Dear all I encountered operational challege were during SIA, specifically OBR using mOPV2 antigen. I observed that the fixed post team were given only bOPV which is the right antigen for routine while ignoring the purpose of the campaign (mOPV2 not given). They were intructed to give both mOPV2 and bOPV concurrently in other to ensure children received RI and SIA doses. When we reffered to the stakeholders it was revealed that guideline stipulated that, child should receive only mOPV2 and resheduled for bOPV next contact. i have little imformation that needs clarification from immunzation experts and/or refference materials for capacity building in support of the guideline. 1. What is the possible consequence of given mOPV2 and bOPV at same time? any scientific justification. 2. Weighing the risk of missed oppurtunities and combining both antigens at same, which one should i prioritised? Thanks alot waiting for your input.

Dear esteemed viewers On the eve of Karnataka State Raising day (Kannada Rajyotsva), KVG team wishes to share the attached for caring the children of Karnataka and beyond. India is committed: - baby Rukhsar was the last case of Poliomyelitis due to wild polio virus in Jan 2011, - it got the certification of Polio Eradication in March 2014 for which entire world congratulated the country. Karnataka is even more committed, and had the last case of polio due to wild virus in Nov 2007. Sustenance of Polio free status till Global eradication is also extremely important through attaining and sustaining very high routine immunization coverage - that's the 1st strategy of polio eradication. WHO experts say that as long as a single child remains infected in the world, children in all countries are at risk of contracting polio. Failure to eradicate polio from the last remaining strongholds could result in as many as 200,000 new cases every year within 10 years all over the world.  Legacy: When immunization coverage in Syria with a population of ~18.3 million, dropped from 91% in 2010 to 68% in 2012, amounting to 500,000 susceptible children in absolute numbers in 2013; fresh polio cases occurred inspite of remaining polio free since 1999. Currently, RI coverage of the country and Karnataka is 62 & 63% respectively as per NFHS 2015-16. In Karnataka, the immunization coverage is ranging from as low as ~41% to 77% among 30 districts. Compared to Syria, it is critically low favoring importation of wild polio virus at any time. IPV is in use, but the coverage of which is much lower than OPV; National IPV2 coverage is 54% and 28% for Karnataka as per ITSU dashboard Indicators for the year 2017-18. In 2017, population of India was 1.339 billion and Karnataka was 66.8 millions, 3.65 times larger than Syria. Hence, on war foot we have to raise immunization coverage to >90% and sustain the same forever. In this context, we wish to share what we are doing in our Medical College which can rapidly close population immunity gap, vaccinate close to the schedule and sustain the same forever. I thank Drs Niranjan & Nirajan, Interns posted in the Rural PHC for giving the title “Sharing for Caring”. Wish you happy reading and replication Holla & Team         

WHO has released the updated surveillance standards for more than 20 vaccine-preventable diseases. Each disease is its own self-contained chapter, available in color and in black and white (for ease of printing).  There is also an introductory chapter detailing some of the basics of surveillance.  French and Russian translations will be available in the coming months.  
https://www.technet-21.org/en/library/explore/vaccines-and-delivery-technologies/4942-vaccine-preventable-diseases-surveillance-standards    

 Dear all, India is more committed, last case of WPV1 was in Jan 2011, along with other 10 countries got the certificate of eradication in March 2014. But as long as there is wild virus circulating in any part of the world, threat exists and may revert back to pre-eradication era as opined by the experts in polio. Hence India is conducting 2 rounds of Pulse Polio [NID] on 28 Jan 2018 and 11 March 2018. In Karnataka, the strategy is to administer 2 drops of Oral Polio Vaccine in the booths on day 1 followed by 2 to 3 days of house-to-house activity. In south states, from the beginning booth activity is very strong and ~90% coverage will happen on booth day itself. We expect the same this year also. The credit of eradicating polio is first given to the community, the responsible parents who brought their children to the booths and got vaccinated followed by innumerable PE’s from grass-root level workers, volunteers, NGO’s, Govt and all stakeholders. KVG Medical College, Sullia along with all other educational Institutions, NSS, NCC, Rotary, IMA along with the Govt, conducted 1 Km long rally to infuse jubilance and to create awareness to mobilize the children tomorrow. 10,845 under 5 children are expected to receive OPV tomorrow. The Block Medical Officer, MO’s of the planning units and all of us are confident to achieve ~97% coverage tomorrow itself and the remaining 3% will be covered on 29th and 30th. with regards  

