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Polio Emergency Alert Extended For 3-Months

Don Hackett — Wed, 08 Jul 2020 12:11:19 +0000

Reviewer:

The World Health Organization (WHO) Polio Emergency Committee recommended that the international risk of poliovirus spread remains a Public Health Emergency of International Concern (PHEIC) under the International Health Regulations during a June 23, 2020, meeting.

The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine-derived polioviruses (cVDPV).

The global situation remains of great concern with the increased number of WPV1 cases that started in 2019 continuing in 2020.

This year, there have been 70 WPV1 cases as of June 16, 2020, compared to 57 for the same period in 2019.

The Committee noted that based on results from the sequencing of WPV1, there were recent instances of international spread of viruses from Pakistan to Afghanistan and from Afghanistan to Pakistan.

The ongoing frequency of WPV1 international spread between the two countries and the increased vulnerability in other countries where routine immunization and polio prevention activities have both been adversely affected by the COVID-19 pandemic are major factors that suggest the risk of international spread may be at the highest level since 2014.

And, during 2020, West Africa and Ethiopia have reported experiencing high levels of transmission of circulating vaccine-derived poliovirus type-2 (cVDPV2), and due to the coronavirus pandemic, with many areas that have reported cases recently not having had an immunization response.

The WHO’s Director-General Tedros Adhanom Ghebreyesus, Ph.D., accepted the committee's recommendations on July 3, 2020, to extend the Temporary Recommendations for a further 3-months.

Dr. Tedros’s remarks included: ‘that while there has been amazing progress on wild poliovirus in Africa, there is still much more work to do to end transmission in Pakistan and Afghanistan.

Similarly, the significantly greater than the expected number of cVDPV2 outbreaks are another major challenge.

At the same time, the polio infrastructure that has been developed in Pakistan and Afghanistan has been used to assist with the tracking and tracing as part of the COVID-19 pandemic response.

He also remarked that the novel oral polio vaccine type-2, which will be made available under the Emergency Use Listing procedure (EUL), is expected to be an important new tool to stop the vicious cycle of using monovalent Sabin OPV2 to combat outbreaks, but in turn, seeding new outbreaks of cVDPV2.’

In Pakistan transmission continues to be widespread, as indicated by both acute flaccid paralysis (AFP) surveillance and environmental sampling.

WPV1 transmission continues to be widespread, with southern Khyber Pakhtunkhwa becoming a new WPV1 reservoir and some areas such as Karachi and the Quetta block having uninterrupted transmission.

There has also been an expansion of WPV1 to previously polio-free areas in Sindh and Punjab.

In Afghanistan, the inaccessibility and missed children particularly in the Southern Region have led to a large cohort of susceptible children in this part of Afghanistan.

The risk of a major upsurge of cases is growing, with other parts of the country that have been free of WPV1 for some time now at risk of outbreaks.

The number of provinces reporting WPV1 has increased from three in 2019 to 11 in 2020.

This would again increase the risk of international spread.

While border closures and lockdowns may mitigate the risk in the short term while in force, this would be outweighed in the longer term by falling population immunity through disruption of vaccination and the resumption of normal population movements.

The Committee repeated its strong support for 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.

The Committee recognizes the concerns regarding the lengthy duration of the polio PHEIC but concludes that the current situation is extraordinary, with clear ongoing and increasing risk of international spread and ongoing need for a coordinated international response.

To advise international travelers, the U.S. Centers for Disease Control and Prevention (CDC) issued a Level 2 Travel Alert on April 20, 2020. This Practice Enhanced Precautions Alert confirms there are polio outbreaks in several countries in Africa.

The CDC recommends that before traveling to these countries, adults who completed their routine polio vaccine series as children should receive a single, lifetime adult booster dose of polio vaccine, and administering an inactivated poliovirus vaccine (IPV) booster dose, which has been the only polio vaccine offered in the USA since 2000.

There are various IPV vaccines available in the USA, such as Kinrix and Pediarix.

Vax-Before-Travel publishes polio outbreak news.

