progress on detection & interruption of poliovirus transmission
TRANSCRIPT
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SAGE
1 April, 2014
Trigger for OPV2 Withdrawal: Prospects for interrupting persistent cVDPV type 2
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Context: Target Date for tOPV cessation: Low Season (April) 2016
Outline:
• Current cVDPV type 2 transmission
• Prospects of Interrupting cVDPV 2
• Areas at risk of cVDPV 2 emergence and spread
• Mitigating risk of emergence around tOPV cessation
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cVDPV type 2 cases, 2011-13
cVDPV2 polio cases only: Affected countries = 11
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AFP cVDPV2 cases only: Affected countries = 6 (NIE, NIG, CAE, CHA, AFG, and PAK) Since 1-Apr-2013
cVDPV type 2 cases, last 12 months
cVDPV2 Case
District
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cVDPV type 2 cases, last 6 months
cVDPV2 Case District
Monthly distribution of cases by country
Persistent cVDPV 2
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2013: 16 cVDPV2 positive samples (Sokoto 6, Kano 2 and Borno 8) 2014: 6 cVDPV2 (Kano 1, Sokoto 1 and Borno 4)
Environmental Surveillance, Nigeria last 12 months
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Jakara Police Station
Gogau Fagge Station
Kurna Masallachi Station
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Kofar Dundaye `
Kofar Kware
Tudun Wada
Rumbukawa
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Otumara Ilaje Bridge
Ijora Canan Site
Maracana Field
Alh Jimoh Street `
Makoko
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Limancin Kaura Junction
Rigasa
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Wupa Treatment Plant
OK Pure Water Lugbe
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GONI ADAM JUNCTION
ABBA GANARAM FILLNI ST.
GAMBORU MARKET BRIDGE
BUDUM ROUND ABOUT
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RAFIU ATIKU BRIDGE
TALAKAU SITE
TUDUN WADA
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Kofar Marusa
Kofar Goga
Nasarawa Day Quarters
WPV1 WPV3 cVDPV2 Negative for WPV Result pending Update: 21 March 2014
WPV1 + cVDPV2
KEBBI
KANO
SOKOTO
LAGOS
KADUNA
FEDERAL CAPITAL TERRITORY (FCT)
BORNO
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Katsina
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Last 6 months
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AFP case – Chad outbreak
ENV positive state– Chad outbreak
ENV positive state– Nigeria outbreak
Sokoto: 13 positive samples in 2013 2 positive samples in 2014 Some ‘Orphan Strains’
Kano: 2 positive samples in 2013 (last collection date 24-Dec-13)
Borno: 14 positive samples in 2014 4 AFP case in 2013 and 2014 (last onset date 9-Feb-14)
Adamawa: 1 AFP case (onset date 3-Nov-13)
Data as of 27-March-2014
Nigeria AFP & ENV cVDPV2 Strains, 2013-14
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Challenges to Interrupting
cVDPV 2
• Co-circulation of cVDPV 2 & wild type 1
– SIA vaccine regimen mainly bOPV
• Inaccessibility & insecurity
• Gaps in quality of SIAs
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Co-circulation of cVDPV 2 & wild
poliovirus type 1
FATA, Pakistan Borno, Nigeria
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BORNO, Access Trend
Mar 100%
Dec 14%
Inaccessibility
Inaccessibility FATA, Pakistan
No Vaccination of children since mid-2012
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BORNO LQAs trend
Gaps in Quality
KANO LQAs trend
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Prospects for interrupting Persistent cVDPV 2
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tOPV SIAs, Last 12 months
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tOPV SIAs, last 6 months
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Planned tOPV SIAs, next 6 months
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Additional Plans
• Pakistan
– Restore health facilities and start RI in N Waziristan
– Use of tOPV & IPV after resumption of SIAs in N Waziristan
• Nigeria
– tOPV vaccination in infected LGAs
– Use of IPV in Borno
– Improving routine immunization
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Timeline for stopping cVDPV with Sabin 2 withdrawal date of April 2016
June – March
10 months to
stop cVDPV 2
Nigeria: 2 tOPV SIAs; Pakistan: 1 tOPV SIA next 6 months -
SIA Plans in Nigeria and Pakistan will be reviewed and updated in April 2014
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SIA Strategy to reduce risk of
emergence & spread of
cVDPV 2
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tOPV SIAs, last 12 months
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India China Tier 1 Tier 2 Tier 3 Tier 4
12 countries
19 countries
14 countries
77 countries
83% 38% 61% 72% 24% 100%
Tiers of OPV-using countries and birth cohort % of birth cohort
# of countries
20
National/sub-National tOPV SIAs in Tier 1 & some Tier 2 Countries each low season, until cessation of tOPV
Sub-national SIAs in some countries e.g. China & India
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Strategies to mitigate the risk of cVDPV 2 emergence
• Full security and personnel deployment
Strategy All Countries Tier 1 Countries
Tier 2 Countries
IPV Introduction
+++
Improve RI +++ ++
*Preventive tOPV SIAs
+++ +
*Preventive tOPV SIAs in low season of 2015 & 2016 in Tier 1 countries/areas and selected Tier 2 countries/areas
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*02 Oct 2013 – 01 April 2014
WPV1 and cVDPV 2 cases, last 6 months
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Issues for Discussion
• Should equal priority be given at this stage to interruption of cVDPV 2 and WPV1?
• At what point would it become necessary to reconsider the target date of tOPV cessation?
• Is the approach to introduce IPV, improve routine immunization coverage and conduct ‘preventive’ tOPV SIAs in Tier 1 and selected Tier 2 countries sufficient to reduce the risk of cVDPV 2 emergence?