Dear viewers  For some long standing problems, solution can be very siimple - we have to just do it. For saving the children from the lethal Vaccine Preventable Diseases (VPDs), they are to be vaccinated timely, with all the vaccines included in the National Immunization Schedule (NIS) and also optional vaccines applicable to the country. In India, for attaining Full Immunization (FIC), a child has to receive one dose of BCG, 3 doses of DPT (now included in Pentavalent), 3 doses of bOPV other than Zero OPV and one dose of Measles Containing Vaccine (MCV) before the first birth day. For complete immunization, after attaining FIC, child has to receive DPT 1st Booster and OPV between 16-24 months, with which MCV 2 is administered. Since April 2016; two doses of 0.1ml IPV are administered intradermally along with first & third doses of OPV & Pentavalent. JE / Rota and PCV are administered in selected states / districts. As per “PRACTICAL GUIDE FOR THE DESIGN, USE AND PROMOTION OF HOME BASED RECORDS IN IMMUNIZATION PROGRAMMES” by Immunization, Vaccines and Biologicals – (WHO); home-based records (HBR) currently vary in complexity across and sometimes within countries and lack standardization in content. Please find the attachment for the simplest solution. Best  wishes Holla  

As part of the WHO African region efforts to improve immunization and surveillance performances in terms of quality, effectiveness, efficiency, coverage and equity and in order to strengthen the capacity of policy makers and health providers in countries, there is a need for accurate data in order to gauge the effectiveness of existing policies and programs in health care system to make it more accessible and reliable. Guided by the WHO regional office, the IVD cluster of the Inter-country Support Teams for the ESA sub-region (IST/ESA) is supporting the use of innovative technologies within the immunization systems through GIS and mHealth. The rapid proliferation of mHealth projects (mostly pilot efforts), has generated considerable enthusiasm among governments, donors, and implementers of health programs. GIS and mHealth are not a new concept to be adopted and recommended by the WHO or MoHs, and they are among the key technologies that have proven impact on the quality, timeliness, and cost effectiveness of the program activities at all levels reaching up to subnational, health facility, and case-based levels (i.e. for VPD surveillance, AFP environmental surveillance, routine immunization and micro-planning, LQAs, EPI reviews, containment, certification and Monitoring & Evaluation etc.). One of the innovations is the Integrated Supportive Supervision (ISS). The ISS is an Integrated Electronic Checklist used for supervision during Active Case Search and Routine Immunization which is mostly administered by both WHO staff and Government personnel via Smart mobile phones in the field at Health Facilities and Focal Sites. These supportive visits are automatically mapped on the country profile server managed by WHO. Supportive Supervision remains the bedrock for highlighting good surveillance and routine Immunization practices through systematic visits to priority sites for assessment, evaluation and on the job training for health workers and entire health system. As we move towards the last miles of polio eradication, advanced well to eliminate measles in our sub-region, thus to bridge immunity and surveillance gaps, WHO IST/ESA has gone a step further in institutionalizing supportive supervision by encapsulating the activity into mobile format that can be administered using smart phones in order to increases the accuracy and reliability of information collected. Accuracy of data can be enhanced by proper data collection and management, the development, execution and supervision of plans, policies, programs and practices that control, protect, deliver accurate, relevant and up-to-date data in the shortest time. In the use of m-health, data collection and management has become a critical component, which requires portable software, mobile devices and the software that houses the collected information. Open Data Kit (ODK) is a free and open-source set of tools that can help organizations author, field, and manage mobile data collection solutions. In the ESA sub-region, Ethiopia, Tanzania, Madagascar, Zambia, Kenya, Uganda and South Sudan had already adopted the use of this real time mobile assisted supportive supervision with over 1,603 visits to health facilities in three months (August – October, 2017) across different regions and districts. Other countries that adopted the tool and are ready to commence using it includes South Africa, Botswana, Namibia, Malawi, Seychelles, Lesotho, Eritrea, Zimbabwe, Swaziland. The Target is to have all countries under the ESA region to conduct all their supportive supervision using smart phones to foster accountability of WHO and Government staff. It also supports other health interventions outside the EPI programmes and countries are encouraged to take advantage of the opportunity to support other health interventions (e.g. Cholera outbreak). We therefore call to Government EPI managers and surveillance officers to position themselves to embrace and use the new innovations to enable them to attain and sustain immunization and surveillance targets. Contributors as well as members of the editorial board: Dr Ahmed Y, Mr Bello I, Dr Byabamazima C, Mr Chakauya J.M, Dr Daniel, F, Dr Eshetu, M.Shibeshi, ,Dr Lebo E, Mr Katsande R, Ms Machekanyanga ,Mr Masvikeni B, Dr Manyanga D, Dr Mumba,M. Dr Okiror S,Dr Petu A, Dr Umar S and Dr Weldegebrie G.

