Polio Eradication; Update on Situation in Pakistan. Meeting of the independent Monitoring Board for GPEI 1 st October 2013

Transcription

1 Polio Eradication; Update on Situation in Pakistan Meeting of the independent Monitoring Board for GPEI st October 0

2 Confirmed Polio Cases By Poliovirus Type, 0-0* NID SNID ^ ^ mopv Vaccine Type mopv Trivalent Bivalent Months / Years ^ Data incomplete Virus Type NSL NSL NSL & NSL * Data as of 0 th, 0

3 Confirmed Polio and Compatible Cases 0 0* Total no. of polio infected districts = 8 Total no. of polio infected districts = P = 55 P = P+P = WPVs=58 P = 6 Compatible = Compatible = 6 Last date of onset of P =8/0/0 Cases randomly placed in districts WILD POLIO CASES PROVINCE ONSET OF n LAST CASE KP 7 0-Nov- FATA 0 0-Nov- BALOCHISTAN 0-Oct- SINDH 09-- GBALTISTAN 06-- PUNJAB -- Pakistan 58 0-Nov- Provincial Boundary Districts Boundary PROVINCE n WILD POLIO CASES ONSET OF LAST CASE FATA 09-- KP PUNJAB 6-- SINDH 09-- PAKISTAN * Data as of 7th, 0

4 Improvements under the NEAP. More children reached Trend of LQAS Lots not rejected for 95% 7/97(7%) 7/9(8%) Improving monitoring results Note: No LQAS conducted all over Pakistan in Dec 0

5 Improvements under the NEAP. No type- polio case since il

6 Oct Nov Dec Oct Nov Dec Oct Nov Dec 0 Improvements under the NEAP Environmental surveillance (Positive Samples) by month Extensive circulation during high-season reversed in Total Specimens Positive * Data source AFP/LAB 6/07/0

7 Improvements under the NEAP. Polio restricted to focal areas Polio cases in the last four months* WILD POLIO CASES PROVINCE ONSET OF LAST n CASE BALOCHISTAN 0 - FATA KP 0- PUNJAB 0 - SINDH 09-- PAKISTAN Cases randomly placed in districts * Data source AFP 0/0/0 Provincial Boundary Districts Boundary

8 Key Challenges. Barriers between vaccinators and children Ban in North & South Waziristan Military operations Bara (Khyber agency) Continued direct security threat to polio workers Peshawar & Karachi (Gaddap). Misconceptions about program (post Abbottabad Incident). Management, oversight & accountability issues Peshawar, Hyderabad, Quetta Block. Maintaining progress in areas without polio cases southern Punjab, northern Sindh, Rawalpindi, Islamabad etc.

9 Current Core Problem Areas of Pakistan Bara (Khyber agency) Peshawar North Waziristan South Waziristan Gadap Province District Tehsil

10 number WPV cases by month, 0* Cases WPV Accessible 9 Inaccessible 7 Total Inaccessible^ (Barrier) Accessible ^Inaccessible: Bara, Waziristan, FR Areas, Peshawar, Gaddap *Data as of

11 Substantial Immunity Gap in North Waziristan; specially among young children (born after the ban) Age distribution & vaccination status of AFP Cases from North Waziristan, 0 (n=56) % 0% 5% 5% 9% % 8% 68% % Age in months 0 dose - doses - 6 doses 7 + doses

12 Missed SIAs in 0* * to Missed SIAs All 0 SIAs 7-8 SIAs 5-6 SIAs - SIAs SIAs SIAs

13 Oct Nov Dec Oct Nov Dec Oct Nov Dec Number Trend of Environmental Surveillance by month, 00-0 Concerning 0 high season Specimens collected Positive * Data as of 7 th, 0

14 Oct Nov Dec Oct Nov Dec Oct Nov Dec Oct Nov Dec Oct Nov Dec Oct Nov Dec Oct Nov Dec Oct Nov Dec 00% 90% Environmental Surveillance by Province Balochistan 00% 90% Khyber Pakhtunkhwa 80% 70% 60% 80% 70% 60% 50% 50% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% Positive Negative Positive Negative Punjab Sindh 00% 00% 90% 80% 70% 60% 50% % 80% 70% 60% 50% % 0% 0% 0% 0% % 0% 0% 0% 0% Positive Negative Positive Negative * Data source AFP/LAB 7/08/0 * Data as of 7 th, 0

