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

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

Pre-‘Acceleration’ Progress 1988 350 000 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

Intensity of indigenous wild poliovirus transmission in 2001 (11 Countries) Year 2000 (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

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

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

Type 2 polio was last found in October 1999 Polio Eradication

Global eradication of all 3 poliovirus types anticipated by 2005

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.

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

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

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

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

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

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

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

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

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

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

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

Timeline for US National Survey and Inventory

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

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

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

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

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