 |
Last update : 14/7/08
Hyper Link to www.npspindia.org
Introduction
In pursuance of the World Health Assembly 1988, to eradicate polio by year 2000 AD. The Pulse Polio Immunization, in addition to routine polio immunization, was first started in the year 1995. Every child below 3 years of age was given two doses of oral polio drops with one month apart. In order to accelerate pace of polio eradication, the target age was increased to cover children below 5 years of age from 1996.
The modified IPPI (Intensified Pulse Polio Immunization) strategy included vaccination of children through fixed booth approach on first day, followed by extensive house-to-house search of missed children for vaccination. During these years new strategies were introduced to cover endemic states and the results were good. At present mostly the transmission is going in Uttar Pradesh & Bihar. All out efforts are being done to eradicate polio from these high risk areas.
Epidemiology of Poliomyelitis
Infectious Agent
The polioviruses belong to the genus Enterovirus in the family Picornaviridae and comprise three related serotypes: types 1, 2 and 3, all of which can cause paralysis
Occurrence
In 1988, the year of the WHA resolution calling for global polio eradication, wild polio virus was endemic in more than 125 countries on five continents, paralyzing more than 1000 children every day. As of May 2005, poliomyelitis occurs primarily in Africa & South Asia
It is seasonal occurring more commonly in summer and early autumn in temperate climates. In developing countries with low immunization coverage poliomyelitis produces a significant amount of illness, death & disability
Transmission
Transmission is primarily person-to-person vial the fecal-oral route. Poliovirus multiplies in the intestines and spread through the feces. The virus is intermittently excreted for up to 2 months or more after infection, with maximum excretion occurring just before paralysis during the first two weeks (14 days) after onset of paralysis.
Reservoir
Poliovirus is found only in human beings; there is no animal reservoir
Communicability
Poliovirus is highly communicable. The cases are most infectious one week before and 2 weeks after onset of paralysis. An infected individual will probably infect all other persons in a household and close contacts especially were sanitation is poor.
Immunity
All unimmunized persons are susceptible to poliomyelitis. Immunity is obtained through wild virus and / or through immunization. Immunity following natural infection (including in apparent and mild infections) or a completed series of immunization with live oral polio vaccine (OPV) results in both humeral and local intestinal cellular responses. Such immunity persists for many years and can serve to block infection with subsequent wild virus.
Strategies for polio eradication
In May 1998, the World Health Assembly committed the member nations of the World Health Organization (WHO) to achieving the goal of global eradication of poliomyelitis. This goal is defined as:
No cases of clinical poliomyelitis associated with wild polio virus, and
No wild poliovirus found worldwide despite intensive efforts to do.
The following strategies to achieve polio eradication were adopted by the WHO for worldwide implementation in all polio-endemic countries:
Achieving and maintaining high routine coverage in infants younger that 1 year with at least 3 doses of oral polio vaccine (OPV3): Paralytic polio can be caused by any 3 closely-related strains (serotypes) of poliovirus. Trivalent OPV (tOPV) provides immunity against all 3 types. Three routine trivalent OPV should be received by infants at ages 6, 10 and 14 weeks. WHO & UNICEF also recommend that all newborns receive a dose of trivalent OPV at birth (birth dose of OPV)
Administering supplemental doses of OPV to all children aged<5 years during national immunization days to rapidly interrupt transmission: National Immunization Days (NIDs) in which a dose of OPV id administered to all children in the target age group, regardless of previous vaccination history. Subsequent doses are administered in the same way after an interval of 4-6 weeks from the previous round. India the term for NID is Pulse Polio Immunization (PPI). PPI rounds are often planned during the low transmission session when conditions are optimal to .to interrupt the remaining chains of poliovirus transmission. In addition to protecting vaccinated children, massive use of OPV probably also results in secondary spread of shed virus, further amplifying the effect of mass OPV administration and facilitating interruption of wild polio virus transmission.
