Mozambique: 2022 - 2023 Polio

[Shiloh]

Source: https://www.bnnbloomberg.ca/mozambiq...1992-1.1767489

1h ago
Mozambique Finds First Wild Polio Case in Country Since 1992
Antony Sguazzin, Bloomberg News

(Bloomberg) -- Mozambique has found a case of wild polio, the first in the country since 1992, just months after an infection was identified in neighboring Malawi, the World Health Organization said.

The case, identified in a child in the northeastern Tete province, is of the same strain as one that had been circulating since 2019 in Pakistan, which along with Afghanistan is the only nation where the paralysis-causing disease is endemic, the WHO said in a statement on Wednesday. The Malawian case was similar...

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Mozambique confirms wild poliovirus case

18 May 2022

Brazzaville/Maputo – Health authorities in Mozambique today declared an outbreak of wild poliovirus type 1 after confirming that a child in the country’s north-eastern Tete province had contracted the disease. This marks the second imported case of wild poliovirus in southern Africa this year, following an outbreak in Malawi in mid-February.

So far, one case in Mozambique – the country’s first since 1992 – has been detected. The virus was found in a child who began experiencing onset of paralysis in late March. Genomic sequencing analysis indicates that the newly confirmed case is linked to a strain that had been circulating in Pakistan in 2019, similar to the case reported in Malawi earlier this year.

The case in Mozambique and the earlier one in Malawi do not affect Africa’s wild poliovirus-free certification because the virus strain is not indigenous. Africa was declared free of indigenous wild polio in August 2020 after eliminating all forms of wild polio from the region.

“The detection of another case of wild polio virus in Africa is greatly concerning, even if it’s unsurprising given the recent outbreak in Malawi. However, it shows how dangerous this virus is and how quickly it can spread,” said Dr Matshidiso Moeti, World Health Organization Regional Director for Africa. “We are supporting southern African governments to step up the polio fight including carrying out large-scale, effective vaccination campaigns to halt the virus and protect children from its damaging impact.”

Further investigations are underway in Mozambique to determine the extent of the risk posed by the new wild poliovirus case and the targeted responses needed. Preliminary analysis of samples collected from three contacts of the newly-detected case were all negative for wild poliovirus type 1.

Mozambique recently carried out two mass vaccination campaigns – in response to the Malawi outbreak – in which 4.2 million children were vaccinated against the disease. Efforts are currently underway to help strengthen disease surveillance in Malawi, Mozambique, Tanzania, Zambia and Zimbabwe. The five countries will continue with mass vaccinations, with plans to reach 23 million children aged five years and below with the polio vaccine in the coming weeks.

Globally, wild poliovirus is endemic only in Afghanistan and Pakistan. Polio is highly infectious and largely affects children younger than five years. There is no cure for polio, and it can only be prevented by immunization. Children across the world remain at risk of wild polio type 1 as long as the virus is not eradicated in the last remaining areas in which it is still circulating.

https://www.afro.who.int/countries/mozambique/news/mozambique-confirms-wild-poliovirus-case

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WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES

Week 21: 16 – 22 May 2022
Data as reported by: 17:00; 22 May 2022
...

Wild Poliovirus Mozambique

1 case
0 Deaths
0% CFR

EVENT DESCRIPTION

On 18 May 2022, the Ministry of Health of Mozambique notified
the World Health Organization of a case of wild poliovirus type 1
(WPV1) in the country’s north-eastern Tete province bordering
Malawi, Zambia, and Zimbabwe following laboratory confirmation.
The case-patient is a 12-year-old female from Changara district,
Tete province with an onset of paralysis on 25 March 2022. The
case-patient had no travel history outside of the country and
had been previously vaccinated with three doses of bivalent oral
poliovirus vaccine (bOPV).

The initial investigation commenced with two stool samples
collected 24 hours apart from the case-patient on 1 and 2 April
2022. The samples were shipped to laboratories at the National
Institute of Communicable Disease (NICD) in South Africa and the
Centers for Disease Control and Prevention (CDC) in the United
States for testing and sequencing. Test results confirm the presence
of WPV1 in the stool samples. Genomic sequencing analysis of the
virus also showed that the outbreak is linked to a strain that had
been circulating in Pakistan in 2019, similar to the imported WPV1
case confirmed in February 2022 in Malawi, signalling that the virus
strain is not indigenous. Stool samples were also collected from
three contacts of the newly detected case. However, test results
showed the absence of poliovirus.

