H5N1

Philippines: Polio outbreak - Sep 2019

Via ReliefWeb, a report from the government of the Philippines: Philippines: Polio Outbreak - Sep 2019. Excerpt:

On 14 September 2019, VDPV2 was confirmed in one three-year-old child with Acute Flaccid Paralysis (AFP) symptoms, from Lanao del Sur (Mindanao). The isolated VDPV2 was found to be genetically linked to the 2 confirmed VDPV2 environmental samples. 

As a result, VDPV2 was classified as circulating (cVDPV2). On 19 September 2019, the Department of Health (DOH) confirmed the re-emergence of polio in the Philippines and declared a national polio outbreak, in line with International Health Regulations (IHR). 

Synchronized polio vaccination conducted in Manila in response to the 1st confirmed VDPV1 samples only reached 53.8% of the target number of children aged 0 to 59 months. (WHO, UNICEF, 19 Sep 2019) 

DOH, in close coordination with local government units and concerned national agencies, and with the support of WHO, the United Nations Children’s Fund (UNICEF), and other partners, is preparing a rapid response, including a series of synchronized oral polio vaccinations to protect every child under the age of 5 years in areas at risk beginning in October 2019. 

Nigeria: Kwara confirms cases of Lassa fever, yellow fever, polio

Via Punch: Kwara confirms cases of Lassa Fever, Yellow fever, Polio. Excerpt:

The Kwara State Government has confirmed two cases of Lassa Fever infecting a husband and wife in the state. 

The government also confirmed an outbreak of circulating Vaccine Derived Polio Virus which claimed the life of a two-year-old girl and a case of Yellow Fever infecting a farmer. 

Speaking with newsmen on Tuesday during at a news briefing, the Kwara Commissioner for Health, Alhaji Usman Rifun-Kolo said the outbreak of Lassa Fever was identified in a farm settlement in Taberu, Baruten Local Government Area. 

 He, however, explained that the two cases of the disease affected a husband and wife, who were natives of Benin Republic, which shares a border with the state. He added that the husband and wife are farming in Baruten. 

“These cases of Lassa Fever originated from Benin Republic, whose citizen have inter-relations with people in Baruten area,” he said. 

According to him, the husband and wife were diagnosed in a health facility, and that the state government had already deployed disease surveillance team to identify those who have been in contact with the patients.  

Rifun-Kolo further explained that the surveillance team identified four people with history of fever in the area.  

He said that the four cases raised suspicion of Lassa fever, which prompted them to take samples from the individuals for further investigation.

WHO: Polio - Democratic Republic of the Congo

WHO has published Poliomyelitis - Democratic Republic of the Congo. Excerpt:

As of October 2018, genetically-linked circulating vaccine-derived poliovirus type 2 (cVDPV2) isolates were detected in two cases from Haut-Katanga province (Mufunga-Sampwe district) in the Democratic Republic of the Congo. The first case was a 11-year old child who experienced onset of acute flaccid paralysis (AFP) on 6 October. The second case was a 29-month old child who experienced onset of symptoms on 7 October, and is a known contact of the first case. 

The isolated viruses are a new emergence and unrelated to previously-detected cVDPV2s affecting the country. This is the fourth distinct outbreak of cVDPV2 detected in the country since June 2017. In total, 42 cVDPV2 cases have now been confirmed since detection of the first outbreak in June 2017, 20 cases of which were detected in 2018. 

Public health response 

In February 2018, the government declared cVDPV2 to be a national public health emergency. On 26 July 2018, the Minister of Health, WHO Director General, the Regional Director for Africa, and provincial governors convened an urgent, high-level meeting and signed the ‘Kinshasa Declaration for Polio Eradication’. Provincial governors pledged to provide the necessary oversight, accountability and resources required to urgently improve the quality of the outbreak response being implemented across the country. It is imperative that the remaining operational gaps in outbreak response are urgently filled with the appropriate oversight and engagement. 

WHO and partners are responding in accordance with international outbreak response protocols including through administration of monovalent oral polio vaccine type 2 (mOPV2). However, operational gaps such as the under-immunization of high-risk populations, continue to hamper the full implementation of these protocols. Thus, the response so far has not adequately controlled the outbreak nor prevented its spread. 

