Global & Disaster Medicine

Archive for the ‘Polio’ Category

The Philippine Department of Health (DOH) has confirmed a fourth polio case in the country

Xinhua

“……Until Sep 19, the Philippines had been polio-free for 19 years. The previous cases have been in children under the age of 5 and classified as poliovirus type 2.

Following the first case detection, the government launched a nationwide polio vaccine campaign, and health officials said that, as of Oct 31 more than 95% of children 0 to 59 months old have been vaccinated against the virus…….”


CDC: Since 1988 polio vaccine has prevented more than 17 million cases of paralysis

YEAR / POLIO CASES

1988 | 350,000

1989 | 261,000

1990 | 233,000

1991 | 134,000

1992 | 137,000

1993 | 76,000                                                    African man, woman, and child

1994 | 73,000

1995 | 60,000

1996 | 33,000

1997 | 18,000

1998 | 10,000

1999 | 10,000

2000 | 4,000

2001 | 548

2002 | 1,922

2003 | 784

2004 | 1,258

2005 | 2,033

2006 | 2,022

2007 | 1,387

2008 | 1,732                                                                                           High levels of vaccination coverage must be maintained to stop Polio transmission and prevent outbreaks

2009 | 1,782

2010 | 1,409

2011 | 650

2012 | 223

2013 | 416

2014 | 359

2015 | 74

2016 | 37

2017 | 22

2018 | 33


World Polio Day is October 24

CDC

In 2019, we will celebrate a couple of incredible milestones: the 25th anniversary of the polio-free status of the Region of the Americas and the Global Certification Commission’s certification of the eradication of type 3 wild poliovirus (WPV3). The announcement of the eradication of WPV3 will signify an important step toward a polio-free world with only one type of wild poliovirus (WPV type 1) still in circulation in just two countries, Afghanistan and Pakistan.

October 24th is World Polio Day

Despite this tremendous progress, the final mile to eradication is an uphill road and will not be easy. The global polio program is facing multiple, ongoing, serious challenges with the increase in the number of wild poliovirus cases and the continued spread of circulating vaccine-derived poliovirus (cVDPV) outbreaks in countries around the world. In 2018, we saw an increase in wild polio cases with 33 reported cases in two countries – Afghanistan and Pakistan. As of October 24, 2019, a total of 95 cases of wild polio have been reported. The two-remaining polio-endemic countries must reach all children with polio vaccine to achieve zero wild poliovirus cases, and ultimately for the world to achieve polio eradication. This will require increased commitments from governments, local communities, donor partners and multilateral organizations. Furthermore, to address the ongoing circulating vaccine-derived polio viruses, all countries must work to strengthen their immunization programs to close any gaps and ensure that all children are protected against polio – the world depends on it!

CDC, along with our Global Polio Eradication Initiative (GPEI) partners, is working closely with leadership and partners in the two endemic countries and countries experiencing cVDPV outbreaks to urgently implement new and proven strategies for strengthening immunization and surveillance. We will overcome the final hurdles to eradication. The global polio program is working relentlessly together so that we can deliver a world where no child lives in fear of paralysis from poliovirus.

This year we highlight an overarching theme, Stories of Progress: Past and present for World Polio Day. This theme was selected to acknowledge the progress made to date in eradication efforts, the polio program’s ability to make the necessary strategic changes needed to continue along the path to eradication, and to recognize the efforts of the people, from front line to global, who have made this program possible.


Mutant polio vaccine viruses: ‘….. cVDPV — which stands for “circulating vaccine-derived polio virus”…..’

NYT

“…….But two major obstacles emerged.

First, millions of families around the world have not let their children have the drops because of persistent false rumors that the vaccine is a Western plot to sterilize Muslim girls or do other harm.

Second, in some countries viruses used in the oral vaccine itself have mutated into a form that can be passed on in diapers and sewage, and can paralyze unvaccinated children. That has contributed to fear of the oral vaccine, even though full vaccination is the only protection against such mutant viruses.

Just in the last two months, cases of paralysis caused by mutant vaccine viruses have been reported in the Philippines, Zambia, Togo and Chad. Because paralysis occurs in only about one in every 200 cases of polio, experts assume many more children have been infected………”


Polio Update in Afghanistan

preview


Cases due to the wild poliovirus found in nature have decreased by more than 99% since 1988, from an estimated 350,000 cases then, to 33 reported cases in 2018

CNN


Polio is making a dangerous comeback in Pakistan and Afghanistan

NYT

“……The global drive to eliminate polio, which has gone on for 31 years and consumed over $16 billion, has been set back again by a surge of new cases in Pakistan and Afghanistan.

