Polio Eradication

From Emergency to “Endgame”
Dr. Anil Kumar
District Immunization & Child Health
Officer
DoPHFW, KURNOOL
 In 2012, the world saw the
fewest polio cases in the fewest
countries ever.
 India, long regarded as the
most difficult...
The 'polio emergency' 2012-13
The ”Year of Intensification of RI”2013-14
The 'polio endgame' 2014-18
EPRP
Emergency Preparedness and
Response Plan
EPRP Goals
Ensure preparedness &Rapidly respond to
any WPV outbreak
To support the transformational change

Serve as a cri...
Intensification of RI 2013 - 14

Focus on Chronically missed children
Special Immunization Weeks – 4 Rounds
Special Im...
Focus on High priority Districts
1

• Augmented Supervision

2

• Accelerated Monitoring

3

• Enhanced Financial Support
...
What is the polio 'endgame'?
The endgame: addressing risks due to the oral polio vaccine
(OPV) after eradication

●

Vacci...
The Strategic Plan has four objectives.
Detect and Interrupt
Polio Virus

Strengthen system
Withdraw OPV

Contain & Certif...
2013

2014

2015

2016

2017

Eradication and Endgame Timeline

1. Detect and Interrupt Polio Virus

Interrupt Wild Polio
...
Advantages of the New Approach
•

accelerate type 1 & 3 eradication (with bOPV)

•

address >90% of VDPV risk while survei...
Strategic Advisory Group of Experts on immunization
Polio Endgame Strategy in India
Considerations and Way Forward
●

No WPV2 in India since 1999

●

tOPV used in RI and duri...
Last wild poliovirus cases by type, India
WPV2
24/10/1999
Aligarh (UP)

WPV3
22/10/2010
Pakur (JH)

WPV1
13/01/2011
Howrah...
Current pattern of vaccine use-India
• tOPV
– EPI schedule: 6,10,14 wks
Birth dose for institutional births
– SIAs: 2 NIDs...
cVDPV cases, India 2009-2011
•cVDPV cases detected in 2009-10
•100% due to type 2

Type 2
District
2009

2010

2011

Badau...
iVDPV & aVDPV cases, India 2009 to 2012*

State
Chhattisgarh
Punjab
Tamil Nadu
Uttar Pradesh
Odisha

Type 1

Type 2

Type ...
tOPV-bOPV switch in India?
Considerations
●
●
●
●

●
●

Pre-switch increase in type 2 immunity
Rapidly improve routine imm...
Polio Endgame Strategy-India,
Possible Way Forward

tOPVbOPV
switch

Polio
certification

Last WPV
case
NID

NID NID

NID
...
The 'Polio Endgame‘_ Conclusions
While the past cannot be re-enacted,
the future can certainly be redesigned
Sequential ...
LET US THANK ALL THE DEDICATED VOLUNTEERS, WITHOUT THEM POLIO
ERADICATION IN INDIA IS NOT POSSIBLE

HOPE THIS IS
THE HISTO...
Polio End Game Strategy _ India
Polio End Game Strategy _ India
Polio End Game Strategy _ India
Polio End Game Strategy _ India
Polio End Game Strategy _ India
Polio End Game Strategy _ India
Polio End Game Strategy _ India
Polio End Game Strategy _ India
Polio End Game Strategy _ India
Polio End Game Strategy _ India
Polio End Game Strategy _ India
Polio End Game Strategy _ India
Polio End Game Strategy _ India
Polio End Game Strategy _ India
Polio End Game Strategy _ India
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Polio End Game Strategy _ India

