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The reliable and timely detection of poliovirus infection through surveillance for acute flaccid paralysis (AFP), supplemented by environmental surveillance (ES) of sewage samples, is a critical component of the polio eradication programme. Since 1988, the number of polio cases caused by wild poliovirus (WPV) has decreased by >99.9%, and eradication of WPV serotypes 2 and 3 has been certified; only serotype 1 (WPV1) continues to circulate and transmission remains endemic in Afghanistan and Pakistan. In this surveillance update, we evaluated indicators of AFP in surveillance, ES for polioviruses and data on the performance of the Global Polio Laboratory Network (GPLN) provided by 28 priority countries for the programme during 2022-2023. No WPV1 cases have been detected outside those countries since August 2022, when importation into Malawi and Mozambique resulted in an outbreak during 2021-2022. During 2022-2023, 20 of 28 priority countries (71.4%) met national AFP surveillance indicator targets, and the number of ES sites increased. Low national rates of reported AFP cases in priority countries in 2023 might have been due to lags in surveillance reporting; substantial national and subnational AFP surveillance gaps persist. Maintaining high-quality surveillance is critical to achieving the goal of global polio eradication. Monitoring surveillance indicators is important to identifying gaps and guiding surveillance-strengthening activities, particularly in countries at high risk for poliovirus circulation. La detection fiable et rapide de l'infection a poliovirus au moyen de la surveillance de la paralysie flasque aigue (PFA), completee par une surveillance des echantillons d'eaux usees, est un element essentiel du programme d'eradication de la poliomyelite. Depuis 1988, le nombre de cas de poliomyelite dus au poliovirus sauvage (PVS) a diminue de >99,9% et l'eradication des serotypes 2 et 3 du PVS a ete certifiee; seul le serotype 1 du poliovirus sauvage (PVS1) continue de circuler et la transmission demeure endemique en Afghanistan et au Pakistan. Dans ce rapport faisant le point sur la surveillance, nous evaluons les indicateurs de la PFA a des fins de surveillance pour la recherche des poliovirus et les donnees relatives aux performances du Reseau mondial de laboratoires pour la poliomyelite (RMLP) communiquees par les 28 pays prioritaires pour le programme en 2022-2023. Aucun cas du au PVS1 n'a ete detecte en dehors de ces pays depuis aout 2022, apres une flambee epidemique en 2021-2022 due a l'importation du virus au Malawi et au Mozambique. En 2022-2023, 20 des 28 pays prioritaires (71,4 %) ont atteint les cibles des indicateurs de surveillance de la PFA, et le nombre de sites de surveillance environnementale a augmente. Le faible nombre de cas de PFA signales dans les pays prioritaires en 2023 pourrait etre du a des retards dans la communication des donnees issues de la surveillance; d'importantes lacunes en matiere de surveillance de la PFA a l'echelle nationale et infranationale persistent. Il est essentiel de maintenir une surveillance de qualite afin d'atteindre l'eradication de la poliomyelite a l'echelle mondiale. Un suivi des indicateurs de surveillance est egalement important pour identifier les lacunes et orienter les activites de surveillance, particulierement dans les pays oU il existe un risque eleve de circulation du poliovirus., Introduction Since the Global Polio Eradication Initiative (GPEI) was established in 1988, the number of WPV cases has decreased by >99.9%, and WPV serotypes 2 and 3 have been declared [...]

In 2013, the 11 Member States of the WHO South-East Asia Region (1) (SEAR) adopted the goals of measles elimination and control of rubella and congenital rubella syndrome (CRS) (2) [...]

Since the Global Polio Eradication Initiative was established in 1988, the number of cases due to wild poliovirus (WPV) has decreased by >99.9%, and WPV serotypes 2 and 3 have [...]

In 2019, India, along with other countries in the WHO South-East Asia Region, (1) adopted the goal of measles and rubella elimination by 2023, (2) a revision of the previous [...]

