Malawi declares outbreak of wild poliovirus type 1

[Shiloh]

Source: https://reliefweb.int/report/malawi/malawi-declares-polio-outbreak

Malawi declares polio outbreak

FormatNews and Press Release
Source WHO
Posted17 Feb 2022
Originally published17 Feb 2022

Brazzaville/Lilongwe, 17 February 2022 – The health authorities in Malawi have declared an outbreak of wild poliovirus type 1 after a case was detected in a young child in the capital Lilongwe. This is the first case of wild poliovirus in Africa in more than five years.
Africa was declared free of indigenous wild polio in August 2020 after eliminating all forms of wild polio from the region. Laboratory analysis shows that the strain detected in Malawi is linked to the one that has been circulating in Sindh Province in Pakistan. Polio remains endemic in Afghanistan and Pakistan. As an imported case from Pakistan, this detection does not affect the African region’s wild poliovirus-free certification status.
“As long as wild polio exists anywhere in the world all countries remain at risk of importation of the virus,” said Dr Matshidiso Moeti, World Health Organization (WHO) Regional Director for Africa. “Following the detection of wild polio in Malawi, we’re taking urgent measures to forestall its potential spread. Thanks to a high level of polio surveillance in the continent and the capacity to quickly detect the virus, we can swiftly launch a rapid response and protect children from the debilitating impact of this disease.”...

 

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GPEI Statement on WPV1 in Malawi

Wild poliovirus type 1 detected in Lilongwe, Malawi


17 February 2022 As a result of ongoing disease surveillance, the Global Polio Laboratory Network (GPLN) has confirmed the presence of type 1 wild poliovirus (WPV1) in a child suffering from paralysis in Tsabango, Lilongwe, Malawi. Analysis shows that the virus is genetically linked to WPV1 that was detected in Pakistan’s Sindh province in October 2019.

The three-year-old girl in Malawi experienced onset of paralysis on 19 November 2021, and stool specimens were collected for testing on 26 and 27 November. Sequencing of the virus conducted in February by the National Institute for Communicable Diseases in South Africa and the U.S. Centers for Disease Control and Prevention confirmed this case as WPV1.

Detection of WPV1 outside the world’s two remaining endemic countries, Pakistan and Afghanistan, is a serious concern and underscores the importance of prioritizing polio immunization activities. Until polio is fully eradicated, all countries remain at risk of importation and must maintain high vaccination coverage to protect all children from polio.

The GPEI is supporting health authorities in Malawi to conduct a thorough assessment of the situation and begin urgent immunization activities in the subregion to mitigate any risk of spread. Surveillance measures are also being expanded in Malawi and neighboring countries to detect any other potential undetected transmission.

As an imported case from Pakistan, this detection does not affect the WHO African Region’s wild poliovirus-free certification status officially marked in August 2020. Malawi last recorded a case of wild poliovirus in 1992. The polio eradication programme has seen importations from endemic countries to regions that have been certified wild poliovirus-free in the past, and has moved quickly to successfully stop transmission of the virus in these areas.

Polio anywhere is a threat to children everywhere. Now is the time for all parties to recommit to ending all forms of polio for good.


https://polioeradication.org/news-p...type 1 detected,in Tsabango, Lilongwe, Malawi.

 

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[Shiloh]

Source: https://www.statnews.com/2022/02/22...concerns-the-virus-could-re-emerge-in-region/

Malawi polio case raises concerns the virus could reemerge in region
By Helen Branswell Feb. 22, 2022


A newly discovered case of wild polio in Malawi has raised the possibility that a virus that had been driven out of the African continent could again find a toehold there.

Teams of international disease investigators arrived in the East African nation over the weekend to probe how it came to have its first wild polio case in three decades and the continent’s first in five years.

“The reported case in Malawi comes as a big disappointment, but sadly not as a surprise,” said Kim Thompson, president of Kid Risk, a nonprofit organization that does disease modeling for the Global Polio Eradication Initiative. “It’s definitely showing us that the quality of immunization has not been high enough. But it also raises questions about the quality of surveillance.”

The case is a 3-year-old girl who lives on the outskirts of the capital, Lilongwe. She was paralyzed on Nov. 19; testing showed she’d been infected with a type 1 wild poliovirus. Comparison of the virus’ genetic sequence to other previous viruses revealed that it derived from a family of viruses that was seen circulating in Pakistan’s Sindh Province in October 2019.

