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• Eradication strategy is targeted mass

OPV immunization with intense virus surveillance

• Polio eradication is the largest global public health initiative ever undertaken

1988

350 000 cases

Pre-‘Acceleration’ Progress

1999

7 094 cases

Polio Eradication

Intensity of indigenous wild poliovirus transmission in 2001 (11 Countries)

Year 2000 (20 countries)

as of 18 December 2001

Zero wild viruses

1 to 4 wild viruses

5 to 20 wild viruses

More than 20 wild viruses

Importations

Under investigation

1 934 viruses

1 126 viruses

196 viruses

1998

1999

2000

Acceleration ImpactIndia as of 30 Nov 2000

Polio Eradication

196 viruses

2000

Americas RegionLuis Fermin TenorioPeru 1991

European RegionMelik MinasTurkey 1998

Western Pacific Region

Mum ChantyCambodia 1997

Polio ‘Last Cases’

Polio Eradication

Type 2 polio was last found in October 1999

Polio Eradication

Global eradication of all 3 poliovirus types anticipated

by 2005

Laboratory Containment The other half of poliomyelitis eradication

Certification of Poliomyelitis eradication requires:

Finding and controlling wild

poliovirus in human populations

+

Finding and controlling wild

poliovirus in laboratories

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

Containment

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

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

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

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

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

All post eradication immunization scenarios assume:

• global surveillance

• adequate vaccine stockpiles

• emergency response plans

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

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

Countries initiating laboratory surveys

AMERICAS REGION:

12 / 48

AFRICAN REGION: To start planning 2002 EASTERN MEDITERREAN REGION:

19 / 23

WESTERN PACIFIC REGION: 36 / 36

EUROPEAN REGION: 48 / 51

SOUTH EAST ASIA REGION: 7 / 10

“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

Timeline for US National Survey and Inventory

O N D J F M A M J J A S O N D J F M A M J J A S

Enlist support

Implement pilot survey - Phase I

Implement pilot survey - Phase II

Implement National Survey

Compile inventory

Prepare for post-eradication

Months

Year 1 Year 2

US Biomedical Laboratory Database

• 10,859 diagnostic

• 301 university (x #)

• 1,217 industry (x #)

• 11 Departmental (x #)

Pilot Surveys, Phase I

Category Institution

Academic Emory

Federal CDC

NIH/FDA

Hospital

Industry Am. Home Products

Private

State & Local Arizona

Phase I: Lessons Learned

• Cooperation good in all sectors

• Customized survey instruments/materials work best

• Greatest challenge is identifying effective communication channels

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

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