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Source: https://www.who.int/csr/don/08-janua...ovirus-drc/en/
Poliomyelitis - Democratic Republic of the Congo
Disease outbreak news
8 January 2019
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.
WHO risk assessment
Currently, WHO finds the overall national public health risk associated with these four outbreaks to be very high. The risk of international spread, particularly to the neighboring countries also remains high due to the continuation of these outbreaks close to international borders. This risk is magnified by known population movements between the affected areas of Democratic Republic of the Congo, Uganda, Central African Republic, Zambia and South Sudan.
As of July 2018, in light of the epidemiology of the reported polio cases, genetic analyses of the isolated polioviruses, risk of further in-country and international spread, and the country?s response capacity, the outbreak has been graded as a Grade 2 public health emergency based on the WHO Emergency Response Framework.
The detection of cVDPV2s underscores the importance of maintaining high routine vaccination coverage to minimize the risk and consequences of poliovirus circulation. These events also highlight the risks posed by any low-level transmission of the virus. A robust outbreak response is necessary to impede further disease transmission, ensure sufficient vaccination coverage in the affected areas, and prevent similar outbreaks in the future. WHO will continue to monitor and evaluate the epidemiological situation and outbreak response measures being implemented.
WHO advice
It is important that all countries, in particular those with frequent travel and contacts with polio-affected countries and areas, strengthen surveillance for AFP cases in order to rapidly detect any new virus importation and to facilitate a rapid response. Countries, territories and areas should also maintain uniformly high routine immunization coverage at the district level to minimize the consequences of any new virus introduction.
WHO?s International Travel and Health recommends that all travelers to polio-affected areas be fully vaccinated against polio. Residents and visitors staying for more than four- weeks in affected areas should receive an additional dose of oral polio vaccine (OPV) or inactivated polio vaccine (IPV) within four weeks to 12 months of travel. Efforts should also be made to ensure that individuals who received vaccinations are provided the appropriate documentation to record their vaccination status.
As per the advice of the Emergency Committee convened under the International Health Regulations (2005), efforts to limit the international spread of poliovirus must continue as it remains a Public Health Emergency of International Concern (PHEIC). Countries affected by poliovirus transmission are subject to Temporary Recommendations. To comply with the Temporary Recommendations issued under the PHEIC, any country affected by poliovirus transmission should declare the outbreak as a national public health emergency.
At this time, WHO does not recommend any restrictions on travel and/or trade to the Democratic Republic of the Congo on the basis of the information available for the current cVDPV2 outbreaks.
Cross border activities should be conducted between the Democratic Republic of the Congo and neighboring countries to strengthen AFP surveillance and routine immunization as well as operations linked to the control of other vaccine preventable diseases. Direct and regular collaboration between neighboring provinces and districts should begin quickly awaiting formal administrative and political address.
Links
Poliomyelitis - Democratic Republic of the Congo
Disease outbreak news
8 January 2019
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.
WHO risk assessment
Currently, WHO finds the overall national public health risk associated with these four outbreaks to be very high. The risk of international spread, particularly to the neighboring countries also remains high due to the continuation of these outbreaks close to international borders. This risk is magnified by known population movements between the affected areas of Democratic Republic of the Congo, Uganda, Central African Republic, Zambia and South Sudan.
As of July 2018, in light of the epidemiology of the reported polio cases, genetic analyses of the isolated polioviruses, risk of further in-country and international spread, and the country?s response capacity, the outbreak has been graded as a Grade 2 public health emergency based on the WHO Emergency Response Framework.
The detection of cVDPV2s underscores the importance of maintaining high routine vaccination coverage to minimize the risk and consequences of poliovirus circulation. These events also highlight the risks posed by any low-level transmission of the virus. A robust outbreak response is necessary to impede further disease transmission, ensure sufficient vaccination coverage in the affected areas, and prevent similar outbreaks in the future. WHO will continue to monitor and evaluate the epidemiological situation and outbreak response measures being implemented.
WHO advice
It is important that all countries, in particular those with frequent travel and contacts with polio-affected countries and areas, strengthen surveillance for AFP cases in order to rapidly detect any new virus importation and to facilitate a rapid response. Countries, territories and areas should also maintain uniformly high routine immunization coverage at the district level to minimize the consequences of any new virus introduction.
WHO?s International Travel and Health recommends that all travelers to polio-affected areas be fully vaccinated against polio. Residents and visitors staying for more than four- weeks in affected areas should receive an additional dose of oral polio vaccine (OPV) or inactivated polio vaccine (IPV) within four weeks to 12 months of travel. Efforts should also be made to ensure that individuals who received vaccinations are provided the appropriate documentation to record their vaccination status.
As per the advice of the Emergency Committee convened under the International Health Regulations (2005), efforts to limit the international spread of poliovirus must continue as it remains a Public Health Emergency of International Concern (PHEIC). Countries affected by poliovirus transmission are subject to Temporary Recommendations. To comply with the Temporary Recommendations issued under the PHEIC, any country affected by poliovirus transmission should declare the outbreak as a national public health emergency.
At this time, WHO does not recommend any restrictions on travel and/or trade to the Democratic Republic of the Congo on the basis of the information available for the current cVDPV2 outbreaks.
Cross border activities should be conducted between the Democratic Republic of the Congo and neighboring countries to strengthen AFP surveillance and routine immunization as well as operations linked to the control of other vaccine preventable diseases. Direct and regular collaboration between neighboring provinces and districts should begin quickly awaiting formal administrative and political address.
Links
- Polio Global Eradication Initiative: Democratic Republic of the Congo
- Kinshasa Declaration for the Eradication of Poliomyelitis and the Promotion of Vaccination
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