Meeliug Reporl

|ileeulh Meeliug o
lhe Regioual Couuissiou or lhe
Cerlicaliou o Poliouyelilis Eradicaliou
iu Jhe wesleru Pacic Regiou
Phuou Peuh, Caubodia
1-2 0eceuber 2009
WORLD HEALTH ORGANIZATION
REGIONAL OFFICE FOR THE WESTERN PACIFIC













REPORT

FIFTEENTH MEETING OF THE REGIONAL COMMISSION
FOR THE CERTIFICATION OF POLIOMYELITIS ERADICATION
IN THE WESTERN PACIFIC REGION

Phnom Penh, Cambodia
1-2 December 2009


















Manila, Philippines
October 2010

(WP)/ICP/IVD/1.1/001-A

Report series number: RS/2009/GE/56(CAM) English only










REPORT

FIFTEENTH MEETING OF THE REGIONAL COMMISSION
FOR THE CERTIFICATION OF POLIOMYELITIS ERADICATION
IN THE WESTERN PACIFIC REGION

Phnom Penh, Cambodia
1-2 December 2009








Convened by:

WORLD HEALTH ORGANIZATION
REGIONAL OFFICE FOR THE WESTERN PACIFIC







Not for sale

Printed and distributed by:

World Health Organization
Regional Office for the Western Pacific
Manila, Philippines

October 2010
NOTE
The views expressed in this report are those of the participants of the fifteenth meeting of
the Regional Commission for the Certification of Poliomyelitis Eradication in the Western
Pacific Region and do not necessarily reflect the policies of the World Health Organization.


















Keywords:
Immunization / Poliomyelitis prevention and control / Certification
This report has been printed by the Regional Office for the Western Pacific of the World
Health Organization for the participants of the fifteenth meeting of the Regional Commission for
the Certification of Poliomyelitis Eradication in the Western Pacific Region, which was held in
Phnom Penh, Cambodia, from 1 to 2 December 2009.
CONTENTS

1. INTRODUCTION................................................................................................................. 1
1.1 Objectives ..................................................................................................................... 1
1.2 Organization ................................................................................................................. 1

2. PROCEEDINGS ................................................................................................................... 2
2.1 Global overview of poliomyelitis eradication (as of December 2009)......................... 2
2.2 Regional status of maintaining poliomyelitis-free status.............................................. 4

3. CONCLUSIONS................................................................................................................... 9
3.1 General ......................................................................................................................... 9
3.2 Country-specific conclusions and recommendations.................................................. 11

1. INTRODUCTION
The Regional Commission for the Certification of Poliomyelitis Eradication (RCC) in the
Western Pacific Region continues to meet on an annual basis in order to review and support
maintenance of poliomyelitis-free status and certification standard quality requirements and to
fulfil its reporting mandate to the Global Certification Commission (GCC).
1.1 Objectives
The objectives of the RCC at its fifteenth meeting were:
(1) to review progress reports from all countries and areas on maintaining the
poliomyelitis-free status, including poliovirus laboratory containment; and
(2) to make recommendations on required action for maintaining the Region's
poliomyelitis-free status.
1.2 Organization
In order to have closer direct interactions with the National Certification Committees
(NCC) in key countries and allow RCC members to observe activities for maintaining
poliomyelitis-free status, the 15th RCC meeting was held in Phnom Penh, Cambodia. Field
activities for a targeted review of the acute flaccid paralysis (AFP) surveillance system were
conducted immediately after the meeting and the main conclusions and recommendations
presented to the National Immunization Programme (NIP) by the RCC rapporteur. Holding the
meeting in the country also presented advocacy opportunities for the significance of and
requirements for maintaining the country's poliomyelitis-free status and subsequently support the
NIP.
The meeting was attended by six of the seven commission members and a WHO
secretariat. Annex 1 includes the meeting timetable, and Annex 2 contains a list of participants.
The opening ceremony was attended by His Excellency, the Secretary of State,
Professor Eng Huot, NCC members, officials of the Ministry of Health and the Regional
Immunization Specialist of the United Nations Children's Fund (UNICEF) East Asia Pacific
Regional Office, representing one of the key stakeholders in the Global Polio Eradication
Initiative (GPEI).
1.3 Opening ceremony
Dr Michel Thieren, acting WHO Representative in Cambodia, presented the opening
remarks of Dr Shin Young-soo, the WHO Regional Director in the Western Pacific.
Dr Shin recognized the important role the RCC has played in keeping the Western Pacific
Region poliomyelitis-free and the invaluable support it provides to the surveillance and
immunization efforts of Member States.
Dr Shin highlighted that it was only fitting to hold the RCC meeting in Cambodia,
which eliminated poliomyelitis in 1997 and by October 2000 was officially certified as
poliomyelitis-free, joining all other Member States in the Region in reaching that important
milestone.
- 2 -
Dr Shin reminded how in the ensuing years, the WHO European Region was also certified
as poliomyelitis-free, and many other countries achieved elimination. He highlighted that there
are still areas where interruption of wild poliovirus transmission has proven to be much more
challenging than expected, including the four remaining poliomyelitis-endemic countries:
Afghanistan, India, Nigeria and Pakistan. He warned that wild poliovirus continues to find its
way back to poliomyelitis-free countries and repeated regional and transcontinental transmission
has occurred in several countries, originating particularly from Nigeria and India.
Dr Shin reiterated that the GPEI continues to pursue its goal with high levels of political
support and new operational approaches that are improving coverage in endemic countries and
reducing the risks and consequences of the international spread of poliovirus. He also felt
encouraged by the recently completed independent evaluation of major barriers to the
interruption of poliovirus transmission.
Despite the ongoing efforts, Dr Shin warned that it must be remembered that wild
poliovirus importations had been confirmed quite recently in less-expected-places in Kenya in
2009, in Nepal in 2008, in Australia and Myanmar in 2007, and in Singapore in 2006 and that
with increased international travel into the country and internal migration, it also could happen in
Cambodia. Dr Shin commended Cambodia for devoting great attention and effort over the past
12 years to maintaining high-quality AFP surveillance and immunization, even as other pressing
health issues competed for attention and resources. Evidence of this could be found in
Cambodia's swift and comprehensive response to the detection in the country of circulating
vaccine-derived poliovirus (cVDPV) in late 2005. That episode also highlighted the importance
of maintaining a high level of surveillance, particularly among high-risk populations.
Dr Shin concluded that as it is likely to take a few more years before global poliomyelitis
eradication and certification may occur, poliomyelitis surveillance and immunization systems
need to be made as sustainable as possible. Areas of synergies with other disease-control efforts
need to be identified in order to maximize resources. A wider circle of health care providers
public and private sectors need to be kept well informed about the requirements to meeting
the final goal. Continuing collaboration among partners need to be ensured poliomyelitis
eradication was jointly achieved in Cambodia and must be jointly maintained.
2. PROCEEDINGS
2.1 Global overview of poliomyelitis eradication (as of December 2009)
In 1988, the World Health Assembly (WHA) adopted resolution WHA41.28 on global
eradication of poliomyelitis by the year 2000. By 2008, all but four countries had interrupted
indigenous transmission of wild polioviruses (Afghanistan, India, Nigeria and Pakistan), and the
annual number of cases had declined by more than 99%. However, case numbers were still
fluctuating between 1000 and 2000 per year and 12 to 23 additional countries were experiencing
cases of poliomyelitis due to imported polioviruses each year. In at least two of these latter
countries (Angola and Chad) and possibly the Democratic Republic of the Congo and Sudan, the
imported virus persisted for more than 12 months and led to further international spread. In
2008, the Health Assembly in resolution WHA61.1 called for a new strategy to eradicate
poliomyelitis from the remaining affected countries. The 'Programme of Work 2009' of the
GPEI was constructed in order to inform this new strategy by evaluating new tactical innovations
in each disease-endemic area, conducting clinical trials of new oral poliovirus vaccine
- 3 -
formulations and facilitating an independent evaluation of major barriers to interrupting
poliovirus transmission.
In India, new tactics increased oral poliovirus vaccination campaign coverage in 2009
among migrant and mobile populations, and enhanced campaign operations being undertaken in
the disease-endemic districts of central Bihar and western Uttar Pradesh, raising the proportion of
very young children with antibodies to type 1 poliovirus in the latter area from 85% in late 2007
to 96% in late 2009.
In Nigeria, comparing the last six months (MayOctober 2009) with the same period in
2008, the proportion of children who had never been immunized in the 10 endemic northern
states (high-risk states) fell from close to 20% (19.5%) to less than 10% (9.6%) in 2009, after
state governors signed the 'Abuja Commitments to Poliomyelitis Eradication' in February 2009
and traditional leaders formed a poliomyelitis eradication committee in June 2009. Both of these
actions have resulted in greater accountability at the local level for the performance of the
poliomyelitis campaigns.
In Pakistan, the Prime Minister launched a 'Polio Action Plan' in February 2009 that
enhanced multisectoral support for the oral poliovirus vaccination campaigns in many areas,
although coverage remained less than 80% in the disease-endemic districts in the north of both
the North West Frontier Province and the Federally Administered Tribal Areas, Baluchistan and
the greater Karachi area of Sindh.
In the two remaining disease-endemic provinces in Afghanistan (Kandahar and Helmand
in the Southern Region), access to children improved in key security-compromised districts
during recent oral poliovirus vaccination campaigns through the use of new tactics, which
included an enhanced role for nongovernmental organizations, the recruitment of local access
negotiators, and negotiations with the International Security Assistance Force and the Taliban
for days of tranquillity. Although access in the Southern Region continues to fluctuate, the
proportion of inaccessible children was reduced for the first time to 5% during the oral poliovirus
vaccination campaigns in July and September 2009, down from more than 20% at the start of the
year.
To improve the efficiency and impact of oral poliovirus vaccination campaigns against the
last two remaining serotypes of wild poliovirus, clinical trial lots of a bivalent oral poliovirus
vaccine (bOPV), containing type 1 and type 3 viruses, were produced. In 2009, the results of the
clinical trial demonstrated that the protection conferred against disease due to both serotypes by
this bivalent vaccine was superior to that provided by the trivalent oral poliovirus vaccine (tOPV)
and non-inferior to the respective monovalent oral poliovirus vaccines (mOPV).
1
The
Advisory Committee on Poliomyelitis Eradication (ACPE) concluded that the use of bivalent
oral poliovirus vaccine in supplementary immunization activities constitutes an important new
tool for the Global Polio Eradication Initiative and made recommendations for its use.
2
This
product was first used in the GPEI in December 2009 with subsequent rapid scale up in order to
meet full demand by mid-2010.

