3. Cameroun
WORLD - WILD POLIO VIRUS CASES - 2010
577 CASES IN 15 COUNTRIES
Pakistan
Afghanistan
Countries
Wild cases
2010
India 25
Afghanistan 12
Angola 16
Pakistan 31
Tajikistan 437
Senegal 18
Sierra Leone 1
Mauritania 5
Mali 3
Nigeria 6
Niger 2
DRC 2
Nepal 4
Liberia 1
Chad 14
Total 577
India
Senegal
Nigeria
Chad
Mauritania
Mali
Angola
Sierra Leone
Nepal
Tajikistan
Liberia
Niger
* data as on 27th Jul 2010
DRC
5. State P1 P3 Total
West Bengal 4 1 5
Jammu & Kashmir 1 0 1
Jharkhand 1 0 1
Maharashtra 1 0 1
Uttar Pradesh 0 10 10
Bihar 0 6 6
Haryana 0 1 1
Total 7 18 25
WPVs
Location of poliovirus by type, 2010*
Most recent virus
14 June 2010
Murshidabad, West Bengal
* data as on 30 Jul 2010
State P1 P2 Total
Uttar Pradesh 0 2 2
Tamil Nadu 0 1 1
Total 0 3 3
VDPVs
6. Genetic linkages of WPV1 cases, 2010*
* data as on 3 July 2010
Genetically related to June 2009
strain in Saharsa district of Bihar
Genetically related to June 2009
strain in Khagaria district of Bihar
Genetically related to an imported Sept
2009 strain in Ludhiana district of Punjab
* data as on 30 Jul 2010
7. State P1 P3 Total
Bihar 38 79 117
Uttar Pradesh** 34 569 602
Delhi 3 1 4
Punjab 2 2 4
Jharkhand 2 0 2
Rajasthan 1 2 3
Haryana 0 4 4
Uttarakhand 0 4 4
Himachal Pradesh 0 1 1
Total 80 662 741
WPVs
Location of poliovirus by type, 2009
State P1 P2 Total
Assam 1 0 1
Bihar 0 3 3
Uttar Pradesh 1 16 17
Total 2 19 21
VDPVs
** One case reported mixture of P1 wild & P3 wild
9. 0
1
2
3
4
5
6
7
8
9
10
Jan
2009
Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Weekly incidence of WPV1 cases, India, 2009 – 10
Jan
2010*
Feb Mar Apr May Jun
* data as on 30 Jul 2010
11. WPV1 Polio cases, India
Jan 10 Feb 10 Mar 10
Apr 10
* data as on 30 Jul 2010
May 10 Jun 10
N=2 N=1 N=0
N=1N=2N=1
12. 0
1
2
3
4
5
6
7
8
9
10
Jan
2009
Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Weekly incidence of WPV1 cases, Uttar Pradesh, 2009 – 10
Jan
2010*
Feb Mar Apr May Jun
* data as on 30 Jul 2010
13. 0
1
2
3
4
5
6
7
8
9
10
Jan
2009
Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Weekly incidence of WPV1 cases, Bihar, 2009 – 10
2010*
Jan Feb Mar Apr May Jun
* data as on 30 Jul 2010
15. 0
5
10
15
20
25
30
35
40
Weekly incidence of WPV3 cases, India, 2009 – 10
Jan
2009
Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan
2010*
Feb Mar Apr May Jun
* data as on 30 Jul 2010
16. WPV3 Polio cases, India
Jan 10 Feb 10 Mar 10
Apr 10
* data as on 30 Jul 2010
May 10 Jun 10
N=14 N=2 N=0
N=1 N=0 N=1
17. 0
5
10
15
20
25
30
35
40
Weekly incidence of WPV3 cases, Uttar Pradesh, 2009 – 10
Jan
2009
Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan
2010*
Feb Mar Apr May Jun
* data as on 30 Jul 2010
18. 0
5
10
15
20
25
30
35
40
Jan
2009
Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Weekly incidence of WPV3 cases, Bihar, 2009 – 10
Jan
2010*
Feb Mar Apr May Jun
* data as on 30 Jul 2010
