Circulatia Viruslui Polio in Contextul International Actual-30.05.2014

5/22/2018 Circulatia Viruslui Polio in Contextul International Actual-30.05.2014

1/22

Circulatia viruslui polio in contextulinternational actual

Urgenta de sanatate publica internationala

INSPCNSCBT

30 Mai 2014


2/22

Fresca din piramideleegiptene 1580 - 1350I.C.

Un virus destept

care a

supravietuit mii de ani sia facut milioane de

victime


3/22

Initiativa de eradicare a poliomielitei - 1988

- 1000 cazuri de polio/zi in lumea intreaga

S-au stabilit:- sisteme de supraveghere a PAF

- programe nationale de vaccinare inclusiv organizarea de zile nationale de

vaccinare in lumea intreaga

- Dezvoltarea si capacitarea laboratoarelor nationale si regionale pentru

izolarea si tipizarea virusului polio

Rezultate:

- In anul 1991ultimul caz de polio in Regiunea Americana a OMS iar in

1994 continentul a fost certificat polio free

- in 1997ultimul caz de polio in Regiunea OMS a Pacificului de Vest si

certificat polio free in 2000 (au fost vaccinati cu OPV peste 550 milionae decopii)


4/22

In 1998ultimul caz de polio in Turcia

In 2002Regiunea OMS Europa este declarata polio free

In 2003campaniile de vaccinare sunt oprite in Nigeria datoritazvonurilor privind siguranta vaccinului (sterlizare a copiilor)

cazuri polio India20022003nr. doze de vaccin

In 2005vaccinul monovalent VPO pentru campanii suplimentare de

vaccinare (VP1cel mai virulent dintre cele 3 tipuri de virus polio)

20064 tari endemice: Afganistan, India, Nigeria si Pakistan si MARE

EPIDEMIE de polio in Yemen si Indonezia

in 2007 cu ocazia Zilei Internationale a Pacii peste 80000 de copii sunt

vaccinati in zone inaccesibile din Afganistan

In 2008o noua epidemie in partea de vest a Nigeriei

In 2009se lanseaza vaccinul bivalent pentru a vaccina copii in Afganistan


5/22

19882009 (21 ani)

1000 cazuri pe zi - mai putin de 2000 cazuri pe tot anul 2009- 2010 in regiunea OMS Europamarea epidemie de polio din Tajikistan

cu peste 460 cazuri de polio confirmate cu laboratorul (plus altele

compatibile) cu virus importat din Afganistan si apoi transmis local

- cu eforturi sustinute prin campanii de vaccinare si supraveghere a

cazurilor de PAF OMS se pragateste sa recertifice Europa polio free

- 27 Martie 2014India a fost declaratapoliofree dupa zeci de ani de

lupta cu virusul polio .


6/22

Zonele de conflictmediu prielnic pentru reintroducerea in circulatie a

virusului polio salbatic si aparitia epidemiilor de polio

- sistemele de sanatate afectate

- programele nationale de vaccinare compromise- deplasari masive de populatii din zonele de conflict in tarile

invecinate

ISRAELizolarea virusului polio salbatic in apa uzata din zonele arabe (luna

februarie 2013 si pana in prezent)

- virusul P1 izolat cu aceeasi structura ca cel izolat in Egipt (importatdin Afganistan) si introdus odata cu deplasarea refugiatilor ca urmare a

conflictului din Egipt

- MASURAvaccinare cu OPV bivalent a tuturor copiilor in varsta

de pana la 14 ani


7/22

1stbOPV campaign 2ndbOPV

Poliovirus detection and interuption

Israel environmental sampling

WHO source


8/22

Siriaconflict armat din 2012

- Epidemie de poliomielita cu virus P1confirmate cu laboratorul 26 cazuri

in 2013urmata de organizarea de vaccinari suplimentare

- Ca urmare a conflictului armatnumar mari de refugiati si azilanti in

Turcia si Bulgaria

- Turcia numar refugiati oficial 1.000.000 plus mai mult de 500.000

neoficial

- masuraorganizarea de zile nationale de vaccinare si intarirea

supravegherii cazurilor de PAF

- Bulgariase confrunta cu 8.000 refugiati legali din care 60-65%

sunt din Siria

- Izolare de virus vaccinal la 3 copii refugiati sirieni

- Intariea sistemului de supraveghere


9/22

Risk of an outbreak following importation of wPV

Georgia

Ukraine

Romania

Bosnia andHerzegovina

Risk of transmission

Low

Intermediate

High

http://www.euro.who.int/en/what-we-do/health-

topics/communicable-diseases/poliomyelitis/activities/polio-

certification-activities/european-regional-commission-for-the-

certification-of-poliomyelitis-eradication
http://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradicationhttp://www.euro.who.int/en/what-we-do/health-topics/communicable-diseases/poliomyelitis/activities/polio-certification-activities/european-regional-commission-for-the-certification-of-poliomyelitis-eradication


