Completing Polio Eradication in Bihar 24 th January.

Completing Polio Eradication in Bihar

24th January

Risk factors for transmission of WPV (population density, diarrhea, low routine OPV3 coverage)

• High force of infection

• Sub-optimal vaccine efficacy due to these factors

Source : N Grasley et al , Imperial College , London

Due to various factors, western UP and north central Bihar are at highest risk for Polio transmission.

Therefore,

Are most challenging for Polio Eradication

Virologic evidence: elimination of all but 1 genetic lineage of type 1 poliovirus

20072006

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*as of 22nd Jun, 2009

In past 3 years, 8 of 9 P1 sub types have been eradicated.

Only one sub type is in circulation now.

Polio Update

State P1 P3 Total

Uttar Pradesh** 34 560 593

Bihar 38 79 117

Delhi 3 1 4

Punjab 2 2 4

Uttarakhand 0 4 4

Jharkhand 2 0 2

Rajasthan 1 2 3

Haryana 0 4 4

Himachal Pradesh 0 1 1

Total 80 653 732

Location of poliovirus by type, 2009*

Most recent virus31 December 09

Bareilly, UP

** One case reported mixture of P1 wild & P3 wild

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WPV Type-1 & Type-3 : 2007 - 10

2007 2008

2009 2010

463

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2007 2008 2009* 2010*

P1 P3

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Prioritization in Bihar(Done in 2007)

Focus Districts

High Priority

Persistent Transmission Blocks

High Risk Blocks

Additional High Risk Blocks

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Prioritization in Bihar

WPV P1 - 2009

13 of 38 P1 cases in PT Blocks7 of 13 in inside embankment30 of 38 P1 cases in pre identified HR Blocks

Persistent Transmission Blocks

High Risk Blocks

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P1 mostly limited to pre-identified HR Blocks of 6 Districts.

Sharp decline in number of P1 in last quarter with NO P1 from more than 2 months

Persistence of Type 1 polio in Bihar – 2007-09

Kosi River flood plain, Bihar, India

Type 1 Polio – 2008



KOSI: Persistence & Spread of P1

Responsible for persistence of virus over the yearsAnd is

Focus of intervention along with other HR Blocks

• Most difficult access compromised areas.

• Often flooded.• Poor Infrastructure.• Change in topography.• Very high concentration of

under served population.• R.I. – Very low in this region.

KOSI riverine areas

Compromised access around the kosi river poses unique challenges for programme planning, implementation &

monitoring

Access Compromised

Areas• ACA : 16 % of Bihar• Major continuous area -

In and around Kosi river and its tributaries

• Inaccessible area: 25 - 50 km wide by 125 km long= 3000 sq. km

• covers parts of 10 districts

• Flooded for more than 6 months in a year

• movement is only by motorbike/boat / horse

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WPV P3: Status

2007 2008

Complete Round

2009Mix Round

(mOPV3)Mix Round

(tOPV & mOPV1) (mOPV3 & mOPV1)

88 Blk Partial

433 Blk

mOPV1 -88 mOPV3- 345

433 Blk 433 Blk 561 Blk

mOPV1 – 58 mOPV3- 503

Partial Round Mix Round

(bOPV, tOPV & mOPV1)

Total : 459 Total : 230(District : 33) (District : 30)

Total : 79(District : 11)

Total : 3(District : 1)

•P3 cases have declined sharply from 233 in 2008 to 79 in 2009.

•Remaining focus is limited to area with lesser P3 antigen.

•bOPV in NIDs in same areas to tackle the problem

Summary• Number of families of P1 reduced to 1 in 2009 from 9 in 2006.

• Total WPV cases in Bihar in 2009 is down to 117 from 233 in 2008 and 503 in 2007.

• Although there was resurgence in P1 cases in 2009, but it was:– Limited geographically to small area. – Most of cases in pre-identified HR Blocks specially around KOSI.

• There is sharp decline in P1 cases and no P1 since October’09.

