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  • Indonesia - Polio outbreak 2022/2023

    Hat tip to Michael Coston:

    Indonesia: Extraordinary Event (KLB) Declared In Aceh After Child Diagnosed With Polio

    https://flutrackers.com/forum/forum/...sed-with-polio

    ---------------------------------------------------

    Translation Google

    The Government Moves Quickly to Handle Polio Cases in Pidie District

    Published On : Saturday, 19 November 2022 00:00:00, Read : 109 Times

    Jakarta, 19 November 2022

    A total of 415 districts/cities in 30 provinces in Indonesia are included in the high risk criteria for polio due to low immunization, including Aceh. For this reason, the government is intensifying immunization efforts.

    "If you look at the coverage of oral poliovirus OPV and IPV, it is indeed low throughout Indonesia, especially during the Covid-19 pandemic," said the Director General of Disease Prevention and Control, dr. Maxi Rein Rondonuwu in Jakarta, Saturday (19/11).

    Meanwhile, in early November 2022, one case of polio was found in Pidie District, Aceh based on RT-PCR tracing. So then the government of Pidie Regency implemented Polio Extraordinary Events at the Pidie Regency level.

    Patient aged 7 years 2 months with paralysis of the left leg. The child started to feel a fever on October 6, then on October 18 he entered the Sigil TCD Hospital. On 21 to 22 October the pediatrician suspected polio and took two specimens and sent them to the province. Then on November 7, the RT-PCR results came out with confirmation of type 2 polio.

    Director General Maxi said the child had wasting in the left thigh and calf muscles and did not have a history of immunizations, no travel history of contact with travellers.

    "But I saw this child's condition yesterday, he was able to walk even though he was limping, but there was no medication. He'll just have to stay at physiotherapy to maintain his muscle mass," said Director General Maxi.

    From epidemiological investigations, in addition to the low coverage of Polio immunization, it was found that factors of clean and healthy living behavior in the population were still lacking. There are still residents who practice open defecation in rivers. Although toilets are available, the sewerage drains directly into the river, while river water is used as a source of community activities, including children's play areas.

    The Pidie District Health Office team together with the Aceh Provincial Health Office, the Ministry of Health, WHO, and Unicef ​​have carried out a number of important actions including conducting tracking to look for other cases of paralysis around the case's residence, taking stool samples in the affected areas for examination, and checking samples of water in dumps and rapid surveys of immunization coverage.

    Furthermore, measures to prevent wider transmission will be taken immediately by increasing the notification of health workers and health facilities to detect other cases of paralysis, to be followed up medically and epidemiologically.

    Furthermore, 2 rounds of additional polio immunization will be given to all children aged 0-13 years in all areas of Aceh Province which is planned to start on November 28, 2022.

    Educating and mobilizing the community to prevent transmission of the polio virus regarding the importance of routine immunization for children, implementing clean and healthy living habits, especially defecating in the latrines.

    Polio disease is very dangerous for children because it causes paralysis and there is no cure, but it is easily prevented with complete polio immunization and routine immunization. Prevention is also carried out by adopting clean and healthy living behaviors such as defecating in standard latrines, washing hands with soap and using boiled water for eating and drinking.

    ''I appeal to all people to immediately complete routine immunizations for children according to schedule, and apply clean and healthy living habits,'' said Director General Maxi.

    This news was broadcast by the Bureau of Communication and Public Services, Ministry of Health of the Republic of Indonesia. For further information, please contact the Halo Ministry of Health hotline number via hotline number 1500-567, SMS 081281562620, facsimile (021) 5223002, 52921669, and contact email address [at] Ministry of Health [dot] go [dot] id (D2).

    https://www.kemkes.go.id/article/vie...ten-pidie.html
    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela

  • #2
    Translation Google

    Three Polio Virus Positive Children Found in Pidie District

    Published On : Thursday, 24 November 2022 00:00:00, Read : 2,014 Times

    Jakarta, 24 November 2022

    Three positive children for the polio virus without symptoms of sudden paralysis were found in Pidie District, Aceh. This finding is based on the results of follow-up examinations of children aged <5 years who live around polio cases in early November. Stool examination through Targeted Healthy Stools Sampling according to WHO recommendations.

