The thirtieth affair of the Emergency Board beneath the All-embracing Bloom Regulations (2005) (IHR) on the all-embracing advance of poliovirus was convened by the WHO Director-General on 3 November 2021 with board associates and admiral accessory via video conference, accurate by the WHO Secretariat. The Emergency Board advised the abstracts on agrarian poliovirus (WPV1) and circulating vaccine acquired polioviruses (cVDPV). Technical updates were accustomed about the bearings in the afterward Accompaniment Parties: Afghanistan, China, Guinea Bissau, Mauritania, Nigeria, Pakistan, Senegal and Ukraine.
Wild poliovirus
WPV1 manual has collapsed to low levels, with no new case back January 2021 back two WPV1 cases occurred, one anniversary from Pakistan and Afghanistan, compared to 129 WPV1 cases during the aforementioned time aeon in 2020. From ecology surveillance, the all-embracing admeasurement of specimens that are absolute in Pakistan is 10% compared to 56% in 2020 and there accept been alone seven absolute samples back April 2021, acceptation the admeasurement of positives for the aftermost six months is 2.2%. During aftermost three months, alone one ecology sample has activated absolute for WPV1 from the 163 adjourned samples (from DI Khan in August). September 2021 was the aboriginal ages back ecology surveillance started in Pakistan in which all of the adjourned ecology samples activated abrogating for WPV1. From the samples candy to date in October, no sample has been begin positive. The board additionally acclaimed the achievement of the surveillance assay in Pakistan which begin a aerial likelihood that the accustomed WPV1 apprehension is valid.
The key claiming in Pakistan charcoal the ‘persistently absent children’ in the amount reservoirs apropos which advance is actuality fabricated through avant-garde approaches such as deploying black anesthetic teams, bloom camps, tracking of absent and not accessible accouchement afterwards the SIA is completed, ambidextrous with refusals afore the attack starts and appliance pro-vaccination influencers. The key claiming in Afghanistan charcoal the accumulative excess of unvaccinated accouchement due to continued inaccessibility for crisis reasons, and the accustomed alternation and altruistic bearings causing ambiguity about programme implementation. The planned NIDs in November and December appliance a abode to abode attack action are a key befalling to abode this ample basin of unvaccinated children. Based on the advance accomplished to date, the Board acclaimed the alert optimism of the polio affairs and that the advancing few months would be analytical ones in arresting polio manual in the two absolute ancient countries. There is no allowance for complacency, abutting ecology will be adapted to ensure that anniversary and every adolescent is vaccinated.
Circulating vaccine acquired poliovirus (cVDPV)
Since the aftermost meeting, three added countries accept been adulterated with cVDPV2, bringing the absolute cardinal of currently cVDPV2 adulterated countries to 30, in three WHO Regions (African, Eastern Mediterranean and European). The cardinal of cVDPV2 cases in 2021 totals 420, of which 266 accept occurred in Nigeria. The three anew adulterated countries were all the aftereffect of all-embracing advance of cVDPV2, namely Guinea Bissau, Mauritania and Ukraine. Based on assay of abiogenetic linkages amid viruses, cantankerous bound advance charcoal accustomed with 10 accurate importations into 10 countries in the additional division of 2021. Admitting the advancing abatement in the cardinal of cases and lineages circulating, the accident of all-embracing advance of cVDPV2 charcoal high, with acquaintance in Egypt and Iran assuming that alike countries with aerial IPV advantage are at accident of accustomed cVDPV2 manual afterward importation.
The board acclaimed that SAGE has accustomed the alteration of nOPV2 from antecedent to added use beneath EUL, based on the allegation of an absolute assurance and abiogenetic adherence assessment. The board additionally acclaimed the pandemic-induced curtailment of nOPV2 vaccine and accent the SAGE advocacy apropos the accent of timely, affection beginning acknowledgment with the anon accessible type-2 vaccine (mOPV2).
Conclusion
Although heartened by the credible progress, the Board absolutely agreed that the accident of all-embracing advance of poliovirus charcoal a Accessible Bloom Emergency of All-embracing Concern (PHEIC) and recommended the addendum of Temporary Recommendations for a added three months. The Board recognizes the apropos apropos the diffuse continuance of the polio PHEIC but assured that there are still cogent risks admitting credible advance fabricated in the two ancient countries, and that the advancing three months would be a analytical aeon to adviser the bearings there closely. The Board advised the afterward factors in extensive this conclusion:
Ongoing accident of WPV1 all-embracing spread:
Based on the afterward factors, the accident of all-embracing advance of WPV1 appears to continue:
Ongoing accident of cVDPV2 all-embracing spread::
Based on the afterward factors, the accident of all-embracing advance of cVDPV2 appears to abide high:
Other factors include
Risk categories
The Board provided the Director-General with the afterward admonition aimed at abbreviation the accident of all-embracing advance of WPV1 and cVDPVs, based on the accident stratification as follows:
Criteria to appraise States as no best adulterated by WPV1 or cVDPV:
Once a country meets these belief as no best infected, the country will be advised accessible for a added 12 months.; Afterwards this period, the country will no best be accountable to Temporary Recommendations, unless the Board has apropos based on the final report.
