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Issue No. 1083, Week 27 Ending 7 July 2019

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Issue No. 1083, Week 27 Ending 7 July 2019 1 Highlights of Polio Fax Bulletin No. 1083 for Week 27_2019 I. Poliovirus Transmission 1. Endemic countries (PAKISTAN & AFGHANISTAN): Nine new wild poliovirus type-1 (WPV1) cases and 3 new positive environmental samples from Pakistan were reported this week. a. Human samples: Nine new WPV1 cases reported this week from Pakistan. Total WPV1 cases in 2019 to date are 51 (10 from Afghanistan and 41 from Pakistan). This compares with 13 cases in 2018 in the same period (Afghanistan – 10 and Pakistan – 3). Afghanistan: In 2019 to date, 10 WPV1 cases are reported. They include four cases from Uruzgan province, three from Hilmand, two from Kandahar province and one from Kunar province. The most recent case has onset of paralysis on 20 May 2019. Pakistan: Case (1): The first new WPV1 case is an 8-month old male child from new infected district namely Jaffarabad in Balochistan province. He has onset of paralysis on 28 May 2019 and reportedly received 5 doses of oral polio vaccine (OPV) from supplementary immunization activities (SIAs) and none from routine. Case (2): The second new WPV1 case is a 2-month old male child from Bannu district, Khyber Pakhtunkhwa province (KP). He has onset of paralysis on 9 June 2019 and reportedly received 1 dose of oral polio vaccine (OPV) from SIAs and none from routine. Case (3): The third new WPV1 case is a 9-month old male child from Killa Abdullah district, Balochistan province. He has onset of paralysis on 9 June 2019 and did not receive any OPV doses. Case (4): The fourth new WPV1 case is an 8-month old male child from Bannu district, KP. He has onset of paralysis on 11 June 2019 and reportedly received 2 doses of oral polio vaccine (OPV) both from SIAs and none from routine. Case (5): The fifth new WPV1 case is a 46-month old female child from Torghar district, KP. She has onset of paralysis on 13 June 2019 and reportedly received 3 doses of oral polio vaccine (OPV) through SIAs. Case (6): The sixth new WPV1 case is a 30-month old male child from Bannu district, Khyber Pakhtunkhwa province (KP). He has onset of paralysis on 14 June 2019 and reportedly received 8 doses of oral polio vaccine (OPV) out of which one dose was from routine and seven from SIAs. Case (7): The seventh new WPV1 case is a 27-month old male child from Bannu district, KP. He has onset of paralysis on 16 June 2019 and reportedly received 7 doses of oral polio vaccine (OPV) - all from SIAs. 2 Case (8): The eighth new WPV1 case is a 16-month old male child from Torghar district, KP. He has onset of paralysis on 17 June 2019 and reportedly received 3 doses of oral polio vaccine (OPV) - all from SIAs. Case (9): The ninth new WPV1 case is a 12-month old female child from Bannu district, KP. She has onset of paralysis on 20 June 2019. The child is zero dose for routine immunization and for SIAs still under investigation. In 2019 to date, 41 WPV1 cases reported from Pakistan. They include 25 from KP, 8 from KP Tribal Districts (KPTD), 2 from Balochistan and 3 each from Punjab and Sindh. The most recent reported case has date of onset of paralysis on 20 June 2019. b. Environmental samples: Three new WPV1 positive environmental samples were reported this week, all from Pakistan. Afghanistan: In 2019 to date, there are 25 positive environmental samples with most recent positive sample collected on 27 May 2019. Pakistan: The 3 new WPV1 positive environmental samples reported this week include one from Punjab (Lahore district); and two from Sindh province (one each from Gadap and Iqbal Karachi towns). In 2019 to date, there are 162 positive environmental samples with most recent positive sample collected on 19 June 2019. 2. Outbreak response countries SOMALIA: No new cVDPV2 or cVDPV3 cases or isolates from human or environmental samples were reported this week. In 2019 to date, Somalia has reported three cVDPV2 cases. The most recent reported case has date of onset of paralysis on 8 May 2019. In addition, cVDPV2 was isolates from healthy child sample collected during community sampling on 25 May 2019. aVDPV2 was isolates from an environmental sample in February 2019. In 2018: Somalia has reported a total of 12 cases due to cVDPVs, which include 5 due to cVDPV2, 6 due to cVDPV3 and 1 due to co-infection of cVDPV2 and cVDPV3. The last cVDPV3 was isolated from a sewage sample from Mogadishu collected on 23 August 2018. II. Surveillance performance indicators In 2019, 19 of 22 member states are meeting the global target of both key surveillance indicators, namely non polio AFP rate of 2 per 100,000 children aged below 15 years and percent AFP cases with adequate specimen 80% and above. a. Djibouti, did not report any AFP case since April 2017. b. Morocco has a percentage of AFP cases with adequate stool specimens of 72.6%. c. Qatar has a non-polio AFP rate of 1.1 and percentage of AFP cases with adequate stool specimens of 50% d. In Yemen there are AFP cases pending final classification more than 90 days due to delayed lab results because of delay shipment of specimens to reference polio laboratories. 