Transcript AFP Surveillance Reporting

Poliovirus Surveillance
status of quality, actions to improve sensitivity
WHO-India
15 March 2012
Outline of the presentation
• National overview of AFP surveillance in India
• Areas/Populations at a relatively higher risk of
wild poliovirus circulation/importation
• Surveillance quality during last 6 months in
areas/ populations at higher risk
• Recent efforts to improve surveillance
sensitivity
AFP Surveillance Reporting
Number of AFP case reporting sites
26,036
27,919
29,932
30,595
31,269
32,877
2007
2008
2009
2010
35,478
35,824
2011
2012*
21,403
2004
2005
2006
Number of AFP cases reported
55,785
41,524
27,049
45,585
60,782
50,405
32,194
13,274
2004
*Data as on 10 March 2012
2005
2006
2007
2008
2009
2010
2011*
Polio laboratory performance
Number of stool specimens processed
83,528
91,148
100,102
109,090
118,866
65,011
2006
2007
2008
2009
2010
2011*
Number of days from stool received in laboratory to final result
35
30
Days
25
20
15
10
5
0
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2006
*Data as on 10 March 2012
2007
2008
2009
2010
2011*
Surveillance performance indicators, last 6 months
Non-polio AFP rate
Stool collection rate
# AFP cases, Jan – Feb
14.3
86%
8156
7375
6515
India
5460
2009
Less than 60%
60% to 69%
70% to 79%
80% and above
No AFP case
2010
2011
2012
Outline of the presentation
• National overview of AFP surveillance in India
• Areas/Populations at a relatively higher risk of
wild poliovirus circulation/importation
• Surveillance quality during last 6 months in
areas/ populations at higher risk
• Recent efforts to improve surveillance
sensitivity
Where could the virus be?
Leads from past incidence
Historic reservoir areas
Wild poliovirus type 1 cases, 2007-11
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Where could the virus be?
Leads from past incidence
Historic reservoir areas
HR blocks
107 High Risk blocks
Where could the virus be?
Leads from past incidence
Historic reservoir areas
HR blocks
Areas with recent transmission
WPV 1 cases, 2010-11
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Where could the virus be?
Leads from past incidence
Historic reservoir areas
HR blocks
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Areas with recent transmission
Migrant sites (1 dot=50 sites)
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Wild poliovirus cases by migratory status
Outside Bihar & Uttar Pradesh, 2007-11
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Migratory,
19 WPV1 cases,
40%
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Non-migratory,
29 WPV1 cases,
60%
Where could the virus be?
Leads from genetics
Tajikistan
2010
Areas involved with
international importations
Where could the virus be?
Leads from genetics
Tajikistan
2010
Areas involved with
international importations
Bangladesh
2006
Where could the virus be?
Leads from genetics
Tajikistan
2010
Angola
2005, 2007
Areas involved with
international importations
Bangladesh
2006
Where could the virus be?
Leads from genetics
Tajikistan
2010
Areas involved with
international importations
Nepal
2004, 2005, 2006, 2010
Angola
2005, 2007
Bangladesh
2006
Where could the virus be?
Threat from neighbouring countries with active circulation
Areas at risk of importation
from neighbouring countries
WPV 1 past 6 months,
neighbouring countries
Outline of the presentation
• National overview of AFP surveillance in India
• Areas/Populations at a relatively higher risk of
wild poliovirus circulation/importation
• Surveillance quality during last 6 months in
areas/ populations at higher risk
• Recent efforts to improve surveillance
sensitivity
Historic reservoir areas
107 HR blocks
% adequate stool specimen
collection rate
Non-polio AFP rate
U.P.
U.P.