20. Spot map of AFP cases
Total Resident AFP cases - 1193
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ANG
SLR
PNA
NSK YTL
GDL
JLG AMT
STR
BED NDD
BLD
CPRABD
THN
NGP
JLN
KLP
SNG
RTG
LTR
DHL
OBD
RGD
PBN
AKL
HIN
WDH
NDB
GNA
SDG
WSM
BND
BMC
* As of Week 29, 2010
Cameroun
WORLD - WILD POLIO VIRUS CASES - 2010
577 CASES IN 15 COUNTRIES
Pakistan
Afghanistan
Countries
Wild cases
2010
India 25
Afghanistan 12
Angola 16
Pakistan 31
Tajikistan 437
Senegal 18
Sierra Leone 1
Mauritania 5
Mali 3
Nigeria 6
Niger 2
DRC 2
Nepal 4
Liberia 1
Chad 14
Total 577
India
Senegal
Nigeria
Chad
Mauritania
Mali
Angola
Sierra Leone
Nepal
Tajikistan
Liberia
Niger
* data as on 27th Jul 2010
DRC
21. AFP Rate
Less than 0.69
2 & Above
0.70 to 0.99
1 to 1.99
No dataMH– 5.57 %
ANG
SLR
PNA
NSK YTL
GDL
JLG AMT
STR
BED NDD
BLD
CPRABD
THN
NGP
JLN
KLP
SNG
RTG
LTR
DHL
OBD
RGD
PBN
AKL
HIN
WDH
NDB
GNA
SDG
WSM
BND
BMC
* As of Week 29, 2010
24. POLIO ERADICATION STRATEGIES
BASED ON DISEASE KNOWLEDGE
POTENT VACCINE .
EFFECTIVE METHODS FOR THE
CONTROL OF POLIO.
25. The disease of
poliomyelitis has a long
history. The first example
may even have been more
than 3000 years ago. An
Egyptian stele dating from
the 18th Egyptian dynasty
(1580 - 1350 BCE) shows
a priest with a deformity of
his leg characteristic of the
flaccid paralysis typical of
poliomyelitis.
.
26. POLIO
MOST VOLUNERABLE GROUP IS <
5YRS.
HIGH TRANSMISSION-JULY TO
SEPTEMBER.
ROUTE OF TRANSMISSION-FAECO-
ORAL ROUTE.
OVER CROWDING,POOR
SANITATION, SLUMS FAVOURABLE
CONDITIONS
INCUBATION PERIOD- 1 TO 2
WEEKS.
27. POLIO DISEASE
• IT IS A VIRAL INFECTION CAUSED BY
AN ENTEROVIRUS –POLIO VIRUS
• THREE TYPES
• TYPE-1—EPEDEMICS
• TYPE-2---THIS IS THE FIRST SERO
TYPE TO DISAPPEAR.
• TYPE-3--- PARALYSIS LESS
FREQUENT.
28. In 1928, Philip Drinker and Louis Shaw at Harvard Medical School introduced the iron
lung to help individuals suffering from acute poliomyelitis. Polio impaired patients'
ability to breathe by paralyzing the diaphragm and intercostal muscles; the iron lung
provided relief in the form of artificial respiration. It consisted of a sealed chamber in
which air pressure is alternately reduced and increased. The patient was placed in the
chamber with his/her head emerging from a port at one end. Each cycle of vacuum
within the chamber allowed their lungs to be filled with atmospheric air; subsequent
increase of pressure forced exhalation of air from the lungs.
29. POLIO DISEASE
IT IS A VIRAL INFECTION CAUSED
BY AN ENTEROVIRUS –POLIO VIRUS
THREE TYPES
TYPE-1—EPEDEMICS
TYPE-2---THIS IS THE FIRST SERO
TYPE TO DISAPPEAR.
TYPE-3--- PARALYSIS LESS
FREQUENT.
30. WHY POLIO IS A CANDIDATE FOR
ERADICATION ?
MAN IS THE ONLY RESERVIOR
NO LONG TERM CARRIER STATE
ROUTE OF TRANSMISSION IS FAECO-
ORAL
HALF LIFE OF EXCRETED VIRUS IN
SEWAGE SAMPLE IN TROPICAL
CLIMATE LIKE INDIA IS 48 HOURS.
POTENT AND EFFECTIVE VACCINE.
