Transcript 1. epidemiologi - polio

Pokok Bahasan
• Epidemiology poliomyelitis
– Agent
• Agent penyebab
• Cara penularan
– Host (Faktor Resiko)
• Imunitas – cara pencegahan
• Umur
– Environment (Faktor Resiko)
• Waktu
• Tempat
• Relevansinya untuk dapat dieradikasi.
• Turunan virus polio
• Batasan VAPP dan VDPV
 Resiko terjadi VAPP &VDPV
• Terjadinya VAPP dan VDPV  Pencegahan VDPV
POLIOMYELITIS
Kerusakan sel motorneuron (cornu anterior) di
Medula Spinalis akibat suatu peradangan yang
disebabkan oleh virus polio, dengan manifestasi
KELUMPUHAN.
Medula spinalis
Penampang horisontal
Cornu
anterior
Virus Polio
agent penyebab Poliomyelitis
X-ray Crystallography
• Virus RNA, ±7500 nucleotide
• Diameter 27-30 nm
• Genus Enterovirus
• Fam. Picornaviridae
Tahan terhadap:
asam,sabun,ether,
chloroform
Inaktivasi dg:
pemanasan,formalin, UV,
chlorine, pengeringan
Lama Virus Polio Bertahan Hidup
berdasarkan Suhu
Suhu Beku
: Beberapa tahun
Suhu Lemari Es
: Beberapa bulan
Suhu Kamar
: Beberapa hari
Suhu 50 oC atau lebih
: Cepat Rusak
Laju Inaktivasi Virus Polio Liar
Berdasarkan Musim
120
100
Laju inaktivasi menurun 90%
(%)
80
60
40
(10%)
20
0
1 1.5 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
hari
Musim Panas
Musim Dingin
Laju Inaktivasi Virus Polio Liar
Berdasarkan Jenis Air
120
100
Laju inaktivasi menurun 90%
(%)
80
60
40
10%
20
25
23
21
19
17
15
13
11
9
7
5. 5
4
2. 5
1
0
hari
Air Laut
Air Bersih
Air Limbah
Laju inaktivasi melambat bila ada bahan organik.
26
Virus Polio (Lanjutan)
•
3 Jenis enteroviruses
– Tipe 1 (Brunhilde), Tipe 2 (Lansig) dan Tipe 3
(Leon)
•
Sangat menular
•
Semua tipe menyebabkan kelumpuhan
•
Tipe 1 : penyebab paling sering,
kemudian Tipe 3 dan Tipe 2
•
Sekali terinfeksi, penderita akan
menularkan ke semua orang yang tidak
imun di sekitarnya.
Virus Polio (Lanjutan)
• Setelah Imunisasi dengan tOPV
– Tipe 2 yang pertama dieradikasi,
diikuti Tipe 3, kemudian Tipe 1
– Perbandingan yang lumpuh diantara
yang terinfeksi, diperkirakan:
• Tipe 1  1:100
• Tipe 3  1:1000
Virus Polio
epidemiology
• Reservoir: manusia
• Penularan:
– Fecal – oral: >>>
• Masa virus dalam tinja lebih lama, beberapa
saat/hari sebelum lumpuh - maks. 100 hr setelah
lumpuh.
• Kebersihan lingkungan rendah:
– Tinja dapat mencemari air dan makanan
– Lalat  virus dari tinja ke mak-min
– Oral – oral: sedikit
• Masa virus dalam air ludah pendek, maks. 2 minggu
• Kebersihan lingkungan baik.
PENYEBARAN VIRUS POLIO DI LINGKUNGAN
ANAK TERINFEKSI
VIRUS POLIO, BAB
VIRUS POLIO
MASUK KE ANAK
LAIN MELALUI
MULUT
ANAK SAKIT
POLIO
TIDAK CUCI TANGAN
DENGAN BAIK
SETELAH BAB
MAK-MIN
TERKONTAMINASI
CARA BERPIKIR EPIDEMIOLOGI
KUMAN
PENYAKIT
INANG
LINGKUNGAN
Exkresi virus polio liar melalui tinja
63-96%
35 – 75%
Penurunan ekskresi rata-rata 10-15% per minggu
Masa Inkubasi
• Inkubasi pendek: 7-14 hr (terpendek 4 hr),
range 3-35 hr
• Eksresi virus melalui tinja secara intermiten
sampai 6-8 minggu atau melalui air ludah 1-2
setelah lumpuh.
• Eksresi virus terbanyak pada:
– Beberapa saat sebelum lumpuh – 2 minggu
setelah lumpuh
– Eksresi virus sangat menurun setelah 4
minggu lumpuh
PATHOGENESIS
• Virus masuk melalui mulut (oral)
• Replikasi pada lapisan tonsil dan usus, serta kelenjar
limfe.
• Viremia melalui darah  Susunan saraf pusat  melalui
sel saraf ke medula spinalis
• Motor neuron, pada Cornu anterior medula spinalis, rusak
karena replikasi virus  lumpuh
• Berat-ringan kelumpuhan tergantung banyaknya motor
neuron yang rusak.