Dear all  We wish to share the activity held in our college (KVG Medical College & Hospiatal) on 24 October 2017 with the readers.  On 24th October 2017, Rotary - Sullia branch in collaboration with KVG Medical College Hospital & IMA Sullia observed “World Polio Day”. Dr K.V. Chidananda, Medical Director, being a Surgeon is a strong supporter of all National Health Programmes, especially Immunization, Polio Eradication, MR campaigns. Rtn. Dr Sudhakar Bhat, a senior Psychiatrist, highlighted on the dedicated and active involvement of Rotary both globally and locally. Dr Narayana Holla, Assoc Professor from the Department of Community Medicine, highlighted the Past / Present and the anticipated future of polio eradication. The world has reduced the burden of polio from >350000 per year distributed in >125 countries in 1988 to 37 confirmed cases in 2016 globally – that too caused by one type – PW1.  In 2017, till date 12 confirmed cases of PW1 were detected – 7 from Afghanistan and 5 from Pakistan, both are endemic countries, Nigeria being the third – the “PAN” countries. However reducing it to zero and sustaining to eradicate at the earliest is obligatory as 61 cVDPVs were detected in the non-endemic countries. In this regard all PEs (Polio Eradicators) will ‘stop not’ as they have to go only a few “meters” for attaining the global eradication, failing which may result in as many as 200 000 new cases every year, within 10 years, all over the world. with regards Holla and the team

A new release of ICE (v1.8.1.0) is now available. (Download ICE v 1.8.2.0) The release includes the following changes: Updates to the Polio Vaccine Group and the Meningococcal ACWY Vaccine Group to better reflect latest guidelines, and addition of Influenza vaccine (CVX 185) to the Influenza Vaccine Group. Combines PCV and PPSV vaccine groups into one, new vaccine group for Pneumococcal. This change was made to better account for shots administered across the patient's lifetime. (To support this new Pneumococcal vaccine group, implementers may need to make adjustments to stop looking for the old PCV and PPSV vaccine group codes (700 and 720), and start looking for the new vaccine group code (750). Child and adult pneumococcal vaccinations are now evaluated and forecast under this new vaccine group. The PCV and PPSV vaccine groups are no longer supported.) Release notes which describe the above changes to the vaccine group logic in more detail. Implementers should refer to the new ICE Implementation Guide (v2r15) when making adjustments to be compatible with this latest release, including the new Pneumococcal vaccine group as well as a few other vaccine and evaluation reason codes that have been added. (A "track changes" version of the guide is also available to make it easy to see what has changed since the last release.) You can determine which release of ICE you are using by viewing the README.HISTORY file that is included with each distribution. Please feel free to e-mail us at ice@hln.com if you have any questions.

Dear viewers Short supply of vaciines requiring multiple doses is one of the causes of accentuating negeative dropout rate, making the indicator invalid for programme review. India introduced two fractional doses of 0.1mL intra-dermal IPV in the National Immunization Schedule (NIS) since April 2016 as an end game strategy of Polio Eradication. It is supplied as multi dose vial of 50 doses per vial [0.1mL per dose – 5mL vial] & 25 doses [0.1mL per dose – 2.5mL]. From the first experiences of the first 5 vials we learnt that 61.6% doses were sacrificed [154 doses were sacrificed out of 250 doses in 5 vials]. Soon we received 25 doses per vial and the wastage became NIL [0%] in the CHC and Medical College. This month we again got 50 doses per vial. With this, to minimize “sacrificing” of precious vaccine and being supported by the midlevel managers, 3 Aces [ANMs, AWWs and ASHAs] stared mobilizing all those who are below one year and missed IPV due to short supply. With this ‘movement’ of clearing the backlog to close population immunity gap & to make optimum use of the vaccine, we observed that first dose IPV administered along with 3rd dose of OPV and Pentavalent was recorded in the ‘cell’ meant for IPV 2nd dose. This will give an accentuated negative IPV1 & IPV2 dropout. India is unique for unity in diversity. In the past, similar errors occurred when OPV supply was inadequate in 2012 in Jharkhand. Solution: Sustained Supportive Supervision, hands on orientation, learning by doing and working together approach by the supervisors, technical assistants and development partners goes a long way in quality data maintenance and programme implementation. The attached illustration is shared and the viewers may get similar observations in the field.  Regards Holla and the team  