1
Advisory Committee on Poliomyelitis Eradication: recommendations on the use of
bivalent oral poliovirus vaccine types 1 and 3. Weekly Epidemiological Record, 2009,
29(84):289-300.
2
Ibid.
- 4 -
An independent evaluation of major barriers to interrupting poliovirus transmission was
chaired by Dr A.J. Mohamed (Oman), a vice-chairman of the Executive Board, and comprised
five subteams with a total of 28 experts in relevant disciplines including public health,
immunization programmes, vaccinology, social mobilization and security. These subteams
collectively spent 24 person-months working on the evaluation in Afghanistan, Angola, India,
Nigeria, Pakistan, Sudan, the WHO regional offices for Africa and the Eastern Mediterranean
and WHO headquarters, with wide consultation with GPEI partners and stakeholders in each
country. The evaluation team submitted its report to the WHO Director-General on
22 October 2009.
The results and impact of the GPEI's Programme of Work 2009 were reviewed by WHOs
Strategic Advisory Group of Experts (SAGE) on immunization on 29 October 2009, and by the
ACPE on 18 and 19 November 2009 at a special consultation of this Group with
poliomyelitis-affected countries and Global Polio Management Team (GPMT) partners. The
SAGE on immunization urged the GPEI to rapidly consider the findings of the independent
evaluation; it also supported an enhanced research agenda and agreed that bOPV vaccination
constituted an important new tool. The Group recommended that the GPEIs major indicators be
internationally monitored with influential oversight by senior management in partner agencies
and poliomyelitis-affected countries.
The ACPE stated that the challenges faced by the GPEI in 2009 should not be allowed to
overshadow significant achievements, particularly in Nigeria, India and Afghanistan.
Participants in the ACPEs consultation concurred that the GPEI should establish a new
three-year programme of work that focused on stopping transmission of wild poliovirus globally,
based on the findings of the independent evaluation, and developed in a consultative process with
countries and partners.
2.2 Regional status of maintaining poliomyelitis-free status
Certification aspects
All countries, except one, continue to have active NCCs in place which met at least one
time in 2009; either face to face or in video conferences. Where countries have separate expert
review panels (ERP) to classify AFP cases, NCC members participated in some of the ERP
meetings. Following the RCC recommendation, at least seven NCCs have updated their terms of
references (TOR) to reflect post-certification aspects and requirements of their work.
In nine countries, NCCs also serve as ERP while for the 20 Pacific island countries and
areas (PIC) one Subregional Certification Committee (SRCC) is in place which also serves as
ERP. In China, each province has an ERP; with varying meeting frequency (though there is a
standard requirement of four times per year) and case review practices. The majority of ERP
(9/17) review all AFP cases for final classification where the others review all cases with
inadequate stool specimens who have residual paralysis, died or were lost to follow up and all
cases with Sabin-like poliovirus isolates.
AFP/poliomyelitis surveillance
The majority of countries in the Western Pacific Region were able to maintain
AFP/poliomyelitis surveillance quality during 2008 and in 2009 to date at the necessary level of
sensitivity
(or 'certification standard'); details are included in Annex 3. Notable performance improvements
were observed in the Lao People's Democratic Republic and Papua New Guinea.
- 5 -
0
0.5
1
1.5
2
2.5
3
AUS CAM CHN HOK LAO MAA MON NEZ PIC PNG PHL SIN VTN
2007 2008 2009
Figure 1: Non-polio AFP rate by country in the Western Pacific Region, 2007-2009*












*dataset as of 9 November 2009
However, while overall quality levels have been maintained, detailed review of country
performances revealed that gaps exist at subnational level in several countries like Cambodia,
and the Philippines, and need to be addressed to ensure timely and reliable identification of
circulating polioviruses.
In 2009, only one VDPV isolation was reported; from an AFP case in Shandong Province
in China. The type 2 VDPV had a sequence diversion in the VP1 region of 1%. Similarly, early
detection of VDPVs was observed in China in the previous years, supporting the good quality of
the AFP surveillance system.
Table 1: Emergence of VDPVs (2006 2009)
Country Place
Onset
paralysis Type
VP1
divergence
# AFP
cases
Cambodia Near Phnom Penh Nov 05 / Jan 06 3 >2% 2
China Guangxi Province Mar-06 1 1.40% 1
China Shanghai None (Aug 06) 3 1% 0
China Shandong Province Feb/Mar 07 1 1.4% / 1% 2
China Shanxi Apr-07 1 1% 1
China Guangxi Jun-07 1 1% 1
China Shandong Province Feb-09 2 1% 1


- 6 -
Important activities in 2009 to keep focus on poliomyelitis surveillance include
introduction of environmental surveillance at selected sites in Australia and China, conduct of
targeted AFP surveillance reviews in Cambodia and China (planned), visit by
Prof Anthony Adams (RCC chairperson) to Papua New Guinea in June for advocacy purposes
with senior health officials and technical discussions and a special surveillance project in the PIC
(CDC funded; also including rash and fever surveillance and re-establishment of the SRCC).
Important issues in 2009 included the need for continuous efforts to retrain and sensitize
new surveillance staff and clinicians on AFP surveillance, particularly in public health offices
and priority health facilities with high staff turnover and the special focus placed by all countries
on H1N1 Pandemic 2009, often involving national and WHO Expanded Programme on
Immunization staff to a significant extent (e.g. surveillance, preparedness plans future vaccine
deployment).
Poliomyelitis laboratory network
The regional poliomyelitis laboratory network continued to function at a good quality level
with all but one of the 43 laboratories (the provincial laboratory in Tibet/China) in operation
under the main WHO accreditation criteria. A new algorithm for faster isolation of polioviruses
(within 14 days of 28 days) was introduced in eight laboratories. Timeliness requirements for
sequencing results were reduced from 14 to seven days. Challenges still existed for obtaining
intratypic differentiation (ITD) results within 45 days of paralysis onset. Delays continued to
occur in shipping AFP stool sample from the point of collection to the isolation laboratory and
sending poliovirus isolates to the reference laboratories, mainly in China.
Table 2: Polio laboratory network performance*

% results w/in
28 days of
receipt (old
algorithm)
% results
w/in 14 days
of receipt
(new
algorithm)
% ITD
results
w/in 14
days of
receipt
% ITD
results
w/in 7 days
of receipt
% ITD
results
w/in 60
days of
onset
% ITD
results
w/in 45
days of
receipt
2007 96 58 52 12
2008 95 85 40 18
2009 96 86 93 78 45
*dataset as of 22 June 2010
Immunization against poliomyelitis
Data on immunization activities in 2008 indicated that, overall, countries were maintaining
high levels of immunity against poliomyelitis, with some notable exceptions (e.g. Lao People's
Democratic Republic, Papua New Guinea, some subnational areas in the Philippines); please see
Figure 2 and Annex 4. Supplementary immunization activities (SIAs) were only conducted in
China and the Lao People's Democratic Republic.
- 7 -

Figure 2: Poliomyelitis 3 coverage in the Western Pacific Region countries, 2008
Data source: JRF
Macao (China) has shifted from OPV to inactivated poliovirus vaccine (IPV) and Malaysia
is piloting IPV use in eight states (DTaP-IPV/Hib to children at 2, 3, 5 months of age. A DTaP-
IPV/Hib booster will be given from March 2010 onwards at age 18 months. Meanwhile, other
states still use DTwP-HBV/Hib + OPV at age 2, 3 and 5 months. Brunei Darussalam is
considering to shift from OPV to IPV in the near future. The current poliomyelitis immunization
schedule by country can be found in Annex 4.
In Japan, the NCC recommended that the adoption of IPV for routine immunization is
essential. For this, it is necessary to get national consensus to reduce the occurrence of vaccine
associated paralytic poliomyelitis (VAPP), and in order to maintain high vaccine coverage rate,
the NCC suggested to introduce a combined vaccine with DPT.
In the Lao People's Democratic Republic, based on the initial available resources (vaccine
and operational costs), 59 priority districts in 12 provinces were selected (319 989 children under
5 years) for two rounds of OPV immunization, first in December 2008 with the Child Health
Days (also providing vitamin A and mebendazole) and a second round in February 2009. After a
donation from the Government of Italy, an additional 191 855 children were targeted in February
and a final round was conducted in March/April 2009. In some difficult-to-reach areas,
additional antigens such as measles vaccine were added. The government reported 463 839
children aged 0-59 months received OPV in February 2009. In the March/April 2009 campaign,
the government reported 174 149 children 0-59 months being vaccinated (again 91% coverage).
The remaining districts were covered during the first round of tetanus toxoid (TT) SIAs for
child-bearing-age women and the next round will be held in January 2010.
China will continue to conduct its annual OPV SIAs in the winter season. Future planning
should include carefully establishing risk criteria for areas/populations to be targeted, operational
- 8 -
aspects including external monitoring and innovative strategies for fund raising ('seed money').
The country is also planning to conduct serosurveys in six provinces. In Papua New Guinea,
inclusion of OPV in the measles SIAs planned in 2010 is being discussed.
Wild poliovirus importation preparedness
One of the essential requirements for regional certification had been a national
preparedness plan for wild poliovirus importation. In light of the large poliomyelitis outbreak in
Indonesia in 2005, following an importation of wild poliovirus, and the introduction of the
International Health Regulation (IHR) 2005 making a wild poliovirus case of the four reportable
diseases, the RCC had previously already requested that all countries should update their national
plans accordingly and regularly reiterated this recommendation.
At the end of 2009, current wild poliovirus importation response plans were in place in
nine countries but the generic protocol of the PIC had been updated the last time only in 2005.
Several large countries like Cambodia, China, Malaysia, the Philippines and Viet Nam, though,
did not yet have updated preparedness plans in place.
Completion of Phase 1 wild poliovirus laboratory containment
Based on reviews of the final reports on Phase 1 wild poliovirus laboratory containment
and findings from the external technical review panel, the RCC concluded in its meeting in
December 2008 that the Phase 1 containment activities documented by China and Japan provided
a complete and accurate national inventory of laboratories with wild poliovirus infectious and
potentially infectious materials. With these final reports, the RCC declared Phase 1 wild
poliovirus laboratory containment, laboratory surveys and national inventories, complete for the
whole Western Pacific Region. A total of 77 260 laboratories were included; the number of
laboratories storing relevant materials has been reduced from 107 in 2008 to 47 as of 16
November 2009; this is in Australia, China, Japan and the Republic of Korea.
With the data analysis from all the countries in the Region now completed, results have
been shared with national containment coordinators and the RCC recommendation is being
reinforced that all countries should maintain a national focal point. In order to protect the huge
investments made into the exercise and facilitate the destruction of materials, maintenance plans
have been established in China and in Japan. Similar work will be done with Australia,
Mongolia and the Philippines and is planned for Cambodia.
Post eradication activities
While several countries and areas have already shifted from OPV to IPV with their own
financial and technical resources (Australia, Hong Kong/China, Macao/China,
Malaysia/partially, New Zealand, Republic of Korea), others require increased technical support.
Particularly in countries with large populations like China, there is a growing need to consider
economic analysis of various aspects to establish the scientific evidence for decision-making on
future poliomyelitis immunization options, including cost-effectiveness of different poliomyelitis
immunization alternatives; in terms of preparations, schedules, health impact of OPV cessation in
terms of VAPP and disability adjusted life years (DALYs) averted, cost of VDPV cases resulting
from the continued use of OPV and bio-safety and population immunity requirements for
domestic IPV production after global eradication. Phase II clinical trials have started for
Sabin-based IPV production in China and work is also going on in Japan.
Furthermore, China and the Philippines participated in the WHO-led multicountry study
on iVDPV detection in persons with primary immune deficiency (PID) while Australia is
planning its own study for detection of chronic poliovirus infection in persons with a PID.
- 9 -
3. CONCLUSIONS
3.1 General

