POLIO [to 12 September 2015]
Public Health Emergency of International Concern (PHEIC)

GPEI Update: Polio this week – As of 9 September 2015
Global Polio Eradication Initiative
[Editor’s Excerpt and text bolding]
Full report: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx
:: A case of vaccine-derived poliovirus type 2 (VDPV2) has been reported with onset of paralysis on 20 July 2015 in Bamako city, Mali. The virus was isolated from a 19-month old boy of Guinean nationality. The closest genetic match to this case is from a case from Kankan, Guinea, with onset of paralysis on 30 August 2014. The genetic changes suggest that the cVDPV2 has been circulating for more than 12 months. Discussions are currently ongoing with national health authorities to plan and implement an urgent outbreak response. [see below]
:: The Global Polio Eradication Initiative is proud to partner with the Global Citizen Festival on 26 September, featuring Ed Sheeran, Pearl Jam and other headliners to help fight extreme poverty and inequality around the world, and support approaches that will make life more sustainable for people and the planet

Selected Country Report Content
Afghanistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week in Zaranj district of Nimroz province. This most recent case had onset of paralysis on 7 August. The total number of WPV1 cases for 2015 is now nine.
:: Intensive and strengthened supplementary immunization activities are planned in the coming months. Subnational Immunization Days (SNIDs) will take place across the south and east of the country on 20 – 22 September using bivalent OPV and National Immunization Days (NIDs) will take place on 18 – 20 October using trivalent OPV.
Pakistan
:: One new wild poliovirus type 1 (WPV1) case was confirmed in the past week in Quetta district of Balochistan. This most recent case had onset of paralysis on 17 August. The total number of WPV1 cases for 2015 is now 30, compared to 137 at this time last year
West Africa
:: One new circulating vaccine-derived poliovirus type 2 (cVDPV2) case was reported in the past week, with onset of paralysis in Commune III, Bamako, Mali, on 20 July. The virus was isolated from a 19-month old boy of Guinean nationality. The closest genetic match to this case is from a case from Kankan, Guinea, from 30 August 2014. The genetic changes suggest that the cVDPV2 has been circulating for more than 12 months. Discussions are currently ongoing with national health authorities to plan and implement an urgent outbreak response following the cVDPV2 outbreak.

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Circulating vaccine-derived poliovirus in Mali
Outbreak stems from poor immunization coverage
GPEI News Story – 9 September 2015 – A case of vaccine-derived poliovirus type 2 (VDPV2) has been reported with onset of paralysis on 20 July 2015 in Bamako city, Mali. The virus was isolated from a 19-month old boy of Guinean nationality. The closest genetic match to this case is from a case from Kankan, Guinea, from 30 August 2014. The genetic changes suggest that the cVDPV2 has been circulating for more than 12 months.

The Ministries of Health in both Mali and Guinea, WHO and partners of the Global Polio Eradication Initiative are immediately taking actions to initiate appropriate and targeted immunization activities that are in line with the Standard Operation Procedures for outbreak of polioviruses. In the last 12 months, two national polio supplemental immunization activities (NIDs) using trivalent oral polio vaccine have been carried out in Mali, one in September 2014 and the most recent in April 2015. At least five rounds of large scale supplementary immunization activities are now being planned as part of emergency outbreak response activities. Planning is underway to reach all children with trivalent OPV in the coming weeks, and further NIDs will take place in October and November 2015.

When a child is immunized with oral polio vaccine (OPV), the weakened vaccine-virus replicates in the intestine for a limited period, thereby developing immunity against polio. The vaccine-virus is also excreted through faecal excreta into the environment. In areas of inadequate sanitation, this excreted vaccine-virus can spread in the immediate community (and this can offer protection to other children through ‘passive’ immunization), before eventually dying out. On rare occasions, if a population is seriously under-immunized, an excreted vaccine-virus can continue to circulate for an extended period of time and genetically change into a form that can paralyse children that are not fully immunized – this is what is known as a circulating vaccine-derived poliovirus (cVDPV). Hence, the problem is not with the vaccine itself but low vaccination coverage. If a population is fully immunized, they will be protected against both vaccine-derived and wild polioviruses.

Due to the Ebola crisis in West Africa, both population immunity levels and surveillance sensitivity have been severely affected in some parts of the region. Subnational surveillance gaps persist in both countries. In Guinea, vaccination coverage dropped from 63% in 2013 to 42% in 2014. In Mali, national coverage in 2014 is 84%, however subnationally gaps remain; Bamako province has coverage rates of 63% in 2015. Nationally Mali has strong surveillance capacity, yet undetected circulation of this strain for an extended period of time suggests possible subnational surveillance gaps.

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Conference: Meeting the Challenges of Global Polio Eradication
Center for Strategic and International Studies
Monday, September 28, 2015 8:30 AM – 2:30 PM
2nd Floor Conference Room
1616 Rhode Island Avenue, NW
Washington, D.C. 20036
Overview
The number of wild poliovirus cases worldwide is significantly lower than last year, as Pakistan improves its immunization reach and Africa goes more than a year since its last reported case. Nonetheless, substantial challenges to global eradication remain, including newly reported cases of vaccine-derived poliovirus in Ukraine and Mali. Join the CSIS Global Health Policy Center on September 28 as it welcomes keynote speakers Dr. Thomas Frieden, Director of the U.S. Centers for Disease Control and Prevention and Chair of the global Polio Oversight Board, and Sir Liam Donaldson, Chair of the Global Polio Eradication Initiative’s Independent Monitoring Board. They and other top experts will discuss current and future eradication challenges, including: the ambitious vaccine switch needed to address vaccine-derived polio cases; plans to transition polio-related assets and knowledge to national health systems and other health priorities; and measures to address political instability and insecurity hampering vaccination efforts. Lunch will be provided.
RSVP here for online and direct participation.