In 2013, the Member States in the WHO South-East Asia Region (SEAR) (1) adopted the goal of measles elimination and rubella and control of congenital rubella syndrome (2) by 2020. [...]

Objective To expand the measles and rubella laboratory network of India by integrating new laboratories. Methods In collaboration with the World Health Organization (WHO), the Indian government developed a 10-step scheme to systematically expand the number of laboratories performing serological and molecular testing for measles and rubella. The Indian Council of Medical Research and WHO identified suitable laboratories based on their geographical location, willingness, preparedness, past performance and adherence to national quality control and quality assurance mechanisms. The 10-step scheme was initiated with training on measles and rubella diagnostic assays followed by testing of both measles and rubella serology and molecular unknown panels, cross- verification with reference laboratories and ended with WHO on-site accreditation. Findings After extensive training, technical support, funding and monitoring, all six selected laboratories attained passing scores of 90.0% or more in serological and molecular proficiency testing of measles and rubella. Since 2018, the laboratories are a part of the measles and rubella network of India. Within 12 months of initiation of independent reporting, the six laboratories have tested 2287 serum samples and 701 throat or nasopharyngeal swabs or urine samples. Conclusion The process led to strengthening and expansion of the network. This proficient laboratory network has helped India in scaling up serological and molecular testing of measles and rubella while ensuring high quality testing. The collaborative model developed by the Indian government with WHO can be implemented by other countries for expanding laboratory networks for surveillance of measles and rubella as well as other infectious diseases. Objectif Etendre le reseau de laboratoires d'analyse de la rougeole et de la rubeole en Inde en y integrant de nouveaux etablissements. Methodes En collaboration avec l'Organisation mondiale de la Sante (OMS), le gouvernement indien a mis au point un programme en 10 etapes destine a accroitre systematiquement le nombre de laboratoires effectuant des tests serologiques et moleculaires de detection de la rougeole et de la rubeole. Le Conseil indien de la recherche medicale et l'OMS ont identifie une serie de laboratoires eligibles en raison de leur situation geographique, de leur volonte d'y participer, de leur niveau de preparation, de leurs performances anterieures et de leur respect des mecanismes nationaux de controle et d'assurance qualite. Ce programme en 10 etapes a commence par une formation aux analyses diagnostiques pour la rougeole et la rubeole, suivie de la realisation de tests serologiques et moleculaires pour detecter la rougeole et la rubeole sur des echantillons inconnus, une verification croisee avec les laboratoires de reference et enfin, une accreditation OMS sur site. Resultats Apres avoir recu une formation complete, un soutien technique, un financement et fait l'objet d'une surveillance, les six laboratoires selectionnes ont tous reussi, obtenant une note egale ou superieure a 90,0% dans les tests d'aptitude au depistage serologique et moleculaire de la rougeole et de la rubeole. Depuis 2018, ces laboratoires font partie du reseau d'analyse de la rougeole et de la rubeole en Inde. Douze mois apres l'etablissement des premiers rapports independants, les six laboratoires avaient teste 2287 echantillons de serum et 701 ecouvillons nasopharynges, prelevements de gorge ou echantillons d'urine. Conclusion Le programme a permis de renforcer et d'etendre le reseau de laboratoires competents. L'Inde a ainsi pu developper un systeme de tests serologiques et moleculaires de haute qualite pour depister la rougeole et la rubeole. Le modele collaboratif adopte par le gouvernement indien avec l'OMS pourrait s'appliquer a d'autres pays qui souhaitent etendre leur reseau de laboratoires charges de surveiller la rougeole et la rubeole, mais aussi d'autres maladies infectieuses. Objetivo Ampliar la red de laboratorios para el diagnostico del sarampion y la rubeola en la India mediante el establecimiento de nuevos laboratorios. Metodos En colaboracion con la Organizacion Mundial de la Salud (OMS), el gobierno de la India desarrollo un programa de 10 pasos para ampliar de manera sistematica el numero de laboratorios que realizan pruebas serologicas y moleculares para detectar el sarampion y la rubeola. El Consejo Indio de Investigacion Medica y la OMS identificaron los laboratorios adecuados segun su ubicacion geografica, su disposicion, su preparacion, sus resultados anteriores y su adhesion a los mecanismos nacionales de control y garantia de calidad. El programa de 10 pasos se inicio con la formacion sobre las pruebas de diagnostico del sarampion y la rubeola, seguida de la realizacion de pruebas serologicas y moleculares para el sarampion y la rubeola en grupos desconocidos, la verificacion cruzada con los laboratorios de referencia y finalizo con la acreditacion in situ a cargo de la OMS. Resultados Luego de una extensa formacion, apoyo tecnico, financiamiento y seguimiento, los seis laboratorios seleccionados alcanzaron puntajes de aprobacion del 90,0 % o mas en las pruebas de aptitud serologica y molecular para el sarampion y la rubeola. Desde 2018, los laboratorios forman parte de la red contra el sarampion y la rubeola de la India. En los 12 meses posteriores al inicio de la presentacion de informes independientes, los seis laboratorios han analizado 2287 muestras de suero y 701 exudados faringeos o nasofaringeos, o muestras de orina. Conclusion El proceso condujo al fortalecimiento y la expansion de la red. Esta competente red de laboratorios ha ayudado a India a ampliar las pruebas serologicas y moleculares para el sarampion y la rubeola, garantizando al mismo tiempo la alta calidad de las pruebas. El modelo de colaboracion que ha desarrollado el gobierno de la India con la OMS se puede aplicar en otros paises para ampliar las redes de laboratorios con el fin de vigilar los casos de sarampion y rubeola, asi como otras enfermedades infecciosas., Introduction Countries in the World Health Organization (WHO) South-East Asia Region have extended their targets to eliminate the vaccine-preventable infections, measles and rubella, by 2023. (1) These infections lead to [...]