The government of Malawi has declared the outbreak a public health emergency.

How the virus traveled more than 3,500 miles is unknown. How many children were exposed to it over that 25-month period is unknowable...

 

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[Pathfinder]

WEEKLY BULLETIN ON OUTBREAKS
AND OTHER EMERGENCIES

Week 9: 21 – 27 February 2022
Data as reported by: 17:00; 27 February 2022
...

Wild Poliovirus Malawi

1 cases
0 Deaths
20.0% CFR

EVENT DESCRIPTION

A four-year old child in Lilongwe, Malawi was confirmed to have
wild poliovirus type 1 (WPV1) after presenting to a health clinic
on 19 November 2021 with symptoms of acute flaccid paralysis
(AFP). Samples were collected the following week and sent to
the National Institute of Communicable Disease (NICD) in South
Africa and to the Centers for Disease Control and Prevention
(CDC) in the United States for testing and sequencing where
the patient was found to have WPV1. Sequencing of the sample
isolates show a close connection to WPV1 isolates that are
currently circulating in Pakistan. The child has had no history of
travel. Furthermore, the child has had the first dose of bivalent
oral poliovirus vaccine (bOPV) given at birth.

The last clinical case of wild poliovirus in Malawi was confirmed 30
years ago in 1992 and no other cases (including vaccine-derived
polio) have been reported since. Through global initiatives, there
was a push to adopt bOPV vaccine schemes replacing trivalent
oral poliovirus vaccination (tOPV) schemes in 2016, which
Malawi completed on 25 April 2016. The bOPV is supposed to
produce a better immune response against poliovirus types 1
and 3 than tOPV but does not protect against poliovirus serotype
2. The bOPV vaccine is also used for responses to poliovirus
outbreaks for types 1 and 3. In order to provide protection for
the population from poliovirus type 2 while tOPV is phased out,
supplemental immunization activities for type 2 are conducted,
which Malawi’s last completed in 2013. Overall, the current
immunization rates in the country, and even in Lilongwe itself,
are estimated to be sufficient surpassing targets, which are >80%
at the district level and >90% at the national level. In Lilongwe the
coverage was estimated at 96% in 2020 and 111% in 2021.

PUBLIC HEALTH ACTIONS

Global and regional rapid response teams have been
assembled to provide support to the country’s response
efforts

A preliminary field investigation was conducted to clinically
assess the case, perform contact tracing, survey the case’s
household to gauge immunization coverage, and assess
water, sanitation, and hygiene systems.

Active case search was conducted in health facility by
reviewing records of patients who have had previous acute
flaccid paralysis and by reviewing reporting tools.

SITUATION INTERPRETATION

Despite the achievements to eradicate Polio in the Africa region,
the first case of wild poliovirus has been confirmed in over 5
years. Though continuous efforts have been made to eliminate
the disease, the threat of resurgence remains. Since sequencing
has shown that the case is closely linked to strains circulating in
other continents, we must understand that the entire world is still
susceptible to the disease as long as strains exist in any part of
the world.

PROPOSED ACTIONS

A call to all countries to strengthen AFP surveillance to
quickly detect polio cases and stop potential importation of
other cases.

Maintain high levels of vaccination rates among the entire
population around the globe so that polio eradication can be
achieved.

View/Open

OEW09-2127022022.pdf (‎1.831Mb)‎

https://apps.who.int/iris/handle/10665/352262

 

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[Shiloh]

Source: https://www.who.int/emergencies/disease-outbreak-news/item/wild-poliovirus-type-1-(WPV1)-malawi


Wild poliovirus type 1 (WPV1) - Malawi

3 March 2022


On 17 February 2022, WHO received an update regarding the detection of wild poliovirus type 1 (WPV1) in Malawi which was previously notified on 31 January 2022 through an IHR notification as a case of poliovirus type 2 (PV2). The case, a child under 5 years old, from Central constituency, Lilongwe district, Central Region, developed acute flaccid paralysis (AFP) on 19 November 2021. Two stool specimens were collected for testing on 26 and 27 November, and were received at the Regional Reference Laboratory, the National Institute of Communicable Disease (NICD) in South Africa, on 14 January 2022, and then forwarded to the United States Centers for Disease Control and Prevention (US CDC).
Sequencing of the virus conducted by the NICD on 2 February, and the US CDC on 12 February confirmed this case as WPV1. Analysis shows that the current WPV1 isolate in Malawi is genetically linked to a Pakistan sequence detected in 2020 in Sindh province.
Africa was declared free of indigenous wild polio in August 2020 after eliminating all forms of wild polio from the region, and in Malawi, the last clinically confirmed WPV case was reported in 1992.


