitute a Public Health Emergency of International Concern (PHEIC). Their full report can be accessed here.
:: National vaccination campaigns to protect children against polio and measles are taking place in Yemen targeting more than 5 million children under the age of five. More

Selected excerpts from Country-specific Reports
Nigeria
:: In line with the National Emergency Action Plan for polio eradication, aggressive and rapid vaccination activities are conducted in response to any detected virus. Three case response ‘mopping-up campaigns’ using trivalent oral polio vaccine (tOPV) have taken place in the FCT and Kaduna and Kogi states, as well as in adjacent LGAs of Niger and Nasarawa states, to stop transmission of the persistent strain of cVDPV2. Subnational Immunization Days (SNIDs) are planned in the north of Nigeria on 5 September and 17 October using trivalent OPV.
Pakistan
:: Two new environmental samples positive for WPV1 were reported this week, the first in Quetta district of Balochistan and the second in Multan district of Punjab, both collected on 28 July. In addition, one new environmental sample positive for VDPV2 was reported in Gulshan-e-Iqbal district of Sindh, collected on 7 July.
:: Environmental surveillance indicates continuing circulation of polioviruses, not just in known infected areas but also in areas without confirmed cases. Environmental surveillance continues to be a very helpful supplemental surveillance tool enabling the programme to increase the overall sensitivity of surveillance for polioviruses.
Forty thousand health workers fan across Yemen
Ensuring children are protected from polio and measles
August 14, 2015
Yemen launches on Saturday 15 August a national round of vaccination campaign against measles and polio, to protect children from these preventable diseases and ensure that Yemen remains polio-free. Despite the ongoing conflict in Yemen, the campaign is aiming to cover the entire country – more than 5 million under five years of age with polio vaccine and 1.4 million children under the age of 15. More than 40,000 health workers and volunteers are being mobilized for this effort, supported by the government and the Global Polio Eradication Initiative.

The conflict in Yemen has posed challenges to the polio eradication programme, including difficulties in distributing vaccines to health facilities, the closure of over 20% of health centres, and the inability of people to reach the centres that remain due to conflict. In spite of the political unrest in Yemen, 88% of children were reached with routine vaccines through health facilities and campaigns in 2014. A national measles, rubella and polio campaign was implemented in November 2014 reaching as many as 93% of children.

The campaign is made possible by contributors to the Horn of Africa polio outbreak, which has included operations in Yemen. The Global Polio Eradication Initiative receives financial support from governments of countries affected by polio; private sector foundations, donor governments, multilateral organizations, private individuals, humanitarian and nongovernmental organizations and corporate partners. Full list of all contributors.