Emergencies

Emergencies
 
 
POLIO
Public Health Emergency of International Concern (PHEIC)
Polio this week as of 04 December 2018 [GPEI]
:: The circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak in Syria, which was first detected in 2017, has been successfully stopped. The announcement came at the heels of an official outbreak response assessment, comprising of experts in public health, epidemiology and virology, who reviewed evidence and concluded the outbreak was closed. Read the full statement here.
 
 
:: On 27 November 2018, the 19th IHR Emergency Committee including members, advisers, and invited Member States convened to discuss the status of international spread of poliovirus. The Committee unanimously agreed that the risk of polio spread continues to be a Public Health Emergency of International Concern (PHEIC) and proposed an extension of Temporary Recommendations for an additional three months. The Committee expressed concern that complacency to achieving a polio-free world could now become the biggest risk to the effort and urged that all countries and partners regard polio eradication as an emergency.  “We have the tools, we need to focus on what works, we need to get to every child,” commented Prof. Helen Rees, Chairperson of the Committee.  “The reality is that there is no reason why we should not be able to finish this job, but we have to keep at it.”  Prof. Rees and the Committee urged countries, donors and partners to continue their support, until a polio-free world is achieved, cautioning that failure to eradicate polio would lead to global resurgence of the disease, with potentially as many as 200,000 new cases occurring annually within ten years.  “We have achieved eradication of a disease once before, with smallpox,” Rees concluded.  “The world is a much better place without smallpox.  It’s now more urgent than ever that we redouble our efforts and finish this job once and for all as well.”  The recommendations come amid the notification of the fourth cVDPV circulation in DRC, which underscores the need for sustained partnership, funding, and socio-political resolve. Read the full WHO statement including the Temporary Recommendations.

:: The Africa Regional Commission for the Certification of poliomyelitis eradication (ARCC) was held in Nairobi, Kenya, from 12-16 November 2018. Made up of 16 health experts, recommendations were made to ten countries to address issues of disease surveillance gaps, inaccessibility and insecurity. Read the recommendations here.

The Technical Advisory Groups (TAG) on Polio Eradication in Horn of Africa and Lake Chad Basin convened recently, to review the current status of polio outbreaks in both the regions and provide guidance on the next phase of the outbreak response.

::Featured on http://www.polioeradication.org: Coffee with Polio Experts – Dr Mohammad Al Safadi, Technical Officer for Polio Outbreak Preparedness and Response, talks about the tactics and strategies used to stop the Syria outbreaks of 2013, 2014, and the most recent outbreak of 2017, which was compounded by accessibility, security, and conflict issues.

:: Call for nomination of experts to serve on the Polio Research Committee to provide guidance to the Director of the Polio Department at WHO HQ on the research and development aspects in poliovirus eradication. Read the details here.

The GPEI report to the upcoming WHO Executive Board (in January) has been published.  The report provides a status update on polio eradication, summarizing programmatic, epidemiological and financial challenges to securing a lasting polio-free world, and introduces the concept of a new extended strategic plan to achieve global certification by 2023, taking into account the fact that circulation of wild poliovirus has not yet been interrupted.  Read the report here.

 
 
Summary of new viruses this week:
Afghanistan – one wild poliovirus type 1 (WPV1) case and two positive WPV 1 environmental samples.
Pakistan – nine WPV1 positive environmental samples.
DRC – two cases of circulating vaccine-derived poliovirus type 2 (cVDPV2).
Nigeria – four cases of cVDPV2.
Somalia – one positive cVDPV2 environmental sample. See country sections below for more details.

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Djibouti carries out mass immunization to protect children against polio, amid outbreaks in the Horn of Africa

5 December 2018 – Early analysis of campaign data points to a successful vaccination round in a polio-free country at risk of possible importation.
In the last week of October, Djibouti’s Ministry of Health, working with WHO, UNICEF and other partners, successfully carried out the country’s first polio National Immunization Days (NIDs) since 2015.
While Djibouti has not had a case of polio since 1999, the recent outbreak of polio in neighbouring countries in the Horn of Africa, and the low levels of routine immunization coverage in some areas in the country, are indications that Djibouti is still at risk if poliovirus spreads through population movements. Other countries in the Horn of Africa are already cooperating to control the existing outbreak and to reduce the risk of spread, and given that Djibouti is on a major migration route in the Horn of Africa, it makes a lot of sense for Djibouti to join this coordinated response…

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Countries of the Americas seek to strengthen measures to keep the Region free of polio and move towards global eradication (12/05/2018)
PAHO convenes strategic partners and 140 public health professionals from 22 countries in the Region, in Guatemala this week. If polio is not eradicated there could be up 200,000 new cases worldwide each year within ten years.