Dear viewers Sharing the following with the viewers who are the true Polio Eradicators / planners / managers / authorized implementers & policy makers of the programme Good intentions alone are not enough for the successful outcome. Intention of healing is always good but it can produce stricture with consequent obstruction and dilatation of proximal part leading to long term complications. Since April 2016, GOI introduced two doses of Inactivated Polio Vaccine as an endgame strategy of Global polio eradication. Routine Immunization is one of the biggest national programmes in operation. Service providers are trained and reoriented on a regular basis in the public sector. In good performing planning units, coverage of any new vaccine will be at par with that of all other antigens. But due to causes and constraints beyond the scope of author to understand, supply of IPV was regularly irregular and inadequate created very low coverage. For the effective impact on the community, ≥85% sustained vaccination coverage is required. What will be the epidemiological impact with coverage as low as 65% of the first dose and 30% of the 2nd dose, with >70% population immunity gap on Polio Eradication is a real concern. This is the true story of one very good performing Planning units; what will be the cumulative effect of ~28,000 Planning Units of India – 2nd most populous country??

A Supplement on EPI in Ethiopia recently published in the Pan African Medical Journal. http://www.panafrican-med-journal.com/content/series/27/2/

HLN has released a new version of its ICE Open Source Immunization Evaluation and Forecasting software (v 1.7.1.0) on February 24, 2017. As always, the most recent version of open source Immunization Calculation Engine (ICE) can be downloaded from the Downloads page on the ICE wiki. This new release of ICE (v 1.7.1.0) has the following new additions & changes: Update to logic that determines when a 5th dose is recommended: (1) removed restriction that patient is born >= 1/1/2006; (2) recommend 5th dose if 4 doses administered before 8/7/2010 (prior logic used 1/1/2010 as this date). Please refer to the ICE Polio rules documentation for additional details. The next two future releases of ICE are expected to include the following updates: Future ICE release v 1.8.1 will include: Updates to combine the PCV vaccine group and the PPSV vaccine group into a single "Pneumococcal" vaccine group. Future ICE release v 1.9.1 will include: Support for Meningococcal B. ICE is a fully Open Source, web-services-based product compliant with US-based ACIP clinical rules. It is fully flexible and could be augmented with other rulesets (like WHO) with appropriate interest, collaboration, and funding. For more information or to join the emerging ICE Open Source Community see the ICE project page or send email to ice@hln.com.

The upcoming supplement "The Future of Immunization in Africa Supplement", guest-editored by Bob Davis (Am Red Cross) , Helen Rees (Wits U) and Steve Cochi (GID, CDC), is still open for submission. The supplement will be published in mid 2017 in the Pan African Medical Journal. Submit your manuscript now for consideration. Follow the link below for more about the supplement http://www.panafrican-med-journal.com/mailalert/MA02122016.htm

The SAGE October 2016 meeting report has been published in the WHO Weekly Epidemiological Record. SAGE reviewed relevant data and evidence, advised and made recommendations on various complex and critical issues including: Global Vaccine Action Plan: 2016 mid-term review of progress and recommendations Maternal and neonatal tetanus elimination (MNTE) and broader tetanus prevention Measles and rubella elimination Hepatitis B vaccination Schedules and strategies for human papillomavirus (HPV) immunization Yellow fever Polio eradication The meeting report can be downloaded at http://apps.who.int/iris/bitstream/10665/251810/1/WER9148.pdf?ua=1

