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Deliberations of the 23 rd IEAG 13 - 14 July 2011

Deliberations of the 23 rd IEAG 13 - 14 July 2011. Questions to the IEAG. What is the significance of the current polio epidemiology – is this progress real? What are the implications of the ensuing high transmission season for the current polio situation?

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Deliberations of the 23 rd IEAG 13 - 14 July 2011

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  1. Deliberations of the 23rd IEAG13 - 14 July 2011

  2. Questions to the IEAG • What is the significance of the current polio epidemiology – is this progress real? • What are the implications of the ensuing high transmission season for the current polio situation? • What are the risks for continued polio transmission in India? • How should these risks be effectively addressed to ensure that the gains made so far are further consolidated to achieve polio eradication?

  3. Questions to the IEAG • What should be the number, timing, scope and vaccine type for SIAs during the remaining months of 2011 and early 2012? • How should the current communication gains be maintained and what are the specific communication challenges at this stage of polio eradication? • How should the program begin to prepare for the next phase of polio eradication?

  4. Q1: What is the significance of the current polio epidemiology – is this progress real?

  5. A Snapshot of Polio Situation in India 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 P1 wild P3 wild

  6. WPV cases during previous 12 months, India Dec 2010 – June 2011* Jun 2010 – Nov 2010 Type 1 Polio N=11 N=2 West Bengal is the only state with wild virus in 2011 N=7 N=0 Type 3 Polio

  7. WPV1 cases in endemic states, 2009-2011 Uttar Pradesh Longest indigenous WPV1 transmission free period simultaneously in both endemic states Bihar Cross-border transmission with Nepal 2009 2011* 2010

  8. Q2: What are the implications of the ensuing high transmission season for the current polio situation?

  9. IEAG Conclusion 2: There is a high risk that any residual or imported wild poliovirus will manifest between July & November.

  10. 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

  11. Q3: What are the risks for continued polio transmission in India?

  12. Risks to India's US$1 Billion Investment in Polio Eradication Undetected low season transmission Return of Indian viruses from Africa New importations from reservoirs

  13. RISK 1: Undetected Virus within India • Highest risk areas • historic reservoirs, • orphan virus areas, • recent/recurrent re- infected areas Districts with ‘Orphan’ viruses, 2008-2011

  14. RISK 2: Movement of Viruses in MigrantsMigration status WPV1 cases, 2007-2011 Non epidemic UP* Rest of India (N= 56) (N= 48) * non epidemic UP excludes Moradabad, JP Nagar, Badaun, Kanshiram Nagar, Bareilly and Rampur districts *Data as on 10 July 2011

  15. RISK 3: Importation of Viruses into IndiaPolio-infected districts globally, last 6 months Virus that originated in India can return by the same routes! wild virus type 1 wild virus type 3

  16. Q4: How should these risks be effectively addressed to ensure that the gains made so far are further consolidated to achieve polio eradication?

  17. IEAG Conclusion 4: • 4 essential elements of risk management: • enhance routine OPV3, esp. in west UP, WB • enhance surveillance • ensure outbreak preparedness plans • extra OPV campaigns in highest risk areas

  18. Risk Mgmt 1: improve routine EPI, with priority to lagging reservoir & 'amplification' areas, building on recent best practices (e.g. session & community monitoring activities) Bihar % Full Immunization coverage Muskan RI Augmentation

  19. Risk Management 1 • Routine Immunization: • Particular attention to those reservoir or amplication areas with lagging OPV3 (e.g. west UP, West Bengal). • Re-emphasize critical importance of ANM and Medical Officer vacancies in these areas. • Continue to build on convergence of polio & routine EPI activities (e.g. microplanning, communications, migrant/marginalized pops).

  20. Risk Management 2 • Surveillance: • complete the planned serosurvey (August) • expand environmental sampling as planned • enhance surveillance among migrant populations (e.g. enrolling appropriate reporting sites/informers) • sustain state-level reviews for quality assurance (esp. reservoirs/amplification areas)

  21. WPV1 notified 07 Feb 2011 7 weeks 1 week 5 weeks 17 weeks WPV1 notified 12 Feb 2010 Risk Mgmt 3: build on best practices to refine WPV/cVDPV emergency preparedness plans 7 Howrah, 2011 6 5 Number of WPV 4 WPV1 3 WPV3 2 1 1 2 3 4 5 6 7 Murshidabad, 2010 bOPV mOPV1

  22. Risk Management 3 • Emergency Preparedness Plans: • ensure all states complete plans & that these are shared/reviewed centrally • ensure the identified risk areas have follow-up risk mitigation activities • conduct simulation exercises in highest risk areas in August 2011 (reservoirs, recently infected areas & amplification sites) • Ensure minimum buffer stock of 40 million bOPV and 10 million tOPV doses (review 6 monthly)

  23. Q5: What should be the number, timing, scope and vaccine type for SIAs during the remaining months of 2011 and early 2012?

  24. IEAG Conclusion 5: Additional OPV campaigns are essential to protect the 'reservoir' and 'amplication' areas going into the 2011 high season.

  25. 2011: additional OPV Campaign in August to reduce risk of high season amplification of any residual or imported virus SNID SNID SNID Jul Aug Sep Oct Nov Dec Aug Sep Nov bOPV

  26. 2012: procure sufficient vaccine for aggressive OPV schedule in 1st half of 2012, then prepone/postpone based on epidemiology NID tOPV NID tOPV/bOPV SNID (bOPV) Endemic & risk states SNID (bOPV) Endemic & risk states SNID (bOPV) Endemic & risk states SNID (bOPV) Endemic & risk states Jan Feb Mar Apr May Jun

  27. Q6: How should the current communication gains be maintained & what are the specific communication challenges at this stage of polio eradication?

  28. 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.

  29. From Every Child, Every Timeto Your Child,Every TimetoMyChild,Every Time New Personalized Branding of the Polio Communications Approach

  30. Recs: Communications • Roll out the new communications approach (incl. major emphasis on routine immunization & other convergence messaging). • Sustain the SMNet in UP and Bihar, and consolidate capacity in West Bengal. • All states should have a media & IEC as key elements of WPV emergency response plans (incl. designated government spokesperson!)

  31. Q7: How should the program begin to prepare for the next phase of polio eradication?

  32. 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.

  33. Recs: Post-eradication planning • intensify implementation of the Global Action Plan for Poliovirus Containment (targeting completion of phase 1 by end-2012) • accelerate research & product development agenda (e.g. mucosal immunity, mathematical modeling, safe & affordable IPV approaches) • consider convening special IEAG-NTAGI session in late 2011

  34. Conclusion

  35. India is definitely on the right path to finish eradication. HOWEVER, a more aggressive approach is essential to manage the risks along this path!

  36. Towards a polio-free India Rukhsar. Let's ensure she is the last polio case in India!

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