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Published Date: 2019-11-21 22:24:56
Subject: PRO/EDR> Poliomyelitis update (91): global, WPV and cVDPVs, Philippines
Archive Number: 20191121.6791409
POLIOMYELITIS UPDATE (91): GLOBAL WILD POLIOVIRUS AND CIRCULATING VACCINE-DERIVED POLIOVIRUSES, PHILIPPINES
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A ProMED-mail post
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International Society for Infectious Diseases
http://www.isid.org

In this update:
[1] Global: 5 WPV1 cases, 11 cVDPV2 cases
[2] Philippines

******
[1] Global: 5 WPV1 cases, 11 cVDPV2 cases
Date: Thu 21 Nov 2019
Source: Global Polio Eradication Initiative / WHO [edited]
http://polioeradication.org/polio-today/polio-now/this-week/


Poliovirus weekly update, as of 20 Nov 2019, WHO

New wild poliovirus isolates reported this week:
AFP cases: 5
Environment: 4
Others: 0

New cVDPV isolates reported this week:
AFP cases: 11
Environment: 0
Others: 1

Headlines
Summary of new viruses this week (AFP cases and ES positives):
Afghanistan: 1 WPV1 case and 2 positive environmental samples;
Pakistan: 4 WPV1 cases, 2 WPV1-positive environmental samples, and 2 cVDPV2 cases;
Nigeria: 1 cVDPV2 case;
Democratic Republic of the Congo (DR Congo): 3 cVDPV2 cases;
Central African Republic: 2 cVDPV2 cases;
Angola: 3 cVDPV2 cases.

Afghanistan
- 1 wild poliovirus type 1 (WPV1) case was reported from Balamurghab in Badghis province. The onset of paralysis was on [17 Oct 2019]. There are 21 WPV1 cases reported in 2019. There were 21 WPV1 cases reported in 2018.
- 2 WPV1-positive environmental samples were reported: 1 each from Nahr-e-Saraj and Lashkargah in Hilmand province. The samples were collected on [28 Oct 2019].

Pakistan
- 4 wild poliovirus type 1 (WPV1) cases were reported: 3 from Lakki Marwat in Khyber Pakhtunkhwa province and 1 from Karachi Jamsheed in Sindh province. The onsets of paralysis were between [23 Oct 2019] and [3 Nov 2019]. There are now 86 WPV1 cases reported in 2019. There were 12 WPV1 cases in 2018.
- 2 WPV1-positive environmental samples were reported: 1 each from Quetta and Bannu in Balochistan and Khyber Pakhtunkhwa provinces, respectively. The samples were collected on [28 and 29 Oct 2019], respectively.
- 2 cVDPV2 cases were reported: 1 each from Torghar and Charsada in Khyber Pakhtunkhwa province. The onsets of paralysis were [28 Oct 2019] and [3 Nov 2019], respectively. There are 9 cVDPV2 cases reported in 2019.

Nigeria
- 1 case of circulating vaccine-derived poliovirus type 2 (cVPDV2) was reported from Surulere in Oyo state. The onset of paralysis was [9 Oct 2019].
- There are 18 cVDPV2 cases reported in 2019. There were 34 cVDPV2 cases in 2018.

Chad
- No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There is 1 cVDPV2 case in the country linked to the Jigawa outbreak in Nigeria.
- The risk of further cVDPV2 spread across the Lake Chad subregion remains high.

Benin
- No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There are 2 cVDPV2 cases in 2019 linked to the Jigawa outbreak in Nigeria.
- The risk of further cVDPV2 spread across West Africa remains high.

Ghana
- No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There are 5 cVDPV2 cases in 2019 linked to the Jigawa outbreak in Nigeria.
- The risk of further cVDPV2 spread across West Africa remains high.

Democratic Republic of the Congo (DR Congo)
- 3 cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported this week: 1 each from Malemba-Nkulu, Kinkondja, and Mulongo, all in Haut Lomami province. The onsets of paralysis were between [17 and 22 Sep 2019]. There are 45 cVDPV2 cases in 2019 and 20 in 2018.

Angola
- 3 cases of cVDPV2 were reported this week: 1 from Bailundo in Huambo province, and 1 each from Cassongue and Seles in Kwanza Sul province. The onsets of paralysis were between [16 and 28 Sep 2019]. There are now 42 cVDPV2 cases from 7 outbreaks reported in 2019.

Central African Republic:
- 2 cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported this week: 1 from Kemo in RS4 province and 1 in Bocaranga-Koui in RS3 province. The onsets of paralysis were [1 Oct 2019] and [6 Oct 2019], respectively. There are 16 reported cases in 2019 from 6 different outbreaks of cVDPV2 in 2019.