15 cvdpv cases, 0 and 0^ ` Oct Nov Dec * Data as of 0th, * Data as of 5th. 0 ^ cvdpv included from Karachi Gaddap Environmental surveillance in 0 0 PROVINCE DISTRICT 0 0 TOTAL Last case 9 BALOCHISTAN KABDULAH 5 5 -Dec- JAFFARABAD -- BALOCHISTAN MASTUNG 7-- SINDH KHIGADAP FATA Waziristan (n) MOHMAND -- TOTAL

16 Basic Framework for the Way-Forward. Removing barriers between children and vaccinators a) Negotiated access b) Protected campaign c) Transit and mobile population strategies. Maintaining progress in polio free areas a) Vigorous oversight and accountability at all levels - Federal and Provincial Task Forces, District and UC Committees b) Central Ministry for Health strengthened for core functions c) Aggressive case response immunization strategy d) Monitoring and evaluation. Improved oversight and operational problems a) Establishment of Special District Task Teams b) Deployment of Emergency Rapid Response Team, led by PMPMC

17 Way Forward N & S Waziristan. Negotiated access a) Government led negotiation to reverse the ban through Jirga to convince the Shura b) Engagement of key national and international religious leaders led by International Islamic University & Al-Azhar Egypt National Islamic Advisory Group & Provincial Task Forces. Protected campaign a) High level Civil Military Coordination. Transit and Mobile Strategy a) Mapping and immunizing population moving out of the Agencies b) Robust intra/inter Agency/Province permanent transit points

18 Way Forward Khyber (Bara) and FR Areas. Protected house-to-house campaign a) High level Civil Military Coordination b) Access to be provided through army and FC support. Closed monitoring of missed areas after every campaign. Implementation of Polio Plus interventions a) All antigens b) Hygiene Kit. Transit and Mobile Strategy a) Mapping and immunizing population moving out of the Agencies b) Vaccination in IDP camps c) Robust intra/inter Agency/Province permanent transit points 5. Ensuring high quality activity in accessible areas of the Agency

19 Way Forward Peshawar and Karachi. Management, oversight, and accountability a) Special Task Teams (headed by Secretary-level officer) b) Strong District Polio Control Room led by DCs c) Deployment of Emergency Rapid Response Team, led by PMPMC. Protected campaign (continuous threat and fear factor) a) Provincial Security Coordination Committees chaired by Home Sec b) Engagement of police & security forces in DPECs c) Complement the police force to protect vaccinators and conduct quality campaign i. Support from Rangers and FC ii. Raise designate security force. Negotiated access a) Engagement with local religious and community leaders, civil societies, and notables at UC level (UPEC) b) Polio Plus activities

20 The Program aims to be fully prepared by end October to capitalize on the next low transmission season (Dec 0 0)

21 Proposed SIAs schedule till e Month Dates Campaign Month Dates Campaign /Oct 0th.-nd Oct. NIDs October - SIADS November - NIDs December 0-0 SNIDs December 09 - SIADS uary SIADs uary 0 - NIDs ruary 0 - SIADs ruary - 6 SNIDs ch 0 - SIADs ch - 6 SIADs il - 6 NIDs il 8-0 SIADs 6-8 SNIDs e 09 - SIADs

22 Public Health Initiatives must not be used for any other purpose (including intelligence) to have confidence of all stake holders & community

23 Thank You

24 Comparison of polio cases by province/region 0-0* Region/ Province As of 7 th tember, 0 No. of polio cases 0 0 Decline in 0 as compared to 0 % Last polio case BALOCHISTAN - 00% 0-Oct- FATA 7 0 8% 05-- SINDH 5% 09-- K.PAKHTUNKHWA % 9-- PUNJAB 0% 6-- Gilgit-Baltistan - 00% 06-- PAKISTAN 6 % BALOCHISTAN FATA SINDH KP PUNJAB GBALTISTAN * Data as of 7th, 0

