Public Health Emergency of International Concern (PHEIC)
Polio this week as of 27 November 2018 [GPEI]
Summary of new viruses this week:
Afghanistan – advance notification of one wild poliovirus type 1 (WPV1) case and six positive WPV 1 environmental samples
Pakistan – two WPV1 positive environmental samples.
Niger – one case of circulating vaccine-derived poliovirus type 2 (cVDPV2).

Statement of the Nineteenth IHR Emergency Committee Regarding the International Spread of Poliovirus
30 November 2018
[Excerpts; Editor’s text bolding]
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…

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 cross ­border cooperation is required to respond to these risks, as much international spread of polio occurs over land borders.

…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…


Editor’s Note:
WHO has posted a refreshed emergencies page which presents an updated listing of Grade 3,2,1 emergencies as below.

WHO Grade 3 Emergencies  [to 1 Dec 2018]
Democratic Republic of the Congo
:: Malaria control campaign launched in Democratic Republic of the Congo to save lives and aid Ebola response
28 November 2018 | BENI: A spike in malaria cases is threatening the health of people in parts of the eastern Democratic Republic of the Congo (DRC) where health workers are also battling an Ebola outbreak.  In response, a four-day mass drug administration (MDA) campaign was launched today in the Northern Kivu province town of Beni, with a target to reach up to 450 000 people with anti-malarial drugs combined with the distribution of insecticide-treated mosquito nets…
:: 17: Situation report on the Ebola outbreak in North Kivu  28 November 2018
:: DONs Ebola virus disease – Democratic Republic of the Congo   29 November 2018
[See Milestones above for more detail]

Bangladesh – Rohingya crisis
:: Weekly Situation Report 52 -22 November 2018
Key Highlights
… The fourth round of oral cholera campaign was launched on 17 November 2018 under the leadership of DGHS in collaboration WHO, UNICEF and other health sector partners.
Syrian Arab Republic
:: WHO update on reported chemical event in Aleppo, Syria   29 November 2018

Myanmar – No new announcements identified
Nigeria – No new announcements identified
Somalia – No new announcements identified
South Sudan – No new announcements identified
Yemen – No new announcements identified


WHO Grade 2 Emergencies  [to 1 Dec 2018]
:: WHO and health partners step up efforts to provide urgent support for victims of flooding in Iraq   26 November 2018
Brazil (in Portugese) – No new announcements identified
Cameroon  – No new announcements identified
Central African Republic  – No new announcements identified
Ethiopia – No new announcements identified
Hurricane Irma and Maria in the Caribbean – No new announcements identified
occupied Palestinian territory – No new announcements identified
Libya – No new announcements identified
MERS-CoV – No new announcements identified
Niger – No new announcements identified
Sao Tome and Principe Necrotizing Cellulitis (2017) – No new announcements identified
Sudan – No new announcements identified
Ukraine – No new announcements identified
Zimbabwe – No new announcements identified

WHO-AFRO: Outbreaks and Emergencies Bulletin, Week 46: 1- 23 November 2018
The WHO Health Emergencies Programme is currently monitoring 53 events in the region. This week’s edition covers key ongoing events, including:
:: Ebola virus disease in the Democratic Republic of the Congo
:: Anthrax (suspected) in Namibia
:: Measles in Madagascar
:: Typhoid fever in Zimbabwe
:: Humanitarian crisis in Mali.


WHO Grade 1 Emergencies  [to 1 Dec 2018]
Indonesia – Sulawesi earthquake 2018
Lao People’s Democratic Republic
Namibia – viral hepatitis
Philippines – Tyhpoon Mangkhut
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. 
YemenNo new announcements identified.
Syrian Arab Republic   No new announcements identified.


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.
:: Ethiopia: Humanitarian Response Situation Report No.19 (November 2018) 26 Nov 2018

Somalia  – No new announcements identified.

“Other Emergencies”
Indonesia: Central Sulawesi EarthquakeNo new announcements identified.