Cote d'Ivoire
- No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week.

Togo
- No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There is 1 cVDPV2 case in 2019 in the country that is linked to the Jigawa outbreak in Nigeria.

Zambia
- No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There is 1 cVDPV2 case from the 1st outbreak.

Horn of Africa
- No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There are 3 cVDPV2 cases reported in Ethiopia in 2019, all linked to the outbreak in neighbouring Somalia.
- Somalia has reported a total of 15 cVDPV cases (8 type 2, 6 type 3, and 1 coinfection of both type 2 and type 3) since the beginning of the outbreaks. The most recent cVDPV3 virus was from an AFP case from Runingod district, Middle Shabelle province, with an onset date of paralysis on [7 Sep 2018]. Circulating VDPV2 has also been detected during 2018 in 1 environmental sample in Kenya collected on 21 March 2018.

Papua New Guinea
- No new cases of circulating vaccine-derived poliovirus type 1 (cVDPV1) were reported this week. There were 26 cases reported in 2018. It has now been one year since the country has had a cVDPV1 case.

Mozambique
- No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. There was 1 case reported in 2018.

Indonesia
- No circulating vaccine-derived poliovirus type 1 (cVDPV1) cases were reported this week. 1 cVDPV1 case was reported in 2018 from Papua province with onset of paralysis on [28 Nov 2018].
- This outbreak is not linked to the cVDPV1 in neighbouring Papua New Guinea.

Iran
- No new WPV1-positive environmental samples were reported this week. In total, 3 WPV1-positive environmental samples have been reported in 2019, all from Sistan and Balochistan province. The isolated viruses have been detected in environmental samples only, and genetic sequencing confirms they are linked to WPV1 circulating in Karachi, Pakistan.

China
- No cVDPV2 cases were reported this week. The total number of cVDPV2 cases in the country remains 1.

Myanmar
- No circulating vaccine-derived poliovirus type 1 (cVDPV1) cases were reported this week. There are 6 reported cases of cVDPV1 in 2019.

Philippines
- No circulating vaccine-derived poliovirus type 1 (cVDPV1) cases were reported this week. There are 3 reported cases of cVDPV2 in 2019.

Officially reported wild poliovirus cases as of 19 Nov 2019
Total global cases in 2019: 107 (compared with 27 for the same period in 2018)
- Total in endemic countries in 2019: 107 (compared with 0 for the same period in 2018)
- Total in non-endemic countries in 2019: 0 (compared with 0 for the same period in 2018)

- Afghanistan: 21 cases in 2019 (compared with 19 for the same period in 2018), onset of paralysis of most recent case: 17 Oct 2019
- Pakistan: 86 cases in 2019 (compared with 8 for the same period in 2018), onset of paralysis of most recent case: 3 Nov 2019
- Nigeria: 0 case in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 21 Aug 2016

Total global WPV1 cases in 2019: 107
Total global WPV1 cases in 2018: 33

Officially reported cVDPV cases as of 19 Nov 2019
- Angola: 42 cases in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 1 Oct 2019
- Benin: 2 cases in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 13 Sep 2019
- Central African Republic: 16 cases in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 6 Oct 2019
- Chad: 1 case in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 9 Sep 2019
- China: 1 case in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 25 Apr 2019
- Democratic Republic of the Congo: 45 cases in 2019 (compared with 18 for the same period in 2018), onset of paralysis of most recent case: 28 Sep 2019
- Ethiopia: 3 cases in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 8 Aug 2019
- Ghana: 5 cases in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 4 Oct 2019
- Indonesia (type 1): 0 case in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 27 Nov 2018
- Mozambique: 0 case in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 21 Oct 2018
- Myanmar (type 1): 6 cases in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 9 Aug 2019
- Niger: 1 case in 2019 (compared with 8 for the same period in 2018), onset of paralysis of most recent case: 3 Apr 2019
- Nigeria: 18 cases in 2019 (compared with 27 for the same period in 2018), onset of paralysis of most recent case: 9 Oct 2019
- Pakistan: 9 cases in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 3 Nov 2019
- Papua New Guinea (type 1): 0 case in 2019 (compared with 25 for the same period in 2018), onset of paralysis of most recent case: 18 Oct 2018
- Philippines (type 2): 3 cases in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 13 Sep 2019
- Somalia (type 2): 3 cases in 2019 (compared with 6 for the same period in 2018), onset of paralysis of most recent case: 8 May 2019
- Somalia (type 3): 0 case in 2019 (compared with 7 for the same period in 2018), onset of paralysis of most recent case: 7 Sep 2018
- Togo: 1 case in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 13 Sep 2019
- Zambia: 1 case in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 16 Jul 2019

Total global cVDPV cases in 2019: 157
Total global cVDPV cases in 2018: 104

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[Both WPV1 and cVDPV2 cases continue to occur; 2019 has not been a good year for the eradication effort. To highlight again what has been transpiring, the global total of WPV1-associated paralytic disease with dates of onset during 2019 to date is now at 107, compared with 27 for the same time period in 2018, and the global total of cVDPV-associated paralytic disease with dates of onset during 2019 is now at 157 compared with 104 for the same time period in 2018.

