Cameroon Case (Part III)

17 April 2014 -  In Equatorial Guinea, 3 new wild poliovirus type 1 (WPV1) cases was reported. There has not been any polio cases in Equatorial Guinea since 1999 and through Genetic Sequencing, it was indicated that the poliovirus strains belonged to that of the poliovirus strains isolated in the Cameroon poiliovirus outbreak. The cases of onset paralysis in Equatorial Guinea was between 28 January and 24 March 2014 from Centro Sur, Bioko Norte and Litoral. Outbreaks in Equatorial Guinea led to an emergency outbreak response with drafted activities to be carried out, such as National Immunization Days with Oral POlio Vaccine on 21-24 April 2014. An estimated 40% children were immunized fully against polio in the country.

Due to the possible spread of poliovirus across the regions, immunity levels and surveillance sensitivity were constantly assessed in neighboring countries, particularly in Gabo and the Republic of Congo. In preparation of a possible spread of poliovirus in Gabon and Republic of Congo, both countries scheduled Nationwide Immunization campaigns in April and May 2014. [5]

WHO stressed the importance of being fully immunized before entering countries infected or close to countries infected with poliovirus. WHO also stressed the importance of increasing surveillance for acute flaccid paralysis for quick detection and to facilitate emergency outbreak responses. WHO finally stressed to neighboring countries, territories and areas close to infected areas to maintain uniformly high routine immunization coverage at the district level to minimize consequences of any new virus introduction. [9]

Reference:
[9] Update on polio in central Africa - polio confirmed in Equatorial Guinea, linked to outbreak in Cameroon. (2014, April ). Retrieved June 26, 2015, from http://www.who.int/csr/don/2014_4_17polio/en/

Equatorial Guinea update - linked to Cameroon cases

On 16 July 2014, Equatorial Guinea reported a total of 5 cases of wild poliovirus type 1 (WPV1) with the onset of paralysis betwee 28 January 2014 and 3 May 2014. Genetic sequencing had suggested that the cases were linked to the outbreak in Cameroon.

A national emergency action plan to respond to this outbreak was developed and initiated by the Ministry of Health and partner agencies. 3 nationwide campaigns with bivalent oral polio vaccine (bOPV) were conducted in the country with 2 of the 3 campaigns targetting children under the age of 15 in April and May 2014 whilst the other campaign targeted children under the age of 5 in late May.
On July 2014, the country had planned and initiated bOPV to be given to all of its citizens whilst another campaign for bOPV will be conducted on August 2014 for children under the age of 15.

The Disease Outbreak News update published on 25 June 2014, reported Brazil on 18 June 2014 confirmed that there was WPV1 detected in a sewage sample collected at the Viracopos International Airport in March 2014, with genetic sequencing similar to the virus that was circulating in Equatorial Guinea. However, with that being said, there was no further reports of polio or onset of paralysis reported in Brazil to date and no further samples from the sewage detected a positive for an strains of poliovirus.

Despite not having spread the disease to Brazil, according to the International Health Regulations (IHR), temporary recommendations issued by the Director General of WHO on 5 May 2014 considered Equatorial Guinea to be a polio exported country and hence the country therefore focused on ensuring all residents and long-term visitors of more than 4 weeks that travel internationally, receive a supplementary dose of poio vaccine between 4 weeks to 12 months before departure. [10]

Reference:
[10] Update on polio in Equatorial Guinea. (2014, July ). Retrieved July 30, 2015, from http://www.who.int/csr/don/2014_07_17_polio/en/

Cameroon Case (Part IV)

6 September 2014 - In Cameroon, 2 new wild poliovirus type 1 (WPV1) cases were reported from the East Region with the onset of paralysis on 26 June and 9 July 2014. Genetic sequencing suggested that this wild poliovirus was a continued wild poliovirus circulation. Gaps in surveillance result in undetected transmission and geographic expansion to new areas of the country.

The outbreak in Cameroon has been ongoing since at least October 2013. The outbreak had also spread internationally to Equatorial Guinea in March 2014. Due to the possible high influx and expanding circulation of vulnerable refugee populations from Central African Republic, Who had elevated the risk assessment of Cameroon to VERY HIGH. Further undetected circulation cannot be ruled out as the risk of virus spreading to Central African Republic is considered to be particularly high given the large scale population movements from there to Cameroon.