The South-East Asia (SEA) Region of the World Health Organization (WHO), through a Regional Committee resolution in 2013, adopted the goal of "measles elimination and rubella control by 2020". The goal was revised in 2019 to "measles and rubella elimination by 2023". Countries of the Region have made significant efforts to achieve the goal. Progress has been made in the Region, with five of the 11 countries of the Region having been verified for having eliminated measles and rubella. Surveillance and immunization program performance for measles and rubella has shown an improvement since 2013. This progress has been possible due to a high level of political and programmatic commitment in the countries of the Region, as well as due to the alliances and infrastructures established for disease elimination initiatives in the past, notably for polio, being utilized effectively to implement strategies for measles and rubella elimination. The unforeseen COVID-19 pandemic had a detrimental effect on the immunization and surveillance efforts, leading to a delay in the achievement of measles and rubella elimination in the Region. Challenges to achieve the goal remain; however, efforts are ongoing in countries to not only protect the gains made so far but also to make further progress towards the goal of measles and rubella elimination. [ABSTRACT FROM AUTHOR]

With 762 laboratories, the Global Measles and Rubella Laboratory Network (GMRLN) is the largest laboratory network coordinated by the World Health Organization (WHO). Like the Global Polio Laboratory Network, the GMRLN has multiple tiers, including global specialized laboratories, regional reference laboratories, national laboratories, and, in some countries, subnational laboratories. Regional networks are supervised by regional laboratory coordinators reporting to a global coordinator at WHO headquarters. Laboratories in the GMRLN have strong links to national disease control and vaccination programs. The GMRLN's goal is to support member states in obtaining timely, complete, and reliable laboratory-based surveillance data for measles and rubella as part of the strategy for achieving measles and rubella elimination. Surveillance data are reported to the national program and are included in annual reports on the status of measles and rubella elimination to national verification committees for review by regional verification commissions. Quality within the GMRLN is ensured by monitoring performance through external quality assurance programs, confirmatory and quality control testing, accreditation, and coordination of corrective action and training where needed. The overall performance of the laboratories has remained high over the years despite many challenges, particularly the COVID-19 pandemic. The GMRLN is well-positioned to support high-quality laboratory-based surveillance for measles and rubella and to transition to supporting laboratory testing for other pathogens, including vaccine-preventable diseases. [ABSTRACT FROM AUTHOR]

