POLIO Public Health Emergency of International Concern (PHEIC); WHO/OCHA Emergencies

Emergencies

 POLIO
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 21 October 2020
:: World Polio Day is around the corner! Observed on the 24 October, the theme for 2020 is “A win against polio is a win for global health.” Mark your calendar to tune in for Rotary International’s World Polio Day Online Global Update, streamed in multiple languages around the world.
:: On 19 September 2019, a polio outbreak was declared in the Philippines after a 3-year-old child and several environmental samples tested positive for polioviruses. Fifteen other children have been paralyzed by polio since the outbreak started. As we approach World Polio Day this year, we are celebrating the heroes who have been working tirelessly to combat polio in the Philippines.

Summary of new WPV and cVDPV viruses this week (AFP cases and environmental samples):
:: Afghanistan: one WPV1 case, one WPV1positive environmental sample, 14 cVDPV2 cases and 2 cVDPV2 positive environmental samples
:: Pakistan: two WPV1 cases and one WPV1 positive environmental sample
:: Benin: one cVDPV2 positive environmental sample
:: Burkina Faso: 21 cVDPV2 cases
:: Côte d’Ivoire: 15 cVDPV2 cases
:: Ethiopia: four cVDPV2 cases
:: Mali: six cVDPV2 case
:: Nigeria: one cVDPV2 case
:: Somalia: five cVDPV2 cases and one cVDPV2 positive environmental sample
:: Sudan: 16 cVDPV2 cases
:: Yemen: two cVDPV1 cases

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Statement of the Twenty-Sixth Polio IHR Emergency Committee
22 October 2020 Statement
The twenty-sixth meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) on the international spread of poliovirus was convened and opened by the WHO Deputy Director-General on 14 October 2020 with committee members attending via video conference, supported by the WHO Secretariat.  Dr Zsuzsana Jakab in opening remarks on behalf of Dr Tedros congratulated all those involved in eliminating wild polioviruses from the WHO African Region despite some very challenging obstacles.  The COVID-19 pandemic and the ongoing spread of cVDPV2 were both growing major challenges, which would require strenuous efforts to overcome in order to restart progress toward global polio eradication.

The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV).  The following IHR States Parties provided an update at the video conference or in writing on the current situation in their respective countries: Afghanistan, Chad, Egypt, Guinea, Pakistan, Somalia, South Sudan, Sudan and Yemen.

Wild poliovirus
The higher incidence of global WPV1 cases seen during 2020 continues, with 121 cases reported between 1 January – 5 October 2020 compared to 85 for the same period in 2019, a 42% increase.  Last year there were 176 WPV1 cases, the highest number reported since the PHEIC was declared in 2014, when there were 359 cases in nine countries.  The lowest number of WPV1 cases was reported in 2017, when only 22 cases were found.  No wild polio cases have been detected outside of Pakistan and Afghanistan since the last cases in Nigeria in 2016 four years ago.  The number of positive environmental samples has increased 70% to 375 compared to 221 for the same time last year.  Since the last meeting, exportation of WPV1 from Pakistan to Afghanistan has been documented.

The Committee noted that based on results from sequencing of WPV1 since the last committee meeting in June, there were further instances of international spread of viruses from Pakistan to Afghanistan.  The ongoing frequency of WPV1 international spread between the two countries and the increased vulnerability in other countries where routine immunization and polio prevention activities have both been adversely affected by the COVID-19 pandemic are two major factors that suggest the risk of international spread may be at the highest level since 2014.  While border closures and lockdowns may mitigate the risk in the short term while in force, this would be outweighed in the longer term by falling population immunity through disruption of vaccination and the resumption of normal population movements.

On the other hand the certification of the WHO African Region as wild polio free in August 2020 indicated a lessening of the global risk from this previous source.

Vaccine derived poliovirus (VDPV)
The committee was very concerned that the international spread of cVDPV2 continues, causing new outbreaks in Guinea, South Sudan and Sudan, the latter two due to importation of a cVDPV2 lineage that emerged in Chad in 2019.  The same virus has also been detected in sewage in Cairo, Egypt but with no evidence of local circulation. The number of cases in 2020 is 409 as at 5 October 2020, already exceeding the 378 cases reported for the whole of 2019.  As in all other years after 2016 when OPV2 was withdrawn, the number of cVDPV2 cases has been greater than the number of WPV1 cases in 2020.  However, the number of sub-types / lineages detected so far in 2020 is 27, compared to 42 for the whole of 2019, and the number of newly emerged viruses is only seven so far this year, compared to 38 during 2019.

Cross border spread of cVDPV2 is now occurring regularly.  Based on analysis by the US CDC of isolates, in the three months from April to June 2020, there has been evidence of exportation of cVDPV2 from:
·     Pakistan to Afghanistan
·     Côte d’Ivoire to Mali
·     Guinea to Mali
·     Côte d’Ivoire to Ghana, and Ghana to Côte d’Ivoire
·     CAR to Cameroon
·     Chad to Sudan and South Sudan
·     Ghana to Burkina Faso

COVID-19
The committee heard that nearly all countries (90%) have experienced disruption to health services especially in low and middle income countries, according to a survey of 105 countries conducted March – June 2020.  Routine immunization particularly outreach services was the area most frequently reported as disrupted.