In May 2014, Director-General of WHO declared Cameroon as one of the states of international spread of wild poliovirus to be a Public Health Emergency of International Concern (PHEIC), under the criteria for 'states currently exporting wild poliovirus ' and was therefore recommended to implement strict measures to lower the risk of further international spread.

Cameroon conducted 7 nationwide supplementary immunization activities (SIAs) in 2014 followed by subnational SIAs for 23-26 August and 4-7 September in the 2 regions, East and Adamaoua, of the country, with the intention of mainly immunizing children less than the age of 10. Central African Republic also responded to the possible outbreak in the country by international spread from Cameroon by starting a series of 5 sub-national polio immunization activities that will cover the western half of the country which will end with the September 2synchronized round covering the central block of Africa.

Outbreak response quality in Cameroon has varied by geographic area and the confirmation of new cases and the possibility of undetected cases resulted with the additional emergency outbreak responses to further increase its measures taken against the possible spread of the poliovirus. Once again, WHO had stressed the importance of maintaining a fully immunized community in th ecountry and surrounding neighboring countries as well as improving the surveillance of possible cases of polio in the country to be reported to World Health Organization for further monitoring of the spread of the disease. [11]

Reference:
[11] Poliovirus in Cameroon – update. (2014, September ). Retrieved June 29, 2015, from http://www.who.int/csr/don/2014_09_06_polio/en/

2014 South Sudan and Madagscar Updates

Although Nigeria, Paskistan and Afghanistan are the primary 3 countries with cVDPVs, the Poliovirus has been spotted outside these 3 countries as well..

14 November 2014

Separate cases of a circulating cVDPVs was confirmed in South Sudan and Madagascar. 

In South Sudan, 2 cases of type 2 cVDPV cases was confirmed with strains isolated from 2 acute flacid paralysis(AFP) cases in Unity State with the onset of paralysis on 9 September and 12 September 2014 respectively. The cause was later discovered that almost 33% of the children in Unity State are under-immunized against Poliovirus. The two patients were found to be from an internally-displaced persons camp due to civil unrest in Unity State which led to displacement and decline in immunization. Other than the Civil unrest, South Sudan was also participating in the Horn of Africa outbreak response which led them to be exposed to the ongoing wild type 1 poliovirus that was affecting that region. 

In response to the posing threat from the Horn of Africa response, South Sudan had conducted 2 National Immunization Days on April and May for trivalent and bivalent Oral Polio vaccines respectively. Upon receiving the confirmation of the 2 cVDPVs, another series of National Immunization Day was conducted on the 4 November 2014 with trivalent OPV, a subnational immunization day with states with civil unrest on 2 December 2014 and January 2015 with trivalent OPV. The series of immunization done was aimed at containing the spread of the disease by further boosting the community against type 1 polio and the risk of a re-infection from parts of the Horn of Africa.

In Madagascar, cVDPV type 1 was detected after the virus was isolated from a case of AFP with the onset of paralysis of the patient on 29 September 2014 and 3 healthy contacts. In response to this, Madagascar also conducted National Immunization Days in January 2015. The last documentation of a National Immunization Day for Madagascar was in December 2011/January 2012. This led to a highly under-immunized community . A cVDPV outbreak had affected Madagascar before in the years 2001/2002 and 2005. Rapid Concerted outbreak responses stopped those events from continuing but repeated emergence of separate cVDPV activities may increase the risk of such diseases occurring in populations not fully immunized against the poliovirus. Hence, stresses the importance of maintaining high levels of vaccination coverage.

WHO Risk Assessment: 

WHO states that circulating VDPVs are rare but there are instances of well documented strains in populations under-immunized. With the low risk of VDPVs, use of OPV must be stopped in a phase manner to secure a polio free environment as it was discovered that type 2 component contained trivalent OPV accounts for 90% of all cVDPV cases.

From the background of the reports in Madagascar and South Sudan, WHO deemed the risk of international spread of the cVDPV to be low and advises any travelers to be vaccinated fully against poliovirus before making a trip to previously affected areas in both countries. [12]

Reference:
[12] Poliovirus in South Sudan and Madagascar. (2014, November ). Retrieved June 30, 2015, from http://www.who.int/csr/don/14-november-2014-polio/en/

WHO Wild Poliovirus update (Week ending 24 June)

According to the Headlines, an outbreak response assessment took place in the Horn of Africa in June. The research team came to the conclusion that the transmission of the virus in Kenya and Ethiopia has been interrupted despite the possibility of an undetected transmission in Somalia.