This is the first case of wild poliovirus recorded in Mozambique
since 1992, although the country has more recently been affected
by an outbreak of circulating vaccine-derived poliovirus type 2
(cVDPV2) with three cases detected since April 2021, the most
recent on 26 March 2022.

According to the latest available 2020 WHO-UNICEF national
immunization coverage estimate, the oral poliovirus vaccine third
dose (OPV3) and inactivated poliovirus vaccine first dose (IPV1)
coverage were 73% and 78% respectively, for Mozambique. The
country has also recently conducted two rounds of mass polio
vaccination campaigns reaching 4.2 million children aged five years
and below as part of a multi-country emergency outbreak response
to the WPV1 recently detected in Malawi. Circumscribed reactive
polio vaccination campaigns, which include the use of the novel
oral polio vaccine type 2 (nOPV2), have also been conducted since
2021 in Mozambique in response to cases of circulating vaccinederived
poliovirus type 2 (cVDPV2).

PUBLIC HEALTH ACTIONS

The outbreak of wild poliovirus type 1 was officially declared
by the Ministry of Health of Mozambique and notified to
WHO as part of the International Health Regulations 2005
requirements.

The Ministry of Health is coordinating the response to the
event with technical and operational support from partners
of the Global Polio Eradication Initiative (GPEI) including the
African Rapid Response Team and the Global Polio Laboratory
Network (GPLN).

A rapid response team involving staff from the national and
sub-national levels as well as GPEI experts have been deployed
to conduct a detailed investigation, assess the risk associated
with this event, and implement targeted response activities.
Surveillance including active case finding is being enhanced in
the affected district.

Two rounds of bivalent OPV campaigns have already been
implemented, the most recent in April, with more than 4.2
million children vaccinated in Mozambique. At the same time,
the response to the cVDPV2 outbreak is also ongoing.

SITUATION INTERPRETATION

Africa’s wild poliovirus-free certification is not affected by the recent
detection of WPV1 cases in Mozambique and Malawi given that the
virus strain is not indigenous. Only two countries, Afghanistan and
Pakistan, are still endemic for the virus. However, these recent
events underscored the importance of maintaining high vaccination
coverage for both OPV and inactivated polio vaccine (IPV),
given the potential for international spread as the wild poliovirus
circulates in parts of the world. The detection of the latest case
highlights the relevance of the ongoing multi-country emergency
outbreak response in Malawi, Mozambique Tanzania, Zambia, and
Zimbabwe in response to the earlier detection of WPV1 in Malawi.
WHO advises countries to implement high-quality surveillance,
routine vaccination, and response activities to prevent the potential
resurgence and spread of the poliovirus.

https://apps.who.int/iris/bitstream/handle/10665/354552/OEW21-1622052022.pdf

https://www.afro.who.int/countries/mozambique/publication/outbreaks-and-emergencies-bulletin-week-21-16-22-may-2022

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WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES

Week 23 : 30 May - 5 June 2022
Data as reported by: 17:00; 5 June 2022
...

All events currently being monitored by WHO AFRO

New Events
...

Mozambique Poliomyelitis (WPV1)

Date notified to WCO
17-May-22

Start of reporting period
18-May-22

End of reporting period
1-Jun-22

Total cases 1
Cases Confirmed 1
Deaths 0
CFR 0,00%

A wild poliovirus type 1 (WPV1) was detected in Mozambique from samples collected in late March 2022 from Changara district in Tete province. This new WPV1 is an orphan virus and is linked to the virus detected in Malawi (for which outbreak response vaccinations are ongoing in Malawi and neighbouring countries). The patient, a 12-year old female, had onset of paralysis on 25 March 2022. Her stool samples were collected on 1 April and 2 April 2022, and sent to the laboratory on 4 April 2022.

