Public Health Emergency of International Concern (PHEIC)
Polio this week as of 14 February 2018 [GPEI]
:: New on http://polioeradication.org/: Sudan’s surveillance system under the microscope, and a new addition to our ‘Reaching the Hard-to-Reach’ series, on AFP surveillance in challenging areas of Afghanistan, Syria and Nigeria.
:: The 16th International Health Regulations Emergency Committee regarding the international spread of poliovirus recommended that the temporary recommendations to prevent virus spread be extended for a further period of three months.
:: Bill and Melinda Gates released their annual letter, answering the 10 tough questions that they hear most often.

:: Weekly country updates as of 14 February 2018
:: One wild poliovirus type 1 (WPV1) positive environmental sample reported from Hilmand province.
Democratic Republic of the Congo:
:: Three cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) reported, from Tanganyika province. Somalia: Circulation of vaccine-derived poliovirus type 2 (cVDPV2) in the environment has been confirmed in Banadir province.
:: Circulation of vaccine-derived poliovirus type 2 (cVDPV2) in the environment has been confirmed in Banadir province, Somalia.
Statement of the Sixteenth IHR Emergency Committee Regarding the International Spread of Poliovirus
WHO statement  –  14 February 2018
[Editor’s text bolding]
The sixteenth 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 7 February 2018 at WHO headquarters with members, advisers and invited member states attending via teleconference…

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:
:: The potential risk of further spread through population movement, whether for family, social or cultural reasons, or in the context of populations displaced by insecurity, returning refugees, or nomadic populations, and the need for international coordination to address these risks, particularly between Afghanistan and Pakistan, Nigeria and its Lake Chad neighbors, and countries bordering the Syrian Arab Republic.
:: The current special and extraordinary context of being closer to polio eradication than ever before in history, with the incidence of WPV1 cases in 2017 the lowest ever recorded.
:: The risk and consequent costs of failure to eradicate globally a highly debilitating vaccine preventable disease. Even though global transmission of WPV1 has fallen dramatically and with it the likelihood of international spread, the consequences and impact of international spread should it occur now would be even more grave and a major set-back to achieving eradication.
:: The risk of global complacency developing as the numbers of polio cases continues to fall and eradication becomes a tangible reality soon.
:: The outbreak of WPV1 (and cVDPV) in Nigeria highlighting that there are high-risk areas where surveillance is compromised by inaccessibility, resulting in ongoing circulation of WPV for several years without detection. The risk of transmission in the Lake Chad sub-region appears considerable.
:: The serious consequences of further international spread for the increasing number of countries in which immunization systems have been weakened or disrupted by conflict and complex emergencies. Populations in these fragile states are vulnerable to outbreaks of polio. Outbreaks in fragile states are exceedingly difficult to control and threaten the completion of global polio eradication during its end stage.
:: The importance of a regional approach and strong cross­border cooperation, as much international spread of polio occurs over land borders, while also recognizing that the risk of distant international spread remains from zones with active poliovirus transmission.
Additionally with respect to cVDPV:
:: cVDPVs also pose a risk for international spread, which without an urgent response with appropriate measures threatens vulnerable populations as noted above;
:: The large number of cases in the Syrian outbreak within a short space of time and close to the international border with Iraq in the context of ongoing population movement because of conflict, considerably heightens the risk of international spread;
:: The ongoing circulation of cVDPV2 in DR Congo, and the Syrian Arab Republic demonstrates significant gaps in population immunity at a critical time in the polio endgame;
:: The ongoing urgency to prevent type 2 cVDPVs following the globally synchronized withdrawal of the type 2 component of the oral poliovirus vaccine in April 2016, noting that population immunity to type 2 polioviruses is rapidly waning in many countries;
:: The ongoing challenges of improving routine immunization in areas affected by insecurity and other emergencies;
:: The global shortage of IPV which poses an additional risk, in that the cohort of children with no type 2 immunity is growing in number in countries affected by the shortage…

Additional considerations
The Committee noted that in all the infected and vulnerable countries, routine immunization was generally quite poor, if not nationally, then in sub-national pockets. The Committee also noted that surveillance in these areas may also be sub-optimal, particularly where access is compromised by conflict. The Committee strongly encourages all these countries to make further efforts to improve routine immunization and strengthen surveillance in such areas, and requested international partners to support these countries in rapidly improving routine immunization coverage to underpin eradication.