HOST
Faktor Resiko
- Tidak mempunyai kekebalan
terhadap polio
- Incident terbesar pada anak < 3
tahun, dan sangat jarang ditemukan
pada anak umur 15 th >
IMUNISASI
MENCEGAH SAKIT POLIO
KEKEBALAN
thd Poliomeylitis
Melalui pemberian imunisasi/infeksi
Kekebalan terhadap satu tipe tidak menyebabkan
kekebalan pada tipe lain.
Ada dua jenis kekebalan: intestinal dan humoral
Kekebalan berlangsung seumur hidup
Bayi yg lahir dari ibu yg mempunyai antibodi tinggi akan
terlindungi selama beberapa minggu pertama.
Imunisasi dengan OPV
(Oral Polio Vaccine)
• OPV yang direkomendasikan oleh WHO
diproduksi memakai Strain Sabin
• Setiap dosis OPV berisi 3 type virus polio
dengan titer:
tipe 1 : ( 10 5.5 – 10 6.5)
tipe 2 : (10 4.5 – 10 5.5)
tipe 3 : (10 5.0 – 10 6)
• OPV: kekebalan intestinal dan humoral
Pembentukan Kekebalan
setelah 3 Dosis OPV
96
100
89
Percent
90
80
65
70
60
67
67
52
50
50
40
30
29
31
20
10
0
Poliovirus type 1 Poliovirus type 2 Poliovirus type 3
John TJ, Devararjan LV, Balasubramanyan A. Immunization in India with trivalent and
monovalent oral poliovirus vaccines of enhanced potency. Bull WHO 1976;54:115-7.
Dose 1
Dose 2
Dose 3
MANFAAT
Imunisasi dengan OPV
• Membentuk kekebalan
– 4 dosis tOPV (3 serotypes) pada bayi
sebelum umur 1 tahun.
• Memutus transmisi virus polio
– Mop-up/Sub PIN/PIN, tanpa melihat status
imunisasi sebelumnya.
• Mempunyai community effect
Anak tidak pernah
divaksinasi
Transmisi (+)
sakit (+)
Anak Divaksinasi
lebih 100 hr yl
Transmisi (+)
sakit (-)
Anak divaksinasi
Kurang dari 100 hr yl
Transmisi (-)
sakit (-)
=Vaksin
= VPL
EPIDEMIOLOGI YANG RELEVAN
UNTUK ERADIKASI
1. Virus hanya hidup di
manusia
2. Daya hidup di
lingkungan singkat
Memungkinkan
dibasmi
3. Virus diekskresi
Waktu pengambilan
spesimen
4. Kekebalan
intestinal
OPV jadi vaksin pilihan
5. Tipe 2 yg pertama
punah
Perkembangan ke
arah eradikasi
POLIOMYELITIS
Faktor Resiko
• Waktu
• Tempat
• Orang
POLIOMYELITIS (Lanjutan)
Faktor Resiko
• Waktu - MUSIM
– M. hujan, di negara tropis
– M. dingin/ awal m. semi di negara 4 musim
• Tempat
– Di daerah dengan:
• Cakupan imunisasi rendah
• Sanitasi lingkungan buruk
• Perkotaan kumuh (PADAT)
• Orang:
– Tidak mempunyai kekebalan
– Anak < 3 th: resiko tertular paling tinggi
– Umur 15 th >: sangat kecil kemungkinan tertular
TEMPAT (2)
Kasus Polio di Kab. Sukabumi, Jawa Barat, Maret-April 2005
Cicurug
Bj.Genteng
13 kasus AFP, dg onset lumpuh
antara 13-03-2005 s/d25-042005:
• 1 ks dg Virus Polio Liar (+)
• 1 ks dg Virus Polio Liar (-)
• 11 kasus, spesimen lab tunggu
120 spesimen kontak lab tunggu
4 desa imunisasi
polio masal balita
24-25 April 2005
TEMPAT (3)
Wild Poliovirus Cases Indonesia March 2005 – 6 April 2006
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ACEH TIMUR
GAYOL UES
LANGKAT
ACEH TENGGARA
KARO
#S
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BANG KALAN
#
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SAMP ANG
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PAME KASAN SUME NEP
#
SITU BOND O
#
PROB OLIN GGO
BOND OWOSO
U MAJAN G
L
JE MBER
BANYU WA NGI
= 1 WPV Case
Total infected district s: 47
Total infected provinces : 10
Data as of 6 April 2006
WAKTU (1)
WPV 1 monthly onset, with targeted SIAs, NIGERIA 2006 – 2010
*
150
140
.
