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Risk factors for transmission of WPV (population density, diarrhea, low routine OPV3 coverage)
• High force of infection
• Sub-optimal vaccine efficacy due to these factors
Source : N Grasley et al , Imperial College , London
Due to various factors, western UP and north central Bihar are at highest risk for Polio transmission.
Therefore,
Are most challenging for Polio Eradication
Virologic evidence: elimination of all but 1 genetic lineage of type 1 poliovirus
20072006
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*as of 22nd Jun, 2009
In past 3 years, 8 of 9 P1 sub types have been eradicated.
Only one sub type is in circulation now.
State P1 P3 Total
Uttar Pradesh** 34 560 593
Bihar 38 79 117
Delhi 3 1 4
Punjab 2 2 4
Uttarakhand 0 4 4
Jharkhand 2 0 2
Rajasthan 1 2 3
Haryana 0 4 4
Himachal Pradesh 0 1 1
Total 80 653 732
Location of poliovirus by type, 2009*
Most recent virus31 December 09
Bareilly, UP
** One case reported mixture of P1 wild & P3 wild
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Gaya
Patna
Jamui
Rohtas
Purnia
KaimurBanka
Araria
Saran
Katihar
Siwan
Supaul
Madhubani
Nawada
Champaran West
BhojpurBuxar
Nalanda
Muzaffarpur
Bhagalpur
Aurangaabad
Sitamarhi
Vaishali
Darbhanga
Champaran East
Samastipur
Gopalganj
Saharsa
Begusarai
Munger
Khagaria
Madhepura
Kishanganj
ArwalLakhisaraiJehanabad
Sheikhpura
Sheohar
###
Gaya
Patna
Jamui
Rohtas
Purnia
KaimurBanka
Araria
Saran
Katihar
Siwan
Supaul
Madhubani
Nawada
Champaran West
BhojpurBuxar
Nalanda
Muzaffarpur
Bhagalpur
Aurangaabad
Sitamarhi
Vaishali
Darbhanga
Champaran East
Samastipur
Gopalganj
Saharsa
Begusarai
Munger
Khagaria
Madhepura
Kishanganj
ArwalLakhisaraiJehanabad
Sheikhpura
Sheohar
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Patna
Jamui
Rohtas
Purnia
KaimurBanka
Araria
Saran
Katihar
Siwan
Supaul
Madhubani
Nawada
Champaran West
BhojpurBuxar
Nalanda
Muzaffarpur
Bhagalpur
Aurangaabad
Sitamarhi
Vaishali
Darbhanga
Champaran East
Samastipur
Gopalganj
Saharsa
Begusarai
Munger
Khagaria
Madhepura
Kishanganj
ArwalLakhisaraiJehanabad
Sheikhpura
Sheohar
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Gaya
Patna
Jamui
Rohtas
Purnia
KaimurBanka
Araria
Saran
Katihar
Siwan
Supaul
Madhubani
Nawada
Champaran West
BhojpurBuxar
Nalanda
Muzaffarpur
Bhagalpur
Aurangaabad
Sitamarhi
Vaishali
Darbhanga
Champaran East
Samastipur
Gopalganj
Saharsa
Begusarai
Munger
Khagaria
Madhepura
Kishanganj
ArwalLakhisaraiJehanabad
Sheikhpura
Sheohar
WPV Type-1 & Type-3 : 2007 - 10
2007 2008
2009 2010
463
380
459
230
79
3
2007 2008 2009* 2010*
P1 P3
Gaya
Patna
Jamui
Rohtas
Purnia
KaimurBanka
Araria
Saran
Katihar
Siwan
Supaul
Madhubani
Nawada
Champaran West
BhojpurBuxar
Nalanda
Muzaffarpur
Bhagalpur
Aurangaabad
Sitamarhi
Vaishali
Darbhanga
Champaran East
Samastipur
Gopalganj
Saharsa
Begusarai
Munger
Khagaria
Madhepura
Kishanganj
ArwalLakhisaraiJehanabad
Sheikhpura
Sheohar
Gaya
Patna
Jamui
Rohtas
Purnia
KaimurBanka
Araria
Saran
Katihar
Siwan
Supaul
Madhubani
Nawada
Champaran West
BhojpurBuxar
Nalanda
Muzaffarpur
Bhagalpur
Aurangaabad
Sitamarhi
Vaishali
Darbhanga
Champaran East
Samastipur
Gopalganj
Saharsa
Begusarai
Munger
Khagaria
Madhepura
Kishanganj
ArwalLakhisaraiJehanabad
Sheikhpura
Sheohar
Prioritization in Bihar(Done in 2007)
Focus Districts
High Priority
Persistent Transmission Blocks
