5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
1/22
Circulatia viruslui polio in contextulinternational actual
Urgenta de sanatate publica internationala
INSPCNSCBT
30 Mai 2014
5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
2/22
Fresca din piramideleegiptene 1580 - 1350I.C.
Un virus destept
care a
supravietuit mii de ani sia facut milioane de
victime
5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
3/22
Initiativa de eradicare a poliomielitei - 1988
- 1000 cazuri de polio/zi in lumea intreaga
S-au stabilit:- sisteme de supraveghere a PAF
- programe nationale de vaccinare inclusiv organizarea de zile nationale de
vaccinare in lumea intreaga
- Dezvoltarea si capacitarea laboratoarelor nationale si regionale pentru
izolarea si tipizarea virusului polio
Rezultate:
- In anul 1991ultimul caz de polio in Regiunea Americana a OMS iar in
1994 continentul a fost certificat polio free
- in 1997ultimul caz de polio in Regiunea OMS a Pacificului de Vest si
certificat polio free in 2000 (au fost vaccinati cu OPV peste 550 milionae decopii)
5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
4/22
In 1998ultimul caz de polio in Turcia
In 2002Regiunea OMS Europa este declarata polio free
In 2003campaniile de vaccinare sunt oprite in Nigeria datoritazvonurilor privind siguranta vaccinului (sterlizare a copiilor)
cazuri polio India20022003nr. doze de vaccin
In 2005vaccinul monovalent VPO pentru campanii suplimentare de
vaccinare (VP1cel mai virulent dintre cele 3 tipuri de virus polio)
20064 tari endemice: Afganistan, India, Nigeria si Pakistan si MARE
EPIDEMIE de polio in Yemen si Indonezia
in 2007 cu ocazia Zilei Internationale a Pacii peste 80000 de copii sunt
vaccinati in zone inaccesibile din Afganistan
In 2008o noua epidemie in partea de vest a Nigeriei
In 2009se lanseaza vaccinul bivalent pentru a vaccina copii in Afganistan
5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
5/22
19882009 (21 ani)
1000 cazuri pe zi - mai putin de 2000 cazuri pe tot anul 2009- 2010 in regiunea OMS Europamarea epidemie de polio din Tajikistan
cu peste 460 cazuri de polio confirmate cu laboratorul (plus altele
compatibile) cu virus importat din Afganistan si apoi transmis local
- cu eforturi sustinute prin campanii de vaccinare si supraveghere a
cazurilor de PAF OMS se pragateste sa recertifice Europa polio free
- 27 Martie 2014India a fost declaratapoliofree dupa zeci de ani de
lupta cu virusul polio .
5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
6/22
Zonele de conflictmediu prielnic pentru reintroducerea in circulatie a
virusului polio salbatic si aparitia epidemiilor de polio
- sistemele de sanatate afectate
- programele nationale de vaccinare compromise- deplasari masive de populatii din zonele de conflict in tarile
invecinate
ISRAELizolarea virusului polio salbatic in apa uzata din zonele arabe (luna
februarie 2013 si pana in prezent)
- virusul P1 izolat cu aceeasi structura ca cel izolat in Egipt (importatdin Afganistan) si introdus odata cu deplasarea refugiatilor ca urmare a
conflictului din Egipt
- MASURAvaccinare cu OPV bivalent a tuturor copiilor in varsta
de pana la 14 ani
5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
7/22
1stbOPV campaign 2ndbOPV
Poliovirus detection and interuption
Israel environmental sampling
WHO source
5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
8/22
Siriaconflict armat din 2012
- Epidemie de poliomielita cu virus P1confirmate cu laboratorul 26 cazuri
in 2013urmata de organizarea de vaccinari suplimentare
- Ca urmare a conflictului armatnumar mari de refugiati si azilanti in
Turcia si Bulgaria
- Turcia numar refugiati oficial 1.000.000 plus mai mult de 500.000
neoficial
- masuraorganizarea de zile nationale de vaccinare si intarirea
supravegherii cazurilor de PAF
- Bulgariase confrunta cu 8.000 refugiati legali din care 60-65%
sunt din Siria