The reliable and timely detection of poliovirus cases through surveillance for acute flaccid paralysis (AFP), supplemented by environmental surveillance of sewage samples, is a critical component of the polio eradication program. Since 1988, the number of polio cases caused by wild poliovirus (WPV) has declined by >99.9%, and eradication of WPV serotypes 2 and 3 has been certified; only serotype 1 (WPV1) continues to circulate, and transmission remains endemic in Afghanistan and Pakistan. This surveillance update evaluated indicators from AFP surveillance, environmental surveillance for polioviruses, and Global Polio Laboratory Network performance data provided by 28 priority countries for the program during 2022-2023. No WPV1 cases have been detected outside of Afghanistan and Pakistan since August 2022, when an importation into Malawi and Mozambique resulted in an outbreak during 2021-2022. During 2022-2023, among 28 priority countries, 20 (71.4%) met national AFP surveillance indicator targets, and the number of environmental surveillance sites increased. However, low national rates of reported AFP cases in priority countries in 2023 might have resulted from surveillance reporting lags; substantial national and subnational AFP surveillance gaps persist. Maintaining high-quality surveillance is critical to achieving the goal of global polio eradication. Monitoring surveillance indicators is important to identifying gaps and guiding surveillance-strengthening activities, particularly in countries at high risk for poliovirus circulation. [ABSTRACT FROM AUTHOR]

Background Unrest in Myanmar in August 2017 resulted in the movement of over 700,000 Rohingya refugees to overcrowded camps in Cox's Bazar, Bangladesh. A large outbreak of diphtheria subsequently began in this population. Methods and findings Data were collected during mass vaccination campaigns (MVCs), contact tracing activities, and from 9 Diphtheria Treatment Centers (DTCs) operated by national and international organizations. These data were used to describe the epidemiological and clinical features and the control measures to prevent transmission, during the first 2 years of the outbreak. Between November 10, 2017 and November 9, 2019, 7,064 cases were reported: 285 (4.0%) laboratory-confirmed, 3,610 (51.1%) probable, and 3,169 (44.9%) suspected cases. The crude attack rate was 51.5 cases per 10,000 person-years, and epidemic doubling time was 4.4 days (95% confidence interval [CI] 4.2-4.7) during the exponential growth phase. The median age was 10 years (range 0-85), and 3,126 (44.3%) were male. The typical symptoms were sore throat (93.5%), fever (86.0%), pseudomembrane (34.7%), and gross cervical lymphadenopathy (GCL; 30.6%). Diphtheria antitoxin (DAT) was administered to 1,062 (89.0%) out of 1,193 eligible patients, with adverse reactions following among 229 (21.6%). There were 45 deaths (case fatality ratio [CFR] 0.6%). Household contacts for 5,702 (80.7%) of 7,064 cases were successfully traced. A total of 41,452 contacts were identified, of whom 40,364 (97.4%) consented to begin chemoprophylaxis; adherence was 55.0% (N = 22,218) at 3-day follow-up. Unvaccinated household contacts were vaccinated with 3 doses (with 4-week interval), while a booster dose was administered if the primary vaccination schedule had been completed. The proportion of contacts vaccinated was 64.7% overall. Three MVC rounds were conducted, with administrative coverage varying between 88.5% and 110.4%. Pentavalent vaccine was administered to those aged 6 weeks to 6 years, while tetanus and diphtheria (Td) vaccine was administered to those aged 7 years and older. Lack of adequate diagnostic capacity to confirm cases was the main limitation, with a majority of cases unconfirmed and the proportion of true diphtheria cases unknown. Conclusions To our knowledge, this is the largest reported diphtheria outbreak in refugee settings. We observed that high population density, poor living conditions, and fast growth rate were associated with explosive expansion of the outbreak during the initial exponential growth phase. Three rounds of mass vaccinations targeting those aged 6 weeks to 14 years were associated with only modestly reduced transmission, and additional public health measures were necessary to end the outbreak. This outbreak has a long-lasting tail, with Rt oscillating at around 1 for an extended period. An adequate global DAT stockpile needs to be maintained. All populations must have access to health services and routine vaccination, and this access must be maintained during humanitarian crises., Author(s): Jonathan A. Polonsky 1,2,*, Melissa Ivey 3, Md. Khadimul Anam Mazhar 4, Ziaur Rahman 5, Olivier le Polain de Waroux 1,6,7,8,9, Basel Karo 6,10, Katri Jalava 4, Sirenda Vong [...]

