1 Polio Strategic Plan India Expert Advisory Group 13-14 July 2011 Impact & prospects at the...
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Transcript of 1 Polio Strategic Plan India Expert Advisory Group 13-14 July 2011 Impact & prospects at the...
1
Polio Strategic Plan
India Expert Advisory Group
13-14 July 2011
Impact & prospects at the half-way point
2
Recap of Major Elements of the New Strategic Plan
West Uttar Pradesh
Central Bihar
High-Risk Blocks
New Tactics: high risk 'blocks' & migrants, India
New Tactics: sub-national & local leaders, Nigeria
1st bivalent OPV campaign
Afghanistan16 Dec 2009
Pakistan President Zardari launches new plan (24 Jan '11)
Angola President Dos Santos meets UNICEF ExD on new plan (Jan '11)
DR Congo President Kabila meets WHO DG on new plan (7 Feb 2011)
7
Impact of the Strategic Planat July 2011
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Key Developments - ProgressPolio-infected districts, last 6 Months
wild virus type 1
wild virus type 3
India: 6 months with no polio case for 1st
time in history!
Nigeria: 95% drop in cases
sustained for > 18 months
Smallest type 3 infected area & cases in history
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Polio cases due to type 3 wild virus 2007-11 (at 13 July 2011)
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Major Risks
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Polio Cases in Endemic CountriesYear-to-Date 2010-11
Persistent outbreaks in the 3 're-established
transmission' countries*
* infected-districts, last 6 months
Chad
DR Congo
Angola
Virus that originated in
India can return by the
same routes!
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< 1 1 – 1.9
>= 2Pop under 15 yrs <100,000
Data in WHO/HQ as of 07 Jun 2011
Non Polio AFP
Sample Collection< 50% 50 – 79%
>= 80% Pop under 15 yrs <100,000
Persistent performance gaps in recently infected
areas.
Polio Financing, 2011-2012US$665 million funding gap
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Summary
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At the mid-point in the new Polio Strategic Plan, there is strong
evidence that full application will stop all polio transmission.
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Strong progress globally, but India still
faces major risksRe-infected countryEndemic country with WPV
Wild virus type 1 Wild virus type 3
Wild Polioviruses Globally, last 4 months22 Feb – 21 Jun 2011
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Undetected low season transmission
Return of Indian viruses from Africa
New importations from reservoirs
Risks to India's US$1 Billion Investment in Polio Eradication
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• What extra actions could protect very high risk areas through the 2011 high season?
• How to ensure preparedness for a rapid, massive response to a new or persistent virus?
• How to enhance surveillance in very high risk areas to rapidly detect a new or residual virus?
• Is there a robust Emergency Preparedness plan for polio with a state-by-state risk assessment?
Potential IEAG Priorities
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Circulating Vaccine-derived Polioviruslast 6 months
cVDPV2 (13 cases)
cVDPV1 (0 case)
cVDPV3 (0 case)
0
1
2
3
4
5
Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11
Nigeria Afghanistan Somalia
cVDPV monthly distribution of cases by country
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Institutionalizing Best Practices (examples)
OPV campaign quality & impact:• district-specific planning process (HR areas)
• public tracking of sub-national leaders actions
• scaled-up role of traditional/local leaders
• short-interval additional dose (SIAD) strategies
• mobile population & transit strategies
• bivalent OPV
• operational research (e.g. serosurveys)
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Institutionalizing Best Practices (examples)
OPV campaign monitoring:• standardized Independent Monitoring• Lot Quality Assurance Sampling (LQAS)• serologic surveys
Poliovirus surveillance:• Rapid field reviews (insecure areas, new import., orphan virus)
• Environmental surveillance• Enhanced performance standards (e.g. AFP rate >2)
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Major Lessons
• immunity thresholds differ
• virus persists in smaller areas & pops than thought
• new mOPVs harder to optimize than thought
• int’l spread & outbreaks largely predictable
• District-specific plans & oversight
• Population-specific approaches
• Bivalent OPV
• 'Importation belt' tactics
Key Elements of the New Strategic Plan
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Major Milestones at 24 March 2011
mid-2010: all 2009 importations interrupted Achieved (15/15)
within 6 months: all new (2010) imports interrupted Achieved/on-track
end-2010: all re-established viruses interrupted.
Achieved: Sudan Off-track: DR Congo Missed: Angola, Chad
end-2011: 2 of 4 endemic countries interrupted.
On-track: India, Nigeria, Afghanistan Off-track: Pakistan
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Genetic Clusters of Poliovirus 1
2008 2009 20102008
2009
2010
Virologic Progress in Africa
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RCCs: elim of cVDPV2
Roadmap for VDPV Elimination
Implementation
Biosafety
Outbreak response
* for areas facilities with type II PV/WPVs, high RI coverage with > 2 doses IPV; for areas with high cVDPV2 risk >1 dose IPV; other areas subject to SAGE IPV WG recs.
Validation/ Certification
Policy
12 mos
Decisions
RoutineImmunization
Surveillance
Timeline 0-12 mos?
Critical Events 6 months after last WPV in main African reservoir?
6 months after last WPV in the
world?
Last polio case in main Asian reservoir
EB
DG/WHO announceSAGE
WPV erad.• RCCs (3) • GCC
30 mos
bOPV cessation
6 mos 0-18 mos? 6 mos
• OPV
• IPV
• AFP
• Env.
Increased environmental sampling
(Event-based)
Prepare enhanced type 2 biosafety (inventory, BSL2)
GAP III for all WPVs
Enhancedtype 2 biosafety
VDPV elim.• RCCs (6) • GCC
WHA
RCCs assess WPV2 elim & no persistent cVDPV2s(?)
GAP III for all PVs
DG/WHO announce
Prepare nat'l OPV producers?Ensure min 50m IPV/year?
SIAstOPV/bOPV/mOPVs
1 or 2 dose IPV?*
tOPV
1 dose IPV?*
bOPV (with tOPV restart option)
tOPV pulse in HR areas?
bOPV/mOPVs
Uncertainty
mOPV1,2,3 +/- IPV IPV +/- mOPVs?mOPVs/tOPV
DG/WHO announce