Overall conclusion
By the time of the 15th RCC meeting, update reports had been received from all countries.
Based on the information received, the RCC was satisfied that the Region has remained free of
poliomyelitis during 2009, despite the persisting risk of wild poliovirus importation from
endemic areas, and despite the existence of subareas in the Region where insufficient immunity
levels may allow wild poliovirus spread, subsequent to an importation. With only one VDPV
isolation reported in 2008/2009, such an occurrence seem to be sporadic, without evidence for
sustained circulation.
Maintaining the certification process
The majority of NCCs have remained very active in their oversight of national
poliomyelitis programmes. Progress reports were generally comprehensive and, to a large
extent, addressed previous RCC recommendations, including updating the NCCs' TOR.
The RCC thanked all NCCs and their secretariats for the timely preparation and
submission of reports.
Maintenance of AFP/poliomyelitis surveillance
The RCC commended countries in the Western Pacific Region for generally upholding
certification standard AFP surveillance during 2009. However, some countries have AFP
surveillance quality gaps, particularly subnationally, or deterioration in AFP surveillance
sensitivity.
The RCC noted continued concern in the Region about the need for more precise
guidelines on VDPV terminology, investigation and response and reporting requirements, and
deemed further guidance in this area necessary from the GPEI.
The RCC highlighted how poliomyelitis eradication efforts have, particularly in
surveillance, established baselines for reporting requirements, use of standardized surveillance
indicators and linkages and collaboration between field and laboratory staff; to be used to
promote the AFP surveillance platform for other vaccine preventable disease (VPD) control
efforts as appropriate and support sustain poliomyelitis surveillance systems in return.
Polio laboratory network
The RCC was satisfied that the regional poliomyelitis laboratory network continued to
provide valuable high-quality laboratory support to Member States, noting in particular the
contribution of the Regional Reference Laboratories. The RCC commended that the Global
Specialized Laboratory at the National Institute of Infectious Diseases (NIID) in Japan, in
addition to its various support functions to countries in the Region, also continued in global
capacity-building by conducting global poliomyelitis laboratory training courses which benefit
countries in other WHO Regions as well (African and South East Asian Regions).
The RCC noted the progress achieved by the regional poliomyelitis laboratory network to
introduce the new real-time polymerase chain reaction methodology to a) more precisely identify
VDPVs and b) reduce the time needed for laboratory testing.
- 10 -
The RCC reiterated the recommendation by the Global poliomyelitis laboratory network
for all network laboratories to report all wild polioviruses and viruses with discordant ITD results
(i.e. potential VDPVs) to national authorities and WHO, including regional and global
coordinators, within 24 hours of their detection. The RCC requested all poliomyelitis
laboratories in the Region to adhere to this recommendation.
Maintaining high immunity levels
The RCC was impressed that available data on immunization activities indicated that most
countries and areas maintained high levels of immunity against poliomyelitis, but noted the lack
of uniformity of reported coverage at the district level. The RCC commended continued efforts
to boost immunity against poliomyelitis in areas with relatively low performance of routine
immunization; special approaches to enhance routine systems, i.e. through defaulter tracking or
better utilization of fixed-site immunization service delivery, comprehensive outreach or targeted
high quality SIAs.
The RCC appreciated that many progress reports included information on subnational
immunization coverage. This approach should be used even more widely, and identified
low-performing areas should be targeted for remedial activities.
Preparedness for wild poliovirus importation and cVDPV
The RCC continued to consider active and current preparedness plans for the detection of
and response to wild poliovirus importation and VDPV emergence as essential in countries'
efforts to stay poliomyelitis-free and requested the WHO Secretariat to work closely with all
countries that do not yet have one. Each NIP should seriously review if their national plan still
meets all requirements; to immediately activate an appropriate surveillance and immunization
response as required. Particularly, IPV-using countries need to include in the plan the vaccine to
be used in the event; considering all implications of securing adequate supplies.
With transmission of both type 1 and type 3 wild poliovirus continuing in the four
endemic countries and wild poliovirus transmission ongoing in several previously
poliomyelitis-free countries following importation from endemic/reinfected countries, the RCC
remained very concerned that this situation would once again compel the shifting of the
anticipated timeline of global eradication further into the future.
By implication, the threat of wild poliovirus importation for countries in the Region
remains and all Member States and key partners need to continue vigorously implementing all
relevant activities to maintain the poliomyelitis-free status. The RCC recommended to the WHO
Secretariat to consider best means to strengthen coordination with other poliomyelitis-free
Regions and interregional exchange; to widely share experiences in environmental and
enterovirus surveillance, conduct of serosurveys and AFP surveillance reviews, preparing for and
shifting to IPV, among others.
Laboratory containment of wild poliovirus infectious/potentially infectious materials
The RCC noted that several, but not all, countries indicated their current national focal
point for laboratory containment as recommended in 2008 and requested the WHO Secretariat to
ensure that all Member States were aware of the requirements. The RCC again encouraged all
laboratories to consider destruction of materials that were no longer essentially required.


