Polio Bulletin 2015 Issue No Week 37 (as of 14 September 2015)

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1 HIGHLIGHTS Implementa on of Polio Endgame Strategy in the WHO region for Western Pacific (Update on progress as of 15 September 2015) According to the global Polio Eradica on and Endgame Strategic Plan , 17 countries and territories in the Western Pacific Region that use only oral polio vaccine (OPV) need to introduce at least one dose of inac vated polio vaccine (IPV) by the end of All countries that will con nue using OPV in their rou ne immuniza on programmes a er January 2016 should make all necessary prepara ons to implement the global switch from trivalent OPV (topv) to bivalent OPV (bopv) in April The status of introduc on of IPV vaccine and development of the Na onal Switch Plans in the Western Pacific Region is summarized in below table (as of 15 September 2015): Countries using OPV IPV introduction date Development of the National Switch Plan Cambodia Dec 2015 In process China Phased from Dec 2014 In process Lao PDR Oct 2015 In process Mongolia Jan 2016 Finalized Papua New Guinea Phased from Aug 2015 In process Philippines Phased from July 2015 In process Viet Nam Jan April 2016 In process Pacific island countries and areas Cook Islands Nov 2015 Draft plan developed Fiji Will switch to all IPV schedule by end 2015 In process Kiribati Introduced nationwide in Jun 2015 Draft plan developed Nauru Oct 2015 In process Samoa Oct 2015 Draft plan developed Solomon Islands Sep 2015 Draft plan developed Tokelau Will switch to all IPV schedule by end 2015 Draft plan developed Tonga Nov 2015 Draft plan developed Tuvalu Will switch to all IPV schedule by end 2015 Draft plan developed Vanuatu Sep 2015 In process 2015 Issue No Week 37 (as of 14 September 2015) Chart 1. Non-polio AFP rate (per persons < 15 years of age), * * AFP rate annualized as of week CHN KHM LAO MYS PHL PNG VNM Chart 3. Percentage of AFP by number of polio vaccination doses, Chart 2. Adequate specimen collection rate, CHN KHM LAO MYS PHL PNG VNM Chart 4. Percentage of AFP with pending classification > 90 days after onset, 2015 CHN KHM China reaffirms its support to Polio Endgame Strategy 60 LAO 0.0 On 3 4 September, the WHO Director General, Dr Margaret Chan visited the People s Republic of China. During the visit Dr Chan received a le er from the Minister of Na onal Health and Family Planning Commission confirming high level support of the Government of China for full and mely implementa on of ac vi es envisaged by the Polio Eradica on Endgame Strategic Plan, including na onwide introduc on of IPV vaccine and switch from topv to bopv vaccine. CONTACT US Expanded Programme on Immunization Regional Office for the Western Pacific World Health Organization P.O. Box 2932, 1000 Manila, Philippines Phone: Fax: , WPR_EPIdata@wpro.who.int Web: CHN KHM LAO MYS PHL PNG VNM 3 doses 1-2 doses 0 doses Unknown Note: Priority countries were selected for the charts. Official WHO acronyms have been used for abbreviation: CHN (China), KHM (Cambodia), LAO (Lao People s Democratic Republic), MYS (Malaysia), PHL (Philippines), PNG (Papua New Guinea), and VNM (Viet Nam). MYS PHL PNG VNM