High Risk Blocks
Additional High Risk Blocks
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Patna
Jamui
Rohtas
Purnia
KaimurBanka
Araria
Saran
Katihar
Siwan
Supaul
Madhubani
Nawada
Champaran West
BhojpurBuxar
Nalanda
Muzaffarpur
Bhagalpur
Aurangaabad
Sitamarhi
Vaishali
Darbhanga
Champaran East
Samastipur
Gopalganj
Saharsa
Begusarai
Munger
Khagaria
Madhepura
Kishanganj
ArwalLakhisaraiJehanabad
Sheikhpura
Sheohar
Prioritization in Bihar
WPV P1 - 2009
13 of 38 P1 cases in PT Blocks7 of 13 in inside embankment30 of 38 P1 cases in pre identified HR Blocks
Persistent Transmission Blocks
High Risk Blocks
Additional High Risk Blocks
2
0 0
3
2
6
4
6
10
5
0 0
JAN
_09
FE
B_0
9
MA
R_0
9
AP
R_0
9
MA
Y_0
9
JUN
_09
JUL
_09
AU
G_0
9
SE
P_0
9
OC
T_0
9
NO
V_0
9
DE
C_0
9
P1 mostly limited to pre-identified HR Blocks of 6 Districts.
Sharp decline in number of P1 in last quarter with NO P1 from more than 2 months
Persistence of Type 1 polio in Bihar – 2007-09
Kosi River flood plain, Bihar, India
Type 1 Polio – 2008
Type 1 Polio – 2007
Type 1 Polio – 2009
KOSI: Persistence & Spread of P1
Responsible for persistence of virus over the yearsAnd is
Focus of intervention along with other HR Blocks
• Most difficult access compromised areas.
• Often flooded.• Poor Infrastructure.• Change in topography.• Very high concentration of
under served population.• R.I. – Very low in this region.
KOSI riverine areas
Compromised access around the kosi river poses unique challenges for programme planning, implementation &
monitoring
Access Compromised
Areas• ACA : 16 % of Bihar• Major continuous area -
In and around Kosi river and its tributaries
• Inaccessible area: 25 - 50 km wide by 125 km long= 3000 sq. km
• covers parts of 10 districts
• Flooded for more than 6 months in a year
• movement is only by motorbike/boat / horse
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Rohtas
Purnia
KaimurBanka
Araria
Saran
Katihar
Siwan
Supaul
Madhubani
Nawada
Champaran West
BhojpurBuxar
Nalanda
Muzaffarpur
Bhagalpur
Aurangaabad
Sitamarhi
Vaishali
Darbhanga
Champaran East
Samastipur
Gopalganj
Saharsa
Begusarai
Munger
Khagaria
Madhepura
Kishanganj
ArwalLakhisaraiJehanabad
Sheikhpura
Sheohar
WPV P3: Status
2007 2008
Complete Round
2009Mix Round
(mOPV3)Mix Round
(tOPV & mOPV1) (mOPV3 & mOPV1)
88 Blk Partial
433 Blk
mOPV1 -88 mOPV3- 345
433 Blk 433 Blk 561 Blk
mOPV1 – 58 mOPV3- 503
Partial Round Mix Round
(bOPV, tOPV & mOPV1)
Total : 459 Total : 230(District : 33) (District : 30)
Total : 79(District : 11)
Total : 3(District : 1)
•P3 cases have declined sharply from 233 in 2008 to 79 in 2009.
•Remaining focus is limited to area with lesser P3 antigen.
•bOPV in NIDs in same areas to tackle the problem
Summary• Number of families of P1 reduced to 1 in 2009 from 9 in 2006.
• Total WPV cases in Bihar in 2009 is down to 117 from 233 in 2008 and 503 in 2007.
• Although there was resurgence in P1 cases in 2009, but it was:– Limited geographically to small area. – Most of cases in pre-identified HR Blocks specially around KOSI.
• There is sharp decline in P1 cases and no P1 since October’09.
• P3 cases have reduced to 77 in 2009 from 230 in 2008.– Most of cases limited to the areas with lesser P3 antigen opportunity.
• bOPV in NIDs in Bihar in these areas:– Will hit hard on P3 transmission.– Without taking off pressure from P1.