10/22

ROMANIA - masuri de protectie

- Acoperire vaccinala de cel putin 90% si cu minim 3 doze de VPI pana lavarsta de 1 an

- Supraveghere de calitate a cazurilor de PAF pentru a fi capabili sa

detectam rapid orice circulatie de virus polio si sa implementam un plan

de izolare a infectiei

- Supravegherea apei uzate (apa de canal) de la statia de epurare a apei

uzata de la Glina a pus in evidenta circulatia virusului Coxackie B din luna

octombrie 2013 pana in luna februarie 2014


11/22

5 Mai 2014 - OMS a decretat raspandirea

virusului polio salbatic urgenta de

sanatate publica de importanta

internationala (USPII)


12/22

Wild Poliovirus Cases by Type 2013 & 2014 - Year to Date Comparison

Data in WHO HQ as of 20 May 2014

W1 W3 W1 W3 2014 W3

Pakistan 93 0 8 0 66 0 01-May-14

Nigeria 53 0 22 0 3 0 19-Apr-14

Afghanistan 14 0 2 0 4 0 06-Apr-14

Total 160 0 32 0 73 0

Equatorial Guinea 0 0 0 0 3 0 19-Mar-14

Iraq 0 0 0 0 1 0 10-Feb-14

Cameroon 4 0 0 0 3 0 31-Jan-14

Syria 35 0 0 0 1 0 21-Jan-14

Ethiopia 9 0 0 0 1 0 05-Jan-14

Somalia 194 0 1 0 0 0 20-Dec-13

Kenya 14 0 1 0 0 0 14-Jul-13

Total 256 0 2 0 9 0Global total 416 0 34 0 82 01Data as of 21 May 2013 for 2013 data and 20 May 2014 for 2014 data.

Outbreak

Country

classification

Total 2013 Date of most

recent case2013 2014

01 January - 20 May1

Endemic


13/22

OMS si ECDCultimele recomandari in urma analizei de risc pentru

importarea si raspndire virusului salbatic polio in UE/EEC din

Afganistan, Pakistan, Siria, Israel, Irak, Camerun, Guineea Ecuatoriala,

Somalia, Nigeria, Etiopia,

- Circulatia virusului salbatic in Israel si Siria reprezinta un mare risc de re-

introducere a virusului polio in UE/EEC (Regiunea Euro OMS)

- Virusul a fost exportat din Camerun, Pakistan si Siria cu ajutorulADULTILOR (calatori)

- Informare populatiei asupra riscului de import/raspandire a virusului

salbatic polio

- RISCUL de aparitie a epidemieiin clusterele de copii nevaccinati sausuboptimal vaccinati


14/22

Evaluarea riscului in functie de tipul de vaccin folosit:

RISC MICpentru tarile care vaccineaza cu VPO (mic pentru infectie si boala)

RISC MODERATpentru tarile care folosesc VPI (moderat pentru infectie/portaj si

mic pentru boala)

RISC RIDICATin grupurile nevaccinate (pentru infectie si boala)

CRUCIALacoperire vaccinala de minim 95%

Posibil ca unele tari sa introduca vaccinarea obligatorie (in prezent

Arabia Saudita si India au aceasta cerinta) !!!!!!


15/22

Grupul de experti din tarile care primesc multi refugiati - ADVISORY FORUM

(Finlanda, Franta, Germania, Norvegia, Spania, Suedia si UK)

- Siria are probleme cu vaccinarea de rutina din 2011toti copii sub 5 ani

trebuie vaccinati- Personalul din centrele de refugiati/azilantitrebuie vaccinati

- Nu se introduce screening-ul pentru statutul vaccinal (masura necesita

resurse umane suplimentare) !!!!

INTREBAREA FARA RASPUNS (INCA) din partea grupului de experti .

- administrarea de VPO sau VPI ????????

- Administrarea de VPI - dar daca copilul este in perioada de incubatie ?????

