Deliberations of the 23rd IEAG
13 - 14 July 2011
Questions to the IEAG
1. What is the significance of the current polio epidemiology – is this progress real?
2. What are the implications of the ensuing high transmission season for the current polio situation?
3. What are the risks for continued polio transmission in India?
4. How should these risks be effectively addressed to ensure that the gains made so far are further consolidated to achieve polio eradication?
Questions to the IEAG
5. What should be the number, timing, scope and vaccine type for SIAs during the remaining months of 2011 and early 2012?
6. How should the current communication gains be maintained and what are the specific communication challenges at this stage of polio eradication?
7. How should the program begin to prepare for the next phase of polio eradication?
Q1: What is the significance of
the current polio epidemiology
– is this progress real?
A Snapshot of Polio Situation in India
P1 wild P3 wild
1 case to date in 2011 vs. 24 cases at same point in 2010.
1 serotype in 2011 vs. 2 in 2010.
1 genetic cluster in 2011 vs 5 in 2010.
No sewage WPV since Nov 2010.
741
42 1
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 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
Q2: What are the implications of the
ensuing high transmission season
for the current polio situation?
IEAG Conclusion 2:
There is a high risk that any
residual or imported wild
poliovirus will manifest between
July & November.
Monthly incidence of WPV1 cases, 2005-2011
High transmission season
Any residual WPV transmission is likely to
be detected in the coming high season for polio
Q3: What are the risks for continued
polio transmission in India?
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
RISK 1: Undetected Virus within India
Highest risk areas
(a) historic reservoirs,
(b) orphan virus areas,
(c) recent/recurrent re- infected areas
Districts with ‘Orphan’ viruses,
2008-2011
Rest of India
(N= 48)
Non epidemic UP*
(N= 56)
* non epidemic UP excludes Moradabad, JP Nagar, Badaun, Kanshiram Nagar, Bareilly and Rampur districts*Data as on 10 July 2011
RISK 2: Movement of Viruses in MigrantsMigration status WPV1 cases, 2007-2011
Data in WHO HQ as of 14 Jun 2011
wild virus type 1
wild virus type 3
RISK 3: Importation of Viruses into IndiaPolio-infected districts globally, last 6 months
Virus that originated in
India can return by the
same routes!
Q4: How should these risks be effectively
addressed to ensure that the gains made
so far are further consolidated to achieve
polio eradication?
4 essential elements of risk management:
1. enhance routine OPV3, esp. in west UP, WB
2. enhance surveillance
3. ensure outbreak preparedness plans
4. extra OPV campaigns in highest risk areas
IEAG Conclusion 4:
Risk Mgmt 1: improve routine EPI, with priority to lagging reservoir & 'amplification' areas, building on
recent best practices (e.g. session & community monitoring activities)
11 11.6
18.6
32.838
41.4
5449
66.8 68
0
10
20
30
40
50
60
70
80
90
100
NFHS 21998-99
CES 2002 CES 2005 NFHS 32005-06
CES 2006-07
DLHS 07-08 FRDS2008/09
CES 2009-10 Unicef
FRDS 2010-11
HtHMonitoring
2011
RI Augmentation
Muskan
% Full Immunization coverage
Bihar
Routine Immunization:1. Particular attention to those reservoir or
amplication areas with lagging OPV3 (e.g. west UP, West Bengal).
2. Re-emphasize critical importance of ANM and Medical Officer vacancies in these areas.
3. Continue to build on convergence of polio & routine EPI activities (e.g. microplanning, communications, migrant/marginalized pops).
Risk Management 1
Surveillance:1. complete the planned serosurvey (August)
2. expand environmental sampling as planned
3. enhance surveillance among migrant populations (e.g. enrolling appropriate reporting sites/informers)
4. sustain state-level reviews for quality assurance (esp. reservoirs/amplification areas)
Risk Management 2
Howrah, 2011
Murshidabad, 2010bOPV mOPV1
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
WPV1 notified
07 Feb 2011
WPV1 notified
12 Feb 2010
1
123
45
6
7
2
3
456
7
Num
ber
of W
PV
5 weeks 17 weeks
1 week7 weeksWPV1
WPV3
Risk Mgmt 3: build on best practices to refine WPV/cVDPV emergency preparedness plans
Emergency Preparedness Plans:1. ensure all states complete plans & that these are
shared/reviewed centrally
2. ensure the identified risk areas have follow-up risk mitigation activities
3. conduct simulation exercises in highest risk areas in August 2011 (reservoirs, recently infected areas & amplification sites)
4. Ensure minimum buffer stock of 40 million bOPV and 10 million tOPV doses (review 6 monthly)
Risk Management 3
Q5: What should be the number,
timing, scope and vaccine type for SIAs
during the remaining months of 2011
and early 2012?
IEAG Conclusion 5:
Additional OPV campaigns are
essential to protect the 'reservoir'
and 'amplication' areas going into
the 2011 high season.
2011: additional OPV Campaign in August to reduce risk of high season amplification of any
residual or imported virusSNID
Sep Oct Nov DecJul Aug
Sep Nov
bOPV
SNID
Aug
SNID
NIDtOPV
Mar Apr May JunJan Feb
SNID (bOPV)Endemic & risk states
NIDtOPV/bOPV
SNID (bOPV)Endemic & risk states
2012: procure sufficient vaccine for aggressive OPV schedule in 1st half of 2012, then
prepone/postpone based on epidemiology
SNID (bOPV)Endemic & risk states
SNID (bOPV)Endemic & risk states
Q6: How should the current
communication gains be maintained & what
are the specific communication challenges
at this stage of polio eradication?
IEAG Conclusion 6:The current plan to maintain communications
gains is endorsed, recognizing that the
greatest challenges are (a) ensuring rapid,
high-quality emergency response & (b)
building on the polio capacity to improve
child health.
From Every Child, Every Time
to Your Child,Every Time
toMy Child,
Every Time
New Personalized Branding of the Polio Communications Approach
1. Roll out the new communications approach (incl. major emphasis on routine immunization & other convergence messaging).
2. Sustain the SMNet in UP and Bihar, and consolidate capacity in West Bengal.
3. All states should have a media & IEC as key elements of WPV emergency response plans (incl. designated government spokesperson!)
Recs: Communications
Q7: How should the program begin to
prepare for the next phase of polio
eradication?
IEAG Conclusion 7: Given the recent eradication progress,
and the long timelines for post-eradication
planning, this work should be intensified
esp. in the absence of high season
transmission.
1. intensify implementation of the Global Action Plan for Poliovirus Containment (targeting completion of phase 1 by end-2012)
2. accelerate research & product development agenda (e.g. mucosal immunity, mathematical modeling, safe & affordable IPV approaches)
3. consider convening special IEAG-NTAGI session in late 2011
Recs: Post-eradication planning
Conclusion
India is definitely on the right
path to finish eradication.
HOWEVER, a more aggressive
approach is essential to manage the
risks along this path!
Towards a polio-free India
Rukhsar. Let's ensure she is the last polio case in
India!