Dear all
I take this opportunity to share the following with the viewers as many of them are in the authorized post who can daringly and decisively "move faster" than the VPDs can kill our children / resurgence of wild virus & or cVDPVs in polio free Country / States as globally witnessed in the past.
India is the 2nd most populous country in the world, inspite of innumerable hurdles it could eradicate polio and got certified by 2014 along with other 10 countries of SEARO buoyed by the milestone success, felicitated by global leaders.
For achieving the goals and objectives of Global Vaccination Action Plan (GVAP) in collaboration with all development partners, for closing the immunization gap by achieving and sustaining more than 90% coverage, Government of India (GoI) launched Intensified of Routine Immunization (IRI) in 201 districts of 14 states but subsequently entire country operated IRI. Of the ~10 strategies, conducting 4 intensified Immunization Weeks (IWs) in 4 consecutive months [4 × 4] was the key strategy. However the grass-root level service providers were not convinced as they were provided with too many forms and formats which amplified their fatigue; could not build their capacity instead it made them dependent on the format providers hence Intensification was short lived and could not make effective impact in improving the coverage even though 4×4 strategy can potentially solve the problem if “tool” was provided in place of “forms and formats” blended with supportive supervision in place of checklist based monitoring (observing / recording / reporting) with minimal or no supportive supervision. Paradoxically; the denominators of the 4 key indicators of MI was not known to the monitors as revealed by the pilot study, shared with Govt. Grass-root level Service providers were not able to comprehend because of multiple directions by supervisors at different level: LHV / RCHO / State Supervisor / Monitor / Consultants. India completed 2 phases of Mission Indradhanush (MI) [200 districts in the first phase, 352 in 2nd phase] since 2015 with the intention of enhancing vaccination coverage from 65% of 2013-14 by 2020 and introduction of IPV in April 2016 is considered as phase 3. In the first phase whole country was buoyed by the “SUCCESS” of MI for vaccinating the children thought to have missed.
Though the causes are too many to list, private sector including private Medical Colleges vaccinating ~25 to 30% of the children are following whimsical schedule. These children will not complete primary vaccination schedule within the first birthday as the earliest opportunity to receive MCV is in 15th month as a component of MMR, OPV starts in 6th month following 3 doses of IPV in some colleges, no birth dose of HepB and the first dose in 7th month, 2nd in 8th month and the 3rd in 13th month. How to administer pentavalent of NIS if these children visit government sector after partial vaccination in private sector is the question from ANMs? FIC is the key indicator in all the surveys.
What the surveys reveal: [I could not get National Fact Sheet of NFHS4/DLHS4]
Survey data is alarming as if the survey is wrong!!


This is further accentuated by the absence of VVM hence the potency of vaccine at the time of administration is not known at the same time opportunity of getting vaccines with known potency from the government is also snatched; as a result and many other causes not listed, all efforts are in vain and the survey data indicates a disastrous fall in coverage.
In 2013, RI coverage dropped to 60% from 90% in Syria and there was outbreak of POLIO after a decade of polio free status. Several such lessons were learnt all over world including the recent outbreaks of Pertussis, Measles in developed countries. Syria has a population of ~18.57 millions and Karnataka has ~66 millions. If the coverage is not dramatically improved through specific / simple / self supporting / capacity building / sustainable tool and approach, history of Syria may repeat and there can be sporadic cases of other VPDs like Diphtheria / Pertussis / Measles, causing delay in achieving State / National & Global goals.
Solution:
1. 1. Providing the simplest all in one; one page tool per session site to the grass-root level workers which can build their capacity, inculcate ownership / custodianship; change work culture, make them self sustained /confident; converting every regular session to Mission Mode for long term sustenance and “TAKE THEM TO GENEVA”.
2. 2. Rapidly roping in the Private Medical Colleges & private vaccination service providers in the mainstream to follow the National Immunization Schedule as IAP India strongly supports NIS and NTAGI.
3. 3. Private Medical Colleges in collaboration with the Govt to establish dedicated vaccination clinic for operating good / right practices as per WHO / GoI guidelines; producing NIS friendly / Nation friendly / children friendly Doctors / Specialists.
4. 4. Administering vaccines with known potency as depicted by the VVM so that the rich children will also get vaccines with known potency & get “immunized” following vaccination.
5. 5. National Immunization Schedule to include MMR / MR at the earliest as the wish list of pediatricians as some of the states are already using.

VACCINATE TO IMMUNIZE

As many of you know, the switch to bOPV has been completed in all 155 countries and territories that were using tOPV. This has been a great achievement that brings us even closer to polio eradication!
Based on the country validation reports that WHO received, approximately 140,000 health facilities were visited by monitors during a period of 2 weeks in April. During the same period, more than 15,000 district, 3500 regional, and 267 national stores were also visited to ensure all tOPV was removed from the cold chain.
Nevertheless, this sampling of cold stores and service points does not represent ALL the facilities in EVERY single country. Additional vigilance should be maintained during the upcoming months to ensure that no tOPV remains in the cold chain with the risk for inadvertent use.
Therefore, we would request that whenever you are on mission in-country, and have the opportunity to visit cold chain stores and/or health facilities, please keep an eye out for any tOPV.
In case you find it, attached is simple guidance on what actions to take. The note may also be found at the following link
http://www.who.int/immunization/diseases/poliomyelitis/endgame_objective2/oral_polio_vaccine/monitoring/en/
How to handle and dispose of tOPV found after 1 May 2016