25 Cases (%) 00% 90% 80% 70% 60% 50% 0% 0% 0% 0% Routine Vaccination status of Non-Polio AFP Cases Aged 06- months; 00 to 0* Punjab Sindh KP FATA Balochistan AJK/GB/ISB Pakistan % * Afp.rec Data as of DOSE DOSE DOSES DOSES As per recall of parents Target

26 Non-Polio AFP Rate by District 0* Percent AFP Cases with Adequate Specimens, By District 0* Population density % - 59 % 60% - 79% 80 % No AFP Case reported Non Polio AFP rate Up to Week No. 7 ended on th tember, 0 * Data source AFP 9/09/0 000 children under 5 years of age

27 Nov Nov Nov Nov Cases (n) AFP Cases reporting by Month, 009-0* *Afp.rec Data as of Non-polio AFP rate of /00,000 children < 5 years

28 Distribution of AFP Cases by Month, Pakistan 00-0* * Data as of 0th, 0

29 Non polio AFP cases/00,000 children <5 years Non Polio AFP Rate By Province/Regions, 0-0* Key AFP Surveillance Indicators by Punjab Sindh Khyber- Pakhtoonkhaw Non Polio AFP rate Up to Week No. 7 ended on th tember, 0 * Data source AFP 9/09/0 Target Non-Polio AFP Rate / < 5 years of the age FATA Balochistan AJK Gilgit-Baltistan Islamabad Pakistan Region / Province

30 Environmental Surveillance Network 8 collection sites in large cities/towns 0 more sites planned ( new cities) Most extensive globally Covers all the provincial capitals and regional hubs Sampling sites selected strategically, biased to towards detecting polio viruses Existing sites (8) Newly identified sites (9) Province District No. of Sites BALOCHISTAN QUETTA KP PESHAWAR FAISALABAD PUNJAB LAHORE 5 MULTAN RAWALPINDI HYDERABAD SINDH KARACHI 8 SUKKUR PAKISTAN 8

31 Update on Surveillance Plans NEAP addendum on AFP Surveillance; prepared and ready to be launched Cascade trainings of the Government & WHO Surveillance Staff in progress 8 trained so far since last y 0 Intensified orientation activities for Healthcare Providers (including informal & faith healers) More than 6000 reportedly oriented since y 0 Further expansion of environmental surveillance Ten new sites identified; sampling to initiate over next quarter Four new cities; Killa Abdullah (Balochistan), D.I.Khan (KP), Jacobabad (Sindh) & Islamabad

32 Poliovirus Isolates During last Six Months 8 th to 7 th, 0

33 Back up -

34 Spot Survey Results; ust 0 NIDs Province No. of districts No. of children screened Proportion of districts <95% Proportion of districts <90% No. % No. % AJK 0,07 0% 0% BALOCHISTAN 0, 7 85% 5 75% FATA 8,6 5 6% 50% GBALTISTAN % 0 0% ISLAMABAD % 0 0% KP 9,06 7 7% 7 0% PUNJAB 6 5, 0 0% 0 0% SINDH 0,7 7 % 7 8% Grand Total 5 7,65 6 % 6 5%

35 Planned Vaccination Rounds; 0 Priority Months / Number of planned vaccination rounds Total Number of planned Vaccination Rounds Priority- 0 Priority- - ^ ^ 6 + partial Priority- - ^ ^ ^ 5 + partial Priority ^ ^ + partial ^ In selected districts

36 LQAS Results; ust 0 NIDs New LQAS Methodology introduced; with sample size of 60 and classification of pass (0- unvaccinated children), intermediate (-8 unvaccinated children) and fail (>8 unvaccinated children) LQAS not conducted in Karachi since December 0

37 LQAS Results in Priority- Areas; ust 0 NIDs **Only Accessible Areas LQAS not conducted in Karachi since December 0

38 Outline Current Epidemiology Immunization Activities (Supplementary & Routine) Key Challenges and Risks Recent Developments / Steps Way Forward Surveillance for Polioviruses