pei update - epidemiology and interventions
TRANSCRIPT
Polio Eradication Afghanistan
Poliovirus Epidemiology and Interventions Afghanistan
Meeting Technical Advisory Group March 24-25, 2011
Islamabad
Presentation outline
• Epidemiology
• Interventions 2010-11
• Challenges, Priorities and Plans
Map of Afghanistan by province and population density
Pakistan
Uzbakistan
Turkmanistan
Iran
Tajikistan
China
Dot = 20,000 Pop
Northeast
Northern
Western
Southern
Southeast
Central
Eastern
Regions - 7
Province - 34
Districts – 329
Target <5 years-7.8 mil
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Classification 2009 2010 2011
Reported AFP cases
1477 1572 278
Confirmed 38 25 1
Compatible 11 5 0
cVDPV2 1 5 1
Discarded 1427 1537 203
Pending - - 73
Comparison of AFP Cases by Classification 2009-2011 Afghanistan
Compared to 2009, there is reduction in number of confirmed cases by 34%
Data up to 16 Mar 2011
$
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Distribution of polio cases 2009-2011 Afghanistan
RegionConfirmed cases2009 2010 2011
Central 1 0 0
East 2 3 0
South east 0 0 0
South 34 19 01
North 0 0 0
Northeast 0 1 0
West 1 2 0
Country 38 25 01
2009
2010
2011
P1
P3
Data up to 16 Mar 2011
Polio virus Circulation is localized, mainly in high districts of Kandahar and Helmand Province
Although sporadic cases detected from East and N.East but no evidence of established circulation
Distribution of confirmed cases in Afghanistan 2008-11 and Area of 13 High Risk Districts
HilmandNimroz
Kandahar
Uruzgan
Zabul
RegGarmser
Dishu
Chahar Burja
Chakhansur
Day Kundi
Panjwayi
Nad Ali
Khash Rod
Maruf
Gizab
Washer
Daman
Chora
Spin Boldak
Baghran
Shorabak
Kijran
Arghistan
Naw Zad
Shahristan
Qalat
Maywand
NeshKajaki
Shah Wali Ko
Daychopan
Shamulzayi
Kang
Arghandab
Shinkay
DihrawudTirin Kot
Ghorak
Musa Qala Shahjoy
Khas Uruzgan
Atghar
Mizan
Shahidi Hass
Khakrez
Nahri Sarraj
Lashkar Gah
Zaranj
Tarnak Wa JaSangin
Kandahar
Naway i Bara
Despite number of rounds poliovirus is isolated at regular intervals indicating continued circulation with a shift from P3 to P1 type in 2010 -11
Almost 80-90% of the confirmed cases reported from the 13 High Priority Districts. Target Population of these districts is 54% of the region and 9% of the Country .
AFP Cases with isolation of cVDPV2 reported during 2010-11 Southern Region Afghanistan
2010 cVDPV2
2011 cVDPV2
Data up to 16 Mar 2011
Five cVDPV2 cases reported during Jun-Dec 2010 and one in 2011 Nad Ali Dist Helmand Almost 30-50 % of the target remain inaccessible in most of the rounds. SIAs coverage also ranged between 18-60%
Routine vaccination coverage among AFP cases <24 months is 9%
tOPV used in July SNIDs only in NadAli. An additional round with tOPV in 4 districts followed by tOPV in November NIDs.
3 rounds of accelerated routine EPI are planned in 2011. First round completed and 7700 children below 1 year vaccinated with tOPV.
Guidance from TAG is requested
Hilmand
Kandahar
Urozgan
Zabul
Nimroz
Characteristics of polio cases 2010-11 Afghanistan
• The Median age of all polio cases is 18 months ranging from (4-144)
• The Median OPV dose of all confirmed polio cases is 4 while among non polio cases it is 13
• 14 out of 21cases in the southern provinces have not received OPV through routine while 8 cases have not received any OPV dose.
• In 2010, 17 cases are of P1 type and 8 cases of P3 type. One case reported for 2011 is also P1 type
• Genetic study of most cases reported from South are indicating indigenous circulation of the virus while cases reported from East, North East and the recent 2011 case from Kandahar matches closely with circulation across the border in Pakistan.
Data up to 16 Mar 2011
Cross border Epidemiological situation and Risks Afghanistan 2010-11
•Continues circulation of virus in KPK Pakistan is posing great risk of virus transmission to the Eastern and Southeastern regions of the country
•Polio outbreak in Tajikistan and transmission of virus to Afghanistan was another epidemiological risk during 2010
Transmission, High risk & non transmission zones Afghanistan 2011
• Transmission zone
South & Farah: with on going virus circulation
• High Risk zone
East, South eastern regions: Risk of virus transmission from across the border
• Non Transmission Zone:
Central , north , northeast. Western region: no evidence of established virus transmission. Transmission
High Risk
Non-Transmission
Out of the house (FM) Surveys (Transmission , Non Transmission &High risk Zones) Feb 2010 to Jan 2011
PCA- Proportion of clusters by Transmission, High risk and non-transmission zone by FM, Afghanistan 2010-2011
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%M
ay
Jun
Jul
Oct
Nov
De
c
Jan
-11
May Ju
n
Jul
Oct
No
v
De
c
Jan-
11
Ma
y
Sep Oct
Nov
Pe
rce
nta
ge
<90 90-94 95+Data up to 16 Mar 2011
Transmission Zone High Risk Zone Non-Transmission Zone
Routine Vaccination of AFP cases 6-23 Months by Region, 2007-Mar 2011 Afghanistan
0%
20%
40%
60%
80%
100%Y
07Y
08Y
09Y
10Y
11
Y07
Y08
Y09
Y10
Y11
Y07
Y08
Y09
Y10
Y11
Y07
Y08
Y09
Y10
Y11
Y07
Y08
Y09
Y10
Y11
Y07
Y08
Y09
Y10
Y11
Y07
Y08
Y09
Y10
Y11
Y07
Y08
Y09
Y10
Y11
3+ DOSES 2 DOSES 1 DOSE UNVACC
South+Farah SoutheastEast Central West North Northeast Badakhshan
Data up to 16 Mar 2011
Steps Taken: SIAs Activity Afghanistan 2010-11Feb-SNID Mar-NID May-NID Jun-Mop up + SNID
Jul-SNID Sep-Mop up Oct-NID Nov-NID Dec-SNID
tOPV mOPV1bOPV3 Not included
•Two rounds of NIDs with bOPV and two with tOPV conducted in 2010. Also 4 rounds of SNIDs with bOPV•Afghanistan introduced De-worming: Using house to house network of polio vaccination teams targeting 4.6 million children of age 2-5 years of age in October NIDs
Jan- Mop up
Feb-SNID Mar-NID May-NID Jun-SNID 2011
2010
Data up to 16 Mar 2011
Steps Taken at Strategy and Policy level , PEI Afghanistan 2010-11
At the strategy and policy level
• Policy and Dialog Group chaired by H.E Minister of Public Health Afghanistan, meeting regulalrly and discussing the policy and strategy issues.
