for more presentations

1. GLOBAL POLIO ERADICATION
STRATEGIES

2. Poliomyelitis - Introduction
• Infantile paralysis
• acute, viral, infectious disease
• spread from person to person, primarily via
the fecal-oral route
• derived from the Greek words ‘polios’-
meaning grey and ‘myelos’– referring to the
spinal cord

3. Poliomyelitis – Key Facts
• Polio was one of the most dreaded childhood
diseases of the 20th century
• Polio mainly affects children under five years
of age
• One in 200 infections leads to irreversible
paralysis
• Among those paralyzed, 5% to 10% die when
their respiratory muscles become paralyzed

5. The Global Polio Eradication Initiative
• The Global Polio Eradication Initiative was
launched in 1988
• Spearheaded by WHO, Rotary
International, the US Centers for Disease
Control and Prevention (CDC) and UNICEF

6. Progress
• Since the Global Polio Eradication Initiative
was launched, the number of cases has fallen
by over 99%
• In 2011, only four countries in the world
remain polio-endemic

8. Objectives
• to interrupt transmission of wild poliovirus as
soon as possible
• to achieve certification of global polio
eradication
• to contribute to health systems development
and strengthen routine immunization and
surveillance for communicable diseases

9. Strategies for Polio eradication in
India

10. 1. Pulse polio Immunization days every
year
• The aim of PPI is to interrupt circulation of
poliovirus
• by immunizing every child under 5 yrs of age
with two doses of oral polio
vaccine, regardless of previous immunization
status

11. • Idea - catch children who are either not
immunized, or only partially protected, and to
boost immunity in those who have been
immunized
• This way, every child in the most susceptible
age group is protected against polio at the
same time

13. 2. Sustain high levels of routine
Immunization coverage
• Immunizing more than 80% of children in the
first year of life with at least three doses of
oral polio vaccine
• good routine OPV coverage increases
population immunity, reduces the incidence of
polio and makes eradication feasible

14. 3. Monitor OPV coverage at district
level and below
• To localize the areas at maximum risk of
developing an outbreak
• Plan specific strategies to improve the
immunization coverage

15. 4. Improve AFP surveillance
• Reporting sites (RS) form the backbone of the
AFP surveillance network
• Hospitals and other health facilities - in the
government or the private sector - that are
likely to see cases of AFP
• Paediatricians and other physicians practicing
allopathic medicine, doctors of indigenous
systems of medicine and others who are likely
to see AFP cases

16. • RS are geographically well distributed to cover
all areas in the country
• There is at least one RS in every block of every
district
• A regular weekly reporting system has been
established
• All health facilities, clinicians and other
practitioners are required to notify AFP cases
immediately to the DIO, by the fastest means
available

17. 5. Ensure rapid case investigation
• All AFP cases are immediately investigated
• usually within 48 hours of notification,by a
trained medical officer – usually the DIO
• After confirming the case as AFP, the
investigator takes a detailed medical history,
examines the child and proceeds with the
other aspects of case investigation

19. Stool specimen collection and
transportation
• Samples of faeces from all suspected cases of
polio should be collected and forwarded to
the lab for virus isolation
• Examination of the child’s stool specimen in a
WHO-accredited laboratory

20. • 2 stool specimens are collected, and must be
collected as soon as possible after the onset of
paralysis
• ideally within 14 days of onset of paralysis and
at least 24 hours apart
• the highest concentrations of poliovirus in the
stools of infected individuals are found during
the first two weeks after onset of paralysis

21. • Each specimen should be 8g - about the size of
one adult thumb – collected in a
clean, dry, screw-capped container.
• The container need not be sterile and no
preservative/transport media should be used

23. • The specimens are collected, labeled and then
transported in the “reverse cold chain”
• On frozen ice packs or ice, in a stool specimen
carrier or a vaccine carrier specifically
designated for this purpose
• Sent to one of India’s eight WHO-accredited
polio laboratories

24. 6. Follow-up of cases of AFP
• Arrange follow-up of
selected cases of AFP at 60
days to check for resisual
paralysis

25. • cases with inadequate or no stool specimens
• cases with isolation of vaccine virus from the
stool
• cases with isolation of wild poliovirus from the
stool
• any case that the investigator thought was
strongly suggestive of poliomyelitis on initial
examination (“hot case”)

26. • the child is assessed for
Weakness
asymmetrical skin folds, and
difference in left/right mid-arm/mid-thigh
circumference
• The finding of residual weakness on follow-up
is suggestive that the case may actually be
polio

27. 7. Outbreak control
• Measures to stop transmission of polio virus
• Children <5 yrs in the locality are given one
dose of OPV regardless of the number of
doses received previously – Outbreak
Response Immunization (ORI)
• a house-to-house active case search is
conducted to find additional AFP cases that
may have occurred

28. • Search is conducted for children aged <15
years who have had the onset of flaccid
paralysis within the preceding 60 days
• All cases that are found are investigated
immediately, with collection from the case of
two stool specimens before administration of
OPV

29. 8. Mopping Up
• Usually the last stage in polio eradication
• Involves door-to-door immunization in high
risk districts, where wild polio virus is known
or suspected to be still circulating

30. THANK YOU….!!