130
120
Number of wpv cases
110
100
90
80
70
60
50
40
30
20
10
J-06
F
M
A
M
J
J
A
S
O
N
D
J-07
F
M
A
M
J
J
A
S
O
N
D
J-08
F
M
A
M
J
J
A
S
O
N
D
J-09
F
M
A
M
J
J
A
S
O
N
D
J-10
F
M
A
0
Continuous arrow = National IPDs
Broken arrows = Sub-national IPDs
* mOPV1 was used only in 4 southern states in October
tOPV
mOPV1
bOPV
WAKTU (2)
Total AFP, Polio*, Non Polio and Pending Cases by Onset of Paralysis,
Indonesia 2005
600
500
400
300
200
100
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Total AFP
67
54
90
122
482
382
190
172
143
82
60
55
Pending
0
0
0
0
0
0
0
1
2
1
4
12
Non Polio
66
54
88
100
393
254
139
123
100
64
53
39
Polio
1
0
2
22
89
128
51
48
41
17
3
4
* WPV, Compatible, and VDPV Cases
Data as of 29 January 2006
ORANG (1)
Age group of WPV cases 2008/2009, NIGERIA
Age’08 (n=782)
60+ Unknown
0%
3%
Age’09 (n=388)
Unknown
< 12 mths
0%
6%
60 + mths
8%
< 12 mths
6%
48 - 59
5%
12 - 23
mths
34%
36 - 47
mths
18%
6
48 - 59
mths
9%
12 - 23
mths
28%
36 - 47
mths
15%
24-35 mths
33%
24 - 35
mths
34%
73% < 3 yrs
68% < 3 yrs
ORANG (2)
Characteristics of Wild Polio Cases, Indonesia 2005
OPV Dose*
Group of Age
>60 Month
18%
36-60 Month
22%
0-11 Month
5%
3+ dose
15%
0 dose
38%
'1-2 dose
47%
*do not include missing data
12-35 Month
55%
Data as of 29 January 2006
EPIDEMIOLOGI
TURUNAN VIRUS POLIO
Kelumpuhan yang
disebabkan oleh:
• Virus vaksin  Secara klinis disebut
VAPP
• VDPV
• VPL
 Secara klinis disebut
Poliomyelitis
- Vaccine Associated Paralytic Polio
- Vaccine Derived Polio virus
VAPP
Vaccine Associated Paralytic Polio
Batasan
• VAPP adalah bentuk KIPI dari OPV.
• WHO: suatu kelumpuhan layuh akut yang terjadi
pada:
– 4-30 hari setelah menerima OPV
– 4-75 hari setelah kontak dg penerima OPV
– dg kelainan neurologi sampai pada 60 hari/lebih setelah
onset
– atau meninggal.
* Global burden VAPP: 250-500 kasus per tahun
MENGAPA TERJADI VAPP?
 Vaksin mengandung virus HIDUP
 Mutasi/Reversi virus vaksin (REVERTANTS) < 1%
 Mutasi virus terjadi karena replikasi lama di usus
 Merupakan suatu respon IMUN LAMBAT
 Resiko meningkat pada IMMUNODEFICIENCY
 Pada umumnya PERMANENT
Risiko VAPP menurut WHO
(Background rates of AEFI:WHO/V&B/00.36)
Dosis pertama OPV
1 : 1.4 – 3.4 juta dosis
Dosis berikutnya
1 : 5.9 juta dosis
Kontak
1 : 6.7 juta dosis
National Immunization
1 : 6 juta dosis
Day
VDPV
(Vaccine-derived Polio Virus)
• Virus vaksin ber-replikasi didalam usus manusia,
diekskresi melalui tinja biasanya 2-3 bln
• Pada saat replikasi terjadi mutasi/reversion virus
vaksin.
• Replikasi dan mutasi yang berulang diantara anak
yang TIDAK IMUN dan suatu saat bergabung dengan
C enterovirus maka akan terjadi recombinant dalam
bentuk VDPV yang bersifat neuro-virulent.
• Kesimpulan:
VAPP & VDPV adalah konsekuensi dari imunisasi
dengan OPV
3 Jenis VDPV
• iVDPV = VDPV berasal dari pasien immunedeficiency.
• cVDPV = VDPV yang bersirkulasi;
• memiliki sifat VPL, yaitu neurovirulen dan
transmissable,
• semua virus yg menyebabkan wabah terbukti
merupakan recombinant dg C – Enterovirus
• aVDPV = ambiguos VDPV yaitu:
– tak ada bukti sirkulasi,
– tak ada hubungan dg pend. imun.def
– berasal dari sample lingkungan yg tak ada
hubungan dg kasus AFP.
Faktor risiko penyebaran VDPV
• Cakupan imunisasi OPV yang rendah
dalam waktu lama sehingga terjadi
akumulasi orang-orang yang tidak/belum
kebal terhadap polio
• Tidak adanya sirkulasi virus polio liar ??
• Sanitasi buruk
Pencegahan penyebaran VDPV
1. Imunisasi OPV: Cakupan tinggi dan merata
(dipertahankan!!)
2. Deteksi dini adanya VDPV dengan
peningkatan kinerja surveilans AFP
3. Screening semua isolat virus polio dengan
kombinasi metode antigenik dan molekuler ,
yaitu: uji ITD (Intratypic Strain Differentiation) dg
ELISA & Probe-hybridization.
