A Snapshot of Polio Situation in India

2000
 P2 cases eradicated in 1999
1750
 14 States and UTs free of polio Since 2001

1500
 NIDs conducted since 1995 covering 170
million children per round
1250  Sharp decline in polio cases in 2010
 Single WPV 1 case reported in 2011 and
1000 longest polio free period
741
750
bOPV
500
mOPV 1

250
42
1
0
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011*

P1 wild P3 wild
 Geographical distribution of Wild Polio cases during last two years

2009 2010

A single case of WPV1 detected in India

in 2011 – in Howrah, West Bengal
WPVs WPVs
State P1 P3 Total State P1 P3 Total
Bihar 38 79 117
West Bengal 6 2 8
Uttar Pradesh** 34 569 602
Maharashtra 5 0 5
Delhi 3 1 4
Bihar 3 6 9
Punjab 2 2 4
Jharkhand 2 0 2 Jharkhand 3 5 8
Rajasthan 1 2 3 Jammu & Kashmir 1 0 1
Haryana 0 4 4 Uttar Pradesh 0 10 10
Uttarakhand 0 4 4 Haryana 0 1 1
Him achal Pradesh 0 1 1 Total 18 24 42
Total 80 662 741
** One case reported mixture of P1 wild & P3 wild
WPV cases during previous 12 months, India
Jun 2010 – Nov 2010 Dec 2010 – June 2011*

Type 1 Polio

N=11 N=2
West Bengal is the only state with wild
virus transmission in past 6 months

N=7
N=0
Type 3 Polio
 AFP surveillance and polio situation in 2011
Year AFP WPV Compatible VDPV
2009 50405 741 473 21
2010 55781 42 188 5
2011 24314 1 1* 4

No circulating VDPVs
No genetic linkage amongst 2011 VDPVs
No genetic linkage with VDPVs of 2009 & 2010

VDPVs
Single P1 case in 2011 Howrah,
West Bengal State P1 P2 Total
Chhattisgarh 1 1
Onset of paralysis - 13 January Madhya Pradesh 1 1
Rajasthan 1 1
Related to wild poliovirus
detected in sewage sample of Uttar Pradesh 1 1
Delhi in August 2010 Total 4 4

*Classification of cases pending

Wild Polio Virus in environmental (sewage) samples
8
Mumbai
Samples not collected
between March 2006
6
and April 2007 due to
fire in Mumbai Lab
4

0
J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M

8
Delhi WPV1 WPV3
Mumbai and Delhi sewage test results confirm that P1 and
6 P3 circulation is at very low levels in 2010.
No evidence of circulation in 2011
4

Collection of
2 sewage samples
started from April
2010
0
J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J J A S O N D J F M A M

2005 2006 2007 2008 2009 2010 2011

Note: six samples reported mixture of P1 wild & P3 wild in Delhi
 WPV1 cases in endemic states, 2009-2011
12

10
Uttar Pradesh
Longest indigenous WPV1 transmission free
8
period simultaneously in both endemic states
6

0
J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J

12
Bihar
10

6
Cross-border transmission
4 with Nepal
2

0
J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J

2009 2010 2011*

 WPV3 cases in endemic states, 2009-2011*
120

100
Uttar Pradesh
80

60

40

20

0
J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J

120

100 • Transmission limited to western UP & central Bihar

80 • No WPV3 case in endemic states for 13 months
60

40
Bihar
20

0
J F M A M J J A S O N D J F M A M J J A S O N D J F M A M J

2009 2010 2011*

 Bihar, WPV1 spill over, 2010
Nepal

Bihar

Champaran East

• Cross-border transmission with Nepal that resulted in 3

cases in a single block
• All 3 cases within a span of 1 month
• 3 mop-up rounds conducted within a period of 10 weeks
• No case in this transmission area for 8 months
 Maharashtra, WPV1 transmission area, 2010

3
WPV1

mOPV1
2

bOPV

mOPV3
1

tOPV

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
10 10 10 10 10 10 10 10 10 10 10 10 11 11 11 11 11 11

• Transmission focused in a small geographical area in

Malegaon and a single case in Beed
• Multiple mop-up rounds
• Last case in September 2010
• No case in this transmission area for last 8 months
West Bengal & Jharkhand, Mix transmission area, 2010-11

3
WPV3
WPV1
Jharkhand
mOPV1
2
bOPV West Bengal
mOPV3

tOPV 1

0
Jan1 Feb1 Mar1 Apr1 May1 Jun1 Jul1 Aug1 Sep1 Oct1 Nov1 Dec1 Jan Feb Mar Apr May
0 0 0 0 0 0 0 0 0 0 0 0 11 11 11 11 11

• Only area with WPV1 & WPV3 transmission simultaneously

• Majority cases in Murshidabad (WB) & Pakur (JH), with the most recent case in
Howrah (the only case of 2011)
• Transmission continued throughout 2010 in northern WB despite multiple SIAs
• The most recent case in Howrah related to a separate importation, most likely
from Delhi
Pulse Polio Response : SIAs conducted during 2011

23 Jan 2nd week Feb 27 Feb

June
April May
March

mOPV1
mOPV3
bOPV
tOPV
 Quality of Response during 2011 regarding SIA Pulse
Polio activities
(Percent average children found unimmunized, End-of-round survey)
% unimmunized
9% 8.40%
8%

7% 6.40%
6.30%
6%

5% 4.80% 4.80%

4% 3.40% 3.50%
3% 2.60%

2% 1.80%

1%
0.30%
0%
 Response : Revised communication strategy launched

Focus on personalizing risk perception of polio, Addressing OPV

safety issues during sickness and Promoting a more active attitude for
RI and polio vaccination, particularly among migrants

Polio Plus Handbook New social mobilizer flip-

The New Logo addressing OPV safety and book addressing OPV safety
convergent interventions and convergent interventions

From ‘Every
Child’to “OPV is totally safe … do not pay
‘My Child’, attention to rumors.”
Two Drops,
Every Time.
EPRG formed in 23 States/UTs *
(out of 35 States/UTs)
# children: 0.7 mn
in each round # children: 0.7 mn
in each round

# children: 0.5 mn # children: 1.1 mn

in each round
in each round
• Informing programme decisions
– Seroprevalence surveys in UP and Bihar to start
from 6-August
– Mucosal immunity study scheduled to start from 5-
September
• AFP and Laboratory Surveillance
– Environmental sampling started in Patna
– Surveillance reviews conducted in Central & Eastern
UP, West Bengal & Gujarat
 Moradabad AFP cases UP Moradabad UP & Bihar
Nov 2007 Nov 08 – May 2009 Aug 2010
(N=121) mid 09 (N=534) (N=1280)
(169)
Age 6-7 mo 6-11 mo 6-7 mo 6-7 mo

Type 1 78% 96.5% 99% 98%

Type 2 56% 33.7% 75% 65%

Type 3 69% 42.6% 49% 77%

High immunity levels achieved both for P1 & P3 in 2010

through bOPV introduction
1. Intensified surveillance for poliovirus
2. Full and consistent coverage of migrant and
mobile populations
3. Intensified program in 107 High-risk Blocks of UP
and Bihar
4. Rapid and effective response to any wild
poliovirus
5. Identify and cover areas and populations at high
risk for importation and spread of poliovirus
6. Identify areas with low RI coverage and
strengthen it
• Country at historic low transmission levels
• Genetic & environmental surveillance confirms
progress
• Simultaneous progress in both endemic states
• The coming high transmission season will be
the test to know whether poliovirus
transmission has stopped in India
• Any case of Wild Polio considered as Pubic
health emergency and needs quick & effective
containment