Greetings, Rotarians:
 
See below and attached for this week’s report.  More good news as we (again) have had ZERO cases of wild polio this week.  One new case of cVDPV in Nigeria.
 
Note that we continue to see quite a number of positive environmental samples in Pakistan and Afghanistan (5 and 7, respectively).  This means the wild virus is still quite active and continued diligence is required.
 
WHAT CAN YOU DO?  Continue to promote polio eradication efforts and our Polio Plus campaign in your clubs and districts.  Funding continues to be critical, and our year end is rapidly approaching.
 
For funding motivation, make sure your districts and members know that we are wanting to take Bill & Melinda Gates Foundation’s matching money!  Without their contributions, we will not obtain the match.  Please make sure your clubs and districts know that we don’t want to leave that money “on the table”!
 
Here’s hoping we can extend the run of zero polio cases for another week!
 
--Ken
Dear colleagues,
Please find attached this week's global update slides as well as the weekly summary.
______________________________________________________________________
Poliovirus Weekly Update
20-Mar-2019, World Health Organization
Please scroll to the end for a summary of officially reported cases.
New wild poliovirus cases reported this week: 0
Total number of wild poliovirus cases in 2019: 6
Total number of wild poliovirus cases in 2018: 33
 
New cVDPV cases reported this week: 1
Total number of cVDPV cases (all types)  in 2019: 2
Total number of cVDPV cases (all types)  in 2018: 104
 
 
Headlines
  • Following cyclone Idai’s landfall in Mozambique, accessibility in many areas remains a challenge, particularly Beira City. However, outside of Beira, polio outbreak response is ongoing in Zambezia. 
  • Summary of new viruses this week: Afghanistan—five wild poliovirus type 1 (WPV1)-positive environmental samples; Pakistan – seven WPV1-positive environmental samples; Nigeria— one circulating vaccine-derived poliovirus type 2 (cVDPV2) case and seven cVDPV2-positive environmental samples; Niger—five cVDPV2-positive community contact samples; Indonesia—one cVDPV1-positive isolate from a healthy community contact. See country sections below for more details.
 
Afghanistan
  • No wild poliovirus type 1 (WPV1) cases were reported in the past week. There are two WPV1 cases reported in 2019. The total number of WPV1 cases for 2018 remains 21.
  • Five WPV1-positive environmental samples were reported in the past week: two from Nahr-e-Saraj district and one from Lashkargah district in Hilmand province; one from Kandahar district in Kandahar province and one from Jalalabad district in Nangarhar province. The samples were collected between 6 January to 23 February 2019.
  • The Technical Advisory Group for polio eradication (TAG) met on 15-16 January 2019 to assess the progress made towards polio eradication in Afghanistan in 2018 and made recommendations for the way forward in 2019.
  • Read the latest polio update from Afghanistan to see information on cases, surveillance and vaccination campaigns.  
 
Pakistan
  • No cases of wild poliovirus type 1 (WPV1) were reported this week. There are four WPV1 cases reported in 2019.  The total number of WPV1 cases in 2018 remains 12. 
  • Seven WPV1-positive environmental samples were reported in the past week: one each from Orangi Town in Karachi, Jacobabad, and Sukkur in Sindh province; one from Lahore in Punjab province; one from South Waziristan in Khyber Pakhtunkhwa province and one from Quetta in Balochistan province. The samples were collected between 12 to 25 February 2019. 
  • Read the latest polio update from Pakistan to see information on cases, surveillance and vaccination campaigns.
 
Nigeria
  • One case of circulating vaccine-derived poliovirus type 2 has been reported this week in Kaiama LGA, Kwara State. This is third case in Kwara State and the second in 2019 in Nigeria. The total number of cVDPV2 cases in 2018 remains 34.
  • Seven cVDPV2-positive environmental samples were reported this week: five in Maiduguri LGA, Borno State; one in Tarauni LGA in Kano State; one in Damaturu LGA in Yobe State, and one in Katsina State. Samples were collected between 16 January to 19 February 2019.
  • No cases of wild poliovirus type 1 (WPV1) has been reported in the country since the one detected from Borno State with a date of onset of paralysis on 21 August 2016.  
  • The country continues to be affected by two separate cVDPV2 outbreaks, the first centered in Jigawa State with subsequent spread to other states as well as to neighbouring Republic of Niger, and the second in Sokoto State.
  • Recent confirmation of spread of one of the cVDPV2 outbreaks, both within Nigeria and internationally, underscores the urgent need to fill remaining vaccination gaps in the ongoing outbreak response, and to optimize the geographic extent and operational quality of mOPV2 response.
  • At the same time, outbreak response to WPV1 continues, including efforts to address surveillance and immunity gaps in parts of Borno State.
  • Read our Nigeria country page to see information on surveillance and vaccination campaigns. 
 
Lake Chad Basin
  • No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) has been reported in the past week. The most recent cVDPV2 isolated in the country was in Magaria district, Zinder region with an onset of paralysis on 5 December 2018.
  • Five cVDPV2-positive isolated from healthy community contacts were reported this week, from Magaria in Zinder region. All the samples were collected on 6 February 2019.
  • The total number of cVDPV2 cases in 2018 reported in Niger in 2018 is ten.  The outbreak is genetically-linked to the cVDPV2 outbreak originating in Jigawa, Nigeria. Virus was isolated from children with acute flaccid paralysis (AFP) from Zinder region, located in the south of Niger and on the border with Nigeria, with dates of onset of paralysis ranging from 18 July through 5 December 2018.
·         Acute flaccid paralysis surveillance and routine immunization across the country with focus on the infected provinces and the provinces at the international borders with Nigeria are being reinforced.
·         Active case finding for additional AFP cases is continuing, and additional surveillance measures such as increasing the frequency and extent of environmental surveillance and community sampling of healthy individuals is being expanded.
 
