polio eradikasi and endgame (prof. ismoedijanto)

8/19/2019 Polio Eradikasi and Endgame (Prof. Ismoedijanto)

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SERTIFIKASI GLOBAL dan POLIO ENDGAME

ISMOEDIJANTO

POKJA AHLI SUVEILANS POLIO


2/65

Kilas balik (1)

• WHA th 1988 !"!#t#ska$ %!"&"k'!"$asika$ PEI(l'bal P'li' E&ai*ati'$ I$itiati+") , ta&,"t th -.../

• Dilak#ka$ i!#$isasi s"&"$tak , OPV ala! NID0 i

I$'$"sia th 1990199201993/ $",a&a 4, t"&ti$,,al

!"$#la&ka$ k" $",a&a 4, sh b"bas/• Diragukan bisa eradikasi ok adanya VAPP dan VDPV, terakhir

adanya klb WPV di Suriah (dari Pakistan) dan WPV1

Palestina di limbah lingkungan .

• Na!#$ WHO t"ta5 , &"$*a$a s"!#la a$ 5"& &",i'$ aka$

iba$t# 677 #$t#k !"!5"&*"5at b"bas 5'li'/ P'li' lia& P-a$ P sh hila$, 0 #5a4a 5aa "&aikasi P1 /


3/65

Kilas balik (-)

• I!#$isasi aalah alat #$t#k !"$,"$alika$ 5"$4akit !"$#la&a$ b"k"&a "$,a$ ala$ – M"!b#at ba4i !"$ai k"bal (s"&'k'$+"&si)

– M"!5"&taha$ka$ k"k"bala$ "$,a$ s#$tika$ b''st"& t"s !"$"s

– M"!b#at *ak#5a$ i!#$isasi ti$,,i s"hi$,,a terbentuk herd immunity

– H"& i!!#$it4 !"$aha$ a$ !"$'lak t&a$s!isi ata# 5"$#la&a$

– H"& i!!#$it4 aka$ !"$4#t a$ !"!i*# ti!b#l KL:

– 7ak#5a$ i!#$isasi has t"ta5 ti$,,i0 s"hi$,,a tiak aa immunization

gap a$ akumulasi penduduk yang tidak kebal

– a5 t"&ai bila t"&b"$t#k s"la 5'5#lasi 4, s"$siti; (ohort yang tidak

diimunisasi) a$ tiak aa "$"la


4/65

Kilas balik ()

• S#&+"ila$s aalah alat #$t#k !"$,"tah#i aa$4a KL: – :"&ti$ak s"ba,ai s"$s'& aa$4a baha4a 5"$4akit #$t#k !as4a&akat

– M"$,a!ati k"aia$ s"*a&a 5asi; "$,a$ !"$*"&!ati la5'&a$

– P"ka t"&haa5 la5'&a$ 4a$, =a$"h>0 il#a& k"la?i!a$

– E&ai*ati'$ !a&*h• E$"!isitas ti$,,i tia5 ha&i aa kas#s i!a$a saa

• Kas#s !"$#$0 KL: t"&ai akibat ak#!#lasi 5"$##k 4a$, tiak k"bal

• KL: !"$ai s"&i$, "$,a$ kas#s 4a$, b"sa&

• KL: !ai$ a&a$, "$,a$ #!al kas#s 4a$, !"$#$

• Kas#s !"$,hila$, a&i t"!5at 5&akt"k0 5'likli$ik0 kas#s t"&abaika$

• A*ti+" s#&+"illa$*"

– A*ti+" !"$*a&i i 6S "$,a$ H66 ata# 5"$*a&ia$ !i$,,#a$ ata#

*'!!#$it4 "$,a$ !"libatka$ l"!ba,a s'sial0 "$,a$ &"5'&ti$, sit"s

4a$, sa$,at ba$4ak/


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• P"$#$a$ @ 99/9 s"!#a kas#s

