States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV
WPV1
Cameroon (last case 9 July 2014)
Niger (last case 15 November 2012)
Chad (last case 14 June 2012)
Central African Republic (last case 8 December 2011)
cVDPV
Ukraine (last case 7 July 2015)
Madagascar (last case 22 August 2015)
Myanmar (last case 5 October 2015)
Guinea (last case 14 December 2015)
Lao PDR (last case 11 January 2016)
These countries should:
Urgently strengthen routine immunization to boost population immunity.
Enhance surveillance quality to reduce the risk of undetected WPV1 and cVDPV transmission, particularly among high risk mobile and vulnerable populations.
Intensify efforts to ensure vaccination of mobile and crossborder populations, Internally Displaced Persons, refugees and other vulnerable groups.
Enhance regional cooperation and cross border coordination to ensure prompt detection of WPV1 and cVDPV, and vaccination of high risk population groups.
Maintain these measures with documentation of full application of high quality surveillance and vaccination activities.
At the end of 12 months* without evidence of reintroduction of WPV1 or new emergence and circulation of cVDPV, provide a report to the Director General on measures taken to implement the Temporary Recommendations.
*For the Lake Chad countries, this will be 12 months after the last case of WPV1 or cVDPV2, whichever is the latest, in the sub-region. Based on the last cases (above) reports will be due for Myanmar in November 2017, for Madagascar in September 2017, for Guinea in January 2018, and in Lao PDR February 2018. In the case of Ukraine, the committee noted that a final report had been provided, but was concerned that this report showed that the risk of WPV importation and cVDPV importation or emergence remained high, largely due to poor immunization coverage. The committee decided to maintain the country in this category, and requested a review of the situation at the next committee meeting.
Additional considerations
The Director-General Dr Tedros attended the Emergency Committee and listened to the recommendations of the committee. He thanked Committee Members and Advisors for their advice, and noted that in the context of polio eradication, even one case of polio should be treated as an emergency. He noted that in all the geographic areas reviewed by the committee at the meeting, a sub-regional or multi-country coordinated response greatly improved the chance of success, and that to achieve the final goal of zero cases, the world may need to respond even more aggressively. He affirmed that he was personally committed as Director-General to providing any support needed to reduce the risk of the international spread of polio recommended by the committee.
The Committee strongly urged global partners in polio eradication to provide optimal support to all infected and vulnerable countries at this critical time in the polio eradication programme for implementation of the Temporary Recommendations under the IHR, as well as providing ongoing support to all countries that were previously subject to Temporary Recommendations (Somalia, Ethiopia, Iraq, Israel and Equatorial Guinea).
The Committee urged all countries to avoid complacency which could easily lead to a resurgence of polio. Surveillance particularly needs careful attention to quickly detect any new transmission, and careful assessment of where insecurity and inaccessibility impact on surveillance was needed. Similarly, there needs to be tracking of populations where there are high proportions of unvaccinated children due to inaccessibility, and requested the secretariat to include a report on this issue at its next meeting.
Based on the current situation regarding WPV1 and cVDPV, and the reports made by Afghanistan, DR Congo, Nigeria, Pakistan, and Syria, the Director-General accepted the Committee’s assessment and on 3 August 2017 determined that the situation relating to poliovirus continues to constitute a PHEIC, with respect to WPV1 and cVDPV. The Director-General endorsed the Committee’s recommendations for countries meeting the definition for ‘States infected with WPV1, cVDPV1 or cVDPV3 with potential risk for international spread’, ‘States infected with cVDPV2 with potential risk for international spread’ and for ‘States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV’ and extended the Temporary Recommendations under the IHR to reduce the risk of the international spread of poliovirus, effective 3 August 2017.