GLOBAL POLIO UPDATES AND HEALTH SYSTEMS STRENGTHENINGCGPP-ADRA INDIA ANNUAL REVIEW MEETING,17TH-18TH MAY 2016, MUSSOORIE

Dr. Suchitra Lisam, National Health Programs Manager, ADRA India

PRESENTATION OUTLINE

PART I : POLIO AT A GLANCE PART II: GLOBAL POLIO UPDATES PART III: END GAME /ERADICATION

TIMELINES PART IV: HEALTH SYSTEMS

STRENGTHENING, POLIO LEGACY IN INDIA

POLIO AT A GLANCE

PART I

POLIO AT A GLANCE Global Polio Eradication Initiatives (GPEI)

is a public-private partnership spearheaded by WHO, Rotary International, US-CDC and UNICEF supported by key partners including BMG Foundation and GAVI- the vaccine alliance

99% reduction in polio since 1988 350,000 cases in 125 endemic countries in 1988 74 cases in 2 endemic countries (Pakistan,

Afghanistan) in 2015 3 types of wild polio viruses (type 1, 2, 3) Wild poliovirus type 2 last detected in 1999,

global eradication declared in Sep 2015

POLIO AT A GLANCE –contd. Wild poliovirus type 3 not detected since Dec 2012 2 types of vaccine- OPV and IPV More than 1.5 million childhood deaths prevented

since 1988 15 million cases averted since 1988 More than 5000 m child immunized every year

through Routine Immunization and campaigns World Health Assembly has declared completion of

polio eradication as a programmatic emergency for global public health.

ELIMINATION STATUS

GLOBAL UPDATES

PART II

GLOBAL UPDATES (April’16)

The Global Oral Polio Vaccine Switch, statistics on WPV/cVDPV

Immunization week Strategic Advisory Group of Experts on

Immunization (SAGE) Meeting Protecting Children in Countries

Vulnerable to Polio

GLOBAL OPV SWITCH

GLOBAL OPV SWITCH-contd.

From the 17 April to the 1 May, 155 countries and territories participated in the historic trivalent to bivalent oral polio vaccine switch, withdrawing the type 2 component of the vaccine to protect future generations against circulating vaccine derived polioviruses (cVDPV)

Type 2 component of the oral polio vaccine (OPV) is being removed from use from the trivalent to bivalent oral polio vaccine to withdraw OPV in a phased manner starting with type 2 component following the eradication of wild poliovirus type 2 in September 2015

 

GLOBAL OPV SWITCH-contd.

152 of 155 (98%) countries and territories have stopped using the trivalent oral polio vaccine.

Independent monitoring to ensure the switch goes smoothly has begun in 126 of 153 countries (82%).

The National Validation Committee has received switch monitoring data from 16 of 153 countries.

The WHO Regional Office has received the National Validation Report from 10 countries. 

GLOBAL OPV SWITCH-Contd.

WPV TYPE 1 & cVDPV -STATISTICS

Total cases

Year-to-date 2016

Year-to-date 2015 Total in 2015

WPV  cVDPV  WPV  cVDPV  WPV  cVDPV

Globally 12 3 23 1 74 32

- in endemic countries

12 0 23 1 74  3

- in non-endemic countries

0 3 0 0 0  29

CountriesYear-to-date

2016Year-to-date

2015 Total in 2015Onset of paralysis of  most  recent

case

WPV cVDPV  WPV  cVDPV  WPV cVDPV   WPV  cVDPV

Afghanistan 4 0 1 0 20 0 27-Mar-16 NA

Pakistan  8 0 22 1 54 2 22-Mar-16 09-Feb-15

Guinea 0 0 0 0 0 7 NA 14-Dect-15

Lao PDR  0 3 0 0 0 8 NA 11-Jan-16

Madagascar 0 0 0 0 0 10 NA22-Aug-15

Myanmar 0 0 0 0 0 2 NA 05-Oct-15

Nigeria 0 0 0 0 0 1 NA 16-May-15

Ukraine 0 0 0 0 0 2 NA 07-Jul-15

VULNERABLE COUNTRIES

Polio remains endemic in two countries – Afghanistan and Pakistan.

Until poliovirus transmission is interrupted in these countries, all countries remain at risk of importation of polio, especially vulnerable countries with weak public health and immunization services and travel or trade links to endemic countries.

Circulating vaccine-derived poliovirus is causing an outbreak in Madagascar, Guinea and Ukraine. 

Vulnerable countries : Cameroon, Equatorial Guinea, Ethiopia, Iraq, Nigeria, Somalia, South Sudan and Syrian Arab Republic.

POLIO IN NUMBERS-2016 Wild poliovirus in 2016 - Global Total: 12 (23) - Global WPV1: 12 (23) - Global WPV3: 0 (0) Endemic: 12 (23) -Afghanistan: 4 (1) - Pakistan: 8 (22) Importation Countries: 0 (0)

Data as of 27 April 2016. Numbers in brackets represent data at this time in 2015

POLIO PUBLIC HEALTH EMERGENCY

Temporary Recommendations to Reduce International Spread of Poliovirus

On 5 May 2014 the Director-General declared the international spread of wild poliovirus in 2014 a Public Health Emergency of International Concern (PHEIC) under the International Health Regulations [IHR 2005], issued Temporary Recommendations to reduce the international spread of wild poliovirus, and requested a reassessment of this situation by the Emergency Committee every 3 months.

