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Issue No. 1081, Week 25 Ending 23 June 2019

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1 Highlights of Polio Fax Bulletin No. 1081 for Week 25_2019 I. Poliovirus Transmission 1. Endemic countries (PAKISTAN & AFGHANISTAN): Five new wild poliovirus type-1 (WPV1) cases were reported this week two from Afghanistan and three from Pakistan. No new positive environmental samples were reported. a. Human samples: Five new WPV1 cases reported this week two from Afghanistan and three from Pakistan. Total WPV1 cases in 2019 to date are 37 (10 from Afghanistan and 27 from Pakistan). This compares with 13 cases in 2018 in the same period (Afghanistan – 10 and Pakistan – 3). Afghanistan: Case (1): The first new WPV1 case is a 30-month old male child from Tirinkot district, Uruzgan province. He has onset of paralysis on 19 May 2019 and reportedly received 9 doses of oral polio vaccine (OPV) out of which 2 were from routine and 7 were from supplementary immunization activities (SIAs). Case (2): The second new WPV1 case is a 21-month old female child from Tirinkot district, Uruzgan province. She has onset of paralysis on 19 May 2019. The child did not receive any OPV doses as the incidence area is under full AGE control where OPV campaign activities were stopped (banned) from May to December 2018. Late, only fixed sites vaccination has been allowed. In 2019 to date, 10 WPV1 cases are reported. They include four cases from Uruzgan province, three cases from Hilmand, two from Kandahar province and one from Kunar province. The most recent case has onset of paralysis on 19 May 2019. Pakistan: Case (1): The first new WPV1 case is a 15-month old male child from new infected district Lakki Marwat district, Khyber Pakhtunkhwa province (KP). He has onset of paralysis on 27 May 2019 and reportedly received 7 doses of oral polio vaccine (OPV) all from supplementary immunization activities (SIAs) and none from routine. The child died before stool specimen collection and the case was identified as positive for wild poliovirus by 2 positive contacts. Case (2): The second new WPV1 case is a 10-month old male child from new infected district Torghar district, KP. He has onset of paralysis on 31 May 2019 and reportedly received 2 doses of oral polio vaccine (OPV) all from routine and none from SIAs. Case (3): The third new WPV1 case is a 21-month old female child from Bannu district, Khyber Pakhtunkhwa province (KP). She has onset of paralysis on 5 June 2019 and reportedly received 7 doses of oral polio vaccine (OPV) all from SIAs and none from routine. 2 In 2019 to date, 27 WPV1 cases reported from Pakistan. They include fourteen from KP, seven from KP Tribal Districts (KPTD), three each from Punjab and Sindh. The most recent reported case has date of onset of paralysis on 5 June 2019. b. Environmental samples: No new wild positive environmental samples were reported this week. Afghanistan: In 2019 to date, there are 23 positive environmental samples with most recent positive sample collected on 25 April 2019. Pakistan: In 2019 to date, there are 141 positive environmental samples with most recent positive sample collected on 20 May 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 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 Mogadihsu 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 70.5%. c. Qatar has a non-polio AFP rate of 1.2 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 24-Jun-19 Week 25, ending 23 June 2019 Number 1081 Table 1: Acute Flaccid Paralysis (AFP) cases by week of onset Reported AFP cases by week of onset - Week (25/19) / Ending on : 23/06/2019 Country 2017 2018 2019 to to date, Total Total AFP Total AFP Total AFP W14 Apr 07 19 W15 Apr 14 19 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 Afghanistan 3094 3378 1750 85 66 55 75 74 66 74 78 56 64 58 9 Bahrain 18 35 10 0 1 0 0 0 1 0 0 1 1 1 0 Djibouti 4 0 0 0 Egypt 1242 1246 609 28 25 13 19 20 30 23 22 18 18 29 Iran 820 896 448 25 23 25 19 20 27 20 16 13 12 2 0 Iraq 699 1023 492 26 19 25 21 11 12 15 16 21 11 9 0 Jordan **** 116 115 76 6 2 3 2 1 5 0 3 1 3 2 1 Kuwait 69 72 22 2 1 0 0 0 0 0 0 1 1 1 1 Lebanon **** 75 89 44 1 5 1 2 1 1 0 1 2 2 1 1 Libya 88 122 37 2 1 1 1 2 1 0 2 0 3 1 Morocco 143 213 95 4 3 6 3 6 4 5 3 1 0 2 Oman 40 28 10 0 1 0 1 1 1 0 0 0 1 1 0 Pakistan 10319 12275 5968 222 231 291 270 238 213 264 230 188 176 95 0 Palestine **** 43 44 27 0 1 3 1 1 0 0 0 3 3 1 0 Qatar 18 10 2 0 0 0 0 0 0 0 0 1 0 0 0 Saudi Arabia 276 241 122 4 10 10 4 4 4 4 0 0 0 0 Somalia 345 353 175 12 6 7 7 8 7 11 6 1 9 5 1 Sudan 570 578 202 15 2 4 11 9 13 5 1 2 1 0 Syria **** 362 362 186 7 7 4 5 10 5 6 4 4 1 4 Tunisia 67 68 28 0 1 1 2 0 0 1 2 1 0 U.A.E 58 40 18 0 3 0 0 0 1 0 1 0 0 0 0 Yemen 713 730 319 17 16 23 13 10 11 13 11 8 3 1 Total EMR 19179 21918 10640 456 424 472 456 416 402 441 396 322 309 213 13 No data = No report received Table 2: Confirmed polio cases by month of onset 23/06 Confirmed polio cases by month of onset Country 2018 2019 May May July July 2018 2018 2018 2018 2018 2018 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 3 2 3 2 1 0 2 1 3 1 3 Bahrain 0 0 0 0 0 0 0 0 0 0 Djibouti 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 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 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 0 Oman 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Pakistan 8 12 3 27 0 1 3 1 0 4 4 2 0 11 9 1 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 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 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 U.A.E 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Yemen 0 0 0 0 Total EMR 22 33 13 37 3 3 6 3 1 4 6 3 3 12 12 1 **** UNRWA cases are included with those of country of residence World Health Organization – Regional Office for Eastern Mediterranean 4 AFP SURVEILLANCE 24-Jun-19 Week 25, ending 23 June 2019 Number 1081 Table 3: Investigation of AFP cases with paralysis onset in 2018 & 2019 up to Week (25/19) / Ending on : 23/06/2019) 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 1750 10 0 246 1494 0 18.0 16 2 94.5 10 0 23-06-2019 Bahrain 35 0 0 2 33 0 12.1 2 0 97.1 0 0 10 0 0 10 0 0 7.2 4 4 90.0 0 0 23-06-2019 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 10-04-2019 Egypt 1246 0 0 2 1243 1 3.2 2 0 93.2 0 0 609 0 0 116 493 0 3.3 1 0 86.9 0 0 20-06-2019 Iran 896 0 0 0 894 2 4.6 0 0 97.0 0 0 448 0 0 25 423 0 4.9 0 0 95.5 0 0 23-06-2019 Iraq 1023 0 0 0 1023 0 6.7 0 0 89.9 0 0 492 0 0 70 422 0 6.8 6 0 95.3 0 0 23-06-2019 Jordan 115 0 0 0 115 0 4.1 0 0 100.0 0 0 76 0 0 6 70 0 5.7 0 0 100.0 0 0 20-06-2019 Kuwait 72 0 0 0 72 0 8.1 0 0 90.3 0 0 22 0 0 5 17 0 5.2 0 0 86.4 0 0 23-06-2019 Lebanon 89 0 0 1 88 0 4.8 1 0 96.6 0 0 44 0 0 13 31 0 5.0 3 0 86.4 0 0 21-06-2019 Libya 122 0 0 0 122 0 4.9 0 0 96.7 0 0 37 0 0 6 31 0 3.1 0 0 97.3 0 0 21-06-2019 Morocco 213 0 0 2 211 0 2.4 2 0 77.5 0 0 95 0 0 56 39 0 2.2 28 11 70.5 0 0 14-06-2019 Oman 28 0 0 0 28 0 3.2 0 0 92.9 0 0 10 0 0 2 8 0 2.2 0 0 90.0 0 0 23-06-2019 Pakistan 12275 12 1 1 12261 0 15.7 1 0 87.0 12 0 5968 27 0 745 5196 0 16.0 96 0 89.8 27 0 23-06-2019 Palestine 44 0 0 0 44 0 2.3 0 0 90.9 0 0 27 0 0 12 15 0 3.0
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