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Philippines/Malaysia: Polio Outbreak - Sep 2019

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On 8 December, the Ministry of Health of Malaysia announced a case of polio in Tuaran District in Sabah state, Malaysia. Testing has confirmed that the virus is genetically linked to poliovirus currently circulating in the southern Philippines. The patient, a 3-month-old male child, developed fever and paralysis on 26 October. On 6 December, testing conducted by the World Health Organization’s Regional Polio Reference Laboratory in Melbourne, Australia, confirmed that poliovirus is the cause of the child’s illness. The last case of this highly infectious disease in Malaysia was in 1992. (WHO & UN Children's Fund, 9 Dec 2019).

As of 15 January, there are three cVDPV1 confirmed cases from Sabah State, Malaysia. All of them are genetically linked to the Basilan case. With three cVDPV1 cases from Malaysia confirmed to be related to the one Philippine cVDPV1 case, the regional risk of potential spread across international borders remains moderate, especially considering the large number of Overseas Filipino Workers (OFW) and the ease of travel between islands without any form of control, especially by traders from Mindanao. (UNICEF/WHO, 15 Jan 2020)


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)

The latest confirmed case of polio was found in a nine-year old female from Basilan, who had not received any vaccines for Polio. This has brought the total number of confirmed polio cases to eight. (Govt. of the Philippines, 25 Nov 2019).

Nine cases of polio have now been confirmed. The Department of Health is planning a mass immunization campaign targeting the Sulu Archipelago, Zamboanga City and Lambayong, Sultan Kudarat for approximately a week, starting 6 January 2020. This immunization initiative aims to see almost 710,300 children under the age of 10 protected against polio. (WHO & UN Children's Fund, 12 Dec 2019).

Launched in consultation with WHO, UNICEF, the Department of Health, and the Philippine Red Cross, the vaccination campaign against polio has seen more than 155,400 children immunised against the outbreak. 900 volunteers were mobilised to reach 300 communities. (IFRC, 23 Dec 2019).

Two new cases with cVDPV2 were reported from Maguindanao in the Bangsamoro Autonomous Region in Muslim Mindanao (BARMM). As of 15 January, there are 11 confirmed cases with cVDPV2; one case with cVDPV1; and one case with immunodeficiency-related VDPV type 2 (iVDPV2). Limited polio outbreak immunization in areas affected with VDPV1 conducted in Zamboanga and Isabella (Region IX), Lambayong (Region XII), and the island provinces of Basilan, Sulu and Tawi-Tawi (BARMM) vaccinated 689,273 children under 10 (93.2% of the target) on 6-12 January 2020. Two more rounds planned for same areas and children on 17 February to 1 March and 23 March to 4 April 2020. (UNICEF/WHO, 15 Jan 2020)

On 16 January, the Department of Health (DOH) confirmed four more polio cases, bringing the total number of polio cases to 16 since the outbreak was declared in September 2019. The Research Institute of Tropical Medicine (RITM) reported two additional polio cases from Maguindanao, both males, ages two- and three-years old; one polio case from Sultan Kudarat, a two-year old male; and one polio case from Quezon City, a three-year old male. DOH extended its Sabayang Patak Kontra Polio (SPKP) campaign to ensure that no child is left unvaccinated and to boost protection for those already vaccinated. in all regions of Mindanao, and the National Capital Region during late January to early February (Govt. of the Philippines, 16 Jan 2019)

Immunization efforts continue through the outbreak, and Sarangani has announced an immunization rate of 85 percent against its current target of inoculating more than 70,800 children under five years old. At the time of writing, the two areas that remain most affected by the polio outbreak are BARMM and Region 12. Local authorities continue to partner with WHO in aiming for an immunization rate of 95 percent of children under the age of five, and are providing the polio vaccine for free as part of the current campaign. (Govt. of the Philippines, 28 Jan 2020).

Since 27 January 2020, no new confirmed human case. Currently, there are 13 cases of cVDPV2, one case with cVDPV1; one case with VDPV1; and one case with immunodeficiency-related VDPV type 2 (iVDPV2). Third round of Sabayang Patak Kontra Polio mOPV2 started in Mindanao on 20 January targeting 3,102,973 children under 5. In the first 14 days of the campaign, 3,057,875 children under 5 were vaccinated. NCR on 27 January started its first mOPV rounds, and targets 1,404,517 children under 5. In the first 4 days of the campaign, 1,126,979 children under 5 were vaccinated (80.2%). The second round is planned for 24 February-8 March 2020. The first poliovirus Outbreak Response Assessment (OBRA) is planned from 8-14 February. (UNICEF/WHO, 6 Feb 2020)