The eight meeting of the Emergency Committee was held in February 2016.  Based on the committee’s advice and the reports made by affected States Parties, the Director-General extended the following Temporary Recommendations under the IHR (2005), effective February 2016.

WORLD IMMUNIZATION WEEK

In 2016(April) there have only been 12 cases of polio, down from 23 cases in the same period for 2015.

World Immunization Week took place between 24 – 30 April with the theme “Close the Immunization Gap”.

SAGE MEETING Recommends amendments of

surveillance case definition to include type 2 Sabin so that all type 2 polioviruses will be notified

Urges all countries to ensure completion of phase I for all type 2 polioviruses, incl. Sabin 2

Endorsed the components of updated MOV strategy to improve coverage, equity and timeliness of vaccination

Implementation research- more attention

Immunization specific indicators to assess progress towards <5 mortality target of SDGs

PROTECTING CHILDREN IN VULNERABLE AREAS

Keeping levels of immunity high by strengthening RI, carrying out polio vaccination campaigns and keeping vigilant surveillance systems for early warning should the virus return is a top priority for the GPEI.

In Jordan, the Ministry of Health with the support of WHO, UNICEF and partners, recently completed a mass immunization campaign against polio, reaching >1 million children <5 across the country with OPV

KEY CHALLENGES

Delivering quality health services. Improving reach, tracking missed children

with OPV in endemic countries Keeping up the pressure Despite the gains, there is still much to be

done, not only in Afghanistan and Pakistan but also in countries with declining immunization rates. So long as polio continues to circulate anywhere, children everywhere are at risk.

END GAME PLAN/ ERADICATION TIMELINES

PART-III

Polio Eradication and Endgame Strategic Plan 2013–2018

IPV INTRODUCTION TIMELINES

POLIO ERADICATION TIMELINES

GPEI AND HEALTH SYSTEMS STRENGTHENING, POLIO LEGACY-HEALTH SECTOR

PART -IV

BUILDING BLOCKS FRAMEWORKS OF HEALTH SYSTEMS

POLIO LEGACY/SCOPE IN VPDs PROG

Over the past 25 years, GPEI-funded personnel and infrastructure have supported the distribution of global and country health priorities including

anti-measles vaccines vitamin A supplements anti-malarial bednets deworming pills surveillance for yellow fever and avian

influenza

INDIA POLIO LEGACY Polio legacy in Action Mainstreaming critical polio eradication functions into

other priority health programmes Ensuring that the best practices and knowledge

gained over years are shared with other health initiatives

Transitioning certain polio functional areas to government counterparts

Transitioning the capacities, processes and assets created by the programme to support other vaccine preventable diseases & strengthening health systems

TRANSITION OF ACTION Polio funded assets of WHO, UNICEF & CORE and

others are supporting RI strengthening activities in India

Lessons learnt from polio/best practices being applied for RI & control/elimination of VPDs

Mission Indradhanush (MI) as a good example of government led legacy in action for RI campaigns.

Other transition areas- health, sanitation, nutrition, Ebola

Transition/Legacy Plans are progressing and new initiatives to bring it under one umbrella.

Legacy Documentation is a major priority, ongoing

TRANSITION OF ACTION Transitioning assets/functions and applying lessons learned Strengthening routine immunization • Intensified RI monitoring –

generating data on quality of immunization, availability of vaccines/logistics, reasons for low RI coverage and Zinc/ORS availability.

Accountability through Task Forces, established in 36 states and 668 districts to review program data.

Capacity building of frontline workers Advocacy and integrated communication including high risk areas in RI

session planning – 96% of high risk areas now included in RI micro plans.

New vaccine introduction (Pentavalent; IPV, MR, Rotavirus) – Developing field guidelines, training material and checklists for assessing preparedness at district/state levels; conducting post-introduction and coverage evaluations. Measles elimination and rubella control –

TRANSITION IN ACTION

Supported catch-up campaigns covering approximately 119 million children. Visceral leishmaniasis (Kala Azar) elimination – Monitoring indoor residual spraying; contributing to national elimination strategy development. VPD surveillance

Coordinating validation of MNT elimination; capacity building for lab personnel; launched lab supported surveillance for diphtheria, pertussis and neonatal tetanus with expansion planned in 2015

AEFI surveillance – Assisting with updated guidelines; training AEFI committees; supporting electronic case reporting. Supporting international health programs – Indian SMOs deployed to Nigeria, Sierra Leone and Liberia in 2014-15.

LEGACY DOCUMENTATION Completed Hosting Learning Missions –

Afghanistan and Pakistan Documents on

Transition/Successful Strategies in States

Completed Legacy photographic book

– demonstrating innovations/game

changers to triumph over polio Several films 7 documenting

Social Mobilization strategies, new

PBS film on transition polio to RI, short

film polio for RI. India Polio Learning Exchange

website

Underway/planned 2015-2016 Joint papers with WHO, GOI and partners under discussion SMNet Legacy Review (PWC) – critical factors for success,

SMNet location/# for RI, and transition

options SMNet Impact on RI,

Convergence, Diarrhea morbidly and mortality IPV Introduction preparedness KAP Impact on the mobilizers

themselves

THANK YOU!