31. WHY OPV ?
ALSO KNOWN AS SABIN VACCINE
POTENT LIVE VACCINE
GIVES GUT IMMUNITY
GIVES HERD IMMUNITY- INTERRUPT’s
TRANSMISSION CYCLE
EASY TO ADMINISTER
COST EFFECTIVE
32. FOUR KEY STRATEGIES FOR
POLIO ERADICATION
RI-PROGRAMME [ UIP ] - 1985
MASS IMMUNIZATION(PPI) – 1995-96
CAMPAIGNS
APF SURVEILLANCE - 1997
MOPING UP IN FOCAL AREAS
33. WHAT IS PULSE POLIO ?
TO IMMUNIZE ALL THE KIDS< 5YRS NATION
WIDE ON A SINGLE DAY IN THE SHORTEST
POSSIBLE TIME WITH OPV & THAT THE
ENVIRONMENT WILL GET SATURATED
WITH THE VACCINE VIRUS SO THAT IT WILL
REPLACE THE WILD VIRUS AND THUS
INTERUPT THE TRANSMISSION OF WILD
VIRUS .
34. WHAT IS SURVEILLANCE ?
• IT IS A CONTINOUS SCRUTINY OF ALL
ASPECTS OF OCCURRENCE & SPREAD
OF DISEASE THAT ARE PERTINENT TO
EFFECTIVE CONTROL.
• IT INCLUDES
1. COLLECTION OF DATA
2. ANALYSIS OF DATA
3. INTERPRETATION OF DATA
4. DISTRIBUTION OF RELEVANT DATA SO
THAT NECESSARY ACTION CAN BE
TAKEN
35. AIM OF AFP
SURVEILLANCE
TO DETECT POLIO TRANSMISSION &
INTERRUPTION OF TRANSMISSION
AFP CASE
POLIO CASE
RESERVOIR OF INFECTION
[ 100 TO 1000 SUB CLINICAL CASES ]
CONTAINMENT MEASURES
[ O.R.I. / MOP UP ]
36. GOAL OF AFP SURVEILLANCE
IDENTIFICATION OF ALL RESERVOIRS
OF CIRCULATING WILD POLIO VIRUS
( THAT COULD BE POLIO ) BY
DOCUMENTING ALL SUCH CASES,IT
IS POSSIBLE TO SHOW THAT NONE
OF THESE “POLIO-LIKE” CASES
WERE CAUSED BY THE POLIO
VIRUS,AND THAT POLIO IS NO
LONGER PRESENT OR EXISTING.
37. WHY AFP SURVEILLANCE INSTEAD OF
POLIO SURVEILLANCE ?
SURVEILLANCE OF A POLIO CASE ALONE
IS NOT SUFFICIENT BECAUSE IT IS
IMPOSSIBLEE TO PRECISELY IDENTIFY ALL
CASES OF POLIO CLINICALLY DUE TO
CONFUSING AND AMBIGUOUS CLINICAL
SIGNS AND VARIABLE CLINICAL
KNOWLEDGE & SKILLS OF DOCTOR.
CLINICALLY POLIO IN ACUTE STAGE, IS
DIFFICULT TO DISTINGUISH FROM OTHER
CAUSES OF ACUTE ONSET OF FLACCID
PARALYSIS.-----
38. SURVEILLANCE OF ACUTE
FLACCID PARALYSIS
STARTED IN 1997 OCTOBER
ACHIEVED GLOBAL BENCHMARKS IN
MAY 1998
MAPPING OF POLIO CASES MADE
POSSIBLE
LABS PROVIDING > 80% RESULTS ON
TIME
GENETIC SEQUENCING CAPACITY
EXPANDED
39. WHAT IS AFP ?
OLD DEFINITION
ANY CHILD AGE < 15 YRS HAVING
ACUTE ONSET OF FLACCID
PARALYSIS FOR WHICH NO OBVIOUS
CAUSE SUCH AS SEVERE TRAUMA OR
ELECTROLYTE IMBALANCE IS FOUND
IT INCLUDES-GBS,TM,TN,POLIOMYELITIS
40. The AFP Surveillance System
Hospitals
Clinics
Investigation
Non-Polio AFP Polio AFP
Community
41. Causes of AFP
• Poliomyelitis
• Gullain Barre Syndrome
• Traumatic neuritis
• Transverse Myelitis
• Any other flaccid/lower motor
presentation
42. AFP case definition broadened
Consequences of missing the case of polio are
more serious then occasionally including and
“ambiguous’’ case, specially during the final stage
of polio eradication.