    Previously, in early November 2022 a case of polio was found in Pidie District, Aceh, so that later Pidie District declared an Extraordinary Polio Incident. Then an epidemiological search was carried out around the location of the polio case through stool examination of 19 healthy and non-contact children from cases under 5 years of age. This is done to assess whether transmission has occurred in the community.

    ''From the results of the examination of 19 children, it was found that three children were positive for the polio virus,'' said the spokesperson for the Ministry of Health, dr. Muhammad Syahril in Jakarta (24/11).

    However, according to WHO guidelines, these three children were not included in the case criteria because they did not meet the criteria for sudden paralysis. Monitoring efforts are continuing, including screening efforts from house to house, to ensure there are no additional cases of paralysis that have not been reported.

    Polio disease is very dangerous for children because the impact is permanent for life, causes paralysis and there is no cure. However, this condition can be easily prevented through complete polio immunization, both bOPV drip immunization and IPV injection immunization.

    ''Therefore, we must protect the future of our children by giving complete polio immunization vaccination,'' explained dr. Syahril.

    In addition to immunization, clean and healthy living behavior is the second key in preventing polio transmission in the community. The presence of the polio virus in the faeces of the three children shows that the population still lacks clean and healthy behavior.

    There are still residents who practice open defecation in rivers. Even though there are toilets, the drainage holes directly flow into the river, while the river water is used for various resident activities including children's play areas.

    ''The polio virus is transmitted through the gastrointestinal tract, while community defecation activities are still carried out in rivers, not in latrines, so there is virus circulation and the potential for transmission there,'' continued dr. Syahril.

    This news was broadcast by the Bureau of Communication and Public Services, Ministry of Health of the Republic of Indonesia. For further information, please contact the Halo Ministry of Health hotline number via hotline number 1500-567, SMS 081281562620, facsimile (021) 5223002, 52921669, and contact email address [at] ministry of health [dot] go [dot] id (NI).

    ditemukan-tiga-anak-positif-virus-polio-di-kabupaten-pidie,kemenkes,kemkes,depkes,departemen kesehatan,kementerian kesehatan
    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela

    Comment


    • #3
      Source: https://www.who.int/emergencies/dise...em/2022-DON430


      Circulating vaccine-derived poliovirus type 2 (cVDPV2) - Indonesia

      19 December 2022







      Outbreak at a glance
      On 12 November 2022, Indonesia’s Ministry of Health notified WHO of a confirmed case of circulating vaccine-derived poliovirus type 2 (cVDPV2) with acute flaccid paralysis (AFP) from Pidie district in Aceh province. Field investigations were immediately launched by local and national public health authorities, with support from partners of the Global Polio Eradication Initiative. On 28 November, the Ministry of Health launched an immunization campaign for children under the age of 13 years in the affected areas.
      Description of the outbreak
      On 12 November 2022, Indonesia’s Ministry of Health notified WHO of a confirmed case of VDPV2. The case was a 7-year-old boy from Pidie district in Aceh province, who developed AFP on 9 October 2022. The case had not received oral polio vaccine (OPV) or inactivated polio vaccine (IPV) and had no travel history or contact with those who had traveled. On 25 November 2022, three more genetically related isolates of cVDPV2 were reported based on the laboratory results of stool samples taken from three healthy children who were in the same community but not close contacts of the confirmed case. Sequencing results from Biofarma lab showed 25 nucleotide changes for the AFP case and 25 to 26 nucleotide changes for the three asymptomatic children. These results are evidence of transmission of the virus and meets the criteria to be classified as circulating VDPV2 (cVDPV2). In the past in Indonesia, a cVDPV type 1 outbreak was reported in Papua province in 2019.
      Aceh province has very low polio vaccination coverage in the routine immunization programme; however, coverage is also low in several other provinces in Indonesia, including three provinces nearby Aceh (North Sumatera, West Sumatera and Riau). In 2021, in Aceh province, bivalent oral polio vaccine (OPV3) coverage was 50.9%, and IPV 28.2%. and for Pidie district the coverage was 17.7% for OPV3 and 0.5% for IPV. There is low population immunity against all polioviruses but primarily type 2 in children born after the switch from the trivalent to bivalent OPV in April 2016.
      Epidemiology of Poliomyelitis
      Polio is a highly infectious disease that largely affects children under five years of age, causing permanent paralysis (approximately 1 in 200 infections) or death (2-10% of those paralyzed).
      The virus is transmitted by person-to-person, 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 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.
      Vaccine-derived poliovirus is a well-documented strain of poliovirus mutated from the strain originally contained in OPV. OPV contains a live, weakened form of poliovirus that replicates in the intestine for a limited period, thereby developing immunity by building up antibodies. On rare occasions, when replicating in the gastrointestinal tract, OPV strains genetically change and may spread in communities that are not fully vaccinated against polio, especially in areas where there is poor hygiene, poor sanitation, or overcrowding. The lower the population immunity, the longer this virus survives and the more genetic changes it undergoes.
      In very rare instances, the vaccine-derived virus can genetically change into a form that can cause paralysis as does the wild poliovirus – this is what is known as a vaccine-derived poliovirus (VDPV). The detection of VDPV in at least two different sources and at least two months apart, that are genetically linked, showing evidence of transmission in the community, should be classified as ‘circulating’ vaccine-derived poliovirus type 2 (cVDPV2). Circulating vaccine-derived poliovirus type 2 continues to affect different areas of the world, notably in the African Region.

