Transcript Wild Poliovirus*, 2006

Global Polio Eradication Initiative
The 'Intensified Effort'
18 May 2008
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Polio
Paralysis for life
Primarily affects children
Preventable with OPV
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Polio – the world in 1988
>350,000 cases
>125 polio-endemic
countries
1988: World Health Assembly Resolution
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Polio - the world in 2008
423 cases
Endemic country
Re-infected country
Since 1988: >99% reduction in disease
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Global Polio Eradication Initiative
Donors (governments,
development banks,
private foundations, etc)
WHO, Rotary,
CDC, UNICEF
UN agencies
Health Ministries
Private sector
20 million
volunteers
NGOs
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Polio Eradication Strategies
1. Routine Immunization
3. Surveillance
2. National Immunization
Days (NIDs/SNIDs)
4. Mop-ups
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Financial Contributions since 1988: US$ 6 billion
and Funding Gap for 2008-2009
G8
48%
France
USAID
USCDC
Italy
UK
Canada
Bangladesh
Germany
Indonesia
Japan
Multilateral Sector
15%
Domestic
Resources
14%
India
IFFIm
Netherlands
European
Commission
Denmark
Norway
World Bank (India)
WB Investment
Partnership for Polio
Sweden
Others
Non-G8 OECD/
Other 8%
UN Foundation
Private Sector
15%
Bill and Melinda Gates
Foundation
Rotary International
2008-9 Funding Gap:
US$ 490m of $1.3b budget
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Intensified eradication
effort
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Launch of intensified eradication effort
28 February 2007
Dr Margaret Chan, WHO DG :
"We will complete polio eradication!"
Stakeholder presence:
Endemic country representatives
International development community
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New Tools
Monovalent OPV1
(mOPV1) Efficacy
New lab procedures
(50% faster detection)
100
tOPV
mOPV1
75
66%
% children
protected 50
per dose
31%
25
10%
16%
0
India
Nigeria
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New tailored eradication tactics
India
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Accelerated SIA schedule with monovalent OPVs
Mop-up strategies for wild poliovirus type 1 (WPV1)
Targeted strategies for access-compromised areas (Kosi river,
Bihar)
Afghanistan & Pakistan

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Synchronization of all activities, particularly in cross-border areas
Improved access to populations (mobile and in areas of insecurity)
Supplementary Interim Administered Dose (SIAD) strategy to
deliver extra dose in between large-scale campaigns
Nigeria


'Immunization Plus Days'
New engagement by all sectors of civil society (eg Quranic school
engagement)
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New political engagement and commitment
India
December 2007
Afghanistan & Pakistan
April 2007
Nigeria, February
2008
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Impact of intensified
eradication effort
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Wild Poliovirus, Asia
as of 14 May 2008
Polio-infected districts, last 6 months
Type 1 Polio, YTD Comparison
40
30
20
No countries
re-infected with
Type 1 WPV
district infected with wild polio virus type 1
10
0
2007
2008
Type 1 Cases
district infected with wild polio virus type 3
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Compelling evidence of real progress in
interrupting WPV1 in UP & Bihar, India
Q1, 06
Q2, 06
Q3, 06
Q4, 06
Q1, 07
Q2, 07
Q3, 07
Q4, 07
Q1, 08
No WPV1 in UP since Nov 07;
1 WPV1 in Bihar in Jan 08
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* data as on 26th April 2008
Very geographically restricted virus in
Afghanistan & Pakistan in 2008
Afghanistan
Pakistan
Type 1 polio cases at 6 May
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Wild Poliovirus, Africa
as of 14 May 2008
Polio-infected districts, last 6 months
Type 1 Polio, YTD Comparison
150
125
100
75
50
7 countries
re-infected with
Type 1 WPV!
district infected with wild polio virus type 1
25
0
2007
2008
Type 1 Cases
district infected with wild polio virus type 3
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Polio in Nigeria - 2008
• Borno, Kano,
Katsina, Jigawa and
Sokoto account for
>50% of Nigeria’s
cases
• >20% of children unimmunized in highrisk LGAs, leaving
>1.5 million children
vulnerable in these
areas
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Polio Eradication in Nigeria
New outbreak in 2008
Year-to-date comparison
of type 1 polio
120
• >6-fold increase in type 1
polio (most dangerous
type)
100
• Nigeria accounts for 90%
of all type 1 polio
worldwide
80
60
40
20
0
2007
2008
• Progress achieved in
2007 put at risk by new
outbreak
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The GPEI is on track to achieve
major landmarks in 2008-2009,
particularly in Asia.
But increase in cases in Africa needs
to be reversed
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Immediate next steps - Asia
India
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Properly implement mop-up strategy for WPV1
Fully implement close operational gaps in remaining endemic
areas (Kosi river, Bihar)
Further curb WPV3 outbreak and prevent geographic spread
Pakistan
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Introduce 'SIAD strategy' in Sindh (planned for July)
Systematic use of finger-marking to guide SIA improvements
Concentrate on high-risk areas & mOPV1 in Sindh (all viruses to
date in 2008)
Afghanistan
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Fully implement SIAD strategy in Southern Region
Use new access to build up immunity
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Immediate next steps - Africa
Nigeria
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Focus activities on high-risk LGAs in high-risk states
Optimize operational improvements (micro-planning, vaccinator
selection, training and supervision)
Accurate monitoring of immunization activities
Urgent need for full engagement/ownership of LGA political leaders
(particularly high-risk LGAs)
Continue to engage all community, traditional and religious leaders
Re-infected countries
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Maintain high population immunity levels in polio-free countries
(currently higher than in 2003-2005)
Stop transmission of imported poliovirus in Angola, Chad and DR
Congo
Rapidly fill sub-national surveillance gaps in key areas
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After interruption of
transmission of wild
poliovirus…
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Long-term poliovirus risks
(after containment & certification of wild polioviruses)
VAPP: Vaccine associated paralytic poliomyelitis
VDPV: Vaccine-derived polioviruses
–
–
cVDPV: circulating VDPV
iVDPV: 'chronic' VDPV excretion by an individual
with a 1o immunodeficiency syndrome.
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Post-eradication timeline
Priority
Activities
WPV Containment
& Certification
VAPP/VDPV Elim.
& Verification
Full WPV containment.
Stop trivalent OPV.
Fill mOPV stockpile.
Interim containment of
Sabin viruses.
Full Sabin containment
(if possible replace with
alternate strains)
Longterm surveillance.
Refine 'affordable'
options for IPV use.
Certify WPV eradication.
Earliest dates
'Post OPV'
Era
2010
2011
2012
Optimize IPV use.
Stockpile maintenance.
Interrupt cVDPVs (mOPV).
Verify VDPVs eliminated.
2013
2014
2015
IPV cessation in countries
using for transition.
2016
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Thank you…
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