- 11 -
3.2 Country-specific conclusions and recommendations
Australia
The RCC commended Australia for comprehensively addressing its recommendations by
updating the TORs of its NCC, updating the national inventory for wild poliovirus laboratory
containment and resolving the discussions about AFP case classification at the Expert Review
Committee (ERC).
The RCC appreciated several innovative efforts to identify ''all potential sources of
poliovirus in Australia", including the initiation of enterovirus surveillance in two sites (which is
in line with the Strategic Plan 2010-2012 of the GPEI) and the iVDPV study. The RCC wished
to be kept informed about these activities. Furthermore, the RCC noted that the Paediatric
Active Enhanced Disease Surveillance (PAEDS) system was working well and a helpful adjunct
to routine AFP surveillance.
The RCC commended the continued outstanding support given by the Regional Reference
Laboratory at VIDRL to the regional poliomyelitis laboratory network.
The RCC recognized that the wild poliovirus importation preparedness plan was endorsed
by the Australian Health Protection Committee in December 2008. The RCC continued to
consider the plan as comprehensive and adequate but recommended to follow discussions at the
WHO Secretariat on the best vaccine of choice responding to evidence, possibly in an area of
low IPV coverage/low immunity, of the importation and spread of a wild poliovirus.
Brunei Darussalam
The RCC commended the national poliomyelitis programme for maintaining surveillance
and immunization performance at certification standards and acknowledged the continued
leadership of the NCC.
The RCC noted that the NCC was considering to establish a separate Expert Review Panel
(ERP); in view of the low number of AFP cases the country experienced, this might not be
necessary. The RCC considered it important though that the NCC was otherwise not directly
involved in the day-to-day operations of the programme. In general, an ERP requires TORs
completely separate from the NCC TORs.
The RCC welcomed the review of the wild poliovirus importation contingency plan and
related risk assessment. The RCC encouraged immediate collaboration with WHO and UNICEF
in an event; also to meet the requirements under the IHR 2005.
Cambodia
The RCC expressed its sincere appreciation to the Government of Cambodia for hosting
its 15th meeting.
The RCC congratulated Cambodia on the excellent report on maintaining its
poliomyelitis-free status, which took a very thorough approach and identified and described all
critically important issues.
The RCC appreciated that all recommendations made at the RCC's 14th meeting had been
responded to, including the opportunity for the RCC members to participate in a targeted field
review of AFP surveillance.
- 12 -
While the RCC agreed with the areas of concern identified by the NCC, the RCC still
wanted to highlight the following points.
AFP surveillance
Overall surveillance indicators have been maintained at the required quality levels, such as
a non-poliomyelitis AFP rate of 1.1/100 000 under age 15 in 2009 to date and stool specimen
adequacy at 82%. However, there was a concern that the number of AFP identified each year
continued to decrease. An increasing number of large provinces each year were either 'silent'
(eight in 2009, including Kampong Thom and Bantay Meanchey) or were not reaching a rate of
1/100 000 (seven provinces in 2009, including Phnom Penh and Siam Reap).
The majority of cases in the whole country were still reported from Kunta Bhopa hospital
in Phnom Penh, with a similar number of cases, compared to 2008, reported directly from
provinces. In this context, the RCC acknowledged the major contribution made by Kunta Bhopa
hospital to AFP surveillance in Cambodia.
The RCC expected that the outcomes of the targeted AFP review could help in better
defining the reasons for which AFP reporting is declining and contribute to the development of
an activity plan to strengthen AFP surveillance over the next two years, and to clarify the
necessary resource requirements. The activity plan should focus also on identifying
opportunities to integrate AFP surveillance with surveillance for other vaccine-preventable or
other priority diseases. The RCC would appreciate a detailed report for its next meeting.
Immunization activities
The RCC found the overall reported third-dose oral poliovirus vaccine (OPV3) coverage
(91%) satisfactory but noted that coverage levels continued to vary considerably at the district
level (from 54% to "> 100%"). Also, the progress report correctly highlighted the continued
problems to access and vaccinate important high-risk groups, such as migrant populations and
slum-dwellers.
The RCC encouraged continued detailed subnational analysis, including use of surveys as
planned for 2010, to identify coverage gaps.
The RCC strongly supported efforts in Cambodia to strengthen the routine immunization
system, such as better utilization of fixed sites, and implementation of the 'coverage
improvement plan' (CIP). However, in areas where coverage gaps cannot be quickly closed
through routine vaccination, targeted preventive SIAs with OPV should be considered.
Whenever possible, OPV should be added to other vaccination campaigns, or child health
interventions, such as the measles catch-up SIAs planned for 2011 and the semi-annual
vitamin A-supplementation campaigns.
The RCC requested regional and global poliomyelitis partners to provide the necessary
resources for potential future SIAs.
Finally, the RCC noted that Cambodia had not yet submitted a specific preparedness and
response plan for wild poliovirus importation and emergence of VDPV and considered that the
development of such a plan has high priority.
China
As in previous years, the RCC appreciated the clear report from China which allowed to
conclude that both surveillance and immunization activities generally remained at levels to
assure the maintenance of poliomyelitis-free status.
- 13 -
The RCC encouraged continued identification of high-risk areas and population groups
and, in coordination with the WHO Secretariat, to consider targeted AFP surveillance reviews
and means to assess reported coverage.
The RCC recommended that the national programme should discuss with WHO the
possible need for additional monitoring for poliovirus, such as environmental surveillance in
low-performing areas that may bear risk factors such as suboptimal population immunity, high
population density and frequent population movements.
The RCC commended the continued excellent support given by the Regional Reference
Laboratory at the Chinese Center for Disease Control and Prevention to the regional
poliomyelitis laboratory network, particularly the systematic work to identify emerging VDPVs.
The RCC noted that the national wild poliovirus importation contingency plan is under
revision and strongly encouraged it finalization (in collaboration with WHO).
The RCC noted the various follow-up activities related to wild poliovirus laboratory
containment, such as the development of a maintenance plan after completion of phase 1, and
commended the Government of China for responding to recommendations the RCC made at its
14th meeting.
Hong Kong (China)
Overall, the RCC was satisfied that, based on the report submitted, both AFP surveillance
and immunization activities had remained at certification quality in Hong Kong (China).
The RCC commended that additional activities had been undertaken to sensitize key
physicians of public hospitals on the need for timely reporting of AFP and stool collection, and
to remind research laboratory staff of the need to inform the national containment focal point
when specimens are received from poliomyelitis-endemic areas (i.e. receipt of potentially
infectious material).
The RCC noted that while the original importation preparedness plan for Hong Kong
(China) had already been updated twice, it specifically mentioned that OPV (either tOPV and/or
mOPV) should be used for outbreak response vaccination. Since routine vaccination in
Hong Kong (China) was switched to use IPV exclusively in 2007, the RCC would appreciate to
hear more from the NCC about the feasibility of using OPV for response immunization, i.e.
whether OPV is still available/licensed in Hong Kong (China), and if yes, whether stockpiles of
OPV have been created to use in an emergency situation. The RCC encouraged consultation
with the WHO Secretariat about these matters.
Macao (China)
As in previous years, the RCC appreciated the clear report from Macau (China) which
allowed to conclude that both surveillance and immunization activities remained at levels to
assure the maintenance of poliomyelitis-free status.
The RCC noted that while the 'importation preparedness plan' was briefly discussed, the
plan itself was not attached to the report. As Macau (China) switched to use IPV for routine
infant immunization at the end of 2008, the RCC would like to know the vaccine to be used in
responding to an importation, should that become necessary. If the plan calls for using OPV for
that purpose (as in some other IPV-using countries), the RCC would appreciate to receive
comments from the NCC on the feasibility of this approach, such as if a relatively large quantity
of OPV could be available quickly, whether OPV is still licensed in Macau (China), and whether
stockpiles of OPV (tOPV and mOPVs) have been created for use in an emergency situation.
- 14 -
Japan
The RCC noted the various follow-up activities related to wild poliovirus laboratory
containment, i.e. development of a maintenance plan after completion of phase 1 - and
commended the Government of Japan for responding to recommendations the RCC made at its
14th meeting.
The RCC commended the continued outstanding support given by the Global Specialized
Laboratory at NIID to the regional and global poliomyelitis laboratory network.
The RCC appreciated the continued functioning of a large enterovirus laboratory network,
which tests large numbers of stool specimens collected from children. The information collected
through this network and other poliomyelitis surveillance activities allowed to conclude that
Japan had maintained its poliomyelitis-free status.
The RCC noted that, so far, no wild poliovirus importation preparedness plan had been
submitted with the annual reports and would appreciate to be briefed about related discussions;
while recognizing that there is very low risk of spread following importation due to high
population immunity levels. The RCC highlighted though that due to the biannual vaccination
schedules, there is the possibility that relatively large proportion of young infants receive
poliomyelitis vaccine during the second half of life only.
The RCC noted the ongoing discussions about a possible switch to IPV (Sabin-IPV),
depending on the outcome of current clinical trials and recommended close collaboration with
the WHO Secretariat for eventual decision-making.
Lao People's Democratic Republic
The RCC commended the Lao People's Democratic Republic for having completed two
nationwide rounds of SIAs with OPV (two rounds from December 2008 to April 2009, covering
around 67% of children under 5 years, with remaining districts covered in early 2010). The RCC
noted that the reported coverage documented in the national report had been 91%, consistent
with feedback from several external monitors who found coverage around 80% using small
sample surveys.
The RCC was also impressed by the continued activities of the NCC, which met three
times in 2009, had already adopted the new suggested terms of reference, continued to act as the
Expert Review Group for final case classification, and facilitated and endorsed the new wild
poliovirus importation preparedness plan for the country. The RCC concurred with the
recommendations made by the NCC for maintaining the country's poliomyelitis-free status and
encouraged the NCC to continue its active oversight and advocacy.
The RCC noted that AFP reporting in 2009 had decreased (non-poliomyelitis AFP rate
1.6/100 000 under age 15 for January - November) compared to 2008 (non-poliomyelitis AFP
rate of 2.8 per 100 000 under age 15) and some large province like Vientiane Capital and
Savannakhet were underreporting. The RCC assumed that, as in other countries, it was likely
that the Pandemic H1N1 2009 response activities increasingly dominated the agenda of public
health workers and reduced the person-time available for other public health tasks. To keep
focus on the poliomyelitis-free status of the country, the RCC encouraged continuation of
activities to search for missed cases and sensitize clinicians in low-reporting areas.


- 15 -
Malaysia
The RCC commended the national programme on the continued enterovirus surveillance
to supplement AFP surveillance but was concerned that AFP reporting decreased in 2009
compared to 2008; with several large states including Kuala Lumpur, Sabah and Sarawak not
achieving the minimum target. The RCC noted that the report did not contain any specific
information which action had been taken in such low performing areas and would appreciate an
update.
The RCC recommended that the national programme should discuss with WHO the
possible need for additional monitoring, such as environmental surveillance in low-performing
areas that may bear risk factors such as suboptimal population immunity, high population density
and frequent population movements.
The RCC noted that the national wild poliovirus importation contingency plan was under
revision and strongly encouraged its finalization (in collaboration with WHO). As Malaysia is
already using IPV in eight states and will introduce the vaccine nationwide shortly, the
importation preparedness plan will also need to spell out/be updated with details on vaccines
used in an eventual poliomyelitis outbreak following importation.
Mongolia
The RCC commended the efforts in Mongolia to strengthen the NCC, which met twice in
2009.
The RCC noted that surveillance levels in 2009 appear lower than in previous years and
encouraged continued specific efforts to sensitize clinicians and search for missed cases at
hospitals; these activities should best be integrated with other disease surveillance and
monitoring/supervision activities, wherever possible.
The RCC commended the updating of the national laboratory list for phase 1 wild
poliovirus laboratory containment; this will be a good reference for future requirements.
The RCC noted that an importation preparedness plan had still not been prepared and
strongly encouraged its finalization; in collaboration with the WHO Secretariat.
New Zealand
As in previous years, the RCC appreciated the clear report from New Zealand which
allowed to conclude that both surveillance and immunization activities remained at levels to
assure the maintenance of poliomyelitis-free status.
In the future, the RCC would appreciate if poliomyelitis coverage be presented for (at
least) three doses and full calendar years.
The RCC recognized that the wild poliovirus importation preparedness plan was
completed and published and welcomed that the designated National IHR Focal Point is also a
member of the NCCEP. The RCC considered the plan as comprehensive and adequate but
recommended to follow discussions with the WHO Secretariat on the best vaccine of choice
responding to evidence, possibly in an area of low IPV coverage/low immunity, of the
importation and spread of a wild poliovirus.


