World Health Organization Regional Office for Europe EURO POLIO PAGE Data as of 04 October 2005 (Week 38) Vaccine-preventable Diseases and Immunization programme, Division of Technical Support website: http://www.euro.who.int/vaccine Cisid: http://data.euro.who.int/cisid Contact: Vaccine@euro.who.int The Eleventh Informal Consultation of the Global Laboratory Network The summary of the conclusions and Recommendations of the Eleventh Informal Consultation of the Global Laboratory Network held on 30 August - 1 September 2005 in Atlanta, GA, USA Conclusions. Recommendations. The polio laboratory network continues to provide virology results that are critical for monitoring the progress towards the achievement of the global polio eradication goal. The network detected wild poliovirus in 22 countries between January 2004 and 1 June 2005. Genetic characterization of viruses, based on VP1 sequences, is critical to tracing virus transmission links and showed that the majority of detected in the countries in the World Health Organization (WHO) region of Africa, in Indonesia, Sudan, Saudi Arabia, and Yemen were due to imported viruses linked to those found in northern Nigeria. Cases in Angola were due to virus imported from India. Cases in Afghanistan, Egypt, India, Nigeria, and Pakistan were due to endemic indigenous viruses. Network laboratories also confirmed outbreaks due to vaccine-derived polioviruses (VDPVs) in China in 2004 (type 2), Madagascar in 2005 (types 2 and 3) and Indonesia (type 1 in 2005). The network's detection of wild polio virus importations and VDPV transmission in several previously polio free countries underscores risks posed to countries from failure to maintain high polio immunization coverage. Network laboratories analyzed approximately 83,000 samples from of acute flaccid paralysis () in 2004 and are expected to analyze approximately 100,000 samples in 2005. Workload increases are a direct result of efforts to improve surveillance in remaining infected countries. LABORATORY SUPPORT. Laboratory support in polio free areas must also continue, because of the risks of occurrence of wild poliovirus importations and VDPV outbreaks. The global polio laboratory network should monitor laboratory workload, support improvement of efficiency and timeliness of reporting. VACCINE DERIVED POLIOVIRUSES. Recent detections of VDPVs in several polio-free countries emphasize the need for continued vigilance for detection and identification of these viruses. VDPV isolates and outbreaks should continue to be investigated to obtain as much information as possible for estimating future risk of outbreaks. Previous studies had established some empirical correlations; however recent episodes have indicated that two of these correlations are imperfect: recombination with species C is not a consistent marker for VDPVs that have evidence of circulation; antigenic drift of vaccine viruses is not always detectable in the ELISA ITD test. QUALITY ASSURANCE ISSUES. The WHO administered polio laboratory accreditation program has been successful in identifying training and resource needs and documenting the high quality of laboratory work. Multiple mechanisms now exist for the routine monitoring of laboratory performance through analysis of annual proficiency tests, weekly reported data and ITD and sequencing results. Annual on-site accreditation reviews should be continued for most network laboratories. However, the frequency of onsite reviews for high performance laboratories may be reduced to a minimum of once every 3 years, World Health Organization 2005 1
based on the following criteria: Attains maximum scores in proficiency tests; Meets al program criteria for timeliness and accuracy of results; has no critical staff or infrastructure changes since the last on-site review. PROCEDURAL CHANGES WITH POTENTIAL TO IMPROVE TIMELINESS. In the final stages of eradication, rapid detection and reporting of any wild poliovirus or VDPV becomes critical for timely programmatic response. The laboratory network has undertaken development and evaluation of new procedures and methodologies to address these requirements. Three general approaches included shortening or eliminating some of the testing steps, specific changes to ITD methods, and the development of new detection and ITD