The recent emergence of the fourth outbreak of cVDPV2 from Haut Katanga can potentially be attributed to the prior use of mOPV2 and may be related to the response program’s current limited capacity to adapt effectively and implement necessary corrective measures in a timely manner. 

With the evidence of geographic spread of some of these strains and emergence of the new strain, two large scale rounds of mOPV2 were administered in September 2018 and October 2018 targeting around 12 million children in 16 of 26 provinces of the country. Surveillance and immunization activities continue to be strengthened in the Democratic Republic of the Congo and neighboring countries. 

The polio outbreak response is being conducted simultaneously to the ongoing Ebola outbreak affecting North Kivu province to the east of the country. Polio outbreak response teams are coordinating closely with the broader humanitarian emergency network, to ensure both outbreaks are addressed in a coordinated manner.

Acute flaccid paralysis (AFP) surveillance: Challenges and opportunities from 18 years’ experience, Spain, 1998 to 2015

Via Eurosurveillance: Acute flaccid paralysis (AFP) surveillance: challenges and opportunities from 18 years’ experience, Spain, 1998 to 2015. The abstract:

Acute flaccid paralysis (AFP) surveillance is key for global polio eradication. It allows detecting poliovirus (PV) reintroductions from endemic countries. This study describes AFP surveillance in Spain from 1998 to 2015. During this time, 678 AFP cases were reported to the Spanish National Surveillance Network. 

The mean notification rate was 0.58 AFP cases/100,000 population under 15 years old (range: 0.45/100,000–0.78/100,000). Two periods (P) are described: P1 (1998–2006) with the AFP notification rate ranging from 0.66/100,000 to 0.78/100,000, peaking in 2001 (0.84/100,000); and P2 (2007–2015) when the AFP rate ranged from 0.43/100,000 to 0.57/100,000, with the lowest rate in 2009 (0.31/100,000). No poliomyelitis cases were caused by wild PV infections, although two Sabin-like PVs and one imported vaccine-derived PV-2 were detected. 

Overall, 23 (3.4%) cases met the hot case definition. Most cases were clinically diagnosed with Guillain–Barré syndrome (76.9%; 504/655). The adequate stool collection rate ranged from 33.3% (7/21) to 72.5% (29/40). The annual proportion of AFP cases with non-polio enterovirus findings varied widely across the study period. 

AFP surveillance with laboratory testing for non-polio enteroviruses must be maintained and enhanced both to monitor polio eradication and to establish sensitive surveillance for prompt detection of other enteroviruses causing serious symptoms.

Polio and vaccination: A memoir of what we’ve forgotten

The Tyee has published my article Polio and Vaccination: A Memoir of What We’ve Forgotten. Excerpt:

We’re seeing reports of a “polio-like” disease turning up in Canada and especially in the U.S. Acute flaccid paralysis is leaving kids partially or completely paralyzed, and parents are understandably scared. The U.S. reportedly has 60 cases so far this year, and Canada has perhaps 30.  

AFP and its subtype, acute flaccid myelitis, are even becoming a political issue: the right-wing American Association of Physicians and Surgeons warns about the “public health threat from uncontrolled immigration” and suggesting that the “caravan” of asylum seekers might be bringing AFP with them. 

As literally a one-in-a-million disease, AFP is a faint echo of poliomyelitis itself. But it comes at a time when we’ve forgotten how deadly childhood diseases can be, and many have even begun to question the vaccines that saved both them and their parents from death or lifelong impairment.  

Seventy years ago this month, I was seven years old, running a fever, and unable to touch my chin to my chest. Every parent in 1948 knew those were likely symptoms of polio, and that same afternoon I was in a downtown hospital for tests. They showed I was indeed one of over 20,000 polio cases in the U.S. that year.  

My memories of the next two weeks are fragmentary but vivid. I’m carried on the shoulder of a tall black man to undergo a spinal tap — not a funny phony band, but my first experience of real pain. I’m in a ward with other kids, each of us in a crib — a crib! — learning to use bedpans and suffering the further indignity of having our temperatures taken rectally. Drop a comic book through the crib slats to the floor, and it’s gone forever.