- Izolare de virus vaccinal la 3 copii refugiati sirieni
- Intariea sistemului de supraveghere
5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
9/22
Risk of an outbreak following importation of wPV
Georgia
Ukraine
Romania
Bosnia andHerzegovina
Risk of transmission
Low
Intermediate
High
http://www.euro.who.int/en/what-we-do/health-
topics/communicable-diseases/poliomyelitis/activities/polio-
certification-activities/european-regional-commission-for-the-
certification-of-poliomyelitis-eradication
http://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradication5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
10/22
ROMANIA - masuri de protectie
- Acoperire vaccinala de cel putin 90% si cu minim 3 doze de VPI pana lavarsta de 1 an
- Supraveghere de calitate a cazurilor de PAF pentru a fi capabili sa
detectam rapid orice circulatie de virus polio si sa implementam un plan
de izolare a infectiei
- Supravegherea apei uzate (apa de canal) de la statia de epurare a apei
uzata de la Glina a pus in evidenta circulatia virusului Coxackie B din luna
octombrie 2013 pana in luna februarie 2014
5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
11/22
5 Mai 2014 - OMS a decretat raspandirea
virusului polio salbatic urgenta de
sanatate publica de importanta
internationala (USPII)
5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
12/22
Wild Poliovirus Cases by Type 2013 & 2014 - Year to Date Comparison
Data in WHO HQ as of 20 May 2014
W1 W3 W1 W3 2014 W3
Pakistan 93 0 8 0 66 0 01-May-14
Nigeria 53 0 22 0 3 0 19-Apr-14
Afghanistan 14 0 2 0 4 0 06-Apr-14
Total 160 0 32 0 73 0
Equatorial Guinea 0 0 0 0 3 0 19-Mar-14
Iraq 0 0 0 0 1 0 10-Feb-14
Cameroon 4 0 0 0 3 0 31-Jan-14
Syria 35 0 0 0 1 0 21-Jan-14
Ethiopia 9 0 0 0 1 0 05-Jan-14
Somalia 194 0 1 0 0 0 20-Dec-13
Kenya 14 0 1 0 0 0 14-Jul-13
Total 256 0 2 0 9 0Global total 416 0 34 0 82 01Data as of 21 May 2013 for 2013 data and 20 May 2014 for 2014 data.
Outbreak
Country
classification
Total 2013 Date of most
recent case2013 2014
01 January - 20 May1
Endemic
5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
13/22
OMS si ECDCultimele recomandari in urma analizei de risc pentru
importarea si raspndire virusului salbatic polio in UE/EEC din
Afganistan, Pakistan, Siria, Israel, Irak, Camerun, Guineea Ecuatoriala,
Somalia, Nigeria, Etiopia,
- Circulatia virusului salbatic in Israel si Siria reprezinta un mare risc de re-
introducere a virusului polio in UE/EEC (Regiunea Euro OMS)
- Virusul a fost exportat din Camerun, Pakistan si Siria cu ajutorulADULTILOR (calatori)
- Informare populatiei asupra riscului de import/raspandire a virusului
salbatic polio
- RISCUL de aparitie a epidemieiin clusterele de copii nevaccinati sausuboptimal vaccinati
5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
14/22
Evaluarea riscului in functie de tipul de vaccin folosit:
RISC MICpentru tarile care vaccineaza cu VPO (mic pentru infectie si boala)
RISC MODERATpentru tarile care folosesc VPI (moderat pentru infectie/portaj si
mic pentru boala)
RISC RIDICATin grupurile nevaccinate (pentru infectie si boala)
CRUCIALacoperire vaccinala de minim 95%
Posibil ca unele tari sa introduca vaccinarea obligatorie (in prezent
Arabia Saudita si India au aceasta cerinta) !!!!!!
5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
15/22
Grupul de experti din tarile care primesc multi refugiati - ADVISORY FORUM
(Finlanda, Franta, Germania, Norvegia, Spania, Suedia si UK)
- Siria are probleme cu vaccinarea de rutina din 2011toti copii sub 5 ani
trebuie vaccinati- Personalul din centrele de refugiati/azilantitrebuie vaccinati
- Nu se introduce screening-ul pentru statutul vaccinal (masura necesita
resurse umane suplimentare) !!!!
INTREBAREA FARA RASPUNS (INCA) din partea grupului de experti .
- administrarea de VPO sau VPI ????????
- Administrarea de VPI - dar daca copilul este in perioada de incubatie ?????