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Global Polio Eradication Initiative – Certification of poliovirus eradication
November 2018 :: Statement
Global Commission for the Certification of Poliomyelitis Eradication (GCC) reviews criteria for certification
Attaining and sustaining a world free from all polioviruses
On 29-31 October 2018, the Global Commission for Certification of Poliomyelitis Eradication (GCC) met to review the criteria that will need to be met to achieve global certification of wild poliovirus (WPV) eradication.

As the world approaches successful eradication of WPV transmission, the GCC’s work takes on urgency, including consideration of circulating vaccine-derived polioviruses (cVDPVs). While these are not a new phenomenon, they become more significant, as does the need for effective containment of all polioviruses in laboratories and vaccine manufacturing facilities. The GCC has recommended a process of sequential certification of WPV eradication and confirmation of the absence of VDPVs, when the data become available. The Director General has accepted the GCC recommendation for sequential certification.

While the operational and programmatic aspects of achieving and sustaining a world free of all polioviruses – be they wild or vaccine-derived – have been well-established, the GCC is focusing its discussions on the necessary verification processes associated with this eventual achievement. Following the certification that WPV transmission has been stopped – and after OPV has been withdrawn – the absence of VDPVs will also need to be validated.

The assessment that all WPV transmission has been interrupted globally is the critical step which will mark the launch of preparations for cessation of all oral polio vaccine (OPV) use. Inadequate routine immunization levels coupled with subnational gaps in surveillance in high-risk countries continue to be the main risk factors for the emergence or continuation of cVDPVs. Both risk factors must be addressed. However, the only and surest way to prevent cVDPVs in the future is to rapidly stop OPV use, which can only occur after the successful eradication of WPVs. As such, the polio eradication program now has two urgent tasks – to eradicate WPVs as quickly as possible and to stop the use of OPV globally.

With no wild poliovirus type 3 (WPV3) reported globally since November 2012 (from Nigeria), the GCC concluded that the world could be ready to certify the eradication of WPV3, and urged the GPEI and Member States to ensure that full documentation is available to achieve this goal. This type-specific global certification would ideally follow a similar process as that used for the certification of WPV2 eradication in 2015. The GCC recommended that the GPEI conduct a comprehensive review of the implications of such sequential certification, and report back to it in 2019.

The GCC also continues to evaluate evidence that polioviruses will be rigorously contained where they are being held (in a limited number of research or diagnostics laboratories, and in vaccine manufacturing facilities). The Containment Advisory Group and the Containment Working Group guide the operationalization of this work, through implementation of the WHO Global Action Plan to minimize poliovirus facility-associated risk after type-specific eradication of wild polioviruses and sequential cessation of oral polio vaccine use (GAPIII).

The WHO Director-General has accepted the outcomes and recommendations of the GCC and these will be incorporated into a global strategy for eradication covering the period 2019-2023 (currently being developed in a broad consultative process, and to be presented to the World Health Assembly in May 2019). The full report from the GCC’s meeting will subsequently be made available upon publication at www.polioeradication.org.

The GCC’s work and efforts will assure the independent verification that transmission of all polioviruses has been interrupted globally, and that all necessary safeguards to sustain a polio-free world have been put in place.

Additional background:
The GCC is independent of WHO and of involvement in national polio vaccination implementation or polio surveillance programmes. WHO Regions are eligible for certification following the absence of WPV from any country in that region from any population source in the presence of certification-standard surveillance. Regional certification is conducted by Regional Certification Commissions (RCCs). Global certification will follow the successful certification of all six WHO regions, and will be conducted by the GCC.
As at 2018, four regions have been certified as free of WPVs: Region of the Americas (1994), the Western Pacific Region (2000), the European Region (2002),  and the South-East Asia Region (2014).
  For more information, please see:
http://polioeradication.org/polio-today/preparing-for-a-polio-free-world/certification/
http://polioeradication.org/polio-today/preparing-for-a-polio-free-world/containment/

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Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.
 
