Poliovirus Outbreak Response (Polio Outbreak) Situation Report No 17

Malawi 15 May 2023.

Summary - Wild Polio Virus 1 (WPV1) outbreak:

Fig 1: WPV1, cVDPV1, cVDPV2 cases and isolates in Malawi

Outbreak confirmation: 16th Feb. 2022

PHE declaration: 17th Feb. 2022
Number of WPV1 cases: 1 Acute Flaccid Paralysis case
Vaccination status: 1 dose of bOPV
Location: Lilongwe
Date of onset: 19th Nov. 2021
Nucleotide changes: 19 nt

Summary Circulating Vaccine Derived Polio Virus 1 & 2

cVDPV2 outbreak in Malawi

Outbreak confirmation: 23 February 2023

Source: Environmental Surveillance (ES) site
Location: Kauma Treatment Plant, Lilongwe
Nucleotide changes: 18nt

cVDPV1 outbreak in Malawi

Outbreak confirmation: 17 July 2022

Total number of cVDPV1 cases: 4
Source: AFP case
Location: Phalombe, Mulanje and Blantyre districts
Date of onset of last case: 1 December 2022
Nucleotide changes: 50nt
Vaccination status: 4 doses of bOPV
Mozambique
8 WPV1, 23 cVDPV1 cases and 5 cVDPV2
Bivalent Oral Polio Vaccine (bOPV) Campaign Response
4 nationwide bOPV SIA conducted in 2022 with last round from 13 – 16 October
2022.

1.0 HIGHLIGHTS
● Nationwide Integrated TCV/MR/bOPV campaign commenced from 15 – 21 May, 2023. The
campaign was launched in Balaka by the Hon. Minister of Health, represented by the Secretary for
Health, Dr. Samson Mndolo, with Heads of Agencies of GPEI partners in attendance.
● NPEC meeting held on 9 May 2023, with 133 AFP cases classified, of which 127 cases were
discarded and 6 cases classified as compatibles. NCC reviewed and endorsed the Annual Polio
Update on 10 May 2023 for submission to regional level.
● NP-AFP rate is 5.7/100,000 population under 15 years, Stool Adequacy is 85% and NPENT rate is
7% as of Epi-Week 19.

Poliovirus Outbreak Response (Polio Outbreak) Malawi Situation Report No 17

2.0 KEY UPDATES

Nationwide Integrated TCV/MR/bOPV campaign update:

● Campaign commenced on Monday 15-21 May 2023.
● Campaign launched in Balaka by the Hon. Minister of Health, represented by the Secretary for
Health, Dr. Samson Mndolo. Heads of Agencies of GPEI partners were in attendance, alongside other
partners. Link: https://nthandatimes.com/health/government-launches-2023-supplementary-
immunization-campaign/
● Ongoing daily EOC meetings for national and district level.
● 90 National supervisors, 540 district supervisors, 350 rapid convenient monitors (RCM) and 58
partners have been deployed for intra-campaign monitoring of the campaign.
● GPEI surge, resources and expertise deployed to support the campaign, including supervision and
monitoring using ODK checklists and Power BI dashboard.
● 542 (71%) health facilities were validated across all 29 districts of the country using ODK checklists
and dashboard. Key findings discussed at EOC and feedback provided to vaccination teams and
supervisors.

Nationwide bOPV campaign update

● Campaign rescheduled for 29 June – 2 July, 2023.
● Target Population: Under 15 years.
● Budget approved by ORPG.
● 8,928,000 doses of bOPV vaccines and 48,000 indelible markers received in-country.

Impact of Cyclone Freddy

● As of 6 May 2023, the number of IDP camps have reduced to approximately 160 camps across 9
districts, hosting at least 134,694 internally displaced persons (IDPs). A total of 53 schools are still
serving as IDP camps.
● IDP camps and affected communities are mapped and prioritized during the campaign, with dedicated
teams deployed to reach them.
● GPEI Surge Officers are supporting overall response activities in IDP camps and affected
communities.

Surveillance
● Active case search ongoing and intensified in all 29 districts as at EPI-week 19.
● NP-AFP rate is at 5.7/100,000 pop. under 15 years, Stool Adequacy is 85% and NPENT rate is 7%

Poliovirus Outbreak Response (Polio Outbreak) Malawi Situation Report No 17

 o 27/29 districts reporting at least one AFP case and 23/ 29 have met recommended NP-AFP
rate of 3/100,000 population under 15 years
o 16/29 Districts met target for both key indicators (NP-AFP Rate & Stool Adequacy)
● A total of 10 Environmental Surveillance (ES) sites are currently operational in 6 districts:
o Lilongwe (2), Dowa (1), Mzimba North (1), Blantyre (3), Karonga (1), Zomba (2)).
o 47/ 81 (58%) positive isolation rate from the ES samples with laboratory results
● Conducted National Polio Committee meetings (NPEC and NCC) from 9-10 May 2023
o NPEC meeting classified a total of 133 AFP cases for 2022 and 2023, with 127 cases
discarded and 6 classified as compatible cases
o NCC reviewed and endorsed the Annual Polio Update for submission to regional level.

