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Inter-Departmental Working Group 03-07-02
• Polio eradication progress
• Poliovirus laboratory containment
• Roles Working Group
The Global Polio Eradication Initiative
• 1980: WHA declared smallpox eradicated
• 1988: WHA resolved to eradicate polio• Eradication strategy is targeted mass
OPV immunization with intense virus surveillance
• Polio eradication is the largest global public health initiative ever undertaken
1988
350 000 cases
Pre-‘Acceleration’ Progress
1999
7 094 cases
Polio Eradication
Intensity of indigenous wild poliovirus transmission in 2001 (11 Countries)
Year 2000 (20 countries)
as of 18 December 2001
Zero wild viruses
1 to 4 wild viruses
5 to 20 wild viruses
More than 20 wild viruses
Importations
Under investigation
1 934 viruses
1 126 viruses
196 viruses
1998
1999
2000
Acceleration ImpactIndia as of 30 Nov 2000
Polio Eradication
196 viruses
2000
Americas RegionLuis Fermin TenorioPeru 1991
European RegionMelik MinasTurkey 1998
Western Pacific Region
Mum ChantyCambodia 1997
Polio ‘Last Cases’
Polio Eradication
Type 2 polio was last found in October 1999
Polio Eradication
Global eradication of all 3 poliovirus types anticipated
by 2005
Laboratory Containment The other half of poliomyelitis eradication
Certification of Poliomyelitis eradication requires:
Finding and controlling wild
poliovirus in human populations
+
Finding and controlling wild
poliovirus in laboratories
Wild poliovirus may be reintroduced from the laboratory:
• In theory, by contaminated clothing, liquid effluents, air exhaust, or improper virus disposal
• In fact, by an infected laboratory worker, who may go unrecognized
Containment
Essential laboratory facilities and biosafety practices to minimize the risks of infection to the worker and the community.
Containment
• Con: Polio will never be eradicated• Pro: Progress thus far indicates polio can
be eradicated
• Con: If polio is eradicated, the risk of reintroducing polio from lab is either small or large
• Pro: Risk of reintroducing polio from the lab grows with time after eradication
Containment
• Con: Immunization will never stop• Pro: OPV (live) immunization at some
point must stop
• Con: Absolute containment can never be ensured
• Pro: Effective containment can be achieved
Poliovirus and smallpox virus containment strategies differ
• Poliovirus task is much larger in numbers of labs and types of infectious materials
• For smallpox, focus was on destruction and global consolidation
• For polio, focus is on destruction and appropriate laboratory containment
WHO Global Action Plan: 3 steps to containment
• Pre eradication: Laboratory survey/clean up and inventory
• Post eradication: Implement required laboratory biosafety levels
• Post immunization: Maximum containment strategy depends on immunization strategy
All post eradication immunization scenarios assume:
• global surveillance
• adequate vaccine stockpiles
• emergency response plans
Purpose of the survey
• Alert labs to impending eradication
• Encourage disposition of unneeded wild poliovirus materials
• Establish a National Inventory of laboratories retaining such materials
Purpose of the National Inventory
• Maintain a current list of laboratories with wild polioviruses
• Keep laboratories informed of biosafety developments
• Notify laboratories when polio has been eradicated and need to implement containment requirements
Countries initiating laboratory surveys
AMERICAS REGION:
12 / 48
AFRICAN REGION: To start planning 2002 EASTERN MEDITERREAN REGION:
19 / 23
WESTERN PACIFIC REGION: 36 / 36
EUROPEAN REGION: 48 / 51
SOUTH EAST ASIA REGION: 7 / 10
“The United States is fully committed …..to the containment of any laboratory material that may harbor specimens of wild poliovirus.”
Tommy G Thompson, Secretary HHS
to
George Alleyne, Director, WHO,AMRO June 2001
Timeline for US National Survey and Inventory
O N D J F M A M J J A S O N D J F M A M J J A S
Enlist support
Implement pilot survey - Phase I
Implement pilot survey - Phase II
Implement National Survey
Compile inventory
Prepare for post-eradication
Months
Year 1 Year 2
US Biomedical Laboratory Database
• 10,859 diagnostic
• 301 university (x #)
• 1,217 industry (x #)
• 11 Departmental (x #)
Pilot Surveys, Phase I
Category Institution
Academic Emory
Federal CDC
NIH/FDA
Hospital
Industry Am. Home Products
Private
State & Local Arizona
Phase I: Lessons Learned
• Cooperation good in all sectors
• Customized survey instruments/materials work best
• Greatest challenge is identifying effective communication channels
Roles of Inter-Departmental Working Group
• Solidarity-work out issues in advance• Advocacy-communicating with
constituents • Advisory-developing survey strategies
for in-house labs• Regulatory-modifying test requirements• Participatory-joining in pilot surveys,
phase II
Pilot Surveys, Phase II
• Anticipated to begin May 2002
• Departments with labs under jurisdiction invited to participate
• PLCP will provide all customized survey materials
• Look forward to working with you