1. Inter-Departmental Working Group 03-07-02
Polio eradication progress
Poliovirus laboratory containment
Roles Working Group

2. The Global Polio Eradication Initiative
1980: WHA declared smallpox eradicated
1988: WHA resolved to eradicate polio
Eradication strategy is targeted mass OPV immunization with intense virus surveillance
Polio eradication is the largest global public health initiative ever undertaken

4. Pre-‘Acceleration’ Progress
1988
cases
1999
7 094 cases
Slide 2: What progress have we made?
As a result of routine polio immunization, National Immunization Days and house-to-house mopping-up activities, there has been a 90% decline in reported polio cases in the last ten years - from over 30 000 to little over 3000 cases. I want to point out that surveillance has significantly increased since 1988, and the success is therefore probably even more impressive.
More important has been the marked reduction in the geographic distribution of wild poliovirus as indicated in red. Polio was endemic on 5 continents and in over 130 countries in 1988, compared with only 50 countries on 2 continents today. Although the vast majority of progress has occurred since only 1995, this is still 50 countries too many.
As large geographic areas become polio-free, it is increasingly important to minimize the risk of inadvertent release of wild poliovirus from laboratory stocks.
Polio Eradication 14

5. Intensity of indigenous wild poliovirus transmission in 2001
(11 Countries)
Year (20 countries)
Zero wild viruses
1 to 4 wild viruses
5 to 20 wild viruses
More than 20 wild viruses
Importations
Under investigation
as of 18 December 2001

6. Acceleration Impact India as of 30 Nov 2000 1998 1999 2000 2000 1 934
viruses
2000
2000
1 126
viruses
196
viruses
196 viruses
Polio Eradication

7. Polio ‘Last Cases’ Americas Region Luis Fermin Tenorio Peru 1991
Western Pacific Region
Mum Chanty
Cambodia 1997
European Region
Melik Minas
Turkey 1998
Polio Eradication

8. Type 2 polio was last found in October 1999
Polio Eradication

9. Global eradication of all 3 poliovirus types anticipated by 2005

10. Laboratory Containment The other half of poliomyelitis eradication
Certification of Poliomyelitis eradication requires:
Finding and controlling wild poliovirus in human populations +
Finding and controlling wild poliovirus in laboratories
I think everyone is familiar with the goal of laboratory containment but I will take just a moment in the next few slides to review. What is containment? Containment is the other half of a successful poliomyelitis eradication program. The Regional Certification Commission will soon consider if this region can be declared “polio-free”. Much work has been done to find and control polio virus in the human populations of this region. However, polio virus still exists in this region - in various biomedical laboratories scattered throughout the member countries. Containment is the task of finding and controlling polio virus in those labs to complete the goal of polio eradication.

11. Wild poliovirus may be reintroduced from the laboratory:
In theory, by contaminated clothing, liquid effluents, air exhaust, or improper virus disposal
In fact, by an infected laboratory worker, who may go unrecognized

12. Containment
Essential laboratory facilities and biosafety practices to minimize the risks of infection to the worker and the community.

13. Containment Con: Polio will never be eradicated
Pro: Progress thus far indicates polio can be eradicated
Con: If polio is eradicated, the risk of reintroducing polio from lab is either small or large
Pro: Risk of reintroducing polio from the lab grows with time after eradication

14. Containment Con: Immunization will never stop
Pro: OPV (live) immunization at some point must stop
Con: Absolute containment can never be ensured
Pro: Effective containment can be achieved

15. Poliovirus and smallpox virus containment strategies differ
Poliovirus task is much larger in numbers of labs and types of infectious materials
For smallpox, focus was on destruction and global consolidation
For polio, focus is on destruction and appropriate laboratory containment

16. WHO Global Action Plan: 3 steps to containment
Pre eradication: Laboratory survey/clean up and inventory
Post eradication: Implement required laboratory biosafety levels
Post immunization: Maximum containment strategy depends on immunization strategy

17. All post eradication immunization scenarios assume:
global surveillance
adequate vaccine stockpiles
emergency response plans

18. Purpose of the survey Alert labs to impending eradication
Encourage disposition of unneeded wild poliovirus materials
Establish a National Inventory of laboratories retaining such materials

19. Purpose of the National Inventory
Maintain a current list of laboratories with wild polioviruses
Keep laboratories informed of biosafety developments
Notify laboratories when polio has been eradicated and need to implement containment requirements

20. Countries initiating laboratory surveys
EUROPEAN REGION:
48 / 51
WESTERN PACIFIC REGION:
36 / 36
SOUTH EAST ASIA REGION:
7 / 10
AFRICAN REGION:
To start planning 2002
AMERICAS REGION:
12 / 48
EASTERN MEDITERREAN REGION:
19 / 23 15

21. Tommy G Thompson, Secretary HHS to
“The United States is fully committed …..to the containment of any laboratory material that may harbor specimens of wild poliovirus.”
Tommy G Thompson, Secretary HHS to
George Alleyne, Director, WHO,AMRO June 2001

22. Timeline for US National Survey and Inventory

23. US Biomedical Laboratory Database
10,859 diagnostic
301 university (x #)
1,217 industry (x #)
11 Departmental (x #)

24. Pilot Surveys, Phase I Category Institution Academic Emory Federal CDC
NIH/FDA
Hospital
Industry
Am. Home Products
Private
State & Local
Arizona

25. Phase I: Lessons Learned
Cooperation good in all sectors
Customized survey instruments/materials work best
Greatest challenge is identifying effective communication channels

26. Roles of Inter-Departmental Working Group
Solidarity-work out issues in advance
Advocacy-communicating with constituents
Advisory-developing survey strategies for in-house labs
Regulatory-modifying test requirements
Participatory-joining in pilot surveys, phase II

27. Pilot Surveys, Phase II Anticipated to begin May 2002
Departments with labs under jurisdiction invited to participate
PLCP will provide all customized survey materials
Look forward to working with you