Surveillance of Acute Flaccid Paralysis cases: This is done to identify all reservoirs of wild polio virus transmission. This includes reporting of ALL AFP cases, investigation them and laboratory resting of all stool specimens collected from such cases for polio viruses in specialized laboratories.
Conduction mop-up vaccination campaigns: When poliovirus transmission has been reduced to well defined and focal geographic areas, intensive house-to-house, child-to-child immunization campaigns are conducted over a period of days to break the final chains of virus transmission.
Polio Vaccine
The live attenuated oral polio vaccine (OPV), which was used in mass campaigns in 1959. In developing countries OPV is the vaccine of choice, not only because of case of administration but also because it simulates natural infection, induces both circulating antibody and intestinal immunity and by secondary spread, probably protects susceptible contacts. OPV is the vaccine recommended for polio eradication
It has been well documented that the use of OPV can successfully interrupt wild poliovirus transmission in both industrialized and developing countries.
Logistics
Cold chain is very important component in the implementation of IPPI campaign. Cold chain equipments and other logistics e.g. Cold boxes, Vaccine Carriers and Ice Packs are available in sufficient number but Walk-in-Freezers (WIFs) and Walk-in-Coolers (WICs) supplied in year 1986 needs replacement and small deep freezer / large deep freezer require for the prepare sufficient ice packs for districts.
AFP Surveillance
The goal of polio eradication is to achieve zero case-status of poliomyelitis associated with the wild polio virus. In year 2001 there was no positive case in state but in year 2002, 21 cases and in year 2003, 11 cases were reported. The last case was from district Sehore and the month of onset was November 2003. Since then Madhya Pradesh has not detected any case inspite of good surveillance and maintaining a free state.
National Polio Surveillance Project (WHO)
The National Polio Surveillance Project is a collaborative project of Govt. of India & the World Health Organization and managed by the latter. Currently a team of more than 250 Surveillance Medical Officer (SMO), Sub-Regional Coordinator (SRC) and Regional Coordinator (RC) are spread across the country who comprise the field staff of project. They are supported by a network of 09 Polio National Laboratories, which undertake the Virological Investigation of AFP (Acute Flaccid Paralysis) cases. The central headquarter unit of the project – The National Polio Surveillance Unit (NPSU) provides logistical & technical backup to the field staff.
In October 1997, active surveillance of Acute Flaccid Paralysis was established to meet the demands of Polio Eradication. SMOs with Government counterparts established Reporting Units for reporting of occurrence of AFP cases to the District, State & National levels Timely Case Investigation & collection of stool specimen form AFP cases and its shipment to laboratories. AFP Surveillance at the local level is institution based through a comprehensive network of reporting sites which includes health facility reporting units & informers. As of 2005 approximately 9500 reporting units & approximately 12,300 informer units have been enrolled under the AFP surveillance network throughout the country. By ensuring reporting of all AFP cases from the above sources, the DIO/SMO aims to capture all AFP cases occurring in his area.
SMOs Network
In Madhya Pradesh there are total 15 SMOs including SRC & State SMO at Bhopal. SMOs are providing extensive training to government counterparts, helping in planning for Supplementary Immunization Activities (SIAs) and maintaining AFP surveillance at highest level.
Sr
No.
Name and address
District covered
Telephone
Fax
Mobile
1
Dr. Ravindra Banpel
2nd floor,Health Section
Directorate of Health Services
West Wing,
Satpuda Bhawan, Bhopal
Entire MP
0755 - 2571104, 2577762, 2577768
0755-2571108
98268-08565
2
Dr.O P Tiwari
SMO, NPSP - unit Bhopal
131/13, Andhra Bank Building,
M P Nagar Zone II, Bhopal (MP)
Bhopal, Sehore & Hoshangabad
0755-2761486
0755-2761487
98262-56090
3
Dr. Vinay Kr Bhai
MO, NPSP- unit Shahdol
IPP-6 Training Centre
District Hospital Campus,
Shahdol-484001 -(MP)
Shahdol, Dindori, Umaria and Anooppur
07652-248713
07652-248712
94251-80823
4
Dr. Bhupesh Kori
SMO,NPSP- unit Jabalpur, Ground floor,
Department of Paediatrics, NSCB Medical College,
Jabalpur-482001-(MP)
Jabalpur, Katni, Mandla and Narsinghpur
0761-2370271
0761-2370418
94253-25376
5
Dr.