• Ti$,,al $",a&a "$"!i* 5'li'

• poliovirus type 2 terakhir tahun 1999

• Polio virus type 3 tidak dilaporkan sejak 2014

• Ti$,,al - WHO 6",i'$s 4a$, b"l#! s"&ti;ikasi b"bas

•

P'li' +is t45" 1 s#ah !"$*a5ai titik &"$ah

"ema#uan yang besar menu#u eradikasi global

(A$%& serta '%&) bebas polio


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Eradikasi Virus Polio liar, 1988-2012

19851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120120

100

200

300

400

Polio cases (thousands)

Kasus Polio tipe

2 di dunia

Kasus Polio

terakhir di India

!"


7/65

S'#th East Asia 6",i'$al O;;i*"

(SEA6O)

&'a t' 5'li' ;&"" &",i'$ *"&ti;i*ati'$

1/ :a$,la"sh

-/ :h#ta$/ DP6 k'&"a

B/ I$ia

/ i$'$"sia

2/ M4a$!a&

3/ N"5al8/ Thaila$

9/ Ti!'& L"st"


8/65

Re#ent

De$elop%ents

Rukshar Khatoon

West Bengal, India January 2011


9/65

Setelah berupaya se#ak tahun 1*, 1 tahun kemudian

+ maret +-1 S'A%& bebas kasus polio


10/65

WHC

• HA6US MELAKUKAN PIN

• MENANTI T'5+ "$,a$ :'5+

•

MENUNAKAN IPV


11/65

na%un kita %e%pun&ai tu'as ()

• Th" N77PE '; all *'#$t&i"s sh'#l a+'*at"


12/65

usulan untuk Indonesia maret 2014 (1)

• Indonesia

• Th"&"


13/65

usulan untuk Indonesia $aret 2014 (2)

• The R**PE re#o%%ends that

• Th" N77PE sh'#l a+'*at"


14/65

S"t"lah s"&ti;ikasi

• 7ak#5a$ 5'li' 4, &"$ah

• a5 i!#$isasi 4, t"ta5 ti$,,i

• P"$i$,kata$ *ak#5a$ i!#$isasi ti$ ,a,al• Ki$"&a s#&+"ila$s 4, *"$"$, t#$

• S"l"sai $4a "!'$st&asi s#$tika$ IPV J',4a


15/65

S'l#si s"b"l#! k" IPVFFF//

PIN

N'$G5'li' AP 6at"


16/65

12

N'$ 5'li' AP 6at"

SEA60 -.11-.1

N#!b"& '; is*a&" AP *as"s 5"& 1..0... *hil&"$ #$"& 1 4"a&s '; a,"

SEAR Mini%u% Tar'et

and a+o$e

7.84

13.4913.94

12.386.12

12.50

Data as '; 1. A#, -.1

P"&*"$t A"#at" St''l S5"*i!"$ 7'll"*ti'$


17/65

13

P"&*"$t A"#at" St''l S5"*i!"$ 7'll"*ti'$

SEA60 -.11G-.1Mini%u% Tar'et

P e r #

e n t

P"&*"$ta,"


18/65

immunization gap 5ndonesia

N K 9 8

N K

N K 8 8 1

N K 8 B 3

N K 1 3 B B

N K . 9 . 8

N K . 8 1

N K B 9 1

N K 8 . .

N K B

N K 1 3 .

N K 1 3

N K 1 9 B

N K - 8

N K - 8 1

N K B B

N K 3 8

N K 3 2 -

N K 9 . 9

N K 1 3

N K

9 1

N K 1 3 .

N K - 3 3 N

K 1 .

Per#ent o, Non-Polio AFP *ases .nder I%%uni/ed ,or OP0

12 Months to 3 4rs56 SEAR6 !!7-!"8

Data as '; .9 S"5 -.1

N K 8 2 -

N K 2 9 1

N K 9 8 3

N K 1 2 B

N K .