For a map showing the locations of both WPV-associated cases and cVDPV-associated cases, see http://polioeradication.org/polio-today/polio-now/.

As done in previous posts, to visualize all of this activity, I am putting links to HealthMap/ProMED-mail maps of countries with poliovirus activity during the past 12 months below. The size of the list remains impressive, now with 23 countries: 15 in Africa, 5 in Asia, and 3 in the Western Pacific, with either WPV or cVDPV isolates in their countries. An important reminder is that positive environmental samples means that the virus is circulating in the area where the samples have been obtained. Hence, if a susceptible individual is infected with the virus, there is a chance the person may develop paralytic disease.

- WPV1
Afghanistan: http://healthmap.org/promed/p/137
Pakistan: http://healthmap.org/promed/p/140
Iran: http://healthmap.org/promed/p/128

- cVDPV
Angola: http://healthmap.org/promed/p/165
Benin: http://healthmap.org/promed/p/59
Cameroon: http://healthmap.org/promed/p/65
Central African Republic: http://healthmap.org/promed/p/66
Chad: http://healthmap.org/promed/p/57
China: http://healthmap.org/promed/p/155
Democratic Republic of the Congo: http://healthmap.org/promed/p/194
Ethiopia: http://healthmap.org/promed/p/95
Ghana: http://healthmap.org/promed/p/53
Indonesia: http://healthmap.org/promed/p/184
Kenya: http://healthmap.org/promed/p/174
Mozambique: http://healthmap.org/promed/p/177
Myanmar: http://healthmap.org/promed/p/148
Niger: http://healthmap.org/promed/p/58
Nigeria: http://healthmap.org/promed/p/62
Papua New Guinea: http://healthmap.org/promed/p/188
Philippines: http://healthmap.org/promed/p/158
Somalia: http://healthmap.org/promed/p/125
Togo: http://healthmap.org/promed/p/64
Zambia: http://healthmap.org/promed/p/170
- Mod.MPP]

******
[2] Philippines
Date: Wed 20 Nov 2019
Source: Xinhuanet [edited]
http://www.xinhuanet.com/english/2019-11/20/c_138570069.htm


The Philippines reported on Wednesday [20 Nov 2019] 3 more confirmed polio cases in the southern Philippines, bringing the total cases to 7 since the outbreak in September [2019].

Health undersecretary Rolando Enrique Domingo said the new cases include a 2-year-old girl from Maguindanao province, a one-year-old boy from Cotabato City, and a 4-year-old girl from Cotabato province.

Domingo said they are looking at the water supply as the possible source of infection, as polio virus is spread through the oral-fecal [fecal-oral - Mod.MPP] route.

"It is unacceptable that more children are falling victim to this vaccine-preventable disease," health secretary Francisco Duque said, adding that the Department of Health is "more determined than ever" to make sure that no child shall be missed during the next round of polio vaccination in Metro Manila and Mindanao.

On [25 Nov 2019], the government will start another round of door-to-door vaccination activity in Metro Manila and the entire Mindanao in the southern Philippines. This will be expanded to the rest of the country next year [2020].

"We are reiterating to all parents and caregivers to have their 0-59-month-old children immunized with the polio vaccine from [25 Nov 2019] to [7 Dec 2019]," Duque added.

Duque said polio is best prevented through vaccination. Proper hygiene like hand washing will also help in the prevention, he added.

On [19 Sep 2019], the Philippines declared a polio outbreak after the infectious disease reappeared 19 years after the country was declared polio-free by the World Health Organization in 2000.

Four polio cases have been reported previously: a 3-year-old girl from Lanao del Sur province, a 4-year-old girl from Maguindanao province, and a 3-year-old girl from Sultan Kudarat province, all in southern Philippines, and a 5-year-old boy from Laguna province. [One of these 4 cases was classified as an iVDPV -- immunodeficiency-related vaccine-derived poliovirus and not due to a cVDPV -- hence the apparent discrepancy in numbers. - Mod.MPP]

Polio is an infectious disease that spreads rapidly. It can cause paralysis and, on rare occasions, can be fatal. There is no cure for polio. However, it can only be prevented with multiple doses of polio vaccine, which have long been proven safe and effective.