methods. Evaluation of al these approaches is ongoing, but preliminary data indicate that all three approaches have the potential to significantly shorten the time needed to provide final results. CONTAINMENT. Completion of Phase I, Laboratory survey and inventory, of the Global Action Plan, has been reported from 116 countries, including al 52 countries of the European Region, and work is underway in WHO Regional Offices to evaluate data quality. Development of containment policies for OPV cessation continues with an expected date for review and completion in 2006. The WHO Global Network laboratories should serve as models for containment and are encouraged to destroy al wild poliovirus materials once: full diagnostic and analytical work is complete; duplicate wild poliovirus isolates are available and retained in global specialized laboratories; materials have not been identified as programmatically important. Vaccine Derived Virus isolation in the European Region in 2005 Country Type of sample Date of first isolation Date of last isolation Slovakia Environmental October 2003 2005 P2 Israel Environmental May 1998 August 2005 P2 Spain case and contacts August 2005 present P2 virus type In the European Region of WHO, a number of VDPVs have been isolated in 2005, thus showing the efficiency of the European Laboratory Network and at the same time underlining the need to remain vigilant and maintain high standards of surveillance. Here are some of the general recommendations that are applicable when a VPDV is detected: -Ensure adequate intra typic differentiation and characterisation of the virus in liaison with the regional reference laboratory and the regional office for Europe of WHO -Repeated sampling of the case or the environment when relevant to know if virus is still excreted -Contact tracing and sampling -Characterise the epidemiology of the case ( vaccine status, age, travel, ethnic/socio-economic background) -Ensure that the community in which a VDPV was detected has high immunization coverage against poliomyelitis -Carry out active case search in hospitals and in the community -Gather and review results of epidemiological and virological investigation in a timely fashion -If any environmental or Enterovirus surveillance exists, all efforts should be made to obtain timely results. The Global Eradication Initiative will hold the Global Management Team meeting on 10 & 13 October and the 2 nd meeting of the Advisory Committee on Eradication (ACPE) on 11-12 October 2005, in Geneva, Switzerland. Events It is with deep sadness that we learned of the death of Professor Elena Leschinskaya. Professor Leschinskaya worked closely with the World Health Organization for many years and was highly respected for her outstanding contribution in the field of public health and particularly the Global myelitis Eradication Initiative. World Health Organization 2005 2
Country Table 1. / Weekly Reporting European Region 2005 (all countries) compatible % Completeness of reporting Week of last report Method of reporting Country using "priority" Albania 0 97% 38 email yes Andorra* 0 100% 39 direct web entry - Armenia 0 95% 38 email yes Austria 0 97% 39 direct web entry yes Azerbaijan 0 95% 39 email yes Belarus 0 92% 38 direct web entry yes Belgium* 0 97% 39 direct web entry - Bosnia and Herzegovina 0 97% 37 email partial Bulgaria 0 100% 38 direct web entry yes Croatia 0 58% 39 direct web entry yes Cyprus 0 97% 38 email yes Czech Republic 0 92% 38 email Denmark 0 DNR - Estonia* 0 100% 39 direct web entry yes Finland 0 DNR - France 0 DNR - Georgia 0 97% 38 email yes Germany 0 100% 38 email yes Greece 0 89% 38 direct web entry partial Hungary 0 97% 38 direct web entry yes Iceland 0 DNR - Ireland 0 100% 39 direct web entry yes Israel 0 97% 38 email yes Italy 0 97% 39 direct web entry yes Kazakstan 0 92% 38 email yes Kyrgyzstan 0 92% 38 email yes Latvia 0 95% 37 email yes Lithuania 0 76% 39 direct web entry yes Luxembourg 0 DNR - Malta 0 92% 35 email yes Monaco 0 DNR - Netherlands 0 DNR - Norway 0 84% 38 direct web entry yes Poland 0 79% 38 direct web entry yes Portugal 0 100% 38 email partial Republic of Moldova 0 82% 39 direct web entry yes Romania 1 76% 38 email partial Russian Federation 2 100% 38 email yes San Marino 0 DNR - Serbia & Montenegro 0 100% 39 email partial Slovak Republic 0 97% 38 direct web entry yes Slovenia* 0 82% 39 direct web entry - Spain 0 97% 39 direct web entry yes Sweden 0 DNR - Switzerland* 0 89% 38 direct web entry yes Tajikistan 0 92% 38 email yes T.F.Y.R.Macedonia 0 100% 38 email no Turkey 0 100% 38 email yes Turkmenistan 0 92% 38 email yes Ukraine 0 89% 37 email yes United Kingdom 0 DNR - Uzbekistan 0 92% 38 email yes Total / average 93% Recently endemic 88% Shaded country name indicates country classified as endemic / recently endemic by the Regional Certification Commission in 1996 * No reported to WHO/EURO; DNR-do not report surveillance data World Health Organization 2005 3