As of July 10, there were a total of 42 polio paralysis cases in the two countries. ……..

Pakistan had 32 of the cases, compared to only three by the same date last year, and the situation is expected to get worse because hot summer weather favors the virus. There were only 12 cases in the country in 2018 and eight in 2017.

For each paralyzed victim — usually a child below age 5 — there are about 200 others who are infected and shedding the virus in their stool…….”


WHO: All about polio

WHO

Key facts

  • Polio (poliomyelitis) mainly affects children under 5 years of age.
  • 1 in 200 infections leads to irreversible paralysis. Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.
  • Cases due to wild poliovirus have decreased by over 99% since 1988, from an estimated 350 000 cases then, to 33 (1) reported cases in 2018.
  • As long as a single child remains infected, children in all countries are at risk of contracting polio. Failure to eradicate polio from these last remaining strongholds could result in as many as 200 000 new cases every year, within 10 years, all over the world.
  • In most countries, the global effort has expanded capacities to tackle other infectious diseases by building effective surveillance and immunization systems.

Symptoms

Polio is a highly infectious disease caused by a virus. It invades the nervous system, and can cause total paralysis in a matter of hours. The virus is transmitted by person-to-person spread mainly through the faecal-oral route or, less frequently, by a common vehicle (for example, contaminated water or food) and multiplies in the intestine. Initial symptoms are fever, fatigue, headache, vomiting, stiffness of the neck and pain in the limbs. 1 in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.

People most at risk

Polio mainly affects children under 5 years of age.

Prevention

There is no cure for polio, it can only be prevented. Polio vaccine, given multiple times, can protect a child for life.

Global caseload

Wild poliovirus cases have decreased by over 99% since 1988, from an estimated 350 000 cases in more than 125 endemic countries then, to 33 (1) reported cases in 2018.

Of the 3 strains of wild poliovirus (type 1, type 2, and type 3), wild poliovirus type 2 was eradicated in 1999 and no case of wild poliovirus type 3 has been found since the last reported case in Nigeria in November 2012.

WHO Response

Launch of the Global Polio Eradication Initiative

In 1988, the Forty-first World Health Assembly adopted a resolution for the worldwide eradication of polio. It marked the launch of the Global Polio Eradication Initiative (GPEI), spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, and supported by key partners including the Bill & Melinda Gates Foundation. This followed the certification of the eradication of smallpox in 1980, progress during the 1980s towards elimination of the poliovirus in the Americas, and Rotary International’s commitment to raise funds to protect all children from the disease.

Progress

Overall, since the GPEI was launched, the number of cases has fallen by over 99%.

In 1994, the WHO Region of the Americas was certified polio-free, followed by the WHO Western Pacific Region in 2000 and the WHO European Region in June 2002. On 27 March 2014, the WHO South-East Asia Region was certified polio-free, meaning that transmission of wild poliovirus has been interrupted in this bloc of 11 countries stretching from Indonesia to India. This achievement marks a significant leap forward in global eradication, with 80% of the world’s population now living in certified polio-free regions.

More than 16 million people are able to walk today, who would otherwise have been paralysed. An estimated 1.5 million childhood deaths have been prevented, through the systematic administration of vitamin A during polio immunization activities.

Opportunity and risks: an emergency approach

The strategies for polio eradication work when they are fully implemented. This is clearly demonstrated by India’s success in stopping polio in January 2011, in arguably the most technically-challenging place, and polio-free certification of the entire South-East Asia Region of WHO occurred in March 2014.

Failure to implement strategic approaches, however, leads to ongoing transmission of the virus. Endemic transmission is continuing in Afghanistan, Nigeria and Pakistan. Failure to stop polio in these last remaining areas could result in as many as 200 000 new cases every year, within 10 years, all over the world.

Recognizing both the epidemiological opportunity and the significant risks of potential failure, the “Polio Eradication and Endgame Strategic Plan” was developed, in consultation with polio-affected countries, stakeholders, donors, partners and national and international advisory bodies. The new Plan was presented at a Global Vaccine Summit in Abu Dhabi, United Arab Emirates, at the end of April 2013. It is the first plan to eradicate all types of polio disease simultaneously – both due to wild poliovirus and due to vaccine-derived polioviruses.

