Polio End game Strategy

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Polio Eradication From Emergency to “Endgame”:

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

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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.

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

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EPRP Emergency Preparedness and Response Plan

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

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Focus on High priority Districts

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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. Outbreaks of circulating vaccine-derived poliovirus ( cVDPV ): very rare event; occurs when vaccine virus regains ability to paralyze and circulate. '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

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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 The Strategic Plan has four objectives.

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2013 2014 2015 2016 2017 2018 LAST WILD CASE OPV2 Withdrawal Certify Eradication 1. Detect and Interrupt Polio Virus 2. Strengthen Immunization systems & Withdraw OPV 3. Contain and Certify 4. Plan Polio Legacy Eradication and Endgame Timeline 2019 – bOPV cessation

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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)

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Strategic Advisory Group of Experts on immunization

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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

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Last wild poliovirus cases by type, India WPV2 24/10/1999 Aligarh (UP) WPV1 13/01/2011 Howrah (WB) WPV3 22/10/2010 Pakur (JH)

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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 bOPV Introduced in Jan 2010 Used extensively during SNIDs in high risk states/ areas 70.4% <60 60 - 70 70 - 80 >= 80 Assessed tOPV3 coverage by CES 2009

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cVDPV cases, India 2009-2011 cVDPV cases detected in 2009-10 100% due to type 2 District Type 2 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

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iVDPV & aVDPV cases, India 2009 to 2012* *: data as on 10 March 2012 ambiguous VDPV ( aVDPV ): origin uncertain e.g. single isolate from single AFP case, non-immunodeficient person

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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

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NID NID 0 Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Polio Endgame Strategy-India, Possible Way Forward 2011 2012 2013 2014 Last WPV case Polio certification IPV NID NID tOPV NID Post-switch Sabin type 2 risk mgt. tOPV-bOPV switch NID NID NID NID Certification standard surveillance, improved RI coverage PQ/ licensing, stockpile Modelling, Research, Development

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The 'Polio Endgame‘_ Conclusions While the past cannot be re-enacted, the future can certainly be redesigned Sequential IPV/OPV schedules considered 1 st 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

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HOPE THIS IS THE HISTORICAL LAST POLIO CASE OF INDIA LET US THANK ALL THE DEDICATED VOLUNTEERS, WITHOUT THEM POLIO ERADICATION IN INDIA IS NOT POSSIBLE 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 Polio Eradication and Endgame Strategic Plan 2013–2018 will pay dividends for generations to come.

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