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Global eradication of poliomyelitis

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Acute flaccid paralysis surveillance 'Mopping-up' immunization (H-H) Objectives of NIDs. To immunize ALL children under 5 with a supplementary dose of OPV during 2 ... – PowerPoint PPT presentation

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Title: Global eradication of poliomyelitis


1
Global eradication of poliomyelitis
130 days
  • Key elements for
  • improving SIA

2
Strategies for Polio Eradication
  • Strong routine OPV immunization
  • programme
  • National Immunization Days (NIDs)
  • Acute flaccid paralysis surveillance
  • "Mopping-up" immunization (H-H)

3
Objectives of NIDs
  • To immunize ALL children under 5 with a
    supplementary dose of OPV during 2 nation wide
    rounds with 4-6 weeks interval.

4
Strategies of SIA
5
Polio Eradication Progress, 1988-99
350,000 cases

6,000 cases
Polio Eradication
as of 31 Jan 2000
6
Acceleration of the PEI
  • More NIDs / rounds
  • India in 1999 and 2000 4 rounds nation-wide plus
    2 rounds SNID (50)
  • DR Congo 3 rounds in 1999 and 2000
  • Angola 3 rounds in 1999 and 2000
  • Mop up in addition to NIDs
  • Nigeria
  • Ethiopia
  • Bangladesh
  • Pakistan 3 rounds in 1999 and 2000
  • House to House strategy in several countries

7
The Problem
  • Persistent circulation of wild polio virus even
    after several consecutive years of NIDs.
  • the quality of supplementary immunization (NIDs
    and SNIDs) is not consistently high.
  • some areas or groups may have low coverage or be
    entirely missed.
  • wild poliovirus still circulates in these pockets
    of unimmunized children.

8
Experience in NIDs is NOT in itself a guarantee
for quality !!!
9
Key elements for improvement
  • General planning (including funding)
  • Strategic choices
  • Micro planning
  • Logistics (fast chain)
  • Monitoring
  • Supervision
  • Social mobilization

10
Key elements for improvementGeneral planning (1)
  • Plan timely (including for funds)
  • From the beginning make a work plan and time
    table with
  • Tasks
  • Person(s) in charge
  • Deadlines
  • Critical progress indicators
  • Share work plan with other levels and request
    theirs for harmonization

11
Plan timely !!!
12
Key elements for improvementGeneral planning (2)
  • Adequate balance between national leadership and
    delegated responsibility to the district
  • Specific national responsibilities
  • Initial plan, dates, budget, etc.
  • Monitoring al all levels
  • Feed back and information to all levels
  • Final evaluation
  • Specific sub national responsibilities
  • Micro planning
  • Sub national monitoring
  • Feedback and information to national and lower
    levels

13
Ensure commitment consensus and involve other
sectors
  • National authorities
  • Major partner agencies
  • Other government departments
  • Private Sector
  • Religious Sector
  • Schools
  • Communities

14
Key elements for improvementStrategic choices
  • Targeting NID
  • increased emphasis on the planning, preparation,
    and conduct of immunization for areas or groups
    at high risk of ongoing wild poliovirus.

15
Choose appropriate strategies
  • Increase number of fixed posts
  • Moving posts
  • Mobile teams
  • Railway/bus station teams
  • Extra days to immunize children
  • House-to-house immunization

16
Key elements for improvement House to House
Immunization
  • Objective
  • To administer within the households a
    supplemental dose of OPV to all children under 5
    years of age in identified areas where the wild
    polio virus is still circulating, or where this
    is suspected

17
What are the differences?
Children go to the post
The team goes to the children in the household
In both strategies, the objective is to immunize
all children under 5
150-300 children immunized/team/day
40-150 children immunized/team/day
Usually 2-3 days
May be up to a week
Teams of 2-4 persons
Teams of 2 persons
Community involvement and MP indispensable
Community involvement and MP important
18
Key elements for improvementMicro planning (1)
  • Special attention to risk areas
  • Proven polio transmission
  • Silent areas
  • Low routine/NID coverage
  • Low access to health services
  • Populations with difficult access
  • Areas bordering endemic zones
  • Displaced populations
  • Immunize each and every child available data on
    target populations are mere guides, and not
    maximum objectives

19
Key elements for improvementMicro planning (2)
  • For each team
  • Maps and itinerary for catchment area per team
  • Clear instructions how to deal with children not
    found at home
  • Use knowledge of local conditions, geography,
    working hours (when are people home), culture...