Central Africa
 
Horn of Africa
  • No circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported in the past week.  
  • The Horn of Africa is currently affected by separate outbreaks of circulating vaccine-derived poliovirus type 2 (cVDPV2) and type 3 (cVDPV3), reporting both AFP cases and environmental positive samples.
  • Somalia has reported a total of 12 cVDPV cases (five type 2, six type 3 and one, coinfection of both type 2 and type 3) in 2018.
  • The most recent cVDPV2 virus was isolated from an environmental sample collected on 11 October 2018 from Waberi district in Banadir province.  The most recent cVDPV3 virus was isolated from an environmental sample also from Waberi district, Banadir province collected on 23 August 2018.  
  • Circulating VDPV2 has also been detected during 2018 in one environmental sample in Kenya collected on 21 March 2018.
  • Outbreak response to both virus types is currently being implemented in line with internationally-agreed guidelines. Large-scale supplementary immunization activities (SIAs) have been implemented in Banadir, Lower Shabelle and Middle Shabelle regions, Somalia.
  • WHO and partners continue to support local public health authorities across the Horn of Africa in conducting field investigations and risk assessments.
  • Read our Somalia country page and Kenya country page to see information on surveillance and vaccination campaigns. 
  • Learn more about vaccine-derived polioviruses through this short animation or this ‘Coffee with Polio Experts’ video.
 
Papua New Guinea
  • No new cases of circulating vaccine-derived poliovirus type 1 (cVDPV1) were reported this week.  The total number of cases in 2018 remains 26.
  • The most recent cVDPV1 virus was isolated from an environmental sample collected in the National Capital district on 6 November 2018. 
  • Emergency Operation Centres are established and operational at the national level and in all affected provinces; environmental surveillance is functional in five sites in two major cities.
  • Three Supplementary Immunization Activities (SIAs) of expanding scope have taken place since late July, from three provinces to nine, to nationwide. The most recent was aimed at children under the age of 15, due to large numbers of poorly-immunized older children.
  • Planning is underway for the next steps of the outbreak response, focusing on both vaccination and surveillance for polioviruses.
  • Read our Papua New Guinea country page to see information on surveillance and vaccination campaigns.
 
Mozambique
  • No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak has been reported this week.  The total number of cases in 2018 remains 1.
  • One circulating vaccine-derived poliovirus type 2 (cVDPV2) isolate was detected, from an acute flaccid paralysis (AFP) case (with onset of paralysis on 21 October 2018, in a six-year old girl with no history of vaccination, from Molumbo district, Zambézia province), and two isolated from a community contact of the case reported on 10 and 17 December 2018.
  • The GPEI and partners are working with country counterparts to support the local public health authorities in conducting a field investigation (clinical, epidemiological and immunological) and thorough risk assessment to discuss planning and implementation of immunization and outbreak response.
  • In January 2017, a single VDPV2 virus had been isolated from a 5-year old boy with AFP, also from Zambézia province (Mopeia district).  Outbreak response was conducted in the first half of 2017 with monovalent oral polio vaccine type 2 (mOPV2). 
  • Read our Mozambique country page to see information on cases, surveillance and response to the developing outbreak.
 
Indonesia
  •       No circulating vaccine-derived poliovirus type 1 (cVDPV1) cases were reported this week. 
  •       One cVDPDV1-positive isolate from a healthy community contact was reported from Yahukimo, Papua province. The sample was collected on 13 February 2019.
  •       In total, three genetically-linked circulating vaccine-derived poliovirus type 1 (cVDPV1) isolates were detected from Papua province.  In addition to the above-listed isolate, cVDPV1 was isolated from an acute flaccid paralysis (AFP) case, with onset of paralysis on 27 November 2018, and from a sample of a healthy community contact, collected on 24 January 2019.  This outbreak is not linked to the cVDPV1 currently affecting neighbouring Papua New Guinea. 
  •       The GPEI and partners are working with country counterparts to support the local public health authorities in conducting a field investigation (clinical, epidemiological and immunological) and thorough risk assessment to discuss planning and implementation of immunization and outbreak response.
 
 
Officially reported wild poliovirus cases as of 19 Mar 2019
Total global cases in 2019: 6 (compared with 5 for the same period in 2018)
Total in endemic countries in 2019: 6 (compared with 5 for the same period in 2018)
Total in non-endemic countries in 2019: 0 (compared with 0 for the same period in 2018)
· Afghanistan: 2 cases in 2019 (compared with 5 for the same period in 2018), onset of paralysis of most recent case: 12-Jan-19
· Pakistan: 4 cases in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 20-Jan-19
· Nigeria: 0 case in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 21-Aug-16
 
· Total global WPV1 cases in 2019: 6
· Total global WPV1 cases in 2018: 33
· Total in endemic countries: 33
· Total in non-endemic countries: 0
Please refer to the attached weekly global update for country-level details of 2018 cases.
 
Officially reported cVDPV cases as of 19 Mar 2019
· Democratic Republic of the Congo: 0 case in 2019 (compared with 3 for the same period in 2018), onset of paralysis of most recent case: 07-Oct-18
· Nigeria: 2 cases in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 07-Feb-19
· Somalia: 0 case in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 07-Sep-18
· Papua New Guinea (type 1): 0 case in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 18-Oct-18
· Niger: 0 case in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 05-Dec-18
· Mozambique: 0 case in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 21-Oct-18
· Indonesia (type 1): 0 case in 2019 (compared with 0 for the same period in 2018), onset of paralysis of most recent case: 27-Nov-18
 
· Total global cVDPV cases in 2019: 2
· Total global cVDPV cases in 2018: 104
Please refer to the attached weekly global update for country-level details of 2018 cases