Polio Eradication

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Polio Eradication
2005 - Year for completing the task
INDIA UPDATE Dr. Anbumani RamAdoss Union Health
Minister Government of India
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Polio Incidence by Month, 1998-2004
Number of cases
NID
NID
NID
NID
NID
NID
SNID
SNID
SNID
SNID
SNID
NID
SNID
SNID
NID
1998
1999
2000
2004
2001
2002
2003
NID National Immunization Day
SNID Sub-National Immunization Day
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Distribution of Polio Cases
2002
2003
1600 cases in 159 districts
225 cases in 87 districts
2004
132 cases in 43 districts
data as on 28th January,05
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Supplementary Immunization Activities (SIAs) in
2004
8 rounds
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Marked Improvements in Surveillance Quality, 2004
Non-polio AFP Rate 2.72
Stool Sample Rate 82
AFP Acute Flaccid Paralysis
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Progress

• Lowest number of cases in a given year
• Smallest geographic area of circulation ever with
  restricted high season transmission
• Type 2 virus last seen in 1999
• Type 3 virus detected in only 2 districts in
  recent months
• Polio cases are predominantly due to type 1 virus
• Highest surveillance sensitivity

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Challenges

• Three focal transmission areas
• Western UP
• Central Bihar
• Mumbai/Thane
• 75 of cases in UP are from 5 districts in
  Western UP.
• Every recent case in India is linked to west UP
  virus
• Ongoing strike/upcoming elections in Bihar a
  threat
• Persistent poliovirus circulation in sewage of
  Mumbai over last 12 months

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SIA Schedule, 2005
NIDs
SNIDs
SNIDs
SNIDs
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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SIA Schedule, Jan May 05
9thJan 27th Feb 3rd Apr 15th May
3rd Apr 15th May
Jan and Feb rounds postponed by 1/2 week in Bihar
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UP
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Polio cases, Uttar Pradesh
2003
2002
1242 cases in 65 districts
88 cases in 25 districts
2004
79 cases in 14 districts
data as on 29th January 2005
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Scale of the programme - UP

• 29 million houses reached each round
• 37 million children immunized each round
• Over 100,000 booths (fixed posts) set up
• Over 300,000 vaccinators trained and utilized

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Improved programme management

• Political will at the highest level Polio
  identified as a priority programme by Chief
  Minister
• Chief Secretarys regular review and
  videoconferencing with field functionaries
• Senior Secretary level officer deputed for the
  programme
• Massive mobilization of non-health government
  departments under the leadership of Commissioners
  and DMs education, disabled welfare etc.
• Strong partner support from UNICEF, Rotary, Core,
  WHO

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Challenges and actions

• Virus largely restricted to underserved and
  resistant groups

• Strategy drawn up for these high risk communities
  and areas
• Support from influentials of high risk
  communities
• Members of high risk communities participate in
  planning
• Call from places of worship
• Influentials accompany teams during
  house-to-house

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Challenges and actions

• Coverage of transient and migratory populations
• Coverage of children on streets

Children in thousands
Number of children immunized at transit points
increased threefold 1.1 million immunized in
streets during Jan05
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Challenges and actions

• Multiple rounds leading to
• programme fatigue
• confidence in vaccine
• Low routine immunization coverage

• Linking polio immunization campaigns with other
  programmes of public welfare in high risk
  districts
• Health camps
• Special camps for polio afflicted children
• Incentive schemes like roads, handpumps for
  communities doing good work
• Non-monetary reward to service providers and
  community members
• Plan for boosting routine immunization in high
  risk areas being implemented soon

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If I believe I cannot do something, it may be
incapable of doing it. But when I believe I can,
I acquire the ability to do it even if I didnt
have it in the beginning - Mahatma Gandhi
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Bihar
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Polio cases, Bihar
2002
2003
18 cases in 13 districts
121 cases in 29 districts
2004
40 cases in 18 districts
data as on 29th January 2005
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Challenges - Bihar

• Floods during high-transmission season
• Difficulties in service delivery in high-risk
  districts
• Local elections in Bihar during February 05
• Feb round postponed by a week
• Large number of children missed during SIAs
• Children missed in false P marked houses -
  vaccination team performance issues
• Children missed in X houses - lack of revisits
  to X houses

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Actions

• Increased political commitment
• Governor Chief Minister committed to polio
  eradication
• Increased programme visibility with their appeals
  to the community and participation in
  inauguration of polio immunization rounds
• Programme regularly reviewed by Chief Secy with
  DMs and Divisional Commissioners

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Actions

• Secy FW regularly reviews programme with Civil
  Surgeons
• State Core group headed by Secy FW meets
  regularly to review progress and oversee
  implementation
• Divisional Commissioner level review before every
  round
• District Task Force meets twice before every
  round
• Block Task Force meetings held in every block

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Actions
Increased NPSP/Govt presence in HR areas
86
Identification of High risk districts
37
17
Existing NPSU staff
Additional NPSU/Govt staff
16 districts
Additional NPSU/Govt staff for monitoring B
team planning
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Actions

• Re-training of vaccinators
• Emphasis on vaccinating every child in each house
• Emphasis of immunizing children outside houses
• Strengthening mechanism of revisits to X marked
  houses
• Biphasic activity by A teams
• Implementation of B team activity throughout the
  state to reach missed children in X houses
• Emphasis on coverage of migratory and transient
  populations

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Mumbai
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Polio cases, Maharashtra
Gr. Mumbai
Maharashtra
Wild poliovirus in sewage samples (85 samples)
Wild poliovirus in AFP cases (3 cases)
data as on 27th January, 2005
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Issues

• Large transient and migrant population from UP
  and Bihar
• Large construction sites
• Sub-optimal quality of SIAs end of round
  coverage survey shows children being missed

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Covering transient and migrant population

• Significant increase in the number of transit
  points
• Transit teams working round the clock
• Children being immunized in trains coming from UP
  and Bihar
• Night teams covering transient population
• Special teams for construction sites, road side
  hutments, slums

Number of transit points
40,000 children immunized at transit
points 12,000 children immunized in moving trains
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Increased NPSP presence in HR areas
Identification of High risk areas
Increased NPSP/Govt presence in Mumbai/Thane
9 wards
27
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Existing NPSU staff
Additional NPSU/Govt staff
In addition, 50 field volunteers being hired by
NPSP for Feb round to support microplanning,
training and monitoring
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Improving quality of SIAs

• Better government involvement - Program being
  reviewed regularly
• Training of vaccinators with support of SMOs and
  government staff
• Greater involvement of non-health departments in
  polio campaigns
• Fewer unimmunized children detected during
  January05

un immunized children in street sweep
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A strategic shift

• Use of Monovalent OPV1
• procurement plans underway for India
• likely to use in high risk areas during May/June
  05 rounds

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Sources of funding (Grants) - 2005-2006(US
321million)
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39
96
13
26
127
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Untied resources (US 96 Million)
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Summary

• India has made significant progress towards polio
  eradication in 2004
• The Government of India and the State
  Governments, are taking all possible steps to
  ensure very high quality SIAs in 2005 with the
  objective of interrupting Polio transmission
  completely.
• India is committed to the implementation of the
  programme till the objective of polio eradication
  is achieved.
• There is urgent need to bridge the resource gap
  for 2006 activities.
•  
•  
• There is urgent need to bridge the resource gap
  for 2006 activities.
•