20
Itinerary team 1
Cattle camp
Compound
River
Chief
Police
Team 2
School
Store
Market
Bus stop
21
Vaccination Teams H-H
  • Each team is composed of 2 members
  • Vaccinator
  • Record-keeper/guide

22
Market
Day 1
Day 2
Church
Supervisor
23
Elements needed for each vaccination team
  • Sufficient OPV with VVMs
  • Vaccine carrier with frozen ice-packs
  • Tally sheet to record
  • - houses visited
  • - doses OPV administered
  • - cases AFP found
  • - zero dose children
  • Means to mark houses visited
  • Hand written map of the area to cover/day

24
Key figures
How many vaccines?? Population x Percentage
target population x Wastage x Number of rounds 1
000 000 x 0.17 x 1.25 x 2 425 000 doses
Operational unit is the household 5-6 persons/hh
How many teams?? Fixed, Urban 200 - 300 children
per team per day Fixed, Rural 100 - 150
children per team per day House to house, Urban
80 - 150 children per team per
day House to house, Rural 40 - 60 children per
team per day
25
Do you really Reach the Unreached?
Example NIDs Tally Sheet
26
Do the teams cover
  • Markets?
  • Stations?
  • Slum areas?
  • Housing areas with mobile/itinerant pops.?
  • Remoter areas?
  • The top floor of apartment buildings?
  • Areas with poor road access?
  • Islands?
  • Areas where population often unreached?

27
Should the cold chain be an obstacle?
28
Key elements for improvementCold chain (2)
  • Reaching hard to reach populations
  • Distance
  • Accessibility
  • Seasons
  • Weight and volume of equipment
  • Cold chain
  • Freezing and storage capacity
  • NID cold chain over-sized for routine
  • Costs
  • Health workers
  • 20 years EPI modules
  • No ice, no move

29
OPV unstable, but it can be monitored
  • Vaccine Vial Monitor (VVM)

WHO STANDARD OPV 48 HOURS AT 37 C
30
VVM specification
  • The VVM should reach the discard point after
  • 2 days at 37C
  • 7 days at 25C
  • 180 days at 5C
  • The expiry date has priority over the VVM!!

31
VVM Experience from the field (vaccine carrier
E4/83-M)
VVM good
VVM bad
days
Icepacks melted
VVM at discard point
32
VVM specification
The absence of ice is not a reason to interrupt
immunization
  • The VVM should reach the discard point after
  • 2 days at 37C
  • 7 days at 25C
  • 180 days at 5C
  • The expiry has priority over the VVM!!

33
The fast cold chain
34
Key elements for improvement Supervision
  • At all levels
  • Number of supervisors
  • Urban 1 for 10 teams
  • Peri urban 1 for 8 teams
  • Rural 1 for 5 teams
  • Identify and pay extra attention to risk areas
  • See criteria on micro planning slide, plus
  • areas where teams do not like to go
  • Ensure mobility
  • Supervisory forms

35
Key elements for improvement Monitoring
  • At all levels
  • Independent and impartial
  • monitoring staff not from the same home area
    but from different regions and levels (higher
    level monitors lower)
  • Define, identify and pay extra attention to risk
    areas
  • Rapid assessments
  • quick and dirty
  • targeted at suspected areas

36
Key elements for improvement Social mobilization
  • Involve all relevant partners at all relevant
    levels
  • national (president), regional and district
    authorities
  • religious leaders
  • community associations
  • Use regionally appropriate materials
  • Continue mobilization during the NIDs
  • loudspeakers
  • Mosques, churches
  • Artists
  • Radio and television

Do not respect long established rules start in
time!
37
  • In the end surveillance is the only true
    indicator for success.

38
Evaluation and monitoring
  • Tally sheets simple and action oriented
  • Number of children immunized rather than coverage
  • Coverage surveys, a hot issue
  • Unreached populations

Information for action, rather than .. !!
39
H-H in Nigeria
40
Good luck
127.7 days !!
41
(No Transcript)
42
Consider using the fast chain for your routine.
It allows immunizing remote people without fixed
CC.
43
Establish planning structure responsibilities
44
Polio Last Cases
Americas Region Luis Fermin Tenorio Peru 1991
Who's next??
Polio Eradication
45
10 global priorities for eradication
Polio Eradication
46
Steps for Planning Targeted NIDs
  • Select high risk areas
  • Make maps
  • Estimate population under 5 yrs
  • Select additional strategies to reach the
    unreached
  • Make logistics resource calculations
  • Obtain extra funds people
  • Provide extra training for health
    workers/volunteers
  • Ensure quality social mobilization supervision

47
Key elements for improvementCold chain (1)
  • Cold chain
  • storage, freezing and transport quantity and
    quality
  • Supplies
  • vaccine
  • equipment
  • distribution plans
  • Organization of the site
  • access and visibility
  • layout
  • user friendly

48
Simple map to show main features and plan
activities
49
It takes courage to review ALL elements of your
strategy in the light of unsatisfactory results
Experience in NIDs is NOT in itself a guarantee
for quality !!!
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