No other case has been reported to date.

https://apps.who.int/iris/bitstream/...0505062022.pdf

[Shiloh]

Source: https://www.who.int/emergencies/dise...em/2022-DON395


Wild poliovirus type 1 (WPV1) - Mozambique

23 June 2022


Outbreak at a glance:
On 15 May 2022, a case of wild poliovirus type 1 (WPV1) was reported in Mozambique through the Global Polio Laboratory Network (GPLN). Results of the genomic sequencing analysis indicate that the current WPV1 isolate is genetically linked to a strain detected in Pakistan in 2019 and similar to a case of WPV1 reported in Malawi in February 2022.

As part of response measures following the confirmation of the case in Malawi, two rounds of bivalent oral poliovirus vaccine (bOPV) campaigns have been conducted in the country, with more than 4.5 million children vaccinated.

The risk of international spread, particularly across the South East region of Africa remains high, due to persisting sub-optimal immunity and surveillance gaps, and large-scale population movements.

Description of the outbreak:

On 15 May 2022, the GPLN reported the confirmation of a case of wild poliovirus type 1 (WPV1) in Mozambique. The case is a 12-year-old female with acute flaccid paralysis (AFP), with onset of paralysis on 25 March, from Changara district, Tête province bordering Zimbabwe and Malawi. Two stool specimens were collected for testing on 1 April and 2 April. On 14 May, the samples were confirmed to be WPV1 by National Institute for Communicable Diseases (NICD) in South Africa. The child had previously received three doses of bivalent oral poliovirus vaccine(bOPV) but no inactivated poliovirus vaccine (IPV). Genomic sequencing analysis indicates that the newly confirmed case is linked to a strain that had been circulating in Pakistan in 2019, similar to a case of WPV1 reported in Malawi in February 2022 (For more details on this case, please see the Disease outbreak news published on 3 March 2022). The last indigenous wild poliovirus case in Mozambique was reported in 1993.
Mozambique is also affected by a concurrent outbreak of circulating vaccine-derived poliovirus type 2 (cVDPV2), with seven cases reported in the country since 2021, the most recent on 25 March 2022.
According to the WHO-UNICEF national immunization coverage estimate, the oral poliovirus vaccine third dose (OPV3) and inactivated poliovirus vaccine first dose (IPV1) coverage was 73% and 78% respectively in Mozambique in 2020.
Figure: 1: Countries reporting cases of WPV1 and neighboring countries implementing preparedness plans


Epidemiology of Poliomyelitis

Poliomyelitis (polio) is a highly infectious viral disease that largely affects children under five years of age. The virus is transmitted by person-to-person and spread mainly through the fecal-oral route or, less frequently, by a common vehicle (e.g., contaminated water or food) and multiplies in the intestine, from where it can invade the nervous system and cause paralysis. The virus is shed by infected people (usually children) through faeces, where it can spread quickly, especially in areas with poor hygiene and sanitation systems.

The incubation period is usually 7–10 days but can range from 4–35 days. Up to 90% of those infected are either asymptomatic or experience mild symptoms and the disease usually goes unrecognized. In mildly symptomatic cases, initial symptoms include fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limbs. These symptoms usually last for 2–10 days and most recovery is complete in almost all cases. However, in the remaining 10% of cases, the virus causes paralysis, usually of the legs, which is most often permanent. Paralysis can occur as rapidly as within a few hours of infection. Of cases with paralysis, 5-10% die when their breathing muscles become immobilized.

Two of the three types of wild poliovirus have been eradicated (WPV2 and WPV3), with ongoing global efforts to eradicate WPV1. Currently, wild poliovirus is endemic in two countries: Pakistan and Afghanistan. The detection of WPV1 outside these two countries where the disease is endemic demonstrates the continuous risk of international spread of the disease until every corner of the world is free of WPV1.

There is no cure for polio; it can only be prevented by immunization.


Public health response

Mozambique has been actively participating in the multi-country emergency outbreak response implemented across the South East Africa region in response to the case of WPV1 reported in Malawi in February 2022, alongside Tanzania, Zambia, and Zimbabwe to reach more than 23 million children across the region. Two rounds of bivalent OPV vaccination campaigns have already been implemented, the most recent at the end of April, with more than 4.5 million children vaccinated in Mozambique. At the same time, the response in the country to the cVDPV2 outbreak is also ongoing.


