POLIO [to 28 May 2016]

POLIO [to 28 May 2016]
Public Health Emergency of International Concern (PHEIC)

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Statement on the 9th IHR Emergency Committee meeting regarding the international spread of poliovirus
WHO statement
20 May 2016
[Excerpts; Editor’s text bolding]
The 9th meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened via teleconference by the Director¬ General on 12th May 2016. As with the seventh and eighth meetings, the Emergency Committee reviewed the data on wild poliovirus as well as circulating vaccine-¬derived polioviruses (cVDPV). The latter is important as cVDPVs reflect serious gaps in immunity to poliovirus due to weaknesses in routine immunization coverage in otherwise polio-¬free countries. In addition, any further spread of type 2 cVDPVs is a public health emergency following the globally synchronized withdrawal of type 2 OPV completed 1st May 2016…

…Conclusion
The Committee unanimously agreed that the international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC), and recommended the extension of the Temporary Recommendations for a further three months. The Committee considered the following factors in reaching this conclusion:
:: The continued international spread of wild poliovirus during 2015 and 2016 involving Pakistan and Afghanistan.
:: The current special and extraordinary context of being closer to polio eradication than ever before in history.
:: The risk and consequent costs of failure to eradicate globally one of the world’s most serious vaccine preventable diseases. Even though globally transmission has fallen and therefore the likelihood of international spread has also fallen, the consequences and impact of international spread should it occur become more serious, and this possibility is greater if global complacency sets in.
:: 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.
:: 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.
:: Additionally with respect to cVDPV:
…cVDPVs also pose a risk for international spread, and if there is no urgent response with appropriate measures, particularly threaten vulnerable populations as noted above;
…the emergence and circulation of VDPVs in four WHO regions demonstrates significant gaps in population immunity at a critical time in the polio endgame;
…there is a particular urgency of preventing type 2 cVDPVs following the globally synchronized withdrawal of type 2 component of the oral poliovirus vaccine in April 2016;
…the ongoing challenges of improving routine immunization in areas affected by insecurity and other emergencies, including Ebola; and
…the global shortage of IPV poses fresh challenges…

…The Committee recognised that the communication message explaining why a PHEIC is being maintained should be carefully prepared. On the one hand the world is applauding the successful switch from tOPV to bOPV and the reduction of new cases of wild poliovirus, while on the other hand a PHEIC is being maintained to ensure that all possible measures are brought to bear to support these final phases of polio eradication. This apparent paradox needs careful explanation.

Based on the advice concerning wild poliovirus and cVDPV, and the reports made by Afghanistan, Pakistan, Nigeria, Lao People’s Democratic Republic and Guinea, the Director¬ General accepted the Committee’s assessment and on 20 May 2016 determined that the events relating to poliovirus continue to constitute a PHEIC, with respect to wild poliovirus and cVDPV. The Director ¬General endorsed the Committee’s recommendations for ‘States currently exporting wild polioviruses or cVDPV’, for ‘States infected with wild poliovirus or cVDPV but not currently exporting’ and for ‘States no longer infected by wild poliovirus, but which remain vulnerable to international spread, and states that are vulnerable to the emergence and circulation of VDPV’ and extended the Temporary Recommendations as revised by the Committee under the IHR to reduce the international spread of poliovirus, effective 20 May 2016.

The Director¬ General thanked the Committee Members and Advisors for their advice and requested their reassessment of this situation within the next three months

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Polio this week as of 25 May 2016
:: This week, health ministers from around the world are convening in Geneva for the annual World Health Assembly (WHA). Among other public health topics, delegates will review and discuss the latest global polio epidemiology. The GPEI has set up a WHA-specific polio website, with the key documents that are guiding discussions.

:: At the Women Deliver conference in Copenhagen focusing on solutions to the health, economic and social challenges facing girls and women, the Government of Canada announced a Can$19.9 million contribution to Nigeria’s polio eradication efforts.

:: From 17 April to 1 May, 155 countries and territories participated in the historic trivalent to bivalent oral polio vaccine switch, withdrawing the type two component of the vaccine to protect future generations against circulating vaccine-derived polioviruses. Track the switch live.

The Trivalent to Bivalent Oral Polio Vaccine Switch
:: Between 17 April and 1 May, the type 2 component of the oral polio vaccine (OPV) is being removed from use through aglobally synchronized switch from the trivalent to bivalent oral polio vaccine. This is the first stage of objective 2 of the Polio Eradication and Endgame Strategic Plan 2013-2018 to withdraw OPV in a phased manner starting with the type 2 component following the eradication of wild poliovirus type 2 in September 2015.

:: Follow a live update of which countries have undergone the switch. Learn more about why the switch is such an important part of ensuring a polio-free world through this series of videos.

:: The following indicators are being carefully tracked to ensure the switch goes smoothly. As of 24 May:
…155 of 155 (100%) countries and territories have stopped using the trivalent oral polio vaccine.
…Independent monitoring to ensure the switch goes smoothly has begun in 152 countries (100%).
…The National Validation Committee has received switch monitoring data in 145 countries (95%).
…The WHO Regional Offices has received the National Validation Report from 147 countries (95%).

Selected Country Levels Updates [excerpted]
Pakistan
:: One new case of wild poliovirus type 1 (WPV1) was reported in the past week, from Bannu district in Khyber Pakhtunkhwa (KP) province with onset of paralysis on 26 April. It is the most recent case in the country, and brings the total number of WPV1 cases for 2016 to 11, compared to 23 at this date in 2015.
:: Four new WPV1 environmental positive samples were reported in the past week: two collected from Sindh province in the districts of Khi Gulshan-Iqbal and Jacobabad on 15 and 10 March respectively, one in the Rawalpindi district of Punjab on 14 April, and the most recent in Peshawar district of Khyber Pakhtunkhwa on 22 April. Although four positives were reported this week, two duplicates were removed, thus the total went from 17 to 19 environmental positives.
:: Efforts continue to further strengthen surveillance activities in all provinces of the country