- 16 -
Pacific island countries and areas
The RCC appreciated that the recommendations made at its 14th meeting were fully
addressed, including the re-establishing the PIC SRCC.
The RCC looked forward to receiving the workplan expected from the SRCC meeting in
December 2009, to further strengthen surveillance and immunization activities to keep the PIC
poliomyelitis free.
Papua New Guinea
The RCC appreciated the support given during Dr Adams' s visit in June 2009 and noted
substantial improvements in surveillance, facilitated by the recruitment of new officers. The
RCC urged to assure that all efforts should be made to retain these staff.
The RCC concurred with the assessment of the NCC that AFP surveillance performance
must also be monitored at the subnational level and gaps subsequently be filled. This should be
part of regular risk assessment (e.g. quarterly desk review), also immunization coverage,
population movements and other aspects to be taken into consideration.
The RCC noted that the AFP line list in the report only included the cases meeting the
standard case definition and recommended to include in the next annual progress report all AFP
cases in the list, even those less likely to have been AFP.
The RCC appreciated the plan to include OPV during upcoming measles campaign and
urged all poliomyelitis partners that the required resources would be provided. The RCC
strongly encouraged that the reported coverage would be validated by external monitoring during
this campaign and requested a summary to be included in the next annual report.
The RCC shared the NCC's concerns about the low immunization coverage, particularly in
the National Capital Region with frequent international travel movements. As it is possible that
the highest risk groups in Port Moresby area may be least well covered, the RCC requested an
update on the current plans to close this immunity gap, in addition to the upcoming SIAs which
will only be able to provide one dose of OPV.
Philippines
The RCC commended the Philippines for multiple continuing efforts to maintain its
poliomyelitis-free status and noted that meetings of the ERP were used as a forum to convene the
NCC, as well as a venue to discuss wider VPD-related activities.
Following its 14th meeting in 2008, the RCC had requested to be informed in more detail
about membership, current set-up and meetings of the NCC. The RCC noted, however, that the
2009 report, again, did not provide the necessary details. The RCC was convinced that an active,
independent NCC remains very important for the Philippines to assure the necessary advocacy
and oversight for maintaining the country's poliomyelitis-free status and urged the Department of
Health to revive this important group as soon as possible.
While AFP reporting remained at a satisfactory level, critical gaps remained again in the
reporting of AFP at the subnational level. Of even more concern than last year, there were four
densely populated regions with non-poliomyelitis AFP rates significantly below the expected
1/100 000; these include the greater Manila area (NCR) and several large regions in Luzon
(Regions 1, 5 and half of Region 4). The RCC was concerned that these densely populated
adjacent regions, including Manila (the main entry point for international travellers) form a large
- 17 -
joint 'blind' area which is currently unlikely to detect either imported wild poliovirus or emerging
circulating vaccine derived poliovirus (cVDPV).
The RCC noted that stool specimen adequacy in 2009 had been below target at around
70%. Unfortunately, the report did not clarify the main reasons causing this problem. Since
86% of AFP cases were reported within 14 days of onset of paralysis, and 97% of cases were
investigated within two days of reporting, the problem may be mainly related to problems in
specimen transport and the RCC requested further discussion in the next annual report, should
the problems persist.
The RCC was satisfied that OPV3 coverage seemed to have further increased, as
confirmed by the National Demographic and Health Survey (85%; DHS 2008) and noted that the
DHS survey indicated that OPV3 coverage was much more homogenous.
The RCC missed again updates on wild poliovirus laboratory containment and encouraged
the Department of Health to create/maintain a permanent focal point or office within/under the
department to:
a. maintain and update the national database and national inventory and provide
institutional memory;
b. maintain communications with institutions listed on the inventory to keep them
informed of progress in poliomyelitis eradication and changes in national laws or
regulations relating to poliovirus containment;
c. serve as the technical resource for the Department of Health on poliovirus
containment and the focal point for technical liaison with WHO; and
d. prepare the country for Phase 2 and implementation of containment requirements
one year after detection of wild poliovirus anywhere in the world.
Republic of Korea
As in previous years, the RCC appreciated the clear report from the Republic of Korea
which allowed to conclude that both surveillance and immunization activities remained at levels
to assure the maintenance of poliomyelitis-free status.
The RCC appreciated the continued functioning of a large enterovirus laboratory network,
which tests large numbers of stool specimens collected from children. The information collected
through this network is likely to largely compensate for the relatively low performance of the
AFP surveillance system in the country.
The RCC also appreciated the discussion on the national wild poliovirus importation
preparedness plan. The RCC considered the plan as comprehensive and adequate but
recommended to follow discussions with the WHO Secretariat on the best vaccine of choice
responding to evidence, possibly in an area of low IPV coverage/low immunity, of the
importation and spread of a wild poliovirus.
Singapore
As in previous years, the RCC appreciated the clear report from Singapore which allowed
to conclude that both surveillance and immunization activities remained at levels to assure the
maintenance of poliomyelitis-free status.

- 18 -
Viet Nam
The RCC commended the national poliomyelitis programme for maintaining general
surveillance and immunization performance at certification standards and acknowledged the
continued leadership of the NCC.
The RCC concurred with the conclusions of the NCC how the Ministry of Health and all
poliomyelitis partners need to continue prioritizing poliomyelitis activities, particularly AFP
surveillance, and provide the necessary financial and human resources.
The RCC appreciated the outline strategy and action plan to maintain the poliomyelitis
eradication achievement in Viet Nam from 2005 to 2010 but did not consider it as an active and
detailed wild poliovirus importation preparedness plan which is also required. The RCC
encouraged the national poliomyelitis programme to collaborate with the WHO Secretariat to
ensure that also global, regional and IHR 2005 requirements are addressed.

FIFTEENTH MEETING OF THE REGIONAL COMMISSION FOR THE CERTIFICATION OF 14 October 2009
POLIOMYELITIS ERADICATION IN THE WESTERN PACIFIC REGION
Phnom Penh, Cambodia
1-2 December 2009 ENGLISH ONLY
TENTATIVE TIMETABLE
Time Tuesday, 1 December 2009

Time Wednesday, 2 December 2009

0800-
0830
Registration
0830-
0930
1. Opening ceremony

Welcome remarks by the Responsible Officer
Opening remarks by the Regional Director (to be given by WR, Cambodia)
Welcome remarks by the Government of Cambodia
Self-introduction, Election of Officers (Chair, Vice-Chair, Rapporteur)
Remarks by the Regional Certification Commission (RCC) Chairperson
Administrative announcements; Group photo

0800-
1000

7. Review of country reports on maintaining poliomyelitis-free status (contd.)

a) Australia b) Brunei Darussalam c) Cambodia
d) China e) Hong Kong (China) f) Japan
g) Lao People's Democratic Republic h) Macao (China) i) Malaysia
j) Mongolia
0930-
1000
COFFEE BREAK
1000-
1030
COFFEE BREAK
1000-
1020
2. Maintaining poliomyelitis-free status in Cambodia: achievements and challenges

1030-
1200
Continuation of country report review:

k) New Zealand l) Pacific island countries and areas
m) Papua New Guinea n) Philippines
o) Republic of Korea p) Singapore
q) Viet Nam
1020-
1050
3. Global overview of the poliomyelitis eradication programme including outcomes of the
Advisory Committee for Polio Eradication (ACPE) - November 2009
1200-
1330
LUNCH BREAK
1050-
1100

4. Summary of conclusions and recommendations of the 14th RCC Meeting
1330-
1500
Discussion on draft conclusions and recommendations
1100-
1130

5. Regional overview of maintaining poliomyelitis-free status, including performance of regional
poliomyelitis laboratory network
1500-
1530
8. Presentation of draft conclusions and recommendations on maintaining
poliomyelitis-free status
1130-
1200

6. Reviewing and evaluating the risks for maintaining poliomyelitis-free status in the
Western Pacific Region


1530-
1600
COFFEE BREAK
1200-
1330

LUNCH BREAK
1600-
1630
9. Closing ceremony
1300-
1500
Individual review of country reports on maintaining poliomyelitis-free status

1500-
1530
COFFEE BREAK

1530-
1700
Individual review of country reports on maintaining poliomyelitis-free status (contd.)


A
N
N
E
X

1

ANNEX 2

WO R L D H E A L T H
ORGANIZATION

ORGANISATION MONDIALE
DE LA SANTE
REGIONAL OFFICE FOR THE WESTERN PACIFIC
BUREAU REGIONAL DU PACIFIQUE OCCIDENTAL



FIFTEENTH MEETING OF THE REGIONAL WPR/2008/DCC/04/EPI(9)/2009/IB2
COMMISSION FOR THE CERTIFICATION 16 October 2009
OF POLIOMYELITIS ERADICATION IN
THE WESTERN PACIFIC REGION

Phnom Penh, Cambodia ENGLISH ONLY
1-2 December 2009

INFORMATION BULLETIN NO. 2

PROVISIONAL LIST OF REGIONAL CERTIFICATION COMMISSION (RCC) MEMBERS
AND SECRETARIAT
1. REGIONAL CERTIFICATION COMMISSION
Dr Anthony I. Adams
Chairman, Regional Certification Commission
No. 6/2-4 Chapman Crescent, Avoca Beach
New South Wales 2251
Australia
Tel: (612) 4382 6516
Fax: n/a
E-mail: aarr@netspeed.com.au

Dr Nobuhiko Okabe
(Vice-Chairman, Regional Certification Commission)
Director
Infectious Disease Surveillance Center
National Institute of Infectious Diseases
1-23-1 Toyama Shinjuku
Tokyo 162-8640
Japan
Tel: (813) 5285 1111 (Ext 2501)
Fax:(813) 5285 1129
E-mail: okabenob@nih.go.jp; okabenob@aol.com
WPR/DCC/04/EPI(9)/2009/IB 2
Page 2


Dr Olen M. Kew
Molecular Virology Section MSG-10
Respiratory and Enterovirus Branch
National Centre for Infectious Diseases
Centers for Disease Control and Prevention
1600 Clifton Road N.E.
Atlanta, Georgia 30333
United States of America
Tel: (1 404) 639 1341
Fax:(1 404) 639 4011
E-mail: omk1@cdc.gov

Professor Nguyen Dinh Huong
Health Policy Adviser
Viet Nam Red Cross Society
104 C10 Giang Vo. Badinh
Ha Noi
Viet Nam
Tel: (844) 846 3601 / 4376
Fax: (844) 771 6608
E-mail: ngdhuonghn@yahoo.com.vn

Dr Aida M. Salonga**
Head, Neurology Section
Department of Neurosciences
University of the Philippines-Philippine General Hospital
Taft Avenue
Manila
Philippines
Tel: (632) 521 8450, local 2405
Fax: (632) 525 4996
E-mail: neuromom@yahoo.com.; rms_md@pldtdsl.net

Dr Steven Gary Fite Wassilak
Medical Epidemiologist
Global Immunization Division
Centers for Disease Control & Prevention
Mailstop MS-E05
Clifton Road
Atlanta, Georgia 30333
United States of Amercia
Tel: (1 404) 639 1867
Fax: (1 404) 639 8573
E-mail: sgw1@cdc.gov





________
**unable to attend
WPR/2008/DCC/04/EPI(3)/2008/IB/2
page 3


Dr Hui Zhuang
Professor, Department of Microbiology
Beijing Medical University
38 Xue-Yuan Road
Haidian District
Beijing 100083
People's Republic of China
Tel: (8610) 8280 2221
Fax: (8610) 8280 1617
E-mail: zhuangbmu@126.com

2. SECRETARIAT


WHO Western Pacific Dr Yang Baoping
Regional Office Regional Adviser
Expanded Programme on Immunization
World Health Organization
Regional Office for the Western Pacific
United Nations Avenue
1000 Manila
Philippines
Tel: (632) 528 9741
Fax: (632) 526 0279
E-mail: yangb@wpro.who.int

Dr Sigrun Roesel
Medical Officer
Expanded Programme on Immunization
World Health Organization
Regional Office for the Western Pacific
United Nations Avenue
1000 Manila
Philippines
Tel: (632) 528 9741
Fax: (632) 526 0279
E-mail: roesels@wpro.who.int



WHO/Cambodia Dr Michel Thieren
Acting WHO Representative
Programme Management
World Health Organization
No. 177-179 corner Pasteur (51) and 254
Phnom Penh
Cambodia
Tel: (855) 23 216610
Fax: (855) 23 216211
E-mail: thierenm@wpro.who.int

WHO/Cambodia Dr Pal Niklas Danielsson
Medical Officer
Diarrhoeal & Acute Respiratory Disease Control
World Health Organization
No. 177-179 corner Pasteur (51) and 254
Phnom Penh
Cambodia
Tel: (855) 23 216610
Fax: (855) 23 216211
E-mail: danielssonn@wpro.who.int