National and subnational authorities continue to be supported by partners of the Global Polio Eradication Initiative (GPEI), notably by experts of the African Rapid Response Team, the GPLN, UNICEF and local organizations. Surveillance across the sub-region continues to be strengthened.
The detection of the current case underscores the need for a large-scale, rapid, multi-country emergency outbreak response across South East Africa, in line with revised international polio outbreak response SOPs. The foremost priority is to continue to implement the sub-regional emergency response, by continuing to conduct large-scale, rapid and high-quality response campaigns.


WHO risk assessment

Detection of a case of WPV1 in Mozambique, and the second case in the South East region of Africa, confirms ongoing WPV1 transmissions in the sub-region.


WHO considers that there is a continuous high risk of international spread of WPV1, particularly across the South East sub-region of Africa, due to persisting sub-optimal national immunity and surveillance gaps, and large-scale population movements. The risk is further increased due to the decreased immunization rate related to the ongoing COVID-19 pandemic.


The risk of spread associated with the concurrent cVDPV2 outbreak is currently assessed as moderate due to historical and epidemiological evidence suggesting that WPVs have a significantly higher propensity for geographic spread than cVDPVs. However, a comprehensive outbreak response to both strains is urgently being implemented, as both strains have the capacity to cause paralytic disease in children.



WHO advice

It is important that all countries, in particular those with frequent travels and contacts with polio-affected countries and areas, strengthen surveillance for AFP cases and commence planned expansion of environmental surveillance 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 International Travel and Health recommends that all travellers to polio-affected areas should be fully vaccinated against polio. Residents (and visitors for more than four weeks) from affected areas should receive an additional dose of OPV or IPV within four weeks to 12 months of travel.

As per the advice of an Emergency Committee convened under the International Health Regulations (2005), the risk of international spread of poliovirus 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 infected by poliovirus should declare the outbreak as a national public health emergency, ensure the vaccination of residents and long-term visitors and restrict at the point of departure travel of individuals, who have not been vaccinated or cannot prove the vaccination status.

The latest epidemiological information on WPVs and cVDPVs is updated weekly on the GPEI website.

WHO does not recommend any restriction on travel and/or trade to Mozambique based on the information available for this current event.

[Shiloh]

Source: https://outbreaknewstoday.com/mozamb...eported-78292/


Mozambique: 3 additional wild polio cases reported
by News Desk
July 30, 2022

In a follow-up on a wild poliovirus type 1 (WPV1) case reported in Mozambique’s north-eastern Tete province in May, the Global Polio Eradication Initiative (GPEI) reported this week an additional three cases from Tete province.

This brings the total number of cases in the country to four.

According to GPEI:

Two of the three new viruses are more closely linked with the WPV1 isolated from the first case of Mozambique with onset in March 2022 from the same province, indicating local circulation of WPV1 within the province and probably the country. However, the WPV1 found in Magoé district (close to the Zimbabwe and Zambia borders), is an orphan virus which is more closely related to the virus found earlier in Malawi...

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WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES

Week 31: 25 - 31 July 2022
Data as reported by: 17:00; 31 July 2022
...

Wild Poliovirus Mozambique

4 cases
0 Deaths
0% CFR

EVENT DESCRIPTION

Following the detection of the first case of wild poliovirus type
1 (WPV1) on 18 May 2022 in north-eastern Tete province of
Mozambique, three new cases have been reported in the country.
The first case is a 1-year and 7 months-old male, resident of
Nkondezi village, located approximately 110 kilometres from
Moatize city, and 30 kilometres to the nearest health facility with
very difficult road network especially during the rainy season. The
case was notified on 3 June 2022 with paralysis onset date of 25
May 2022. Subsequently, timely stool samples were collected on
6 and 7 June 2022 respectively, and sent to regional laboratory
for analysis. The child had no history of any routine vaccination
doses. No travel history was nor contact with any child or person
with paralysis was reported.

