Polio eradication programme in India – Progress, Response and Issues for action

1. Polio eradication programme in India – Progress, Response and Issues for action Dr Ajay Khera Deputy Commissioner Ministry of Health & FW, Govt. of India Presentation Prepared for IEAG Meeting on 13th July, 2011 at New Delhi

2. A Snapshot of Polio Situation in India • P2 cases eradicated in 1999 • 14 States and UTs free of polio Since 2001 • NIDs conducted since 1995 covering 170 million children per round • Sharp decline in polio cases in 2010 • Single WPV 1 case reported in 2011 and longest polio free period 741 bOPV mOPV 1 42 1 P1 wild P3 wild

3. Geographical distribution of Wild Polio cases during last two years 2009 2010 A single case of WPV1 detected in India in 2011 – in Howrah, West Bengal ** One case reported mixture of P1 wild & P3 wild

4. 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 transmission in past 6 months N=7 N=0 Type 3 Polio

5. AFP surveillance and polio situation in 2011 VDPVs State P1 P2 Total Chhattisgarh 1 1 Madhya Pradesh 1 1 Rajasthan 1 1 Uttar Pradesh 1 1 Total 4 4 No circulating VDPVs No genetic linkage amongst 2011 VDPVs No genetic linkage with VDPVs of 2009 & 2010 Single P1 case in 2011 Howrah, West Bengal Onset of paralysis - 13 January Related to wild poliovirus detected in sewage sample of Delhi in August 2010 *Classification of cases pending

6. Wild Polio Virus in environmental (sewage) samples WPV3 WPV1 Mumbai Samples not collected between March 2006 and April 2007 due to fire in Mumbai Lab Delhi • Mumbai and Delhi sewage test results confirm that P1 and P3 circulation is at very low levels in 2010. • No evidence of circulation in 2011 Collection of sewage samples started from April 2010 2007 2008 2009 2010 2011 2005 2006 Note: six samples reported mixture of P1 wild & P3 wild in Delhi

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. WPV3 cases in endemic states, 2009-2011* Uttar Pradesh • Transmission limited to western UP & central Bihar • No WPV3 case in endemic states for 13 months Bihar 2009 2011* 2010

9. Champaran East Bihar, WPV1 spill over, 2010 Nepal Bihar • Cross-border transmission with Nepal that resulted in 3 cases in a single block • All 3 cases within a span of 1 month • 3 mop-up rounds conducted within a period of 10 weeks • No case in this transmission area for 8 months

10. mOPV1 bOPV mOPV3 tOPV Jan 10 Feb 10 Mar 10 Apr 10 May 10 Jun 10 Jul 10 Aug10 Sep 10 Oct 10 Nov10 Dec 10 Jan 11 Feb 11 Mar 11 Apr 11 May 11 Jun 11 Maharashtra, WPV1 transmission area, 2010 WPV1 • Transmission focused in a small geographical area in Malegaon and a single case in Beed • Multiple mop-up rounds • Last case in September 2010 • No case in this transmission area for last 8 months

11. mOPV1 bOPV mOPV3 tOPV Jan10 Feb10 Mar10 Apr10 May10 Jun10 Jul10 Aug10 Sep10 Oct10 Nov10 Dec10 Jan 11 Feb 11 Mar 11 Apr 11 May 11 Jharkhand West Bengal West Bengal & Jharkhand, Mix transmission area, 2010-11 WPV3 WPV1 • Only area with WPV1 & WPV3 transmission simultaneously • Majority cases in Murshidabad (WB) & Pakur (JH), with the most recent case in Howrah (the only case of 2011) • Transmission continued throughout 2010 in northern WB despite multiple SIAs • The most recent case in Howrah related to a separate importation, most likely from Delhi

12. Pulse Polio Response : SIAs conducted during 2011 23 Jan 2nd week Feb 27 Feb June April May March mOPV1 mOPV3 bOPV tOPV

13. Quality of Response during 2011 regarding SIA Pulse Polio activities (Percent average children found unimmunized, End-of-round survey)

14. Focus on personalizing risk perception of polio, Addressing OPV safety issues during sickness and Promoting a more active attitude for RI and polio vaccination, particularly among migrants Response : Revised communication strategy launched Polio Plus Handbook addressing OPV safety and convergent interventions New social mobilizer flip-book addressing OPV safety and convergent interventions The New Logo From ‘Every Child’to ‘My Child’, Two Drops, Every Time. “OPV is totally safe … do not pay attention to rumors.”

15. Emergency Preparedness & Response Plan prepared & shared with State Govts EPRG formed in 23 States/UTs * (out of 35 States/UTs)

16. Response to migrants: coverage of migratory communities in states with large migratory population during each SNID # children: 0.7 mn in each round # children: 0.7 mn in each round # children: 0.5 mn in each round # children: 1.1 mn in each round

17. Actions Taken on Research & AFP Surveillance • Informing programme decisions • Seroprevalence surveys in UP and Bihar to start from 6-August • Mucosal immunity study scheduled to start from 5-September • AFP and Laboratory Surveillance • Environmental sampling started in Patna • Surveillance reviews conducted in Central & Eastern UP, West Bengal & Gujarat

18. Trends in Seroprevalence Against PoliovirusResults from Different Sero-surveys High immunity levels achieved both for P1 & P3 in 2010 through bOPV introduction

19. Current Program Priorities • Intensified surveillance for poliovirus • Full and consistent coverage of migrant and mobile populations • Intensified program in 107 High-risk Blocks of UP and Bihar • Rapid and effective response to any wild poliovirus • Identify and cover areas and populations at high risk for importation and spread of poliovirus • Identify areas with low RI coverage and strengthen it

20. Summary • Country at historic low transmission levels • Genetic & environmental surveillance confirms progress • Simultaneous progress in both endemic states • The coming high transmission season will be the test to know whether poliovirus transmission has stopped in India • Any case of Wild Polio considered as Pubic health emergency and needs quick & effective containment

21. Thanks