Containment of
polioviruses
2 Global Polio Eradication Initiative
Scenario
August 15: Country X reports WPV3. First case in >2 years
Minister & DG WHO informed. Emergency Plan
August 16: Order 22 million doses of OPV; delivery in 3 days
August 18: Letters to district magistrates of 45 districts
August 20: Dispatch of 75 member outbreak response team
August 22: Campaign begins
REPORT FROM LAB OF CONTAMINATION
3 Global Polio Eradication Initiative
To minimize the risk of reintroducing
facility based wild and Sabin
polioviruses to post-eradication /
post OPV communities
Polio Eradication Containment Objective
4 Global Polio Eradication Initiative
GAPIII strategy
Risk elimination: destruction of
unneeded poliovirus materials
Risk Management: minimize the risk
and consequences of PV release
through effective management and
safeguards
5 Global Polio Eradication Initiative
GAPIII strategy – risk management
Reducing risk of facility associated poliovirus infection
Primary safeguards: Minimize risk through facility design,
management, and oversight
• BSL requirements/Annex 4 of GAPIII
• legal frameworks
• national and international accreditation
6 Global Polio Eradication Initiative
GAPIII strategy – risk management
Reducing consequences of poliovirus reintroduction
Secondary safeguards: facilities in areas of high immunity
WPV facilities: full national routine polio immunization policy (IPV)
Sabin facilities: post eradication routine polio immunization policy (as
per SAGE and WHO recommendations)
Tertiary safeguards: facilities in areas with low poliovirus
reproductive rates (R0)
WPV facilities: high standards of hygiene/sanitation (closed sewage)
Sabin facilities: tertiary safeguards not required
7 Global Polio Eradication Initiative
Phases linked to achievements in global polio eradication
Phase I: National facility survey and inventory (now)
Phase II: Establishment of national long-term poliovirus policy & regulation (after Phase I)
Phase III: Global destruction and containment of polio materials (one year after last WPV and at time of tOPV/bOPV switch)
Phase IV: Global destruction and containment of OPV/Sabin materials (at time of global OPV cessation)
Global Action plan to minimize poliovirus risk Implementation
>10 WPV facilities
5-10 WPV facilities
2-4 WPV facilities
1 WPV facility
Either no WPV facility or survey data not yet submitted
Countries with WPV facilities*, 2012
180
103
56
27
22 21
*Facilities may include institutions with multiple laboratories and
holding either WPV infectious or potentially infectious materials
17
15
11
~550 WPV facilities identified to date in 46 countries
10 countries have 85% of the facilities globally
Post-OPV surveillance
2013 2014 2015 2016 2017 2018 2019
Years
Last wild polio case
Wild Virus Eradication
Sabin Virus Elimination
WPV Phase 2 containment
WPV certification
Sabin 2 elimination & validation
Containment & Certification Wild virus
eradication
1-dose IPV introduction
Sabin 2 cessation
Sabin 1 & 3 cessation
WPV
Sabin Conta
inm
ent 1o containment
2o full national IPV policy
3o location in areas with hygiene standards
1o Type 2 control Containment
All Sabins 2o Post Erad IPV use
3o Not required
Phases 1 and 2 (inventory /regulations)
Phases 1 and 2 (inventory for Sabin 2 /
regulations)
10 Global Polio Eradication Initiative
Next steps / remaining issues
Continue completion of inventories in polio
free countries (particularly India)
Begin process of Sabin 2 survey and
inventory
Finalize GAPIII with governing body approval
Begin work with Member States on national
regulatory framework
Establish expert body for evaluating profile
of candidate vaccine seed strains
11 Global Polio Eradication Initiative
THANK YOU
12 Global Polio Eradication Initiative
All countries will have completed Phase I inventory and survey
GAP3 approved by World Health Assembly
WHO will have worked with Member States to review / guide development of national regulatory policy for retaining poliovirus materials
Discussions held with national authorities and facilities to determine fate of WPV materials – many unneeded WPV materials destroyed
Discussions held with national authorities who will be overseeing risk in facilities retaining WPV materials
Full primary, secondary, and tertiary safeguards achieved in facilities and countries with WPV materials
1 year after last case of WPV What will be in place in terms of containment?
13 Global Polio Eradication Initiative
All countries will have completed Phase I inventory and survey
GAP3 approved by World Health Assembly
All facilities with WPV2 and Sabin2 infectious or potentially infectious materials identified
WHO will have worked with Member States to review / guide development of national regulatory policy for retaining poliovirus materials
Discussions held with national authorities and facilities to determine fate of the type 2 materials – many unneeded materials destroyed
Discussions held with national authorities who will be overseeing risk in facilities retaining type 2 materials
tOPV / bOPV switch What will be in place in terms of containment?