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Polio

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Virology, Poliomyelitis

Virology, Poliomyelitis

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  • 1. Highlights of the Global Polio Eradication Initiative Strategic Plan 2009-2013 Virology Discipline Meeting - 24 February 2009 Dr Preneshni R Naicker
  • 2. 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
  • 3. Objective 1: Interrupt wild poliovirus transmission
  • 4. Areas with Active Polio Transmission 1988 > 125 endemic countries 2006* 4 endemic countries 8 reinfected countries
  • 5. 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
  • 6. 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)
  • 7. 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
  • 8.  
  • 9. Objective 2: Ensure sustainable surveillance for polioviruses
  • 10. 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)
  • 11. 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
  • 12. 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
  • 13. Objective 3: Achieve certification & containment of wild polioviruses
  • 14.
    • 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
  • 15.
    • 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
  • 16. 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
  • 17.
    • 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.
  • 18. 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
  • 19. Objective 4: Prepare for VAPP & VDPV elimination & the post-OPV era
  • 20. 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
  • 21. 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.
  • 22. 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.
  • 23. Objective 5: Plan for Re-structuring of the Global Polio Eradication Initiative for the VAPP/VDPV Elimination Phase
  • 24. 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
  • 25.
    • 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%
    • **************************************************