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1 Highlights of Polio Fax Bulletin No. 1133 for Week 25 2020

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1 Highlights of Polio Fax Bulletin No. 1133 for Week 25 2020 1 Highlights of Polio Fax Bulletin No. 1133 for Week 25_2020 I. Salient features 1. Polio eradication teams at the Regional and Country levels are contributing into COVID19 Response, particularly in areas of surveillance (field and laboratory), analytics and communications and coordination. 2. Wild Poliovirus Type-1 (WPV1): ▪ Five new WPV1 cases reported this week, three from Afghanistan and two from Pakistan; total cases in 2020 in the EMR to date 72 (Afghanistan – 19 and Pakistan – 53). ▪ Seven new WPV1 positive environmental samples reported this week, two from Afghanistan and five from Pakistan. 3. Vaccine Derived Poliovirus (VDPV): ▪ Four new cVDPV2 cases reported this week from Afghanistan; total cVDPV2 cases in 2020 in the EMR to date 64 (Afghanistan – 17 and Pakistan 47). ▪ No new VDPV positive environmental samples reported this week. II. Wild Poliovirus Transmission Endemic countries (Pakistan & Afghanistan): Following was reported this week: a. Human samples: Five new WPV1 cases reported this week, 3 from Afghanistan and 2 from Pakistan. Total WPV1 cases in 2020 to date is 72 (19 from Afghanistan and 53 from Pakistan). This compares with 55 cases in 2019 in the same period (13 from Afghanistan and 42 from Pakistan). • Afghanistan: 3 new WPV1 cases reported this week and details are as follows: Case (1): Reported from Balabuluk district, Farah province, with date of onset 11 May 2020. The case is of a 48-month old female child. The child reportedly received 4 OPV doses from supplementary immunization activities (SIAs) and none from routine. Case (2): Reported from Nesh district, Kandahar province, with date of onset 23 May 2020. The case is of a 12-month old female child. The child reportedly received 3 OPV doses from SIAs and none from routine. The index case was identified as wild by positive contacts. Case (3): Reported from Kajaki district, Hilmand province, with date of onset 25 May 2020. The case is of a 9-month old male child. The child did not receive any OPV doses neither from routine nor from SIAs. In 2020, 19 WPV1 cases are reported so far - five cases from Hilmand province, four from Kandahar province, three from Farah province and one each from Zabul, Nimroz, Laghman, Kunar, Badakhshan, Balkh and Herat provinces. The most recent case has onset of paralysis on 25 May 2020. • Pakistan: Two new WPV1 cases reported this week and details are as follows: Case (1): Reported from Ghotki district, Sindh province, with date of onset 18 May 2020. The case is a 48-month old male child. The child reportedly received 2 OPV doses from routine and 7+ doses from SIAs. Case (2): Reported from Dukki district, Balochistan province, with date of onset 26 May 2020. The case is a 3-month old male child. The child did not receive any OPV doses neither from routine nor from SIAs. In 2020, 53 WPV1 cases are reported so far, 20 cases from Khyber Pakhtunkhwa (KP) province, 18 from Sindh, 13 from Balochistan and 2 from Punjab province. The most recent case has onset of paralysis on 26 May 2020. b. Environmental samples: 7 new positive environmental samples reported this week, two from Afghanistan and five from Pakistan. 2 • Afghanistan: In 2020 to date, there are 17 WPV1 positive environmental samples including 1 combined (WPV1 and cVDPV2) with most recent sample collected on 27 May 2020. • Pakistan: In 2020 to date, there are 209 WPV1 positive environmental samples including 10 combined (WPV1 and cVDPV2) and 3 combined (WPV1 and aVDPV2) with most recent positive sample collected on 8 June 2020. III. Vaccine Derived Polioviruses (VDPVs) 1. Afghanistan: Four new cVDPV2 cases reported and no positive environmental samples were reported this week. Human samples: The four new cVDPV2 cases are one each from Chaparhar, Shinwar and Lalpur districts, Nangarahar province and one from Narang district, Kunar province. The dates of onset of the new cases varies between 1 – 15 May 2020. In 2020 to date, there are 17 cVDPV2 cases; 15 reported from Nangarhar province and two (2) from Kunar province, with most recent case’s onset on 15 May 2020. Environment: In 2020 to date, 22 cVDPV2 positive environmental samples including 1 combined (WPV1 and cVDPV2) were reported; 19 from Jalalabad and 3 from Batikot districts, Nangarhar province, with most recent collection on 27 April 2020. 