non- rate* 2004 2005 Surveillance index*** pending priority pending % with 2 stool non- rate* % with 2 stool spec.** Surveillance index*** Country spec.** Albania 0.9 100% 0.9 6 0 0 0.89 100% 0.89 Andorra 0 0% 0 0 0 0 0 0% 0 Armenia 1.51 82% 0.91 8 1 4 1.32 100% 1 Austria 0.56 57% 0.4 1 1 1 0.11 0% 0.11 Azerbaijan 0.98 95% 0.98 18 0 0 1.2 100% 1 Belarus 2.94 87% 0.91 47 0 0 3.97 94% 0.94 Belgium 0.59 0% 0.18 2 0 0 0.16 0% 0 Bosnia and Herzegovina 0.15 0% 0 2 1 0 0.39 100% 0.39 Bulgaria 1.6 94% 1 23 17 1 2.91 91% 0.96 Croatia 0 0% 0 4 2 0 0 0% 0 Cyprus 0 67% 0 1 0 0 0 100% 0 Czech Republic 0.85 77% 0.78 10 0 1 0.87 100% 0.87 Estonia 0.5 100% 0.5 0 0 0 0 0% 0 Georgia 0.86 88% 0.76 8 0 0 1.17 88% 0.88 Germany 0.57 45% 0.36 54 0 0 0.55 43% 0.42 Greece 0.72 45% 0.39 12 5 0 1.04 25% 0.5 Hungary 1.04 44% 0.69 13 0 0 1.12 46% 0.62 Ireland 0.61 40% 0.24 5 1 0 0.78 0% 0.47 Israel 0.83 27% 0.39 11 0 0 0.78 27% 0.64 Italy 0.9 62% 0.69 48 1 0 0.79 79% 0.66 Kazakhstan 1.43 93% 0.95 37 0 0 1.28 95% 0.95 Kyrgyzstan 2.48 95% 0.97 23 3 0 1.93 96% 1 Latvia 0.88 100% 0.88 1 0 0 0.4 100% 0.4 Lithuania 1.79 73% 1 8 0 0 1.77 88% 1 Malta 0 0% 0 2 0 0 3.55 100% 1 Norway 0.92 0% 0.46 7 2 0 1.06 29% 0.57 Poland 0.77 76% 0.65 23 0 1 0.48 52% 0.41 Portugal 0.42 43% 0.24 2 1 0 0.16 0% 0.08 Republic of Moldova 1.19 80% 0.8 2 2 0 0.32 50% 0.32 Romania 0.67 62% 0.48 15 0 1 0.56 87% 0.52 Russian Federation 1.84 91% 0.93 271 88 22 1.71 90% 0.92 Serbia and Montenegro 1.14 91% 0.95 13 1 0 0.89 92% 0.82 Slovakia 0.63 67% 0.53 3 0 1 0.42 67% 0.42 Slovenia 0 0% 0 0 0 0 0 0% 0 Spain 0.77 44% 0.53 31 1 0 0.73 58% 0.58 Switzerland 1.08 8% 0.33 2 0 0 0.24 0% 0 Tajikistan 1.05 100% 1 23 0 0 1.4 100% 1 The former Yugoslav Republic of Macedonia 2.12 89% 1 8 0 0 2.52 100% 1 Turkey 0.95 84% 0.82 144 21 9 0.9 83% 0.78 Turkmenistan 1.84 94% 1 19 0 0 1.38 100% 1 Ukraine 1.59 93% 0.94 69 12 1 1.29 97% 0.97 Uzbekistan 1.5 98% 0.98 90 1 4 1.39 98% 0.98 Average/Totals 1.16 81% 0.87 1066 164 46 0.82 84% 0.74 Recently Endemic 1.38 90% 0.93 756 133 41 0.97 92% 0.91 **Two stool specimens collected at least 24 hours apart within 14 days of onset of paralysis and adequately shipped target of 80%. ***Index = non-polio rate up to 1.0 x (% 1 adequate specimens), Bold = 0.8, Italics = between 0,6 and 0,79 Number of assigned a priority coding and pending. All indicators are calculated year to date unless specified otherwise. Recently endemic countries are highlighted with this colour TABLE 2. Reporting - European Region for 2004 and 2005 among countries with surveillance *Annualized rate per 100 000 children under the age of 15. Bold = meeting WHO target of 1.0. Total number of pending final classification 90 days after Date of onset. to the laboratory. Bold = meeting WHO World Health Organization 2005 4
POLIO LABORATORY DATA: Nr of and specimens processed in the laboratory network in 2005 (Source LDMS, Week 38) Nr Nr specimens 2500 2000 1500 Nr 1000 500 0 Case Contact Other Illness Healthy Sewage Other Environmental Unknown Case type Performance indicators in the laboratory network in 2005 (source LDMS, Week 38) Case Contact Other Illness Healthy Sewage 100 90 80 70 60 50 40 30 20 10 0 specimen with 14 days from onset to collection of specimen specimen 3 days from collection to arrival at NRL specimen with good temperature, quantity and condition specimen with 28 days from arrival at NRL to typing result isolates with 7 days from typing results at NRL to arrival at RRL isolates with 14 days from arrival at RRL to ITD result 52 days from collection of specimen to ITD results at RRL NRL: National Reference Laboratory RRL: Regional Reference Laboratory ITD: Intra Typic Differentiation World Health Organization 2005 5