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 13th July, 2011 at New Delhi
A Snapshot of Polio Situation in India
2000
 P2 cases eradicated in 1999
1750
 14 States and UTs free of polio Since 2001
1500
 NIDs conducted since 1995 covering 170
million children per round
1250
 Sharp decline in polio cases in 2010
1000
 Single WPV 1 case reported in 2011 and
longest polio free period
741
750
bOPV
mOPV 1
500
250
42
1
0
1998
1999
2000
2001 2002
2003
P1 wild
2004 2005
2006
P3 wild
2007
2008 2009
2010 2011*
Geographical distribution of Wild Polio cases during last two years
2009
2010
A single case of WPV1 detected in India
in 2011 – in Howrah, West Bengal
WPVs
State
WPVs
P1
P3
Total
Bihar
38
79
117
Uttar Pradesh**
34
569
602
Delhi
3
1
4
Punjab
2
2
4
Jharkhand
2
0
Rajasthan
1
Haryana
Uttarakhand
P1
P3
Total
West Bengal
6
2
8
Maharashtra
5
0
5
Bihar
3
6
9
2
Jharkhand
3
5
8
2
3
Jammu & Kashmir
1
0
1
0
4
4
Uttar Pradesh
0
10
10
0
4
4
Haryana
0
1
1
Him achal Pradesh
0
1
1
Total
18
24
42
Total
80
662
741
** One case reported mixture of P1 wild & P3 wild
State
WPV cases during previous 12 months, India
Dec 2010 – June 2011*
Jun 2010 – Nov 2010
Type 1 Polio
N=11
N=2
West Bengal is the only state with wild
virus transmission in past 6 months
N=7
N=0
Type 3 Polio
AFP surveillance and polio situation in 2011
Year
AFP
WPV
Compatible
VDPV
2009
50405
741
473
21
2010
55781
42
188
5
2011
24314
1
1*
4
No circulating VDPVs
No genetic linkage amongst 2011 VDPVs
No genetic linkage with VDPVs of 2009 & 2010
VDPVs
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
*Classification of cases pending
State
P1
P2
Total
Chhattisgarh
1
1
Madhya Pradesh
1
1
Rajasthan
1
1
Uttar Pradesh
1
1
Total
4
4
Wild Polio Virus in environmental (sewage) samples
8
Mumbai
Samples not collected
between March 2006
and April 2007 due to
fire in Mumbai Lab
6
4
2
0
8
J
F M A M
J
J
A S O
N D J
F M
A M J
J
A S
O N D J
F
M A M J
J
A S O N D
J
J
J
A S O
N D J
F M
A M J
J
A
S O N D J
F
M A M J
J
A S O N D
J
F M A M
F
M A M J
J
A S O N D
J
F M A M
WPV3
WPV1
Delhi
F M A M
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
6
4
Collection of
sewage samples
started from April
2010
2
0
J
F M A M
J
J
A S O
2005
N D J
F M
A M J
J
A S
2006
O N D J
F
M A M J
J
A S O N D
2007
J
F M A M
J
J
A S O
N D J
F M
A M J
J
A
S O N D J
2008
2009
2010
2011
Note: six samples reported mixture of P1 wild & P3 wild in Delhi
WPV1 cases in endemic states, 2009-2011
12
Uttar Pradesh
10
Longest indigenous WPV1 transmission free
period simultaneously in both endemic states
8
6
4
2
0
J
F
M
A
M
J
J
A
S
O
N
D
J
F
M
A
M
J
J
A
S
O
N
D
J
F
M
A
M
J
12
Bihar
10
8
Cross-border transmission
with Nepal
6
4
2
0
J
F
M
A
M
J
2009
J
A
S
O
N
D
J
F
M
A
M
J
J
2010
A
S
O
N
D
J
F
M
A
2011*
M
J
WPV3 cases in endemic states, 2009-2011*
120
Uttar Pradesh
100
80
60
40
20
0
J
F
M
A
M
J
J
A
S
O
N
D
J
F
M
A
M
J
J
A
S
O
N
D
J
F
M
A
M
J
M
J
120
• Transmission limited to western UP & central Bihar
• No WPV3 case in endemic states for 13 months
100
80
60
40
Bihar
20
0
J
F
M
A
M
J
2009
J
A
S
O
N
D
J
F
M
A
M
J
J
2010
A
S
O
N
D
J
F
M
A
2011*
Bihar, WPV1 spill over, 2010
Nepal
Bihar
Champaran East
• 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
Maharashtra, WPV1 transmission area, 2010
3
WPV1
mOPV1
2
bOPV
mOPV3
1
tOPV
0
1 2 3 4
5 6 7 8
Jan Feb
10
10
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 1
Mar
10
Apr
10
May
10
Jun Jul
10 10
Aug
10
Sep Oct
10 10
Nov
10
2 3 4 5
6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
Dec Jan Feb
10 11 11
Mar
11
Apr May
11
11
Jun
11
• 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
West Bengal & Jharkhand, Mix transmission area, 2010-11
WPV3
WPV1
3
Jharkhand
mOPV1
2
West Bengal
bOPV
mOPV3
1
tOPV
0
Jan1 Feb1 Mar1 Apr1 May1 Jun1 Jul1 Aug1 Sep1 Oct1 Nov1 Dec1 Jan Feb
0
0
0
0
0
0
0
0
0
0
0
0
11 11
•
•
•
•
Mar
11
Apr
11
May
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
Pulse Polio Response : SIAs conducted during 2011
2nd week Feb
23 Jan
March
April
27 Feb
May
June
mOPV1
mOPV3
bOPV
tOPV
Quality of Response during 2011 regarding SIA Pulse
Polio activities
(Percent average children found unimmunized, End-of-round survey)
% unimmunized
9%
8.40%
8%
7%
6.30%
6%
4.80%
5%
4%
3.40%
2.60%
3%
1.80%
2%
1%
0%
0.30%
3.50%
4.80%
6.40%
Response : Revised communication strategy launched
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
The New Logo
From ‘Every
Child’to
‘My Child’,
Two Drops,
Every Time.
Polio Plus Handbook
addressing OPV safety and
convergent interventions
New social mobilizer flipbook addressing OPV safety
and convergent interventions
“OPV is totally safe … do not pay
attention to rumors.”
Emergency Preparedness & Response Plan
prepared & shared with State Govts
EPRG formed in 23 States/UTs *
(out of 35 States/UTs)
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: 0.7 mn
in each round
# children: 1.1 mn
in each round
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 5September
• AFP and Laboratory Surveillance
– Environmental sampling started in Patna
– Surveillance reviews conducted in Central & Eastern
UP, West Bengal & Gujarat
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)
6-7 mo
6-11 mo
6-7 mo
6-7 mo
Type 1
78%
96.5%
99%
98%
Type 2
56%
33.7%
75%
65%
Type 3
69%
42.6%
49%
77%
Age
High immunity levels achieved both for P1 & P3 in 2010
through bOPV introduction
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
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
Thanks