During 2 September-4 October 2016, 4 sewage samples collected in Hyderabad in Telangana state between 3 August and 19 September 2016 and 1 sewage sample collected in Ahmedabad in Gujarat [...]

Neonatal pertussis is a resurging disease, possibly due to waning immunity in pregnant women. We report seven cases of neonatal pertussis (Bordetella pertussis DNA PCR positive) in this retrospective study conducted at a tertiary care teaching hospital in north India over eight months (March to October 2018). All except one were male infants and presented at the age of 14–30 days with paroxysmal cough in all, four had fever, four had respiratory distress, three had similar illness in the family, and two had leucocytosis. All recovered well with azithromycin. The duration of hospital stay was 5–7 days. A strong suspicion of neonatal pertussis in neonates with paroxysmal cough and similar family history should be maintained as the prognosis is excellent, if treated appropriately. [ABSTRACT FROM AUTHOR]

Residual blood specimens collected at health facilities may be a source of samples for serosurveys of adults, a population often neglected in community-based serosurveys. Anonymized residual blood specimens were collected from individuals 15 - 49 years of age attending two sub-district hospitals in Palghar District, Maharashtra, from November 2018 to March 2019. Specimens also were collected from women 15 - 49 years of age enrolled in a cross-sectional, community-based serosurvey representative at the district level that was conducted 2 - 7 months after the residual specimen collection. Specimens were tested for IgG antibodies to measles and rubella viruses. Measles and rubella seroprevalence estimates using facility-based specimens were 99% and 92%, respectively, with men having significantly lower rubella seropositivity than women. Age-specific measles and rubella seroprevalence estimates were similar between the two specimen sources. Although measles seropositivity was slightly higher among adults attending the facilities, both facility and community measles seroprevalence estimates were 95% or higher. The similarity in measles and rubella seroprevalence estimates between the community-based and facility serosurveys highlights the potential value of residual specimens to approximate community seroprevalence.

Residual blood specimens provide a sample repository that could be analyzed to estimate and track changes in seroprevalence with fewer resources than household-based surveys. We conducted parallel facility and community-based cross-sectional serological surveys in two districts in India, Kanpur Nagar District, Uttar Pradesh, and Palghar District, Maharashtra, before and after a measles-rubella supplemental immunization activity (MR-SIA) from 2018 to 2019. Anonymized residual specimens from children 9 months to younger than 15 years of age were collected from public and private diagnostic laboratories and public hospitals and tested for IgG antibodies to measles and rubella viruses. Significant increases in seroprevalence were observed following the MR SIA using the facility-based specimens. Younger children whose specimens were tested at a public facility in Kanpur Nagar District had significantly lower rubella seroprevalence prior to the SIA compared to those attending a private hospital, but this difference was not observed following the SIA. Similar increases in rubella seroprevalence were observed in facility-based and community-based serosurveys following the MR SIA, but trends in measles seroprevalence were inconsistent between the two specimen sources. Despite challenges with representativeness and limited metadata, residual specimens can be useful in estimating seroprevalence and assessing trends through facility-based sentinel surveillance.