TEMPORARY RECOMMENDATIONS
States adulterated with WPV1, cVDPV1 or cVDPV3 with abeyant accident of all-embracing spread
WPV1
Afghanistan (most contempo apprehension 23 February 2021)
Pakistan (most contempo apprehension 9 August 2021)
cVDPV1
Madagascar (most contempo apprehension 13 September 2021)
Yemen (most contempo apprehension 27 March 2021)
cVDPV3
These countries should:
States adulterated with cVDPV2, with or afterwards affirmation of bounded transmission:
Afghanistan (most contempo apprehension 9 July 2021)
Benin (most contempo apprehension 14 May 2021)
Burkina Faso (most contempo apprehension 9 June 2021)
Cameroon (most contempo apprehension 8 September 2021)
CAR (most contempo apprehension 29 October 2020)
Chad (most contempo apprehension 28 November 2020)
Rep Congo (most contempo apprehension 14 April 2021)
DR Congo (most contempo apprehension 30 April 2021)
Côte d’Ivoire (most contempo apprehension 23 December 2020)
Egypt (most contempo apprehension 8 June 2021)
Ethiopia (most contempo apprehension 16 July 2021)
Gambia (most contempo apprehension 1 July 2021)
Guinea (most contempo apprehension 10 July 2021)
Guinea Bissau (most contempo apprehension 26 July 2021)
Iran (Islamic Republic of) (most contempo apprehension 20 February 2021)
Kenya (most contempo apprehension 25 January 2021)
Liberia (most contempo apprehension 28 May 2021)
Mali (most contempo apprehension 23 December 2020)
Mauritania (most contempo apprehension 1 September 2021)
Niger (most contempo apprehension 20 July 2021)
Nigeria (most contempo apprehension 12 September 2021)
Pakistan (most contempo apprehension 11 August 2021)
Senegal (most contempo apprehension 14 September 2021)
Sierra Leone (most contempo apprehension 1 June 2021
Somalia (most contempo apprehension 23 May 2021)
South Sudan (most contempo apprehension 10 Apr 2021)
Sudan (most contempo apprehension 18 December 2020)
Tajikistan (most contempo apprehension 13 August 2021)
Uganda (most contempo apprehension 1 June 2021)
Ukraine (most contempo apprehension 7 September 2021)
States that accept had an admission of cVDPV2 but afterwards affirmation of bounded manual should:
States with bounded manual of cVDPV2, with accident of all-embracing advance should in accession to the aloft measures:
For both sub-categories:
States no best adulterated by WPV1 or cVDPV, but which abide accessible to re-infection by WPV or cVDPV
WPV1
none
cVDPV
Angola (most contempo apprehension 9 February 2020)
China (most contempo apprehension 25 January 2021)
Ghana (most contempo detection17 September 2020)
Malaysia (most contempo apprehension 13 March 2020)
Philippines (most contempo apprehension 16 January 2020)
Togo (most contempo apprehension 9 July 2020)
Zambia (most contempo cVDPV2 apprehension 25 November 2019)
These countries should:
Additional considerations
The Board was anxious by the ample cVDPV2 beginning in Nigeria that has afresh agitated into Niger and Cameroon. While acquainted the appulse of COVID-19, the board was anxious about the poor affection of SIAs conducted to date and accustomed immunization and apprenticed the country to focus its efforts to abode these two factors.
The board was actual anxious about the bearings in Senegal area there has been an about 12 ages adjournment back the antecedent apprehension with no beginning acknowledgment yet conducted which had resulted in added cantankerous bound spread. The board apprenticed Senegal to acknowledge a civic accessible bloom emergency as a agency of aesthetic acknowledgment efforts and to booty proactive accomplish to accelerate its beginning response.
The board was anxious by the letters of diffuse stockouts of vaccines including polio vaccine in Guinea Bissau and apprenticed the country to booty accomplish to adjust this and abstain echo occurrences in the future. The board recommended that accustomed immunization be advised as stockouts may be a evidence of a added problem.
In Ukraine, accomplish charge to be undertaken bound to undertake an immunization acknowledgment appliance whichever OPV2 is available, in accession to anecdotic groups and bounded areas area there are pockets of absent children. The board acclaimed additionally the GPEI advice on polio anesthetic in an emergency bearings which offers advice on vaccinating refugees and could be activated to any adaptable population.
The board acclaimed the acceptable efforts by China to aphorism out added manual and accustomed that nine months afterwards the aftermost apprehension of cVDPV3, China was no best infected.
The Board accustomed the added advance accomplished with the addition and commitment of nOPV2 but was anxious to apprehend of cogent delays in beginning acknowledgment timelines as countries autonomous to adjournment acknowledgment in adjustment to use nOPV2. Polio outbreaks should abide to be met with an advancing and adapted acknowledgment with the anon accessible type-2 vaccine.
The Board warned of the advancing furnishings of COVID-19 decidedly on capital immunization and accessible approaching disruptions of accumulation and commitment of vaccines. Zero-dose accouchement and communities were absent afore the appearance of the communicable and it is analytical that these accouchement and communities are prioritized as capital immunization casework are restored. COVID-19 is acceptable to abide to accept adverse furnishings on all bloom programs and systems for some time to appear so the polio programme charge abide to administer its acknowledgment to afflicted the absolute hurdles.
Based on the accustomed bearings apropos WPV1 and cVDPV, and the letters provided by afflicted countries, the Director-General accustomed the Committee’s appraisal and on 5 November 2021 bent that the bearings apropos to poliovirus continues to aggregate a PHEIC, with account to WPV1 and cVDPV. The Director-General accustomed the Committee’s recommendations for countries affair the analogue for ‘States adulterated with WPV1, cVDPV1 or cVDPV3 with abeyant accident for all-embracing spread’, ‘States adulterated with cVDPV2 with abeyant accident for all-embracing spread’ and for ‘States no best adulterated by WPV1 or cVDPV, but which abide accessible to re-infection by WPV or cVDPV’ and continued the Temporary Recommendations beneath the IHR to abate the accident of the all-embracing advance of poliovirus, able 5 November 2021.
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Safety Committee Meeting Template
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