      Public health response

      The Ministry of Health has publicly announced the outbreak, and on 28 November, immunization campaigns were launched for 1.2 million children under the age of 13 years in the province of Aceh.
      Risk assessment and field investigations were immediately launched and are still ongoing by the local and national public health authorities, with support from the Global Polio Eradication Initiative (GPEI) partners, including a more detailed assessment of the origin of the isolated viruses.
      The Ministry of Health, with support from WHO, UNICEF and other partners, is undertaking strong measures to stop the transmission. Measures include enhanced surveillance- active search for AFP cases at health facilities and communities, assessment of OPV/IPV coverage through a rapid community survey in a sample of 200 households, and training on the surveillance guidelines for the use of novel oral polio vaccine type 2 (nOPV2).
      The WHO Director General approved the release of the nOPV2 for rapid response on 25 November 2022 and a rapid vaccination response was initiated on 28 November in Pidie district (the affected district) with approximately 95 603 children aged under 13 years to be vaccinated.
      A rapid response vaccination campaign was launched in Aceh province for those aged zero to 12 years on 5 December 2022. Large-scale supplementary immunization activities (SIAs) with nOPV2 are proposed for those aged zero to 12 years in Aceh and zero to four years in North Sumatera, West Sumatra, and Riau in the first week of January 2023 and the first week of February 2023.
      Advocacy campaigns, risk communication messaging, and social mobilization have been implemented.

      WHO risk assessment

      WHO assesses the risk to be high at the national level due to low polio vaccination coverage in Aceh and other provinces in Indonesia, the susceptibility of the population to poliovirus type 2 after switching from trivalent oral polio vaccine (tOVP) to bOPV in April 2016 combined with low uptake of inactivated polio vaccine (IPV), sub-optimal surveillance capacity, and vaccine hesitancy among the at-risk population.
      The detection of cVDPVs highlights the importance of maintaining high levels of routine vaccination coverage everywhere to minimize the risk and consequences of the circulation of any poliovirus, as well as the need to ensure quality surveillance for early detection of any poliovirus.

      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 and commence any 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’s International travel and health recommends that all travellers to polio-affected areas be fully vaccinated against polio.
      As per the advice of the Emergency Committee convened under the International Health Regulations (2005) on the international spread of poliovirus, countries affected by poliovirus transmission are subject to Temporary Recommendations. To comply with the Temporary Recommendations issued under the PHEIC, any country that have had an importation of cVDPV2 with local transmission should (i) declare the outbreak as a national public health emergency (ii) encourage residents and long-term visitors to receive a dose of IPV four weeks to 12 months prior to international travel, (iii) ensure that travellers who receive such vaccination have access to an appropriate document to record their polio vaccination status, (iv) further intensify efforts to increase IPV immunization coverage, including sharing coverage data, and (v) intensify regional cooperation and cross border coordination to enhance surveillance for prompt detection of poliovirus, and vaccinate refugees, travellers and cross border populations, according to the advice of the Advisory Group.
      WHO does not recommend any travel and/or trade restrictions to Indonesia based on the information available for this current event.

