Global Polio Eradication & Endgame Strategy. December 2015

Transcription

1 Global Polio Eradication & Endgame Strategy December 2015

2 Poliovirus detection & interruption OPV withdrawal, IPV introduction, RI strengthening Containment & Global Certification Legacy Planning Polio Eradication & Endgame Strategic Plan,

3 WPV milestones and achievements (1) November 2012: Most recent case of WPV3 July 2014: Most recent WPV case in Nigeria August 2014: Most recent WPV case in Africa Since August 2014: No WPV outside of Afghanistan & Pakistan 20 September 2015: WPV2 eradication certified 25 September 2015: Nigeria removed from list of endemic countries by WHO 3

4 WPV1 Cases, Afghanistan and Pakistan as on 15 December, 2014 & Cases Afghanistan Pakistan

5 Myanmar cvdpv 2 cases Last 5 Oct 15 Lao PDR cvdpv 5 cases Last 28 Oct 15 Data from WHO HQ 19 Jan 2016 Country Guinea NA 0 02-Oct-15 4 Nigeria NA 0 16-May-15 1 Madagascar NA 0 22-Aug AFR 0 02-Oct Pakistan 21-Nov Feb-15 2 Afghanistan 19-Nov NA 0 EMR 21-Nov Feb-15 2 Ukraine NA 0 07-Jul-15 2 EUR 0 07-Jul-15 2 Lao People's Democratic Republic Wild poliovirus Onset of most recent case Total WPV1 cvdpv Onset of most recent case Total cvdpv* NA 0 28-Oct-15 5 WPR 0 28-Oct-15 5 Myanmar NA 0 05-Oct-15 2 SEAR 0 05-Oct-15 2 Global 21-Nov Oct-15 26

6 Afghanistan Key Actions Better governance and coordination through the National and Provincial Emergency Operations Centres Focusing resources on low-performing districts, identifying and targeting persistently missed children Systematic vaccinator selection, training & supervision Closer cross-border coordination in border areas with Pakistan

7 Progress in Pakistan Intensified government commitment Emergency Operations Centres established Improved access in insecure areas Improved coordination with Army & security agencies Innovations to reach missed children Female community volunteers, health camps, transit posts Focus on 12 high risk districts

8 4-5 June 2015 Female Community Volunteers in high threat areas of Pakistan

9 Decline in Inaccessibility, Pakistan Jan 2013-Sep Jan Mar May Jul Sep Nov Jan Mar May Jul Sep Nov Jan Mar May Jul Sep

10 cvdpv outbreaks cvdpv1: Ukraine cvdpv2: Myanmar cvdpv2: Guinea VDPV2: S Sudan cvdpv1: Lao DPR cvdpv2 cvdpv1 cvdpv2: Nigeria cvdpv1: Madagascar Type 2 MUST BE STOPPED! Sufficiently in advance of OPV2 withdrawal 10

11 Preventing International spread

12 Preventing International spread Public Health Emergency of International Concern (PHEIC) declared by DG, WHO, on 5 May 2014 and temporary recs. put in place Extended in Aug, Nov 2014 & then in March, April, Aug 2015 Temporary recommendations include: Declaration of polio eradication a national public health emergency Efforts to stop circulation of poliovirus in countries with transmission Vaccination of travellers leaving country, atleast 4 weeks prior to departure Cross-border coordination and regional cooperation

13 Preventing International spread Seventh Meeting of the Emergency Committee of IHR held on 10 Nov 2015 Unanimously agreed that spread of wild poliovirus still constitutes PHEIC Recommends extension of the temporary recs, as revised, for a further three months Extended recommendations to countries with VDPVs (earlier recommendations were for WPVs only) Recommendations accepted by DG WHO on 25 Nov 2015

14 Poliovirus detection & interruption OPV withdrawal, IPV introduction, RI strengthening Containment & Global Certification Legacy Planning Polio Eradication & Endgame Strategic Plan,

15 Withdrawal of type 2 OPV First serotype in the phased removal of all OPV

16 OPV type 2 withdrawal Complete replacement of topv by bopv 156 topv using countries and territories (topv only and sequential IPV-OPV schedules) 16

17 'Readiness' criteria for OPV2 withdrawal (topv to bopv switch) 1. at least 1 dose of inactivated polio vaccine (IPV) in all OPVusing countries 2. bivalent OPV (bopv) licensed and available for routine immunization 3. surveillance + response protocols for possible type 2 poliovirus outbreaks 4. completion of phase 1 (pre-containment lab survey/ inventory) + poliovirus type 2 containment 5. verification of global eradication of wild poliovirus type 2 (WPV2) Trigger for OPV2 withdrawal: all persistent cvdpv2 circulation interrupted

18 Role of IPV Reduce the risk of paralytic poliomyelitis if exposure to type 2 virus occurred after OPV2 withdrawal Improve response to any future use of IPV or mopv2 in the case of an outbreak Reduce transmission of reintroduced type 2 virus Boost immunity to type 1 and 3

19 Countries using IPV vaccine to date and formal decision to introduce Introduced to date (132 countries or 68%) Formal commitment to introduce in (24 countries or 12%) 2015 Introduction delayed to 2016 due to global IPV (38 countries or 20%) vaccine shortage Not available Not applicable Date of slide: 3 December 2015 The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved.

20 'Readiness' criteria for OPV2 withdrawal (topv to bopv switch) 1. at least 1 dose of inactivated polio vaccine (IPV) in all OPVusing countries 2. bivalent OPV (bopv) licensed and available for routine immunization 3. surveillance + response protocols for possible type 2 poliovirus outbreaks 4. completion of phase 1 (pre-containment lab survey/ inventory) + poliovirus type 2 containment 5. verification of global eradication of wild poliovirus type 2 (WPV2) Trigger for OPV2 withdrawal: all persistent cvdpv2 circulation interrupted

21 Poliovirus containment A system for confining polioviruses within a defined space WHA resolution 68.3: The May 2015 resolution urges countries to implement GAPIII 21

22 Containment of type 2 poliovirus (PV2) Goal: prevent inadvertent or malicious release from facilities and transmission of PV2 to people Phase I: Phase II: Reduce the number of facilities containing PV2: Countries: identify and destroy unneeded PV2 WPV2 by end-2015 OPV2/Sabin2 by July 2016 Countries: designate poliovirus-essential facilities for needed PV2 Reduce risk in remaining facilities: Countries and facilities: ensure appropriate containment of PV2 in designated poliovirusessential facilities 22

23 Certification of WPV2 Eradication

24 Summary WPV transmission lowest ever - restricted to parts of Pakistan and Afghanistan International spread of poliovirus a public health emergency of international concern under IHR (2005) Temporary recommendations extended to countries with circulating VDPVs Globally synchronized OPV2 withdrawal in April 2016 Preparatory activities for the OPV2 withdrawal in progress Increasing focus on cvdpv urgency to stop type 2 Acceleration of GAP III mitigate poliovirus facility associated risks

25 Thank You