2 Table 1A. Classification of AFP with onset in 2014 and key surveillance indicators 2014 Classification Indicators 2013 Annual expected <15 years of age Confirmed wild Vaccinederived (VDPV) Poliocompatible Discarded (Non-polio) > 90 days 1 # () Non-polio AFP rate with adequate specimens 2 investigated 2 days of notification 3 Latest report date 4 Days since last report Australia (0.0) Apr-15 - Brunei Darussalam (0.0) Apr-15 - Cambodia (0.0) May-15 - China (0.0) May-15 - China, Hong Kong SAR (0.0) Mar-15 - China, Macao SAR (0.0) Jan-15 - Japan Lao People's Democratic Republic (0.0) Apr-15 - Malaysia (0.0) Mar-15 - Mongolia (0.0) Mar-15 - New Zealand (0.0) Mar-15 - Papua New Guinea (0.0) Apr-15 - Philippines (0.0) Jun-15 - Republic of Korea (0.0) Feb-15 - Singapore (0.0) Jan-15 - Viet Nam (0.0) Apr-15 - Pacific island countries and areas (13.3) Sep (0.0) Number () of pending classification more than 90 days from date of onset of paralysis to date of last report Green Reached or surpassed target 2. Percentage of with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Yellow Nearly reached target: for non-polio AFP rate; for other indicators 3. Percentage of investigated within two days of notification Red Substantially below target 4. Report date is fixed as soon as all for the year have been classified 5. Countries are expected to submit data at least once per month to WPRO 2

3 Table 1B. Classification of AFP with onset in 2015 and key surveillance indicators 2015 Classification Indicators 2014 Annual expected <15 years of age Confirmed wild Poliocompatible Vaccinederived (VDPV) Discarded (Non-polio) > 90 days 1 # () Non-polio AFP rate 2 with adequate specimens 3 investigated 2 days of notification 4 Latest report date Days since last report Australia (10.3) Sep-15 6 Brunei Darussalam (0.0) Aug Cambodia (0.0) Sep China (8.2) Sep-15 5 China, Hong Kong SAR (0.0) Sep China, Macao SAR (0.0) Aug Japan Lao People's Democratic Republic (0.0) Aug Malaysia (1.1) Sep-15 5 Mongolia (0.0) Sep-15 5 New Zealand (0.0) Aug Papua New Guinea (0.0) Sep-15 0 Philippines (9.3) Sep-15 3 Republic of Korea (0.0) Aug Singapore (0.0) Sep-15 5 Viet Nam (20.0) Aug Pacific island countries and areas (0.0) Sep (8.5) Number () of pending classification more than 90 days from date of onset of paralysis to date of last report Green Reached or surpassed target 2. Annualized non-polio AFP rate per population under 15 years of age Yellow Nearly reached target: for non-polio AFP rate; for other indicators 3. Percentage of with two stool specimens collected 24 hours apart and within 14 days of onset of paralysis Red Substantially below target 4. Percentage of investigated within two days of notification 5. Countries are expected to submit data at least once per month to WPRO 3

4 Table 2A. Laboratory investigation of AFP with onset in 2014 and key laboratory indicators Virus isolation results Intratypic differentiation ()/sequencing results no. Intratypic Type 3 results Polio results Discordant 7 laboratory 1 specimens Latest differentiation/ No. of of AFP with positive + only Negative positive for report date Sequencing pending days of > 14 days VDPV Sabin VDPV laboratory 1 received 2 specimens positive 14 days 14 days W ild Sabin VDPV Wild Sabin W ild sequencing receipt Australia VIDRL