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Inter-Departmental Working Group 03-07-02

Inter-Departmental Working Group 03-07-02. Polio eradication progress Poliovirus laboratory containment Roles Working Group. The Global Polio Eradication Initiative. 1980: WHA declared smallpox eradicated 1988: WHA resolved to eradicate polio

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Inter-Departmental Working Group 03-07-02

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  1. Inter-Departmental Working Group 03-07-02 • Polio eradication progress • Poliovirus laboratory containment • Roles Working Group

  2. The Global Polio Eradication Initiative • 1980: WHA declared smallpox eradicated • 1988: WHA resolved to eradicate polio • Eradication strategy is targeted mass OPV immunization with intense virus surveillance • Polio eradication is the largest global public health initiative ever undertaken

  3. 1999 7 094 cases Pre-‘Acceleration’ Progress 1988 350 000 cases Polio Eradication

  4. Zero wild viruses 1 to 4 wild viruses 5 to 20 wild viruses More than 20 wild viruses Importations Under investigation Intensity of indigenous wild poliovirus transmission in 2001 (11 Countries) Year 2000 (20 countries) as of 18 December 2001

  5. Acceleration Impact India as of 30 Nov 2000 1998 1999 1 934 viruses 2000 2000 1 126 viruses 196 viruses 196 viruses Polio Eradication

  6. Western Pacific Region Mum Chanty Cambodia 1997 European Region Melik Minas Turkey 1998 Polio ‘Last Cases’ Americas Region Luis Fermin Tenorio Peru 1991 Polio Eradication

  7. Type 2 polio was last found in October 1999 Polio Eradication

  8. Global eradication of all 3 poliovirus types anticipated by 2005

  9. + Finding and controlling wild poliovirus in human populations Finding and controlling wild poliovirus in laboratories Laboratory Containment The other half of poliomyelitis eradication Certification of Poliomyelitis eradication requires:

  10. Wild poliovirus may be reintroduced from the laboratory: • In theory, by contaminated clothing, liquid effluents, air exhaust, or improper virus disposal • In fact, by an infected laboratory worker, who may go unrecognized

  11. Containment Essential laboratory facilities and biosafety practices to minimize the risks of infection to the worker and the community.

  12. Containment • Con: Polio will never be eradicated • Pro: Progress thus far indicates polio can be eradicated • Con: If polio is eradicated, the risk of reintroducing polio from lab is either small or large • Pro: Risk of reintroducing polio from the lab grows with time after eradication

  13. Containment • Con: Immunization will never stop • Pro: OPV (live) immunization at some point must stop • Con: Absolute containment can never be ensured • Pro: Effective containment can be achieved

  14. Poliovirus and smallpox virus containment strategies differ • Poliovirus task is much larger in numbers of labs and types of infectious materials • For smallpox, focus was on destruction and global consolidation • For polio, focus is on destruction and appropriate laboratory containment

  15. WHO Global Action Plan: 3 steps to containment • Pre eradication: Laboratory survey/clean up and inventory • Post eradication: Implement required laboratory biosafety levels • Post immunization: Maximum containment strategy depends on immunization strategy

  16. All post eradication immunization scenarios assume: • global surveillance • adequate vaccine stockpiles • emergency response plans

  17. Purpose of the survey • Alert labs to impending eradication • Encourage disposition of unneeded wild poliovirus materials • Establish a National Inventory of laboratories retaining such materials

  18. Purpose of the National Inventory • Maintain a current list of laboratories with wild polioviruses • Keep laboratories informed of biosafety developments • Notify laboratories when polio has been eradicated and need to implement containment requirements

  19. Countries initiating laboratory surveys EUROPEAN REGION: 48 / 51 WESTERN PACIFIC REGION: 36 / 36 SOUTH EAST ASIA REGION: 7 / 10 AFRICAN REGION: To start planning 2002 EASTERN MEDITERREAN REGION: 19 / 23 AMERICAS REGION: 12 / 48

  20. “The United States is fully committed …..to the containment of any laboratory material that may harbor specimens of wild poliovirus.” Tommy G Thompson, Secretary HHS to George Alleyne, Director, WHO,AMRO June 2001

  21. Timeline for US National Survey and Inventory

  22. US Biomedical Laboratory Database • 10,859 diagnostic • 301 university (x #) • 1,217 industry (x #) • 11 Departmental (x #)

  23. Pilot Surveys, Phase I

  24. Phase I: Lessons Learned • Cooperation good in all sectors • Customized survey instruments/materials work best • Greatest challenge is identifying effective communication channels

  25. Roles of Inter-Departmental Working Group • Solidarity-work out issues in advance • Advocacy-communicating with constituents • Advisory-developing survey strategies for in-house labs • Regulatory-modifying test requirements • Participatory-joining in pilot surveys, phase II

  26. Pilot Surveys, Phase II • Anticipated to begin May 2002 • Departments with labs under jurisdiction invited to participate • PLCP will provide all customized survey materials • Look forward to working with you

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