Public Health Emergency of International Concern (PHEIC)
Polio this week as of 23 February 2022
:: On Monday 7 March 2022, a case of circulating vaccine-derived poliovirus type 3 (cVDPV3) was confirmed in an unvaccinated girl aged three years and nine months in Israel. The girl had developed acute flaccid paralysis and upon testing of her stool, poliovirus was confirmed…Read more
:: International Women’s Day was marked on 8 March and among several online activities, the GPEI released a video featuring the voices of some of the women involved in the polio eradication effort in Pakistan. Spanish Minister for Foreign Affairs, European Union and Cooperation and Gender Champion for Polio Eradication José Manuel Albares also paid tribute to all the women in polio eradication.
Summary of new WPV and cVDPV viruses this week (AFP cases and ES positives):
– Côte d’Ivoire: one cVDPV2 positive environmental sample
– DR Congo: one cVDPV2 case
– Israel: one cVDPV3 case and six positive environmental samples
– Mauritania: one cVDPV2 positive environmental sample
– Nigeria: one cVDPV2 case
– Occupied Palestinian territory: eight cVDPV3 positive environmental samples
Statement of the Thirty-first Polio IHR Emergency Committee
11 March 2022
The thirty-first meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) on the international spread of poliovirus was convened by the WHO Director-General on 28 February 2022 with committee members and advisers attending via video conference, supported by the WHO Secretariat. The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV)…
The committee was encouraged that WPV1 transmission has fallen to very low levels, with no new case in Pakistan since January 2021 and only four in Afghanistan in 2021 and one in 2022. Environmental surveillance continues to detect low levels of WPV1 transmission in Pakistan with 7.6% of samples testing positive in 2021 compared to 56% in 2020. In the second half of 2021 the proportion was only 1.5%. So far in 2022 there has been no positive sample; the most recent positive sample was collected 3 December 2021 in southern Khyber Pakhtunkhwa (KP).
The committee was very concerned that for the first time since the PHEIC was declared in 2014, there has been a case of polio due to new international spread from the Afghanistan – Pakistan epidemiological block, with WPV1 confirmed in a three year old child from Lilongwe, capital city of Malawi with onset of paralysis in November 2021. Genomic sequencing indicates the closest matching virus to that found in the case is a virus found in 2019 in Pakistan. Of concern, it is unknown whether transmission has been missed in Africa or Asia. This is the first WPV1 detection in the WHO African Region since 2016, when four cases occurred due to endemic transmission in Nigeria. This long distance international spread of polio, presumably by sea or by air traffic, is the first such spread since the 2013 introduction of WPV1 into Syria and Israel. The committee noted that a strong multi country response is being planned in Malawi and four neighboring countries, including a thorough investigation to try to determine more clearly when and how importation of WPV1 occurred.
The committee was very disturbed by the news that eight front line workers in Afghanistan had been attacked and killed in four different locations. These are the first attacks on polio workers since nationwide campaigns resumed in November last year and underline that major challenges remain in the country including security challenges and the adverse economic situation. Nevertheless it was encouraging that 2.6 million previously unreached children had been vaccinated in the November 2021 polio campaign. Data provided to the committee clearly showed that where house to house polio campaigns are possible the vaccine coverage is far higher.
Circulating vaccine derived poliovirus (cVDPV)
There have been four new countries infected with cVDPV2, Chad, Djibouti, Mozambique and Yemen bringing the total number of cVDPV2 infected countries to 29. Of these 29 cVDPV2 infected countries, 12 appear to have halted transmission with no detection for at least six months. Chad which appeared to have halted transmission for 12 months has had a new importation and is again considered infected. The total number of cVDPV2 cases in 2021 is 614, of which 413 have occurred in Nigeria, which is considerably less than the 1079 cases in 2020. As in all the years following 2016 when OPV2 was withdrawn, the number of cVDPV2 cases globally has been greater than the number of WPV1 cases.
