GLOBAL POLIO ERADICATIONSTRATEGIES

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

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

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

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

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

Strategies for Polio eradication in India

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

• 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

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

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

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

• 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

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

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

• 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

• 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

• 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

6. Follow-up of cases of AFP

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

• 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”)

• the child is assessed for Weaknessasymmetrical 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

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

• 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

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

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