1. Polio eradication programme in India – Progress, Response and Issues for action Dr Ajay Khera Deputy Commissioner Ministry of Health & FW, Govt. of India Presentation Prepared for IEAG Meeting on 13 th July, 2011 at New Delhi

2. A Snapshot of Polio Situation in India P1 wildP3 wild P2 cases eradicated in 1999 14 States and UTs free of polio Since 2001 NIDs conducted since 1995 covering 170 million children per round Sharp decline in polio cases in 2010 Single WPV 1 case reported in 2011 and longest polio free period 741 42 1 mOPV 1 bOPV

3. Geographical distribution of Wild Polio cases during last two years ** One case reported mixture of P1 wild & P3 wild 20092010 A single case of WPV1 detected in India in 2011 – in Howrah, West Bengal

4. WPV cases during previous 12 months, India N=2 Dec 2010 – June 2011* N=11 Jun 2010 – Nov 2010 N=0 N=7 Type 1 Polio Type 3 Polio West Bengal is the only state with wild virus transmission in past 6 months

5. AFP surveillance and polio situation in 2011 Single P1 case in 2011 Howrah, West Bengal Onset of paralysis - 13 January Related to wild poliovirus detected in sewage sample of Delhi in August 2010 StateP1P2Total Chhattisgarh11 Madhya Pradesh11 Rajasthan11 Uttar Pradesh11 Total44 VDPVs YearAFPWPVCompatibleVDPV 20095040574147321 201055781421885 20112431411*4 No circulating VDPVs No genetic linkage amongst 2011 VDPVs No genetic linkage with VDPVs of 2009 & 2010 *Classification of cases pending

6. Wild Polio Virus in environmental (sewage) samples 2006 20072008200920102011 2005 Mumbai WPV1 WPV3 Delhi Collection of sewage samples started from April 2010 Samples not collected between March 2006 and April 2007 due to fire in Mumbai Lab Note: six samples reported mixture of P1 wild & P3 wild in Delhi Mumbai and Delhi sewage test results confirm that P1 and P3 circulation is at very low levels in 2010. No evidence of circulation in 2011

7. WPV1 cases in endemic states, 2009-2011 2009 2010 Uttar Pradesh Bihar 2011* Longest indigenous WPV1 transmission free period simultaneously in both endemic states Cross-border transmission with Nepal

8. WPV3 cases in endemic states, 2009-2011* Uttar Pradesh Bihar 2009 2011* 2010 Transmission limited to western UP & central Bihar No WPV3 case in endemic states for 13 months

9. Champaran East Bihar, WPV1 spill over, 2010 Cross-border transmission with Nepal that resulted in 3 cases in a single block All 3 cases within a span of 1 month 3 mop-up rounds conducted within a period of 10 weeks No case in this transmission area for 8 months Bihar Nepal

10. Jan 10 Feb 10 Mar 10 Apr 10 May 10 Jun 10 Jul 10 Aug 10 Sep 10 Oct 10 Nov 10 Dec 10 Jan 11 Feb 11 Mar 11 Apr 11 May 11 Jun 11 Maharashtra, WPV1 transmission area, 2010 Transmission focused in a small geographical area in Malegaon and a single case in Beed Multiple mop-up rounds Last case in September 2010 No case in this transmission area for last 8 months mOPV1 bOPV mOPV3 tOPV WPV1

11. West Bengal Jharkhand Jan1 0 Feb1 0 Mar1 0 Apr1 0 May1 0 Jun1 0 Jul1 0 Aug1 0 Sep1 0 Oct1 0 Nov1 0 Dec1 0 Jan 11 Feb 11 Mar 11 Apr 11 May 11 West Bengal & Jharkhand, Mix transmission area, 2010-11 Only area with WPV1 & WPV3 transmission simultaneously Majority cases in Murshidabad (WB) & Pakur (JH), with the most recent case in Howrah (the only case of 2011) Transmission continued throughout 2010 in northern WB despite multiple SIAs The most recent case in Howrah related to a separate importation, most likely from Delhi mOPV1 bOPV mOPV3 tOPV WPV1 WPV3

12. Pulse Polio Response : SIAs conducted during 2011 23 Jan March 2 nd week Feb27 Feb mOPV1 mOPV3 bOPV tOPV AprilMay June

13. Quality of Response during 2011 regarding SIA Pulse Polio activities ( Percent average children found unimmunized, End-of-round survey)

14. Focus on personalizing risk perception of polio, Addressing OPV safety issues during sickness and Promoting a more active attitude for RI and polio vaccination, particularly among migrants From ‘Every Child’to ‘My Child’, Two Drops, Every Time. The New Logo Polio Plus Handbook addressing OPV safety and convergent interventions New social mobilizer flip- book addressing OPV safety and convergent interventions “OPV is totally safe … do not pay attention to rumors.” Response : Revised communication strategy launched

15. Emergency Preparedness & Response Plan prepared & shared with State Govts EPRG formed in 23 States/UTs * (out of 35 States/UTs)

16. Response to migrants: coverage of migratory communities in states with large migratory population during each SNID # children: 0.7 mn in each round # children: 0.5 mn in each round # children: 1.1 mn in each round # children: 0.7 mn in each round

17. Actions Taken on Research & AFP Surveillance Informing programme decisions –Seroprevalence surveys in UP and Bihar to start from 6-August –Mucosal immunity study scheduled to start from 5- September AFP and Laboratory Surveillance –Environmental sampling started in Patna –Surveillance reviews conducted in Central & Eastern UP, West Bengal & Gujarat

18. Trends in Seroprevalence Against Poliovirus Results from Different Sero-surveys Moradabad Nov 2007 (N=121) AFP cases UP Nov 08 – mid 09 (169) Moradabad May 2009 (N=534) UP & Bihar Aug 2010 (N=1280) Age 6-7 mo6-11 mo6-7 mo Type 1 78% 96.5% 99%98% Type 2 56% 33.7% 75%65% Type 3 69% 42.6% 49%77% High immunity levels achieved both for P1 & P3 in 2010 through bOPV introduction

19. Current Program Priorities 1.Intensified surveillance for poliovirus 2.Full and consistent coverage of migrant and mobile populations 3.Intensified program in 107 High-risk Blocks of UP and Bihar 4.Rapid and effective response to any wild poliovirus 5.Identify and cover areas and populations at high risk for importation and spread of poliovirus 6.Identify areas with low RI coverage and strengthen it

20. Summary Country at historic low transmission levels Genetic & environmental surveillance confirms progress Simultaneous progress in both endemic states The coming high transmission season will be the test to know whether poliovirus transmission has stopped in India Any case of Wild Polio considered as Pubic health emergency and needs quick & effective containment

21. Thanks