1 / 41

Polio Eradication Initiative Pakistan

Polio Eradication Initiative Pakistan. Meeting of the Independent Monitoring Board for GPEI; 7 th May 2013. Outline. Current Situation Supplementary Immunization Activities Surveillance for Polioviruses. Current Situation. mOPV1. mOPV3. Trivalent. Bivalent.

tobias
Download Presentation

Polio Eradication Initiative Pakistan

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Polio Eradication Initiative Pakistan Meeting of the Independent Monitoring Board for GPEI; 7th May 2013

  2. Outline • Current Situation • Supplementary Immunization Activities • Surveillance for Polioviruses

  3. Current Situation

  4. mOPV1 mOPV3 Trivalent Bivalent Confirmed Polio Cases By Poliovirus Type, 2011-2013* NID SNID Cases (n) 2013 2012 2011 Vaccine Type Months / Years Virus Type NSL3 NSL1 NSL1 & NSL3 * Data source AFP 25/04/2013

  5. Comparison of polio cases by province/region 2011 & 2013* * Data source AFP 25/04/2013

  6. Polio cases 2012 – 2013* 2012 2013 cVDPV cases (2) cVDPV cases (16) Last WPV3 case: 18th April 2012 Last WPV3 positive Env. Sample: 7th Oct. 2010 Provincial Boundary Districts Boundary Cases randomly placed in districts * Data source AFP 03/04/2013

  7. Environmental Surveillance, Pakistan Data as of 30-04-2013

  8. Environmental Surveillance by Province Khyber Pakhtunkhwa Balochistan Sindh Punjab Data as of 30-04-2013

  9. Summary Environmental Surveillance- Pakistan SUMMARY Total Sites = 23 Total Samples Collected (2011-2012-2013) = 530 Total Samples with results available = 513 Total samples positive for Wild PV (2011-2012-2013) =237 (136+88+13)(WPV1= 237) Wild poliovirus type 1 (WPV1) Wild poliovirus type 3 (WPV3) Mixture WPV1 & WPV3 No WPV Isolated Under process Scheduled sampling, sample not collected X No sampling scheduled

  10. The Last Low Season ? • Program was set to fully utilize the low season • Consultative Workshop (Nov. 2012) - Gov/WHO/UNICEF with focus on reservoirs (Op/Com action plan) • Revision of NEAP for 2013 • Technical Expert Group Consultation (Dec. 2012) to review the NEAP 2013 • Closer collaboration with the Military on FATA • Prime Minster’s Task Force Meeting (Dec. 2012) • Plans was seriously hampered by security situation • “New Reality” emerged • Security of front-line workers became paramount • The program put under serious & unprecedented threat

  11. Headlines Dec 18, 2012

  12. Security Situational Analysis • Attacks on Polio workers continue • 16 Killed since Jul. 2012 (14 since Dec. 2012) • 11 polio workers and 3 escorting security personnel • Series of threats to polio workers • Written and verbal by unknown elements • Teams chased in the field • Government’s investigations inconclusive so far • No one claimed responsibility

  13. Steps Taken • Ensuring safety of polio workers • Emergency Op. Guidelines developed • Security component included in all micro-plans; with op. & comm. plans • Prov. Security Coordination Committees established (Chaired by Home Secretary) • DCs/DCOs were tasked in assessing security situation and provide necessary protection • DPEC and UPEC to include active participation of Law Enforcement Agencies • Continue the campaigns with mitigation of security threats • Partners support continues in SIAs monitoring & UC level support for HR UCs

  14. Operating in Insecure Environment

  15. Supplementary Immunization Activities (SIAs)

  16. Prioritization of districts for low season SIAs (revised as of 30th Apr.)(Feb – Apr 2013) Priority 1: Reservoirs/Core endemic areas: Central Khyber Pakhtunkhwa, FATA, High Risk Towns of Karachi, Quetta Block, Demographically Linked areas with the Reservoirs Priority 2: High Risk Districts Other than the Reservoirs: Parts of Northern Sindh, Southern Punjab, Southern Khyber Pakhtunkhwa * * Priority 3: Other High Risk Areas: Infected Areas during last six months (outside reservoir and High Risk Belt) * * Rest of the Country * * * * Partial (high Risk Populations / areas)

  17. SIAs: Jan to Apr 2013 Jan 28-30SNIDs(35% of the target) Feb 18-20SNIDs(48% of the target) Jan 14-16SNIDs(38% of the target) Mar 4-6SNIDs(30% of the target) * * * * * Apr 15-17NIDs Apr 5-7SIAs(7% of the target) Mar 25-27SIAs(23% of the target) Priority3 Priority4 Priority1 Priority2 * Partial (high Risk Populations / areas)

  18. Trend of children reached in Priority1 areas SIAs Dec 2012 – Mar 2013

  19. Children reached Dec 2012 - Mar 2013 in Priority1 KP Sindh % children reached % children reached Balochistan FATA % children reached % children reached Dec SIAs (2nd round) Feb Dec SNIDs (1st round) Mar (1st round) Mar (2nd round) Jan (1st round) Jan (2nd round)

  20. Number of SIAs conducted in 2013 (1st Jan to 31st Mar) Priority-1 Priority-2 Priority-3 Priority-4 NIDs in April except north & south Waziristan and Gaddap Town

  21. No. of SIAs by Quarter – FATAJan 2012 – Mar 2013

  22. LQAS Results of Priority-1 Districts *LQAS could not be conducted in Karachi since December, 2012 <80% 80% - 89% >90%