28.4
55.2
85%
86%
Bihar
42.1
31
Non HR blocks
*Data – September 2011 to February 2012
Bihar
89%
India
Less than 60%
60% to 69%
70% to 79%
80% and above
No AFP
Non
HR case
blocks
Areas with recent transmission
Non-polio AFP rate
% adequate stool specimen
collection rate
India
Less than 60%
60% to 69%
70% to 79%
80% and above
No AFP
Non
HR case
blocks
Jharkhand
Average
Jharkhand
89%
13.5
West Bengal
*Data – September 2011 to February 2012
Average
West Bengal
Areas with recent transmission
Non-polio AFP rate
% adequate stool specimen
collection rate
Average
Average
12.9
87%
India
Less than 60%
60% to 69%
70% to 79%
80% and above
No AFP
Non
HR case
blocks
*Data – September 2011 to February 2012
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Migrant AFP cases, 2011*
Estimated non-polio AFP rate**
amongst migrants
16
15.5
12
8
12.7
9.0
4
0
2009
N=2,040
*data as on 10 March 2011
2010
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##
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2011*
** Estimate based on the number of migrant
children vaccinated in SIAs
#
#
Areas linked with international spread
of poliovirus
% adequate stool specimen
collection rate
Non-polio AFP rate
UTTAR PRADESH
BIHAR
Average
Average
33.5
JHARKHAND
86%
India
*Data – September 2011 to February 2012
Less than 60%
60% to 69%
70% to 79%
80% and above
No AFP case
Areas at risk of importation from
neighbouring countries
% adequate stool specimen
collection rate
Non-polio AFP rate
Average
Average
6.8
83%
India
*Data – September 2011 to February 2012
Less than 60%
60% to 69%
70% to 79%
80% and above
No AFP case
Outline of the presentation
• National overview of AFP surveillance in India
• Areas/Populations at a relatively higher risk of
wild poliovirus circulation/importation
• Surveillance quality during last 6 months in
areas/ populations at higher risk
• Recent efforts to improve surveillance
sensitivity
Field surveillance reviews, 2011
JA M MU & K A S HMI R
States reviewed
Districts reviewed
HIM AC HA L
PRA DE S H
PUN J AB
CH
UTTA RA NCHA L
HAR YA NA
DL
SIK K IM
ARU NA CHA L PR .
UTTA R P RA DE SH
RAJA S THA N
AS S AM
BIH AR
NAG A L AND
ME G HA LA YA
MA NIP UR
JH AR KH AN D
MA DHY A PR AD ES H
GU JAR AT
TRIP URA
W E ST BE NG A L
MIZO R AM
CHHA TTIS G A RH
Number of states reviewed
OR IS SA
DAM A N & DI U
D&N HA V EL I
MA HA RA SH TRA
7
AND HRA P RA DE S H
GO A
4
3
KA RNA TA K A
A& N I SL AN DS
PO ND ICH ER RY
LA KS HA DW EE P
TAM IL NA DU
KE RA LA
2009
2010
2011
West Bengal
Number of reporting sites
1495
973
2009
1611
982
2010
2011*
2012*
AFP cases reported till week 10
Year to date comparison
416
248
248
2010
2011*
215
2009
*Data as on 10 March 2012
2012*
Significant efforts to
improve AFP surveillance
noticed post surveillance
review in March’11 to
ensure early detection of
virus circulation
Delhi
Expansion of reporting network
340
182
2008
184
182
2009
2010
2011
# AFP cases
Non-migrant
Migrant
281
136
30
171
158
156
2009
2010
2011
AFP surveillance system
sensitivity enhanced,
particularly in high risk
populations, following the
surveillance review.
Bihar & West UP
Number of reporting sites in review districts
300
244
250
Bihar
254
245
239
224
218
208
200
206
192
190
174 176
164
170174
151156
149
150
127
107
96 94
100
82
74
50
“AFP surveillance system
in Western UP & Bihar is
sensitive enough to pick
up virus transmission at
the earliest”
0
CHAMPARAN EAST
DARBHANGA
KHAGARIA
PATNA
SAHARSA
SAMASTIPUR
“Need for greater
involvement of the district
and block government
staff in surveillance
activities”
300
West UP
250
200
150
100
50
0
AGRA
BADAUN
FARRUKHABAD
2008
Data at the time of review
GB Nagar
2009
GHAZIABAD
2010
2011
MORADABAD
SHAHJAHANPUR
Maharashtra, Nov’11
# AFP cases reported, Nasik
46
39
29
24
Q1
Q2
2011
Q3
Q4
% adequate stool specimen, Nasik
80
68
Before review, 2011
*Data as on 10 March 2012
“AFP surveillance system is
likely to pick up virus
circulation; however, efforts
need to be strengthened in
Nasik.”
