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Polio End Game Strategy
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Polio EradicationFrom Emergency to “Endgame”
Dr. Anil KumarDistrict Immunization & Child Health
OfficerDoPHFW, KURNOOL
In 2012, the world saw the fewest polio cases in the fewest countries ever. India, long regarded as the most difficult place to end polio, has not recorded a case in more than two years.
The 'polio emergency' 2012-13
The ”Year of Intensification of RI”2013-14
The 'polio endgame' 2014-18
EPRP
Emergency Preparedness andResponse Plan
EPRP Goals
Ensure preparedness &Rapidly respond to any WPV outbreak
To support the transformational change
Serve as a critical precursor for the End game
Focus on Chronically missed children
Intensification of RI 2013 - 14
Special Immunization Weeks – 4 Rounds
Special Immunization Weeks – 2 Roundsin HRAs
Focus on High priority Districts
1• Augmented Supervision
2• Accelerated Monitoring
3• Enhanced Financial Support
4• Focus on Quality
What is the polio 'endgame'?
The endgame: addressing risks due to the oral polio vaccine (OPV) after eradication
● Vaccine-Associated Paralytic Poliomyelitis (VAPP): very rare adverse event.
● Outbreaks of circulating vaccine-derived poliovirus (cVDPV): very rare event;
occurs when vaccine virus regains ability to paralyze
and circulate.
'After interruption of wild poliovirus, continued use of OPV would compromise the goal of a polio-free world.
Expert Consultation on Vaccine-derivedPolioviruses (VDPVs), Sept 2003, Geneva
Detect and Interrupt Polio Virus
Strengthen systemWithdraw OPV
Contain & Certify
Plan Polios’ legacy
The plan provides a strategy to interrupt all wild poliovirus transmission by the end of 2014To eliminate the risk of vaccine-derived poliovirus (VDPV), oral polio vaccines (OPV) will be phased out & inactivated polio vaccines (IPV) will be gradually introduced. Strong immunization systems will help rapidly and successfully introduce new polio vaccines.
All regions must pass three years without a case to attain polio-free status, to be followed by global certification.
The polio program provides a blueprint for accessing the most marginalized and hard-to-reach communities in the world. Sharing this expertise can benefit other health and development initiatives
The Strategic Plan has four objectives.
2013 2014 2015 2016 2017 2018
OPV2Withdrawal
Certify Eradication
Interrupt Wild Polio transmission
Respond to continuing vaccine derived polio outbreaks
Strengthen Immunization
system, Prepare vaccine switch
Introduce IPV
Withdraw OPV2
Continue immunization with IPV and
OPV
Finalize containment plans
Carry out eradication certification
Identify legacy opportunitiesMainstream knowledge,
infrastructure to benefit other programs
1. Detect and Interrupt Polio Virus
2. Strengthen Immunization systems & Withdraw OPV
3. Contain and Certify
4. Plan Polio Legacy
Eradication and Endgame Timeline
2019 –bOPV cessation
Advantages of the New Approach
• accelerate type 1 & 3 eradication (with bOPV)
• address >90% of VDPV risk while surveillance &
response capacity is optimized
• substantially shorten the post-eradication phase
• boost routine immunization coverage (i.e. IPV at DPT3)
Strategic Advisory Group of Experts on immunization
Polio Endgame Strategy in IndiaConsiderations and Way Forward
● No WPV2 in India since 1999
● tOPV used in RI and during NIDs
● bOPV used in most SNIDs since Jan 2010
● Areas and populations with low routine immunization coverage
● All cVDPVs in India due to type 2 in setting of low immunity to type 2
Last wild poliovirus cases by type, India
WPV2 24/10/1999Aligarh (UP)
WPV1 13/01/2011
Howrah (WB)
WPV3 22/10/2010Pakur (JH)
Current pattern of vaccine use-India
A
• tOPV– EPI schedule: 6,10,14 wks
Birth dose for institutional births
– SIAs: 2 NIDs with tOPV each year
• bOPV
– Introduced in Jan 2010
– Used extensively during SNIDs in high risk states/ areas
70.4%
<60
60 - 7070 - 80>= 80
AssessedtOPV3 coverageby CES 2009
cVDPV cases, India 2009-2011
•cVDPV cases detected in 2009-10
•100% due to type 2
DistrictType 2
2009 2010 2011
Badaun 3 0 0
Bulandshahar 2 0 0
Ghaziabad 0 1 0
Meerut 2 0 0
Moradabad 2 0 0
Pilibhit 4 0 0
Shahjahanpur 2 1 0
Total 15 2 0
iVDPV & aVDPV cases, India 2009 to 2012*
State Type 1 Type 2
Assam 1
Bihar 3
Karnataka 1
Madhya Pradesh 1
Rajasthan 1
Uttar Pradesh 4
West Bengal 1
Total 1 11
*: data as on 10 March 2012
State Type 1 Type 2 Type 3
Chhattisgarh 1
Punjab 1
Tamil Nadu 1
Uttar Pradesh 1
Odisha 1
Total 1 3 1
ambiguous VDPV (aVDPV): origin uncertain e.g. single isolate from single AFP case, non-immunodeficient person
tOPV-bOPV switch in India?Considerations
● Pre-switch increase in type 2 immunity
● Rapidly improve routine immunization coverage
● Use of IPV in conjunction with bOPV/tOPV to reduce risk of emergence and consequences of cVDPV
● Availability of vaccines
– IPV availability for use in routine immunization
– bOPV availability for routine immunization and SIAs
● Management of post-switch risks of type 2 VDPVs
● cVDPV type 2 circulation stopped everywhere & switch synchronised globally
NID NID
0Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May
Polio Endgame Strategy-India, Possible Way Forward
2011 2012 2013 2014
Last WPV case
Polio certification
IPV NID NID
tOPV NID
Post-switch Sabin type 2 risk mgt.
tOPV-bOPV switch
NID NID NID NID
Certification standard surveillance, improved RI coverage
PQ/ licensing, stockpile
Modelling, Research, Development
The 'Polio Endgame‘_ Conclusions
While the past cannot be re-enacted, the future can certainly be redesignedSequential IPV/OPV schedules considered 1st phase transition towards all IPV schedule in
Routine Immunization.The program should attend
TO COUNTRY SPECIFIC NEEDSAnd Not get overawed by Global needs
Ultimately success of the whole initiative will depend on steps being taken now to improve the economics of IPV.
V Vashishtha RTC Series 2010(24) RSF India
HOPE THIS IS
THE HISTORICAL
LAST POLIO CASE
OF INDIA
LET US THANK ALL THE DEDICATED VOLUNTEERS, WITHOUT THEM POLIO ERADICATION IN INDIA IS NOT POSSIBLE
• Each national immunization day involved:
• 225,000,000 doses of polio vaccine• 172,000,000 children vaccinated
• 2,500,000 vaccinators• 2,000,000 vaccine carriers
• 155,000 supervisors
Polio Eradication and Endgame Strategic Plan
2013–2018 will pay dividends for generations to come.