N K 1 . .


19/65

19

N K 3 9 B

N K 8 8

N K . 3 1

N K 9 2 B

N K 1 B

N K - 9 1

N K 3 2

N K 9 . 9

N K 1 3

N K 9

1

N K 1 3 .

N K - 3 3

N K 1 .

P"&*"$t '; N'$GP'li' AP 7as"s U$"& I!!#$i?" ;'& OPV

(2 M'$ths t' C&s)0 SEA60 -.11G-.1

N K 8 2 -

N K 2 9 1

N K 9 8 3

N K 1 2 B

N K .

N K 1 . .

N K - 8 3 B 9

N K 8 9 8

N K 1 8

N K - 2

N K 8 .

N K B 3 -

N K 1 1 B 9 1

N K -

N K B B

N K 9 3

N K

Data as '; 1. A#, -.1

Risk anal&sis ,or SEAR #ountries ,or trans%ission ,ollo9in' :P0


20/65

Risk anal&sis ,or SEAR #ountries ,or trans%ission ,ollo9in' :P0

i%portation into polio-,ree areas6 !"

High Risk

Medium Risk

Low Risk


21/65

Su+-national risk anal&sis ,or SEAR #ountries ,or trans%ission

,ollo9in' :P0 i%portation into polio-,ree areas6 !"

Data as '; 1 D"* -.1-

High Risk

Medium Risk

Low Risk

SEARO and WPRO: Sub-national Polio Risk


22/65

SEARO and WPRO: Sub national Polio RiskAssessment: 2012

Low

risk Medium risk

Hi! risk

"ross-bordermeetin "!ina#M$anmar# Laos#%!ailand# &iet 'am(lanned 201)*WPRO# SEARO+

S#&+"illa$*" I$i*at'&s b4 P&'+i$*"


23/65

-

I$'$"sia0 -.1

T'tal AP 7as"s 218

N'$GP'li' AP 6at" 1/

A"#at" St''l s5"*i!"$ 9BP&'+i$*"s &"5'&ti$, AP *as"s . (8)

Non-Polio AFP Rate

1

1 1/99

@-

N' N'$GP'li' AP 7as"

N'$G5'li' AP 6at"

N#!b"& '; is*a&" AP *as"s 5"& 1..0... *hil&"$ #$"& 1 4"a&s '; a," (a$$#ali?" b4


24/65

-B

I$'$"sia0 -.1B

T'tal AP 7as"s 132

N'$GP'li' AP 6at" -/B

A"#at" St''l s5"*i!"$ 89P&'+i$*"s &"5'&ti$, AP *as"s B (1..)

Non-Polio AFP Rate

1

1 1/99

@-

N' N'$GP'li' AP 7as"

N'$G5'li' AP 6at"

N#!b"& '; is*a&" AP *as"s 5"& 1..0... *hil&"$ #$"& 1 4"a&s '; a,"

P"&*"$ta,"


25/65

polio end !ame6 men!apa bP* dan IP* +


26/65

c*,P* -ases1' Previous . $onths2


27/65

*apaian dan kendala se#ara u%u%

• T"lah aa B &",i'$ 4, b"bas 5'li' PAHO0 EU6O a$ WP6O0

SEA6O0 4a$, b"l#! b"bas 5'li' EM6O0 A6O• 677 ib"$t#k #$t#k !"$'&'$, &",i'$ !"!b"&a$tas 5'li' i

s"!#a $",a&a a$,,'ta$4a a$ !"$*",ah 5"$#la&a$/

– Aa$4a klb i!5'&tasi i$t"& a$ a$ta& &",i'$

–

6"+i"< a$ +aliasi 'k#!"$ $",a&a – 6"+i"< a$ +aliasi i$t"&$asi'$al k" $",a&a !asi$,-