Vaccination is one of the most successful and cost-effective interventions designed by science which has helped in preventing millions of deaths, especially in children. The Expanded Programme on Immunization (EPI) was established by World Health Organization (WHO) in 1974 to develop immunization programmes throughout the world with polio, measles, diphtheria, tetanus, tuberculosis and whooping cough. The WHO South-East Asia Region (SEAR) has a disproportionately high burden of infectious diseases and has greatly benefitted from the EPI as compared to other regions with more than 90 per cent of the population having access to vaccines. The story of vaccines in South-East Asia is a testament to scientific progress, global collaboration, and unwavering commitment to public health. This article aims to discuss the journey of EPI in the WHO SEAR.

During 2013, the 11 countries of the World Health Organization (WHO) South-East Asia Region* (SEAR) adopted the goals of measles elimination and rubella and congenital rubella syndrome (CRS) control † by 2020. During 2019, SEAR countries declared a broader goal for eliminating both measles and rubella § by 2023 (1). Before 2013, only five SEAR countries had introduced rubella-containing vaccine (RCV). This report updates a previous report and describes progress toward rubella elimination in SEAR during 2013-2021 (2). During 2013-2021, six SEAR countries introduced RCV; all countries in the Region now use RCV in routine immunization. Routine immunization coverage with the first dose of a rubella-containing vaccine (RCV1) increased >600%, from 12% during 2013 to 86% during 2021, and an estimated 515 million persons were vaccinated via RCV supplementary immunization activities (SIAs) ¶ during 2013-2021. During this time, annual reported rubella incidence declined by 80%, from 5.5 to 1.1 cases per million population. Maldives and Sri Lanka are verified as having achieved rubella elimination; Bhutan, North Korea, and Timor-Leste have halted endemic transmission of rubella virus for >36 months. SEAR has made substantial progress toward rubella elimination; however, intensified measures are needed to achieve elimination., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Since the Global Polio Eradication Initiative (GPEI) was established in 1988, the number of wild poliovirus (WPV) cases has declined by >99.9%, and WPV serotypes 2 and 3 have been declared eradicated (1). By the end of 2022, WPV type 1 (WPV1) transmission remained endemic only in Afghanistan and Pakistan (2,3). However, during 2021-2022, Malawi and Mozambique reported nine WPV1 cases that were genetically linked to Pakistan (4,5), and circulating vaccine-derived poliovirus (cVDPV) outbreaks were detected in 42 countries (6). cVDPVs are oral poliovirus vaccine-derived viruses that can emerge after prolonged circulation in populations with low immunity allowing reversion to neurovirulence and can cause paralysis. Polioviruses are detected primarily through surveillance for acute flaccid paralysis (AFP), and poliovirus is confirmed through stool specimen testing. Environmental surveillance, the systematic sampling of sewage and testing for the presence of poliovirus, supplements AFP surveillance. Both surveillance systems were affected by the COVID-19 pandemic's effects on public health activities during 2020 (7,8) but improved in 2021 (9). This report updates previous reports (7,9) to describe surveillance performance during 2021-2022 in 34 priority countries.* In 2022, a total of 26 (76.5%) priority countries met the two key AFP surveillance performance indicator targets nationally compared with 24 (70.6%) countries in 2021; however, substantial gaps remain in subnational areas. Environmental surveillance expanded to 725 sites in priority countries, a 31.1% increase from the 553 sites reported in 2021. High-quality surveillance is critical to rapidly detect poliovirus transmission and enable prompt poliovirus outbreak response to stop circulation. Frequent monitoring of surveillance guides improvements to achieve progress toward polio eradication., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.