Includes every case with
• current flaccid paralysis
• History of flaccid paralysis in the current illness
• Boarder line and ambiguous case
• Transient weakness / paralysis
43. When too much polio is around…..
Non-AFP cases
Polio cases
AFP cases
Borderline AFP cases
Surveillance
sensitivity is
adequate enough
to detect 90%
polio cases
44. Adequacy of surveillance
• Programme Monitoring indicators
1. Non polio AFP rate
2. Adequate stool specimen collection
45. Non Polio AFP Rate
Proportion of Non Polio AFP cases –
is the indicator of quality of surveillance.
More the no. of AFP cases reported –
better the quality of
surveillance
46. Non Polio AFP Rate
1 Non Polio AFP case in 1 Lakh children (0 to 15 Years) .
Pune District – 27 lakh (0 to 15 years) – 27 non Polio AFP cases
expected
PMC - 10 Lakh (0-15 years) – 10 non Polio AFP cases
expected
This is the lowest limit of this indicator – applicable to
western countries
47. Non Polio AFP Rate
Non polio AFP rate = Reported AFP cases
Expected AFP cases
e.g. In PMC = 10
10
= 1
2005 = 23
10
= 2.3
This rate should be more then 2.
48. When to report AFP case
Immediately ( Just one phone call)
9689931339 / 9822912062 /
24487700
So that stool samples are collected within
14 days from onset of paralysis
Stool can be collected up to 2 months
Case can be reported up to 6 month of
onset
49. WHAT TO REPORT
Any Case of Acute Flaccid Paralysis
< 15 Yrs age
It May be
Monoplegia,Paraplegia,Hemiplegia,Fa
cial Palsy,or Any Trasient weakness.
Any case of Suspected Polio Clinically
Irrespective of any age
50. AFP SURVEILLANCE
STEPS FOR EACH AFP CASE
1. CASE INVESTIGATION
2. 2 STOOL SPECIMENS,COLLECTED 24
HOURS APART,AND WITHIN 14 DAYS OF
ONSET OF PARALYSIS
3. SENT FOR CULTURES TO LAB TO ISOLATE
POLIO VIRUS
4. ORI ACTIVITY & SEARCH FOR MORE AFP
CASES IN THE AREA
5. 60 DAYS FOLLOW-UP EXAMINATION
AFTER ONSET.
51. STOOL COLLECTION
2 STOOL SAMPLES, COLLECTED 24
HOURS APART
COLLECTED WITHIN 14 DAYS OF
ONSET
APPROXIMATELY 8 gms OR ADULT’s
THUMB SIZE
KEPT IN REFRIGERATOR( DO NOT
FREEZ)
SEND IN REVERSE COLD CHAIN TO
LAB WITH PROPER DOCUMENTATION
52. ADEQUATE SPECIMENS
TWO SPECIMENS
- COLLECTED 24 TO 48 HOURS APART
- WITHIN 14 DAYS OF PARALYSIS
ONSET
SPECIMENS ARRIVING @ LAB
- GOOD CONDITION
- NO LEAKAGE
- NO DESICCATION
- IN COLD CHAIN
- WITH APPROPRIATE DOCUMENTATION
53. OUTBREAK RESPONSE
IMMUNIZATION
TARGET AGE- 0- 59 MONTH OLD
CHILDREN
AFTER COLLECTION OF
SPECIMENS
ONE ROUND OF H-T-H
WHOLE VILLAGE / URBAN WARD
IMMEDIATELY FOLLOWING AN
AFP CASE
54. WHY ORI ?
CONTROL OF OUTBREAK ESPECIALLY IN
UPSURGE OF EPIDEMIC CURVE
AVOID NEGATIVE CONSEQUENCES OF
COMPLACENCY
TO PROTECT AGAINST OTHER POLIO VIRUS
TYPES
INFORMATION FOR ACTION- MOTIVATES
REPORTING SITES,OPPORTUNITY FOR
ACTIVE CASE SEARCH
55. 60 DAYS FOLLOW UP
EACH AFP CASE MUST BE
FOLLOWED-UP AFTER 60 DAYS
AFTER ONSET OF PARALYSIS TO
DETERMINE IF THERE IS STILL A
RESIDUAL PARALYSIS
FOR FOLLOW-UP, EXACT
PERMANENT ADDRESS OF THE
PATIENT SHOULD BE WRITTEN ON
THE CIF @ THE TIME OF INITIAL
INVESTIGATION.