Polio is spread when the stool of an infected person is introduced into the mouth of another person through contaminated water or food.

[Byline: Xuxin]

--
Communicated by:
ProMED-MBDS
<promed-mbds@promedmail.org>

["Routine immunization (RI) is the sustainable, reliable and timely interaction between the vaccine, those who deliver it, and those who receive it to ensure every person is fully immunized against vaccine-preventable diseases.

Strengthening routine immunization is one of the pillars of the polio eradication strategy. In polio-endemic countries, the virus persists in marginalised populations and where health and immunization services are largely non-existent and oversight and management are weak.

However, the poliovirus cannot survive for long periods outside of the human body. Without an unvaccinated person to infect, the polio virus will die out. Strong routine immunization helps to facilitate the interruption of all poliovirus transmission and protect populations from a re-infection.

Strengthening routine immunization involves:
- Maximising the reach of quality vaccines through a well-functioning supply and cold chain system, improving equity, detecting unreached groups, efficient service delivery, and the capacity building of vaccinators and supervisors;
- Managing programmes with strong political and management support, effective planning, as well as policy and strategy development;
- Mobilising people to generate demand through community and caretaker engagement; and
- Monitoring programme performance with rigorous disease surveillance, data analysis, and evaluation."
Extracted from https://www.who.int/immunization/diseases/poliomyelitis/endgame_objective2/routine_immunization/en/. - Mod.ST

These 3 additional cases are all from the southern provinces. In another media report there is mention of an additional 1-2 suspected cases currently under investigation (see https://www.philstar.com/headlines/2019/11/22/1970907/more-possible-polio-cases-being-monitored).

A map of the Philippines showing provinces can be found at http://mapsof.net/philippines/philippines-regions-and-provinces. - Mod.MPP

HealthMap/ProMED map available at:
Philippines: http://healthmap.org/promed/p/158]

See Also

Poliomyelitis update (90): global, Pakistan, summary status WPV, cVDPV 20191116.6780748
Poliomyelitis update (89): Pakistan (WPV, cVDPV), Cote d'Ivoire (cVDPV), global 20191109.6769679
Poliomyelitis update (88): Philippines (SK or MG) 20191106.6765416
Poliomyelitis update (87): Philippines (Mindanao) RFI 20191105.6763633
Poliomyelitis update (86): global (WHO), Pakistan (KP,SD) 20191101.6756961
Poliomyelitis update (85): Ukraine, cVDPV, RFI 20191029.6751145
Poliomyelitis update (84): Pakistan (KP) 20191026.6748154
Poliomyelitis update (83): Philippines cVDPV, WHO 20191025.6747387
Poliomyelitis update (82): global (WPV: 2 countries, cVDPV: 7 countries) 20191024.6745453
Poliomyelitis update (81): Zambia, Chad, Togo (cVDPV) WPV3 erad. pending 20191021.6739521
Poliomyelitis update (80): Pakistan, global, RFI 20191020.6737769
Poliomyelitis update (75): Philippines, WHO, no new confirmed cases 20190925.6694087
Poliomyelitis update (74): Pakistan (KP) Philippines (Zambagoan Peninsula) susp. 20190924.6692404
Poliomyelitis update (73): Philippines, Pakistan, global (Angola) 20190921.6685797
Poliomyelitis update (72): Afghanistan (OZ) Philippines (MM) VDPV environmental 20190903.6655037
Poliomyelitis update (70): Pakistan (KP, SD) 20190826.6641139
Poliomyelitis update (60): global WPV1, cVDPV2, cVDPV1 20190719.6577836
Poliomyelitis update (50): Afghanistan (OZ) 20190619.6528976
Poliomyelitis update (40): Central African Republic (MP,UK) cVDPV, WHO, RFI 20190529.6493464
Poliomyelitis update (30): (Afghanistan, Pakistan) social media 20190503.6454173
Poliomyelitis update (20): (Pakistan, Nigeria) isolates, real-time surveill. 20190315.6367838
Poliomyelitis update (10): (Afghanistan, Pakistan, Nigeria) positive environ. 20190131.6288339
Poliomyelitis update (01): global 20190104.6241814
2018
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Poliomyelitis update (62): (Nigeria, Niger) cVDPV2 20181228.6226490
Poliomyelitis update (01): global (Afghanistan) 20180105.5539242
2017
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Poliomyelitis update (47): Pakistan, global (Congo DR) 20171229.5526565
Poliomyelitis (01): Pakistan (GB), global, RFI 20170314.4898724
2015
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Poliomyelitis update (05): Ukraine, vaccine-derived, WHO 20150901.3616558
Poliomyelitis update (04): Ukraine, 2 cases, RFI 20150901.3616015
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