Aug-15 VIDRL Brunei Darussalam VIDRL Jan-15 VIDRL Cambodia NIID Feb-15 NIID China (total) May China, Anhui Prov. Lab Prov. Lab/CCDC China, Beijing Prov. Lab Prov. Lab/CCDC China, Fujian Prov. Lab Prov. Lab/CCDC China, Gansu Prov. Lab Prov. Lab/CCDC China, Guangdong Prov. Lab Prov. Lab/CCDC China, Guangxi Prov. Lab Prov. Lab/CCDC China, Hebei Prov. Lab Prov. Lab/CCDC China, Heilongjiang Prov. Lab Prov. Lab/CCDC China, Henan Prov. Lab Prov. Lab/CCDC China, Hunan Prov. Lab Prov. Lab/CCDC China, Jiangsu Prov. Lab Prov. Lab/CCDC China, Jiangxi Prov. Lab Prov. Lab/CCDC China, Jilin Prov. Lab Prov. Lab/CCDC China, Shaanxi Prov. Lab Prov. Lab/CCDC China, Shandong Prov. Lab Prov. Lab/CCDC China, Shanghai Prov. Lab Prov. Lab/CCDC China, Shanxi Prov. Lab Prov. Lab/CCDC China, Sichuan Prov. Lab Prov. Lab/CCDC China, Tianjin Prov. Lab Prov. Lab/CCDC China, Xinjiang Prov. Lab Prov. Lab/CCDC China, Yunnan Prov. Lab Prov. Lab/CCDC China, Zhejiang Prov. Lab Prov. Lab/CCDC China, Chongqing Prov. Lab CCDC China, Guizhou Prov. Lab CCDC China, Hainan Prov. Lab CCDC China, Hubei Prov. Lab CCDC China, Liaoning Prov. Lab CCDC China, Neimongol Prov. Lab CCDC China, Ningxia Prov. Lab CCDC China, Qinghai Prov. Lab CCDC China, Tibet Prov. Lab CCDC China, Hong Kong SAR PHLC Jan-15 PHLC China, Macao SAR PHLC Jan-15 PHLC Japan NIID NIID Lao People's Democratic Republic NIID Jan-15 NIID Malaysia IMR Feb-15 IMR Mongolia PHI Mar-15 NIID New Zealand IESR Jan-15 IESR Papua New Guinea VIDRL Jan-15 VIDRL Philippines RITM Mar-15 RITM Republic of Korea NIH Feb-15 NIH Singapore SGH Jan-15 SGH Viet Nam (North) NIHE Feb-15 NIHE Viet Nam (South) PI Jan-15 PI Pacific island countries and areas VIDRL Jan-15 VIDRL CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); NIH (National Institute of Health, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) 2. growing in cells 4

5 5 Table 2B. Laboratory investigation of AFP with onset in 2015 and key laboratory indicators Virus isolation results Intratypic differentiation ()/sequencing results no. Intratypic Type 3 results results No. of Polio of AFP specimens Latest differentiation/ Discordant 7 laboratory 1 with 14 Sequencing positive only 14 days Wild days laboratory 1 received 2 positive Negative > 14 positive report date pending days of specimens Wild Sabin VDPV Sabin Wild days for VDPV Sabin VDPV + sequencing receipt Australia VIDRL Sep-15 VIDRL Brunei Darussalam VIDRL Aug-15 VIDRL Cambodia NIID Sep-15 NIID China (total) Sep China, Anhui Prov. Lab Prov. Lab/CCDC China, Beijing Prov. Lab Prov. Lab/CCDC China, Fujian Prov. Lab Prov. Lab/CCDC China, Gansu Prov. Lab Prov. Lab/CCDC China, Guangdong Prov. Lab Prov. Lab/CCDC China, Guangxi Prov. Lab Prov. Lab/CCDC China, Hebei Prov. Lab Prov. Lab/CCDC China, Heilongjiang Prov. Lab Prov. Lab/CCDC China, Henan Prov. Lab Prov. Lab/CCDC China, Hunan Prov. Lab Prov. Lab/CCDC China, Jiangsu Prov. Lab Prov. Lab/CCDC China, Jiangxi Prov. Lab Prov. Lab/CCDC China, Jilin Prov. Lab Prov. Lab/CCDC China, Shaanxi Prov. Lab Prov. Lab/CCDC China, Shandong Prov. Lab Prov. Lab/CCDC China, Shanghai Prov. Lab Prov. Lab/CCDC China, Shanxi Prov. Lab Prov. Lab/CCDC China, Sichuan Prov. Lab Prov. Lab/CCDC China, Tianjin Prov. Lab Prov. Lab/CCDC China, Xinjiang Prov. Lab