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Virology, Poliomyelitis

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    Polio Polio Presentation Transcript

    • Highlights of the Global Polio Eradication Initiative Strategic Plan 2009-2013 Virology Discipline Meeting - 24 February 2009 Dr Preneshni R Naicker
    • Goal of the Global Polio Eradication Initiative: To ensure that no child will ever again be paralysed by either a wild or vaccine-derived poliovirus
    • Objective 1: Interrupt wild poliovirus transmission
    • Areas with Active Polio Transmission 1988 > 125 endemic countries 2006* 4 endemic countries 8 reinfected countries
    • Situation analysis
      • Indigenous poliovirus eradicated from all but 4 countries worldwide
      • India, Nigeria, Pakistan, Afghanistan, indigenous type 1 and 3 wild poliovirus transmission is continuing
      • Type 2 wild poliovirus has been eradicated globally since 1999
    • Key challenges
      • 1) Sub-optimal OPV delivery
      • 2) Sub-optimal OPV efficacy
      • 3) Prolonged outbreaks (persistent transmission for >12 months) due to suboptimal outbreak response
      • 4) Continued international spread of poliovirus from areas of indigenous (eg Nigeria, India) and imported poliovirus transmission (eg Angola, Chad, parts of the Horn of Africa)
    • Strategic approach
      • In all polio-infected areas:
      • Implement an aggressive SIA strategy
      • prioritize eradication of type 1 poliovirus (higher paralytic attack rate and propensity for geographic spread)
      • Optimize the OPV campaign
      • In areas of prolonged outbreaks
      • International outbreak response guidelines
      • To address international spread
      • Maintain/increase routine immunization
      • Ensure immediate notification of newly-infected areas
    •  
    • Objective 2: Ensure sustainable surveillance for polioviruses
    • Situation analysis
      • Surveillance for acute flaccid paralysis (AFP) cases:
      • In endemic regions
      • 59 of 66 countries are achieving certification standard surveillance
      • In polio-free regions
      • 16 of 80 countries are achieving certification standard surveillance
      • Global Polio Laboratory Network (GPLN):
      • 141 of 145 laboratories are fully accredited by WHO
      • In 2008, new Real-time PCR assays to improve screening for vaccine-derived polioviruses (VDPVs) were evaluated
      • Environmental surveillance :
      • Systematic environmental sampling (in Egypt and Mumbai, India)
      • Environmental surveillance elsewhere (especially in polio-free regions as part of broader enterovirus surveillance systems)
    • Key challenges
      • Persistence of surveillance gaps
      • Revitalizing AFP surveillance to achieve certification-standard in polio free areas
      • Enhancing the speed of detection of wild polioviruses and VDPVs globally
      • Coordinating a system for environmental surveillance efforts globally
    • Achieve certification-standard surveillance, down to subnational level Achieve certification-standard surveillance globally, at national level Initiate global environmental surveillance strategy Introduce new laboratory procedures globally Achieve enhanced surveillance standards (AFP rate >2) at the subnational level in all high risk, re-infected and endemic areas Through end-2013, achieve certification-standard surveillance, down to subnational level End-2013 End-2012 End-2011 End-2010 End-2009 5-year target
    • Objective 3: Achieve certification & containment of wild polioviruses
      • Certification-standard surveillance
      • A minimum AFP detection rate of 1 case per 100,000 children <15 yrs
      • At least 80% of AFP cases have adequate stool collection
      • Stool adequacy  2 x 5-10g stool specimens taken 24-48 hrs apart within 14 days of onset of paralysis
      • Certification of Global Polio eradication
      • Before a WHO region can be certified polio-free:
      •  at least 3 years of no wild polio virus cases
      •  under conditions of certification-standard surveillance
      •  demonstrate capacity to detect, report & respond to ‘imported’ polio cases
    • Situation analysis
      • Three Regions are certified polio-free (AMR, EUR, WPR).
      • Regional Certification Commissions (RCCs) are functioning in all three remaining endemic Regions, with National Certification Committees
      • A framework for long-term containment of all polioviruses has been established
      • Containment of wild polio virus stocks
      • Purpose: To minimize the risk of an accidental or intentional reintroduction of wild poliovirus into the community from a laboratory or vaccine production site post-eradication
      • Aim: to locate laboratories worldwide that store wild poliovirus and potentially infectious materials, and ensure that those materials are handled under appropriate biosafety conditions.
    • Key challenges
      • Establishing international consensus on long-term containment requirements for all polioviruses
      • Strategic approach
      • Establish an area-specific process for certifying eradication in each conflict-affected area
      • Finalize and implement the long-term containment activities
    • Objective 4: Prepare for VAPP & VDPV elimination & the post-OPV era
    • Situation analysis
      • The VAPP burden is 250-500 cases/yr
      • Since 2000, at least 10 cVDPV outbreaks in 10 countries
      • Of 33 recorded individuals with iVDPVs, 5 have excreted for >5 years (chronic excretors)
      • ?date for the eventual cessation of the use of OPV in routine immunization programmes
    • Key challenges
      • Fully characterising VDPV risks in low- and middle-income settings
      • Coordinating OPV cessation internationally as soon as possible after certification of wild poliovirus eradication.
      • Developing affordable options for IPV use in low- and middle-income countries
      • Establishing a process for verification of VAPP/VDPV elimination.
    • Strategic approach
      • Expand new laboratory diagnostic procedures to enhance sensitivity to detect VDPVs
      • Implement studies to better quantify and characterize iVDPV risks/implications
      • Develop antiviral drugs to treat chronic iVDPVs
      • Establish affordable IPV options
      • Establish WHA Resolutions on the eventual coordination of OPV cessation, long-term containment of all polioviruses and use of mOPV in response to cVDPVs following OPV cessation (including use of international stockpile of mOPV)
      • Update risk assessment on potential for intentional use of polioviruses in the post-eradication era.
    • Objective 5: Plan for Re-structuring of the Global Polio Eradication Initiative for the VAPP/VDPV Elimination Phase
    • Polio status in South Africa
      • Last lab confirmed case was in 1989
      • AFP is notifiable since 1994
      • Case-based surveillance since 1995
      • 4 strategies
      • High routine coverage with OPV
      • Mass immunisation campaigns
      • ‘ Mopping-up’ campaigns
      • AFP surveillance
      • National immunisation campaigns 1995, 1996, 1997, 2000 (2002 = WC), 2004, 2007
      • SA: national certificate in Oct 2006
      • Target for 2008: AFP detection rate of at least 2/100,000
      • SA 2008: AFP 2/100,000, stool adeq 82%
      • WC 2008: AFP 2,3/100, 000
      • Stool adequacy 96%
      • **************************************************