Getting to Zero: On the Verge of Polio Eradication...OPV2 withdrawal, IPV introduction, immunization...
Transcript of Getting to Zero: On the Verge of Polio Eradication...OPV2 withdrawal, IPV introduction, immunization...
Getting to Zero:On the Verge of Polio Eradication
Ellyn Ogden, MPHUSAID Worldwide Polio Eradication Coordinator
May 17, 2017
1. Poliovirusdetection&interruption
2. OPV2withdrawal,IPVintroduction,immunizationsystemstrengthening
3. Containment&GlobalCertification
4. TransitionPlanning
Polio Eradication and Endgame Strategy
2
1988 2016
Progress in WPV eradication
37Casesin2016
PublicHealthEmergencyofInternationalConcern
declaredinMay2014andreconfirmedevery3monthssince
thattime
5casesin2017(AfghanistanandPakistan)asof10May2017
4Currentrolling6months:10November2016– 09May 2017Sameperiodpreviousyear:10November 2015– 09May 2016
Endemiccountry1Excludesvirusesdetectedfromenvironmentalsurveillance2Onsetofparalysis10November2016– 09May 2017
GlobalWildPoliovirus&cVDPVCases1,Previous6Months2
Wildpoliovirustype1cVDPVtype22
DatainWHOHQasof09May2017
Country Onset of most recent WPV1 case Current4 Same period
last year4 Current4 Same period last year4
Nigeria 0 0 0 0 0
AFR 0 0 0 0Pakistan 13-Feb-17 3 17 3 12Afghanistan 21-Feb-17 4 5 4 4
EMR 21-Feb-17 7 22 7 16
Global 21-Feb-17 7 22 7 16
Number of cases
10
1
1
0
Number of WPV1 cases
Number of WPV infected districts
cVDPV current 6 months2
Pakistan – AfghanistanLowestnumberofcaseseverinthe
epidemiologicalblock
PakistanandAfghanistan:Corridorsoftransmission—commonreservoirsspanningbordersbetweenAfghanistanandPakistaninvolving:1)selectedgeographic
areas,and2)demographic groups
Threemainsharedtransmissioncorridors/endemic zones:a) Southern/Western(Kandahar&Helmand—Quetta)b) SoutheastAfghanistan/SouthKP(Paktika—South Waziristan)c) Eastern/Northern(Nangahar&Jalalabad—Peshawar Valley)
4riskscenariosforfutureWPVtransmissionduetomovementofpeople,andGPEI action:• Movementwithinreservoir areas
• Areaswithhighpopulationmovementidentifiedand focused
• Emphasisonguestchildren (vaccinators,SMs,Supervisorsandmonitors)
• Straddlingpopulationsatborder areas• Mappingofareasandrelationsonother
sideof border• Inclusioninhighriskareaforincreased
focus• Nomads
• Routes,seasonality identified• Nomadspecificcampaigns,Nomadspecific
PTTs,Inclusionin SNID/NID• Returnees
• Vaccinationatborder,UNHCR/IOM centers• IPV(under5)andOPV(under 10)• Identificationofsettlementandinclusionin
microplan
Inaccessiblechildren:May2016- Mar 17400,000
300,000
200,000
100,000
0MayNID Aug NID Oct NID Mar NID2
South&West East North East Restof Afghanistan
Afghanistan
Pakistan
NigeriaandLakeChad
WPV1andVDPV2inNigeria,2016-20172016:• 4WPV1fromBorno.Dateofonsetof
lastcaseAugust21,2016• WPV1inBorno areorphansand
isolatedinsecuritycompromisedareasinnorthernpartofthestate
• 2cVDPV2casesbothfromcontacts(Borno andSokoto).
• LastcaseisfromBodinga LGAinSokoto StatewithdateofonsetSeptember28,2016
2017:• 10VDPV2isolatesfrom
environmentalsurveillancesites:• 6inSokoto• 2inGombe• 1inBauchi• 1inKatisna
• 1VDPV2wasisolatedfromahealthycontactinSokoto (50th Stoolsample)
• Nucleotidechangesrangefrom6- 10AllVDPV2isolatedin2017arenotcirculatingbyGPEIguidelines
THE OUTBREAK LED TO A MASSIVE REGIONALRESPONSE TARGETING 40+ MILLION WITH OPV MULTIPLE TIMES• Overall cost of the outbreak Aug-Dec: $140m
10
HornOfAfrica
HOAWILDPOLIOVIRUS (Type1)OUTBREAKS2004to 2013
2004-2008 Outbreak2009-2012 Outbreak
2013 Outbreak
2016??