Public health response

• Global Polio Eradication Initiative (GPEI) partners, including WHO, is supporting the Malawi health authorities to carry out a risk assessment and outbreak response, including supplemental immunization. Surveillance measures are being activated and expanded in Malawi and neighbouring countries to detect potential cases.
• GPEI Rapid Response Team has been sent to Malawi to support coordination, surveillance, data management, communications, and operations. Partner organizations also sent teams to support emergency operations and innovative vaccination campaign solutions.

WHO risk assessment

Polio is a highly infectious disease, caused by a virus that invades the nervous system and can cause permanent paralysis (approximately one in 200 infections) or death (approximately 2-10% of paralyzed cases). The virus is transmitted by person-to-person, mainly through the faecal-oral route or, less frequently, by a common vehicle (for example, contaminated water or food).
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 the 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.
The risk at the national level in Malawi is assessed as high given the presence of high population density, low vaccination coverage (<80%) in many districts and lack of a catch-up campaign for more than six years, accumulated susceptible populations, suboptimal AFP surveillance, and lack of environmental surveillance, that may be affecting the ability to ascertain cases. Furthermore, the switch from the trivalent Oral Polio Vaccine (OPV) to bivalent OPV in Malawi was completed on 25 April 2016, and Inactivated Polio Vaccine (IPV) was introduced on 14 December 2018. The most recent supplementary immunization activities (SIAs) with a vaccine containing type 2 vaccine were conducted in 2013.
Additionally, the country is currently affected by tropical storm Ana which may impact the country’s response capacity by impairing Polio SIAs and surveillance activities. According to the UN flash update on Malawi tropical storm Ana, as of 11 February, there have been 995 072 people affected in 19 districts, 206 people injured, 46 people reported dead, and 18 people are reported still missing. The United Nations and partners are supporting the life-saving emergency flood response
The risk at the regional level is assessed as moderate given the significant population movement between Mozambique and Malawi, suboptimal vaccination coverage in the neighbouring countries, and suboptimal AFP surveillance activities.
The risk at the global level is assessed as low given the existing response capacity in place and the moderately high global Polio coverage estimates.

WHO advice

It is important that all countries, particularly those with frequent travel and contacts with polio-affected countries and areas, strengthen the surveillance of AFP cases to rapidly detect any new poliovirus importations and to facilitate a rapid response.
Under the International Health Regulations (2005) (IHR), countries must investigate and notify any poliovirus isolate, whether the isolate is from AFP cases, AFP contacts or environmental surveillance. Local health authorities should initiate the investigation within 24 hours of a poliovirus isolate being reported.
Isolation of poliovirus in a previously non-infected area represents an event or outbreak that requires national authorities to complete an immediate risk assessment to inform the type and scale of response. Following initial investigation and risk assessment, national authorities must continue to collect detailed information to update the situation analysis and risk assessment (i.e. results from laboratory investigations, or detailed information on affected communities, etc.). Neighbouring countries/regions must also continue to update their risk assessment with support from WHO regional offices.
Countries, territories, and areas should also maintain systematically high routine immunization coverage rates (>90%) both at national and subnational levels to minimize the consequences of any new poliovirus introduction. WHO recommends that two high-quality large-scale vaccination campaigns (>90% of children vaccinated) should be completed within eight weeks of laboratory sequencing results. A mop-up round might be required as an additional step wherever monitoring suggests children have been missed in certain health districts or areas, to ensure interruption of transmission (even in the absence of new poliovirus detections). Communication and social mobilization activities should be an integrated part of reactive Polio immunization campaigns.
WHO does not recommend any restriction on travel and/or trade to Malawi based on the information available for this current event. WHO’s International Travel and Health recommends that all travelers to polio-affected areas be fully vaccinated against polio. Residents (and visitors for more than 4 weeks) from infected 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), efforts to limit the international spread of poliovirus remain 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, consider vaccination of all international travelers, ensure such travelers are provided with an international certificate of vaccination, restrict at the point of departure the international travel of any resident lacking documentation of appropriate polio vaccination, intensify cross-border efforts to substantially increase vaccination coverage of travelers, and intensify efforts to increase routine immunization coverage.

 

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