  23. Multi-district Case Response Activities in 2013 Mardan* polio case (Target: 1.7 million children in 4 districts) Round1: 25-27 FebRound2: 11-13 MarRound3: 25-27 Mar Round4: 5-7 AprRound5: 15-17 Apr *Mardan is part of the central KP reservoir targeted with intensified SIA strategy Malakand polio case (Target: 1.5 million children in 6 districts)Round1: 11-13 MarRound2: 18-20 MarRound3: 25-27 Mar Mianwali polio case (Target: 0.6 million children in 5 districts)Round1: 11-13 MarRound2: 18-20 MarRound3: 25-27 Mar Bannu polio case (Target: 0.7 million children in 6 districts and 2 FRs)Round1: 18-20 FebRound2: 4-6 MarRound3: 11-13 Mar Jaffarabad VDPVcase (Target: 0.7 million children in 4 districts)Round1: 11-13 MarRound2: 18-20 MarRound3: 1-3 Apr Bin Qasim polio case(Target: 44,000 children in 1 town)Round1: 11-13 FebRound2: 20-22 MarRound3: Could not be conducted Dadu polio case (Target: 1.7 million children in 7 districts)Round1: 15-17 AprilRound2: 29 April – 1 MayRound3: 15-17 May * District with WPV and VDPV

  24. Recorded Missed Children* Due to Refusals *Remaining at the end of SIAs

  25. Major Obstacle: Peshawar in Khyber Pakhtunkhwa • Continued inconsistent performance in some HR areas • Insecurity and targeted attacks • Management issues • Pockets of refusals

  26. Risks: Hyderabad, Gaddap, Quetta Block • Hyderabad • Inconsistent performance due to weak management & oversight • Some improvement recently • Intensified SIA strategy in Hyderabad division • Gaddap • Continued insecurity, targeted attacks & threats • DCs providing leadership • security forces onboard • Quetta Block • Ongoing management issues; including problems with DDM • Continued inconsistent performance

  27. Routine Vaccination status€ of Non polio AFP cases aged 06-23 months 2011 to 2013* Target 0 DOSE 1 DOSE 2 DOSES 3 DOSES Punjab Sindh KP FATA Balochistan AJK/ISB/GB Pakistan ^ Including AFP Cases pending for classification €As per recall of parents *Source AFP.rec: Data as of 25-04-2013 € As per recall of parents

  28. Summary – SIAs • The momentum in 2012 is seriously shaken by targeted attacks on polio workers • SIAs missed in critical areas • Quality of implemented SIAs not consistent in priority-1 areas • Courageous stance by the Govt. partners and frontline workers – to continue SIAs • Missed children tracking also hampered due to insecurity • Pockets of refusals in KP and Balochistan • North & South Waziristan remain un-reached

  29. Way Forward – SIAs • Safety of polio workers – highest priority • Enhanced and Systematic implementation missed children tracking mechanisms • Improving communication strategies to mitigate the “new reality” • Bridging between PEI & RI for synergy • Strengthening civil-military partnership to reach the un-reached

  30. Surveillance for Polioviruses

  31. AFP Cases reporting by Month, 2009-2013* Cases (n) 2013 2009 2010 2011 2012 @ Non-polio AFP rate of 2/100,000 children < 15 years *Afp.rec Data as of 25-04-2013

  32. Key Surveillance Indicators; 2011-2013* Non Polio AFP rate Up to Week No. 16 ended on 20 h April, 2013 Target * Afp.rec Data as of 25-04-2013

  33. Non Polio AFP Rate By Province/Regions, 2011-2013* Non Polio AFP rate Up to Week No.14 ended on 06h April, 2013 Target Non-Polio AFP Rate 2/ 100000 < 15 years of the age Percent AFP Cases with Adequate Specimens By Province/Regions, 2011-2013* * Data source AFP 11/04/2013

  34. 0% - 59 % 60% - 79% ≥ 80 % No AFP Case reported Non-Polio AFP Rate by District 2013* Percent AFP Cases with Adequate Specimens, By District – 2013* Population density 0.00 - 0.99 1 – 1.99 ≥ 2 Non Polio AFP rate Up to Week No.14 ended on 06h April, 2013 2000 children under 15 years of age * Data source AFP 11/04/2013

  35. Long Chain (orphan) WPV Isolates (AFP & Environment) 2009-2013** 2009 (28) 2010 (24) 2011 (15) 2012 (10) **Data Source Afp/Afp Lab: 25-04-2013

  36. Environmental Surveillance Network • 23 collection sites in 11 large cities/towns • Most extensive globally • Covers all the provincial capitals and regional hubs • Sampling sites selected strategically, biased to towards detecting polio viruses One site

  37. Possible Reasons for decline in AFP reporting • Intensified SIAs in 2012 & 2013 • Frequency and quality of active surveillance • Overall monitoring of the surveillance • Inadequate Contribution of Health Department (ownership) • District surveillance Coordinators not fully functional • More dependence on partners • Security situation in FATA

  38. Way Forward – Surveillance (1) • NEAP addendum on AFP Surveillance • Defining indicators and performance tracking mechanisms • Desk review of district and sub-district level performance • Review, appropriating and prioritization of the surveillance network • Training of the Government and WHO Surveillance Staff • Orientation of Healthcare Providers including informal ones and faith healers • Engagement of medical and pediatric associations

  39. Way Forward – Surveillance (2) • Further Expansion in environmental surveillance • Innovative approaches: • Community based surveillance initiative • Strengthening active AFP search during SIAs • Incentives for reporting in selective areas • Utilizing technology like text messages (sms) improving the reporting timeliness

  40. Summary – Surveillance • There is an overall drop in the number of reported AFP cases • Key indicators remain above the global standards • AFP surveillance is complimented by an extensive environmental surveillance network • Long chain (orphan) viruses have decreased over the years indicating functional surveillance for polioviruses

  41. More than ever Thank you!

More Related