2016??
Childrenininaccessibleareas,May2017
Accessstatus SouthSudan Somalia Yemen Sudan TotalinHOAPartiallyaccessibleareas
16,282 655,967 363,864 109,2221,145,335
CompletelyInaccessible
areas 296,320236,081
(comparedto400,000in2016)
51,972 142,532
726,905Total
populationU5in
securitychallenged
area
312,602(comparedto450,000in2016)
892,048
415,836(comparedto600,000in
2016)
251,754(comparedto305867in
2016)1,872,240
Yemen
S.Sudan
SudanSomalia
VDPVOutbreaks
GlobalCirculatingVaccine-derivedPoliovirusCases1,2,2000- 2017
DatainWHOHQasof09May2017
1ForcVDPVdefinitionsee http://polioeradication.org/wp-content/uploads/2016/09/Reporting-and-Classification-of-VDPVs_Aug2016_EN.pdf.Niger2006,Niger2009,Niger2010,Chad2010cVDPVsarelinkedtotheNigeriaoutbreak.Kenya2012cVDPVsarelinkedtotheSomaliaoutbreak.NigeriafiguresincludecaseswithWPV1/cVDPV2mixture:2005- 2,2006- 1,2007- 1,2008- 3,2009- 1,2011- 1;WPV3/cVPDV2mixture2007- 2.2InNigeria,1cVDPV2fromahealthychildcontactofaWPV1casenotincludedincountryorglobalcasecount. 3Figuresincludemultipleemergencesandtransmissionchains.
Country 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Onset of most recent case
Laos 8 3 11-Jan-16Madagascar 1 10 22-Aug-15Ukraine 2 07-Jul-15Mozambique 2 02-Jun-11Myanmar 1 4 06-Dec-07Indonesia 46 26-Oct-05China 2 11-Nov-04Philippines 3 26-Jul-01DOR/Haiti 12 9 12-Jul-01Total type 1 12 12 0 0 2 46 1 4 0 0 0 2 0 0 1 20 3 0
Country 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Onset of most recent case
Pakistan 16 48 22 2 1 17-Dec-16Nigeria 3 22 71 68 155 27 34 8 4 30 1 1(12) 28-Oct-16Guinea 1 7 14-Dec-15Myanmar 2 05-Oct-15South Sudan 2 12-Sep-14Cameroon 4 12-Aug-13Niger 2 2 1 1 1 11-Jul-13Chad 1 12 4 12-May-13Afghanistan 5 1 9 3 13-Mar-13Somalia 1 6 1 9 1 1 09-Jan-13Kenya 3 29-Aug-12DRCongo 13 5 18 11 17 04-Apr-12China 2 06-Feb-12Yemen 9 05-Oct-11India 15 2 18-Jan-10Ethiopia 3 1 16-Feb-09Madagascar 1 4 3 13-Jul-05Total type 2 0 1 4 0 0 6 24 71 85 184 55 65 68 65 55 12 2 0
Country 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Onset of most recent case
Yemen 3 1 12-Jul-13Ethiopia 1 5 17-May-10Cambodia 1 1 15-Jan-06Total type 3 0 0 0 0 0 1 1 0 0 1 5 0 3 1 0 0 0 0
cVDPV type 13
cVDPV type 23
cVDPV type 33
1. Poliovirusdetection&interruption
2. OPV2withdrawal,IPVintroduction,immunizationsystemstrengthening
3. Containment&GlobalCertification
4. LegacyPlanning
Polio Eradication and Endgame Strategy
Introduction• atleastonedoseofIPVinto routineimmunization
Switch• tOPVtobOPV
Withdrawal• ofbOPV&routineOPVuse
Transitioning Away from tOPVin Three Stages
2015-2016
2016
2019-2020
Ongoing STRENGTHENING of routine immunization services
IMG, IPV Introduction and OPV Withdrawal
Data source: WHO/IVB Database, as of 08December 2016
Map production Immunization VaccinesandBiologicals (IVB),
World Health Organization
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. ©WHO 2016. All rightsreserved.
Introduced* to date (173 countries or 89%)Introduction delayed to 2017/2018 (21 countries or 11%)
Not available
Not applicable
* Including partial introduction in India
Introduction delayed :Angola, Burkina Faso, Cabo Verde, Egypt, Eritrea, Ghana, Kyrgyzstan, Liberia, Malawi, Mongolia, Republic of Moldova (the), Rwanda, Sierra Leone, Tajikistan, Togo, Turkmenistan, United Republic of Tanzania (the), Uzbekistan, Viet Nam, Zambia, Zimbabwe
173countriesusing IPV
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. ©WHO 2016. All rights reserved.