3.0 NEXT STEPS

● Closely monitor implementation of MR/TCV/bOPV campaign.

● Commence daily national and district task force coordination meetings.
● Enhance active surveillance, particularly in IDP camps and poorly accessible communities.
● Plan for post campaign review for the integrated campaign and use lessons for upcoming bOPV
campaign.
4.0 CONTACTS
For more information about this situation report, please contact:
Organization Role Name Email address

Incident Manager Dr Storn Kabuluzi skabuluzi@yahoo.com

Deputy Incident Manager Dr Annie Mwale chaumaannie@gmail.com

MoH
Program and Technical Lead Dr Mike Chisema nchisema@gmail.com

GPEI Country GPEI Coordinator Dr Emeka Agbo emeka.agbo@outlook.com

Deputy GPEI Coordinator Ibrahim Hussein Ibrahimhussein2010@gmail.com

WHO Country Office Country Representative Dr Neema Kimambo kimambon@who.int

Polio OBR Lead Dr Boston Zimba bzimba@who.int

UNICEF Country Office Country Representative Gianofranco Rotigliano glotigliano@unicef.org

Polio OBR Lead Dr Sethy Ghanashyam gsethy@unicef.org

CDC Country Office Country Representative Dr Kelsey Mirkovic xdj1@cdc.gov

Country Polio OBR Focal Person Dr. Fikru Z. Abebe plu1@cdc.gov

Poliovirus Outbreak Response (Polio Outbreak) Malawi Situation Report No 17

5.0 ANNEXES

Fig 1. Polio cases in Malawi as of Epi-Week 19, 2023

Polio District Sou EPID Number Age Sex Date of Nos of Nt Closest
Virus rce Onset OPV Chang Match
type doses es
WPV1 Lilongwe AFP MAL-CEN-LIL-21- 36 months F 19 Nov 2021 1 dose 19nt
016

cVDPV1 Phalombe AFP (MAL-SOU-PHA-22- 78 months M 17 July, 2022 1 dose 44nt MOZ-ZAM-MLB-
004) 22-003

cVDPV1 Mulanje AFP MAL-SOU-MUL-22- 30 months M 15 August 1 dose 44nt MOZ-ZAM-MLB-

012 2022 22-003

cVDPV1 Phalombe AFP MAL-SOU-PHA-22- 61 months M 27 August Zero dose 44 nt MAL-SOU-PHA-

013 2022 22-004

cVDPV1 Blantyre AFP MAL-SOU-BLA-22- 14 Years F 1 Dec 2022 Unknown 50nt MOZ-ZAM-MLB-
030 22-003

cVDPV2 Lilongwe ENV ENV-MAL-CEN-LIL- NA NA 2 Jan 2023 NA 18nt ENV-BOT-FRA-

KMA-23-001 (Date of FRA-MAM-22-
sample 004 F6
collection)

Poliovirus Outbreak Response (Polio Outbreak) Malawi Situation Report No 17

 Fig 2. Proposed Timelines for Nationwide Polio SIAs in 2023

25 -28 15-21 29 June–2 July 3-6 September October November December

April 2023 May 2023 2023 August 2023 2023 2023 2023 2023

SNID NID NID NID NID NID

OCV Integrated bOPV bOPV nOPV2 nOPV2
TCV/MR/bOPV

Figure 3. Integrated TCV/MR/bOPV Health Facility Validation Dashboard

Link to Integrated TCV/MR/bOPV Dashboard:

https://app.powerbi.com/view?r=eyJrIjoiYTA3OWY5NTUtOTAyNi00NDEzLWJhNTktMjAyZmFiM2RlZTFiIiwidCI6ImY2MTBjMGI3LWJkMjQt
NGIzOS04MTBiLTNkYzI4MGFmYjU5MCIsImMiOjh9

Poliovirus Outbreak Response (Polio Outbreak) Malawi Situation Report No 17

Fig 4. AFP Surveillance Indicators as of Epi-Week 19

• 23 out of 29 Districts have an NP-AFP rate higher than 3.0 as of Epi-Week 18 (2023)
• 2 Districts have not detected any case as of Epi-Week 18
• 20 Districts have Stool Adequacy of more than 80% as of Epi-Week 18 (2023)
• Only 16 Districts have met both key indicators (NP-AFP Rate & Stool Adequacy)

Poliovirus Outbreak Response (Polio Outbreak) Malawi Situation Report No 17

Fig 5. Active case search as of 8 May 2023

Fig 6. Environmental Surveillance Indicators as of Week 19, 2023

Poliovirus Outbreak Response (Polio Outbreak) Malawi Situation Report No 17

Fig 7. Status of Implementation of OBRA Recommendations

• A total of 27 recommendations were made across 4 pillars, of which 9 (33%) have been fully completed; 15 (56%) partially
completed; and 3 (11%) not yet implemented.
• The partially implemented are activities that will continue till the end of the year while all the 3 recommendations not yet implemented
are related to SIAs and not due for implementation.

Poliovirus Outbreak Response (Polio Outbreak) Malawi Situation Report No 17