56. Onset of paralysis
Investigation of
suspected case
(≤48 hours of report)
2 stool
specimens
collected (≤14
days since onset
of paralysis)
24 hours apart
Outbreak
response
immunization
additional case
finding
60-day follow-up
exam
Specimens
arrive at
national
laboratory
Results
reported
from
national
laboratory
Poliovirus isolates
send to regional
reference laboratory
for intratypic
differentiation
Final classification of the case by the expert
committee (≤ 12 weeks since onset of paralysis)
Appendix 5 :
Flow diagram of case investigation,
stool specimen collection and
outbreak response immunization
≤ 3 Days ≤ 24 Days
≤ 7 Days
57. WHAT IS NOT AFP ?
TRAUMA
ISOLATED FACIAL NERVE PALSY
HYPOKALAEMIA
ACUTE RHEUMATIC FEVER
CONGENITAL FLACCID PARALYSIS
58. CONDITIONS SOMETIMES
PRESENTING WITH AFP
TUMOR
ENCEPHALITIS
HYPOKALEMIC PARALYSIS [ DUE TO
LOW SERUM POTASSIUM USUALLY
REVERSIBLE ]
POTT’s DISEASE
TB MENINGITIS
OSTEOMYELITIS
59. AFP Reporting Network
Gen. Pract.Paediatrician Neurologist Physician
Dist. Hospital
Traditional Healer
MPW/ ANM
RH
PHC
Quack
DHO/
MOH/
SMO
State
WHO
Delhi
60. Data Flow
Reporting Units Districts
Districts State
States NPSU Delh
Delhi WHO
Mondays
Tuesdays
Wednesdays
Thursday
61. Reporting Units
Reporting
Units
Informers
PMC 39 141
PCMC 18 7
PUNE
RURAL
43 139
Pune Dist 100 287
Reporting units – sending reports weekly regularly
Informers – whenever AFP case - Informs by phone
75. Expectation from GP’s
• Immunization –
1. Insist for Zero dose OPV
2. Routine immunization
3. Pulse polio immunization
4. Observing VVM during all immunization
activities
(to train nursing staff – for VVM & cold
chain)
76. Expectation from GP’s
Surveillance –
1. Report AFP case immediately – Just
telephone – 9689931339 / 9822912062 /
24487700 Dr. Sunil A. Tore
2. To give information of AFP case –
whenever phone calls from WHO or PMC
office
3. An issue of reporting of referred case to
neurologist for EMG/NCV in Pune.
77. Expectation from Paediatrians
An issue of reporting of referred case
to neurologist for EMG/NCV in
Pune
Should neurologist & EMG / NCV Labs
also report this cases to PMC
An ethical issue
81. OPV: unstable, but more stable than before and it can be
monitored
Vaccine Vial Monitor (VVM)
1 = good OPV
2 = good OPV
3 = bad OPV
4 = bad OPV
82. Vaccine Vial Monitor (VVM)
The square is lighter than the circle.
If the expiry date is
not passed, use the vaccine
The square colour changes but lighter than the outer circle.
If the expiry date is not
passed, use the vaccine
The square matches the circle.
Do not use the vaccine.
Inform your supervisor
The square is darker than the circle.
Do not use the vaccine.
Inform your supervisor
83. Thermal Characteristics of the
Vaccine
OPV, Measles. : Heat Sensitive Vaccine
DPT, DT, TT. : Freeze Sensitive Vaccine
BCG : Light Sensitive VaccineRecommended Temperature for Storage of
OPV & Measles Vaccine
Level Temperature Storage Time
Central Storage
-200 C (-150 C to –250
C)
8 Months
State/ District Storage
-200 C (-150 C to –250
C)
3 months
PHC/Dispensary/Nursing
Home
+20 C to +80 C 1 Months
Transport
+20 C to +80 C 1 week
84. Routine immunization
Plan of routine immunization for out reach
areas
Ward wise out reach sessions planned
Provision of giving vaccine to private
practitioner
85. mOPV1 Effects
• Humoral immunity:
– Circulating antibodies will prevent paralytic
disease (individual protection)
• Mucosal immunity:
– Secretory antibodies will prevent replication and
excretion (community barrier to transmission)
• Rationale for mOPV1 effectiveness:
– No interference from Sabin types 2 & 3
– In tOPV, type 2 most immunogenic, will outgrow
types 1+3
86. REPORT EVERY CASE OF AFP
• REPORT TO
• Dr.SUNIL TORE
• IMMUNIZATION OFFICER
• PUNE MUNICIPAL CORPORATION
• CONTACT NO.
• 9689931339
• 9822912062
• 020-24487700