– M"$'&'$, i!#$isasi a$ s a;5 !asi$,- $",a&a

• KL: 5'li' s"t"lah s"&ti;ikasi b"bas 5'li' t"ta5 t"&ai0 $a!#$

$",a&a "$"!is k#&a$, (ti$,,al ) a$ kas#s sa$,at !"$#$0

PEI '5ti!is bisa t"&*a5ai th -.18/

• S'A%& 6 bukti adanya komitmen pimpinan pusat dan lokal serta

peran serta masyarakat tinggi, bisa untuk peny lain


28/65

UPDATE ON POLIO

P- sh tiak aa s"ak 1999

P sh tiak ila5'&ka$ s"ak -.1B

P1 s#ah sa$,at &"$ah

*VDPV P- !"$ai 5'li' lia& ba

Sabi$ bisa ai lia& k"!bali


29/65

*accine/associated paralytic poliomyelitis lumpuh ok P*


30/65

arti dari "78 VDPV, +---9+-1+6 polio liar sdh hampir punah'

muncul c*,P* dan *"PP seba!ai polio liar baru

T&pe 1>?@ #ases5

T45" 1 (39 *as"s)

T45" (9 *as"s)

ipe 2 komponent dari tP* harus dihentikan karena


31/65

p p

menyebabkan 5 906 dari circulatin! vaccine derived poliovirus

(c*,P*) pada beberapa tahun terakhir ini

as '; 1 D"*"!b"& -.1B)


32/65

Re,ised oal or ERAPO

to !om"lete the eradi!ation and

!ontainment o# all wild, vaccine-

related and Sabin

polioviruses.

Penemuan baru yan meruba!


33/65

Penemuan baru yan meruba!

endame

• t$(e 2 !$%&$ is the main /(ost-eradiation/

(roblem.

• Vaksin bivalent baru "b#PV$ ter'ukti le'ihe(sien dari )aksin tOPV untuk kekebalan wP1

& wP3 (P2 sdh tidak ada)

•

merupakan opsi pilihan untuk menggantitOPV *

• %ew &'PV& options allow all !ountries to

(asus Polio virus tipe 1 201)


34/65

(asus Polio virus tipe 1, 201)

%idak ada kasus (olio liar$an terla(orkan di Arikaatau %imur %ena! seak

11 Austus# 201

E$"!i* *'#$t&i"s

I$;"*t" *'#$t&i"s

.2

837

Is&a"l E$+/ 5'siti+" is'lat"s ( -.1B0 N1B 0 last . Ma& -.1B)

a?a E$+/ 5'sit+" is'lat"s (-.1B0 N10 Ja$ )

(asus Polio liar tipe 1


35/65

(asus Polio liar tipe 1,2012-1*+

A,'hanistan Ni'eria Pakistan!

3!

"!!

"3!

!!

3!

8!!

83!

8?

"!8

33

">

38

78

@

2

8!8!" !"8 !"> !"3

*ases

6

6

6

6

6

6

64

12

0

Tidak ada kasus polioliar &an' terlaporkan

di Ni'eria seak > Buli!">

6

3ata (er 14 Auust 2015 :

pdate terkini tt cVPVs . polio 2


36/65

2

pdate terkini tt cVPVs . polio 2

7i&*#lati$, Va**i$"GD"&i+"

P'li'+is O#b&"aks

(*VDPVs) -...G-.1.

Sin#e !!76 7?C o,

#0DP0 #ases are due

to t&pe

1 >!C o, 0APP5

T45" - 1>3! #ases5

T45" 1 (39 *as"s)

T45" (9 *as"s)

Hi,hli,hts '; N"< Wil P'li'+is a$ *VDPV 7as"s


37/65

, ,

Th" b'#$a&i"s a$ $a!"s sh'


38/65

What $"t

•M"$,,#$aka$ IPV #$t#k !"$,,a$ti OPV – U$t#k !"$*",ah *VDPV a$ VAPP

• IPV ala! b"$t#k +aksi$ k'!bi$asi – Dala! b"$t#k 5"$ta+al"$t ata# h"a+"l"$t

• S"la!a t&a$sisi – M"$,,a$ti tOPV "$,a$ bOPV0 !"$*",ah *VDPV-

– M"!b"&ika$ !i$i!al sat# 'sis IPV0 5&i!!i$, P-

– M"$i$,katka$ i!#$isasi ti$ sa!5ai *ak#5a$ @9.