• Nasik (Malegaon)
– Weak reporting network leading
to delayed reporting of cases
• Rest of Maharashtra
– Extensive reporting network with
adequate government & private
involvement
After review till date
– Timely & adequate response to
all AFP cases reported
Andhra Pradesh, Dec 2011
% AFP cases with adequate stool specimen, 2011*
ADILABAD
SRIKAKULAM
KARIMNAGAR
NIZAMABAD
VIZIANAGARAM
WARANGAL
MEDAK
VISAKHAPATNAM
KHAMMAM
HYDERABAD
EAST GODAVARI
RANGAREDDY
NALGONDA
WEST GODAVARI
KRISHNA
MAHBUBNAGAR
GUNTUR
PRAKASAM
KURNOOL
ANANTPUR
CUDDAPAH
NELLORE
India
Less than 60%
60% to 69%
70% to 79%
80% and above
No AFP case
CHITTOOR
Blocks without any AFP case in 2011*
“AFP surveillance needs
improvements to ensure
early detection of any virus
circulation”
• Existing public health cadre underutilized for surveillance
• Inadequate involvement of private
sector health facilities in reporting
AFP cases
Conclusions of recent surveillance reviews
Surveillance sensitive to pick-up virus circulation
Gaps identified, improvements made after review
Gaps identified, improvements required
Surveillance reviews, 2012
2011
JAMMU
KASHMIR
JA
M MU & K
A S HMI R
States reviewed 2011
Districts reviewed 2011
HIM
AC HA L
HIMACHAL
PRA
DE S H
PRADESH
PUNJAB
PUN
J AB
CH
CH
Proposed reviews, 2012
UTTA
RA NCHA L
UTTARANCHAL
HARYANA
HAR
YA NA
DL
DL
SIKKIM
SIK
K IM
ARUNACHAL
PR..
ARU
NA CHA L PR
UTTA
RP
RA DE SH
UTTAR
PRADESH
RAJASTHAN
RAJA
S THA N
ASSAM
AS
S AM
BIHAR
BIH
AR
NAG
A L AND
NAGALAND
ME
G HA LA YA
MEGHALAYA
MA
NIP UR
MANIPUR
JH
AR KH AN D
JHARKHAND
MADHYA
PRADESH
MA
DHY A PR
AD ES H
GUJARAT
GU
JAR AT
TRIPURA
TRIP
URA
WEST
BENGAL
W
E ST BE
NG A L
MIZO
R AM
MIZORAM
CHHA
TTIS G A RH
CHHATTISGARH
OR
IS SA
ORISSA
DAM
AN &
U
DAMAN
& DI
DIU
D&N
V EL I
D&N HA
HAVELI
MA
HA RA SH TRA
MAHARASHTRA
AND
HRA P
RA DE S H
ANDHRA
PRADESH
GO
A
GOA
Plans for 2012
Follow up on recommendations of 2011 reviews
Field reviews in 6 additional states
KA
RNA TA K A
KARNATAKA
A&
N IISLANDS
SL AN DS
A&N
PO
ND ICH ER RY
PONDICHERRY
LA
KS HA DW EE P
LAKSHADWEEP
TAM
IL NA
DU
TAMIL
NADU
KE
RA LA
KERALA
Environmental surveillance expansion plans
WPV 1 past 6 months,
neighbouring countries
Punjab
Delhi
May 2010
Patna
April 2011
Gujarat
Mumbai
2001
Existing environmental
surveillance sites
Proposed additional sites
for environmental surveillance
Kolkata
December 2011
Summary
• Overall surveillance quality maintained at high levels
• Areas at risk of WPV importation/circulation identified
and being closely monitored for surveillance quality
• Actions being taken to enhance surveillance
sensitivity in high risk areas following reviews
e.g. West Bengal, Delhi, Nasik (Malegaon)
• Sewage sampling sites being expanded strategically
to minimize risk of missing poliovirus in the
environment
Thank You