      Further informationCitable reference: World Health Organization (19 December 2022). Disease Outbreak News; Circulating vaccine-derived poliovirus type 2 (cVDPV2)-Indonesia. Available at: https://www.who.int/emergencies/dise...em/2022-DON430



      Comment


      • #4
        Source: https://www.bbc.com/indonesia/articles/c721xw7g480o

        Polio outbreak: 3.9 million toddlers in West Java will be immunized after the case finding in Purwakarta
        Polio immunization in Aceh

        Image source, BETWEEN PHOTOS
        6 hours ago

        As many as 3.9 million toddlers in West Java will be immunized to prevent transmission, after one positive case was found in Purwakarta Regency, West Java.

        Four months after the discovery of a polio case in Pidie District, Aceh, a four-year-old girl in Maniis District, Purwakarta experienced Acute Flaccid Paralysis (AFP) or paralysis of her left leg.

        After a stool sample was examined on March 14, 2023, the child was confirmed positive for type 2 VDVP polio.

        Director General of P2P Immunization Management at the Ministry of Health, Prima Yosephine said the child had been taken to a public hospital to undergo physiotherapy and further examination.

        "In the case of polio, the disability will be permanent, it will not disappear, but it will be recognized sooner, rehabilitated sooner, at least minimizing [his paralysis]," said Prima when met in Bandung on Monday (27/3)....

        Comment


        • #5
          Source: https://www.who.int/emergencies/dise...em/2023-DON458


          Circulating vaccine-derived poliovirus type 2 (cVDPV2) - Indonesia
          17 April 2023

          Outbreak at a glance

          On 17 March 2023, the Indonesia Ministry of Health notified WHO of the detection of a circulating vaccine-derived poliovirus type 2 (cVDPV2) in a 48-month-old female with acute flaccid paralysis (AFP), from Purwakarta district in West Java province. Field investigations were immediately launched by local and national public health authorities, with support from partners of the Global Polio Eradication Initiative (GPEI). Two rounds of immunization with novel OPV2 have been planned to cover children below five years of age, regardless of their prior vaccination status. The first round was implemented in April 2023.

          Description of the outbreak

          On 17 March 2023, the Indonesia Ministry of Health notified WHO of the detection of a circulating vaccine-derived poliovirus type 2 (cVDPV2) in a 48-month-old female with acute flaccid paralysis (AFP), from Purwakarta district in West Java province. The case had the onset of paralysis on 16 February 2023. The girl had not received any previous doses of oral poliovirus vaccine (OPV) or inactivated poliovirus vaccine (IPV). A stool specimen was collected on 21 February 2023 and was confirmed to be cVDPV2 on 14 March 2023. Genetic sequencing results showed that the isolate has undergone 30 to 31 nucleotide changes from vaccine strains. The results of whole genome sequencing are pending. The patient and her parents had no travel history within the month before the onset of AFP; however, during this period, the household had received visitors including relatives from another village.

          A total of four confirmed cases of VDPV2 have been reported in Indonesia since November 2022. This includes three cases of circulating VDPV2 (cVDPV2) with acute flaccid paralysis (AFP) in Aceh province and one in West Java province. Additionally, four healthy children in Aceh province were confirmed to have cVDPV2 on 25 November 2022. The poliovirus was identified as being from the same emergence group as the cases reported in Aceh in 2022 and hence classified as cVDPV2 but is divergent from the Aceh viruses, signifying potentially missed transmission. A rapid risk assessment was conducted for the outbreak in Aceh in November 2022, which assessed the risk at the national level as high, regional level as moderate and global level as low.

          The administrative coverage of the bivalent oral polio vaccine (bOPV4) between 2018 and 2022 in West Java ranged from 88% to 102%, while coverage of inactivated polio vaccine (IPV) ranged from 26% to 106%. Vaccination coverage rates for bOPV and IPV were also above 90% in a catch-up campaign in West Java. Coverage with bOPV in the Purwakarta district has been consistently high between 2018 and 2022, ranging from 94% in 2020 to 104% in 2021; however, coverage with IPV decreased to 26% in 2020 before increasing to 80% in 2021, and reaching 100% in 2022.

          However, a pocket of unvaccinated children (for either bOPV and IPV) remains in West Java, which is mainly related to a lack of understanding of the importance of immunization by parents, concerns about the safety of the vaccines (including fever following immunization, receiving multiple injections and as a result of other sources of misinformation) and religious beliefs.

          Epidemiology of Poliomyelitis

          Polio is a highly infectious disease that largely affects children under five years of age, causing permanent paralysis (approximately 1 in 200 infections) or death (2-10% of those paralyzed).