• Informal consultative Group (ICG) mainly for 13 high priority districts. Chaired by DG preventive medicine. WHO and Unicef also member.
• Establishment of PIT for Joint planning, monitoring and resource sharing
• Integrating de worming with polio campaigns to increase demand for vaccination.
• H.E Minister of Public Health Signed MoU with ARCS on their involvement in PEI
Steps Taken : Access and Staff Safety, PEI Afghanistan
• Maintained close coordination with ICRC and assigned DSTs, DC through ICRC in selected districts
• Hiring Local Access Negotiators
• Keeping neutrality of the program
• Promote selection of local staff to be acceptable for community
• Coordination with ISAF and ANA
Overall trend of inaccessible children in number and %age Southern region 2009 & 2011
2009 2010-2011
Month Target # inaccessible % Month Target # inaccessible %
Jan 1249321 235794 19 Feb 1298495 126748 10
March 1249321 182786 15 March 1298495 90233 7
April 1249321 187442 15 May 1298495 82782 6
May 1249321 212784 17 June 1298495 80510 6
June 1249321 95078 8 July 1298495 82500 6
Jul 1249321 62912 5Oct 1298495 109563 8
sep 663290 30788 5 Nov 1298495 92763 7
Oct 1249321 147325 12 Dec 1298495 96986 7
Nov 1249321 105449 8Jan ,2011 1330742 72423 5.4
Dec 1249321 153220 12
Steps Taken: Improve Campaign Quality in 13 HRDs, Afghanistan
• District Specific Plans for all 13 HR districts completed in August, 2010 at Kandahar
• Strengthening District SIAs Management by assigning District Managers in all 13 Districts by September 1, 2010
• Capacity building trainings completed for key SIAs Staff in 13 high risk District in July 2010 by special training consultants.
• Maintain and expanding involvement of BPHS NGO as implementing partner in 4 districts of Farah and 2 districts of Kandahar in 2010.
Trend of Vaccination from May -2010 to Jan-2011 SIAs in 13 high risk districts of Southern Region, 2010, Afghanistan
(Coverage Adjusted for Inaccessible children)
Steps Taken: Cross border Coordination, PEI AfghanistanCovering the target children on the move crossing
border from Pakistan and Afghanistan
Permanent Vaccination Posts • Permanent posts vaccinated almost
around 1 mil <5 years old children in 2010
Returnees • Almost 8000 children of Returnees
are vaccinated in 2010
Nomads• Special Vaccination Teams and plans;
Almost 13500 children are vaccinated by South East region during June 2010 rounds
Coordination• Maintaining high level coordination
and SIAs are synchronized with Pakistan
Steps Taken in Non transmission zone, 2010 Afghanistan
Preparedness and response :
• Two rounds on Mop up in the North east and Balkh province of Northern region using mOPV1
• Establishment of 4
vaccination posts between the borders of AFG TAJ and one post with Uzbekistan
• Continue risk prediction analysis
• Strengthening AFP
surveillance Activity
Nov 10Districts >=95%
Districts 90-94%
Districts <90%
Range
FMBalkh Kunduz Takhar Badak
75-100 89-100 87-100 93-100
Range
FMBalkh Kunduz Takhar Badak
85-100 89-99 93-100 88-98Oct-10
Gornyi Badakhshan
KulyabSukhandariya
Kurgan-Tube
Districts of Republic Subordination
Dushanbe City
Balkh
Badakhshan
Baghlan
TakharKunduz
Uzbekistan Border
Tajikistan Border
Priorities and Plans 2011, PEI Afghanistan
• Priority 1: 13 High Risk Districts– Efforts of improve access (ICRC, NGOs, ARCS)
– High risk cluster approach
– SIADs and Accelerated EPI (CHW)
– Special communication plans
• Priority 2: Maintain PEI under difficult security situation– Continuation of sensitive surveillance
– Alternate ways of monitoring
– Window of opportunity
• Priority 3: Ensuring PEI services among underserved population– IDPs, Nomads, Returnees and other mobile groups
• Priority 4: Strengthening Community bases surveillance
• Priority 5: Preparedness and timely response
• Priority 6: New partnerships (ARCS, Animal Health) and advocacy
• Priority 7: Using PEI Network to Strengthen Routine EPI
THANK YOU