- Administrarea simultana de VPO si alte vaccinuri injectabile posibila
5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
16/22
ROMANIA
- Informarea MS, MAE,MAI, MAPN, MT, CRSP, DSPJ
- Informarea calatorilor in tarile listate de OMS (prin site-ul CNSCBT sicabinetele internationale de vaccinare) despre obligativitatea vaccinarii cu o
doza de VPI cu cel putin 4 saptamani inaintea calatoriei in tarile cu circulatia
de virus polio salbatic
- Inscrierea vaccinarii pe formatul standard OMS din IHR 2005 si va insoti
documentele de calatorie (exista riscul de vaccinare cu OPV in tarilerespective)
- Identificarea comunitatilor la risc cu acoperire vaccinala suboptimala si care
traiesc in conditii igienice precare
- Inventarierea dozelor de VPI disponibile177.000 (la nivel national)
5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
17/22
PLAN DE MASURI PENTRU URMATOARELE 6 LUNI (IUNIENOIEMBRIE 2014)
- Vaccinarea copiilor de pana la 5 ani care nu au cel putin 3 doze de VPI
- Se face o prioritizare a localitatilor/grupurilor la risc in functie de dozele de
VPI din stoc
- Adresa la MS pentru dozele suplimentare de VPI pentru recuperarea
copiilor astfel incat sa avem un confort de cel putin 95% acoperire
vaccinala
- Mobilizarea mediatorilor sanitari si a liderilor romi pentru accesul incomunitate
- Intensificarea supravegherii cazurilor de PAF cu raportare imediata a
cazurilor la CNSCBT si investigarea materiilor fecale conform metodologiei
5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
18/22
- Esantioanele de materii fecale se trimit la INDCMI Cantacuzino imediat dupa
recoltarea celei de a 2a probe fie ca sunt sau nu prelucrate conformmetodologiei de recoltare - folosirea postei rapide
- Materiile fecale NU SE TIN O SAPTAMANA pana sunt trimise !!!
- Introducerea supravegherii de mediu in apele uzate din judetele
- SatuMare, Maramures, Suceava, Botosani, Constanta si Tulcea (localitatile
se vor stabili de comun acord CNSCBT- DSPJ); probele se trimit la INDCMICantacuzino
- Investigarea focarelor de boala in care se suspecteaza o infectie enterovirala
- Informarea medicilor din judeteindiferent de specilitate (conform planului
trimis catre DSPJ si CRSP)
5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
19/22
Masuri in caz de :
1. Aparitie a unui caz de polio (semnificatiecirculatie intensa de virus polio
salbatic !!!!!!)
- Internare obligatori in spital de B.I. - pana la negativarea materiilor
fecale
- Membrii familiei si a contactilor vor fi supravegheati si le se vor colecta
materiile fecale
- ANCHETA EPIDEMIOLOGICA - DESCOPERIREA SURSEI !!!- Adultii sunt cei care transporta virusul
- Militarimisiuni in tarile mentionate ???
- Turisti ????
- Munca temporara ??????
Acoperirea vaccinala !!!????catch up sau mopping upin functiede rezultate !!!
Supravegherea cazurilor de PAF
5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
20/22
2. Izolarea de virus polio salbatic de la o peroana sanatoasa :
- purtator infectat recent prin calatorie in tarile cu circulatie de virus
polio salbatic
- contact cu o persoana infectata originara sau istorie de calatorie
din/in tarile cu circulatie de virus polio salbatic
-Colectare materii fecale de la copii/contacti apropiati
(casa/gospodarie)
- Supravegherea clinica a contactilor
- Intarirea supavegherii cazurilor de PAF
- Cercetarea acoperirii vaccinalecatch up sau mopping up
VPO SAU VPIse va decide la momentul respectiv
(OMS are o cantitate de VPO de rezerva in caz de necesiate)
5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
21/22
3. Izolarea de virus salbatic polio din ape reziduale - cantitate mare de virus
excretat
- ancheta epidemiologicaidentificarea sursei (azilanti adulti si
copii din tarile cu circulatie de virus polio salbatic, calatori , etc)
- purtator infectat recent prin calatorie in tarile cu circulatie de virus
polio salbatic
- contact cu o persoana infectata originara sau istorie de calatoriedin/in tarile cu circulatie de virus polio salbatic
- cercetarea acoperirii vaccinale
- Intarirea supavegherii cazurilor de PAF
- Cercetarea acoperirii vaccinalecatch up sau mopping upVPO SAU VPIse va decide la momentul respectiv
(OMS are o cantitate de VPO de rezerva in caz de necesitate)
5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014
22/22
INGRIJORARE MAJORA
Clinicienii tineri fara experienta vor fi
capabili sa diagnosticheze clinic corect un
caz de polio ????????
Pentru majoritatea POLIO este ISTORIE !!!