– M"!5"&taha$ka$ s#&+"ila$s AP a,a& KL: t"&"t"ksi


39/65

:a,ai!a$a s"la$#t$4a A5a 4a$, b"bah

•5'li'+is lia& t45" - t"&akhi& i t"!#ka$ i I$ia th 1999

• L"bih a&i 1. tah#$ ta$5a 5'li'+is lia& t45" - – Na!#$ 0 B. a&i +a**i$"Gass'*iat" 5a&al4ti* 5'li'!4"litis

( *"PP) !lobal berasal dari 7abin type 2 (1..G-.. *as"s

a$$#all4)0 – 9 a&i kas#s c*,P* ok type 2

• Kas#s 5'li'+is lia& t45" 5ali$, &"$ah s"la!a i$i• SA:' Working :roup merekomendasikan endgame strategy

baru (Sabin + essation) and ne! polio 0aines.

i *i P li


40/65

ipe *irus Polio

T45" 1tOP0 8 rin's '; 5&'t"*ti'$a,ai$st t45"s 10 -0 a$

S#he%ati# des#ription o,te#hni#al rationale ,or

use o, at least one dose

o, IP0 as part o, the


41/65

T45" -

T45"

!OPV-

+OP0 = %OP0P&'t"*ti'$ a!ainst

type 2 provided bysupplementary use

o8 mP*2 i$ th"

s"tti$, '; a$

'#tb&"ak

%OP0

+OP0 = IP0 = %OP0

+OP0 %OP0 e,,e#t isenhan#ed in an IP0

population thus

,a#ilitatin' out+reak

#ontrol

bOPV

Q

IP0+OP0 = IP0

IP0 adds prote#tion

a'ainst t&pe +oosts

i%%unit& to " 8

1enhan#in' +OP0 e,,e#t5

P't"$tial T45" -

'#tb&"ak

&"#i&i$,

!OPV-

+OP0- &i$,s '; 5&'t"*ti'$

a!ainst types 1 and

3

tOPVGbOPV

s


42/65

B-

/ivalent #PV Ecacy se

Sero#on$ersion a,ter H +OP0

$s) tOP06 India6 !!@-!!7

T&pe " T&pe 8

+i$alent OP0 use

as o, Sept !""

Introdu#ed

De# !7-Au' ""

Planned +&end-!""

M"$,a5a b OPV a$ IPV


43/65

• tOPV !"$i!b#lka$ a$tib'i s"*a&a la!bat a$ s"#"$tial0 'k

aa i$t"&;"&"$si i$t"sti$al a$ta& 5'li' Sabi$ P10P-0P *'$t'h i

I$ia tOPV k"k"bala$ s"kita& 2.

• !OPV a$ bOPV t"&b#kti epat – !"$i$,katka$ a$tib'i

–

M"$"ka$ t&a$s!isi0 !"$,hila$,ka$ '#tb&"ak s"*a&a *"5at – !OPV !"!#$*#lka$ WPV s"hi$,,a t"&5aksa !"$,,#$aka$ bOPV

(P1 a$ P)