On 15 February, the Department of Health (DOH) reported one confirmed polio case in Nueva Ecija, bringing the total number of polio cases in the country to 17. DOH also reported environmental samples collected from Butuanon River, Cebu tested positive for the poliovirus as confirmed by the Research Institute of Tropical Medicine. In response to this development, DOH coordinated with the World Health Organization for an appropriate vaccination response. DOH has been assisting the Cities of Cabanatuan and Mandaue in strengthening their Acute Flaccid Paralysis surveillance capacities, including their identification and reporting mechanisms. (Govt. of the Philippines, 15 Feb 2020)

As of 10 March 2020, the country is responding to two poliovirus outbreaks, with 17 polio cases confirmed across the country. Polio vaccination campaigns are ongoing in six regions of Mindanao and Metro Manila. (OCHA, 10 Mar 2020)

The third round of mass immunization campaign to the poliovirus (types 1 and 2) outbreak is currently on hold due to the COVID-19 community quarantine. Vaccination campaigns planned for April and May targeting 2.4 million children up to 5 years of age in region 3 and 4-A have been postponed due to movement restrictions in Luzon island (OCHA, 20 Apr 2020).

After a vaccine-derived poliovirus outbreak was detected in the Philippines in 2019, health workers have been working to close a polio immunity gap present amongst some of the nation’s children. (GPEI, 5 June 2020)

The total number of polio cases in the country remains at 16 as of 14 May 2020. The Philippines is affected by both cVDPV1 and cVDPV2. cVDPV is considered a public health emergency of international concern (PHEIC). Currently, there are 13 cases of cVDPV2, one case with cVDPV1; one case with VDPV1; and one case with immunodeficiency related VDPV type 2 (iVDPV2). The Synchronized Polio Vaccination (SPV) is scheduled on 20 July to 2 August 2020. (UNICEF/WHO, 15 Jun 2020).

As of 26 Jun, the total number of polio cases in the country remains at 16. Currently, there are 13 cases of cVDPV2, one case with cVDPV1; one case with VDPV1; and one case with immunodeficiency related VDPV type 2 (iVDPV2). The Regional EPI Managers in Mindanao Region have already started conducting online orientation and microplanning for the third round of vaccination campaign targeting 3,102,974 children below 59 months old and 373,570 children from 60 months old to 119 months old. The implementation of the vaccination campaign in Regions 3 and 4A are phase approach to gain important operational experience for conducting a vaccination campaign in the context of COVID-19 pandemic (UNICEF/WHO, 26 Jun 2020).

The Department of Health (DOH), with support from the World Health Organization (WHO) and United Nations Children's Fund (UNICEF), is resuming its Sabayang Patak Kontra Polio campaign to combat the poliovirus outbreak in the Philippines. The polio immunization campaign was shortly put on hold because of the COVID-19 pandemic. The next phase of the Sabayang Patak Kontra Polio campaign in the whole of Mindanao will start on 20 July and last until 2 August 2020 for children under 5 years old. Children under 10 years old in selected areas in Mindanao will also receive polio drops. (UNICEF/WHO/Gov't of the Philippines, 20 Jul 2020).

About 3.65 million children under 5 years in Mindanao and Central Luzon received life-saving polio vaccines during a mass immunization campaign from 20 July to 2 August led by Department of Health with the support of UNICEF and WHO. Almost 84,000 children in Central Luzon remain unvaccinated due to refusals, deferrals, and lockdown in some communities. Discussions are ongoing for the extension of the campaign in Mindanao and Central Luzon to cover the unvaccinated children. The next phase of the campaign which will cover the provinces of Bulacan and Laguna is tentatively scheduled from 3 to 16 August. (OCHA, 4 Aug 2020).

The Department of Health (DOH) announced the commencement of the 2nd round of Sabayang Patak Kontra Polio (SPKP) in Region III and in three provinces of Region IVA, namely Laguna, Rizal and Cavite, during 14-27 September. Two drops of monovalent Oral Polio Vaccine Type 2 (mOPV2) will be given to children under five years of age for free, regardless of their immunization status. Last July and August 2020, DOH in partnership with the Local Government Units (LGUs) conducted the first round of SPKP in the same regions. The results, however, were below the desired target of 95% vaccination coverage of children under five years of age — 80.6% (Phase 1) and 81.39% (Phase 2) in Region III, and 81.71% (Phase 1) and 70.88% (Phase 2) in the three provinces of Region IVA. (Gov't of the Philippines, 14 Sep 2020).