Every day we lie on our stomachs in our cribs while “hot packs” — steaming-hot blankets — are piled on us. This is state-of-the-art therapy for polio patients.  

Toward the end of my hitch, I’m taken from my crib in a wheelchair, plunked into a bathtub and sloshed with green disinfectant soap. Then I’m taught how to walk again. After two weeks in a crib, it’s not easy.  

Finally back home, I begin to understand that I am really lucky. Other kids have died, or been trapped for life in iron lungs that keep them breathing. When I’m back in school, I see a girl with a brace on one leg from her own case of polio. She’s not the last.

WHO: Circulating vaccine-derived poliovirus type 2 – Niger

WHO has published Circulating vaccine-derived poliovirus type 2 – Niger. Excerpt:

From July through September 2018, six cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) were reported from Niger, genetically linked to a cVDPV2 case in Jigawa and Katsina States, Nigeria. The virus was isolated from children with acute flaccid paralysis (AFP) from Zinder region, located in the south of Niger and on the border with Nigeria, with dates of onset of paralysis ranging from 18 July through 16 September 2018. This outbreak has also affected Jigawa, Katsina, Yobe, Gombe, and Borno states in Nigeria, with 17 cases reported since April 2018. 

Nigeria has also reported a separate cVDPV2 outbreak in Sokoto State that dates back to January 2018. Nigeria is one of only three countries in the world classified as endemic for wild poliovirus, along with Afghanistan and Pakistan. 

As part of the polio outbreak response in the Lake Chad Basin countries (Cameroon, the Central African Republic, Chad, Niger and Nigeria) the last monovalent oral polio vaccine type 2 (mOPV2) round was implemented in Niger in January 2017.  

Public health response 

The outbreak response plan is being finalized to include the outbreak zone most at risk and the exact scale and extent of the response is being determined.  

• Two mOPV2 response vaccination campaigns will reach 3.2 million children under five years of age in four provinces in Niger (Agadez, Diffa, Maradi and Zinder). The first round took place from 24 through 27 October 2018 and the second is scheduled for 7 through 11 November 2018. 

• Acute flaccid paralysis surveillance and routine immunization across the country with focus on the infected provinces and the provinces at the international borders with Nigeria are being reinforced. 

• WHO and its partners are continuing to support local public health authorities in conducting field investigations and risk assessments to more clearly assess risk of the identified cVDPV2 and to conduct additional response measures as appropriate and necessary. 

• Active case finding for additional AFP cases is continuing, and additional surveillance measures such as increasing the frequency and extent of environmental surveillance and community sampling of healthy individuals is being expanded. 

• WHO is supporting the Ministry of Health to strengthen the risk communication and community engagement. 

• WHO in collaboration with the Ministry of Health are working together to finalize the deployment of the human resources needed at national and provincial levels.

Cases of rare, polio-like paralysis targeting kids appear in Canada

Via CBC News: Cases of rare, polio-like paralysis targeting kids appear in Canada. Excerpt:

Last week, the U.S. Centers for Disease Control reported a small surge in cases of a mysterious disease in children. More than 60 cases of the polio-like illness have been confirmed in 22 U.S. states in recent weeks. Now, doctors in Toronto say they're seeing cases appear in Canada.  

"I can confirm that since September, we have certainly seen an increase of patients with muscle weakness who also had a preceding viral illness," said Dr. Jeremy Friedman, associate pediatrician-in-chief at the Hospital for Sick Children. "These symptoms are typical of acute flaccid paralysis (AFP) and increases of similar cases have been reported by many other North American pediatric centres." 

Doctors do not know what causes the ailment, nor are they sure why more cases have been reported recently. Children are the victims in the vast majority of cases and doctors are not exactly sure why.

Dr. Friedman would not give an exact figure on the number of new cases in Canada, but did say SickKids has seen "fewer than 20 probable cases of AFP."  

Canada has systems in place, led by the Public Health Agency of Canada, to look for cases of sudden onset muscle weakness in children.  