– I$ia *"5at hila$, kas#s$4a s"kali5#$ *ak#5a$$4a b"l#! 9.0 $a!#$

!"!#$*#lka$ *VDPV t"ta!a 4, P-

– Sabi$ has ih"$tika$ !"ski5#$ =asa> $4a sa$,at b"sa&

• Ka&"$a *VDPV !#$*#l s"ba,ai =5'li' lia& ba> WHA

!"&"k'!"$asika$ !"$,h"$tika$ OPV0B

P b h i i l ik -.1


44/65

P"baha$ "5i"!i'l',ik -.1

• VDPV OPV 4, de attenuated ala! #s#s !a$#sia

• S"!#la "&aikasi it##ka$ WPV0 $a!#$ ki$i t"&!as#k *VDPV

a$ bahka$ '&al 5'li' +a**i$" OPV Sabi$"

• VAPP dan VDPV setara dengan WPV seara epidemiologik

• T"&ai KL: i a"&ah *ak#5a$ &"$ah a$ !iski$0 baik WPV

!a#5#$ VDPV

• nvironmental surveillance !"$*a&i *VDPV ta5i k"t"!#

WPV i Is&a"l

• E$,a!" ai s4$*h&'$i?" WPV a$ OPV

P b h t t i


45/65

P"baha$ st&at",i

•

S"!#la WPV ba VDPV0 ki$i s"!#a s"kali,#s

• !OPV a$ bOPV l"bih *"5at !"$,atasi KL: iba$i$, tOPV

• Ok WPV- sh l"$4a5 th 19990 OPV- has ih"$tika$ a,a&

tiak b"bah !"$ai *VDPV-

• Shi;t a&i tOPV k" bOPV (5'li'1 a$ ) #$t#k i!#$isasi ti$

• P&i!!i$, 5'li'- , IPV/

•$emperkuat imunisasi rutin dan 7"#P harus mampu

mendeteksi peredaran polio


46/65

Potential benefits of 'at least 1 IPV dose !io! to "PV2 cessation'

a- "re)ent "olio i# e."osed to a $%&$2 orW&$2

'- im"ro)e res"onse to m/&$2 in an

out'reak

!- redu!e transmission o# a reintrodu!ed ty"e2

d- 'oost immunity to W&$1

Some 'mplications or 'PV. must be used


47/65

B3

• OP0 should +e repla#e +& IP0

• T&a$ssisi s"la!a "$ ,a!"

• IPV a5at i5"&*"5at 5"$,,#$aa$$4a (i/"/ tOPVGbOPV s


48/65

B8

instead o# seuential risk management

! > 2 @ "! " 4ears

Last 9ild polio #ase tri$alent OP0 #essation

VDPV "li!i$ati'$

+aliati'$

Wil +is

"&ai*ati'$Se;uential risk

%ana'e%ent

P'stGOPV

s#&+"illa$*"

7"&ti;i*ati'$

*'$tai$!"$t

*,P*2 "li!i$ati'$

+aliati'$

P'stGOPV

s#&+"illa$*"

Wil +is

"&ai*ati'$

Parallel risk

%ana'e%ent7"&ti;i*ati'$

*'$tai$!"$t

OP0 #essation

IP0 introdu#tionbivalent P* 1:3

(bP*) cessation

Potential polio policies or


49/65

p peac! p!ase

N'< !">-"3 !"@-"7

tOPV bOPV

IPV i$t&'#*ti'$

St'5 all OPV

H"a+al"$t i$t&'#*ti'$

IPV ;'&

a**"l"&ati'$

bOPV i$ &'#ti$"

i!!#$i?ati'$ Q

1 's" IPV

H"a+al"$t IPV ;'&

&'#ti$" i!!#$i?ati'$

E&ai*ati'$ l'bal *"&ti;i*ati'$

O+e#ti$e o, The Plan addresses the End'a%e throu'h three distin#t


50/65

.

sta'es

Introdu#e• at l"ast '$" 's" '; IP0•

i$t' routine i%%uni/ation

S9it#h• tOPV t' bOPV

:ithdra9• '; bOPV &'#ti$" OPV

#s"Be,ore end

!"3

!"2

!"7-!!