The second case is a 7 months-old-male, resident of chikhona
village, who had received 2OPV doses with no IPV. The case
was notified on 26 May 2022 with paralysis onset date of 20
May 2022. Stool samples were collected on 5 and 6 June 2022
respectively, and sent to regional laboratory. The family reports
receiving visitors from Tete district a month before onset of
paralysis. Notably, the child was taken to Tete province seeking
better medical assistance after being notified and investigated as
AFP case.

The third case; a 3-year and 8 months-old female, from Chinhanje
village. Parents to the child report no history of any vaccination.
The case was notified on 13 June 2022 with paralysis onset date
of 10 June 2022. Stool samples were collected on 14 and 15 June
2022 respectively, and sent to regional laboratory for analysis.

All the samples were shipped to laboratories at the National
Institute of Communicable Disease in South Africa and the
Centers for Disease Control and Prevention in the United States
for further testing and sequencing. Test results received on 18
July 2022, confirmed the presence of WPV1 in the stool samples.

Genetic analysis further indicates that there are clearly at least
two transmission chains that co-evolved after introduction of
the virus in Tete province in Mozambique. While it is difficult
to speculate, distribution of WPV1 and their genetic linkage
suggests that missed transmission in bordering areas around
Mozambique-Zimbabwe-Zambia cannot be ruled out.

In 2022, Tete province has registered acceptable AFP indicators
/ Polio surveillance performance in nearly all its districts 14/15
(93.7%) noting improvement as compared with the previous
year (2021). However, slight improvement in proportion of cases
with adequate stool samples was registered in the same year as
compared to the previous year -2021.

PUBLIC HEALTH ACTIONS

The Ministry of Health is coordinating the response with
technical and operational support from partners of the Global
Polio Eradication Initiative (GPEI) including the African Rapid
Response Team and the Global Polio Laboratory Network.
A rapid response team involving staff from the national
and sub-national levels as well as GPEI experts have been
deployed to conduct a detailed investigation, assess the risk
associated with this event, and implement targeted response
activities.

Surveillance including active case finding is being enhanced
in the affected district.

Two rounds of bivalent OPV campaigns have already been
implemented, the most recent in April, with more than 4.2
million children vaccinated in Mozambique. At the same time,
the response to the cVDPV2 outbreak is also ongoing.

SITUATION INTERPRETATION

Mozambique has implemented three immunization rounds
using bOPV since the detection of the first case from March.
Assessments of these rounds show gradual improvements in
quality, round to round, though quality remains suboptimal in
Tete province.

With detection of more WPVI cases, cross-border collaboration
for enhanced surveillance and high-quality public health response
including vaccination remains critical in protecting countries of
the sub-region and preventing a potential resurgence of the polio
epidemic in Africa. WHO advises countries to implement highquality
surveillance, routine vaccination, and response activities
to prevent the potential resurgence and spread of the poliovirus.

https://apps.who.int/iris/bitstream/handle/10665/361243/OEW31-2531072022.pdf

[Pathfinder]

Polio this week as of 09 November

...

Mozambique

• No wild poliovirus type 1 (WPV1) case was reported this week. There are eight cases reported in 2022. Reporting of these new cases within a short time span indicates that intensified surveillance efforts are working in the province.
• Three cases of circulating vaccine-derived poliovirus type 1 (cVDPV1) were reported in Zambezia. There are now 16 cases in 2022.
• No case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported this week. The number of cases in 2022 remains four. There were two cases reported in 2021.

...

https://polioeradication.org/polio-today/polio-now/this-week/

[Pathfinder]

WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES

Week 12: 13 - 19 March 2023
Data as reported by: 17:00; 19 March 2023
...
All events currently being monitored by WHO AFRO
...
Mozambique Poliomyelitis (WPV1) Grade 2

Date notified to WCO 17-May-22
Start of reporting period 18-May-22
End of reporting period 15-Mar-23

Total cases 10
Cases Confirmed 10
Deaths 0
CFR 0.0%

According to the Global Polio Eradication Initiative, two cases of circulating vaccine-derived poliovirus type 1 (cVDPV1) were reported in Zambezia this week. There were 21 cases in 2022. Intensified surveillance efforts continue across the country.
...

https://apps.who.int/iris/bitstream/handle/10665/366585/OEW12-1319032023.pdf?sequence=1&isAllowed=y