POLIO [to 26 November 2106]

POLIO [to 26 November 2106]
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 23 November 2016
:: Rotary Foundation named “world’s outstanding foundation for 2016”, by the Association of Fundraising Professionals. The judges cited Rotary’s PolioPlus efforts as a major driver for its selection. More.

:: The GPEI report to the January Executive Board (EB) meeting has now been finalized and is available here. The report summarizes the status against the Polio Endgame Plan and Resolution WHA68.3, adopted by the WHA in May 2015, including the impact of national emergency action plans in the remaining infected countries and of the IHR Temporary Recommendations; the achievements of the globally coordinated switch from trivalent OPV to bivalent OPV and associated IPV global supply issues and risk mitigation strategies (including fractional-dose IPV); the status of global containment activities; transition planning; and, the global budget. This report will be the main tool to inform the discussions by Member States at the January EB.

:: Also published this week: WHO’s Human Resources Update to the EB. The report includes an update on WHO’s component of the human resources infrastructure funded by the GPEI and the associated financial liabilities.

: The 11th meeting of the Emergency Committee under the International Health Regulations (IHR) met on 11 November and concluded that current epidemiology continues to constitute a Public Health Emergency of International Concern (PHEIC). Read about the IHR findings and recommendations here. [see below]

Country Updates [Selected Excerpts]
Pakistan
:: One new wild poliovirus type 1 (WPV1) case was reported in the past week, from Sujawal district in central Sindh, with onset of paralysis on 3 November. It is the most recent case in the country and brings the total number of WPV1 cases for 2016 to 17.
:: One new WPV1 positive environmental sample was reported in the past week, from Lahore, Punjab (collected on 18 October).

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Statement of the 11th IHR Emergency Committee regarding the international spread of poliovirus
WHO statement – 11 November 2016
[Selected excerpts; text bolding by Editor]

The eleventh 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 11 November 2016.

The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine-derived polioviruses (cVDPV). The Secretariat presented a report of progress for affected IHR States Parties subject to Temporary Recommendations. The following IHR States Parties presented an update on the implementation of the WHO Temporary Recommendations since the Committee last met on 11 August 2016: Afghanistan, Pakistan, Nigeria, Cameroon, Chad and Niger…

…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 new outbreak of WPV1 in Nigeria highlighting that there are high-risk areas where surveillance is compromised by inaccessibility, resulting in ongoing circulation of WPV for several years without detection. The risk of transmission in the Lake Chad sub-region appears very high.
:: The continued international spread of wild poliovirus during 2016 from Pakistan to Afghanistan, resulting in intense transmission in vulnerable populations.
:: The persistent, wide geographical distribution of positive WPV1 in environmental samples in Pakistan.
:: 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 global transmission has fallen dramatically and with it the likelihood of international spread, the consequences and impact of international spread should it occur would be grave.
:: The possibility of global complacency developing as the numbers of polio cases continues to fall and eradication becomes a possibility.
:: 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 continued necessity for a coordinated international response to improve immunization and surveillance for wild poliovirus, to stop international spread and reduce the risk of new spread.
:: The importance of a regional approach and strong cross¬border cooperation, as much international spread of polio occurs over land borders, while also 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, which without an urgent response with appropriate measures threatens vulnerable populations as noted above;
:: The ongoing circulation of cVDPV2 in Nigeria and possibly in Guinea, and in Lao PDR, demonstrates significant gaps in population immunity at a critical time in the polio endgame;
:: The ongoing urgency to prevent type 2 cVDPVs following the globally synchronized withdrawal of the 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;
:: The global shortage of IPV which poses an additional threat from cVDPVs…

…Additional considerations for all infected and high risk countries
The Committee strongly urged global partners in polio eradication to provide optimal support to all infected and vulnerable countries at this critical time in the polio eradication programme for implementation of the Temporary Recommendations under the IHR, as well as providing ongoing support to countries, such as Somalia that were recently subject to Temporary Recommendations. The Committee requested that future secretariat reports should include a cumulative table of countries which have been removed from the ‘vulnerable country’ list, with comments on the current situation in those countries.

Learning from recent events in Nigeria, the committee requested the secretariat provide a global report on all inaccessible areas where polio surveillance may be compromised. Recognizing that cVDPV illustrates serious gaps in routine immunization programmes in otherwise polio free countries, the Committee recommended that the international partners in routine immunization, for example Gavi, should assist affected countries to improve the national immunization programme.

The Committee noted the threat posed to eradication efforts caused by the global IPV shortage and requested that SAGE continue to monitor and make recommendations to address this situation.

The Committee noted the Secretariat’s report on the identification of Sabin 2 virus detected in environmental samples in India probably due to the ongoing use of tOPV in the private sector. As Sabin 2 virus has also been detected in Russia, Nigeria and Afghanistan, the Committee requested a full report on this at the next meeting.

The Committee noted a more detailed analysis of the public health benefits and costs of implementing temporary recommendations was under way and requested a report be made available to the committee in February 2017.

The Committee urged all countries to avoid complacency which could easily lead to a polio resurgence. Surveillance particularly needs careful attention to quickly detect any resurgent transmission.

Based on the advice concerning wild poliovirus and cVDPV, and the reports made by Afghanistan, Pakistan, Nigeria, Cameroon, Chad and Niger, the Director General accepted the Committee’s assessment and on 18 November 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 countries falling into the definition of ‘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 18 November 2016.