Polio eradication programme in India – Progress, Response and Issues for action Dr Ajay Khera Deputy Commissioner Ministry of Health & FW, Govt. of India Presentation Prepared for IEAG Meeting on 13 th July, 2011 at New Delhi
Jan 15, 2016
Polio eradication programme in India – Progress, Response and
Issues for action
Dr Ajay KheraDeputy Commissioner
Ministry of Health & FW, Govt. of India
Presentation Prepared for IEAG Meeting on 13th July, 2011 at New Delhi
A Snapshot of Polio Situation in India
P1 wild P3 wild
P2 cases eradicated in 1999
14 States and UTs free of polio Since 2001
NIDs conducted since 1995 covering 170 million children per round
Sharp decline in polio cases in 2010
Single WPV 1 case reported in 2011 and longest polio free period
741
42 1
mOPV 1bOPV
State P1 P3 Total
Bihar 38 79 117
Uttar Pradesh** 34 569 602
Delhi 3 1 4
Punjab 2 2 4
Jharkhand 2 0 2
Rajasthan 1 2 3
Haryana 0 4 4
Uttarakhand 0 4 4
Himachal Pradesh 0 1 1
Total 80 662 741
WPVs
Geographical distribution of Wild Polio cases during last two years
** One case reported mixture of P1 wild & P3 wild
State P1 P3 Total
West Bengal 6 2 8
Maharashtra 5 0 5
Bihar 3 6 9
Jharkhand 3 5 8
Jammu & Kashmir 1 0 1
Uttar Pradesh 0 10 10
Haryana 0 1 1
Total 18 24 42
WPVs
2009 2010
A single case of WPV1 detected in India in 2011 – in Howrah, West Bengal
WPV cases during previous 12 months, India
N=2
Dec 2010 – June 2011*
N=11
Jun 2010 – Nov 2010
N=0N=7
Type 1 Polio
Type 3 Polio
West Bengal is the only state with wild virus transmission in past 6 months
AFP surveillance and polio situation in 2011
Single P1 case in 2011 Howrah, West Bengal
Onset of paralysis - 13 January
Related to wild poliovirus detected in sewage sample of Delhi in August 2010
State P1 P2 Total
Chhattisgarh 1 1
Madhya Pradesh 1 1
Rajasthan 1 1
Uttar Pradesh 1 1
Total 4 4
VDPVs
Year AFP WPV Compatible VDPV
2009 50405 741 473 21
2010 55781 42 188 5
2011 24314 1 1* 4
No circulating VDPVsNo genetic linkage amongst 2011 VDPVsNo genetic linkage with VDPVs of 2009 & 2010
*Classification of cases pending
Wild Polio Virus in environmental (sewage) samples
2006 2007 2008 2009 2010 20112005
Mumbai
WPV1 WPV3Delhi
Collection of sewage samples started from April
2010
Samples not collected between March 2006 and April 2007 due to
fire in Mumbai Lab
Note: six samples reported mixture of P1 wild & P3 wild in Delhi
Mumbai and Delhi sewage test results confirm that P1 and P3 circulation is at very low levels in 2010. No evidence of circulation in 2011
WPV1 cases in endemic states, 2009-2011
2009 2010
Uttar Pradesh
Bihar
2011*
Longest indigenous WPV1 transmission free period simultaneously in both endemic states
Cross-border transmission with Nepal
WPV3 cases in endemic states, 2009-2011*
Uttar Pradesh
Bihar
2009 2011*2010
• Transmission limited to western UP & central Bihar• No WPV3 case in endemic states for 13 months
Champaran East
Bihar, WPV1 spill over, 2010
• Cross-border transmission with Nepal that resulted in 3 cases in a single block
• All 3 cases within a span of 1 month• 3 mop-up rounds conducted within a period of 10 weeks• No case in this transmission area for 8 months
Bihar
Nepal
Jan 10
Feb 10
Mar 10
Apr 10
May 10
Jun 10
Jul 10
Aug10
Sep 10
Oct 10
Nov10
Dec 10
Jan 11
Feb 11
Mar 11
Apr 11
May 11
Jun 11
Maharashtra, WPV1 transmission area, 2010
• Transmission focused in a small geographical area in Malegaon and a single case in Beed