Dear Colleagues,
A new e-learning course from GPEI is online now at UNICEF/AGORA.
The course is highly recommended to all polio consultants. It will help to build capacity of program managers in handling polio vaccines during supplementary immunization activities (SIA). This dynamic and interactive course builds on the "GPEI/UNICEF Guidance note on Cold Chain Logistics & Vaccine Management during polio SIA" and allows the learner to ‘learn by doing’ through simulated exercises.
On successful completion, learners will be awarded a GPEI certificate. Participants can also download all the resources used in the course for future reference.

Happy e-learning!

Dr. Ahmet Afsar
CCL Specialist, UNICEF/PD/Health (Polio)

Dear viewers
Out of inquisitiveness, we studied the usage of the First IPV vial of 5 facilities and got many things to learn from the service providers of 3 attached planning units, one First Referral Unit and the vaccination clinic of our own College. These lessons are universal and hence can certainly help the policy makers to make necessary revisions / refresh training for the benefit of innocent infants.
Following are the observations:

Average beneficiaries per month for 3 planning units were 11 / 18 & 24; requiring
Actual doses administered were 8; 11; 11 in 3 PHCs; 14 in the tertiary care hospital. 46 doses of 1st vial were administered in the First Referral Unit (FRU) which is centrally located at the Block: total of 90 doses from 5 vials (5×50=250 doses) were administered. Due to accidental touching of the needle/spillage of vaccine due to sudden jerky movement of the child, 6 doses got “wasted”. Remaining 154 doses were “sacrificed” on completing 28 days since the starting day as per MDVP/Open Vial Policy.
Number of times the septum pricked ranged from 8 to 48 per vial.
Number of trips made by the vial ranged from 3 to 14 and the temperature excursions (TEs) ranged from 6 to 28.
On video recording and viewing the intradermal procedure for study purpose to assess the training need, we observed that:
The tense wheal with satisfactory diameter expelled fractions of fractional dose of the vaccine through needle puncture.
Where the diameter was less than 5mm, vaccine comfortably got lodged in thesubcutaneous space and no leakage.

The SAGE April 2016 meeting report has been published today in the WHO Weekly Epidemiological Record. SAGE reviewed relevant data and evidence, advised and made recommendations on various complex and critical issues including the:

Use of dengue vaccine;
Progress towards polio eradication;
Implementation of immunization in the context of Health Systems Strengthening and Universal Health Coverage;
Second-year-of-life immunization platform;
Missed opportunities for vaccination; and
Pre-empting and responding to vaccine supply shortages.

You can download the meeting report at http://www.who.int/wer/2016/wer9121/en/.

From 17 April to 1 May, the globally synchronised switch from trivalent oral polio vaccine (tOPV) to bivalent oral polio vaccine (bOPV) is taking place in 155 countries and territories. This will be followed by an intensive monitoring and validation phase through to 18 May.
To follow progress as countries stop use of tOPV and complete their national validation reporting requirements, a live web site has been launched to share real time updates and related stories. The site features interactive maps updated daily, tracking the status per country, and is linked to the polio endgame objective 2 website with more details on the overall Polio Eradication Strategic Plan.
At the time of writing, implementation of the switch and subsequent monitoring activities were progressing smoothly in countries that had already stopped use of tOPV.
Removal of the type 2 component from OPV marks a major historic milestone; it is testimony to the progress being made towards a polio-free world and to the commitment of all countries that this dream may one day become reality.