3 World Health Organization – Regional Office for Eastern Mediterranean AFP SURVEILLANCE 8-Jul-19 Week 27, ending 7 July 2019 Number 1083 Table 1: Acute Flaccid Paralysis (AFP) cases by week of onset Reported AFP cases by week of onset - Week (27/19) / Ending on : 07/07/2019 Country 2017 2018 2019 to to date, Total Total AFP Total AFP Total AFP W16 Apr 21 19 W17 Apr 28 19 W18 May 05 19 W19 May 12 19 W20 May 19 19 W21 May 26 19 W22 Jun 02 19 W23 Jun 09 19 W24 Jun 16 19 W25 Jun 23 19 W26 Jun 30 19 W27 Jul 07 19 Afghanistan 3094 3378 1929 55 75 74 66 74 81 56 65 85 83 64 9 Bahrain 18 35 10 0 0 0 1 0 0 1 1 1 0 0 0 Djibouti 4 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Egypt 1242 1246 677 14 19 20 30 23 22 19 18 36 28 20 11 Iran 820 896 469 25 19 22 25 19 16 16 18 7 6 2 0 Iraq 699 1023 540 25 21 11 12 15 16 21 13 27 19 9 Jordan **** 116 115 80 3 2 1 5 0 3 1 3 2 2 3 Kuwait 69 72 23 0 0 0 0 0 0 1 1 1 1 1 0 Lebanon **** 75 89 45 1 2 1 1 0 1 2 2 2 1 0 Libya 88 122 38 1 1 2 1 0 2 0 3 2 0 Morocco 143 213 106 6 3 6 4 5 4 1 2 5 3 2 Oman 40 28 11 0 1 1 1 0 0 0 2 0 1 0 0 Pakistan 10319 12275 6634 292 276 244 217 273 248 204 212 303 272 79 1 Palestine **** 43 44 27 3 1 1 0 0 0 3 3 1 0 Qatar 18 10 2 0 0 0 0 0 0 1 0 0 0 0 0 Saudi Arabia 276 241 128 10 4 4 4 4 1 1 1 1 1 1 0 Somalia 345 353 191 7 7 8 7 11 6 1 9 9 5 7 1 Sudan 570 578 225 4 11 9 13 5 2 4 5 12 4 0 Syria **** 362 362 198 4 5 10 5 6 4 6 1 9 4 1 Tunisia 67 68 33 1 3 0 0 1 2 3 1 1 0 0 U.A.E 58 40 18 0 0 0 1 0 1 0 0 0 0 0 0 Yemen 713 730 319 23 13 10 11 13 11 8 3 1 Total EMR 19179 21918 11703 474 463 424 404 449 420 349 363 505 430 189 22 No data = No report received Table 2: Confirmed polio cases by month of onset 07/07 Confirmed polio cases by month of onset Country 2018 2019 May May July July 2018 2018 2018 2018 2018 2019 2019 2019 2019 2019 2019 2019 April June June March March August August January January October October February February December December November November September September Total year 2017 Total year 2018 Total year Afghanistan 14 21 10 10 2 3 2 1 0 2 1 3 1 3 Bahrain 0 0 0 0 0 0 0 0 0 Djibouti 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Egypt 0 0 0 0 0 0 0 0 0 0 0 Iran 0 0 0 0 0 0 0 0 0 0 0 0 0 Iraq 0 0 0 0 0 0 0 0 0 0 0 0 0 Jordan **** 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Kuwait 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Lebanon **** 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Libya 0 0 0 0 0 0 0 0 0 0 0 0 0 Morocco 0 0 0 0 0 0 0 0 Oman 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Pakistan 8 12 3 41 1 3 1 0 4 4 2 0 11 11 13 Palestine **** 0 0 0 0 0 0 0 0 0 0 0 0 Qatar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Saudi Arabia 0 0 0 0 0 0 0 0 0 0 0 Somalia 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Sudan 0 0 0 0 0 0 0 0 0 0 0 0 Syria **** 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Tunisia 0 0 0 0 0 0 0 0 0 0 0 0 0 U.A.E 0 0 0 0 0 0 0 0 0 0 0 0 0 Yemen 0 0 0 0 Total EMR 22 33 13 51 3 6 3 1 4 6 3 3 12 14 13 0 **** UNRWA cases are included with those of country of residence World Health Organization – Regional Office for Eastern Mediterranean 4 AFP SURVEILLANCE 8-Jul-19 Week 27, ending 7 July 2019 Number 1083 Table 3: Investigation of AFP cases with paralysis onset in 2018 & 2019 up to Week (27/19) / Ending on : 07/07/2019) 2018 2019 Wild cases Wild cases AFP Specimen AFP Specimen **** **** Case classification Case classification ** COUNTRY ** * * adequate adequate *** *** rate rate VDPV VDPV Cases Cases Cases specimens specimens Latest onset of paralysis onset of paralysis Wild P1 Poliovirus P1 Wild Poliovirus P3 Wild Poliovirus P1 Wild Poliovirus P3 Wild AFP cases pending cases AFP pending cases AFP pending cases AFP pending cases AFP % with % with Polio CompatiblePolio CompatiblePolio Non polio AFP rate line List Total Confirmed Polio Total Confirmed Polio Pending Classification Pending Classification classification and lab > 90 andclassification > 90 lab andclassification > 90 lab Annualized Non polio AFP Total AFP cases onset 2018 Total cases AFP onset 2019 Total cases AFP days from days onset of paralysis from days onset of paralysis classification > 90 days from days > 90 classification classification > 90 days from days > 90 classification Date Discarded (nonDiscarded polio AFP) (nonDiscarded polio AFP) Afghanistan 3378 21 0 0 3357 0 16.6 0 0 93.8 21 0 1929 10 0 261 1658 0 18.4 20 2 94.6 10 0 07-07-2019 Bahrain 35 0 0 0 35 0 12.1 0 0 97.1 0 0 10 0 0 6 4 0 6.7 2 2 100.0 0 0 07-07-2019 Djibouti 0 0 0 0 0 0 0.0 0 0 0 0 0 0 0 0 0 0 0.0 0 0 0 0 07-07-2019 Egypt 1246 0 0 2 1243 1 3.2 2 0 93.2 0 0 677 0 0 164 513 0 3.4 1 0 84.9 0 0 06-07-2019 Iran 896 0 0 0 894 2 4.6 0 0 97.0 0 0 469 0 0 16 453
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