  1. 1. Polio Eradication From Emergency to “Endgame” Dr. Anil Kumar District Immunization & Child Health Officer DoPHFW, KURNOOL
  2. 2.  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.
  3. 3. The 'polio emergency' 2012-13 The ”Year of Intensification of RI”2013-14 The 'polio endgame' 2014-18
  4. 4. EPRP Emergency Preparedness and Response Plan
  5. 5. EPRP Goals Ensure preparedness &Rapidly respond to any WPV outbreak To support the transformational change Serve as a critical precursor for the End game
  6. 6. Intensification of RI 2013 - 14 Focus on Chronically missed children Special Immunization Weeks – 4 Rounds Special Immunization Weeks – 2 Rounds in HRAs
  7. 7. Focus on High priority Districts 1 • Augmented Supervision 2 • Accelerated Monitoring 3 • Enhanced Financial Support 4 • Focus on Quality
  8. 8. 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. very rare event; occurs when vaccine virus regains ability to paralyze and circulate. ● Outbreaks of circulating vaccine-derived poliovirus (cVDPV): 'After interruption of wild poliovirus, continued use of OPV would compromise the goal of a polio-free world. Expert Consultation on Vaccine-derived Polioviruses (VDPVs), Sept 2003, Geneva
  9. 9. The Strategic Plan has four objectives. Detect and Interrupt Polio Virus Strengthen system Withdraw OPV Contain & Certify Plan Polios’ legacy The plan provides a strategy to interrupt all wild poliovirus transmission by the end of 2014 To 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
  10. 10. 2013 2014 2015 2016 2017 Eradication and Endgame Timeline 1. Detect and Interrupt Polio Virus Interrupt Wild Polio transmission 2018 Respond to continuing vaccine derived polio outbreaks 2. Strengthen Immunization systems & Withdraw OPV Strengthen Immunization system, Prepare vaccine switch Introduce IPV Withdraw OPV2 3. Contain and Certify Finalize containment plans Continue immunization with IPV and OPV 2019 –bOPV cessation Carry out eradication certification 4. Plan Polio Legacy Identify legacy opportunities Mainstream knowledge, infrastructure to benefit other programs OPV2 Withdrawal Certify Eradication
  11. 11. 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)
  12. 12. Strategic Advisory Group of Experts on immunization
  13. 13. Polio Endgame Strategy in India Considerations 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
  14. 14. Last wild poliovirus cases by type, India WPV2 24/10/1999 Aligarh (UP) WPV3 22/10/2010 Pakur (JH) WPV1 13/01/2011 Howrah (WB)
  15. 15. Current pattern of vaccine use-India • tOPV – EPI schedule: 6,10,14 wks Birth dose for institutional births – SIAs: 2 NIDs with tOPV each year Assessed tOPV3 coverage by CES 2009 A • bOPV – Introduced in Jan 2010 – Used extensively during SNIDs in high risk states/ areas 70.4% <60 60 - 70 70 - 80 >= 80
  16. 16. cVDPV cases, India 2009-2011 •cVDPV cases detected in 2009-10 •100% due to type 2 Type 2 District 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
  17. 17. iVDPV & aVDPV cases, India 2009 to 2012* State Chhattisgarh Punjab Tamil Nadu Uttar Pradesh Odisha Type 1 Type 2 Type 3 1 1 1 State Type 1 *: data as on 10 March 2012 1 1 3 1 1 Total Total 1 Assam Bihar Karnataka Madhya Pradesh Rajasthan Uttar Pradesh West Bengal 1 Type 2 3 1 1 1 4 1 11 ambiguous VDPV (aVDPV): origin uncertain e.g. single isolate from single AFP case, non-immunodeficient person
  18. 18. 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
  19. 19. Polio Endgame Strategy-India, Possible Way Forward tOPVbOPV switch Polio certification Last WPV case NID NID NID NID NID NID NID IPV NID Postswitch Sabin type 2 risk mgt. Modelling, Research, Development PQ/ licensing, stockpile Certification standard surveillance, improved RI coverage 0 Jan Mar May 2011 Jul Sep Nov Jan Mar May Jul 2012 Sep Nov Jan Mar May Jul 2013 Sep Nov Jan Mar May 2014 tOPV NID
  20. 20. The 'Polio Endgame‘_ Conclusions While the past cannot be re-enacted, the future can certainly be redesigned Sequential IPV/OPV schedules considered 1st phase transition towards all IPV schedule in Routine Immunization. The program should attend TO COUNTRY SPECIFIC NEEDS And 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
  21. 21. LET US THANK ALL THE DEDICATED VOLUNTEERS, WITHOUT THEM POLIO ERADICATION IN INDIA IS NOT POSSIBLE HOPE THIS IS THE HISTORICAL LAST POLIO CASE OF INDIA Polio Eradication and Endgame Strategic Plan 2013–2018 will pay dividends for generations to come. • 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
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