Sub Title:

Polio outbreaks in Ethiopia, Afghanistan, and Pakistan concern the WHO Polio Emergency Committee

References:

WHO: Statement of the twenty-fifth polio IHR Emergency Committee

CDC: Polio in Africa

Polio Outbreak Alert Issued For Certain African Countries

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Polio Outbreak Alert Issued For Certain African Countries

Danielle Reiter RN — Fri, 14 Feb 2020 13:31:39 +0000

Reviewer:

Robert Carlson, MD

Holly Lutmer PharmD

According to an updated Centers for Disease Control and Prevention (CDC) Travel Alert there is an increased health risk when visiting certain African countries in 2020.

The CDC said in a Level 2 Travel Alert published on February 11, 2020, that ‘there are confirmed polio outbreaks in various countries primarily located in central and eastern Africa.’

This ‘Practice Enhanced Precaution’ Travel Alert says ‘before departure abroad, travelers going to countries in Africa with circulating poliovirus who have completed their routine polio vaccine series, but who have not already received an adult booster dose, the CDC recommends administering an inactivated poliovirus vaccine (IPV) booster dose.’

The IPV has been the only polio vaccine offered in the USA since 2000.

This polio vaccine is given by a shot in the leg or arm, at 4 different times, depending on the patient’s age.

In the USA, there are various IPV vaccines available, such as Kinrix and Pediarix.

Once vaccinated, your vaccine provider should supply you with an International Certificate of Vaccination or Prophylaxis Yellow Card. This will serve as your official documentation of polio vaccination when arriving at your destination.

The CDC has identified these 15 countries in the reissued, Level 2 Travel Alert:

Angola
Benin
Burkina Faso
Cameroon
The Central African Republic
Chad
The Democratic Republic of the Congo
Ethiopia
Ghana
Mozambique
Niger
Nigeria
Somalia
Togo
Zambia

According to the CDC, the United States has been polio-free since 1979.

Polio is a crippling and potentially deadly disease that affects the nervous system.

But, most people with polio do not feel sick, says the CDC.

Some people have only minor symptoms, such as fever, tiredness, nausea, headache, nasal congestion, sore throat, cough, stiffness in the neck and back, and pain in the arms and legs.

In rare cases, polio infection causes permanent loss of muscle function. Polio can be fatal if the muscles used for breathing are paralyzed or if there is an infection of the brain, says the CDC.

Because the virus lives in the feces of an infected person, people infected with the disease can spread it to others when they do not wash their hands well after defecating.

People can also be infected with polio if they drink water or eat food contaminated with infected feces.

There was good news reported during 2019 regarding the elimination of 2 out of 3 polio types.

An independent commission of experts concluded during October 2019, that wild poliovirus type 3 (WPV3) has been ‘eradicated’ around the world.

This announcement follows the earlier eradication of wild poliovirus type 2 during 2015.

Prior to traveling abroad, medication and vaccine counseling appointments can be scheduled with a travel specialist at Vax-Before-Travel.

Polio vaccine news published by Vax-Before-Travel.

Sub Title:

An inactivated poliovirus vaccination suggested before visiting African countries with outbreaks

Reference:

CDC: Polio in Africa

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CDC Alert - Level 2, Practice Enhanced Precautions

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Polio Case Confirmed in Malaysia

Danielle Reiter RN — Sun, 08 Dec 2019 17:26:38 +0000

Reviewer:

Robert Carlson, MD

Holly Lutmer PharmD

According to local media reporting, the Malaysian Health Ministry has confirmed the 1st local polio case in a local child under 1 year of age.

"The Health Ministry regrets to inform there has been a confirmed case of poliovirus infection in Malaysia,” said director-secretary Dr. Noor Hisham Abdullah, on December 8, 2019.

Dr. Noor Hisham confirmed that the toddler was suffering from circulating vaccine-derived poliovirus type 1 (cVDPV 1).

He said cVDPV 1 originates from a weakened poliovirus used in vaccines administered orally. And the weakened virus can still appear in the feces of those who consume the vaccine but those who have been vaccinated are immune.