- Administrarea simultana de VPO si alte vaccinuri injectabile posibila


16/22

ROMANIA

- Informarea MS, MAE,MAI, MAPN, MT, CRSP, DSPJ

- Informarea calatorilor in tarile listate de OMS (prin site-ul CNSCBT sicabinetele internationale de vaccinare) despre obligativitatea vaccinarii cu o

doza de VPI cu cel putin 4 saptamani inaintea calatoriei in tarile cu circulatia

de virus polio salbatic

- Inscrierea vaccinarii pe formatul standard OMS din IHR 2005 si va insoti

documentele de calatorie (exista riscul de vaccinare cu OPV in tarilerespective)

- Identificarea comunitatilor la risc cu acoperire vaccinala suboptimala si care

traiesc in conditii igienice precare

- Inventarierea dozelor de VPI disponibile177.000 (la nivel national)


17/22

PLAN DE MASURI PENTRU URMATOARELE 6 LUNI (IUNIENOIEMBRIE 2014)

- Vaccinarea copiilor de pana la 5 ani care nu au cel putin 3 doze de VPI

- Se face o prioritizare a localitatilor/grupurilor la risc in functie de dozele de

VPI din stoc

- Adresa la MS pentru dozele suplimentare de VPI pentru recuperarea

copiilor astfel incat sa avem un confort de cel putin 95% acoperire

vaccinala

- Mobilizarea mediatorilor sanitari si a liderilor romi pentru accesul incomunitate

- Intensificarea supravegherii cazurilor de PAF cu raportare imediata a

cazurilor la CNSCBT si investigarea materiilor fecale conform metodologiei


18/22

- Esantioanele de materii fecale se trimit la INDCMI Cantacuzino imediat dupa

recoltarea celei de a 2a probe fie ca sunt sau nu prelucrate conformmetodologiei de recoltare - folosirea postei rapide

- Materiile fecale NU SE TIN O SAPTAMANA pana sunt trimise !!!

- Introducerea supravegherii de mediu in apele uzate din judetele

- SatuMare, Maramures, Suceava, Botosani, Constanta si Tulcea (localitatile

se vor stabili de comun acord CNSCBT- DSPJ); probele se trimit la INDCMICantacuzino

- Investigarea focarelor de boala in care se suspecteaza o infectie enterovirala

- Informarea medicilor din judeteindiferent de specilitate (conform planului

trimis catre DSPJ si CRSP)


19/22

Masuri in caz de :

1. Aparitie a unui caz de polio (semnificatiecirculatie intensa de virus polio

salbatic !!!!!!)

- Internare obligatori in spital de B.I. - pana la negativarea materiilor

fecale

- Membrii familiei si a contactilor vor fi supravegheati si le se vor colecta

materiile fecale

- ANCHETA EPIDEMIOLOGICA - DESCOPERIREA SURSEI !!!- Adultii sunt cei care transporta virusul

- Militarimisiuni in tarile mentionate ???

- Turisti ????

- Munca temporara ??????

Acoperirea vaccinala !!!????catch up sau mopping upin functiede rezultate !!!

Supravegherea cazurilor de PAF


20/22

2. Izolarea de virus polio salbatic de la o peroana sanatoasa :

- purtator infectat recent prin calatorie in tarile cu circulatie de virus

polio salbatic

- contact cu o persoana infectata originara sau istorie de calatorie

din/in tarile cu circulatie de virus polio salbatic

-Colectare materii fecale de la copii/contacti apropiati

(casa/gospodarie)

- Supravegherea clinica a contactilor

- Intarirea supavegherii cazurilor de PAF

- Cercetarea acoperirii vaccinalecatch up sau mopping up

VPO SAU VPIse va decide la momentul respectiv

(OMS are o cantitate de VPO de rezerva in caz de necesiate)


21/22

3. Izolarea de virus salbatic polio din ape reziduale - cantitate mare de virus

excretat

- ancheta epidemiologicaidentificarea sursei (azilanti adulti si

copii din tarile cu circulatie de virus polio salbatic, calatori , etc)

- purtator infectat recent prin calatorie in tarile cu circulatie de virus

polio salbatic

- contact cu o persoana infectata originara sau istorie de calatoriedin/in tarile cu circulatie de virus polio salbatic

- cercetarea acoperirii vaccinale

- Intarirea supavegherii cazurilor de PAF

- Cercetarea acoperirii vaccinalecatch up sau mopping upVPO SAU VPIse va decide la momentul respectiv

(OMS are o cantitate de VPO de rezerva in caz de necesitate)


22/22

INGRIJORARE MAJORA

Clinicienii tineri fara experienta vor fi

capabili sa diagnosticheze clinic corect un

caz de polio ????????

Pentru majoritatea POLIO este ISTORIE !!!

Documents

Circulatia Viruslui Polio in Contextul International Actual-30.05.2014