Completing Polio Eradication in Bihar 24 th January

Risk factors for transmission of WPV (population density, diarrhea, low routine OPV3 coverage) High force of infection Sub-optimal vaccine efficacy due to these factors Source : N Grasley et al, Imperial College, London Due to various factors, western UP and north central Bihar are at highest risk for Polio transmission. Therefore, Are most challenging for Polio Eradication

Virologic evidence: elimination of all but 1 genetic lineage of type 1 poliovirus Grey 1 Grey 2 Grey 3 Black 1 Black 2 Pink 1 Yellow 2 Yellow 3 Yellow 4 Grey 1 Grey 2 Grey 3 Black 1 Pink 1 Yellow 2 Yellow Grey 1 Grey Pink Pink * *as of 22 nd Jun, 2009 In past 3 years, 8 of 9 P1 sub types have been eradicated. Only one sub type is in circulation now.

Polio Update

Location of poliovirus by type, 2009* Most recent virus 31 December 09 Bareilly, UP ** One case reported mixture of P1 wild & P3 wild

WPV Type-1 & Type-3 :

Prioritization in Bihar (Done in 2007) Focus Districts High Priority Persistent Transmission Blocks High Risk Blocks Additional High Risk Blocks

Prioritization in Bihar WPV P of 38 P1 cases in PT Blocks 7 of 13 in inside embankment 30 of 38 P1 cases in pre identified HR Blocks Persistent Transmission Blocks High Risk Blocks Additional High Risk Blocks P1 mostly limited to pre-identified HR Blocks of 6 Districts. Sharp decline in number of P1 in last quarter with NO P1 from more than 2 months

Persistence of Type 1 polio in Bihar – Kosi River flood plain, Bihar, India Type 1 Polio – 2008 Type 1 Polio – 2007 Type 1 Polio – 2009 KOSI: Persistence & Spread of P1 Responsible for persistence of virus over the years And is Focus of intervention along with other HR Blocks

Most difficult access compromised areas. Often flooded. Poor Infrastructure. Change in topography. Very high concentration of under served population. R.I. – Very low in this region. KOSI riverine areas Compromised access around the kosi river poses unique challenges for programme planning, implementation & monitoring

Access Compromised Areas ACA : 16 % of Bihar Major continuous area - In and around Kosi river and its tributaries Inaccessible area: km wide by 125 km long= 3000 sq. km covers parts of 10 districts Flooded for more than 6 months in a year movement is only by motorbike/boat / horse

WPV P3: Status Complete Round 2009 Mix Round (mOPV3) Mix Round (tOPV & mOPV1) (mOPV3 & mOPV1) 88 Blk Partial 433 Blk mOPV1 -88 mOPV Blk 561 Blk mOPV1 – 58 mOPV Partial Round Mix Round (bOPV, tOPV & mOPV1) Total : 459 Total : 230 (District : 33) (District : 30) Total : 79 (District : 11) Total : 3 (District : 1) P3 cases have declined sharply from 233 in 2008 to 79 in Remaining focus is limited to area with lesser P3 antigen. bOPV in NIDs in same areas to tackle the problem

Summary Number of families of P1 reduced to 1 in 2009 from 9 in Total WPV cases in Bihar in 2009 is down to 117 from 233 in 2008 and 503 in Although there was resurgence in P1 cases in 2009, but it was: –Limited geographically to small area. –Most of cases in pre-identified HR Blocks specially around KOSI. There is sharp decline in P1 cases and no P1 since October’09. P3 cases have reduced to 77 in 2009 from 230 in –Most of cases limited to the areas with lesser P3 antigen opportunity. bOPV in NIDs in Bihar in these areas: –Will hit hard on P3 transmission. –Without taking off pressure from P1.

Intensified efforts

Operations… KOSI: –Satellite offices in inside KOSI embankment –Increased presence of Medical Officers, UNICEF and WHO. –State monitors being sent to KOSI area in every round –Rotary support –Intensified monitoring: Each team –CMCs in KOSI HR Blocks: –Intensified operations. –MOs deployed from Non HR blocks to HR blocks –District Health Officials deployed for direct oversight. Strong oversight by highest levels of government.

Satellite Office Stay Point Stay Facilities inside KOSI

Feb-09 Mar-09 5Apr-09 3May-09 24May-09 Jun-09 Aug-09 Sep-09 Oct-09Nov-09 Dec-09 OPV type wise SIA Round in Bihar : 2009 mOPV1 tOPV mOPV3 P1 P3 VDPV Jan-10 bOPV bOPV in High risk zones of Bihar in NIDs To break the transmission of P3 without releasing pressure from P1

More and more BASAs being covered Coverage of BASA increased with BASA Strategy. >1,70,000 BASAs being covered in KOSI riverine areas

Newborns being registered & tracked for 8 doses!!

Nomadic Population coverage

Coverage during floods/ Monsoon

1.2 Communication efforts: Underserved strategy Mothers being convinced regarding Polio in Madhepura Imam Meeting: Madhubani Madarsa Involvement: Supaul

Operations… All newborns being identified and tracked. BASAs: Survey before every round to cover all BASAs. Transit teams: children in movement Migratory families of Nomads, Brick Kilns and construction workers being covered. Repeated efforts to convert X houses.

Efforts… Routine Immunization: –From 11% in 2002 to 56%. –Statewide microplan revision to include all areas. –Focused monitoring of RI including HtH monitoring. Convergence: –Intensification of MC Health, nutrition, water and sanitation efforts in KOSI area.

Summary… P1 circulation in 2009 was in limited geographical area mostly HR blocks and has declined sharply. The intensified efforts in KOSI and HR Blocks along with bOPV/ mOPV1 rounds planned in 2010 present unique opportunity to finish the transmission. P3 in Bihar has declined sharply and use of bOPV in NIDs in concerned area has presented the opportunity to stop transmission without releasing the pressure from P1

Thank You