Dr. Noor Hisham said an investigation showed that 23 out of 199 children aged 2-months to 15-years-old in the area where the case was discovered, or 11.6 percent, had not been vaccinated.

"This is a concerning situation as the spread of cVPDV can only be stopped through polio immunization.”

“As a result of a validation test conducted by the World Health Organisation Polio Regional Laboratory in Australia, the virus is linked to the poliovirus detected in the Acute Flaccid Paralysis case in the Philippines,” Dr. Noor Hisham said. This is the first polio case in about 27 years.

As of December 8th, there are have not been any travel alerts issued for Malaysia regarding polio.

During January 2018–June 2019, cVDPV type 1 (cVDPV1) circulation was detected in Indonesia, Myanmar, and Papua New Guinea.

The World Health Organization (WHO) did announce some good news in October 2019 when another strain of polio, WPV3, was deemed eradicated, leaving just one strain left to eliminate, the WPV1.

Poliomyelitis is a crippling infectious disease caused by a virus that spreads from person to person, invading the brain and spinal cord, which can lead to paralysis, says the US Centers for Disease Control and Prevention (CDC).

If a population is seriously under-immunized, vaccine-derived poliovirus can begin to circulate in a community.

One suggestion to stop polio outbreaks would be to discontinue administering the live oral vaccine and switch to the not-live, injectable vaccine, currently used in the USA.

The CDC recommends that all travelers to polio-affected areas be fully vaccinated against polio with an IPV. Even if you were vaccinated as a child or have been sick with polio before, you may need a polio vaccine booster dose to make sure you are protected, says the CDC.

In the USA, there are various polio vaccines available, such as Kinrix and Pediarix. IPV vaccination has not been known to cause serious problems, but side effects are a potential risk, says the CDC.

Once vaccinated, your doctor should provide you with an International Certificate of Vaccination or Prophylaxis yellow card. This will serve as your official documentation of vaccination against polio.

In addition to polio warnings, the CDC has issued Measles Travel Alerts for Malaysia in 2019.

Prior to traveling abroad, vaccine counseling appointments can be scheduled with a travel specialist at Vax-Before-Travel.

Polio vaccine news published by Vax-Before-Travel.

Sub Title:

Polio cVDPV type 1 circulation detected in Indonesia, Myanmar, and Papua New Guinea during 2019

References:

Malaysia records first polio case after 27 years

CDC: Malaysia

CDC: Updte on Vaccine-Derived Poliovirus outbreaks- Worldwide, January 2018-June 2019

Pakistan’s Wild Polio Problem Found in the Water

Polio makes comeback in Malaysia

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Pakistan’s Wild Polio Problem Found in the Water

Danielle Reiter RN — Sun, 17 Nov 2019 02:12:41 +0000

Reviewer:

Robert Carlson, MD

Danielle Reiter, RN

Throughout 2019, cases of wild polio have increased relative to 2018, and outbreaks of vaccine-derived polio continue to spread across Africa and Asia.

Poliomyelitis is a crippling infectious disease caused by a virus that spreads from person to person, invading the brain and spinal cord, which can lead to paralysis.

If a population is seriously under-immunized, vaccine-derived poliovirus can begin to circulate in a community.

Such as in Pakistan.

According to the Global Polio Eradication Initiative (GPEI) report published on November 14, 2019, Pakistan vaccinated about 6 million children this year.

But, during early November, 2 wild poliovirus type 1 (WPV1) cases were confirmed, increasing Pakistan's 2019 total to 82 cases, which is a significant increase from 12 totals cases last year.

Of the WPV1 cases with onset during January 2018–September 2019, (73%) were from the Khyber Pakhtunkhwa, (11%) from Balochistan, (11%) from Sindh, and (6%) from Punjab provinces.

In addition, the US Centers for Disease Control and Prevention (CDC) MMWR report published on November 15, 2019, said ‘the sharp rise of polio activity in Pakistan is due to a combination of factors.’

The Pakistan polio eradication program has undertaken a series of management, community engagement, and epidemiologic reviews that have identified various gaps needing urgent attention.