Data source: WHO/IVB Database, as of 11 April 2017 Map production Immunization Vaccines and Biologicals (IVB),
World Health Organization
Countries with delayed introduction (18 countries or 9.2%)
Countries with delayed resupply (17 countries or 8.8%)
Not available / Countries already introduced Not applicable
0 950 1,900
20
3,800Kil
CountrieswithIPVsupply disruptions
1. Poliovirusdetection&interruption
2. OPV2withdrawal,IPVintroduction,immunizationsystemstrengthening
3. Containment&GlobalCertification
4. TransitionPlanning
Polio Eradication and Endgame Strategy
figure 1: containment requirements
Phase I: Preparation for containment of poliovirus type 2
Phase II: Poliovirus type 2 containment period
Phase III: Final poliovirus containment
Global readiness
criteria met
OPV2 withdrawal
6 x Regional certification of
WPV eradication
bOPV cessation
Poliovirus- essential facilities
holding WPV
Inventory Destruction, Preparation for containment
IIa: WPV2 containment IIIa: Final containment of all WPV Containment certification
Poliovirus- essential
facilities holding OPV/Sabin only
(no WPV)
Destruction, Preparation for containment
IIb: OPV2/Sabin2 poliovirus containment Containment certification
IIIb:Final containment of all OPV/Sabin polioviruses
Poliovirus- non-essential
facilities
Destruction, Safe handling, No storage Adopt
safe measures
Safe handling of new samples potentially containing poliovirus material in poliovirus-non-essential laboratories
GlobalPolioLaboratoryNetwork– 146Laboratories Worldwide
*Includes 16 in process of implementation AFR: African RegionAMR: Americas RegionEMR: Eastern Mediterranean Region
EUR: European Region ITD: Intratypic differentiationSEAR: South Eastern Asia Region WPR: Western PacificRegion
b
AMRAFR
Laboratories WorldwideVirus Isolation Laboratory (43)
ITD Laboratory (70*)
Sequencing Laboratory (26)
Global Specialized Laboratory (7)
EUR
WPREMR
SEAR
World HealthOrganization
EMROandAFRONOTCertified80%oftheWorld’sChildrenliveinPolio-freeRegions
1. Poliovirusdetection&interruption
2. OPV2withdrawal,IPVintroduction,immunizationsystemstrengthening
3. Containment&GlobalCertification
4. TransitionPlanning
Polio Eradication and Endgame Strategy
Purpose:Definehowapolio-freeworldwillbesustained
26
Goal1: ContainPolioSources
Goal2:ProtectPopulations § Immunizepopulationsagainstunanticipatedpolioevents
Goal3:DetectandRespond
§ Detectanypoliovirusintroductionandrapidlyrespondtopreventtransmission
Goal4:ManageEffectivelyandMonitor
§ Ensureongoingpoliofunctionsareembeddedinexistingordevelopnewapproachestosustainthegoalsofpoliopost-certification
§ Ensurepotentialsourcesofpoliovirusareproperlycontrolledorremoved
Post-CertificationStrategyGoals
• RoutineImmunization• SIAQuality– Immunitygaps• AFPSurveillance– missed
transmission• EnvironmentalSurveillance• MobileandCross-border
populations• Securitycompromised/access• CommunityTrustinVaccines• Containment• IPVsupply• OPVsupply• Complacency• Funding• PoorTransitionPlanning
ProgramRisks
ReasonsforOptimism
• LowestNumberofCases
• Declininggeneticdiversity
• ExpandEnvironmentalSurveillance
• Risksareknownw/solutionspossible
• WindowsofOpportunityinInsecureAreas
• EvidenceBasedCommunications
• Technology:GIS,Mobilephones/remote
monitoring,babyregistries
• CostSavingsIdentified
• TransitionPlanningImproving
• Strongeroversight
• Country-ledeffortsandownership
• Accountabilityframeworks
GlobalPolioEradicationisthelargesteffortoutsideofarmedconflictintheworld.With20millionvolunteers,healthworkers,labtechs,vaccinators,mobilizersdedicatedtothecommongoalofpreventingchildhoodparalysis.
13MillionCasesofParalysisPrevented
Every Child Counts!
Thank You