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Polio Eradication Program in India: Actions in Post-Eradication Phase

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Title: Slide 1 Author: P.k. Saha Last modified by: P.k. Saha Created Date: 3/13/2006 1:50:39 PM Document presentation format: Custom Other titles: Arial MS Mincho ... – PowerPoint PPT presentation

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Title: Polio Eradication Program in India: Actions in Post-Eradication Phase


1
Polio Eradication Program in IndiaActions in
Post-Eradication Phase
  • By
  • Prasanta K. Saha, M.Sc., FRSS(UK), CSTAT(UK)
  • Sr. Consultant National Council of Applied
    Economic Research, India
  • Former Chief Director Ministry of Health
    Family Welfare, Additional Director General
    Ministry of Statistics Program Implementation,
    Govt. of India.
  • prasant20012001_at_yahoo.co.in, 91-11-22716998
  • 91-9873247997, 91-9818473935

2
Polio Eradication Program in IndiaActions in
Post-Eradication Phase---------------------------
------------------
  • Under the Polio Eradication program of India,
    the most relevant issues-both technical and
    administrative, which will arise in
    post-eradication situation, are discussed in this
    lecture.

3
Polio Eradication Program in IndiaActions in
Post-Eradication Phase
  • That Polio Eradication program in India is
    extraordinarily time-overrun is well known.
  • Original target was the year 2000-revised as
    2002-further revised as 2005. Unfortunately the
    last revised target of the year 2005 could also
    not be achieved.

4
Contd.
  • It is evident from the factual positions that the
    whole matter is bordering uncertainty.
  • Polio Cases in India as on 5th June, 2006
  • Total Polio Cases 2004 134
  • Total Polio Cases 2005 65
  • Total Polio Cases 2006(as on 5th June,06) 36

5
Contd.
  • Location of most recent cases Uttar Pradesh
    (23), Bihar (12) Madhya Pradesh (1)
  • Though WHO designed global eradication strategy
    in1988, India participated much late in 1995.

6
Contd.
  • Serious Actions needed in Post- Eradication
    Phase
  • First to characterize the actual factors that
    country-level policy makers must weigh to manage
    polio risks during the first 5 years after
    certification by WHO.

7
Contd.
  • Policy makers are to primarily formulate
    policies related to
  • routine and supplemental immunization,
  • outbreak response (including whether to
    create a stockpile),
  • surveillance and
  • containment of Wild Vaccine-Derived Polio
    Viruses (VDPVs).

8
Contd.
  • Global certification will occur once all 6
    Regions of World Health Organization (WHO)
    confirm no wild poliovirus under high-quality
    surveillance for at least 3 years and the Global
    Certification Commission becomes satisfied that
    sufficient laboratory containment exists.

9
Contd.
  • Determination of reasons for high incidence of
    vaccine failure
  • Answer to this query is derived from some of
    the reasons as revealed in various PPI rounds are
    as follows

10
Contd.
  • Expiry of effectiveness of a few vials of
    vaccine.
  • Portable cold storage containing the vaccines not
    providing desired cool temperature
  • Note A few vials of Polio vaccines might have
    expired their effectiveness but that might have
    escaped notice of the health workers. It has been
    experienced that in rural areas

11
Contd.
  • the portable cold storage containing the
    vaccines does not provide desired cool
    temperature as the ice kept inside gets melted
    after sometime and there is no scope of filling
    it with fresh ice because the same is not
    available in the locality NPSU, WHO regional
    office, New Delhi may supplement with further
    information.

12
Contd.
  • Even that great event of eradication of Polio
    takes place in India in near future, there are
    more serious concerns in the post -eradication
    phase which will need appropriate attention and
    actions. Those technical problems are narrated
    below

13
Contd.
  • As eradication process approaches finishing line,
    there is greater need for new polio vaccines.
  • These new vaccines will be needed to create a
    stockpile for future outbreaks.

14
Contd.
  • Experts may be aware
  • (1) After eradication there was again outbreak
    of Polio in China after 5 years, Hispaniola
    after 6 years, the Philippines after 4
    years, Madagascar after 3 years and in Egypt
    perhaps, after 25 years.

15
Contd.
  • (2) Effective bio-containment of all existing
    polio viruses is essential to minimize risk of
    accidental infections.
  • Such arrangement is yet to be initiated in
    India.

16
Contd.
  • OPV Cessation Plan
  • As concerned experts dealing with eradication
    program may be aware, after eradication, use of
    OPV Oral Polio Vaccine should be discontinued
    to minimize the possibility of mutated strains of
    vaccines leading to new out-breaks.