Gaps such as the spread of false information, particularly through social media (vaccine contains pork products) have increased community resistance to vaccination programs.

Moreover, the CDC noted in this report that ‘WPV1 has been widely detected in 51 sewage samples.’ Not only in the major water reservoir areas in 3 provinces but also among other districts and provinces across Pakistan.

Approximately 45 percent of all environmental sites tested were positive for WPV1 in 2019, compared with just 15 percent during the same period in 2018.

This data indicates the WPV1 is now found in the environment and Pakistani children are at serious risk.

While starting to address these issues, the Pakistan polio vaccination program has suspended supplementary immunization activities (SIA) in core reservoirs until December 2019, reports the CDC.

The CDC says the current status of polio eradication in Pakistan has serious global implications, with the increased risk for WPV1 spreading beyond Pakistan’s borders is high.

Stopping WPV1 transmission in Pakistan will also require continuing cross-border coordination with Afghanistan. During September 2019, cross-border teams vaccinated 164,692 children, says the GPEI.

The Pakistan polio eradication program has grown complex in its management and the operational organization says the CDC.

A management review in Karachi revealed overlapping terms of reference, delayed availability of information, systematic gaps in managerial oversight of decisions and activities, and an overall failure in staff members’ accountability when implementing SIAs (McKinsey and Company, unpublished report, 2019).

This review concluded that meeting programmatic challenges might require managerial restructuring so that decision-making, oversight, and future implementations occur as “One Team.”

‘The goal of interrupting WPV1 transmission in Pakistan is achievable but will require the full and rapid implementation of Technical Advisory Group recommendations to improve program management and operational effectiveness’ concluded this CDC report.

One suggestion to stop these WPV1 outbreaks would be to discontinue administering the live oral vaccine and switch to the not-live, injectable vaccine, currently used in the USA.

The inactivated polio vaccine (IPV) is the only polio vaccine that has been given in the USA since 2000. IPV is given by a shot in the leg or arm, at 4 different times, depending on the patient’s age. The CDC recommends that all travelers to polio-affected areas, such as Pakistan, be fully vaccinated against polio with an IPV.

Even if you were vaccinated as a child or have been sick with polio before, you may need a polio vaccine booster dose to make sure you are protected, says the CDC.

Therefore, the strategy to eradicate polio is based on prevention by immunizing children to stop the transmission and make the world polio-free.

The World Health Organization (WHO) did announce some good news in October 2019 when another strain of polio, WPV3 was deemed eradicated, leaving just one strain left to eliminate, the WPV1.

In the USA, there are various polio vaccines available, such as Kinrix and Pediarix. IPV vaccination has not been known to cause serious problems, but side effects are a potential risk, says the CDC.

Furthermore, if you will be in Pakistan for more than 4 weeks, the government of Pakistan may require you to show proof of polio vaccination when you are exiting the country.

To meet this requirement, you should receive a polio vaccine between 4 weeks and 12 months before the date you are leaving Pakistan.

In addition to polio warnings, the CDC has issued Dengue, Measles, and Typhoid Travel Alerts for Pakistan in 2019.

Prior to traveling abroad, vaccine counseling appointments can be scheduled with a travel specialist at Vax-Before-Travel.

The Global Polio Eradication Initiative is a public-private partnership led by national governments with five core partners - the World Health Organization (WHO), Rotary International, the US CDC, the United Nations Children’s Fund (UNICEF) and the Bill & Melinda Gates Foundation. Its goal is to eradicate polio worldwide

Polio vaccine news published by Vax-Before-Travel.

Sub Title:

In Pakistan about 45 percent of environmental sites tested were positive for WPV1 in 2019

References:

CDC: Polio

Polio this week as of 13 November 2019

CDC: Update on Vaccine-Derived Poliovirus Outbreaks — Worldwide, January 2018–June 2019

CDC: Progress Toward Poliomyelitis Eradication — Pakistan, January 2018–September 2019

CDC: Health Information for Travelers to Pakistan

UK to Fund Vaccinating 750 Children Per Minute Against Polio

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