Furthermore, 5 cases of circulating cVDPV1 was reported in Madagscar with dates of onset paralysis in April and May 2015. These cases are genetically linked to that of September 2014 cases indicating a prolonged and widespread circulation of cVDPV1. The emergency outbreak response has now been increased and intensified to build an immunity against the virus in the country. approximately 25% of the children across Madagscar is underimmunized.

WHO is now closely monitoring the countries that has been detected positive for poliovirus since the year 2014, namely Pakistan, Afghanistan, Somalia, Nigeria, Cameroon, Equatorial Guinea, Iraq, Syrian Arab Republic and Ethiopia. By 24 June 2015, 25 cases of wild poliovirus have been officially reported in Pakistan with the onset of paralysis last documented on 24 May 2015. 4 cases of wild poliovirus have also been reported in Afghanistan, with  the last onset of paralysis documented there on the 5 May 2015. Finally, 0 cases for the remaining countries in the year 2015 with last documented cases of poliovirus induced paralysis in the year 2014.

Despite the 29 documented cases so far, WHO has recognized a significant amount of improvement in the number of reported cases compared to the year 2014, where by this period, there were 83 cases, 6 cases, 1 case, 4 cases, 3 cases, 4 cases, 2 cases and 1 case each of wild poliovirus documented in Pakistan, Afghanistan, Somalia, Nigeria, Cameroon, Equatorial Guinea, Iraq, Syrian Arab Republic and Ethiopia respectively. The mass improvement is shown when data of cases reported in the same period was collected of the total global cases in 2015 compared to 2014 was decreased from 105 to 29. [13]

Reference:
[13] World Health Organization Wild Polio Virus Update Week ending 24 June. (2015, June 24). Retrieved July 26, 2015, from http://clubrunner.blob.core.windows.net/00000050024/en-ca/files/sitepage/polio-headlines/24-jun-2015/Polio-Headlined-JUne-24.pdf

WHO Wild Polio Virus Updates (Week ending 22 July)

On 14 July 2015, Forbes featured a live discussion on Polio eradication efforts, contributed by Mr Devin Thrope. The live discussion was between Dr Hamid Jafari, Director for the Global Polio Eradication Initiative at WHO, and Dr John Sever, Vice Chair of Rotary International's Polio Plus Program. The article focused on how to reduce the number of Polio cases from once a week to 0. The article emphasis on the recent outbreak of circulating vaccine-derived poliovirus (cVDPV) in Madagascar where a total of 8 cases were discovered in the non-endemic country which posts as a challenge as Madagascar was last reported with an outbreak of cVDPV in September 2014.[14]

Shown below is the video of the live discussion conducted between the contributor as well as the 2 individuals taken from  http://www.forbes.com/sites/devinthorpe/2015/07/14/number-of-polio-cases-globally-drops-to-1-per-week-how-do-we-get-to-zero/2/.

By the week ending 22 July 2015, the total number of globally reported cases of Wild Poliovirus (WPV) and circulating vaccine-derived Poliovirus (cVDPV) are 33 and 9 respectively, with the most recent cases reported being 1 new case in Afghanistan, 2 new cases of wild poliovirus type 1 in Pakistan and the 8 cases reported in Madagascar.[15] Images below show the statistics of polio cases of the year to date 2015. [16]

As shown in the statistics in the images above, there has been significant improvements as there is an immense decrease in Polio cases as compared to the year 2014. However, the sudden cases reported in Madagascar is a cause for worry as it has only been a few months since the last National Immunization Day conducted in Madagascar in response to the cases reported on 29 September 2014. [16] 

Reference:

[14] Thrope, D. (2015, July 14). Number of polio cases drop globally drop to one per week how do we get to zero. Retrieved July 30, 2015, from http://www.forbes.com/sites/devinthorpe/2015/07/14/number-of-polio-cases-globally-drops-to-1-per-week-how-do-we-get-to-zero/2/

[15]World Health Organization Wild Polio Virus Update Week ending 15 July. (2015, July ). Retrieved July 30, 2015, from http://clubrunner.blob.core.windows.net/00000050024/en-ca/files/sitepage/polio-headlines/15-jul-2015/Polio-Headlines-July-15.pdf

[16]Global Polio Eradication Initiative Data and monitoring Polio this week. (2015, July 29). Retrieved July 30, 2015, from http://www.polioeradication.org/dataandmonitoring/poliothisweek.aspx