Sirkulasi VPVD yang
Dilaporkan
Hispaniola
2000-1
22 cases
Note:
V1
V2
Nigeria
2005-2010
307 cs
Ethiopia
2008-2009
4 cs
Madagascar
2002/2005
4/3 cases
Egypt
1988-93
32 cases
India
2009-2010
12 cs
Indonesia
On-going
46 cases
Congo
2008-2009
16 cs
Philippines
2001
3 cases
VAPP
 Akibat respon imun
yang rendah dari
individu
 Tidak ada kasus lain
(tidak menular)
VDPV
 Akibat rendahnya
imunitas masyarakat
 Menjadi KLB
Studi pada penerima
vaksin polio oral
• Tipe-3 paling cepat mengalami mutasi/reversi, diikuti tipe-2
dan tipe-1, rekombinasi antara serotipe vaksin sering
terjadi
• Pendeknya waktu ekskresi dan tingginya kekebalan
penduduk membatasi penyebaran virus revertant
• Sebagian besar isolat dari penerima OPV maupun
kontaknya berhubungan erat dg strain Sabin
• Perbedaan sekuens >1 % dibanding Sabin menunjukan
replikasi berkepanjangan, disebut VDPV
• Perbedaan sekuens VP1 1% berarti replikasi virus vaksin
telah terjadi paling sedikit 1 tahun
VDPV di Madura
• Dari Madura, ditemukan > 30 kasus AFP dg
vi.polio positif oleh Lab. BLK Surabaya
• Bf mendapatkan isolat dg hasil ITD yg
Discordant yi:
Elisa: NSL=Wild, Probe : SL
• Sequencing Mumbai: 31 kasus AFP + 2 kontak
dg VDPV + , sekuens nukleotida menunjukan
perbedaan >1% dibandingkan dg SL.
Weekly AFP and VPD Update for
Week 40, 2012
Data as of 08 October 2012
Immunization and Vaccine
Development (IVD) SEARO
Protecting People from Vaccine
Preventable Diseases
SEARO, New Delhi, 2012
Wild Polio Virus
India, 2011
Wild Polio Cases, 2011
Total P1 Wild cases
Total P3 Wild cases
Total polio cases
1
0
1
Total districts with wild cases
Date and location of
most recent case
P1 Wild
P3 Wild
1
13-Jan-2011; District Howra,
West Bengal
-
Districts with cases in 2011
Districts with cases in current week
= Most recent P1 Wild polio case
49
*Dots are randomly placed within blocks (Sub-districts)
Data as of 08 Oct 2012
Wild Polio Cases by Type (P1, P3) and Month of Onset
India, 2007-2012
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Sub-Total
Total*
220
200
180
140
120
100
2008
P1 P3
1
111
2
51
1
39
0
40
1
33
3
35
7
46
21
46
17
32
5
27
8
16
9
8
75 484
559
2009
P1 P3
7
7
2
3
3
13
4
9
4
19
8
71
6
83
11 108
19 126
11 118
3
57
1
47
79 661
740
2010
P1 P3
2
14
1
2
0
0
1
1
2
0
1
1
3
2
4
3
3
0
0
1
0
0
1
0
18
24
42
2011
P1 P3
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
1
2012
P1 P3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
*Note: Wild polio mixtures (P1+P3) not included in the graph or table.
80
60
40
20
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Polio Cases
160
2007
P1 P3
15
9
6
8
8
6
3
11
7
25
1
29
10
54
10
67
4
77
3
95
8
194
5
216
80 791
871
2007
2008
2009
P1
2010
2011
P3
50
Data as of 08 Oct 2012
2012
Monthly Distribution of AFP Cases
SEAR, 2011 – 2012
Country
2011
total
AFP
2012
AFP to
date
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
AFP cases by month of paralysis onset, last 14 months (data from weekly case-based reports)
Date of last
report
Bangladesh
1610
1230
154
142
92
103
122
112
135
169
141
145
146
113
143
4
08-Oct-12
6
7
1
1
0
0
1
1
1
2
0
1
0
1
0
0
08-Oct-12
129
92
12
7
13
10
8
8
12
7
14
22
10
8
3
0
02-Oct-12
India
60542
46058
6854 5802 5403 5025 4621 4149 4225 4328 5074 5064 5510 7176 5911
0
05-Oct-12
Indonesia
1720
1413
137
178
171
134
164
160
173
199
203
163
188
107
56
0
05-Oct-12
Maldives
3
4
0
1
1
0
1
0
0
1
0
0
2
0
0
0
30-Sep-12
Myanmar
418
315
53
52
38
25
18
9
11
22
37
42
43
54
79
0
05-Oct-12
Nepal
567
541
63
43
48
45
51
51
47
51
60
69
72
90
50
0
05-Oct-12
Sri Lanka
88
62
12
4
8
4
8
5
10
5
12
5
5
4
8
0
04-Oct-12
Thailand
249
199
24
27
22
24
22
24
25
7
20
15
30
30
26
0
05-Oct-12
0
3
0
0
0
0
1
0
0
2
0
0
0
0
0
0
30-Sep-12
65332
49924
Bhutan
DPR Korea
Timor-Leste
TOTAL
7310 6257 5796 5370 5017 4519 4639 4793 5561 5526 6006 7583 6276
51
Data as of 08 Oct 2012
4
Primary culture results from AFP cases 2011
Primary culture results from AFP cases 2011
Pending1
Positive
Culture
Positive
Culture +
NPEV
NPEV
Only
Negative
<=14