Based on analysis of genetic linkages between viruses, cross border spread continues to occur, with spread from Nigeria into Cameroon, CAR, Chad and Niger and from Yemen into Djibouti and Egypt. Despite the ongoing decline in the number of cases and lineages circulating, the risk of international spread of cVDPV2 remains high.
The committee noted that the roll out of wider use of novel OPV2 continues under EUL. The committee also noted the delays concerning the importance of timely, quality outbreak response with countries avoiding timely response with monovalent OPV2, preferring to wait for novel OPV2 to become available.
Although heartened by the apparent progress particularly in Pakistan, 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 and the importance of exploring alternative IHR measures in the future but concluded that there are still significant risks as exemplified by the importation of virus into Malawi…
…The Committee warned of the ongoing effects of COVID-19 particularly on essential immunization and possible future disruptions of immunization activities, and suggested the polio programme could play a role in expediting delivery of COVID vaccines. The committee noted the ongoing work around the duration of the polio PHEIC, and suggested that any lessons learnt from the COVID-19 PHEIC be made available to the committee.
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 4 March 2022 determined that the situation relating to poliovirus continues to constitute a PHEIC, with respect to WPV1 and cVDPV…
Disease Outbreak News (DONs)
No new reports identified.
WHO has issued a single situation report on Ukraine [5 March 2022 Emergency in Ukraine – Situation Report 1] which we featured in last week’s edition. Ukraine has not yet been listed in the omnibus inventory on WHO emergencies below.
Health emergencies list – WHO
“The health emergencies list details the disease outbreaks, disasters and humanitarian crises where WHO plays an essential role in supporting countries to respond to and recover from emergencies with public health consequences.”
Afghanistan crisis [Last apparent update: 17 Jan 2022]
Crisis in Northern Ethiopia [Last apparent update: 1 June 2021]
Ebola outbreak, Democratic Republic of the Congo, 2021 [Last apparent update: 17 Aug 2021]
Ebola outbreak outbreak, N’Zerekore, Guinea, 2021 [Last apparent update: 17 Aug 2021]
Coronavirus disease (COVID-19) pandemic [See COVID above]
Ebola outbreak, Equateur Province, Democratic Republic of the Congo, 2020
[Last apparent update: 17 Aug 2021]
Ebola outbreak, North Kivu, Ituri, Democratic Republic of the Congo, 2018 – 2020
[Last apparent update: 17 Aug 2021]
Ebola outbreak, Democratic Republic of the Congo, 2018 [Last apparent update: 24 July 2018]
Yemen crisis [Last apparent update: 12 February 2021]
Syria crisis [Last apparent update: 18 June 2021]
Somalia crisis [Last apparent update: 24 March 2018]
Nigeria crisis [Last apparent update: 1 Oct 2021]
Ebola outbreak, Democratic Republic of the Congo, 2017 [Last apparent update: 17 Aug 2021]
Zika virus disease outbreak, 2015-2016 [Last apparent update: 24 Jan 2020]
Ebola outbreak: West Africa, 2014-2016 [Last apparent update: 17 Aug 2021]
Iraq crisis [Last apparent update: 9 Jan 2008]
South Sudan crisis [Last apparent update: 23 Sep 2020]
Avian influenza A (H7N9) virus outbreak [Last apparent update: 13 September 2021]
Middle East respiratory syndrome (MERS-CoV) outbreak [Last apparent update: 8 July 2019]
Influenza A (H1N1) virus, 2009-2010 pandemic [Last apparent update: 10 Aug 2010]
Ethiopia – Northern Ethiopia Humanitarian Update Situation Report, 10 March 2022
Ongoing hostilities continue to increase humanitarian needs with a growing number of displaced people in Afar and Amhara.
About 100 metric tons of health and nutrition supplies were airlifted during the reporting week to Mekelle, Tigray.
Only about 10,000 people and about 22,500 refugees were assisted with food during the reporting period in Tigray.
More than 102,000 displaced people were reached with essential health service in Amhara during February.
About 87,000 people were assisted with food in Afar during the reporting week, while high energy biscuits were distributed to more than 5,000 newly displaced people.