Dear viewers Context: India in collaboration with development partners like WHO/UNICEF/USAID/MCHIP etc has made remarkable advances in the last ten years: introduction of Measles 2nd dose, HepB vaccine including Birth dose vaccine, JE 2 doses, Pentavalent vaccine, year 2012-13 declared as year of Intensified Routine Immunization, India with SEARO declared as Polio Free, launching of Mission Indradhanush – the flagship programme of India. Karnataka Piloted Immunogram in a difficult district in 2013. India is now entering in to a new era of introducing Injectable Inactivated Polio Vaccine under routine Immunization from 1st April 2016 as part of Global Endgame Strategic Plan. India Expert Advisory Group, based on evidences recommends 2 fractional doses of 0.1ml intradermally at 6 and 14 weeks in selected States including Karnataka. Injectable vaccine has VVM on the label and MDVP / OVP is made applicable to minimize wastage, to be operated at all levels. Background: Globally immunization programme is rapidly expanding in covering more beneficiaries from newborn to the old through children, teenagers and pregnant; administering the doses close to the recommended schedule for timely attaining adequate immunity – jointly closing population immunity gap – an aspiration of WORLD; including more and more vaccines in the National Immunization Schedule on the basis of country specific epidemiology of Vaccine Preventable Diseases (VPDs), periodically reviewed and revised / upgraded by the Expert Advisory Group / Committees of the countries, World is convinced about the advantages of vaccination in preventing morbidity and mortality form VPDs like neonatal / puerperal tetanus, crippling polio & post encephalitic residual paralysis of JE, Diphtheria, Whooping cough, measles, childhood tuberculosis, pneumonias, diarrhoea, Varicella, herpes zoster, Ca cervix, HCC, rabies etc. World has witnessed Smallpox eradication, Polio at the verge of eradication, measles under elimination – others declining and under control. But: Expenditure of vaccination is increasing & Vaccine wastage is rising. Hence: Countries all over the world expressed the concern to avoid “preventable wastage without compromising efficacy and safety” [WHO – MDVP 2014]. We wish to share the experiences of practically operationalizing MDVP / OVP guidelines in the attached planning unit - RHTC Sampaje in view of introduction of IPV in the country and the one page jobaid which we made in regional Kannada launguage, the same is now edited with new circular guideline, translated to english as suggetsed by consultants form ITSU also. This may please be edited / corrected further by the viewers. Regards Narayana Holla

The Strategic Advisory Group of Experts on immunization (SAGE) convened by WHO on 20 October 2015 has confirmed that the globally coordinated withdrawal of the type 2 component in the oral poliovirus vaccine (OPV) will take place in April 2016. SAGE’s landmark decision follows the endorsement by the World Health Assembly (WHA) in May 2015, when Ministers of Health from 194 member states adopted a resolution on the global effort to eradicate polio, as part of the Polio Endgame Strategy. In a milestone towards the switch, wild poliovirus (WPV) type 2 was recently declared as eradicated worldwide. WPV type 3 has not been detected globally since November 2012, and the only remaining endemic WPV type 1 strains are now restricted to Pakistan and Afghanistan. The globally synchronized switch is therefore of great significance for the polio eradication programme with tremendous public health benefits. Countries have already demonstrated an exceptional level of commitment to meeting the timelines of the Polio Endgame. In the lead-up to April 2016, countries should begin to intensify their preparations to be ready to switch nationwide from trivalent oral polio vaccine (tOPV) to bivalent OPV (bOPV) on any one day in the window from 17 April to 1 May 2016. It is also critical that countries meet established deadlines to protect populations by moving the world towards destruction of WPV2 type 2 stocks or their appropriate containment in designated ‘poliovirus essential’ facilities. The requirements for containment are detailed in the Global Action Plan III and steps for countries are summarized here. For more information on the OPV switch and reference materials to guide switch implementation, communications, training, and monitoring, please consult the OPV switch section on the Polio Endgame objective 2 website. In addition, the summary report from the SAGE meeting that confirmed the switch date is available here, and a statement from the Global Polio Eradication Initiative can be found here. Any questions on the switch can be directed to Alejandro Ramirez Gonzalez (ramirezgonzaleza@who.int) or Lisa Menning (menningl@who.int).

WHO recommends 2 temperature ranges for keeping all vaccines at health facilities (+2C +8C) and (-15C -25C) for OPV above district level. The rationale for using first range is explained in “Thermostability of vaccines”. What is the reason for use of second range (-15C -25C) for OPV and some freeze-dried vaccines? Could (-5C -15C) or (-10C -20C) or other T range work instead?

