PEI in Afghanistan - Update, Epidemiology and InterventionsPresentation Transcript
Polio Eradication Afghanistan Poliovirus Epidemiology and Interventions Afghanistan Meeting Technical Advisory Group March 24-25, 2011 Islamabad
Challenges, Priorities and Plans
Map of Afghanistan by province and population density Dot = 20,000 Pop Northeast Northern Western Southern Southeast Central Eastern Regions - 7 Province - 34 Districts – 329 Target <5 years-7.8 mil Pakistan Uzbakistan Turkmanistan Iran Tajikistan China
Comparison of AFP Cases by Classification 2009-2011 Afghanistan Compared to 2009, there is reduction in number of confirmed cases by 34% Data up to 16 Mar 2011 Classification 2009 2010 2011 Reported AFP cases 1477 1572 278 Confirmed 38 25 1 Compatible 11 5 0 cVDPV2 1 5 1 Discarded 1427 1537 203 Pending - - 73
Distribution of polio cases 2009-2011 Afghanistan 2009 2010 2011 Data up to 16 Mar 2011 Polio virus Circulation is localized, mainly in high districts of Kandahar and Helmand Province Although sporadic cases detected from East and N.East but no evidence of established circulation Region Confirmed cases 2009 2010 2011 Central 1 0 0 East 2 3 0 South east 0 0 0 South 34 19 01 North 0 0 0 Northeast 0 1 0 West 1 2 0 Country 38 25 01 P1 P3
Distribution of confirmed cases in Afghanistan 2008-11 and Area of 13 High Risk Districts Despite number of rounds poliovirus is isolated at regular intervals indicating continued circulation with a shift from P3 to P1 type in 2010 -11 Almost 80-90% of the confirmed cases reported from the 13 High Priority Districts. Target Population of these districts is 54% of the region and 9% of the Country .
AFP Cases with isolation of cVDPV2 reported during 2010-11 Southern Region Afghanistan Data up to 16 Mar 2011 Five cVDPV2 cases reported during Jun-Dec 2010 and one in 2011 Nad Ali Dist Helmand Almost 30-50 % of the target remain inaccessible in most of the rounds. SIAs coverage also ranged between 18-60% Routine vaccination coverage among AFP cases <24 months is 9% tOPV used in July SNIDs only in NadAli. An additional round with tOPV in 4 districts followed by tOPV in November NIDs. 3 rounds of accelerated routine EPI are planned in 2011. First round completed and 7700 children below 1 year vaccinated with tOPV. Guidance from TAG is requested Nimroz 2010 cVDPV2 2011 cVDPV2 Hilmand Kandahar Urozgan Zabul
Characteristics of polio cases 2010-11 Afghanistan
The Median age of all polio cases is 18 months ranging from (4-144)
The Median OPV dose of all confirmed polio cases is 4 while among non polio cases it is 13
14 out of 21cases in the southern provinces have not received OPV through routine while 8 cases have not received any OPV dose.
In 2010, 17 cases are of P1 type and 8 cases of P3 type. One case reported for 2011 is also P1 type
Genetic study of most cases reported from South are indicating indigenous circulation of the virus while cases reported from East, North East and the recent 2011 case from Kandahar matches closely with circulation across the border in Pakistan.
Data up to 16 Mar 2011
Cross border Epidemiological situation and Risks Afghanistan 2010-11
Continues circulation of virus in KPK Pakistan is posing great risk of virus transmission to the Eastern and Southeastern regions of the country
Polio outbreak in Tajikistan and transmission of virus to Afghanistan was another epidemiological risk during 2010
Transmission, High risk & non transmission zones Afghanistan 2011
South & Farah: with on going virus circulation
High Risk zone
East, South eastern regions: Risk of virus transmission from across the border
Non Transmission Zone :
Central , north , northeast. Western region: no evidence of established virus transmission.
Transmission High Risk Non-Transmission
Out of the house (FM) Surveys ( Transmission , Non Transmission &High risk Zones ) Feb 2010 to Jan 2011
PCA- Proportion of clusters by Transmission, High risk and non-transmission zone by FM, Afghanistan 2010-2011 Data up to 16 Mar 2011 Transmission Zone High Risk Zone Non-Transmission Zone
Routine Vaccination of AFP cases 6-23 Months by Region, 2007-Mar 2011 Afghanistan Data up to 16 Mar 2011 South+Farah Southeast East Central West North Northeast Badakhshan
Steps Taken: SIAs Activity Afghanistan 2010-11 Feb-SNID Mar-NID May-NID Jun-Mop up + SNID Jul-SNID Sep-Mop up Oct-NID Nov-NID Dec-SNID
Two rounds of NIDs with bOPV and two with tOPV conducted in 2010. Also 4 rounds of SNIDs with bOPV
Afghanistan introduced De-worming: Using house to house network of polio vaccination teams targeting 4.6 million children of age 2-5 years of age in October NIDs
Jan- Mop up Feb-SNID Mar-NID May-NID Jun-SNID 2011 2010 Data up to 16 Mar 2011 tOPV mOPV1 bOPV3 Not included
Steps Taken at Strategy and Policy level , PEI Afghanistan 2010-11
At the strategy and policy level
Policy and Dialog Group chaired by H.E Minister of Public Health Afghanistan, meeting regulalrly and discussing the policy and strategy issues.
Informal consultative Group (ICG) mainly for 13 high priority districts. Chaired by DG preventive medicine. WHO and Unicef also member.
Establishment of PIT for Joint planning, monitoring and resource sharing
Integrating de worming with polio campaigns to increase demand for vaccination.
H.E Minister of Public Health Signed MoU with ARCS on their involvement in PEI
Steps Taken : Access and Staff Safety, PEI Afghanistan
Maintained close coordination with ICRC and assigned DSTs, DC through ICRC in selected districts
Hiring Local Access Negotiators
Keeping neutrality of the program
Promote selection of local staff to be acceptable for community
Coordination with ISAF and ANA
Overall trend of inaccessible children in number and %age Southern region 2009 & 2011 2009 2010-2011 Month Target # inaccessible % Month Target # inaccessible % Jan 1249321 235794 19 Feb 1298495 126748 10 March 1249321 182786 15 March 1298495 90233 7 April 1249321 187442 15 May 1298495 82782 6 May 1249321 212784 17 June 1298495 80510 6 June 1249321 95078 8 July 1298495 82500 6 Jul 1249321 62912 5 Oct 1298495 109563 8 sep 663290 30788 5 Nov 1298495 92763 7 Oct 1249321 147325 12 Dec 1298495 96986 7 Nov 1249321 105449 8 Jan ,2011 1330742 72423 5.4 Dec 1249321 153220 12
Steps Taken: Improve Campaign Quality in 13 HRDs, Afghanistan
District Specific Plans for all 13 HR districts completed in August, 2010 at Kandahar
Strengthening District SIAs Management by assigning District Managers in all 13 Districts by September 1, 2010
Capacity building trainings completed for key SIAs Staff in 13 high risk District in July 2010 by special training consultants.
Maintain and expanding involvement of BPHS NGO as implementing partner in 4 districts of Farah and 2 districts of Kandahar in 2010.
Trend of Vaccination from May -2010 to Jan-2011 SIAs in 13 high risk districts of Southern Region, 2010, Afghanistan (Coverage Adjusted for Inaccessible children)