Polio End Game Strategy

1. Polio Eradication
From Emergency to “Endgame”
Dr. Anil Kumar
District Immunization & Child Health
Officer
DoPHFW, KURNOOL

3.  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.

6. The 'polio emergency' 2012-13
The ”Year of Intensification of RI”2013-14
The 'polio endgame' 2014-18

9. EPRP
Emergency Preparedness and
Response Plan

10. EPRP Goals
Ensure preparedness &Rapidly respond to
any WPV outbreak
To support the transformational change
Serve as a critical precursor for the End
game

13. Intensification of RI 2013 - 14
Focus on Chronically missed children
Special Immunization Weeks – 4 Rounds
Special Immunization Weeks – 2 Rounds
in HRAs

14. Focus on High priority Districts
1
• Augmented Supervision
2
• Accelerated Monitoring
3
• Enhanced Financial Support
4
• Focus on Quality

16. 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

17. 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

18. 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

24. 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)

25. Strategic Advisory Group of Experts on immunization

27. 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

28. 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)

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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