The committee was very concerned that most of the current outbreak countries have had to delay immunization responses in recent months, meaning that transmission is likely continuing unchecked.  Furthermore, there appear to be significant falls in surveillance indicators in many of the outbreak countries, such as drops in AFP reporting rates, and lesser drops in environmental sampling.  Vaccine management and supply has been significantly impacted.  More than 60 campaigns in 28 countries have been postponed since late February and early March. Vaccine supplies have been disrupted in many ways, with some quantities already in-country at risk of exceeding their expiry data and therefore unusable.  Some suppliers are reaching storage capacity and may well be forced to stop production.

Although the resumption of Supplementary Immunization Activities (SIAs) is now occurring, the waves of the pandemic are expected to fluctuate considerably from country to country and across the WHO Regions, so the program will need to adjust according to the COVID-19 situation for the foreseeable future.

Although in general surveillance processes are continuing, there are clear signs of a significant drop in AFP case reporting, including in endemic countries, some outbreak countries and some other non-infected high risk countries.

The committee noted that GPEI modeling indicated there is a risk of an exponential rise in the number of cVDPV2 infected districts in the African Region, leading to a 200% increase if response SIAs had not resumed. In addition to the risk of WPV1 geographical spread and intensification, cVDPV2 cases could rise exponentially in Pakistan and Afghanistan potentially reaching more the 3,500 cases without a resumption of immunization response.   Consequently, both Pakistan and Afghanistan are now implementing large scale mOPV2 campaigns and will continue with tOPV/mOPV2 until controlled. While there has been rapid spread, particularly in Afghanistan, expected exponential rise has been curtailed by the resumption of campaigns in July.

Conclusion
The Committee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC) and recommended the extension of Temporary Recommendations for a further three months.  The Committee recognizes the concerns regarding the lengthy duration of the polio PHEIC, but concludes that the current situation is extraordinary, with clear ongoing and increasing risk of international spread and ongoing need for coordinated international response…

Based on the current situation regarding WPV1 and cVDPV, and the reports provided by affected countries, the Director-General accepted the Committee’s assessment and on 19 October 2020 determined that the situation relating to poliovirus continues to constitute a PHEIC, with respect to WPV1 and cVDPV.  The Director-General endorsed the Committee’s recommendations for countries meeting the definition for ‘States infected with WPV1, cVDPV1 or cVDPV3 with potential risk for international spread’, ‘States infected with cVDPV2 with potential risk for international spread’ and for ‘States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV’ and extended the Temporary Recommendations under the IHR to reduce the risk of the international spread of poliovirus, effective 19 October 2020.

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WHO Grade 3 Emergencies [to 24 Oct 2020]

Democratic Republic of the Congo – No new digest announcements identified
Mozambique floods – No new digest announcements identified
Nigeria – No new digest announcements identified
Somalia – No new digest announcements identified
South Sudan – No new digest announcements identified
Syrian Arab Republic – No new digest announcements identified
Yemen – No new digest announcements identified

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WHO Grade 2 Emergencies [to 24 Oct 2020]
Burkina Faso
:: Burkina Faso : les tradipraticiens de santé de la région du Sud-Ouest à l’école de …
21 octobre 2020

Afghanistan – No new digest announcements identified
Angola – No new digest announcements identified
Burundi – No new digest announcements identified
Cameroon – No new digest announcements identified
Central African Republic – No new digest announcements identified
Ethiopia – No new digest announcements identified
Iran floods 2019 – No new digest announcements identified
Iraq – No new digest announcements identified
Libya – No new digest announcements identified
Malawi Floods – No new digest announcements identified
Measles in Europe – No new digest announcements identified
MERS-CoV – No new digest announcements identified
Mozambique – No new digest announcements identified
Myanmar – No new digest announcements identified
Niger – No new digest announcements identified
occupied Palestinian territory – No new digest announcements identified
HIV in Pakistan – No new digest announcements identified
Sao Tome and Principe Necrotizing Cellulitis (2017) – No new digest announcements identified
Sudan – No new digest announcements identified
Ukraine – No new digest announcements identified
Zimbabwe – No new digest announcements identified

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WHO Grade 1 Emergencies [to 24 Oct 2020]

Chad – No new digest announcements identified
Djibouti – Page not responding at inquiry
Kenya – No new digest announcements identified
Mali – No new digest announcements identified
Namibia – viral hepatitis – No new digest announcements identified
Tanzania – No new digest announcements identified

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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. 
Syrian Arab Republic
:: Recent Developments in Northwest Syria – Situation Report No. 21 – As of 20 October 2020

Yemen – No new digest 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.
COVID-19
::   Coronavirus disease 2019 (COVID-19) Situation Report 49: occupied Palestinian territory, issued 22 October 2020, information for period: 5 March – 22 October 2020

East Africa Locust Infestation
:: Desert Locust situation update – 19 October 2020

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