1 Highlights of Polio Fax Bulletin No. 1138 for Week 30_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), data analysis, communications and coordination. 2. Wild Poliovirus Type-1 (WPV1): ▪ No new WPV1 cases reported this week, accordingly the total number of WPV1 cases remains in the region to 94 (Afghanistan – 34 and Pakistan – 60). ▪ 13 new WPV1 positive environmental samples reported this week, all from Pakistan. 3. Vaccine Derived Poliovirus (VDPV): ▪ 2 new cVDPV2 cases reported this week from Pakistan. ▪ 15 new cVDPV2 positive environmental samples reported this week, ten from Afghanistan and five from Pakistan. II. Wild Poliovirus Transmission Endemic countries (Pakistan & Afghanistan): Following was reported this week: a. Human samples: No new wild poliovirus cases reported this week. Total WPV1 cases in 2020 to date is 94 (34 from Afghanistan and 60 from Pakistan). This compares with 70 cases in 2019 in the same period (15 from Afghanistan and 55 from Pakistan). • Afghanistan: In 2020, 34 WPV1 cases are reported so far - 11 cases from Hilmand province; seven from Kandahar province, four from Farah province; three from Uruzgan province; 2 from Herat province; and one each from Zabul, Nimroz, Laghman, Kunar, Badakhshan, Balkh, and Badghis provinces. The most recent case has onset of paralysis on 29 June 2020. • Pakistan: In 2020, 60 WPV1 cases are reported so far, 21 cases from Khyber Pakhtunkhwa (KP) province, 20 from Sindh, 15 from Balochistan and 4 from Punjab province. The most recent case has onset of paralysis on 29 June 2020. b. Environmental samples: 13 new WPV1 positive environmental samples reported this week, all from Pakistan. • Afghanistan: In 2020 to date, there are 22 WPV1 positive environmental samples including one combined (WPV1 and cVDPV2) with most recent sample collected on 25 June 2020. • Pakistan: In 2020 to date, there are 257 WPV1 positive environmental samples including 23 combined (WPV1 and cVDPV2) and 3 combined (WPV1 and aVDPV2) with most recent positive sample collected on 14 July 2020. III. Vaccine Derived Polioviruses (VDPVs) 1. Afghanistan: No new VDPV cases reported, but 10 new cVDPV2 positive environmental samples were reported this week. Human samples: In 2020 to date, there are 29 cVDPV2 cases; 24 reported from Nangarhar province and two each from Kunar and Laghman provinces and one from Badakhsan, with most recent case’s onset on 8 June 2020. Environment: In 2020 to date, 36 cVDPV2 positive environmental samples including 1 combined (WPV1 and cVDPV2) were reported: 27 from Jalalabad, six from Batikot, one from Behsud districts, Nangarhar province, one from Kabul district, Kabul province and one from Asadabad district, Kandahar province; with most recent collection on 8 June 2020. Also, there is one aVDPV2 isolate detected in the environment from Lashkargah district, Hilmand province, with stool collection on 27 May 2020. 2 2. Pakistan: Two new cVDPV2 cases and 5 positive environmental samples were reported this week. Human samples: The 2 newly reported cases are from Muzaffargarh district, Punjab province, and Karachi Gadap town, Sindh province, with dates of onset 8 and 11 June 2020 respectively. In 2020 to date, there are 52 cVDPV2 cases reported. Cases include 42 from KP province, 6 from Punjab province, 3 from Sindh province and 1 from Balochistan province, with most recent case’s onset on 11 June 2020. Environment: In 2020, there are 32 positive environmental samples for cVDPV2 so far (including 23 combined WPV1 and cVDPV2), the most recent sample collected on 10 June 2020. Also, there are four aVDPV2 isolates detected in the environment samples, which include three combined (WPV1 + aVDPV2). The most recent aVDPV2 positive environmental sample was collected on 10 April 2020. 