/ngoing 34R5674H56I67 o# routine immuni8ation ser)i!es

%1%12

Pen!!unaan IP* ;ekomendasi 7"


51/65

IP* tidak men!!antikan dosis P*


52/65

K#b# '5ti!is "&aikasi aka$ i*a5ai


53/65

K#b# '5ti!is "&aikasi aka$ i*a5ai

•

S"ak tah#$ 1999 tiak aa WPV-• K"!#$,ki$a$ !"$,hila$,ka$ baik WPV !a#5#$ WPV1

"$,a$ bOPV ata# !OPV t"&b#ka

• M"$,hila$,ka$ VAPP a$ *VDPV "$,a$ IPV

• P'li' ha$4a hi#5 i #s#s !a$#sia

• P"$"litia$ C',4a s"t"lah 2 b#la$ 5"$,,#$aa$ IPV 0 tiak

b"&"a& la,i 5'li' Sabi$ (+aksi$) i li!bah

• P"$,a!ata$ s"la!a B tah#$ tiak i #!5ai aa$4a Sabi$

a&i l#a& 5&'5i$si 5aa li!bah s"$t&al C',4a

• T&a$s!isi a$ i!#$itas t"&,a$t#$, 5aa tia5 $",a&a

K#b# 5"si!is !"$,i$,atka$ aa kendala eradikasi


54/65

• I!#$itas i$t"sti$al bisa !"$#$0 s"hi$,,a a5at ih#$i +is

5'li' la,i

• S"t"lah s"&ti;ikasi t"&*a5ai aka$ t"&ai 5"$#$a$ k",iata$

i!#$isasi a$ s#&+"iala$s

• 7ak#5a$ i!#$isasi s#$tika$ &"$ah i b"b"&a5a $",a&a

• Mai$t"$a$*" 5&',&a! KL: i;t"&i0 *a!5ak0 5"&t#ssis

• P"&l#


55/65

Th" b'#$a&i"s a$ $a!"s sh'


56/65

E$"!i* *'#$t&41E*l#"s +is"s "t"*t" ;&'! "$+i&'$!"$tal s#&+"illa$*"/-O$s"t '; 5a&al4sis .- S"5t"!b"& -.1B .1 S"5t"!b"& -.1

Wil 5'li'+is t45" 1

*VDPV t45" 1

*VDPV t45" -

Data i$ WHO H as '; .1 S"5t -.1

Wil P'li'+is 7as"s10 P&"+i'#s 2 M'$ths-


57/65

E$"!i* *'#$t&4

Wil 5'li'+is t45" 1

1E*l#"s +is"s "t"*t" ;&'! "$+i&'$!"$tal s#&+"illa$*"/-O$s"t '; 5a&al4sis .- Ma&*h .1 S"5t"!b"& -.1


*VDPV 7as"s10 P&"+i'#s 2 M'$ths-


58/65

E$"!i* *'#$t&41E*l#"s +is"s "t"*t" ;&'! "$+i&'$!"$tal s#&+"illa$*"/-O$s"t '; 5a&al4sis .- Ma&*h .1 S"5t"!b"& -.1

*VDPV t45" 1

*VDPV t45" -


J/J'h$ a$ *'G


59/65

9

i$ s"+"&al ;i"l i$t"&+"$ti'$ st#i"s

• Intervention study in Tamil Nadu (1987-1992 !y I"#$

% 2.5 million re&eived I') in&iden&e dro**ed +rom 14 to 0.3,100000

*erson-years it/ " o+ 84

% 2.5 million re&eived ') in&iden&e dro**ed +rom 9 to 0.4,100000

*erson-years it/ " o+ 95

• Intervention study in #um!ai slums (1988-1991 !y $.'atel

% u&&essive introdu&tion o+ I' in 3 !lo&s o+ 100000 *o*ulation over a

3-year *eriod +rom 1988 to 1990

% In&iden&e dro**ed to 0,100000 *erson-years in t/e year +olloin

introdu&tion in ea&/ !lo&

o/n T amuel $ alra o/n $. an&et 1998352)58-61o/n T. 'ro& Indian Natl &i :&ad 200369)393-422o/n T. Indian #ed $es 2004119)1-17

IPV i$t&'#*ti'$ 5&',&a! i$ th" C',4aka&ta 5&'+i$*" ';I$'$"sia Hi,h i!5a*t '$ +a**i$ati'$ *'+"&a,"0 PV


60/65

2.