WHO Headquarters Dr Rudolf Tangermann
Geneva Medical Officer
Strategy Implementation Oversight and Monitoring
World Health Organization
CH-1211 Geneva 27
Switzerland
Tel: (4122) 791 4358
Fax: (4122) 791 0746
E-mail: tangermannr@who.int



Dat e of onset of last indigenous wild polio virus case: 19 March 1997
AFP cases invest igat ed since: 79,823
Table 1: Classificat ion of AFP cases wit h onset in 2008 and key surveillance indicat ors
Confirmed
Polio
Polio-
compat ible
Non-polio
(Discarded)
Pending
Non-polio AFP
Rat e/ 100,000 <
15 yrs
% wit h 2
Specimens w/ n
14 Days of Onset
% Report ed
Wit hin 14 Days
of Onset
% Wit h Follow-
up
% I nadequat e
St ools Wit h
Follow-up
Pending
Classificat ion > 90
Days Aft er Onset
Aust ralia 35 41 62 0 0 62 0 1.51 34% 52% 0%* 0% 0 24-Jun-09
Brunei Darussalam 4 1 4 0 0 4 0 4.00 75% 75% 100% 100% 0 07-Mar-09
Cambodia 94 54 76 0 0 76 0 1.41 83% 89% 100% 100% 0 12-May-09
China 4,985 2,794 5,154 0 3 5,151 0 1.84 90% 93% 97% 94% 0 12-Jun-09
Hong Kong, SAR, China 14 9 12 0 0 12 0 1.33 92% 92% 100% 100% 0 30-Mar-09
Japan 0 171 0 - - - - - - - - - - -
Korea, Republic of 26 84 8 0 0 8 0 0.10 100% 88% 100% - 0 02-Feb-09
Lao PDR 19 23 58 0 0 58 0 2.52 69% 81% 71% 83% 0 21-Feb-09
Macao, SAR, China 0 1 1 0 0 1 0 1.00 100% 100% 100% - 0 07-Jan-09
Malaysia 106 95 122 0 0 122 0 1.28 67% 85% 55% 100% 0 06-Mar-09
Mongolia 8 8 7 0 0 7 0 0.88 71% 71% 100% 100% 0 18-Feb-09
New Zealand 4 9 7 0 0 7 0 0.78 57% 57% 100% 100% 0 19-Mar-09
Pacific I sland Count ries 13 10 10 0 0 10 0 1.00 40% 10% 100% 100% 0 15-Jun-09
Papua New Guinea 25 26 12 0 2 10 0 0.46 17% 92% 100% 100% 0 18-Mar-09
Philippines 509 335 494 0 1 493 0 1.47 73% 87% 92% 99% 0 22-Apr-09
Singapore 12 7 8 0 0 8 0 1.14 75% 75% 100% 100% 0 24-Apr-09
Viet nam 391 330 384 0 0 384 0 1.16 94% 85% 99% 100% 0 13-Apr-09
West er n Paci f i c Regi on 6,245 3,998 6,419 0 6 6,413 0 1.61 88% 91% 95% 91% 0
* Follow-up is not required by t he Polio Expert Commit t ee if a case can be classified as non-polio AFP on t he informat ion available.
More Than 12 Years Without Indigenous Wild Polio Virus!
Lat est Report
Dat e
Report ed AFP
2007
I ndicat ors
Pol i omy el i t i s Sur v ei l l ance - Repor t f or Pol i o Week 52, endi ng December 28, 2008
(as of 04 Aug 2009)
Classificat ion
Expect ed AFP
2008
Report ed AFP
2008
0%
20%
40%
60%
80%
100%
CAM CHN LAO MAA MOG PNG PHL VTN
adequat e st ools ( 2006)
adequat e st ools ( 2007)
adequat e st ools ( 2008)
0
0. 5
1
1. 5
2
2. 5
3
CAM CHN LAO MAA MOG PNG PHL VTN
non- polio AFP rat e ( 2006)
non- polio AFP rat e ( 2007)
non- polio AFP rat e ( 2008)
A
N
N
E
X

3
Table 2: Laborat ory invest igat ion of AFP cases wit h onset in 2008
P1 P2 P3 Polio Mix Polio/ NPEV
Aust ralia VI DRL* 44 0 0 0 0 0 0 10% 100% 03-Feb-09
Brunei Darussalam VI DRL* 4 0 0 0 0 0 0 0% 100% 05-Jan-09
Cambodia NI I D 76 0 0 0 0 1 0 29% 100% 12-Feb-09
China, Anhui Prov. Lab 230 0 2 3 1 1 0 7% 93% 12-Jun-09
China, Beij ing Prov. Lab 45 1 0 0 0 0 0 13% 100% 12-Jun-09
China, Chongqing Prov. Lab 75 0 2 0 0 0 0 6% 97% 12-Jun-09
China, Fuj ian Prov. Lab 110 0 0 1 1 0 0 11% 97% 12-Jun-09
China, Gansu Prov. Lab 115 0 1 2 0 0 0 3% 99% 12-Jun-09
China, Guangdong Prov. Lab 294 0 3 1 5 1 0 11% 89% 12-Jun-09
China, Guangxi Prov. Lab 297 4 0 1 1 0 0 12% 99% 12-Jun-09
China, Guizhou Prov. Lab 196 1 5 3 2 0 0 10% 98% 12-Jun-09
China, Hainan Prov. Lab 39 2 0 0 0 0 0 15% 100% 12-Jun-09
China, Hebei Prov. Lab 396 2 5 4 10 3 0 14% 97% 12-Jun-09
China, Heilongj iang Prov. Lab 81 0 0 0 2 0 0 5% 99% 12-Jun-09
China, Henan Prov. Lab 494 3 2 4 6 0 0 10% 90% 12-Jun-09
China, Hubei Prov. Lab 237 0 2 1 0 0 0 11% 87% 12-Jun-09
China, Hunan Prov. Lab 258 0 3 0 1 0 0 15% 98% 12-Jun-09
China, Jiangsu Prov. Lab 269 0 2 2 1 0 0 6% 99% 12-Jun-09
China, Jiangxi Prov. Lab 178 1 6 5 1 0 0 12% 97% 12-Jun-09
China, Jilin Prov. Lab 58 0 0 0 1 1 0 13% 100% 12-Jun-09
China, Liaoning Prov. Lab 97 0 1 0 1 0 0 10% 87% 12-Jun-09
China, Neimongol Prov. Lab 67 0 0 0 0 0 0 5% 97% 12-Jun-09
China, Ningxia Prov. Lab 30 0 1 0 0 0 0 7% 98% 12-Jun-09
China, Qinghai Prov. Lab 38 0 0 0 0 0 0 3% 97% 12-Jun-09
China, Shaanxi Prov. Lab 102 0 3 2 1 2 0 12% 98% 12-Jun-09
China, Shandong Prov. Lab 346 2 15 8 5 2 0 13% 90% 12-Jun-09
China, Shanghai Prov. Lab 28 0 2 0 1 0 0 4% 100% 12-Jun-09
China, Shanxi Prov. Lab 207 0 3 2 1 1 0 10% 96% 12-Jun-09
China, Sichuan Prov. Lab 326 0 2 0 1 1 0 9% 97% 12-Jun-09
China, Tianj in Prov. Lab 24 0 0 0 0 0 0 17% 98% 12-Jun-09
China, Tibet Prov. Lab 9 0 0 0 0 0 0 0% 22% 12-Jun-09
China, Xinj iang Prov. Lab 61 0 1 0 0 0 0 3% 99% 12-Jun-09
China, Yunnan Prov. Lab 216 1 6 2 1 1 0 8% 98% 12-Jun-09
China, Zhej iang Prov. Lab 148 2 2 2 0 0 0 6% 87% 12-Jun-09
Hong Kong
2
, SAR, China PHLC 13 0 0 0 0 0 0 8% 96% 07-Feb-09
Korea, Rep. Of NI H 8 0 0 0 0 0 0 0% 88% 02-Feb-09
Lao PDR NI I D 57 0 1 0 0 0 0 26% 100% 31-Jul-09
Malaysia I MR, KL 127 1 0 0 2 0 0 0% 98% 10-Apr-09
Mongolia PHI 7 1 0 0 0 0 0 0% 100% 02-Mar-09
New Zealand I ESR 4 0 0 0 0 0 0 25% 100% 02-Feb-09
Pacific I sland Count ries VI DRL* 8 0 0 0 0 0 0 7% 100% 03-Feb-09
Papua New Guinea VI DRL* 9 0 0 0 0 0 0 0% 100% 02-Apr-09
Philippines RI TM 506 0 0 0 3 0 0 5% 90% 22-Apr-09
Singapore SGH 7 0 0 0 0 0 0 8% 100% 06-Feb-09
Viet nam, Nort h NI HE 192 0 0 1 1 0 0 11% 98% 16-Mar-09
Viet nam, Sout h PI 195 0 0 1 0 0 0 13% 100% 04-May-09
Tot al 6,328 21 70 45 49 14 0 10% 95%
* Specimen t est report s are under t he guidelines of t he June 2006 t est algorit hm.
1
Acr onyms:
