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Syria: Polio Outbreak - Jun 2017

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A circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak has been confirmed in the Deir-Ez-Zor Governorate of the Syrian Arab Republic. The virus strain was isolated from two cases of acute flaccid paralysis (AFP), with onset of paralysis on 5 March and 6 May, as well as from a healthy child in the same community. (GPEI, 8 Jun 2017)

Since the confirmation of the first VDPV2 during May 2017, AFP surveillance has been intensified in the Governorate, especially in the Al Mayadeen district. As of 6 June 2017, a total of 58 AFP cases have been reported from the Governorate this year. In addition to the two cases that have tested positive for VDPV2, a further 11 have tested negative for polioviruses, with the remaining samples being under process in the laboratories or being transported to the laboratories. (WHO, 13 Jun 2017)

A response task force has been established at the national level to follow-up on the Syria cVDPV2 outbreak. A national response plan for the cVDPV2 outbreak and a micro plan for rural Deir-ez-Zoir campaigns have been developed to conduct two immunization rounds in Deir-ez-Zor with monovalent oral polio vaccine type-2 (mOPV2 targeting 328,000 children under five years of age and Inactivated polio vaccine (IPV) will be used in the secondround targeting 114,500 children aged between 2-24 months). (OCHA, 26 Jun 2017)

Two new cases of [cVDPV2] were reported in the past week, bringing the total of cVDPV2 cases to 24...Although access to Deir-Al-Zour is compromised due to insecurity, the Governorate has been partially reached by several vaccination campaigns against polio and other vaccine-preventable diseases since the beginning of 2016. Most recently, two campaigns have been conducted in March and April 2017 using the bivalent oral polio vaccine (OPV). However, only limited coverage was possible through these campaigns. In response to the isolation of cVDPV2 from Raqua governorate, the Syrian Ministry of Health in collaboration with WHO and UNICEF is considering adding the area to the outbreak response. This is under discussion due to ongoing military operations. (GPEI, 4 Jul 2017)

One of the previously-reported cases from Raqua, on re-testing, has been confirmed as negative for circulating vaccine-derived poliovirus type 2 (cVDPV2), and has been removed from the list of cases. The total number of cVDPV2 cases is now 23 (22 from Deir-Al-Zour and one from Raqua). (GPEI, 12 July 2017)

Monovalent type-2 oral polio vaccine (mOPV2) was shipped with 350 vaccine carriers dispatched by MoH to Deir Ez-Zor governorate on 11 July to prepare for the first immunization campaign in the area. An mOPV2 campaign in affected areas of Raqqa governorate is now planned. (WHO, 12 July 2017)

Adding Raqqa Governorate to the outbreak response will increase the target population by almost 120,000 children under 5 years of age. In addition to the outbreak, sector partners are increasingly concerned about limited capacities to provide adequate trauma care particularly in areas close to hostilities. Discussions are taking place amongst health partners seeking to mobilize additional resources and capacities to respond to needs. (OCHA, 14 Jul 2017)

As of 18 July, twenty seven cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) have been confirmed. This is an increase of 4 cases, since the last situation report dated 12 July. The total number of acute flaccid paralysis (AFP) cases detected in Deir Ez - Zor governorate since the beginning of 2017 is 87 ( 66 from Mayadeen, 10 from Deir Ez - Zor, and 11 from Boukamal districts). Raqqa governorate has reported 14 AFP cases (6 from Raqqa, 7 from Tell Abyad, and 1 from Thawra districts). (WHO, 18 July 2017)

An immunization campaign was conducted in Deir-ez-Zor from 22 to 26 July by the Ministry of Health with support from UNICEF and the World Health Organization. A total of 259,950 children under the age of five (U5) were vaccinated (79 per cent of the children to be reached in 2017), including 62,864 children aged 0-11 months (24 per cent of the planned reach) and 2,862 children above the target age group. (UNICEF, 31 Jul 2017)

As of 10 October, one new case of cVDPV2 have been confirmed in the first week of October from Mayadeen district, Deir Ez-Zor governorate. The case, a 19-month-old child with no history of polio vaccination, had onset of paralysis on 19 August. The second immunization round for Raqqa commenced 7 October. mOPV2 is being administered to children 0-59 months of age, and IPV to children aged between 2-23 months. Aqua tabs are being provided to families together with vaccination. (WHO, 10 Oct 2017)

As of 31 October, two outbreak response rounds utilizing mOPV2 have been completed in both Deir Ez-Zor and Raqqa governorates. A single dose of IPV has also been offered to children 2-23 months in all districts of these two governorates except Tell Abyad district, Raqqa. Additional IPV immunization aiming to reach children aged between 2-23 months in high risk areas of Aleppo and Idlib has concluded. IPV activities Hama governorate are ongoing. Total administrative coverage to date reports 223,001 children between ages 2-23 months were vaccinated (representing 98% of the target). IPV vaccination activities continue at border points in Lebanon and Turkey. Lebanon is also using IPV to boost population immunity against poliovirus in identified high risk sub-districts. (WHO, 31 Oct 2017)

As of 15 November, almost 3,000 children under the age of 5 have received all scheduled routine immunization antigens in newly accessible areas of Deir Ez-Zor city. Volunteers ran opportunistic vaccination activities in the areas between 7 – 10 November. (GPEI, 15 Nov 2017)

On 20 Nov, WHO’s Director-General accepted the Emergency Committee under the International Health Regulations (2005) assessment that the risk of the international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC) with respect to WPV1 and cVDPV, and agreed to the extension of revised Temporary Recommendations for a further three months, noting that the ongoing circulation of cVDPV2 in DR Congo, Nigeria, Pakistan and the Syrian Arab Republic demonstrates significant gaps in population immunity at a critical time in the polio endgame. (WHO, 14 Nov 2017)

An inactivated polio vaccine (IPV) immunization round has successfully concluded in Damascus, Al Hassakeh, parts of Aleppo and Rural Damascus governorates. Reportedly, a total of 233,518 children aged 2-23 months received IPV, representing 71% of the estimated target. IPV vaccination is continuing in accessible parts of Aleppo governorate. Overall, post campaign monitoring (that was completed in all implementing governorates) indicates 81% vaccination rates by parental/caregiver recall and 77% by finger marking (WHO, 28 Feb 2018)

An inactivated polio vaccine (IPV) immunization round has started in Ain Arab/Aleppo and its countryside on 24/2/2018 for 5 days. The campaign is targeting 8000 children aged 2-23 months, utilizing mobile and fixed centers (WHO, 01 Mar 2018)

In line with the regional vaccination week April 2018, MOH in coordination with WHO will conduct sub-national polio campaign in addition to routine vaccination activities to follow up the dropout children in all governorates with a special focus on Deir-ez-Zoir, Ar-Raqqa, Aleppo and other hard to reach areas. MOH/EPI program conducted preparatory meeting to discuss the work plan for each governorates and to finalize all technical and logistics issues of April vaccination week. (WHO, 5 Apr 2018)

No new cases of cVDPV2 have been reported in 2018. The last reported case of circulating vaccine-derived poliovirus (cVDPV2) is from Boukamal district, Deir Ez-Zor governorate with a date of onset of paralysis of 21 September 2017. The total number of cVDPV2 cases recorded during the outbreak remains 74. (WHO/UNICEF, 31 Jul 2018)

The Outbreak and Response Assessment (OBRA) mission conducted in October concluded that the 2017 outbreak of vaccine-derived polio has now been contained. (WHO/Health Cluster, 31 Oct 2018)