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IPV – Need of the hour Dr Gaurav Gupta Pediatrician, Charak Clinics, Mohali [email_address]
A brief history of Polio ,[object Object],[object Object],[object Object],[object Object]
A brief history of Polio Vaccine ,[object Object],[object Object],[object Object],[object Object],[object Object]
Summary of Key Attributes of OPV and IPV Adapted from  1, 11 Sutter et al.  Vaccines , 2008  Plotkin & Vidor .  Vaccines , 2008
Despite Significant Progress, 4 Countries Still Remain Endemic for Polio  WHO. Poliomyelitis Fact sheet. Available at:  http://www.who.int/mediacentre/factsheets/fs114/en/print.html , 2009 WHO. Polio Case Count. Available at:  http://www.who.int/immunization_monitoring/en/diseases/poliomyelitis/case_count.cfm , 2009 Graph adapted from WHO. Progress Towards Global Immunization Goals. Available at: http://www.who.int/immunization_monitoring/data/SlidesGlobalImmunization.pdf , 2009 Polio Eradication Progress, 1988-2008  ,[object Object],[object Object],[object Object],[object Object],[object Object],Endemic with wild polio virus (4 Countries) Certified polio-free regions (114 countries) Not certified but non-endemic (73 countries)
Polio Eradication:  A Godzilla of Campaigns ,[object Object],[object Object],[object Object],[object Object]
Weekly AFP and VPD Update for Week 48, 2011 Data as of 05 December 2011
Wild Polio Virus India, 2010 *Dots are randomly placed within blocks (Sub-districts) Data as of 05 Dec 2011 Districts with cases in 2010 = Most recent P3 Wild polio case = Most recent P1 Wild polio case
Wild Polio Virus India, 2011 *Dots are randomly placed within blocks (Sub-districts) Data as of 05 Dec 2011 = Most recent P1 Wild polio case Districts with cases in 2011 Districts with cases in current week
Vaccine Derived Polio Virus (VDPV) India, 2011 *Dots are randomly placed within blocks (Sub-districts) Data as of 05 Dec 2011 Districts with cases in 2011 Districts with cases in current week = Most recent P2 VDPV case = Most recent P3 VDPV case
Wild Polio Cases by Type (P1, P3) and Month of Onset India, 2007-2011 Data as of 05 Dec 2011
 
But why talk about IPV now? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],Issues Surrounding the Use of OPV
Polio is Still Endemic in 4 Countries, Reflecting both “Failure to Vaccinate” and “Vaccine  Failure” WHO. Polio Case count. Available at:  http://www.who.int/immunization_monitoring/en/diseases/poliomyelitis/case_count.cfm , 2009 Graphs from WHO. Polioeradication. Progress & Prospect. 2008 Roberts.  Science , 2009 W. Uttar Pradesh  Bihar  Rest of country High risk  Medium risk  Rest of country In Nigeria,  high “failure to vaccinate” In India, polio cases despite high coverage, thus “high vaccine failure” 0 doses 1-3 doses 4-6 doses 7+ doses OPV doses administrated per area in Nigeria 2003-2008 OPV doses  administrated  per area in India 2003-2008 % of children < 5 years receiving doses % of children < 5 years receiving doses
Seroconversion after 3 doses of OPV ,[object Object],[object Object],[object Object],Review of 32 studies. Patriarca, Wright & John. Rev Infect Dis 1991; 13:926-39 Type Weighted average seroconversion 1 2 3 73% 90% 70%
Paralytic polio cases are occurring predominantly among the children who had received 4 or more doses of vaccine, and lately among those who had received more than 7 doses of OPV. On the other hand among the polio cases percentage of unvaccinated children is very low. In case children develop paralytic disease after taking many doses of OPV, it means that many doses of vaccine had failed to provide protection.
VAPP:  A Rare But Serious and Inevitable Adverse Event  Associated with OPV ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Sutter et al.  Vaccines , 2008 Paul.  Vaccine , 2004 John.  Bull of the WHO , 2004
VDPV:  No Longer Just a Theoretical Concern ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],WHO.  WER , 2006
[object Object],[object Object],2000- July 2009:  At Least 13 cVDPV Outbreaks in 12 Countries Caused et Least of 300 Paralytic Polio cases  DOR / HAITI 2000-01 VDPV 1 21 cases NIGER 2006 VDPV 2 2 cases NIGERIA 2005-08 VDPV 2 148 cases DR CONGO 2008 VDPV 2 11 cases MADAGASCAR VDPV 2 2001-02 5 cases 2005 3 cases MYANMAR 2006-07 VDPV 1 5 cases INDONESIA 2005 VDPV 1 46 cases CHINA 2004 VDPV 1 2 cases CAMBODIA 2005-06 VDPV 3 2 cases PHILIPPINES 2001 VDPV 1 3 cases ETHIOPIA 2008-09 VDPV 2 4 cases WHO. cVDPV 2000-2008. Available at:  http://www.polioeradication.org/content/general/cvdpv_count.pdf , 2009 GPEI.Strategic Plan 2009-2013. Available at:  http://www.polioeradication.org/content/publications/PolioStrategicPlan09-13_Framework.pdf ,2009 Wringe et al.  Plos One , 2008 INDIA 2009 VDPV 1, 2 2 & 18 cases
 