Last Thursday, Public Health Agency of Canada spokesperson Anna Maddison said in an email there were fewer than five cases of acute flaccid myelitis (AFM), a subtype of AFP, reported from January to August 2018. 

On Monday, the agency provided an update based on the broader definition of AFP.   

"To date in 2018, 25 probable cases and five confirmed cases of sudden onset muscle weakness in children have been reported. This reporting includes a variety of conditions related to sudden onset muscle weakness in children," said Maddison, who also serves as a spokesperson for Health Canada, said in an email.  

"Currently, the surveillance data do not indicate an increase in the number of potential cases in Canada."  

The agency also said it is enhancing real-time surveillance of AFP based on the increase reported in the U.S. 

WHO: Circulating vaccine-derived poliovirus type 2 – Nigeria

WHO has published Circulating vaccine-derived poliovirus type 2 – Nigeria. Excerpt:

On 5 June 2018, a circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak was confirmed in Sokoto State, Nigeria. From 30 January through 23 May 2018, ten environmental samples collected from two collection sites all tested positive for genetically-related VDPV2 viruses. No associated cases of acute flaccid paralysis (AFP) have been detected with this cVDPV2.  

Nigeria is also affected by an ongoing separate cVDPV2 outbreak. A cluster of cVDPV2 was detected in Yobe State from a stool sample from an AFP case with onset on 16 June 2018, and an environmental sample collected on 31 May 2018. The same cVDPV2 was detected in Gombe State from an environmental sample collected on 9 April 2018. Previously, the same cVDPV2 was detected in Jigawa State from an AFP case with onset of paralysis on 15 April 2018 and six environmental samples collected from 10 January through 2 May 2018. 

Public health response 

Detailed investigations were conducted within 48 hours of virus detection from the AFP cases and at each of the different environmental surveillance catchment areas. In addition, the detailed investigation included the search of any residual trivalent oral polio vaccine (OPV) and/or monovalent OPV type 2 (mOPV2), a community coverage survey, health facility retrospective case searching and community active case searching for acute flaccid paralysis, and healthy children stool sampling. 

In May 2018, two rounds of an outbreak response with mOPV2 were organized in 54 Local Government Areas in Jigawa, Bauchi, Gombe and Sokoto States, to address the two cVDPV2 outbreaks at the same time. Surveillance enhancement activities as well as routine immunization intensification activities were implemented and are ongoing.  

Since September 2016, there has been no detection of either wild poliovirus type 1 or cVDPV2 in Borno State. However, a regional public health emergency across the Lake Chad subregion remains in place, following detection of both strains in 2016. Borno State continues to be affected by inaccessibility in some areas, hampering access for both vaccinations and surveillance. 

WHO risk assessment 

A risk assessment that was carried out prior to the outbreak response concluded that there was a high risk of geographical spread of the two outbreak virus strains. The detection of these cVDPV2 strains underscores the importance of maintaining high levels of routine polio vaccination coverage at all levels to minimize the risk and consequences of any poliovirus circulation.

NCDC epidemiological report, week 25

NCDC has published its Weekly Epidemiological Reports, Week 25.

PRIORITISING NIGERIA’S LASSA FEVER RESEARCH AND DEVELOPMENT ROAD-MAP 

Between January and May 2018, Nigeria experienced its largest reported outbreak of Lassa fever. In responding to the outbreak, critical questions were raised concerning the disease for which answers were either not readily available or required additional validation. 

In this regard, the Nigeria Centre for Disease Control (NCDC) has taken a leadership role to build a Research and Development (R&D) roadmap for Lassa fever in Nigeria.  

To bring the roadmap into reality, a National Lassa fever R&D Stakeholders meeting was convened between the 3rd and 4th of July 2018 in Abuja. The participants at this meeting included case management physicians from the various Lassa fever treatment centres, local and international researchers, partners including the World Health Organization and the host, NCDC. 

The meeting was aimed at identifying the key research areas for Lassa fever, developing research objectives and plans for each area and engaging partners for research implementation. The main areas of research cut across epidemiology of Lassa fever, case management, vector transmission, laboratory diagnosis and risk communications. 