 
WHO Grade 3 Emergencies  [to 8 Dec 2018]
Democratic Republic of the Congo
:: 18: Situation report on the Ebola outbreak in North Kivu  5 December 2018
:: DONs Ebola virus disease – Democratic Republic of the Congo   6 December 2018
[See Milestones above for more detail]
 
 
Bangladesh – Rohingya crisis
:: Weekly Situation Report 53 -30 November 2018
[Excerpt]
HEALTH OPERATIONS
OCV Campaign:
After completion of 2nd week of OCV campaign, 163,441 ( 101.5%.) received the vaccination. Among them 119,649 (107.3%) were FDMN beneficiaries and 43,792 (88.5%) from host community. Out of total target of 328, 556, 49.7% vaccination completed. Among them 53.2% were FDMN beneficiaries and 42.3% from host community. Besides the major portion of the FDMN and HC: Registered camps, No-man’s land and people engaged in different activities adjacent to camps are being covered.
Rapid Convenience monitoring through house to house:
In total 2116 beneficiaries were interviewed till 28 November 2018. Evaluated coverage was 92.5%. The main reasons not being vaccinated were beneficiaries not at home (32%), not aware of campaign (23%) and beneficiaries too busy (14%). The main means of mobilization were majhee and FDMN mobilizers (46.2), megaphone (30.1) and moni flag (17.5)…
 
 
Syrian Arab Republic
:: WHO update on reported chemical event in Aleppo, Syria   29 November 2018
 
 
Myanmar – No new announcements identified
Nigeria – No new announcements identified
Somalia – No new announcements identified
South Sudan – No new announcements identified
Yemen – No new announcements identified
 
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WHO Grade 2 Emergencies  [to 8 Dec 2018]
Sudan
:: WHO Member States sign Khartoum Declaration on Sudan and Bordering Countries: Cross-Border Health Security
4 December 2018 – Six countries in WHO’s Eastern Mediterranean and African Regions have signed a declaration committing themselves to strengthening preparedness and response to public health threats and events across borders in an effort to further the implementation of the International Health Regulations (IHR 2005) and enhance global health security. The Khartoum Declaration on Sudan and Bordering Countries: Cross-Border Health Security was signed by Chad, Egypt, Ethiopia, Libya, South Sudan and Sudan on 22 November 2018 in Khartoum, Sudan…
 
 
Brazil (in Portugese) – No new announcements identified
Cameroon  – No new announcements identified
Central African Republic  – No new announcements identified
Ethiopia – No new announcements identified
Hurricane Irma and Maria in the Caribbean – No new announcements identified
Iraq – No new announcements identified
occupied Palestinian territory – No new announcements identified
Libya – No new announcements identified
MERS-CoV – No new announcements identified
Niger – No new announcements identified
Sao Tome and Principe Necrotizing Cellulitis (2017) – No new announcements identified
Ukraine – No new announcements identified
Zimbabwe – No new announcements identified
 
 
WHO-AFRO: Outbreaks and Emergencies Bulletin, Week 48: 24-30 November 2018
The WHO Health Emergencies Programme is currently monitoring 57 events in the region. This week’s edition covers key ongoing events, including:
:: Yellow fever in South Sudan
:: Ebola virus disease in the Democratic Republic of the Congo
:: Cholera in Zimbabwe
:: Hepatitis E in Central African Republic
:: Humanitarian crisis in Ethiopia.
 
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WHO Grade 1 Emergencies  [to 8 Dec 2018]
Afghanistan
Chad
Indonesia – Sulawesi earthquake 2018
Kenya
Lao People’s Democratic Republic
Mali
Namibia – viral hepatitis
Peru
Philippines – Tyhpoon Mangkhut
Tanzania
 
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UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
Yemen
:: Yemen: Al Hudaydah Update Situation Report No. 15, Reporting period: 14 November – 2 December 2018

Syrian Arab Republic   No new announcements identified.

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UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
Ethiopia  No new announcements identified.
Somalia  – No new announcements identified.

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 “Other Emergencies”
Indonesia: Central Sulawesi EarthquakeNo new announcements identified.
 
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Editor’s Note:
We will cluster these recent emergencies as below and continue to monitor the WHO webpages for updates and key developments.
 
 
EBOLA/EVD  [to 8 Dec 2018]
http://www.who.int/ebola/en/
:: 18: Situation report on the Ebola outbreak in North Kivu  5 December 2018
:: DONs Ebola virus disease – Democratic Republic of the Congo   6 December 2018
[See Milestones above for more detail]
 
 
MERS-CoV [to 8 Dec 2018]
http://who.int/emergencies/mers-cov/en/
No new announcements identified.
 
 
Yellow Fever  [to 8 Dec 2018]
http://www.who.int/csr/disease/yellowfev/en/
No new announcements identified.
Zika virus  [to 8 Dec 2018]
http://www.who.int/csr/disease/zika/en/
No new announcements identified.