The Committee also urged that Nigeria and the Lake Chad countries increase cross border efforts and joint planning and response. Intensified effort is needed to identify and reach vulnerable populations in the sub-region, particularly in the Lake Chad islands. Noting the low number of international travelers being vaccinated in Nigeria, the committee again recommended that the country needs to improve implementation of the Temporary Recommendations regarding traveler vaccination, including reporting of achievements, and requests the secretariat to report back on this aspect of Nigeria’s response to the next Committee meeting. Nigeria should ensure continuing political commitment and take measures to counter fatigue in the fight against polio. Similarly, the DR Congo government needs to regard the current outbreak of cVDPV2 as a public health emergency and pay more attention to prevention of international spread of cVDPV2 from DR Congo, noting that neighboring countries are affected by the global shortage of IPV.

Noting the issues that continue in countries previously subject to Temporary Recommendations such as the Ukraine and Somalia, the Committee requested the secretariat to continue to monitor these and other previously infected countries, and highlight to the Committee issues that pose a risk of international spread. The Committee requested an update on the situation in Somalia at its next meeting.

Based on the current situation regarding WPV1 and cVDPV, and the reports made by Afghanistan, DR Congo, Nigeria, Pakistan, and the Syrian Arab Republic, the Director-General accepted the Committee’s assessment and on 13 February 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 13 February 2018.
Global Certification Commission – GPEI
Special Meeting of the Global Commission for the Certification of the Eradication of Poliomyelitis (GCC) on Poliovirus Containment
Geneva, Switzerland, 23 – 25 October 2017
Release date [not identified] :: 15 pages
Summary of recommendations

  1. Role of GCC in containment

:: WHO should review GCC’s ToRs at the time of certification of eradication to determine GCC’s role in the post-certification period as the oversight body for containment.

  1. Reduction in the number of PEFs

:: WHO should continue to work with Member States so that only those facilities fulfilling critical national or international functions in countries and complying with secondary and tertiary safeguards (as and when required) enter the containment certification process.
:: Member States should coordinate and communicate closely with facilities to make them aware of the implications of becoming and remaining PEFs.
:: WHO should engage the Regional Directors to raise awareness of containment during the Regional Committee Meetings. This could be explored through the Global Policy Group http://www.who.int/dg/global-policy/en/.
:: Countries using PQ polio vaccines are recommended to accept the release certificate issued by the NRA of reference to avoid duplication of testing and use of PV material

  1. Completion of Phase I (Preparation for containment of poliovirus type 2) of GAPIII

:: GCC encourages the establishment of a standardized data collection and verification mechanism.
:: NCC/RCC reports need to clearly indicate where and when activities in Phase I have been completed, based on a standardized data collection and verification mechanism, so that, on the basis of equivalent data quality between regions, the GCC can declare global completion of Phase I.
:: The deadline for completion of Phase I for all PV2 is set at one year after the publication of the Guidance for non-poliovirus facilities to minimize risk of sample collections potentially infectious for polioviruses
:: GCC urges countries affected by ongoing transmission of cVDPV2 to repeat their inventories and destroy, transfer or contain PV2 materials after the outbreak is declared closed.
:: GCC requests RCCs to urge countries to complete the identification, destruction, transfer or containment (Phase I) of WPV1 and WPV3 materials by the end of Phase II.
:: GCC urges countries planning to designate facilities for the retention of WPV1 and WPV3 materials to weigh the risks and benefits of having such facilities and the commitments that will be required to comply with the primary (facility), secondary (population immunity) and tertiary (sanitation and hygiene) safeguards.
:: GCC requests a letter be prepared and distributed via Regional Offices formally acknowledging countries for the completion of Phase I of GAPIII.

  1. Acceleration of the implementation of the CCS process

:: WHO should consider an EB request for a WHA 2018 resolution urging countries hosting PEFs to accelerate the appointment of a competent NAC as soon as possible and no later than 31 Dec 2018, processing all CP applications as soon as possible and no later than 30 June 2019. After June 2019, new PEF applications will not be considered unless under exceptional circumstances GCC will review these dates in early 2018.
:: WHO should carry out a risk assessment of designated PEFs’ status to ensure that facilities at highest priority are entered into the CCS process as soon as possible.

  1. Coordination and oversight

:: The WHO secretariat needs to ensure coordination of information exchanges between the ECBS, CAG, CWG, SAGE, IHR EC, CMG, SC and the GCC
:: WHO should determine which group is best placed to advise CWG on requirements associated with secondary and tertiary safeguards.
:: A mechanism needs to be established for the CWG to obtain more frequent technical support from CAG for clarifications on the operationalization of GAPIII.

  1. GCC-CWG capacity

:: GCC requests WHO to expand the CWG membership.

  1. Containment criteria for global certification of eradication

:: The GCC recommends that facilities awarded a CP should begin the CC application process and only if absolutely needed, obtain an ICC for the shortest possible duration.