Prov. Lab/CCDC China, Yunnan Prov. Lab Prov. Lab/CCDC China, Zhejiang Prov. Lab Prov. Lab/CCDC China, Chongqing Prov. Lab CCDC China, Guizhou Prov. Lab CCDC China, Hainan Prov. Lab CCDC China, Hubei Prov. Lab CCDC China, Liaoning Prov. Lab CCDC China, Neimongol Prov. Lab CCDC China, Ningxia Prov. Lab CCDC China, Qinghai Prov. Lab CCDC China, Tibet Prov. Lab CCDC China, Hong Kong SAR PHLC Jul-15 PHLC China, Macao SAR PHLC Jul-15 PHLC Japan NIID NIID Lao People's Democratic Republic NIID Sep-15 NIID Malaysia IMR Aug-15 IMR Mongolia PHI Sep-15 NIID New Zealand IESR Sep-15 IESR Papua New Guinea VIDRL Sep-15 VIDRL Philippines RITM Sep-15 RITM Republic of Korea NIH Aug-15 NIH Singapore SGH Aug-15 SGH Viet Nam (North) NIHE Sep-15 NIHE Viet Nam (South) PI Sep-15 PI Pacific island countries and areas VIDRL Sep-15 VIDRL CCDC (Chinese Center for Disease Control and Prevention, China); IESR (Institute of Environmental Science and Research, New Zealand); IMR (Institute of Medical Research, Malaysia); NIH (National Institute of Health, Republic of Korea); NIHE (National Institute of Hygiene and Epidemiology, Ha Noi, Viet Nam); NIID (National Institute of Infectious Diseases, Japan); PHI (Public Health Institute, Mongolia); PHLC (Public Health Laboratory Center, China, Hong Kong SAR); PI (Pasteur Institute, Ho Chi Minh, Viet Nam); RITM (Research Institute for Tropical Medicine, Philippines); SGH (Singapore General Hospital); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) 2. growing in cells

6 Table 3. Laboratory confirmation of polio from environmental samples in Intratypic number number number Type 3 Discordant number Type 3 Discordant differentiation lab 2 of samples of samples of samples pending of samples pending with polio with polio processed Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV sequencing processed Wild Sabin VDPV Wild Sabin VDPV Wild Sabin VDPV sequencing Australia VIDRL China (total) China, Fujian Prov. Lab/CCDC China, Guangdong Prov. Lab/CCDC China, Heilongjiang Prov. Lab/CCDC China, Shandong Prov. Lab/CCDC China, Shanghai Prov. Lab/CCDC China, Xinjiang Prov. Lab/CCDC Malaysia IMR Based on year of collection of sample, if available. Otherwise, based on year of receipt at reference laboratory. 2. CCDC (Chinese Center for Disease Control and Prevention, China); IMR (Institute of Medical Research, Malaysia); VIDRL (Victorian Infectious Diseases Reference Laboratory, Australia) Cambodia China Table 4. Vaccine-derived specimens identified from laboratory testing, China, Hong Kong SAR Japan Lao People's Democratic Republic 2006 (1 case) (2 ) 2009 (1 case) (27 ) 2005 (3 ) 2005 (1 case) (2 ) 2004 (3 ) avdpv2 (5 ) avdpv3 (2 ) avdpv2 (3 ) cvdpv2 (2 ) ivdpv2 (2 ) ivdpv3 (1 case) avdpv2 (2 ) avdpv2 (1 case) cvdpv2 (3 ) ivdpv2 + ivdpv3 (1 case) ivdpv2 + ivdpv3 (1 case) avdpv2 (2 ) ivdpv3 (1 case) avdpv2 (1 case) ivdpv2 (1 case) Mongolia 2003 (1 case) Philippines 2001 (3 ) avdpv2 (1 case) Viet Nam avdpv2 (2 ) 1. Prefix letter refers to the VDPV category: "cvdpv" = circulating VDPV, "ivdpv" = immunodeficiency-associated VDPV, "avdpv" = ambiguous VDPV, "?VDPV" = pending. Suffix number refers to the serotype (types 1, 2 or 3). 2. Refers to year of last VDPV case, and aggregate total of VDPV for