VI DRL - Vict orian I nfect ious Diseases Reference Laborat ory, Aust ralia I MR, KL - I nst it ut e of Medical Research, Kuala Lumpur PHI - Public Healt h I nst it ut e, Mongolia
NI I D - Nat ional I nst it ut e of I nfect ious Diseases, Japan I MR, PNG - I nst it ut e of Medical Research, Papua New Guinea NI H - Nat ional I nst it ut e of Healt h, Seoul
PHLC - Public Healt h Laborat ory Cent re, Hong Kong I ESR - I nst it ut e of Environment al Science and Research, New Zealand NI HE - Nat ional I nst it ut e of Hygiene and Epidemiology, Hanoi
SGH - Singapore General Hospit al RI TM - Research I nst it ut e for Tropical Medicine, Philippines PI - Past eur I nst it ut e, Ho Chi Minh
2
I ncludes cases from Macao, SAR, China
Count ry
Nat ional
Lab
1
AFP Cases
wit h
Specimens
AFP Cases Posit ive For:
Pending
% Posit ive
for NPEV
% Result s
Report ed
w/ n 28 Days
Lat est Report
Dat e
Table 3: I nt rat ypic different iat ion of polio isolat es from AFP cases wit h onset in 2008
P1S P1W P2S P2W P3S P3W Pending
3
Discordant
4
VDPV Not VDPV Pending
China CCDC 204 53 0 119 0 90 0 0 0 - - - 83% 38%
Hong Kong, SAR, China PHLC 0 - - - - - - - - - - - - -
New Zealand I ESR 0 - - - - - - - - - - - - -
Singapore SGH 0 - - - - - - - - - - - - -
Aust ralia VI DRL 0 - - - - - - - - - - - - -
Malaysia VI DRL 3 1 0 2 0 3 0 0 0 - - - 100% 75%
Pacific I sland Count ries VI DRL 0 - - - - - - - - - - - - -
Papua New Guinea VI DRL 0 - - - - - - - - - - - - -
Philippines VI DRL 3 3 0 7 0 6 0 0 0 - - - 100% 100%
Japan NI I D 0 - - - - - - - - - - - - -
Cambodia NI I D 1 0 0 1 0 0 0 0 0 - - - 100% 100%
Korea, Rep. Of NI I D 0 - - - - - - - - - - - - -
Lao PDR NI I D 1 0 0 2 0 0 0 0 0 - - - 100% 100%
Mongolia NI I D 1 1 0 0 0 0 0 0 0 - - - 100% 0%
Viet nam NI I D 3 2 0 2 0 4 0 0 0 - - - 100% 33%
Tot al 216 60 0 133 0 103 0 0 0 0 0 0 85% 40%
Table 4: Laborat ory invest igat ion of polio isolat es from non- AFP cases in 2008
5
P1S P1W P2S P2W P3S P3W Pending Discordant VDPV Pending
China CCDC 58 25 0 11 0 22 0 0 0 - -
Hong Kong, SAR, China* PHLC 5 1 0 4 0 0 0 0 0 - -
New Zealand I ESR 0 - - - - - - - - - -
Singapore SGH 3 0 0 0 0 3 0 0 0 - -
Aust ralia VI DRL 0 - - - - - - - - - -
Malaysia VI DRL 16 10 0 5 0 5 0 0 0 - -
Pacific I sland Count ries VI DRL 0 - - - - - - - - - -
Papua New Guinea VI DRL 0 - - - - - - - - - -
Philippines VI DRL 0 - - - - - - - - - -
Cambodia NI I D 0 - - - - - - - - - -
Japan NI I D 0 - - - - - - - - - -
Korea, Rep. Of NI I D 0 - - - - - - - - - -
Lao PDR NI I D 0 - - - - - - - - - -
Mongolia NI I D 0 - - - - - - - - - -
Viet nam NI I D 1 1 0 0 0 0 0 0 0 - -
Tot al 83 37 0 20 0 30 0 0 0 0 0
* I ncludes isolat es from Macao, SAR, China.
1
Acr onyms:
2
I TD Resul t s:
4
Ant igenic I TD < > Molecular I TD for all serot ypes. Cases wit h discordant I TD result s
CCDC - Chinese Cent er for Disease Cont rol and Prevent ion S - Sabin; W - Wild may be count ed more t han once under "I TD result s", ie. as "discordant " and "S" or "W",
VI DRL - Vict orian I nfect ious Diseases Reference Laborat ory, Aust ralia depending on t he result s of sequencing.
NI I D - Nat ional I nst it ut e of I nfect ious Diseases, Japan
3
Pending I TD = Pending Ant igenic I TD and/ or Pending Molecular I TD
PHLC - Public Healt h Laborat ory Cent re, Hong Kong Tot al Pending Cases = Pending I TD + Pending Sequencing
5
Based on year of collect ion of sample, if available. Ot herwise, based on year of receipt
SGH - Singapore General Hospit al at reference laborat ory.
Sequencing
Count ry
Regional
Reference
Lab
Polio
I solat es
I TD Result s
Count ry
Regional
Reference
Lab
1
AFP Cases
w/ Polio
I solat es
I TD Result s
w/ n 60 Days of
Onset
I TD Result s
2
I TD Result s
w/ n 14 Days of
Receipt
Sequencing
Table 1: Classificat ion of AFP cases wit h onset in 2009 and key surveillance indicat ors
2008
Confirmed
Polio
Polio-
compat ible
Non-polio
(Discarded)
Pending
Non-polio
AFP rat e*
per 100,000
< 15 yrs
% cases wit h
2 specimens
wit hin 14
days of onset
% report ed
wit hin 14
days of onset
% wit h
follow-up
%
inadequat e
st ools wit h
follow-up
Pending
classificat ion
> 90 days
aft er onset
Aust ralia 62 41 34 0 0 34 0 0.96 41% 79% 0%* * 0% 0 22-Oct -09
Brunei Darussalam 4 1 0 - - - - - - - - - - 13-Oct -09
Cambodia 76 54 57 0 0 44 0 1.22 81% 93% 77% 55% 0 28-Oct -09
China 5,154 2,794 3,472 0 3 3,281 188 1.44 90% 94% 73% 69% 158 26-Oct -09
Hong Kong (China) 12 9 8 0 0 6 2 1.03 63% 75% 100% 100% 2 28-Oct -09
Japan 0 171 0 - - - - - - - - - - -
Lao PDR 58 23 34 0 0 27 7 1.71 74% 82% 41% 78% 3 15-Oct -09
Macao (China) 1 1 1 0 0 1 0 1.16 100% 100% 100% - 0 21-Oct -09
Malaysia 122 95 63 0 0 55 8 0.77 73% 94% 22% 76% 8 26-Oct -09
Mongolia 7 8 4 0 0 4 0 0.58 100% 100% 100% - 0 28-Oct -09
New Zealand 7 9 7 0 0 6 1 0.90 43% 43% 29% 25% 1 28-Aug-09
Pacific island count ries 10 10 15 0 0 8 7 1.73 60% 53% 80% 67% 5 27-Oct -09
Papua New Guinea 12 26 31 0 0 31 0 1.38 39% 65% 16% 26% 0 05-Nov-09
Philippines 494 335 460 0 0 242 218 1.59 65% 80% 38% 29% 88 02-Nov-09
Republic of Korea 8 82 13 0 0 13 0 0.18 100% 54% 100% - 0 21-Oct -09
Singapore 8 7 4 0 0 4 0 0.66 100% 100% 100% - 0 29-Sep-09
Viet Nam 384 330 240 0 0 210 30 0.84 95% 85% 68% 82% 6 14-Oct -09
West er n Paci f i c Regi on 6,419 3,996 4,443 0 3 3,966 461 1.28 86% 91% 67% 55% 271
* AFP rat e is annualized based on current week, and t hus, may be underest imat ed depending on count ry's dat a submission.
* * Follow-up is not required by t he Polio Expert Commit t ee if a case can be classified as non-polio AFP on t he informat ion available.
Report ed
number of
cases