• Multiple mop-up rounds• Last case in September 2010• No case in this transmission area for last 8 months
mOPV1
bOPV
mOPV3
tOPV
WPV1
West Bengal
Jharkhand
Jan10
Feb10
Mar10
Apr10
May10
Jun10
Jul10
Aug10
Sep10
Oct10
Nov10
Dec10
Jan 11
Feb 11
Mar 11
Apr 11
May 11
West Bengal & Jharkhand, Mix transmission area, 2010-11
• Only area with WPV1 & WPV3 transmission simultaneously• Majority cases in Murshidabad (WB) & Pakur (JH), with the most recent case in
Howrah (the only case of 2011)• Transmission continued throughout 2010 in northern WB despite multiple SIAs• The most recent case in Howrah related to a separate importation, most likely
from Delhi
mOPV1
bOPV
mOPV3
tOPV
WPV1WPV3
Pulse Polio Response : SIAs conducted during 2011
23 Jan
March
2nd week Feb 27 Feb
mOPV1mOPV3
bOPV
tOPV
April MayJune
Quality of Response during 2011 regarding SIA Pulse Polio activities
(Percent average children found unimmunized, End-of-round survey)
Focus on personalizing risk perception of polio, Addressing OPV safety issues during sickness and Promoting a more active attitude for
RI and polio vaccination, particularly among migrants
From ‘Every Child’to
‘My Child’, Two Drops, Every Time.
The New LogoPolio Plus Handbook
addressing OPV safety and convergent interventions
New social mobilizer flip-book addressing OPV safety
and convergent interventions
“OPV is totally safe … do not pay attention to rumors.”
Response : Revised communication strategy launched
Emergency Preparedness & Response Plan prepared & shared with State Govts
EPRG formed in 23 States/UTs *
(out of 35 States/UTs)
Response to migrants: coverage of migratory communities in states with large migratory population during each SNID
# children: 0.7 mn in each round
# children: 0.5 mn in each round
# children: 1.1 mn in each round
# children: 0.7 mn in each round
Actions Taken on Research & AFP Surveillance
• Informing programme decisions– Seroprevalence surveys in UP and Bihar to start from
6-August – Mucosal immunity study scheduled to start from 5-
September
• AFP and Laboratory Surveillance– Environmental sampling started in Patna
– Surveillance reviews conducted in Central & Eastern UP, West Bengal & Gujarat
Trends in Seroprevalence Against PoliovirusResults from Different Sero-surveys
Moradabad Nov 2007(N=121)
AFP cases UPNov 08 –
mid 09(169)
Moradabad May 2009(N=534)
UP & BiharAug 2010(N=1280)
Age 6-7 mo 6-11 mo 6-7 mo 6-7 mo
Type 1 78% 96.5% 99% 98%
Type 2 56% 33.7% 75% 65%
Type 3 69% 42.6% 49% 77%
High immunity levels achieved both for P1 & P3 in 2010through bOPV introduction
Current Program Priorities
1. Intensified surveillance for poliovirus
2. Full and consistent coverage of migrant and mobile populations
3. Intensified program in 107 High-risk Blocks of UP and Bihar
4. Rapid and effective response to any wild poliovirus
5. Identify and cover areas and populations at high risk for importation and spread of poliovirus
6. Identify areas with low RI coverage and strengthen it
Summary
• Country at historic low transmission levels
• Genetic & environmental surveillance confirms progress
• Simultaneous progress in both endemic states
• The coming high transmission season will be the test to know whether poliovirus transmission has stopped in India
• Any case of Wild Polio considered as Pubic health emergency and needs quick & effective containment
Thanks