days
Wild
Polio Laboratories
% Primary Culture
Received by
Reports Within 14
lab
>14 days
days
Specimens from other
sources 2
Results
Number
received by
lab
Vaccine
Country
Number of AFP
cases with
specimens received
in Lab
AFP specimens
% NPEV
AFP cases
1587
30
2
349
1206
0
0
3166
93.0
18.0
412
23
0
4
0
0
0
4
0
0
7
71
0
0
0
0
Bangladesh
IPH, Dhaka
Bhutan
NIH, Bangkok
DPRK
NPL, Pyongyang
117
1
0
11
105
0
0
270
99
9.7
0
0
0
BJMC, Ahmedabad
7618
381
37
1423
5777
0
0
15282
100.0
15.5
179
10
0
NIV, Bangalore
4818
325
92
1497
2904
0
0
9654
97.9
27.5
25
0
0
IoS, Kolkatta
7121
278
38
1057
5748
0
0
14238
98.2
11.5
44
4
0
KIPM, Chennai
9266
337
69
1968
6892
0
0
18533
99.6
17.2
40
2
0
NCDC, Delhi
5782
256
25
485
5016
0
0
11580
78.7
6.5
64
3
0
India
CRI, Kasauli
1783
84
4
306
1389
0
0
3576
100.0
14.7
30
2
0
SGPGI, Lucknow
16629
771
196
6465
9197
0
0
33328
99.2
28.6
107
10
0
ERC, Mumbai
5775
341
68
1647
3719
0
0
11645
93.2
24.7
143
5
0
58792
2773
529
14848
40642
0
0
117836
96.6
20.0
632
36
0
Biofarma, Bandung
523
12
0
46
465
0
0
1044
98
8.1
0
0
0
NIHRD, Jakarta
640
5
1
65
569
0
0
1275
100
8.9
5
0
0
PHL, Surabaya
528
13
0
58
457
0
0
1057
100
9.6
5
0
0
1691
30
1
169
1491
0
0
3376
99.2
8.9
10
0
0
India Sub Total
Indonesia
Indonesia Sub Total
Maldives
MRI, Colombo
1
0
0
0
1
0
0
2
0
0
0
0
0
Myanmar
NHL, Yangon
417
10
2
70
335
0
0
834
92
14.0
0
0
0
Nepal
NIH, Bangkok
539
17
0
108
414
0
0
1078
100
16.1
208
16
0
Sri Lanka
MRI, Colombo
82
1
0
2
79
0
0
175
99
1.2
358
21
0
Thailand
NIH, Bangkok
235
8
0
18
209
0
0
473
100.0
6
0
0
0
Timor-Leste
PHL, Surabaya
0
0
0
0
0
0
0
0
0.0
0
0
0
0
63465
2870
534
15575
44486
0
0
127217
96.5
19.5
1620
96
0
SEAR
1
Calculation based on date specimen received in laboratory subtracted from date data received in SEARO as shown in Table 1.
2
Stool samples collected from contact and healthy children survey.
52
Data as of 08 Oct 2012
Weekly Bulletin Comparison,
India, 2010-2012
Weekly Comparison of AFP, Wild, VDPV, Compatible & Classification Pending, India, 2010-2012
P1 (WPV)
P2
(VDPV)
P3
(WPV)
Compatible
Pending
AFP
P1 (WPV)
P2
(VDPV)
P3
(WPV)
P3
(VDPV)
Compatible
Pending
AFP
P1 (WPV)
P2
(VDPV)
P3
(WPV)
P3
(VDPV)
Compatible
Pending
Week Number
2012
AFP
2011
Week Number
2010
Week1
Week2
Week3
Week4
Week5
Week6
Week7
Week8
Week9
Week10
Week11
Week12
Week13
Week14
Week15
29
427
1151
1864
2564
3352
4197
5031
5548
6515
7325
8097
9135
9919
10751
0
0
0
0
1
2
2
2
2
3
3
3
3
3
3
0
0
0
1
1
1
2
2
2
2
3
3
3
3
3
0
0
3
3
7
10
14
14
16
16
16
16
16
16
16
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
29
427
1008
1313
1262
1518
1600
1742
1532
1862
1993
2038
2038
2338
2465
15
345
1024
1848
2888
3773
4662
5522
6381
7375
8281
9024
9949
11026
11914
0
0
0
0
0
1
1
1
1
1
1
1
1
1
1
0
0
0
0
0
1
1
1
1
1
2
2
2
2
3
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
15
345
925
1274
1526
1709
1687
1720
1893
2118
2209
2150
2319
2687
2779
2
417
1230
2230
3154
4039
5115
6117
7112
8156
8912
9985
11057
12042
12944
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
1
1
1
1
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
2
417
1141
1585
1590
1633
1748
1872
2054
2296
1985
2361
2525
2778
2578
Week1
Week2
Week3
Week4
Week5
Week6
Week7
Week8
Week9
Week10
Week11
Week12
Week13
Week14
Week15
Week35
Week36
Week37
Week38
Week39
34035
35519
36931
38221
39914
11
13
14
15
16
3
3
3
3
3
22
22
22
22
23
64
64
64
64
79
4980
5141
5298
5310
5212
35049
36630
38240
39807
41496
1
1
1
1
1
5
5
5
5
5
0
0
0
0
0
0
0
0
0
0
24
24
24
30
30
4975
4998
5392
5007
5289
37091
38963
40752
42727
44390
0
0
0
0
0
1
1
1
1
1
0
0
0
0
0
0
0
0
0
0
5
5
5
5
5
5465
5809
5725
5873
5829
Week35
Week36
Week37
Week38
Week39
16
3
23
79
1
5
0
0
30
0
1
0
0
5
16
16
16
16
17
17
17
17
17
17
3
3
3
3
3
3
3
3
3
3
23
23
23
23
23
23
23
23
24
24
79
79
96
96
96
96
108
108
108
108
1
1
1
1
1
1
1
1
1
1
5
5
5
5
5
5
5
5
5
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
1
1
30
30
30
30
33
33
33
43
43
43
Week40 41245
Week41
Week42
Week43
Week44
Week45
Week46
Week47
Week48
Week49
