Emergencies – POLIO

Emergencies

POLIO
Public Health Emergency of International Concern (PHEIC)

Polio this week as of 08 April 2020
Summary of new viruses this week (AFP cases and ES positives):
:: Pakistan: one WPV1 case and 16 WPV1 positive environmental samples
:: Ghana: three cVDPV2 positive environmental samples
:: Central African Republic – one cVDPV2 case
:: Burkina Faso: two cVDPV2 cases
:: Côte d’Ivoire: one cVDPV2 case and two cVDPV2 positive environmental samples

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Statement of the Twenty-Fourth IHR Emergency Committee
8 April 2020 Statement
The Twenty-fourth meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) on the international spread of poliovirus was convened by the Director General on 26 March 2020 with committee members only attending via teleconference, supported by the WHO Secretariat…
Reports were received from Afghanistan, Burkina Faso, Central African Republic, Cote d’Ivoire, Democratic Republic of Congo (DR Congo), Ethiopia, Ghana, Pakistan, and Philippines.
The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV).  The WHO Secretariat presented a report of progress for affected IHR States Parties subject to Temporary Recommendations.

Wild poliovirus
The Committee remains gravely concerned by the significant increase in WPV1 cases globally in 2019 and 2020, with 175 cases in 2019 compared to 33 in 2018, and already 32 cases as at 17 March 2020, compared to six for the same period in 2019, with no significant success yet in reversing this trend…

Vaccine derived poliovirus (VDPV)
The multiple circulating VDPV (cVDPV) outbreaks in four WHO regions (African, Eastern Mediterranean, South-east Asian and Western Pacific Regions) are very concerning, with two new countries reporting outbreaks since the last meeting (Malaysia and Burkina Faso).  Unlike historical experience, cross border spread of cVDPV2 has become quite common, with recent spread from Angola to DR Congo and Zambia, and from Chad and CAR to Cameroon, and from Ghana to Burkina Faso.  In addition, local emergences attributable to mOPV2 use have recently occurred in Togo, Chad and Ethiopia.
The Committee noted that the GPEI has published a strategy to address cVDPV2 outbreaks but was extremely concerned that the monovalent OPV2 stockpile was still depleted.  The Committee strongly supports the development and proposed Emergency Use Listing of the novel OPV2 vaccine which should become available mid-2020, and which it is hoped will result in no or very little seeding of further outbreaks.

Impact of COVID-19
The Committee noted the very recent policy guidance of the GPEI:
:: GPEI recommendations for countries during the COVID-19 pandemic. This document summarizes the recommendations from the Polio Oversight Board meeting on 24 March 2020 which calls for postponement of both preventive and outbreak response campaigns, while ensuring surveillance and nOPV2 development and roll out plans continue in full.
:: The COVID-19 Polio programme continuity plan. The operational guide was developed in collaboration with the regional polio eradication teams and the GPEI Partners to ensure essential GPEI functions continue, polio programme personnel and staff are kept safe, and to plan for a fast and effective resumption of polio eradication activities including supplementary immunization activities as soon as the public health situation with COVID-19 allows.
The Committee is extremely concerned about the impact of the COVID-19 pandemic on the risk of heightened transmission of polio and consequently the potential for international spread and significant reversal of polio eradication.     

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.  However noting that some if not many international borders are closed to prevent  international spread of COVID-19, State Parties may not currently be able to enforce the Temporary Recommendations in all places. The Committee strongly urges countries subject to these recommendations to maintain a high state of readiness to implement them as soon as possible ensuring the continued safety of travelers as well as health professionals .  The Committee recognizes the concerns regarding the lengthy duration of the polio PHEIC, but concludes that the current situation is extraordinary, with clear ongoing risk of international spread and ongoing need for coordinated international response…

…Based on the current situation regarding WPV1 and cVDPV, and the reports provided by affected countries, the Director-General accepted the Committee’s assessment and on 7 April 2020 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 7 April 2020.