          The virus is transmitted person-to-person, 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 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.

          Vaccine-derived poliovirus is a well-documented strain of poliovirus mutated from the strain originally contained in OPV. OPV contains a live, weakened form of poliovirus that replicates in the intestine for a limited period, thereby developing immunity by building up antibodies. On rare occasions, when replicating in the gastrointestinal tract, OPV strains genetically change and may spread in communities that are not fully vaccinated against polio, especially in areas where there is poor hygiene, poor sanitation, or overcrowding. The lower the population's immunity, the longer this virus survives and the more genetic changes it undergoes.

          In very rare instances, the vaccine-derived virus can genetically change into a form that can cause paralysis as does the wild poliovirus – this is what is known as a vaccine-derived poliovirus (VDPV). The detection of VDPV in at least two different sources and at least two months apart, that are genetically linked, showing evidence of transmission in the community, should be classified as ‘circulating’ vaccine-derived poliovirus type 2 (cVDPV2).
          Public health response

          Following confirmation of the case in West Java, field investigations have been completed by the Ministry of Health, with support from WHO, UNICEF, and other partners, including an active search for AFP cases targeting at least 200 households and a review of hospital records.
          Faecal samples have been collected from 30 healthy children, of which six samples were identified as VDPV2, which confirms that the virus was already circulating.
          Two rounds of immunization with novel OPV2 have been planned to vaccinate a total of 3 984 797 children between 0 to 59 months in all 27 districts in West Java. The first round started on 3 April 2023. A cumulative coverage of 85.6% has been achieved in West Java in the first round as of 11 April 2023. The second round is planned for the third week of May.
          Following the outbreak in Aceh on 25 November 2022, two rounds of supplementary immunization activities (SIAs) with nOPV2 were held in Aceh province for children aged 12 years and younger, starting on 28 November 2022. The cumulative coverage of 96% was achieved in the first and second rounds.
          SIAs with nOPV2 in Aceh neighboring North Sumatra province started on 13 February 2023 and are ongoing. Currently, coverage with the first round among those aged 0-59 months is 93%. The total target population for the two provinces combined is 2 564 594. This number has met the minimum number target to be covered during SIAs for cVDPV2 outbreak control, as recommended by WHO.

          WHO risk assessment

          WHO assesses the risk to be high at the national level. Despite Indonesia having a strong capacity to respond to poliovirus outbreaks and West Java having a moderate to strong outbreak response capacity to interrupt transmission, there is a high susceptibility of the population to poliovirus type 2 after switching from trivalent to bivalent OPV; sub-optimal IPV coverage in Aceh, West Java and several other provinces in Indonesia; high population mobility between West Java and other provinces within Indonesia; and reluctance to vaccinate among at-risk populations. The outbreak in Indonesia poses a moderate regional risk and a low risk globally.

          The detection of cVDPVs highlights the importance of maintaining high levels of routine vaccination coverage everywhere to minimize the risk and consequences of the circulation of any poliovirus, as well as the need to ensure quality surveillance for early detection of any poliovirus.
          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 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’s International travel and health recommends that all travellers to polio-affected areas be fully vaccinated against polio.

          As per the advice of an Emergency Committee convened under the International Health Regulations (2005), the 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 i) declare the outbreak as a national public health emergency; ii) encourage residents and long-term visitors to receive a dose of IPV four weeks to 12 months prior to international iii) encourage residents and long-term visitors to receive a dose of IPV four weeks to 12 months prior to international travel iv) further intensify efforts to increase IPV immunization coverage, including sharing coverage data, and v) further intensify efforts to increase IPV immunization coverage, including sharing coverage data.

          The latest epidemiological information on cVDPVs is updated on a weekly basis.

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

          Global Polio Eradication Initiative
          Poliomyelitis (Polio) Fact sheets
          WHO/UNICEF estimates of national routine immunization
          GPEI Public health emergency status
          International travel and health
          Vaccine-derived polioviruses
          Fifteenth Meeting of the WHO South-East Asia Regional Certification Commission for Poliomyelitis Eradication

          Citable reference: World Health Organization (17 April 2023). Disease Outbreak News; Circulating vaccine-derived poliovirus type 2 (cVDPV2) – Indonesia. Available at: https://www.who.int/emergencies/dise...em/2023-DON458

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