• P3 cases have reduced to 77 in 2009 from 230 in 2008.– Most of cases limited to the areas with lesser P3 antigen opportunity.

• bOPV in NIDs in Bihar in these areas:– Will hit hard on P3 transmission.– Without taking off pressure from P1.

Intensified efforts

Operations…• KOSI:

– Satellite offices in inside KOSI embankment– Increased presence of Medical Officers, UNICEF and WHO.– State monitors being sent to KOSI area in every round– Rotary support– Intensified monitoring: Each team– CMCs in KOSI

• HR Blocks:– Intensified operations.– MOs deployed from Non HR blocks to HR blocks– District Health Officials deployed for direct oversight.

• Strong oversight by highest levels of government.

Satellite Office

Stay Point

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Stay Facilities inside KOSI

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Satellite Office Stay Facility

2008 June'09 Oct'09

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Feb-09 Mar-09 5Apr-09 3May-09

24May-09 Jun-09 Aug-09 Sep-09

Oct-09 Nov-09 Dec-09

OPV type wise SIA Round in Bihar : 2009

mOPV1 tOPV mOPV3 P1 P3 VDPV

Jan-10

bOPV

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Nalanda

Muzaffarpur

Bhagalpur

Aurangaabad

Sitamarhi

Vaishali

Darbhanga

Champaran East

Samastipur

Gopalganj

Saharsa

Begusarai

Munger

Khagaria

Madhepura

Kishanganj


Sheikhpura

Sheohar

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•bOPV in High risk zones of Bihar in NIDs

•To break the transmission of P3 without releasing pressure from P1

More and more BASAs being covered

•Coverage of BASA increased with BASA Strategy.

•>1,70,000 BASAs being covered in KOSI riverine areas

0

50000

100000

150000

200000

250000

SIA Rounds

No

. o

f H

ut

Clu

ste

rs

Newborns being registered & tracked for 8 doses!!

0

500000

1000000

1500000

2000000

2500000

3000000

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

No. o

f New

Bor

n

2006 2007 2008 2009

Bihar

Nomadic Population coverage

20

11

17

69

41

9

16

0821

94

21

34

50

0

18

80

24

24

27

05

23

76

15

94

42

42

29

46

30

65

27

91

17

30

44

66

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Mar_09 Apr_09 May_09 24May_09 Jun_09 Aug_09 Sep_09 Oct_09 Nov_09

SIA Round

Total Number of Families Total Number of Children Vaccinated

Coverage during floods/ Monsoon

Mosque Announcement

35%

40% 40.32%41.65%

44.45%

40.00%

42%

20%

25%

30%

35%

40%

45%

50%

Jun

.08

Sep

.08

No

v.08

Dec

.08

Feb

.09

Mar

.09

Ap

r.09

1.2 Communication efforts: Underserved strategy

Mothers being convinced regarding Polio in Madhepura Imam Meeting: Madhubani

Madarsa Involvement: Supaul

Operations…

• All newborns being identified and tracked.

• BASAs: Survey before every round to cover all BASAs.

• Transit teams: children in movement

• Migratory families of Nomads, Brick Kilns and construction workers being covered.

• Repeated efforts to convert X houses.

Efforts…

• Routine Immunization:– From 11% in 2002 to 56%.– Statewide microplan revision to include all areas.– Focused monitoring of RI including HtH monitoring.

• Convergence:– Intensification of MC Health, nutrition, water and

sanitation efforts in KOSI area.

Summary…

• P1 circulation in 2009 was in limited geographical area mostly HR blocks and has

declined sharply. The intensified efforts in KOSI and HR Blocks along with bOPV/ mOPV1 rounds planned in 2010 present unique opportunity to finish the transmission.

• P3 in Bihar has declined sharply and use of bOPV in NIDs in concerned area has presented

the opportunity to stop transmission without releasing the pressure from P1

Thank You

Completing Polio Eradication in Bihar 24 th January.

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