2. Pakistan: No new VDPV isolates from human or environmental samples were reported this week. Human samples: In 2020 to date, there are 47 cVDPV2 cases reported. Cases include 41 from KP province, 4 from Punjab province and 1 each from Balochistan and Sindh provinces, with most recent case’s onset on 2 May 2020. Environment: In 2020, there are 15 positive environmental samples for cVDPV2 so far (including 10 combined WPV1 and cVDPV2), the most recent sample collected on 11 March 2020. Also, there are four aVDPV2 isolates detected in environmental samples, which include three combined (WPV1 + aVDPV2). The most recent cVDPV2 positive environmental sample was collected on 10 April 2020. 3. SOMALIA: No new VDPV isolates from human or environmental samples were reported this week. In 2020 to date: No cVDPV2 cases. There are 11 cVDPV2 positive environmental samples reported, the most recent collected on 5 May 2020. IV. Surveillance performance indicators In 2020, 13 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. This compares with 19 countries meeting the both indicators in the same period in 2019. There is a decline in reporting of AFP cases due to COVID-19 Pandemic. ▪ Djibouti and Qatar are missing both indicators since they did not report any AFP case in 2020 ▪ Morocco and Tunisia are also missing both indicators as their non-polio AFP rate is 1.2 and 1 and their percentage of AFP cases with adequate stool specimens is 69.4% and 61.5% respectively. ▪ Jordan, Oman, Palestine, Saudi Arabia and Sudan have a non-polio AFP rate of 1.2, 1.9, 0.8, 1.3, and 1.3 respectively. 3 World Health Organization – Regional Office for Eastern Mediterranean AFP SURVEILLANCE 22-Jun-20 Week 25, ending 21 June 2020 Number 1133 Table 1: Acute Flaccid Paralysis (AFP) cases by week of onset Reported AFP cases by week of onset - Week (25/20) / Ending on : 21/06/2020 Country 2018 2019 2020 to to date, Total Total AFP Total AFP Total AFP W14 5 20 Apr W15 20 Apr 12 W16 20 Apr 19 W17 20 Apr 26 W18 3 May 20 W19 May 20 10 W20 May 20 17 W21 May 20 23 W22 May 20 31 W23 7 Jun 20 W24 Jun 20 14 W25 Jun 20 21 Afghanistan 3378 3768 1478 54 42 54 55 63 62 57 28 49 68 59 6 Bahrain 35 17 9 0 0 0 0 1 0 1 0 0 0 0 0 Djibouti 0 5 0 0 0 0 0 0 0 0 0 0 Egypt 1246 1343 410 9 18 9 13 24 15 18 1 7 22 16 1 Iran 896 1070 289 5 3 11 4 7 8 13 17 7 7 2 0 Iraq 1023 1157 247 8 7 8 2 8 7 8 2 6 3 3 Jordan **** 115 113 21 0 1 1 0 0 0 0 0 0 2 0 0 Kuwait 72 48 15 0 0 1 0 1 0 0 1 0 0 1 Lebanon **** 89 87 28 0 0 1 0 0 0 0 1 0 2 0 Libya 122 107 50 1 2 1 1 2 1 1 1 2 1 1 0 Morocco 212 247 49 0 0 1 0 0 1 Oman 28 30 10 0 1 1 0 1 0 0 0 0 0 0 Pakistan 12276 15215 5231 108 155 140 141 161 169 164 113 153 116 17 0 Palestine **** 44 62 7 1 0 0 0 0 0 0 0 0 0 0 Qatar 10 9 0 0 0 0 0 0 0 0 0 0 0 0 0 Saudi Arabia 242 236 54 0 1 1 2 5 0 0 0 2 1 0 0 Somalia 353 361 185 12 3 6 1 4 3 6 6 5 6 2 2 Sudan 579 608 121 5 0 Syria **** 362 377 172 1 1 8 5 5 8 6 7 5 9 17 Tunisia 68 79 13 0 1 0 0 1 0 0 0 0 0 U.A.E 40 50 13 0 0 0 0 0 0 0 0 1 1 0 Yemen 730 779 279 14 10 13 9 8 8 5 5 10 6 1 Total EMR 21920 25768 8681 218 245 256 233 291 282 279 182 247 244 119 9 No data = No report received Table 2: Confirmed polio cases by month of onset 21/06 Confirmed polio cases by month of onset Country 2019 2020 May May July July 2019 2019 2019 2019 2019 2019 2020 2020 2020 2020 2020 2020 April June June March March August August January January October October February February December December November November September September Total year 2018 Total year 2019 Total year Afghanistan 21 29 13 19 2 2 3 1 7 1 2 3 7 7 Bahrain 0 0 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 0 0 0 Iran 0 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 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 Libya 0 0 0 0 0 0 0 0 0 0 0 0 Morocco 0 0 0 0 0 0 0 0 0 0 0 0 Oman 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Pakistan 12 147 42 53 12 14 5 17 23 32 18 17 7 6 5 Palestine **** 0 0 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 0 Saudi Arabia 0 0 0 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 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 0 0 0 0 0 Total EMR 33 176 55 72 14 16 8 18 30 33 20 20 14 6 12 0 **** UNRWA cases are included with those of country of residence World Health Organization – Regional Office for Eastern Mediterranean 4 AFP SURVEILLANCE 22-Jun-20 Week 25, ending 21 June 2020 Number 1133 Table 3: Investigation of AFP cases with paralysis onset in 2019 & 2020 up to Week (25/20) / Ending on : 21/06/2020) 2019 2020 Wild Wild cases AFP Specimen AFP Specimen cases **** **** Case classification Case classification ** COUNTRY ** * * adequate adequate *** *** rate VDPV VDPV Cases specimens Cases specimens Latest onset of onsetparalysis of onsetparalysis of Wild P1Wild Poliovirus P3Wild Poliovirus P1Wild Poliovirus P3Wild Poliovirus AFP AFP cases pending AFP cases pending AFP cases pending AFP
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