Status: affected by circulating vaccine-derived poliovirus

Somalia is affected by circulation of both vaccine-derived poliovirus type 2 (cVDPV2) and vaccine-derived poliovirus type 3 (cVDPV3).

Circulation of vaccine-derived poliovirus type 2 (cVDPV2) has been confirmed in the Horn of Africa, with the same strain confirmed in Kenya and Somalia. No cases of acute flaccid paralysis (AFP) associated with this cVDPV2 have been detected at this time – the viruses were all isolated from environmental samples. Surveillance for AFP cases in the area is being strengthened.

In Somalia, three VDPV2s were isolated from environmental samples collected 4 and 11 January 2018, from Hamarweyn district in Banadir province (Mogadishu). These isolates are genetically linked to previously isolated VDPV2s from 2017, collected on 22 October and 2 November 2017 from environmental samples collected from Waberi district, Banadir province.

In Kenya, one cVDPV2 was isolated from an environmental sample collected on 21 March 2018 from Nairobi, linked to the cVDPV2 previously confirmed in Somalia.

Since detection of the initial isolates in 2017, outbreak response campaigns in line with internationally-agreed guidelines have been implemented, consisting of three large-scale immunization activities (SIAs) in Banadir, Lower Shabelle and Middle Shabelle provinces in Somalia, with further campaigns planned for April and May.

With detection of the virus in Nairobi, indicating a regional event, the possibility of a region-wide response is now being evaluated.  The exact scale and extent of the response is being finalized. WHO and its partners are continuing to support local public health authorities in conducting field investigations and risk assessments to more clearly assess any potential risk of circulation of the identified cVDPV2, and to continue to support the outbreak response and strengthening of disease surveillance.

Health personnel at all levels are undertaking efforts to strengthen surveillance for acute flaccid paralysis (AFP) cases, including by conducting active case searches. The frequency of sampling from the environment is being increased.

Somalia and Kenya conducted their last immunization campaigns with trivalent OPV in early 2016, in advance of the trivalent to bivalent OPV switch in April 2016. Searches for residual trivalent OPV stocks are ongoing including public, private and NGOs. No tOPV stocks have been found.

Circulating VDPV3

In Somalia, a circulating vaccine-derived poliovirus type 3 (cVDPV3) has been confirmed, following isolation of this virus from four environmental samples collected between 8-22 March, from two environmental sites in Waberi district, Banadir province (Mogadishu). Virus has been isolated from environmental samples only; no associated cases of acute flaccid paralysis have been detected. Outbreak response is ongoing following international response guidelines.

Polio this week in Horn of Africa

  • No circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported in the past week.
  • The Horn of Africa is currently affected by separate outbreaks of circulating vaccine-derived poliovirus type 2 (cVDPV2) and type 3 (cVDPV3), reporting both cases and environmental positives.
  • Somalia has reported a total of 12 cVDPV cases (five type 2, six type 3 and one, coinfection of both type 2 and type 3) in 2018.
  • The most recent cVDPV2 virus was isolated from an environmental sample collected on 11 October 2018 from Waberi district in Banadir province.  The most recent cVDPV3 virus was isolated from an environmental sample also from Waberi district, Banadir province collected on 23 August 2018.
  • Circulating VDPV2 has also been detected during 2018 in one environmental sample in Kenya collected on 21 March 2018.
  • Outbreak response to both virus types is currently being implemented in line with internationally-agreed guidelines. Large-scale supplementary immunization activities (SIAs) have been implemented in Banadir, Lower Shabelle and Middle Shabelle regions, Somalia. Another vaccination round is planned during end-November as part of the ongoing outbreak response, to further enhance the population immunity in the highest risk areas.   Special surveillance activities continue to be undertaken to determine the origin of the viral circulation.
  • WHO and partners continue to support local public health authorities across the Horn of Africa in conducting field investigations and risk assessments.
  • Read our Somalia country page and Kenya country page to see information on surveillance and vaccination campaigns.
  • Learn more about vaccine-derived polioviruses through this short animation or this ‘Coffee with Polio Experts’ video.

International Health Regulations

Somalia is classified by the International Health Regulations (IHR) as a state infected with cVDPV2 and cVDPV3, with potential risk of international spread. It is therefore subject to temporary recommendations as of November 2018.

Travel advice

WHO’s International Travel and Health recommends that all travellers to polio-affected areas be fully vaccinated against polio. Residents (and visitors for more than 4 weeks) from infected areas should receive an additional dose of OPV or inactivated polio vaccine (IPV) within 4 weeks to 12 months of travel.

More on this outbreak of cVDPV in Somalia

More on vaccine-derived polioviruses