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Issue No. 1094, Week 38 Ending 22 September 2019

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Issue No. 1094, Week 38 Ending 22 September 2019 1 Highlights of Polio Fax Bulletin No. 1094 for Week 38_2019 I. Poliovirus Transmission 1. Endemic countries (PAKISTAN & AFGHANISTAN): Four new wild poliovirus cases reported this week from Pakistan. Eight new positive environmental samples reported this week one from Afghanistan and seven from Pakistan. a. Human samples: Four new wild poliovirus cases reported from Pakistan this week. Total of WPV1 cases in 2019 to date are 82 (16 from Afghanistan and 66 from Pakistan). This compares with 22 cases in 2018 in the same period (Afghanistan – 16 and Pakistan – 6). Afghanistan: In 2019 to date, 16 WPV1 cases are reported. They include 8 cases from Uruzgan province, 5 cases from Hilmand province, 2 from Kandahar province and 1 from Kunar province. The most recent case has onset of paralysis on 2 August 2019. Pakistan: Four new WPV1 cases were reported this week and their details are as follows: - Case (1): The case was reported from Torghar district, Khyber Pakhtunkhwa (KP) province, with date of onset 2 August 2019. The case is a 23-month old male child. The child received reportedly a total of 10 OPV doses out of which 3 were from routine and 7 from supplementary immunization activities (SIAs). - Case (2): The case was reported from Lakki Marwat district, KP province, with date of onset 18 August 2019. The case is an 18-month old male child. The child did not receive any OPV doses from routine and for SIAs it is still under investigation. The case also has as a wild positive contact in addition to the index case. - Case (3): The case was reported from Lakki Marwat district, KP province, with date of onset 24 August 2019. The case is a 30-month old female child. The child reportedly received 7 OPV doses all from SIAs and none from routine. - Case (4): The case was reported from Lakki Marwat district, KP province, with date of onset 28 August 2019. The case is a 6-month old male child. The child reportedly received 3 OPV doses all from SIAs and none from routine. In 2019 to date, 66 WPV1 cases are reported from Pakistan. They include 39 from Khyber Pakhtunkhwa (KP) province, 11 from KP Tribal Districts (KPTD), 6 from Sindh province, and 5 each from Punjab and Balochistan provinces. The most recent case has onset of paralysis on 28 August 2019. Environmental samples: Eight new WPV1 positive environmental samples were reported this week, one from Afghanistan and seven from Pakistan. Afghanistan: In 2019 to date, there are 36 positive environmental samples with most recent positive sample collected on 28 August 2019. 2 Pakistan: In 2019 to date, there are 224 positive environmental samples with most recent positive sample collected on 5 September 2019. 2. Outbreak response countries SOMALIA: No new cVDPV2 or cVDPV3 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 isolated from healthy child sample collected during community sampling on 25 May 2019. aVDPV2 was isolated from an environmental sample on 3 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. Djibouti has a non-polio AFP rate of 1.1 and percentage of AFP cases with adequate stool specimens of 66.7%. Morocco has a percentage of AFP cases with adequate stool specimens of 77.5%. Tunisia has a percentage of AFP cases with adequate stool specimens of 73.2%. 