SEA/RC63/19 - Follow-up action on pending issues and selected Regional Committee resolutions/decisions of the last three years: Challenges in polio eradication (SEA/RC60/R8)
AbstractPolio eradication continues to be a priority in the South-East Asia Region. In the first four months of 2010, 20 polio cases were detected in India with three subtype 1 poliovirus (P1) and 17 subtype 3 poliovirus (P3) cases. This paper presents an update on the progress and challenges in polio eradication. No P1 case has been detected in UP and Bihar in 2010. The three P1 cases reported this year are from Jammu and Kashmir, Maharashtra and West Bengal. In 2009, 80 cases of type 1 wild polio virus (WPV) were detected in India. Intense efforts reduced the circulation of imported type1 poliovirus in and around western UP. The most affected districts either did not sustain transmission or stopped transmission after 2-7 months. Even though at the beginning of 2009 a reduction in the transmission of P3 cases was observed, the latter half of 2009 witnessed P3 transmission in the endemic areas of western UP and central Bihar. Transmission was more intense in these areas because of fewer type 3 vaccine rounds. The final P3 case count for India in 2009 was 662. There are several challenges to the eradication of polio in the Region. The principal challenge in India is overcoming suboptimal vaccine efficacy in the districts of western UP which continues to be polio endemic. The key challenge here is the low levels of sanitation and personal hygiene. While some efforts have been made by the government, these are at present not of sufficient scale to have an impact. More needs to be done in this area. In non-endemic areas, migrants have been playing an important role in the spread of WPV1 as they are highly mobile, more likely to be missed and need special efforts of surveillance and supplementary immunization activity (SIA) operations. The P1 case detected in Nepal in February 2010 in a district adjoining Bihar and the current P1 outbreak in Tajikistan epidemiologically linked to India indicate that the key challenge for other countries in the Region and beyond is to protect their polio-free status by preventing re-infection. A strong routine immunization programme that can deliver and maintain OPV3 coverage greater than 80% in all districts in all countries will help prevent re-infection. Additionally, all polio-free countries must conduct periodic risk assessment to determine the level of risk of re-infection and spread, and to decide whether or not polio immunization campaigns will be required to boost population immunity. Finally, polio eradication requires substantial funding. A substantial proportion is being met through external funding. Member States can help the eradication effort by committing funds for surveillance, outbreak response, and strengthening routine immunization delivery. The High-Level Preparatory (HLP) Meeting held in the Regional Office in New Delhi from 28 June to 1 July 2010 reviewed the working paper and made the following recommendations: Actions by Member States (1) National efforts should be focused on maintaining the acute flaccid paralysis (AFP) surveillance system, and also on increasing and sustaining the high-level routine immunization coverage, improving water and sanitation, and addressing issues of importation of polio cases. (2) High-quality supplemental immunization activities (SIAs) should be conducted in the Member States that still have polio-endemic areas, in order to eliminate the final chains of transmission of type 1 and then type 3 wild polio virus. Action by WHO-SEARO • The Regional office should continue to conduct regular risk assessments and review the AFP surveillance indicators, immunization coverage and epidemiology at regular intervals, and continue to provide support to Member States as requested. The working paper and the HLP meeting recommendations based on it are submitted to the Sixty-third Session of the Regional Committee for its consideration.
World Health Organization, Regional Office for South-East Asia. (2010). SEA/RC63/19 - Follow-up action on pending issues and selected Regional Committee resolutions/decisions of the last three years: Challenges in polio eradication (SEA/RC60/R8). WHO Regional Office for South-East Asia. http://www.who.int/iris/handle/10665/128385
Gov't Doc #SEA/RC63/19
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