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Sixteenth Meeting of the India Expert Advisory Group for Polio Eradication - Conclusions and Recommendations

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Summary

Abstract:

This paper was presented as part of a December 2006 meeting hosted by the India Expert Advisory Group (IEAG) and held in New Delhi, India. Participating organisations included the World Health Organization (WHO), Rotary International, the United States Centres for Disease Control and Prevention (CDC) and the United Nations Children’s Fund (UNICEF). The goal of this paper was to review progress on polio eradication since the last full meeting of the IEAG held seven months earlier, and to make recommendations on accelerated strategies to ensure the interruption of wild poliovirus (WPV) transmission in India.

Major Findings:

According to the IEAG, as of December 2006, a total of 583 cases of WPV (with onset in 2006) were confirmed in India. Of these, the vast majority of cases were concentrated in two highly affected states - 481 cases in Uttar Pradesh and 48 in Bihar. The IEAG provided a detailed description of transmission trends, with specific focus on genetic evidence behind the viral spread, for each of these states.

It was stressed that polio in endemic areas is now a disease of the very young - 85% of cases reported in Uttar Pradesh were seen in children less than 3 years of age. This was attributed in part to two major issues identified in the previous IEAG meeting; firstly, a failure to consistently reach all eligible children in key areas with oral polio vaccine (OPV); and secondly, the lower vaccine efficacy achieved in Northern India. These factors resulted in the accumulation of large numbers of susceptible children and allowed for rapid transmission of the virus.

Several positive developments, however, were noted since the previous IEAG meeting:

  • Major efforts were made in both Uttar Pradesh and Bihar to improve the quality of supplementary immunisation activities (SIAs) with great success.
  • Scientific evidence confirms that the efficacy of monovalent OPV (mOPV) is much greater than trivalent OPV (tOPV) in inducing immunity against WPV, providing a more potent weapon against transmission.
  • The peak of transmission had passed in October 2006, and case numbers had been declining since then.
  • Surveillance quality and laboratory performance remained excellent in the face on an extremely high workload.
  • Communication efforts in western Uttar Pradesh and Bihar have been expanded to cover more high risk areas.

Recommendations:

Recognising that population immunity against WPV will be very high by the end of 2006 due to improvements in SIA quality, the use of mOPV and recent outbreaks, the IEAG concentrated on optimising the use of polio vaccines to create adequate immunity to stop WPV1 transmission in the low season of 2007. They provided specific objectives within each of the following key areas:

  1. OPV supplementary immunisation schedule.
  2. Other strategies to improve immune response in highest risk areas.
  3. Enhancing the quality of SIAs.
  4. Routine immunisation (RI).
  5. Programme research


Intensive monitoring, mobilisation of funds to ensure coverage of communication/operational funds, and public support of key influencers through the media were all seen as important WPV interruption strategies.

Click here to download the full report as a PDF document.