SMO, NPSP- unit Rewa
3rd floor, PSM department,
S. S. Medical College , Rewa
Rewa ,Satna and Sidhi
07662-255229
07622-255230
6
Dr. Parag Shah
SMO, NPSP- unit Gwalior
Room no.3 ,Department of
Community Medicine,
G R Medical College,
Gwalior-474009 (MP)
Gwalior , Datia and Shivpuri
0751-2338803
0751-2338804
94254-07667
7
Dr.Santosh Shukla
SMO, NPSP-unit Sagar
O/O C.M & H.O.,Danida Building
Room no.7, Tili Hospital, Tili
Sagar-470001
Sagar , Raisen and Damoh
07582-236461
07582-236580
94251-93964
8
Dr. Arun G Katkar
SMO, NPSP-unit Indore
Health & Family Welfare Training Centre,
CRP Lines, Behind M Y Hosp.
Indore-452001 ( MP)
Indore, Ujjain, Shahjapur and Dewas
0731-2528645
0731-2528646
98260-44883
9
Dr. Sandeep Sangle
SMO, NPSP-unit Guna
1st floor, Civil Surgeon Office,
District Hospital Campus
Guna-473001
Guna, Vidisha and Rajgarh and Ashok Nagar
07542-251127
07542-251115
94253-10048
10
Dr. Sushil Wakchaure
SMO , NPSP- unit Balaghat
Old X-Ray room, Near Bus stand,
Balaghat-481001
Balaghat, Seoni and Chindwara
07632-240565
07632-241565
94258-22410
11
Dr. J M Gandhi
SMO, NPSP- unit Chhattarpur
CM & HO Office Opp. Maharaja College,
Chhattarpur-471001
Chhattarpur, Tikamgarh and Panna
07682-244465
07682-244467
98263-23295
12
Dr. V P Vaidya
SMO, NPSP-unit Betul
District Training Centre,
IPP6 Bld, 2nd Floor,
Hospital Campus,
Near Nehru Park Betul
Betul, Harda , Khandwa, and Burhanpur
07141-232414
07141-232413
94253-04214
13
Dr. O P Tiwari
SMO, NPSP-unit Ratlam
Ist floor Bal Chikitsalaya
GPO Road Ratlam-457001
Ratlam, Mandsaur, Neemuch and Jhabua
07412-221960
07412-220859
94253-29190
14
Dr. D G Chavhan
SMO, NPSP- unit Khargone
Ist Floor, Old Eye Ward,
Sanawad Road, Khargon
Barwani, Dhar and Khargone
07282-244008
07282-244009
94253-27058
15
Dr.Anup Gurha
SMO, NPSP- unit Morena
Civil Hospital Campus, Morar,
Gwailor - 474006
Morena, Bhind and Sheopur
0751-2663046
0751-4032124
94253-09029
State Indicator
Comparison in Year (Madhya Pradesh)
Indicator Year
2000 2001 2002 2003 2004 2005 2006 2007 2008* Total AFP Cases
632 383 497 548 772 1141 1397 2145 876 Virus Positive
2 0 21 11 0 0 3 0 0 Compatible
13 13 24 29 25 14 14 10 0 AFP Rate
2.01 1.58 2.02 2.16 2.98 4.3 5.15 7.74 5.83 N.P AFP Rate
1.96 1.53 1.84 2.00 2.88 4.25 4.91 7.70 4.69 Adeq. Stool (%)
86 85 82 78 79 81 76 82 82 * As on 30/06/2008
|
|
|
|
