SEA/RC61/18 - Follow-up action on selected resolutions/ decisions of the last three years: challenges in polio eradication

Abstract

Despite major challenges, the polio eradication efforts in India successfully eliminated subtype P1 polio cases from western Uttar Pradesh (‎UP)‎. Furthermore, the lowest number of P1 cases were recorded due to sustained efforts with the use of mOPV1 in successive rounds of supplemental immunization in the two endemic states, i.e Bihar and UP. However, this strategy also led to lowering of population immunity in UP and Bihar against the type 3 poliovirus that had led to a P3 outbreak in 2007. Fortunately, with the aggressive use of monovalent type 3 vaccine (‎mOPV3)‎ in the last few months of 2007 and in early 2008, the outbreak was brought under control. Intensified efforts are under way to achieve the goal of sequential elimination of subtype P1 poliovirus in 2008, and P3 in 2009. However, appropriate rounds with sufficient size for mop-ups are essential to keep the pressure on the virus in India, particularly in UP and Bihar. In all countries, efforts to sustain high-level acute flaccid paralysis (‎AFP)‎ surveillance are crucial to ensure timely detection of any case of polio and for appropriate response when a case, either indigenous or imported, is detected. Also, to sustain the gains of polio eradication, it is critical that countries achieve and sustain high routine coverage for all antigens, particularly against poliomyelitis. This paper was discussed at the Meeting of the Advisory Committee (‎ACM)‎ held in SEARO, New Delhi from 30 June to 3 July 2008. The ACM made the following recommendations: Action by Member States (‎1)‎ Scale up the routine OPV coverage in countries where OPV3 coverage is still less than 80%; and (‎2)‎ High quality surveillance for AFP should be maintained, including in countries that are polio-free. Action by WHO/SEARO (‎1)‎ Enhance support to Member States to eradicate poliomyelitis where it is still endemic, and to sustain polio-free status in countries that have already eradicated polio; and (‎2)‎ Provide technical guidance to Member States on OPV cessation and future options to maintain population immunity against polio including the possibility of IPV use and its cost implications for national programmes. The paper is now submitted to the Sixty-first Session of the Regional Committee for its consideration.