:: At the time of the declaration of WPV eradication, all facilities retaining WPVs should have a CC, and if not, have a time-limited ICC, with a clear end point for obtaining a CC agreed with the GCC.

  1. Containment breaches: public health management of breaches in PV containment

:: WHO should ensure GCC is also informed.

  1. Verification of compliance with GAPIII

:: The CWG should establish an agreement with NACs to enable verification of containment under routine working circumstances or when breaches or other exceptional situations arise, and to clarify the possible impact of a containment breach on the potential award/status of a containment certificate.

  1. Communication strategy for Certification and Containment

:: GCC encourages WHO to ensure that the new communication officer being recruited by WHO is assigned to cover both areas of Objective 3 of the Polio Eradication and Endgame Strategic Plan (PEESP, Certification and Containment)
:: GCC requests WHO to develop a communication strategy as soon as possible addressing Objective 3 of the PEESP
:: GCC recommends ensuring the containment communication strategy encourages risk elimination by destruction of PV materials. It should also address the long term nature of the commitment to host a PEF, including cost and personnel required.
Syria cVDPV2 outbreak situation report 34, 13 February 2018
Situation update 13 February 2018
[Editor’ text bolding]
:: No new cases of cVDPV2 were reported this week. The total number of cVDPV2 cases remains 74. The most recent case (by date of onset of paralysis) is 21 September 2017 from Boukamal district, Deir Ez-Zor governorate.
:: An inactivated polio vaccine (IPV) immunization round has successfully concluded in Damascus and Hasakah governorates, parts of Aleppo governorate and Jurmana district of rural Damascus as part of the second phase of the outbreak response. A total of 233,518 children aged 2-23 months received IPV, representing 71% of the estimated target. Activities are ongoing in accessible areas of Aleppo governorate.
:: A total of 1,456 children under 5 years have received mOPV2 in Hasakah governorate during the IPV vaccination round, as part of special strategies to reach children who were missed by mOPV2 vaccination in January.
:: Independent post campaign monitoring of the IPV campaign is ongoing in all areas that have completed the vaccination round.
:: The Emergency Committee under the International Health Regulations (IHR) was briefed this week on the cVDPV2 outbreak in Syria and the response to date.
   :: An orientation session was held this week with Syrian Arab Red Crescent (SARC) to strengthen the coordination and to refresh training on reporting of vaccine preventable diseases in inaccessible areas. SARC has been supporting the implementation of immunization activities for outbreak response, routine immunization and AFP surveillance. 


WHO Grade 3 Emergencies  [to 17 February 2018]
The Syrian Arab Republic
:: Syria cVDPV2 outbreak situation report 34, 13 February 2018
[See Polio above for detail]

:: WHO moves to contain Nigeria’s Lassa fever outbreak
13 February 2018, ABUJA – The World Health Organization is scaling up its response to an outbreak of Lassa fever in Nigeria, which has spread to 17 states and may have infected up to 450 people in less than five weeks.
From the onset of the outbreak, WHO Nigeria deployed staff from the national and state levels to support the Government of Nigeria’s national Lassa fever Emergency Operations Centre and state surveillance activities. WHO is helping to coordinate health actors and is joining rapid risk assessment teams travelling to hot spots to investigate the outbreak.
Between 1 January and 4 February 2018, nearly 450 suspected cases were reported, of which 132 are laboratory confirmed Lassa fever. Of these, 43 deaths were reported, 37 of which were lab confirmed…

WHO Grade 2 Emergencies  [to 17 February 2018]
No new announcements identified

UN OCHA – L3 Emergencies
The UN and its humanitarian partners are currently responding to three ‘L3’ emergencies. This is the global humanitarian system’s classification for the response to the most severe, large-scale humanitarian crises. 
:: Iraq: 2018 Humanitarian Response Plan Overview – February 2018 [EN/AR]  Published on 13 Feb 2018
Protection remains the overriding humanitarian priority during 2018

Syrian Arab Republic
:: 16 Feb 2018   Statement attributed to Ali Al-Za’tari, UN Resident and Humanitarian Coordinator in Syria, on the humanitarian situation in Nashabieh, East Ghouta…

:: 12 Feb 2018   Yemen Humanitarian Update Covering 5 – 11 February 2018

UN OCHA – Corporate Emergencies
When the USG/ERC declares a Corporate Emergency Response, all OCHA offices, branches and sections provide their full support to response activities both at HQ and in the field.
:: 12 Feb 2018  Ethiopia: Humanitarian Response Situation Report No.17 (January 2018)

:: ISCG Situation Update: Rohingya Refugee Crisis, Cox’s Bazar | 11 February 2018