Week50
42410
43648
44907
46065
46989
47987
48994
50093
51171
52172
5382 43223
5291
5276
4861
5166
4969
5063
4746
4860
4958
5125
44495
46066
47442
48458
49744
51035
52590
53994
55203
56340
5782 46058
6058
5925
5992
5606
5179
5130
5510
5277
4993
5001
5782 Week40
Week41
Week42
Week43
Week44
Week45
Week46
Week47
Week48
Week49
Week50
53
Data as of 08 Oct 2012
Wild poliovirus detected in sewage samples, 2010-2011
2010
Mumbai
Mumbai
Week
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
X
F ward
X
X
X
X
G ward
M ward
Delhi
Delhi
Week
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
X
Red cross hospital
X
X
Bhalaswa lake
X
X
Wazirpur JJ colony
X
X
Swarn cinema
X
Batala house (Okhla)
X
X
X
X
X
X
X
X
Mumbai
2011
Week
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
F ward
G ward
M ward
Delhi
Week
Red cross hospital
X
Bhalaswa lake
X
X
X
Wazirpur JJ colony
X
X
Swarn cinema
X
X
X
Batala house (Okhla)
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Sonia vihar
X
X
X
X
X
Nangloi
X
X
X
X
Patna
Week
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Choti pahari
Dujara
Transport nagar
Kolkata
Week
Ward 8, MM
Ward 135, KMC
Wild poliovirus type 1
Negative for wild poliovirus
Wild poliovirus type 3
Result pending
X
Scheduled but sample not collected
Sampling not scheduled
54
Data (NPSP) as of 05 Oct 2012
Wild poliovirus detected in sewage samples, 2012
Mumbai
Week
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
X
F ward
X
X
X
G ward
M ward
Delhi
Week
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Red cross hospital
Bhalaswa lake
Wazirpur JJ colony
Swarn cinema
Batala house (Okhla)
Sonia vihar
Nangloi
Patna
Week
X
Choti pahari
X
X
Dujara
X
Transport nagar
X
X
X
X
X
X
X
X
X
Kolkata
Week
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Ward 8, MM
Ward 135, KMC
Ward 29, KMC
Ward 66, KMC
`
Wild poliovirus type 1
Negative for wild poliovirus
Wild poliovirus type 3
Result pending
X
Scheduled but sample not collected
Sampling not scheduled
55
Data (NPSP) as of 05 Oct 2012
Vaccine Preventable Diseases
SEAR, 2011
Vaccine Preventable Diseases reported to SEARO for year 2011 (data upto Dec 2011)
Routine Reporting of clinically suspected
measles cases
Country
Cases
Lab confirmed Measles Lab confirmed Rubella Lab confirmed Mixed
Outbreaks
Outbreaks
Outbreaks
Number of
Neonatal
Serology Serology
Number of
Tested for
Number of
Number
Deaths
+ve
+ve
Outbreaks
Deaths
Tetanus Diphtheria Pertussis Encephalitis Cases of
serology
Outbreaks
of Cases
Number of
Number
measles Rubella
Investigated *
AEFI 2 Date of last
%
%
Number of Number of Number of Number of
Number (NNT)
of
reports
Outbreaks cases Outbreaks cases
of cases
report
Complete
Timely
Outbreaks
expected
1
2683 1445 267
333
333
Bhutan
98
1
98
10
3
0
0
0
DPR Korea
70
0
70
0
0
0
0
0
India
NR
NR
NR
NR NR
NR
4694 1175 1808
Indonesia
Number of Cases
Timeliness and Completeness of reports
received in SEARO, 2011 3
2993
Bangladesh
Classification of Outbreaks 1
Suspected measles outbreaks
23282 0
2802
89
4744
48
1572
98
11
44
708
1197 14-Aug-12
12
100 100
0
0
0
0
0
0
0
0
0
0
0
4
10-Jan-12
12
67
58
0
0
0
0
0
0
0
0
0
0
0
0
06-Jan-12
12
58
50
NR
NR NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
12
0
0
356
286
4993 14
251
3747
60
586
23
415
114
816
10-Sep-12
12
100
92
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
22
15-Jan-12
12
75
75
7
5
0
7
15-May-12
12
100 100
1336
6
14-Mar-12
12
100 100
0
0
Myanmar
1605
3
1547 879 87
38
38
895
3
36
873
2
22
0
0
32
Nepal
733
0
514
71 112
64
63
1579 5
22
797
31
545
4
68
13
Sri Lanka
574
0
254
6
140
10
10
369
0
0
0
10
369
0
0
0
0
55
165
5511 14-Feb-12
12
100 100
Thailand
3056
0
272
67
13
12
11
269
0
9
22
0
1
0
0
1
29
10
500
18-Jan-12
12
83
33
1
0
0
0
0
1
1
763
0
1
763
0
0
0
0
4
0
4
25
4
02-Jul-12
12
25
17
742
20731 33
410
9004
192
6267
75
2055
262
863
118
2734
6751
Total
1
0
91
Maldives
Timor-Leste
0
11863 11
32412 5 10132 3653 2430
At least 5 blood samples should be collected and tested from each outbreak.