Future benefits of polio eradication

Once polio is eradicated, the world can celebrate the delivery of a major global public good that will benefit all people equally, no matter where they live. Economic modelling has found that the eradication of polio would save at least US$ 40–50 billion, mostly in low-income countries. Most importantly, success will mean that no child will ever again suffer the terrible effects of lifelong polio-paralysis.


Polio, Pakistan, and Politics

NYT

“……Pakistan has had 17 cases of polio paralysis this year; it had only three by this date last year, and only 12 in all of 2018.

In mid-April, widespread panic among parents in Peshawar and the surrounding northern tribal areas forced the suspension of a national immunization drive.

A scaremongering video spread on Twitter, purporting to show students collapsing after getting an expired batch of vaccine…..”

 


Statement of the Nineteenth IHR Emergency Committee Regarding the International Spread of Poliovirus

WHO

The nineteenth meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) regarding the international spread of poliovirus was convened by the Director General on 27 November 2018 at WHO headquarters with members, advisers and invited Member States attending via teleconference.

The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV).  The Secretariat presented a report of progress for affected IHR States Parties subject to Temporary Recommendations.  The following IHR States Parties provided an update on the current situation and the implementation of the WHO Temporary Recommendations since the Committee last met on 15 August 2018: Afghanistan, Democratic Republic of the Congo (DR Congo), Nigeria, Niger, Papua New Guinea (PNG), and Somalia.

Wild polio

The Committee commended the continued high level commitment seen in Afghanistan and Pakistan, and the significant degree of cooperation and coordination, particularly in reaching high risk mobile populations that frequently cross the international border.  The committee noted that it is four years since there has been international spread outside of these two epidemiologically linked countries.

However, the Committee was very concerned by the increase in WPV1 cases globally in 2018, especially regarding the increased number of WPV cases in Afghanistan.  Furthermore, after a 10-month period of no international spread of wild poliovirus between the two neighbors, Pakistan and Afghanistan, cross border spread in both directions has occurred in the last three months.

In Pakistan the situation in 2018 has stagnated, with the number of cases so far at the same level in 2018 as for the whole of 2017.  Furthermore, positive environmental isolates in 2018 continue to be widely spread geographically indicating multiple areas of transmission and missed susceptible population groups.  Nevertheless, the performance of the eradication program has shown some improvement in areas such as SIA quality.

In Afghanistan, the number of polio cases has almost doubled in 2018, with 19 cases reported so far, compared to 10 at the same time last year, due to worsened security and greater inaccessibility, and persistent pockets of refusals and missed children.  Environmental surveillance is also finding an increased proportion of positive samples.  The security situation and access would need to significantly improve for eradication efforts to progress, as currently 1 million children under 5 years old are inaccessible in recent polio immunization campaigns.

It is now more than two years since the last WPV1 was detected in an accessible area of Nigeria, and four years since there has been any international spread of WPV1 from the country.  The Committee commended the strong efforts to reach inaccessible and trapped children in Borno, Nigeria, even in the face of increased insecurity, and noted that the inaccessible target population was now down to around 70,000 children, scattered across Borno in smaller pockets.

Vaccine derived poliovirus

The outbreaks of cVDPV2 in Somalia, Kenya, DR Congo, Niger and cVDPV1 in PNG and cVDPV3 in Somalia continue to be of major concern, particularly the apparent international spread between Somalia and Kenya and the recent spread from Nigeria into Niger of cVDPV2, given that traditionally cVDPV viruses have rarely spread across borders.  Conflict and population movement within and outside DR Congo indicate a degree of risk of spread.
Large inaccessible areas of Somalia are a significant constraint on achieving interruption of transmission of the cVDPV2 and cVDPV3 in the area, exacerbated by large population movements into and out of these areas.
Nevertheless because of the limited supply of IPV, in cVDPV type 2 outbreaks the implementation of the Temporary Recommendations for border immunization of departing travelers can be difficult.  The committee noted the progress made with cross border cooperation between PNG and Indonesia, but was concerned that new cases of cVDPV1 in new provinces of PNG had been detected in the last three months, and that surveillance indicators in Indonesian provinces neighboring PNG were sub-optimal. Similarly, countries neighboring Somalia, such as South Sudan, Ethiopia and Djibouti, have areas of weak surveillance which poses the risk that international spread may go undetected.  The outbreak of cVDPV2 in Syria has been successfully controlled with no international spread, and Syria is no longer considered infected but remains vulnerable.