17
Contd.
  • WHO has discovered that out-break in China was
    caused by Circulating Vaccine Derived Polio Virus
    (cVDPV) mutated from OPV.
  • Normally after eradication, manufacturing of
    trivalent OPV gets stopped.

18
Contd.
  • This plan will take into account the risk of
    reintroducing virulent poliovirus from a
    laboratory or a manufacturing unit.

19
Contd.
  • So there is need of manufacturing mono-valent OPV
    mOPV ( WHO, perhaps, has granted license to
    some Indian company).
  • A proper strategy is to be formulated to
    guarantee that Polio outbreak does not recur.

20
Contd.
  • Recent discussions predominantly focused on
    stopping immunization as the ultimate goal of the
    eradication initiative and on characterizing
    related issues.

21
Contd.
  • Policy Options for the First 5 Years Following
    Certification
  • From the analysis of the implications of
    delays in outbreak response, experts recommended
    (a) maintaining active surveillance for at least
    5 years after ceasing all polio vaccination, (b)
    minimizing delays in diagnosis and confirmation
    of an outbreak,

22
Contd.
  • (c) restricting poliovirus work to a few
    high-level containment laboratories, (d)
    maintaining OPV manufacturing capacity, and (e)
    establishing a stockpile and a response protocol
    for outbreaks.

23
Contd.
  • Routine Immunization
  • Current policies
  • The decision to vaccinate routinely requires
    choosing both the type of vaccine for use and the
    schedule for vaccine administration.
  • Currently, the WHO recommends that each child
    receive 4 doses of trivalent oral polio vaccine
    tOPV

24
Contd.
  • (administered at 6, 10, and 14 weeks, with the
    fourth dose given either at birth or within the
    first year) in order to be fully protected
    against polio.
  • Consistent with this recommendation, most
    countries perform primary vaccination (defined as
    the first 3 doses of polio vaccination) with tOPV.

25
Contd.
  • Post-certification options
  • In the post-certification era, routine
    immunization policies include stopping
    vaccination altogether, using the same or a
    different vaccine, and changing or maintaining
    the vaccination schedule.

26
  • Containment Strategies
  • Current policies
  • Containment strategies focus on reducing the
    risk of reintroduction of poliovirus into the
    environment, notably through vaccine
    manufacturing facilities and laboratories that
    handle materials that could contain poliovirus
    (wild or vaccine-related).

27
Contd.
  • WHO recommends that laboratories handle wild
    poliovirus infectious or potentially infectious
    materials under biosafety level procedures.
  • According to guidance of WHO policy, countries
    are required to complete a national inventory of
    wild poliovirus infectious materials and
    potentially wild poliovirus infectious materials
    before global certification of eradication.

28
Contd.
  • Management of Chronic Excretors of
    Polioviruses
  • Current policies
  • No known cases exist of chronic excretion of wild
    poliovirus.
  • WHO reports have catalogued a cumulative
    experience consisting of a total of 19
    immuno-deficient chronic excretors of
    vaccine-derived polioviruses (iVDPV) globally in
    more than 40 years of OPV use. These individuals
    lived in middle level to upper-level income
    countries, primarily in the United States and
    Europe.

29
Contd.
  • Management of Chronic Excretors of Polioviruses
    Current policies-continued
  • Assessment of the sensitivity of the AFP
    surveillance system for detecting iVDPV is
    needed, given that prolonged excretion may occur
    prior to the development of paralysis.
  • To manage the risk of reintroduction of
    poliovirus to the community from identified
    patients, countries may choose whether to conduct
    screening and/or offer education about strategies
    for minimizing exposure to others.

30
Contd.
  • Acknowledgement
  • 1. Nature,Vol.434,April,2005 A global call
    for new polio vaccines
  • 2. Dr. François Bompart, Aventis Pasteur, 2,
    avenue Pont Pasteur, 69367 Lyon Cedex 07, France.
  • 3. Nalinee Sangrujee, PhD, MPH Radboud J.
    Duintjer Tebbens, MS and others Medscape
    General Medicine Policy Decision Options During
    the First 5 Years Following Certification of
    Polio Eradication. www.medscape.com

31
PEP in IndiaActions in Post-Eradication Phase
  • THANKS
  • For any query I may me contacted through my
    e-mails
  • pkssaahhaa_at_hotmail.com
  • prasant20012001_at_yahoo.co.in
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