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Rc66 polio eradication-english
1. Tehran,
Islamic Republic of Iran
14 –17 October 2019
Agenda item 3(a)
Dr Hamid Syed Jafari, Director,
Polio Eradication
Update on polio eradication in the
Eastern Mediterranean Region
1
2. 2
Global wild poliovirus type 1 (WPV1) and
circulating vaccine-derived poliovirus
(cVDPV) cases in the previous 12 months
Only the Eastern
Mediterranean Region
has reported wild
poliovirus circulation
since August 2016
Onset of paralysis: 25 Sept 2018–24
Sept 2019
WPV1 cases
cVDPV2 cases
cVDPV1 cases
Endemic country (WPV1)
3. 3
Resurgence of wild poliovirus:
cases and environmental samples, 2019
Cases (85)
Samples (273)
Infected districts
(61)
4. 0
50
100
150
200
250
300
350
400
2013 2014 2015 2016 2017 2018 2019
Number
Afghanistan
Pakistan
Iraq
Somalia
Syrian Arab
Republic
4
Eastern Mediterranean Region:
WPV1 cases by year and country 2013–2019
Years
PUBLIC HEALTH
EMERGENCY OF
INTERNATIONAL CONCERN
Declared under the
International Health
Regulations in May 2014,
Confirmed on 14 May 2019
5. 5
Eastern Mediterranean Region polio
situation and risk categories 20192020
Endemic countries:
Afghanistan and Pakistan
Countries with outbreaks and
at very high risk:
Somalia, Syrian Arab Republic,
Yemen
Countries at high risk:
Djibouti, Iraq, Libya, Sudan
6. 6
Wild poliovirus detection in environmental
samples, Islamic Republic of Iran
Konarak District, Sistan-Baluchistan,
Islamic Republic of Iran
Positive environmental samples
7. 7
Somalia cVDPV2 and cVDPV3 outbreak
2017–2019
Somalia: VDPV cases,
2018
Somalia: VDPV cases,
2019
2017–2018
cVDPV2 – first detection:
December 2017
(environmental sample)
Last cVDPV2
positive sample: 11
October 2018
cVDPV3 – first detection
February 2018
(environmental sample)
Last cVDPV3
detection 7
September 2018
2019
Three cVDPV2
cases – the last
case was
8 May
Evidence of spread within country, and to Kenya (2018) and
Ethiopia (2019)
Origin? – large number of children not accessed for
vaccination for a significant period
Response:
Synchronized monovalent oral poliovirus type 2 campaigns,
enhanced surveillance
Djibouti and Yemen on high alert and at very high risk
8. 8
Surveillance in the Eastern Mediterranean
Region 2017–2019
Non-polio AFP rate and wild virus, 2019
Percent of AFP cases with adequate samples, 2019
Certification standard maintained in
20 of 22 countries
Strong support from laboratory
network
Environmental surveillance
expansion: Islamic Republic of Iran,
Jordan, Lebanon, Somalia, Syrian
Arab Republic and Sudan; within
Pakistan and Afghanistan
Independent reviews, quarterly risk
assessments
Priorities
Maintain high-quality surveillance to
detect and respond; support
certification
Expand environmental surveillance:
Iraq, Yemen, Gulf Cooperation
Council countries
10. 10
Key challenge – inaccessibility; ban* on
mass vaccination in Afghanistan
*Ban partially lifted on 25 September, permitting
only health facility-based campaigns
Dec
Nov
Oct
Sep
Aug
Jul
Jun
May
Apr
Mar
Feb
Jan
Target planned Children reached Children not reached
11 10 9 8 7 6 5 4 3 2 1 0 1 2 3 4 5 6 7 8
million
Implemented
Not vaccinated
Not vaccinated
Not vaccinated
Not vaccinated
Planned
5–10 million
children not
vaccinated since
March 2019
11. 11
Type of challenge and level of influence on
programme success – Pakistan
Political leadership at all levels
(National, provincial and district level)
Community trust and
acceptance
Management
structures and
leadership
Vaccinator
motivation,
trust and
safety
Operation
s
...
