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Philippines: Polio Outbreak - Sep 2019

Disaster types

On 14 September 2019, VDPV2 was confirmed in one three-year-old child with Acute Flaccid Paralysis (AFP) symptoms, from Lanao del Sur (Mindanao). The isolated VDPV2 was found to be genetically linked to the 2 confirmed VDPV2 environmental samples. As a result, VDPV2 was classified as circulating (cVDPV2). On 19 September 2019, the Department of Health (DOH) confirmed the re-emergence of polio in the Philippines and declared a national polio outbreak, in line with International Health Regulations (IHR). Synchronized polio vaccination conducted in Manila in response to the 1st confirmed VDPV1 samples only reached 53.8% of the target number of children aged 0 to 59 months. (WHO/UNICEF, 19 Sep 2019)

On 19 September, the second VDPV2 case was confirmed in a 5-year-old boy from Laguna Province, approximately 100 km south-east of Metro Manila. Investigations and further characterization of the virus are ongoing. In addition, VDPV1 has also been isolated from environmental samples collected on 1 July, 22 July, 13 August, and 27 August from Manila. WHO currently assesses the risk of international spread from the Philippines to be low. However, the risk of further spread within the Philippines is high due to limited population immunity (coverage of bivalent oral polio vaccine (OPV) and inactivated polio vaccine (IPV) was at 66% and 41% respectively in 2018) and suboptimal AFP surveillance. (WHO, 24 Sep 2019)

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. (IFRC, 28 Sep 2019)

DOH is planning 3 vaccination rounds targeting 6,650,308 under-five children with monovalent Oral Polio Vaccine against poliovirus type 2 (mOPV2) in affected areas...DOH is planning 2 vaccination rounds targeting 2,553,262 under-five children with bivalent Oral Polio Vaccine (bOPV) in the National Capital Region (NCR). Enhanced routine immunization with 3 doses of bOPV as well as inactivated poliovirus vaccine (IPV) nationwide is ongoing. (WHO/UNICEF, 9 Oct 2019)

Synchronized polio vaccination campaigns began on 14 October in National Capital Region (NCR), Davao City, Davao del Sur, and Lanao del Sur, including Marawi City. The current campaign in NCR aims to vaccinate almost 1.3 million children under five and over 400,000 in Mindanao between 14-27 October. No further cases have been confirmed. The current polio outbreak figures were derived from nine confirmed environmental samples and two human cases, resulting from persistently low routine immunization coverage, and poor sanitation and hygiene. (WHO/UNICEF, 17 Oct 2019)

In Mindanao, one 4-year old child from Datu Piang, Maguindanao, Mindanao was confirmed with VDPV type 2 on 24 October 2019. This is a newly infected province and represents an expansion of the outbreak in Mindanao. This is the second human case categorised as positive for cVDPV2, as the case from Laguna is categorized as positive for immunodeficiency-related VDPV (iVDPV2). A third child from Maguindano residing in Datu Paglas was confirmed testing positive for VDPV2 on 25 October. This brings the total of cVDPV2 cases to three. (WHO & UNICEF, 25 Oct 2019)

As of 9 November, a fourth confirmed polio case has been confirmed in a three-year old female from Lambayong in Sultan Kudarat province (Mindanao), who had not received any dose of oral polio vaccine (OPV). On 4 November, stool samples sent to the National Institute of Infectious Diseases (NIID) in Japan tested positive for VDPV2. This is the third human case categorised as positive for cVDPV2: all polio viruses isolated are genetically linked. The case from Laguna is categorized as positive for immunodeficiency-related VDPV (iVDPV2). (WHO, 9 Nov 2019)

On 20 November, the Department of Health (DOH) confirmed three more cases of poliovirus, all from Mindanao, bringing the total of new cases this year to seven. All three cases were admitted to the Cotabato Regional Medical Center. The first two cases were unvaccinated with the polio vaccine, while the third received incomplete doses. The previous polio vaccination campaigns in October reported a 96% coverage among children 0-59 months old from the 17 cities/municipality in NCR. Davao del Sur recorded a 92% coverage from its 10 city/municipalities while Lanao del Sur reported an 85% coverage from 40 city/municipalities. (Govt. of the Philippines, 20 Nov 2019)