The committee noted that in all infected countries, routine immunization was weak.  The outbreaks of cVDPV2 in Jigawa, and for the second time in Sokoto, Nigeria, again underlines the vulnerability of northern Nigeria to poliovirus transmission.  Routine immunization coverage remains very poor in many areas of the country, although the political leadership and national emergency programme to strengthen routine immunisation is beginning to make an impact in some areas.

Conclusion

The Committee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC), and recommended the extension of Temporary Recommendations for a further three months. The Committee considered the following factors in reaching this conclusion:

  • Although the declaration of the PHEIC and issuance of Temporary Recommendations has reduced the risk of international spread of WPV, progress is fragile, and should international spread now occur, the impact on WPV eradication would be even more grave in terms of delaying certification and prolonging requirements for dedicated human and financial resources in support of the eradication effort. The reversal in progress in Afghanistan and the stagnation in Pakistan with exportation of WPV continuing between the two countries, heighten concerns.
  • There is a risk of global complacency as the numbers of WPV cases remains low and eradication becomes a tangible reality, and a concern that removal of the PHEIC now could contribute to greater complacency.
  • Many countries remain vulnerable to WPV importation. Gaps in population immunity in several key high-risk areas is evidenced by the current number of cVDPV outbreaks of all serotypes, which only emerge and circulate when polio population immunity is low as a result of deficient routine immunization programmes.
  • The international outbreak of cVDPV2 affecting Somalia and Kenya, with a highly diverged cVDPV2 that appears to have circulated undetected for up to four years, highlights that there are still high-risk populations in South and Central zones of Somalia where population immunity and surveillance are compromised by conflict.
  • Similarly the new spread of cVDPV2 between Nigeria and Niger highlights the significant risk of persisting type 2 outbreaks two years after OPV2 withdrawal, and the inability so far to prevent further spread within and outside Nigeria through application of consistently high quality mOPV2 SIAs is a concern.
  • The difficulty in controlling spread of cVDPV2 in DR Congo heightens these concerns and demonstrates significant gaps in population immunity at a critical time in the polio endgame;the low coverage with routine IPV vaccination in several countries neighboring DR Congo heightens the risk of international spread, as population immunity is rapidly waning.
  • Inaccessibility continues to be a major risk, particularly in several countries currently infected with WPV or cVDPV, i.e. Afghanistan, Nigeria and Somalia, which all have sizable populations that have been unreached with polio vaccine for prolonged periods.
  • The increasing number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies pose another risk. Populations in these fragile states are vulnerable to outbreaks of polio.
  • The risk is amplified by population movement, whether for family, social, economic or cultural reasons, or in the context of populations displaced by insecurity and returning refugees. There is a need for international coordination to address these risks.A regional approach and strong cross­border cooperation is required to respond to these risks, as much international spread of polio occurs over land borders.

Risk categories

The Committee provided the Director-General with the following advice aimed at reducing the risk of international spread of WPV1 and cVDPVs, based on the risk stratification as follows:

  • States infected with WPV1, cVDPV1 or cVDPV3, with potential risk of international spread.
  • States infected with cVDPV2, with potential risk of international spread.
  • States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV.

Criteria to assess States as no longer infected by WPV1 or cVDPV:

  • Poliovirus Case: 12 months after the onset date of the most recent case PLUS one month to account for case detection, investigation, laboratory testing and reporting period OR when all reported AFP cases with onset within 12 months of last case have been tested for polio and excluded for WPV1 or cVDPV, and environmental or other samples collected within 12 months of the last case have also tested negative, whichever is the longer.
  • Environmental or other isolation of WPV1 or cVDPV (no poliovirus case): 12 months after collection of the most recent positive environmental or other sample (such as from a healthy child) PLUS one month to account for the laboratory testing and reporting period
  • These criteria may be varied for the endemic countries, where more rigorous assessment is needed in reference to surveillance gaps (e.g. Borno)

Once a country meets these criteria as no longer infected, the country will be considered vulnerable for a further 12 months.  After this period, the country will no longer be subject to Temporary Recommendations, unless the Committee has concerns based on the final report.

