ERADICATION OF POLIOMYELITIS

RISHI KASHYAP

WHY POLIO IS A CANDIDATE FOR ERADICATION ?

• MAN IS THE ONLY RESERVIOR• NO LONG TERM CARRIER STATE• ROUTE OF TRANSMISSION IS FAECO-ORAL• HALF LIFE OF EXCRETED VIRUS IN SEWAGE

SAMPLE IN TROPICAL CLIMATE LIKE INDIA IS 48 HOURS.

• POTENT AND EFFECTIVE VACCINE.

Strategies for polio eradication in India

Conduct Pulse Polio Immunization days every year until poliomyelitis is eradicated. Sustained high levels of routine immunization coverage. Monitor OPV coverage at district level and below.Improve surveillance capable of detecting all cases of AFP due to polio and non polio etiology.

• Ensure rapid case investigation, including the collection of stool samples for virus isolation.

• Arrange follow-up of all cases of AFP at 60 days to check for residual paralysis.

• Conduct outbreak control for cases confirmed or suspected to be poliomyelitis to stop transmission.

• Even a single case is treated as an outbreak and preventive measures are initiated.

• The complete and timely reporting of cases is an important element for the eradication of poliomyelitis.

Line listing of cases

• Line listing of reported cases was started in 1989 to check for duplication of case.

• Line listing of cases made it possible to take appropriate follow-up action from where the cases had been reported.

• The line lists have also provided useful epidemiological data for programme purposes.

• All cases of acute flaccid paralysis must be reported immediately to the chief medical officer/district immunization officer with the following details:

• Name, age and sex of the patient.• Father’s name and complete address.• Vaccination status• Date of onset of paralysis and data for

reporting.

• Clinical diagnosis.• Doctor’s name, address and phone number.

Mopping Up

• Mopping up activities are usually the last in polio eradication.

• It involves door-to-door immunization in high risk districts, where wild polio virus is known or suspected to be still circulating.

• This strategy is being implemented in India.

Pulse Polio Immunization

• The term “pulse” has been used to describe this sudden, simultaneous, mass administration of OPV on a single day to all children 0-5 years of age regardless to previous immunization.

• PPIs occurs as two rounds about 4 to 6 weeks apart during low transmission season of polio, i.e. between November to February.

• In India, the peak transmission is from June to September.

• An important improvement in PPI during 1998 has been the use of vaccine vial monitor.

• When the color of the white square becomes blue like that of surrounding circle, the vaccine should be considered ineffective.

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STEPS INVOLVED

ACUTE FLACCID PARALYSIS Surveillance

DEFINITION :Sudden onset of weakness of a limb or paralysis over a period of 15 days in a patient less 15 years of age .

A.F.P.

WHAT IS SURVEILLANCE ?• IT IS A CONTINOUS SCRUTINY• OF ALL ASPECTS OF OCCURRENCE & SPREAD OF

DISEASE• THAT ARE PERTINENT TO EFFECTIVE CONTROL.

• SURVEILLANCE INCLUDES1. COLLECTION OF DATA2. ANALYSIS OF DATA3. INTERPRETATION OF DATA4. DISTRIBUTION OF RELEVANT DATA SO THAT

NECESSARY ACTION CAN BE TAKEN

The AFP Surveillance System

Hospitals Clinics

Investigation

Non-Polio AFP Polio AFP

Community

GOAL OF AFP SURVEILLANCE

• IDENTIFICATION OF ALL RESERVOIRS OF CIRCULATING WILD POLIO VIRUS

• ( THAT COULD BE POLIO ) BY DOCUMENTING ALL SUCH CASES,IT IS POSSIBLE TO SHOW THAT NONE OF THESE “POLIO-LIKE” CASES WERE CAUSED BY THE POLIO VIRUS,AND THAT POLIO IS NO LONGER PRESENT OR EXISTING.

WHY AFP SURVEILLANCE INSTEAD OF POLIO SURVEILLANCE ?

• SURVEILLANCE OF A POLIO CASE ALONE IS NOT SUFFICIENT BECAUSE IT IS IMPOSSIBLE TO PRECISELY IDENTIFY ALL CASES OF POLIO CLINICALLY DUE TO CONFUSING AND AMBIGUOUS CLINICAL SIGNS AND VARIABLE CLINICAL KNOWLEDGE & SKILLS OF DOCTOR.

• CLINICALLY POLIO IN ACUTE STAGE, IS DIFFICULT TO DISTINGUISH FROM OTHER CAUSES OF ACUTE ONSET OF FLACCID PARALYSIS.

WHAT TO REPORT

• Any Case of Acute Flaccid Paralysis < 15 Yrs age.

• It May be Monoplegia, Paraplegia, Hemiplegia,Facial Palsy, or Any Transient weakness.

• Any case of Suspected Polio Clinically Irrespective of any age.

WHAT IS NOT AFP ?

• TRAUMA• ISOLATED FACIAL NERVE PALSY• HYPOKALAEMIA• ACUTE RHEUMATIC FEVER• CONGENITAL FLACCID PARALYSIS

CONDITIONS SOMETIMES PRESENTING WITH AFP

• TUMOR• ENCEPHALITIS• HYPOKALEMIC PARALYSIS [ DUE TO LOW

SERUM POTASSIUM USUALLY REVERSIBLE ]• POTT’s DISEASE• TB MENINGITIS• OSTEOMYELITIS

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Last Reported Polio Cases

Polio Virus Type Date of last case Location

P1 13 January 2011 Howrah (Panchla), WB

P2 24 October 1999 Aligarh, UP

P3 22 October 2010 Pakur , Jharkhand

Source: WHO

• In 2012, WHO removed India from a list of countries with active endemic wild polio transmission after it passed one year without registering any new cases.

• Completing three full years without reporting any case of polio, India celebrated a landmark achievement in public health on 11 February 2014 – the victory over polio.

Thank you