Transcript POLIO END GAME – GLOBAL PERSPECTIVE

POLIO END GAME –
GLOBAL PERSPECTIVE
A.Parthasarathy
Egyptian Stele
(1403 – 1365 B.C.)
What exactly is polio eradication?
AFP due to Infection:
Non-polios OPV virus
Infection:
wild virus
Endemicity
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Eradication
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Phase “w”
Eradication
Phase “v”
18 July 2015
(John TJ. Frontiers in Pediatrics 1996; NEJM 2000)
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Polio Eradication Initiative: Progress 1988-2012
1988
350,000 cases
125 countries
2012*
96 cases
4 countries
*Data as of 17th July, 2012
Polio Eradication Challenges
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Maintaining immunity
Maintaining surveillance
Readiness to respond
Reducing risk
Building on Wpv /cVdpv
transmission cessation/eradication
Preparing for the endgame
Risks
• Importing WPV
• Development of
cVDPVs
Global Spread of Wild Polio Virus 2003 - 2011
wild virus type 1
wild virus type 3
endemic countries
ongoing importation
598 circulating Vaccine-derived Polioviruses, 2000-12*
17 countries, 20 outbreaks
China
2004
DOR/Haiti
2000-01
Niger
2006
Nigeria
2005-12
DR Congo
2008-2012
6 outbreaks with cVDPV1
12 outbreaks with cVDPV2
2 outbreak with cVDPV3
Data in WHO/HQ as of 7th August, 2012
Ethiopia
20082010
Philippines
2001
Myanmar
2006-07
Cambodia
2005-06
Madagascar
2001-02; 2005
Indonesia
2005
cVDPV type 1 (79 cases)
cVDPV type 2 (510 cases)
cVDPV type 3 (9 cases)
Preparing for the
endgame
Recent developments
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SAGE Nov 2011: recommended that the endgame
strategy be based on phased rather than
simultaneous Sabin strain removal
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WHO Executive Board Jan 2012: requested
Director-General to develop comprehensive
endgame strategy and timeline based on phased
Sabin strain removal
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SAGE Apr 2012: may consider an 'early switch' (by
Apr 2014), preceded by universal introduction of at
least 1 dose of IPV (ID or IM) at DPT3 contact.
'Endgame'
Following the WHO Executive Board
resolution of January 2012 endorsing
eventual replacement of tOPV with bOPV
globally, member states should start
preparing appropriate policies, esp. on the
role of IPV, guided by and considering the
global recommendations of SAGE.
'Endgame' planning (1)
1. The national immunization programme should
now begin incorporating into its planning:
(a) an eventual tOPV-bOPV switch globally,
potentially as early as April 2014, and
(b) eventual cessation of all remaining bOPV
globally at some point in the future (e.g.
2017-18 period).
'Endgame' planning (2)
2. This planning should include
consideration of the introduction, in
advance of a tOPV-bOPV switch, of at
least one dose of IPV (e.g. at DPT3
contact), to boost population immunity
thereby reducing the risk of a type 2
cVDPV emergence & the consequences of
a potential cVPDV.
SUMMARY
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According to GPEI’s IMG recommendations a new 'endgame' strategy could
accelerate eradication, boost routine immunization & reduce long-term risks
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Depending on IPV price, the new 'polio endgame' could be cost-neutral in the near
term & cost-saving in the long term(No.of doses 1/2/3 in the NIP IM/ID)
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Next steps (by Nov 2012):
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Further cost-effectiveness analysis by Individual Nations(Affordable IPV IM/ID)
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Consultation with with (a) Regional & National authorities on policy & program
implications, (b) regulators & manufacturers on licensing & supply.
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Consolidation of a draft Polio Endgame Strategic Plan replacing tOPV with bOPV
1&3 to start with and finally phasing out bOPV with affordable All IPV schedule
& Budget for the time line of 2013-18
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Feasibility introducing cost effective Hexavalent DTPw-HB-Hib-SabinIPV in the
NIPs of developing countries.
Polio Endgame Strategy-India,
Potential Timeline
tOPVbOPV
switch
Polio
certification
Last WPV
case
NID
NID NID
NID
NID
NID
IPV intro?
NID
NID
Modelling, Research, Development
Postswitch
VDPV
type 2
risk mgt.
Certification standard surveillance, improved RI coverage
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Jan
Mar
May
2011
Jul
Sep
Nov
Jan
Mar
May
Jul
2012
Sep
Nov
Jan
Mar
May
Jul
2013
Sep
Nov
Jan
Mar
May
2014
tOPV NID