Breaking: WHO Warns on Poliovirus Outbreak

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By Correspondent

The World Health Organization, WHO has announced the outbreak of polio in Indonesia.

According to the global health body, the report came on November 12, 2022.

The statemnent issued yesterday reads: “On 12 November 2022, Indonesia’s Ministry of Health notified WHO of a confirmed case of VDPV2.

“The case was a 7-year-old boy from Pidie district in Aceh province, who developed AFP on 9 October 2022.

“The case had not received oral polio vaccine (OPV) or inactivated polio vaccine (IPV) and had no travel history or contact with those who had traveled.

“On 12 Indonesia’s Ministry of Health notified WHO of a confirmed case of circulating vaccine-derived poliovirus type 2 (cVDPV2) with acute flaccid paralysis (AFP) from Pidie district in Aceh province.

“Field investigations were immediately launched by local and national public health authorities, with support from partners of the Global Polio Eradication Initiative.

“On 28 November, the Ministry of Health launched an immunization campaign for children under the age of 13 years in the affected areas.

“On 25 November 2022, three more genetically related isolates of cVDPV2 were reported based on the laboratory results of stool samples taken from three healthy children who were in the same community but not close contacts of the confirmed case.

“Sequencing results from Biofarma lab showed 25 nucleotide changes for the AFP case and 25 to 26 nucleotide changes for the three asymptomatic children.

“These results are evidence of transmission of the virus and meets the criteria to be classified as circulating VDPV2 (cVDPV2). In the past in Indonesia, a cVDPV type 1 outbreak was reported in Papua province in 2019.

“Aceh province has very low polio vaccination coverage in the routine immunization programme; however, coverage is also low in several other provinces in Indonesia, including three provinces nearby Aceh (North Sumatera, West Sumatera and Riau).

“In 2021, in Aceh province, bivalent oral polio vaccine (OPV3) coverage was 50.9%, and IPV 28.2%. and for Pidie district the coverage was 17.7% for OPV3 and 0.5% for IPV.

“There is low population immunity against all polioviruses but primarily type 2 in children born after the switch from the trivalent to bivalent OPV in April 2016.”

WHO explained that Polio is a highly infectious disease that largely affects children under five years of age, causing permanent paralysis (approximately 1 in 200 infections) or death (2-10% of those paralyzed).

The virus is transmitted by person-to-person, mainly through the fecal-oral route or, less frequently, by a common vehicle (e.g., contaminated water or food) and multiplies in the intestine, from where it can invade the nervous system and cause paralysis.

The incubation period is usually 7–10 days but can range from 4–35 days. Up to 90% of those infected are either asymptomatic or experience mild symptoms and the disease usually goes unrecognized.

WHO added that the vaccine-derived virus can genetically change into a form that can cause paralysis as does the wild poliovirus – this is what is known as a vaccine-derived poliovirus (VDPV).

“The detection of VDPV in at least two different sources and at least two months apart, that are genetically linked, showing evidence of transmission in the community, should be classified as ‘circulating’ vaccine-derived poliovirus type 2 (cVDPV2).

“Circulating vaccine-derived poliovirus type 2 continues to affect different areas of the world, notably in the African Region.

“Risk assessment and field investigations were immediately launched and are still ongoing by the local and national public health authorities, with support from the Global Polio Eradication Initiative (GPEI) partners, including a more detailed assessment of the origin of the isolated viruses.”

WHO has launched a rapid response vaccination campaign in Aceh province, where the outbreak started, for those aged zero to 12 years on 5 December 2022.

WHO has therefore advised that it is important that all countries, in particular those with frequent travel and contacts with polio-affected countries and areas, strengthen surveillance for AFP cases and commence any planned expansion of environmental surveillance in order to rapidly detect any new virus importation and to facilitate a rapid response.

“Countries, territories and areas should also maintain uniformly high routine immunization coverage at the district level to minimize the consequences of any new virus introduction.

“WHO’s International travel and health recommends that all travellers to polio-affected areas be fully vaccinated against polio.

As per the advice of the Emergency Committee convened under the International Health Regulations (2005) on the international spread of poliovirus, countries affected by poliovirus transmission are subject to Temporary Recommendations. To comply with the Temporary Recommendations issued under the PHEIC, any country that have had an importation of cVDPV2 with local transmission should (i) declare the outbreak as a national public health emergency (ii) encourage residents and long-term visitors to receive a dose of IPV four weeks to 12 months prior to international travel, (iii) ensure that travellers who receive such vaccination have access to an appropriate document to record their polio vaccination status, (iv) further intensify efforts to increase IPV immunization coverage, including sharing coverage data, and (v) intensify regional cooperation and cross border coordination to enhance surveillance for prompt detection of poliovirus, and vaccinate refugees, travellers and cross border populations, according to the advice of the Advisory Group.

WHO however, has not recommended any travel or trade restrictions to Indonesia based on the information available for this current event.

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