Polio eradication programme in India – Progress, Response and

Issues for action

Dr Ajay KheraDeputy Commissioner

Ministry of Health & FW, Govt. of India

Presentation Prepared for IEAG Meeting on 13th July, 2011 at New Delhi

A Snapshot of Polio Situation in India

P1 wild P3 wild

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

42 1

mOPV 1bOPV

State P1 P3 Total

Bihar 38 79 117

Uttar Pradesh** 34 569 602

Delhi 3 1 4

Punjab 2 2 4

Jharkhand 2 0 2

Rajasthan 1 2 3

Haryana 0 4 4

Uttarakhand 0 4 4

Himachal Pradesh 0 1 1

Total 80 662 741

WPVs

Geographical distribution of Wild Polio cases during last two years

** One case reported mixture of P1 wild & P3 wild

State P1 P3 Total

West Bengal 6 2 8

Maharashtra 5 0 5

Bihar 3 6 9

Jharkhand 3 5 8

Jammu & Kashmir 1 0 1

Uttar Pradesh 0 10 10

Haryana 0 1 1

Total 18 24 42

WPVs

2009 2010

A single case of WPV1 detected in India in 2011 – in Howrah, West Bengal

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 transmission in past 6 months

AFP surveillance and polio situation in 2011

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

State P1 P2 Total

Chhattisgarh 1 1

Madhya Pradesh 1 1

Rajasthan 1 1

Uttar Pradesh 1 1

Total 4 4

VDPVs

Year AFP WPV Compatible VDPV

2009 50405 741 473 21

2010 55781 42 188 5

2011 24314 1 1* 4

No circulating VDPVsNo genetic linkage amongst 2011 VDPVsNo genetic linkage with VDPVs of 2009 & 2010

*Classification of cases pending

Wild Polio Virus in environmental (sewage) samples

2006 2007 2008 2009 2010 20112005

Mumbai

WPV1 WPV3Delhi

Collection of sewage samples started from April

2010

Samples not collected between March 2006 and April 2007 due to

fire in Mumbai Lab

Note: six samples reported mixture of P1 wild & P3 wild in 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

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

WPV3 cases in endemic states, 2009-2011*

Uttar Pradesh

Bihar

2009 2011*2010

• Transmission limited to western UP & central Bihar• No WPV3 case in endemic states for 13 months

Champaran East

Bihar, WPV1 spill over, 2010

• 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

Bihar

Nepal

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

• 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

mOPV1

bOPV

mOPV3

tOPV

WPV1

West Bengal

Jharkhand

Jan10

Feb10

Mar10

Apr10

May10

Jun10

Jul10

Aug10

Sep10

Oct10

Nov10

Dec10

Jan 11

Feb 11

Mar 11

Apr 11

May 11

West Bengal & Jharkhand, Mix transmission area, 2010-11

• 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

mOPV1

bOPV

mOPV3

tOPV

WPV1WPV3

Pulse Polio Response : SIAs conducted during 2011

23 Jan

March

2nd week Feb 27 Feb

mOPV1mOPV3

bOPV

tOPV

April MayJune

Quality of Response during 2011 regarding SIA Pulse Polio activities

(Percent average children found unimmunized, End-of-round survey)

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

From ‘Every Child’to

‘My Child’, Two Drops, Every Time.

The New LogoPolio Plus Handbook

addressing OPV safety and convergent interventions

New social mobilizer flip-book addressing OPV safety

and convergent interventions

“OPV is totally safe … do not pay attention to rumors.”

Response : Revised communication strategy launched

Emergency Preparedness & Response Plan prepared & shared with State Govts

EPRG formed in 23 States/UTs *

(out of 35 States/UTs)

Response to migrants: coverage of migratory communities in states with large migratory population during each SNID

# children: 0.7 mn in each round

# children: 0.5 mn in each round

# children: 1.1 mn in each round

# children: 0.7 mn in each round

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

Trends in Seroprevalence Against PoliovirusResults from Different Sero-surveys

Moradabad Nov 2007(N=121)

AFP cases UPNov 08 –

mid 09(169)

Moradabad May 2009(N=534)

UP & BiharAug 2010(N=1280)

Age 6-7 mo 6-11 mo 6-7 mo 6-7 mo

Type 1 78% 96.5% 99% 98%

Type 2 56% 33.7% 75% 65%

Type 3 69% 42.6% 49% 77%

High immunity levels achieved both for P1 & P3 in 2010through bOPV introduction

Current Program Priorities

1. Intensified surveillance for poliovirus

2. Full and consistent coverage of migrant and mobile populations

3. Intensified program in 107 High-risk Blocks of UP and Bihar

4. Rapid and effective response to any wild poliovirus

5. Identify and cover areas and populations at high risk for importation and spread of poliovirus

6. Identify areas with low RI coverage and strengthen it

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

Thanks