The OPV Paradox  – how OPV Use May Compromise the Final Goal of Eradication  ,[object Object],WHO. cVDPV 2000-2008. Available at:  http://www.polioeradication.org/content/general/cvdpv_count.pdf , 2009 GPEI. Strategic Plan 2009-2013. Available at: http://www.polioeradication.org/content/publications/PolioStrategicPlan09-13_Framework.pdf ,2009 WHO.  WER , 2004  Jacob.  Bull  of the WHO , 2002  Dowdle et al.  Rev Med Virol , 2003   RISK FREQUENCY GLOBAL ESTIMATES VAPP 2-4 per million birth cohort 250-500 cases/year (WHO) 400-800 cases/year (other experts’ estimate) cVDPV 13 independent cVDPV outbreaks in 12 countries since 2000  iVDPV 33 cases since 1962
eIPV: The Vaccine of Choice for Today and the Future ,[object Object],[object Object],[object Object],[object Object],[object Object]
eIPV:  High Immunogenicity, Even After 2 Doses ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Polio Eradication Committee et al.  Indian Pediatr , 2008  Plotkin & Vidor.  Vaccines , 2008
IPV Provides Good Herd Immunity  ,[object Object],[object Object],[object Object],[object Object],John.  Expert Rev Vaccines , 2009 Stickle.  Am J Public  Health , 1954 Paralytic Poliomyelitis Cases Expected with or without Vaccine use, 1951-1954 Observed Expected in absence of vaccine use Expected with vaccine effect limited to vaccinees
Role of OPV + eIPV  ,[object Object],[object Object],[object Object],[object Object],OPV & IPV are not contradictory but complementary !
Indian Academy of Pediatrics: Schedules ,[object Object],[object Object],[object Object],[object Object],[object Object],Indian Pediatrics 2008; 45: 635-648 Polio immunization naïve child Child has received OPV primary series ,[object Object],[object Object]
[object Object],[object Object],Indian Academy of Pediatrics: Schedules Immunocompromised child Indian Pediatrics 2008; 45: 635-648
‘ End game’ & ‘Post –eradication’ strategy – IAP PEC ,[object Object],[object Object]
 

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Ipv – need of the hour dr gaurav gupta

  • 1. IPV – Need of the hour Dr Gaurav Gupta Pediatrician, Charak Clinics, Mohali [email_address]
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  • 4. Summary of Key Attributes of OPV and IPV Adapted from 1, 11 Sutter et al. Vaccines , 2008 Plotkin & Vidor . Vaccines , 2008
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  • 7. Weekly AFP and VPD Update for Week 48, 2011 Data as of 05 December 2011
  • 8. Wild Polio Virus India, 2010 *Dots are randomly placed within blocks (Sub-districts) Data as of 05 Dec 2011 Districts with cases in 2010 = Most recent P3 Wild polio case = Most recent P1 Wild polio case
  • 9. Wild Polio Virus India, 2011 *Dots are randomly placed within blocks (Sub-districts) Data as of 05 Dec 2011 = Most recent P1 Wild polio case Districts with cases in 2011 Districts with cases in current week
  • 10. Vaccine Derived Polio Virus (VDPV) India, 2011 *Dots are randomly placed within blocks (Sub-districts) Data as of 05 Dec 2011 Districts with cases in 2011 Districts with cases in current week = Most recent P2 VDPV case = Most recent P3 VDPV case
  • 11. Wild Polio Cases by Type (P1, P3) and Month of Onset India, 2007-2011 Data as of 05 Dec 2011
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  • 15. Polio is Still Endemic in 4 Countries, Reflecting both “Failure to Vaccinate” and “Vaccine Failure” WHO. Polio Case count. Available at: http://www.who.int/immunization_monitoring/en/diseases/poliomyelitis/case_count.cfm , 2009 Graphs from WHO. Polioeradication. Progress & Prospect. 2008 Roberts. Science , 2009 W. Uttar Pradesh Bihar Rest of country High risk Medium risk Rest of country In Nigeria, high “failure to vaccinate” In India, polio cases despite high coverage, thus “high vaccine failure” 0 doses 1-3 doses 4-6 doses 7+ doses OPV doses administrated per area in Nigeria 2003-2008 OPV doses administrated per area in India 2003-2008 % of children < 5 years receiving doses % of children < 5 years receiving doses
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  • 17. Paralytic polio cases are occurring predominantly among the children who had received 4 or more doses of vaccine, and lately among those who had received more than 7 doses of OPV. On the other hand among the polio cases percentage of unvaccinated children is very low. In case children develop paralytic disease after taking many doses of OPV, it means that many doses of vaccine had failed to provide protection.
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