Operations…• KOSI:
– Satellite offices in inside KOSI embankment– Increased presence of Medical Officers, UNICEF and WHO.– State monitors being sent to KOSI area in every round– Rotary support– Intensified monitoring: Each team– CMCs in KOSI
• HR Blocks:– Intensified operations.– MOs deployed from Non HR blocks to HR blocks– District Health Officials deployed for direct oversight.
• Strong oversight by highest levels of government.
Satellite Office
Stay Point
20
37
Stay Facilities inside KOSI
0
10
20
30
40
50
60
Satellite Office Stay Facility
2008 June'09 Oct'09
Gaya
Patna
Jamui
Rohtas
Purnia
KaimurBanka
Araria
Saran
Katihar
Siwan
Supaul
Madhubani
Nawada
Champaran West
BhojpurBuxar
Nalanda
Muzaffarpur
Bhagalpur
Aurangaabad
Sitamarhi
Vaishali
Darbhanga
Champaran East
Samastipur
Gopalganj
Saharsa
Begusarai
Munger
Khagaria
Madhepura
Kishanganj
ArwalLakhisaraiJehanabad
Sheikhpura
Sheohar
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Munger
Khagaria
Madhepura
Kishanganj
ArwalLakhisaraiJehanabad
Sheikhpura
Sheohar
Feb-09 Mar-09 5Apr-09 3May-09
24May-09 Jun-09 Aug-09 Sep-09
Oct-09 Nov-09 Dec-09
OPV type wise SIA Round in Bihar : 2009
mOPV1 tOPV mOPV3 P1 P3 VDPV
Jan-10
bOPV
#
##
# # #
Gaya
Patna
Jamui
Rohtas
Purnia
KaimurBanka
Araria
Saran
Katihar
Siwan
Supaul
Madhubani
Nawada
Champaran West
BhojpurBuxar
Nalanda
Muzaffarpur
Bhagalpur
Aurangaabad
Sitamarhi
Vaishali
Darbhanga
Champaran East
Samastipur
Gopalganj
Saharsa
Begusarai
Munger
Khagaria
Madhepura
Kishanganj
ArwalLakhisaraiJehanabad
Sheikhpura
Sheohar
<Empty Picture>
•bOPV in High risk zones of Bihar in NIDs
•To break the transmission of P3 without releasing pressure from P1
More and more BASAs being covered
•Coverage of BASA increased with BASA Strategy.
•>1,70,000 BASAs being covered in KOSI riverine areas
0
50000
100000
150000
200000
250000
SIA Rounds
No
. o
f H
ut
Clu
ste
rs
Newborns being registered & tracked for 8 doses!!
0
500000
1000000
1500000
2000000
2500000
3000000
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
No. o
f New
Bor
n
2006 2007 2008 2009
Bihar
Nomadic Population coverage
20
11
17
69
41
9
16
0821
94
21
34
50
0
18
80
24
24
27
05
23
76
15
94
42
42
29
46
30
65
27
91
17
30
44
66
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
Mar_09 Apr_09 May_09 24May_09 Jun_09 Aug_09 Sep_09 Oct_09 Nov_09
SIA Round
Total Number of Families Total Number of Children Vaccinated
Mosque Announcement
35%
40% 40.32%41.65%
44.45%
40.00%
42%
20%
25%
30%
35%
40%
45%
50%
Jun
.08
Sep
.08
No
v.08
Dec
.08
Feb
.09
Mar
.09
Ap
r.09
1.2 Communication efforts: Underserved strategy
Mothers being convinced regarding Polio in Madhepura Imam Meeting: Madhubani
Madarsa Involvement: Supaul
Operations…
• All newborns being identified and tracked.
• BASAs: Survey before every round to cover all BASAs.
• Transit teams: children in movement
• Migratory families of Nomads, Brick Kilns and construction workers being covered.
• Repeated efforts to convert X houses.
Efforts…
• Routine Immunization:– From 11% in 2002 to 56%.– Statewide microplan revision to include all areas.– Focused monitoring of RI including HtH monitoring.
• Convergence:– Intensification of MC Health, nutrition, water and
sanitation efforts in KOSI area.
Summary…
• P1 circulation in 2009 was in limited geographical area mostly HR blocks and has
declined sharply. The intensified efforts in KOSI and HR Blocks along with bOPV/ mOPV1 rounds planned in 2010 present unique opportunity to finish the transmission.
• P3 in Bihar has declined sharply and use of bOPV in NIDs in concerned area has presented
the opportunity to stop transmission without releasing the pressure from P1