Most
influence/
Most impact
12. 12
Way forward: Afghanistan and Pakistan
Overriding priority: stopping endemic
WPV transmission in Afghanistan and
Pakistan
Renewed national and international
commitment
Reviews and assessments; sharpened
analysis of communities harbouring endemic
transmission
Updated national emergency action plans
Transforming tactics, operations and
communications
Sharpened focus on core endemic reservoirs
Contingency planning in Afghanistan
Stronger synergy with Expanded Programme
on Immunization
Integrated services to the most-affected
communities
13. 13
Way forward for the Region
Prevent and control polio outbreaks
Maintain certification standard quality,
expand environmental surveillance
Maintain immunity, especially among
those at high risk
Progress toward certification and
poliovirus containment
Polio transition is an increasing focus of
WHO/Global Polio Eradication Initiative,
donors and Member States
– Polio staff perform essential public health functions
(e.g. measles, cholera and other outbreak
response campaigns)
– Polio assets transition to integrated systems to
sustain eradication, enhance broader surveillance,
essential immunization and emergency outbreak
response
– Support and ownership of Member States
14. 14
Summary
Resurgence of wild poliovirus in Afghanistan and Pakistan
Increased risk of international spread
Large ban on mass vaccination campaigns in Afghanistan; now partially lifted
Gaps in community trust and engagement, and in the management of frontline
workers
Risk of spread of cVDPV2 from Ethiopia/Somalia to Yemen
Need for Member States to maintain high levels of vaccination coverage,
surveillance and readiness for outbreak response as a national emergency
Enhanced regional solidarity – Islamic Advisory Group for Polio Eradication,
bilateral support (e.g. United Arab Emirates), Islamic Development Bank
Polio transition – a priority for Member States
Narrative:
Wild poliovirus type 1 (WPV1) has continued in Afghanistan and Pakistan in 2018 and 2019. (2018/33 cases reported & 2019/73 cases reported at 5 September)
Environmental sampling also indicates ongoing and expanding transmission in a number of areas in both countries.
Eradication efforts are being hindered by conflict and insecurity, and by a ban on immunization campaigns in large areas of the south in Afghanistan. Significant population movements continue to play a role in the spread of wild poliovirus.
Narrative:
A number of other countries in the Region are at high risk of outbreaks caused by importation of WPV1 or development of vaccine-derived poliovirus: Djibouti, Iraq, Libya, Sudan, Syrian Arab Republic and Yemen.
All are experiencing varying degrees of complex emergency and have access or security constraints that hamper efforts to maintain high population immunity and sensitive surveillance
Narrative: cVDPVs
The emergence of vaccine-derived poliovirus in the Region and other WHO regions is of great concern.
Although the programme successfully stopped the outbreak of circulating vaccine-derived poliovirus type 2 (cVDPV2) in the Syrian Arab Republic (the last case reported having onset of paralysis in September 2017), ongoing outbreak response efforts are continuing to stop transmission of cVDPV2 in Somalia.
Narrative:
Certification standard indicators for acute flaccid paralysis (AFP) surveillance are being maintained in 20 of 22 countries of the region.
Environmental Surveillance continues to expand across the region to enable rapid detection of the virus: Iran, Lebanon, Jordan, Somalia, Syria and Sudan in addition to AFG / PAK
Independent field reviews in Somalia, Sudan and Iraq
Quarterly risk assessments inform the programme
Intensive support to Djibouti for revlitazing surveillance system as a risk mitigation measure (neighbouring Somalia outbreak)
This image beautifully demonstrates how all of the units within the regional programme interact to have an impact.
This is an image taken from an environmental collection site in Mogadishu, Somalia, in July this year.
This was the first formal documentation of environmental surveillance in Somalia. To get this shot, it took coordination between the External Relations team, the Laboratory and Surveillance teams, the country support team. From this, we have developed a guidance video on environmental surveillance and collection which will be an important tool for the programme as environmental surveillance expands in the Region, and globally.
This work is also really important in highlighting the real value of maintaining such close collaboration with the technical team in Amman. Materials are developed based on a need determined by the country teams with the technical guidance of the people in this room.
Time period needs to be defined so interventions are delivered together. There is no point correcting operational (vaccination/communication) issues if there is no community trust, political leadership, etc.
NEAP