814
2
Adverse Events Following Immunization; Sri Lanka AEFI data do not reflect cases but events.
3
Monthly VPD and AEFI reports due to SEARO/IVD on or before 15th of each month.
NR=No Report
* Total suspected outbreaks may not add to total lab confirmed outbreaks because some outbreak samples are in process with results pending and/or outbreak reports are not received from the field (investigation in process).
56
Updated on 24 Sep 2012
Vaccine Preventable Diseases
SEAR, 2012
Vaccine Preventable Diseases reported to SEARO for year 2012 (data upto Jul 2012)
Routine Reporting of clinically suspected
measles cases
Country
Cases
0
Bhutan
67
0
65
13
DPR Korea
44
0
44
India
NR
NR
NR
Indonesia
8473
2
Maldives
0
0
0
0
Myanmar
911
0
907
Nepal
397
3
Sri Lanka
91
0
Thailand
3558
0
12
0
14843
5
Timor-Leste
Total
1
Number of Cases
Lab confirmed Measles Lab confirmed Rubella Lab confirmed Mixed
Outbreaks
Outbreaks
Outbreaks
Number of
Neonatal
Serology Serology
Number of
Tested for
Number of
Number
Deaths
+ve
+ve
Outbreaks
Deaths
Tetanus Diphtheria Pertussis Encephalitis Cases of
serology
Outbreaks
of Cases
Number
measles Rubella
Investigated *
(NNT)
AEFI 2
Number of Number of Number of Number of
Number
of
Outbreaks cases Outbreaks cases
of cases
Outbreaks
1290
Bangladesh
Classification of Outbreaks 1
Suspected measles outbreaks
1209 543 129
167
146
4727
1
33
1092
57
2273
15
494
37
8
7
117
14
0
0
0
0
0
0
0
0
0
0
0
0
0
0
3
0
1
0
0
0
0
0
0
0
0
0
0
0
0
8
0
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
NR
1807 172 429
78
62
1099
1
35
582
20
246
3
48
65
742
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
743
10
41
40
1189 16
40
1189
0
0
0
0
17
13
2
328
64
84
64
63
1366
7
14
244
28
482
5
119
7
45
0
19
1
1
30
0
0
0
1
30
0
0
0
0
62
36
4
4
93
0
4
25
0
0
0
0
0
21
10
0
8
11
0
0
7
1
1
0
0
3
126
3139
107
3032
23
661
129
1272 558
0
0
5677 2093 732
At least 5 blood samples should be collected and tested from each outbreak.
355
324
2
8515 25
Adverse Events Following Immunization; Sri Lanka AEFI data do not reflect cases but events.
3
Timeliness and Completeness of reports
received in SEARO, 2012 3
Date of last
report
1121 12-Sep-12
Number of
%
%
reports
Complete Timely
expected
8
100 100
10-Sep-12
8
100 100
0
31-Aug-12
8
63
50
NR
NR
8
0
0
14-Sep-12
8
88
38
9
20-Sep-12
8
88
63
0
0
17-Sep-12
8
100
88
630
13
14-Sep-12
8
100 100
161
3210 10-Sep-12
8
100 100
9
310
23-Aug-12
8
50
0
1
0
0
0
14-Aug-12
8
13
13
785
88
1218
4356
Monthly VPD and AEFI reports due to SEARO/IVD on or before 15th of each month.
NR=No Report
* Total suspected outbreaks may not add to total lab confirmed outbreaks because some outbreak samples are in process with results pending and/or outbreak reports are not received from the field (investigation in process).
