The polio situation in Philippines


Dr Pankaj Bhatnagar, WHO    21 September 2019

The polio situation in Philippines is summarized in the report below:

The situation On 19 September 2019, the Department of Health (DOH) confirmed the re-emergence of polio in the Philippines and declared a national polio outbreak. This follows a confirmed Vaccine Derived Poliovirus Type 2 (VPDV2) case in a three-year old child in Lanao de Sur (Mindanao). Subsequently, another case of polio (strain to be confirmed) was reported on 20 September, and this time in a five-year-old boy from Laguna, bringing the total number of people afflicted with the disease to two. The re-emergence of the disease comes almost 20 years since the Philippines was declared polio-free in 2000. The last known case of wild poliovirus recorded in the Philippines was in 1993.

Between 1 July and 27 August 2019, four environmental samples tested positive for VPDV1 from Tondo (Manila) with no genetic linkage found with any known VDPV1, indicating new emergence. Between 13 and 22 August 2019, two environmental samples tested positive for VDPV2 from Tondo (Manila) and Davao City. Both samples were founded to be genetically linked. As a result, VDPV2 was classified as circulating (cVDPV2).

After the confirmation of the VDPV2 case in Mindanao, the DOH is prioritizing the following activities in collaboration with UNICEF, WHO and other partner organizations:

  • Second round of synchronized polio vaccinations (planned October 2019).
  • Development and dissemination of appropriate risk communication messages.
  • Case investigation and tracing activities, as well as enhanced surveillance.
  • Procurement of required vaccine supplies for campaigns.

UNICEF and WHO are supporting DOH with convening the Health Cluster for coordination with partner organizations in response to the outbreak. This is expected to happen during week of 23 September 2019.

Actions that countries may take:

  • To mitigate the risk of importations countries should ensure high coverage with bivalent Oral Polio Vaccine (bOPV) and Inactivated Polio Vaccine (IPV) under national EPI/ routine immunisation programme.
  • Countries should identify pockets with low routine immunisation coverage in rural and urban areas. Marginalized and migratory populations living in urban slums, waterways along rivers or their banks, international and national borders, populations movements due to social, economic and economic reasons, displaced populations due to floods/typhoons/insecurities/ other reasons, nomadic groups, isolated settlements in forest, pockets with vaccine hesitancy issues etc. generally have low coverage and are particularly at risk of importation or emergence of vaccine derived polioviruses. Countries should undertake special drives to reach them with bOPV and IPV and other antigens as per their national EPI schedules.  
  • AFP surveillance sensitivity should be maintained as per global norms to rapidly detect and response to any wild or vaccine derived polioviruses.
  • Countries should update their emergency preparedness and response plans to respond in case of any virus detection.     
  • Travel related guidance on polio vaccination is available at https://www.who.int/ith/updates/20140612/en/

Advice for travellers

Before travelling to areas with active poliovirus transmission, travellers from polio-free countries should ensure that they have completed the age-appropriate polio vaccine series, according to their respective national immunization schedule. Adult travellers to polio- infected areas who have previously received three or more doses of OPV or IPV should also be given another one-time booster dose of polio vaccine. Travellers to polio-infected areas who have not received any polio vaccine previously should complete a primary schedule of polio vaccination before departure.

Before travelling abroad, persons of all ages residing in polio-infected countries (i.e. those with active transmission of a wild or vaccine- derived poliovirus) and long term visitors to such countries (i.e. persons who spend more than 4 weeks in the country), should have completed a full course of vaccination against polio in compliance with the national schedule. Travellers from infected areas should receive an additional dose of OPV or IPV within 4 weeks to 12 months of travel, in order to boost intestinal mucosal immunity and reduce the risk of poliovirus shedding, which could lead to re- introduction of poliovirus into a polio-free area. For persons who previously received only IPV, OPV should be the choice for the booster dose, if available and feasible. In case of unavoidable last – minute travel, travellers should still receive one dose of OPV or IPV prior to departure, if they have not received documented dose of polio vaccine within the previous 12 months. Some polio-free countries may require such travellers from polio-infected countries to provide documentation of recent vaccination against polio in order to obtain an entry visa, or they may require that travellers receive an additional dose of polio vaccine on arrival, or both.

All travellers are advised to carry their written vaccination record (patient-retained record) in the event that evidence of polio vaccination is requested for entry into countries being visited. Preferably travellers would use the IHR 2005 International Certificate of Vaccination or Prophylaxis. The certificate is available from the WHO web site at http://www.who.int/ihr/IVC200_06_26.pdf

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