TEMPORARY RECOMMENDATIONS

States infected with WPV1, cVDPV1 or cVDPV3 with potential risk of international spread

 

WPV1                                                                                       

Afghanistan (most recent detection 25 Oct 2018)

Pakistan (most recent detection 25 Oct 2018)

Nigeria (most recent detection 27 Sept 2016)
cVDPV1

Papua New Guinea (most recent detection 1 Oct 2018)

cVDPV3

Somalia (most recent detection 7 Sept 2018)

 

These countries should:

  • Officially declare, if not already done, at the level of head of state or government, that the interruption of poliovirus transmission is a national public health emergency and implement all required measures to support polio eradication; where such declaration has already been made, this emergency status should be maintained as long as the response is required.
  • Ensure that all residents and long­term visitors (i.e. > four weeks) of all ages, receive a dose of bivalent oral poliovirus vaccine (bOPV) or inactivated poliovirus vaccine (IPV) between four weeks and 12 months prior to international travel.
  • Ensure that those undertaking urgent travel (i.e. within four weeks), who have not received a dose of bOPV or IPV in the previous four weeks to 12 months, receive a dose of polio vaccine at least by the time of departure as this will still provide benefit, particularly for frequent travelers.
  • Ensure that such travelers are provided with an International Certificate of Vaccination or Prophylaxis in the form specified in Annex 6 of the IHR to record their polio vaccination and serve as proof of vaccination.
  • Restrict at the point of departure the international travel of any resident lacking documentation of appropriate polio vaccination. These recommendations apply to international travelers from all points of departure, irrespective of the means of conveyance (e.g. road, air, sea).
  • Further intensify cross­border efforts by significantly improving coordination at the national, regional and local levels to substantially increase vaccination coverage of travelers crossing the border and of high risk cross­border populations. Improved coordination of cross­border efforts should include closer supervision and monitoring of the quality of vaccination at border transit points, as well as tracking of the proportion of travelers that are identified as unvaccinated after they have crossed the border.
  • Further intensify efforts to increase routine immunization coverage, including sharing coverage data, as high routine immunization coverage is an essential element of the polio eradication strategy, particularly as the world moves closer to eradication.
  • Maintain these measures until the following criteria have been met: (i) at least six months have passed without new infections and (ii) there is documentation of full application of high quality eradication activities in all infected and high risk areas; in the absence of such documentation these measures should be maintained until the state meets the above assessment criteria for being no longer infected.
  • Provide to the Director-General a regular report on the implementation of the Temporary Recommendations on international travel.

States infected with cVDPV2s, with potential risk of international spread

  • DR Congo(most recent detection 25 Sept 2018)
  • Kenya(most recent detection 21 March 2018)
  • Nigeria(most recent detection 17 Oct 2018)
  • Niger(most recent detection 9 Sept 2018)
  • Somalia(most recent detection 4 Oct 2018)

These countries should:

  • Officially declare, if not already done, at the level of head of state or government, that the interruption of poliovirus transmission is a national public health emergency and implement all required measures to support polio eradication; where such declaration has already been made, this emergency status should be maintained.
  • Noting the existence of a separate mechanism for responding to type 2 poliovirus infections, consider requesting vaccines from the global mOPV2 stockpile based on the recommendations of the Advisory Group on mOPV2.
  • Encourage residents and long­term visitors to receive a dose of IPV (if available in country) four weeks to 12 months prior to international travel; those undertaking urgent travel (i.e. within four weeks) should be encouraged to receive a dose at least by the time of departure.
  • Ensure that travelers who receive such vaccination have access to an appropriate document to record their polio vaccination status.
  • Intensify regional cooperation and cross­border coordination to enhance surveillance for prompt detection of poliovirus, and vaccinate refugees, travelers and cross­border populations, according to the advice of the Advisory Group.
  • Further intensify efforts to increase routine immunization coverage, including sharing coverage data, as high routine immunization coverage is an essential element of the polio eradication strategy, particularly as the world moves closer to eradication.
  • Maintain these measures until the following criteria have been met: (i) at least six months have passed without the detection of circulation of VDPV2 in the country from any source, and (ii) there is documentation of full application of high quality eradication activities in all infected and high risk areas; in the absence of such documentation these measures should be maintained until the state meets the criteria of a ‘state no longer infected’.
  • At the end of 12 months without evidence of transmission, provide a report to the Director-General on measures taken to implement the Temporary Recommendations.

