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Polio Endgame Strategy in India Considerations and Way Forward

Polio Endgame Strategy in India Considerations and Way Forward. WHO-India, NPSP 15 March 2012. Outline of the presentation. Background/Context Considerations Possible Way forward. Context. No WPV2 in India since 1999 tOPV used in RI and during NIDs bOPV used in most SNIDs since Jan 2010

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Polio Endgame Strategy in India Considerations and Way Forward

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  1. Polio Endgame Strategy in IndiaConsiderations and Way Forward WHO-India, NPSP 15 March 2012

  2. Outline of the presentation • Background/Context • Considerations • Possible Way forward

  3. Context • 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

  4. 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)

  5. <60 60 - 70 70 - 80 >= 80 Current pattern of vaccine use-India Assessed tOPV3 coverage by CES 2009 • 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%

  6. cVDPV cases, India 2009-2011 • cVDPV cases detected in 2009-10 • 100% due to type 2

  7. Low seroprevalence against poliovirus type 2Results from different serosurveys

  8. Evaluated OPV3 coverage by district – DLHS 3 (2007-08) and cVDPVs cVDPV type 2 < 25% 25 to 50% 50 to 75% >= 75% tOPV NID tOPV NID tOPV sNID tOPV sNID tOPV c VDPV type 2 Uttar Pradesh Number of cases 2009 2010 2011

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

  10. Managing the risk of VDPVs

  11. 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 tOPV-bOPV switch in India?Considerations

  12. Pre-switch boosting of type 2 immunity • Switch soon after tOPV NIDs • Improve RI, particularly DTP3 and OPV3 coverage • Adding a dose of IPV in RI for infants prior to switch

  13. IPV introduction • Benefit – impact on RI ? • Timing/Age/Doses/Route – follow global SAGE recs ? • Frequency: 2 doses in known cVDPV risk areas? Modelling and Research in the India context may help optimise strategy for India

  14. bOPV availability • Licensure and pre-qualification of additional manufacturers to meet requirements of India pre and post-switch bOPV assessment study to support licensure of additional manufacturers

  15. Post-switch VDPV type 2 risk management • Heightened surveillance to detect post-switch Sabin type 2 (not just VDPV type 2!) • Stockpile/ Capacity to produce mOPV2 at short notice Certification standard surveillance to continue beyond certification

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

  17. Conclusions • India can be in a position to move ahead with polio endgame strategy • Careful planning and consideration of risks required before implementation • Earliest possible timing for tOPV-bOPV switch: Qtr.1 2014 • Lessons from tOPV-bOPV switch significant for subsequent withdrawal of all OPV from programme

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