The next few weeks will involve finalising the plans and mapping out resources for the research.  

The outcomes of these activities will help define the landscape with improved knowledge about Lassa fever, guide preparedness and response activities for future outbreaks and drive control/prevention measures for the disease. 

SUMMARY OF REPORTS 

In the reporting week ending on June 24, 2018: 

o There were 125 new cases of Acute Flaccid Paralysis (AFP) reported. None was confirmed as Polio. The last reported case of Polio in Nigeria was in August 2016. Active case search for AFP is being intensified as Nigeria has reinvigorated its efforts at eradicating Polio. 

o 828 suspected cases of Cholera were reported from 34 LGAs in 12 States (Adamawa – 29, Bauchi – 183, Borno – 27, FCT – 2, Gombe – 41, Jigawa – 13, Kaduna – 11, Kano – 110, Katsina – 45, Kogi – 4, Plateau - 24 & Zamfara - 339). Of these, nine were laboratory confirmed and nine deaths were recorded. 

o 24 suspected cases of Lassa fever were reported from nine LGAs in six States (Adamawa – 1, Edo – 9, Gombe – 1, Ondo – 8, Osun - 2 & Plateau – 2). Six were laboratory confirmed and two deaths were recorded.  

o There were 16 suspected cases of Cerebrospinal Meningitis (CSM) reported from 12 LGAs in eight States (Abia -1, Ebonyi – 1, Gombe – 1, Kaduna – 4, Katsina – 4, Oyo – 1, Taraba – 2 & Yobe - 2). Of these, two were laboratory confirmed and no death was recorded.  

o There were 222 suspected cases of Measles reported from 33 States. No laboratory confirmed and no death was recorded. 

In the reporting week, all States sent in their report except Taraba State. Timeliness of reporting remains 89% in both the previous and current weeks (week 24 & 25) while completeness also remains 99% at same period. It is very important for all States to ensure timely and complete reporting at all times, especially during an outbreak.

WHO: Circulating vaccine-derived poliovirus type 2 – Democratic Republic of the Congo

WHO has published Circulating vaccine-derived poliovirus type 2 – Democratic Republic of the Congo. Excerpt:

In the Democratic Republic of the Congo, three different circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreaks have been detected in acute flaccid paralysis (AFP) cases. In February 2018, the government declared cVDPV2 to be a national public health emergency.  

The cVDPV2 strain initially detected and reported in June 2017 from Haut Lomami Province spread in late 2017 and early 2018 to Tanganyika and Haut Katanga provinces, respectively. The same virus was confirmed in Ituri Province in June 2018, close to the border with Uganda, from an AFP case with onset of paralysis on 5 May 2018. Investigations are ongoing. 

WHO assessed the overall public health risk at the national level to be very high and the risk of international spread to be high due to the proximity of the recent detection of the AFP case in Ituri which is close to an international border and with known population movement.  

Maniema Province is affected by a separate cVDPV2 outbreak, with two cases confirmed in 2017. The date of onset of paralysis of the most recent case was 18 April 2017. So far, no new cases have been detected in 2018, and there is no evidence that this virus has spread further geographically. 

The third and most recently detected outbreak of cVDPV2 was found in Mongala Province and isolated from an AFP case in the Yamongili Health Zone. The onset date of paralysis was 26 April 2018. Circulation of the strain was confirmed when the same strain was isolated in stool specimens from two healthy community contacts.

Public health response 

WHO and partners are responding to these outbreaks, including through the use of monovalent oral polio vaccine type 2 (mOPV2) in line with internationally-agreed upon outbreak response protocols. However, operational gaps in the response continue to hamper the full implementation of these protocols, as high-risk populations remain under-immunized, and the response thus far has not controlled the outbreak nor prevented its spread. 

The geographic extent of the outbreak response to all three strains is now being re-evaluated, given the confirmed spread of one of the strains to Ituri and confirmation of the new strain in Mongala. 

Surveillance and immunization activities are being strengthened in neighbouring countries.  

In February 2018, the government declared cVDPV2 to be a national public health emergency. The remaining operational gaps in the outbreak response must be urgently addressed.