States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV

WPV1

  • Cameroon (last case 9 Jul 2014)
  • Central African Republic (last case 8 Dec 2011)
  • Chad (last case 14 Jun 2012)

CVDPV

  • Syria (last case 21 Sept 2017)

These countries should:

  • Urgently strengthen routine immunization to boost population immunity.
  • Enhance surveillance quality, including considering introducing supplementary methods such as environmental surveillance, to reduce the risk of undetected WPV1 and cVDPV transmission, particularly among high risk mobile and vulnerable populations.
  • Intensify efforts to ensure vaccination of mobile and cross­border populations, Internally Displaced Persons, refugees and other vulnerable groups.
  • Enhance regional cooperation and cross border coordination to ensure prompt detection of WPV1 and cVDPV, and vaccination of high risk population groups.
  • Maintain these measures with documentation of full application of high quality surveillance and vaccination activities.
  • At the end of 12 months* without evidence of reintroduction of WPV1 or new emergence and circulation of cVDPV, provide a report to the Director-General on measures taken to implement the Temporary Recommendations.

*For the Lake Chad countries, this will be linked to when Nigeria is considered no longer infected by WPV1 or cVDPV2.

 

Additional considerations

In areas where specific geographies are inaccessible, an intensive effort should be made to immunize communities on the periphery of inaccessible areas including providing immunisation posts at key transit points of high population movement.

The outbreak in Papua New Guinea is an example of the ongoing vulnerability of some parts of the world to polioviruses. The committee urged countries in close proximity to the current outbreaks, such as Ethiopia, South Sudan, Djibouti, Indonesia, Central African Republic and Lake Chad basin countries to urgently strengthen polio surveillance and routine immunization including with bOPV and IPV.  There needs to be a renewed urgency to addressing these gaps wherever they exist.  The world is at a critical point in polio eradication, and failure to boost population immunity through strengthening routine immunization, and where outbreaks have occurred through implementation of high quality SIAs, in areas of known high risk could jeopardize or severely delay polio eradication. The current situation calls for unabated efforts and use of every tool available, to achieve the goal in these most challenging countries.

The Committee noted that the extension of the PHEIC for over four years in the context of the end game of the global eradication effort, was an exceptional use of the IHR.  The committee noted that there is a legitimate debate about whether this continued declaration of a PHEIC may weaken its impact as a tool to address global health emergencies, and specifically whether it continues to have utility noting that the risk of international spread appears to have substantially diminished since 2014.  It noted that it was not originally envisaged that a PHEIC would continue for such a long period, but the committee feels that the circumstances of an eradication program such as polio are unique.  In an eradication program, it is the mere existence of the virus in a country that necessitates strenuous emergency measures, in addition to the number of cases.  The committee was concerned that the removal of the PHEIC in the current situation where exportation of WPV and cVDPV continues and progress has may even have reversed, might send out the wrong message to the global community and might weaken the gains made in reducing the risk of international spread in some areas.  There is sound evidence that the Temporary Recommendations have been an important factor in reducing the risk of international spread since 2014 [1],[2].

Based on the current situation regarding WPV1 and cVDPV, and the reports provided by Afghanistan, DR Congo, Nigeria, Niger, Papua New Guinea and Somalia, the Director-General accepted the Committee’s assessment and on 27 November 2018 determined that the situation relating to poliovirus continues to constitute a PHEIC, with respect to WPV1 and cVDPV.  The Director-General endorsed the Committee’s recommendations for countries meeting the definition for ‘States infected with WPV1, cVDPV1 or cVDPV3 with potential risk for international spread’, ‘States infected with cVDPV2 with potential risk for international spread’ and for ‘States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV’ and extended the Temporary Recommendations under the IHR to reduce the risk of the international spread of poliovirus, effective 27 November 2018.

 


[1] Wilder-Smith A, Leong WY, Lopez LF, et al. Potential for international spread of wild poliovirus via travelers. BMC Med 2015; 13: 133.

[2] Duintjer Tebbens RJ, Thompson KM. Modeling the costs and benefits of temporary recommendations for poliovirus exporting countries to vaccinate international travelers. Vaccine 2017; 35(31): 3823-33

 


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