3. SOMALIA: No new VDPV cases or positive environmental samples reported this week. In 2020 to date: No cVDPV2 cases. There are 13 cVDPV2 positive environmental samples reported, the most recent collected on 19 May 2020. IV. Surveillance performance indicators In 2020, 12 out 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 is missing both indicators and has not reported any AFP case in 2020 to date. ▪ Morocco and Tunisia are, also, missing both indicators as their non-polio AFP rate is 1.4 for both countries and their percentage of AFP cases with adequate stool specimens is 66.7% and 61.9%, respectively. ▪ Egypt, Jordan, Oman, Palestine, Qatar and Saudi Arabia have a non-polio AFP rate of 1.9, 1.0, 1.7, 0.7, 0.4, and 1.3 respectively. ▪ Note: Sudan has a non-polio AFP rate of 1.7 in this analysis which does not include few cases reported at the state level but not included in the country line-list communicated to POL EMR due to operational reasons. Per country team’s latest weekly report, it is 2.1. Efforts are afoot to deal with this inconsistency. 3 World Health Organization – Regional Office for Eastern Mediterranean AFP SURVEILLANCE 27-Jul-20 Week 30, ending 26 July 2020 Number 1138 Table 1: Acute Flaccid Paralysis (AFP) cases by week of onset Reported AFP cases by week of onset - Week (30/20) / Ending on : 26/07/2020 Country 2018 2019 2020 to to date, Total Total AFP Total AFP Total AFP 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 W26 Jun 20 28 W27 5 Jul 20 W28 Jul 12 20 W29 Jul 19 20 W30 Jul 26 20 Afghanistan 3378 3768 1922 63 57 34 53 71 82 79 92 87 83 62 10 Bahrain 35 17 10 0 1 1 0 0 0 0 0 0 0 0 0 Djibouti 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 Egypt 1246 1343 421 15 18 1 7 22 18 10 0 0 0 0 Iran 896 1070 322 8 14 16 8 10 8 7 8 6 0 2 0 Iraq 1023 1157 270 7 8 2 6 4 6 8 2 2 4 3 Jordan **** 115 113 22 0 0 0 0 2 0 1 0 0 0 Kuwait 72 48 18 0 0 1 0 0 1 1 2 0 0 0 Lebanon **** 89 87 28 0 0 1 0 2 0 0 0 0 0 0 Libya 122 107 57 1 1 1 2 1 1 1 0 3 3 0 Morocco 212 247 72 2 0 1 2 3 2 0 3 1 2 0 Oman 28 30 11 0 1 0 0 0 1 0 0 0 0 0 0 Pakistan 12276 15216 6025 173 173 125 162 178 143 138 123 130 127 37 0 Palestine **** 44 62 8 0 0 0 0 0 0 0 0 1 0 0 Qatar 10 9 1 0 0 0 0 0 0 1 0 0 0 0 Saudi Arabia 242 236 64 0 0 0 2 4 2 0 2 0 0 3 0 Somalia 353 361 207 3 6 6 5 7 7 10 3 2 2 1 Sudan 579 608 179 0 3 1 2 4 5 4 5 4 6 0 0 Syria **** 362 377 215 8 6 7 5 10 22 4 11 10 8 3 1 Tunisia 68 79 21 0 1 2 0 0 2 0 2 0 0 0 U.A.E 40 50 15 0 0 0 1 1 0 0 1 0 1 0 0 Yemen 730 779 357 9 5 7 10 9 8 8 15 16 12 13 Total EMR 21920 25769 10245 289 294 206 265 328 308 272 269 262 248 124 11 No data = No report received Table 2: Confirmed polio cases by month of onset 26/07 Confirmed polio cases by month of onset Country 2019 2020 May May July July 2019 2019 2019 2019 2019 2020 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 15 34 2 3 1 7 1 2 3 7 12 10 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 Libya 0 0 0 0 0 0 0 0 0 0 0 0 0 Morocco 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 55 60 14 5 17 23 32 18 17 7 6 6 6 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 Saudi Arabia 0 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 Sudan 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 0 0 0 0 0 0 Total EMR 33 176 70 94 16 8 18 30 33 20 20 14 6 18 16 0 **** UNRWA cases are included with those of country of residence World Health Organization – Regional Office for Eastern Mediterranean 4 AFP SURVEILLANCE 27-Jul-20 Week 30, ending 26 July 2020 Number 1138 Table 3: Investigation of AFP cases with paralysis onset in 2019 & 2020 up to Week (30/20) / Ending on : 26/07/2020) 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 cases pending % with % with Polio Compatible Polio Compatible Non polio AFP Non rate line List Total PolioConfirmed Total PolioConfirmed Pending Classification Pending Classification classification and lab 90 > classification and lab 90 > Annualized polio Non AFP Total AFP cases onset 2019 Total AFP cases onset 2020 days from onsetparalysis of days from onsetparalysis of classification 90 > days from classification 90 > days from Discarded polio AFP) (non Discarded polio AFP) (non Date Afghanistan 3768 29 1 0 3738 0 18.1 0 0 94.1 29 0 1922 34 0 324 1535 30 15.7 30 2 94.6 34 0 26/07/2020 Bahrain 17 0 0 0 17 0 5.9 0 0 100.0 0 0 10 0 0 6 4 0 6.1 3 3 90.0 0 0 26/07/2020 Djibouti 5 0 0 0 5 0 1.4 0 0 80.0 0 0 0 0 0 0 0 0 0.0 0