57
Updated on 24 Sep 2012
Measles and Rubella Serology (IgM) Results
SEAR, 2011-2012
Measles and Rubella Serology (IgM) Results - Monthly Reporting, SEAR,
Country
Bangladesh
Bhutan
DPR Korea
India
2011
Laboratories
Dhaka
Thimphu
Pyongyang
Ahmedabad
Bangalore
Chennai
Hyderabad
Jaipur
Kolkata
Pune
India Total from six labs
BANDUNG
JAKARTA
SURABAYA
YOGYAKARTA
Indonesia Total from four labs
Maldives
Male 2
Yangon
Myanmar
Kathmandu
Nepal
Colombo
Sri Lanka
Bangkok
Thailand
Dilli
Timor-Leste
Total
Indonesia
2011 (data up to Dec 2011)
Number of Serum
Number Tested for
Samples
Measles & Rubella
Received
4417
98
70
302
208
157
180
103
326
617
1893
1015
2640
1582
2248
7485
501
1907
1101
254
362
109
18197
4381
98
70
302
208
157
177
103
326
617
1890
1015
2637
1582
2042
7276
501
1769
1047
247
319
109
17707
Positive Results 1
Measles
#
1934
9
0
234
120
88
106
77
193
448
1266
539
857
708
365
2469
1
1248
176
6
96
84
7289
%
44.1
9.2
0.0
77.5
57.7
56.1
59.9
74.8
59.2
72.6
67.0
53.1
32.5
44.8
17.9
33.9
0.2
70.5
16.8
2.4
30.1
77.1
41.2
Rubella
#
711
7
0
2
44
34
8
4
39
43
174
284
888
412
922
2506
11
97
350
140
37
8
4041
%
16.2
7.1
0.0
0.7
21.2
21.7
4.5
3.9
12.0
7.0
9.2
28.0
33.7
26.0
45.2
34.4
2.2
5.5
33.4
56.7
11.6
7.3
22.8
% Measles Results
Date of Last Report
Reported with in 7
Received in SEARO
Days
68.5
100.0
100.0
97.7
100.0
92.4
89.3
99.0
91.1
81.5
90.4
98.7
47.3
50.0
50.0
55.8
99.8
83.9
88.0
89.5
99.4
100.0
70.5
09-May-12
06-Jan-12
06-Jan-12
04-Jan-12
02-Jan-12
03-Jan-12
05-Mar-12
04-Jan-12
02-Jan-12
19-Mar-12
11-Jun-12
11-Jun-12
11-Jun-12
11-Jun-12
08-Jan-12
09-Aug-12
08-Jan-12
05-Jan-12
09-Mar-12
13-Jun-11
Source: Reported by SEAR Measles Laboratory Network
NR=No Report
Percentages may not add to 100%; Equivocal results not included and some samples are in process with results pending. Some countries test samples for both Measles and Rubella.
1
2
497 samples were received for Rubella testing from the hospital (routine Antenatal cases).
Measles and Rubella Serology (IgM) Results - Monthly Reporting, SEAR,
Country
Bangladesh
Bhutan
DPR Korea
India
2012
Laboratories
Dhaka
Thimphu
Pyongyang
Ahmedabad
Bangalore
Chennai
Hyderabad
Jaipur
Kolkata
Pune
India Total from six labs
BANDUNG
JAKARTA
SURABAYA
YOGYAKARTA
Indonesia Total from four labs
Maldives
Male 2
Yangon
Myanmar
Kathmandu
Nepal
Colombo
Sri Lanka
Bangkok
Thailand
Dilli
Timor-Leste
Total
Indonesia
2012 (data up to Aug 2012)
Number of Serum
Number Tested for
Samples
Measles & Rubella
Received
Positive Results 1
Measles
2073
56
44
111
119
252
14
67
142
3
708
302
1392
874
1168
3736
296
1287
852
45
282
2073
56
44
111
119
220
14
67
142
3
676
298
1384
769
954
3405
296
1240
852
45
281
#
693
1
0
38
16
85
0
40
53
3
235
32
282
198
45
557
0
1065
193
0
133
9379
8968
2877
%
33.4
1.8
0.0
34.2
13.4
38.6
0.0
59.7
37.3
100.0
34.8
10.7
20.4
25.7
4.7
16.4
0.0
85.9
22.7
0.0
47.3
32.1
Rubella
#
442
1
1
23
59
19
7
0
17
0
125
169
339
203
282
993
1
10
289
19
22
1903
%
21.3
1.8
2.3
20.7
49.6
8.6
50.0
0.0
12.0
0.0
18.5
56.7
24.5
26.4
29.6
29.2
0.3
0.8
33.9
42.2
7.8
21.2
% Measles Results
Date of Last Report
Reported with in 7
Received in SEARO
Days
38.0
80.4
100.0
100.0
100.0
60.9
100.0
89.6
95.1
33.3
84.9
100.0
95.1
100.0
100.2
98.1
99.0
21.3
57.2
68.9
98.9
68.5
06-Sep-12
10-Sep-12
31-Aug-12
04-Sep-12
04-Sep-12
07-Sep-12
03-Sep-12
01-Aug-12
08-Aug-12
10-Sep-12
05-Sep-12
05-Sep-12
05-Sep-12
05-Sep-12
09-Sep-12
07-Sep-12
10-Sep-12
06-Sep-12
10-Sep-12
Source: Reported by SEAR Measles Laboratory Network
NR=No Report
Percentages may not add to 100%; Equivocal results not included and some samples are in process with results pending. Some countries test samples for both Measles and Rubella.
1
2
292 samples were received for Rubella testing from the hospital (routine Antenatal cases).
58
Updated on 17 Sep 2012