Pol i o Bul l eti n
Week 45, 2009, endi ng 08 November 2009 ( as of 09 Nov 2009)
Classificat ion I ndicat ors
Lat est
report dat e
2009
Report ed
number of
cases
Expect ed
number of
cases
0.0
0.5
1.0
1.5
2.0
2.5
3.0
CAM CHN LAO MAA MOG PNG PHL VTN
N
o
n
-
p
o
l
i
o

A
F
P

r
a
t
e
2007 2008 2009
0%
20%
40%
60%
80%
100%
CAM CHN LAO MAA MOG PNG PHL VTN
%

c
a
s
e
s

w
i
t
h

a
d
e
q
u
a
t
e

s
p
e
c
i
m
e
n
s
2007 2008 2009
Chart 1. Non- polio AFP rat e per count ry, 2007- 2009 Chart 2. Percent cases wit h adequat e specimens, 2007- 2009
Table 2. Laborat ory invest igat ion of AFP cases wit h onset in 2009
P1 P2 P3 Polio Mix Polio/ NPEV NPEV only Negat ive 28 days > 28 days L20B+
L20B+
+ NPEV
NPEV only Negat ive 14 days > 14 days
Aust ralia VI DRL 25 - - - - - - - - - - - 25 0 0 1 23 1 0 87% 3% 02-Nov-09
Brunei Darussalam VI DRL 0 - - - - - - - - - - - - - - - - - - - - 02-Nov-09
Cambodia NI I D 52 52 0 0 0 0 0 20 32 0 0 96% - - - - - - - - 37% 06-Nov-09
China, Anhui Prov. Lab 139 139 0 2 0 0 0 21 101 0 14 95% - - - - - - - - 12% 26-Oct -09
China, Beij ing Prov. Lab 21 21 0 0 0 0 0 2 17 0 2 100% - - - - - - - - 8% 26-Oct -09
China, Chongqing Prov. Lab 54 54 0 2 1 0 0 6 41 1 1 97% - - - - - - - - 7% 26-Oct -09
China, Fuj ian Prov. Lab 71 71 0 0 0 2 0 8 57 1 2 99% - - - - - - - - 10% 26-Oct -09
China, Gansu Prov. Lab 87 87 0 0 0 3 0 2 73 1 7 97% - - - - - - - - 1% 26-Oct -09
China, Guangdong Prov. Lab 178 178 0 2 2 5 1 33 127 0 6 89% - - - - - - - - 18% 26-Oct -09
China, Guangxi Prov. Lab 215 215 1 2 2 0 0 26 167 0 14 93% - - - - - - - - 11% 26-Oct -09
China, Guizhou Prov. Lab 170 170 0 2 3 1 0 13 144 2 5 100% - - - - - - - - 6% 26-Oct -09
China, Hainan Prov. Lab 20 20 0 0 0 1 0 2 15 0 2 100% - - - - - - - - 11% 26-Oct -09
China, Hebei Prov. Lab 264 264 3 1 5 4 0 34 191 2 21 98% - - - - - - - - 12% 26-Oct -09
China, Heilongj iang Prov. Lab 48 48 0 0 1 1 0 5 40 0 1 97% - - - - - - - - 7% 26-Oct -09
China, Henan Prov. Lab 363 363 1 3 0 2 1 65 272 0 12 96% - - - - - - - - 13% 26-Oct -09
China, Hubei Prov. Lab 144 144 1 0 1 1 0 13 124 0 4 94% - - - - - - - - 9% 26-Oct -09
China, Hunan Prov. Lab 183 183 1 4 1 0 0 31 130 1 13 98% - - - - - - - - 15% 26-Oct -09
China, Jiangsu Prov. Lab 184 184 0 1 3 0 0 12 147 0 21 98% - - - - - - - - 7% 26-Oct -09
China, Jiangxi Prov. Lab 146 146 1 1 2 2 0 25 107 0 8 96% - - - - - - - - 14% 26-Oct -09
China, Jilin Prov. Lab 41 41 1 0 0 0 0 1 31 0 8 91% - - - - - - - - 3% 26-Oct -09
China, Liaoning Prov. Lab 90 90 0 1 1 0 0 17 65 0 4 100% - - - - - - - - 19% 26-Oct -09
China, Neimongol Prov. Lab 38 38 0 0 0 0 0 1 34 0 1 99% - - - - - - - - 3% 26-Oct -09
China, Ningxia Prov. Lab 17 17 0 2 0 0 0 1 11 1 2 93% - - - - - - - - 10% 26-Oct -09
China, Qinghai Prov. Lab 28 28 0 0 0 0 0 0 26 0 1 94% - - - - - - - - 0% 26-Oct -09
China, Shaanxi Prov. Lab 83 83 0 1 0 0 0 5 66 1 8 94% - - - - - - - - 6% 26-Oct -09
China, Shandong Prov. Lab 152 152 2 4 0 3 0 3 122 0 18 97% - - - - - - - - 1% 26-Oct -09
China, Shanghai Prov. Lab 21 21 0 0 0 0 0 2 19 0 0 100% - - - - - - - - 10% 26-Oct -09
China, Shanxi Prov. Lab 155 155 0 0 1 0 0 26 118 0 10 99% - - - - - - - - 16% 26-Oct -09
China, Sichuan Prov. Lab 192 192 0 4 1 0 0 20 145 0 20 94% - - - - - - - - 10% 26-Oct -09
China, Tianj in Prov. Lab 18 18 0 0 0 0 0 1 17 0 0 100% - - - - - - - - 6% 26-Oct -09
China, Tibet Prov. Lab 1 1 0 0 0 0 0 0 1 0 0 0% - - - - - - - - 0% 26-Oct -09
China, Xinj iang Prov. Lab 26 26 0 0 1 4 0 0 14 0 6 100% - - - - - - - - 0% 26-Oct -09
China, Yunnan Prov. Lab 174 174 1 1 0 0 0 9 153 2 6 99% - - - - - - - - 5% 26-Oct -09
China, Zhej iang Prov. Lab 94 94 0 1 0 0 0 8 79 0 6 98% - - - - - - - - 7% 26-Oct -09
Hong Kong (China) PHLC 7 - - - - - - - - - - - 7 0 0 0 7 0 0 85% 0% 04-Nov-09
Lao PDR NI I D 34 34 0 0 0 1 0 5 28 0 0 94% - - - - - - - - 15% 02-Nov-09
Macao (China) PHLC 1 - - - - - - - - - - - 1 0 0 0 1 0 0 50% 0% 11-May-09
Malaysia I MR, KL 21 - - - - - - - - - - - 21 0 0 0 22 0 0 98% 0% 20-May-09
Mongolia PHI 6 6 0 0 0 0 0 2 4 0 0 100% - - - - - - - - 25% 27-Oct -09
New Zealand I ESR 3 - - - - - - - - - - - 3 0 0 0 3 0 0 100% 0% 03-Jul-09
Pacific island count ries VI DRL 18 - - - - - - - - - - - 18 0 0 4 14 0 0 82% 18% 02-Nov-09
Papua New Guinea VI DRL 36 - - - - - - - - - - - 36 0 0 5 24 0 7 37% 20% 05-Oct -09
Philippines RI TM 431 - - - - - - - - - - - 431 5 0 33 370 0 27 90% 7% 30-Oct -09
Republic of Korea NI H 13 13 0 0 0 0 0 0 13 0 0 100% - - - - - - - - 0% 21-Oct -09
Singapore SGH 4 - - - - - - - - - - - 4 0 0 0 4 0 0 100% 0% 22-Sep-09
Viet Nam, Nort h NI HE 126 126 0 0 1 0 0 17 107 4 0 100% - - - - - - - - 12% 05-Nov-09
Viet Nam, Sout h PI 153 153 0 1 0 0 0 24 113 15 0 100% - - - - - - - - 16% 02-Nov-09
Tot al 4,347 3,801 12 35 26 30 2 460 2,951 31 223 97% 546 5 0 43 468 1 34 88% 10%
% posit ive
for NPEV
Lab result s
Count ry
Nat ional
reference lab
Tot al no. of
AFP cases
wit h
specimens
Processed by old algorit hm
AFP cases
wit h
specimens
Lat est report
dat e
Pol i o Bul l eti n
Week 45, 2009, endi ng 08 November 2009 ( as of 09 Nov 2009)
Processed by new algorit hm
AFP cases
wit h
specimens
Pending result s % result s
report ed
wit hin 14
days
Lab result s % result s
report ed
wit hin 28
days
Pending result s
Acr onyms:
I ESR - I nst it ut e of Environment al Research, New Zealand
I MR, KL - I nst it ut e of Medical Research, Kuala Lumpur, Malaysia
I MR, PNG - I nst it ut e of Medical Research, Papua New Guinea
NI H - Nat ional I nst it ut e of Healt h, Seoul, Korea
NI HE - Nat ional I nst it ut e of Hygiene and Epidemiology, Hanoi, Viet Nam
NI I D - Nat ional I nst it ut e of I nfect ious Diseases, Japan
PHI - Public Healt h I nst it ut e, Mongolia
PHLC - Public Healt h Laborat ory Cent er, Hong Kong (China)
PI - Past eur I nst it ut e, Ho Chi Minh, Viet Nam
RI TM - Research I nst it ut e for Tropical Medicine, Philippines
SGH - Singapore General Hospit al, Singapore
VI DRL - Vict orian I nfect ious Diseases Reference Laborat ory, Aust ralia
Table 3. I nt rat ypic different iat ion of polio isolat es from AFP cases wit h onset in 2009
P1S P1W P2S P2W P3S P3W Pending
3
VDPV Not VDPV Pending
China CCDC 119 29 0 66 0 58 0 3 1 1 0 0 93% 40% 79%
Hong Kong (China) PHLC 0 - - - - - - - - - - - - - -
New Zealand I ESR 0 - - - - - - - - - - - - - -
Singapore SGH 0 - - - - - - - - - - - - - -
Aust ralia VI DRL 0 - - - - - - - - - - - - - -
Malaysia VI DRL 0 - - - - - - - - - - - - - -
Pacific island count ries VI DRL 0 - - - - - - - - - - - - - -
Papua New Guinea VI DRL 0 - - - - - - - - - - - - - -
Philippines VI DRL 5 1 0 1 0 3 0 0 0 - - - 100% 78% 78%
Japan NI I D 0 - - - - - - - - - - - - - -
Cambodia NI I D 0 - - - - - - - - - - - - - -
Lao PDR NI I D 1 1 0 0 0 1 0 0 0 - - - 100% 0% 0%
Mongolia NI I D 0 - - - - - - - - - - - - - -
Republic of Korea NI I D 0 - - - - - - - - - - - - - -
Viet Nam NI I D 1 0 0 0 0 2 0 0 0 - - - 100% 0% 0%
Tot al 126 31 0 67 0 64 0 3 1 1 0 0 93% 42% 77%
Table 4. Laborat ory invest igat ion of polio isolat es from non- AFP cases in 2009
5
P1S P1W P2S P2W P3S P3W Pending Discordant VDPV Pending
China CCDC 41 15 0 10 0 16 0 0 0 - -
Hong Kong (China) PHLC 2 2 0 0 0 0 0 0 0 - -
New Zealand I ESR 0 - - - - - - - - - -
Singapore SGH 0 - - - - - - - - - -
Aust ralia VI DRL 0 - - - - - - - - - -
Malaysia VI DRL 9 4 0 1 0 4 0 0 0 - -
Pacific island count ries VI DRL 0 - - - - - - - - - -
Papua New Guinea VI DRL 0 - - - - - - - - - -
Philippines VI DRL 0 - - - - - - - - - -
Japan NI I D 0 - - - - - - - - - -
Cambodia NI I D 0 - - - - - - - - - -
Lao PDR NI I D 0 - - - - - - - - - -
Mongolia NI I D 0 - - - - - - - - - -
Republic of Korea NI I D 0 - - - - - - - - - -
Viet Nam NI I D 0 - - - - - - - - - -
Tot al 52 21 0 11 0 20 0 0 0 0 0
% I TD result s
wit hin 45 days
of onset
% I TD result s
wit hin 60 days
of onset
Pol i o Bul l eti n
Week 45, 2009, endi ng 08 November 2009 ( as of 09 Nov 2009)
% I TD result s
wit hin 7 days
of receipt
Count ry
Regional
reference
lab
1
Discordant
4
I TD
I TD result s
2
AFP cases
wit h polio
isolat es
Sequencing result s
Sequencing result s
Count ry
Regional
reference lab
Polio isolat es
I TD result s
1
Acr onyms:
CCDC - Chinese Cent er for Disease Cont rol and Prevent ion, China
NI I D - Nat ional I nst it ut e of I nfect ious Diseases, Japan
PHLC - Public Healt h Laborat ory Cent er, Hong Kong (China)
SGH - Singapore General Hospit al, Singapore
VI DRL - Vict orian I nfect ious Diseases Reference Laborat ory, Aust ralia
2
I TD Resul t s:
S - Sabin; W - Wild
3
Pending I TD = Pending ant igenic I TD and/ or
pending molecular I TD; Tot al pending cases =
Pending I TD + pending sequencing
4
Ant igenic I TD < > molecular I TD for all serot ypes. Cases wit h discordant I TD result s
may be count ed more t han once under "I TD result s", ie. as "discordant " and "S" or "W",
depending on t he result s of sequencing.
5
Based on year of collect ion of sample, if available. Ot herwise, based on year of receipt
at reference laborat ory.

Poliomyelitis vaccine immunization schedules in the Pacific island countries and areas, 2009

# doses OPV IPV DTaPIPV dTapIPV DTaPHepIPV DTaPHibIPV
DTaPHep
HibIPV
American Samoa 4 2, 4, 6m; 4y

Cook Islands 3 6w, 3, 5m

Fiji 4 B, 6, 10, 14w

French Polynesia 5 11y 2, 3, 4, 16m

Guam 5 2, 4, 6, 12-18m, 4-6y 2, 4, 6, 15-18m

Kiribati 3 6, 10, 14w

Mariannas 4 6w, 4, 6m, 4y 6w; 6m

Marshall Islands 4 2, 4, 6m, 4-6y

Micronesia 5 2, 4, 6, 12m; 4y

Nauru 5 6, 10, 14w, 18m, 4y

New Caledonia 7 6, 16y 11y 2, 3, 4, 16m

Niue 4 6w, 3, 5m, 4y

Palau 4 4-6y 6w, 4, 6m

Samoa 3 6, 10, 14w

Solomon Islands 4 6, 10, 14w, 5y

Tokelau 3 6, 10, 14w

Tonga 3 6, 10, 14w

Tuvalu 3 6, 10, 14w

Vanuatu 5 6, 10, 14w; 6, 12y

Wallis and Futuna 6
2, 3, 4, 16m, 6,
11y


(data source: JRF)

A
N
N
E
X

4