*i&*#lati'$ a$ s"&'5&"+al"$*"

•it&/ +rom an '-only to an I'-only s&/edule (;&ondensed3 95

• ?nvironmental sam*lin (inlet seae – #aintenan&e o+ a!sen&e o+ @' &ir&ulation

– ery ra*id de&rease o+ isolated ' it/ only 5 sam*les it/ a!in lieand no A's (!ut 24 out o+ t/e 55 mont/s *eriod o+ B,C ere missed

• ero*revalen&e and dose 3-to-dose 4 sero&onversion survey

done on 188 in+ants revealed 100 ' *ost-dose 3 and in&reasein D#T +rom dose 3 to dose 4

I' Introdu&tion 'roe&t in Eoyaarta tae/older meetin 25 F 26 :*ril 2012

IPVG;'ll'


61/65

21

b""$ th" !'st '*#!"$t"

• 13 trials done it/ several ty*es o+ I'-&ontainin va&&ines in 7 &ountries sin&e

1986

– C: (5 "/ina (3 CG raHil #ei&o Taian J Duatemala

• 1 or 2 I' +olloed !y 1 or 2 ' administered as 2


62/65

2-

&"l"+a$t ;&'! a P#bli* H"alth 5"&s5"*ti+"

•

:ddress t/e :'' issue• "om!ine t/e +ull !ene+it o+ !ot/ va&&ines in terms o+ !reat/ o+ immune

res*onses (mu&osal and /umoral

• T/e in&or*oration o+ at least one dose o+ I' at t/e start o+ t/e immuniHations&/edule in&rease *ost-*rimary series :! levels &om*ared to '-onlys&/edules

•I-I- *rimary series durin t/e +irst year o+ li+e s&/edule is t/e !est *er+ormer in terms o+ a!solute *ost-*rimary series anti!ody levels (versus'-only

• To doses o+ I' durin t/e +irst year o+ li+e s&/edule is a!le to redu&e *revalen&e intensity and duration o+ ' e&retion +olloin an early 'va&&ination , &/allene &om*ared to 1st time '-re&i*ients

•Ly*ot/esis t/at *rior I' mi/t result in +aster e&retion o+ revertant virusa+ter ' in+e&tion (!y ' is not &on+irmed

IPVG*'$tai$i$, +a**i$"s ha+" "!'$st&at""*"ll"$t a$ *'$sist"$t i!!#$',"$i*it4 5&';il"

h t iti ;


63/65

2


64/65

2B

• Immunoloi&al *rimin do&umented a+ter 1st dose

• Li/ immunoeni&ity a+ter 2nd dose

– In 30 trials involvin >4500 su!e&ts sero*rote&tion

aainst *oliovirus

• 89-100 aainst ty*e 1



• Immunoeni&ity e*e&tedly rein+or&ed a+ter 3rd dose

– In 48 trials involvin >6000 su!e&ts 95-100

sero*rote&tion rates aainst all 3 ty*es

al!'st all s#b"*ts a;t"& t


65/65

2

% P&'t"*ti'$ a,ai$st 5'ssibl" *VDPV t45" - '$l4 th&'#,h IPV#$"& $"< 5la$

• Th" !'st !"i*all4G a$ "5i"!i'l',i*all4Gs'#$"&",i!"$ is th" IPVG;'ll'

polio eradikasi and endgame (prof. ismoedijanto)

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