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 23-Sep-19 Week 38, ending 22 September 2019 Number 1094 Table 1: Acute Flaccid Paralysis (AFP) cases by week of onset Reported AFP cases by week of onset - Week (38/19) / Ending on : 22/09/2019 Country 2017 2018 2019 to to date, Total Total AFP Total AFP Total AFP W27 Jul 07 19 W28 Jul 14 19 W29 Jul 21 19 W30 Jul 28 19 W31 Aug 19 04 W32 Aug 19 11 W33 Aug 19 18 W34 Aug 19 25 W35 Sep 01 19 W36 Sep 08 19 W37 Sep 15 19 W38 Sep 22 19 Afghanistan 3094 3378 2715 78 75 81 68 79 37 75 82 59 67 55 9 Bahrain 18 35 11 0 0 1 0 0 0 0 0 0 0 0 0 Djibouti 4 0 3 0 0 0 0 0 1 0 0 1 0 0 0 Egypt 1242 1246 909 33 28 23 28 15 7 23 29 25 15 16 Iran 820 896 668 20 19 24 17 15 24 21 16 10 2 1 Iraq 699 1023 755 30 18 22 22 12 6 15 28 17 19 3 Jordan **** 116 115 91 0 2 1 1 0 0 2 2 0 2 1 Kuwait 69 72 29 1 0 0 0 0 0 0 0 1 3 0 0 Lebanon **** 80 94 59 1 3 2 2 2 1 0 1 0 2 0 Libya 88 122 66 0 1 3 2 1 1 3 9 3 1 2 Morocco 143 212 129 3 4 7 3 1 Oman 40 28 14 1 0 0 0 0 0 1 1 0 0 0 0 Pakistan 10319 12276 9849 316 322 291 305 257 241 272 314 262 192 53 2 Palestine **** 43 44 42 1 5 0 1 1 0 1 1 1 1 1 0 Qatar 18 10 5 0 0 1 0 0 1 0 0 0 1 0 0 Saudi Arabia 276 242 131 0 0 0 0 0 0 0 0 0 0 0 Somalia 345 353 259 8 7 9 8 4 7 5 5 6 5 2 0 Sudan 570 579 381 10 23 8 14 8 4 10 18 16 13 5 0 Syria **** 362 362 265 8 12 7 6 5 2 3 5 3 6 5 Tunisia 67 68 56 3 0 2 2 1 1 2 0 1 3 1 U.A.E 58 40 28 1 2 0 1 1 0 1 1 2 0 0 0 Yemen 713 730 528 29 26 12 8 14 8 12 10 11 9 3 Total EMR 19184 21925 16993 543 547 494 488 416 341 446 522 418 341 148 11 No data = No report received Table 2: Confirmed polio cases by month of onset 22/09 Confirmed polio cases by month of onset Country 2018 2019 May May July July 2018 2018 2018 2019 2019 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 16 16 2 1 0 2 1 3 1 5 1 2 1 Bahrain 0 0 0 0 0 0 0 0 Djibouti 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 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 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 0 Libya 0 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 6 66 1 0 4 4 2 0 11 11 16 12 10 Palestine **** 0 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 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 Sudan 0 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 0 U.A.E 0 0 0 0 0 0 0 0 0 0 0 0 0 Yemen 0 0 0 0 0 Total EMR 22 33 22 82 3 1 4 6 3 3 12 16 17 14 11 0 **** UNRWA cases are included with those of country of residence World Health Organization – Regional Office for Eastern Mediterranean 4 AFP SURVEILLANCE 23-Sep-19 Week 38, ending 22 September 2019 Number 1094 Table 3: Investigation of AFP cases with paralysis onset in 2018 & 2019 up to Week (38/19) / Ending on : 22/09/2019) 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 2715 16 0 295 2404 0 18.4 36 6 94.3 16 0 22-09-2019 Bahrain 35 0 0 0 35 0 12.1 0 0 97.1 0 0 11 0 0 11 0 0 5.2 10 10 100.0 0 0 22-09-2019 Djibouti 0 0 0 0 0 0 0.0 0 0 0 0 3 0 0 3 0 0 1.1 0 0 66.7 0 0 22-09-2019 Egypt 1246 0 0 2 1243 1 3.2 2 0 93.2 0 0 909 0 0 83 826 0 3.3 2 0 90.1 0 0 19-09-2019 Iran 896 0 0 0 894 2 4.6 0 0 97.0 0 0 668 0 0 43 625 0 4.8 0 0 96.1 0 0 21-09-2019 Iraq 1023 0 0 0 1023 0 6.7 0 0 89.9 0 0 755 0 0 50 705 0 6.8 10 0 94.8 0 0 19-09-2019 Jordan 115 0 0 0 115 0 4.1 0 0 100.0 0 0 91 0 0 6 85 0 4.5 0 0 100.0 0 0 19-09-2019 Kuwait 72 0 0 0 72 0 8.1 0 0 90.3 0 0 29 0 0 2 27 0 4.5 0 0 86.2 0 0 22-09-2019 Lebanon 94 0 0 3 91 0 5.0 3 0 92.6 0 0 59 0 0 9 50 0 4.4 5 0 86.4 0 0 20-09-2019 Libya 122 0 0 0 122 0 4.9 0 0 96.7 0 0 66 0 0 10 56 0 3.6 1 0 98.5 0 0 21-09-2019 Morocco 212 0 0 1 211 0 2.4 1 0 77.8 0 0 129 0 0 56 73 0 2.0 37 11 77.5 0 0 02-08-2019 Oman 28 0 0 0 28 0 3.2 0 0 92.9 0 0 14 0 0 0 14 0 2.1 0 0 92.9 0 0 23-09-2019 Pakistan 12276 12 1 0 12263 0 15.7 0 0 87.0 12 0 9849 66 0 823 8960 0 17.3 209 0 88.8 66 0 22-09-2019 Palestine 44 0 0 0 44 0 2.3 0 0 90.9 0 0 42 0 0 8 34 0 3.1 0 0 97.6 0 0 22-09-2019 Qatar 10 0 0 0 10 0 2.8 0 0 100.0 0 0 5 0 0 4 1 0 1.9 1 0 80.0 0 0 22-09-2019 Saudi Arabia 242 0 0 0 242 0 3.0 0 0 95.9 0 0 131 0 0 37 94 0 2.2 36 6 90.8
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