The September 2015 Vaccine Information Management System (VIMS)Report on Global Vaccine Introductionfrom IVAC at Johns Hopkins is now availablehere. Recent vaccine introduction updates (since May 2015) include: · Pneumococcal conjugate vaccine (PCV) has been introduced in Eritrea, Guinea-Bissau, Lebanon, Lesotho, and Portugal. · Rotavirus vaccine has been introduced in Kiribati. · Inactivated polio vaccine (IPV) has been introduced in Benin, Bhutan, Cameroon, Central African Republic, Chad, Cote D'Ivoire, Guyana, Kiribati, TFYR Macedonia, Morocco, Niger, Pakistan, Papua New Guinea, Saint Vincent and the Grenadines, Sri Lanka, and Sudan.
Current and archived reports, as well as the PowerPoint slide deck with the latest report graphics, can also be found on the VIMS page of the IVAC website at:http://www.jhsph.edu/ivac/vims/ What is the VIMS Report? The VIMS report displays data and figures on the introduction status of Hib, pneumococcal, rotavirus, and inactivated polio vaccines both globally and in the 73 Gavi countries. The images and text in the report describe: · How many countries have introduced each vaccine or plan to in the future · National levels of vaccine coverage and access, globally and in Gavi countries · Vaccine introduction trends over time · Vaccine introduction status of each of the 194 countries, listed individually

Thirty countries have now introduced IPV vaccine as part of objective 2 of the Polio Eradication and Endgame Strategic Plan. In August, the second of the polio endemic countries, Pakistan, introduced IPV nationally. There are now 30 countries that have introduced the vaccine. Nigeria, the other endemic country to introduce IPV has now also successfully gone one year without a case of reported wild poliovirus. To document the experience of early adopters of IPV, Johns Hopkins Bloomberg School of Public Health’s International Vaccine Access Center (IVAC) worked with four countries, WHO, UNICEF, Gavi, the Task Force for Global Health and the Bill and Melinda Gates Foundation to create a series of written cases studies, a multi-country video, individual country videos and guidance for countries to develop their own case studies and human interest stories to support the monumental effort to introduce IPV into 126 countries previously using only OPV and help strengthen their routine immunization programs. These materials, now available on the IVAC and WHO websites as well as YouTube include: • Short graphic movie about global IPV introduction; • Film Series on IPV introduction: Albania, Nepal, Nigeria, and Tunisia; • Case Studies of IPV introduction in Albania, Nigeria, and Tunisia; • Guidelines for documenting vaccine introductions and human interest stories We hope you will join us in marking this occasion. Please feel free to use these materials to support your efforts. Please contact Katie Gorham at: Kgorham3@jhu.edu if you need additional assistance.

Well-planned, adequately funded communications affect the success of immunization services and are particularly needed to achieve vaccination coverage goals and maintain trust in vaccines. A communications plan and its activities – such as media briefings, stakeholder engagement, and social mobilization – all should be guided by research findings, carefully planned, and systematically implemented, integrated within the overall immunization programme plan or vaccine introduction plan. To support the addition of IPV to a national immunization programme, this Communications Planning Guide offers a range of checklists, tools, templates, examples and best practices, to support the effective planning and implementation of communication activities associated with IPV and related efforts to strengthen routine services. The contents should be adapted to local contexts as applicable. The Communications Planning Guide is available through this page of the website dedicated to objective 2 of the Polio Eradication and Endgame Strategic Plan 2013-2018.

In its January 2015 meeting, the WHO Executive Board called on all Member States to accelerate preparation for a globally coordinated switch from trivalent to bivalent OPV in April 2016. The Board’s request follows the WHO SAGE announcement in October 2014 that preparations are on track for this important milestone towards achieving polio eradication. The withdrawal of OPV is a critical step within objective 2 of the Polio Eradication and Endgame Strategic Plan 2013-2018. OPV works by using live attenuated (weakened) polioviruses to stimulate an immune response against three different types of poliovirus (types 1, 2 and 3). Use of OPV has nearly eliminated polio from the planet, with the last case of wild poliovirus type 2 seen in 1999. However, on very rare occasions, in countries where immunization coverage is low, vaccine-derived polioviruses from strains initially contained in OPV can change and spread to others. To counter this potential risk, OPVs will be removed in a phased manner, starting with the replacement of trivalent OPV with bivalent OPV, the latter protecting against types 1 and 3. The introduction of IPV will also help to manage risks associated with the withdrawal of the type 2 component of trivalent OPV, and help to boost immunity to types 1 and 3. In each country, the switch is expected to occur within a two-week period. Preparations for the switch will affect every stage of the supply chain from procurement to delivery to disposal. In anticipation of the switch, TechNet subscribers are encouraged to read and familiarize themselves with the rationale for, timing, and logistical implications of this important stage in polio eradication. WHO will continue posting information about the switch on TechNet and through other relevant channels and will be available to answer questions and address issues as they arise. To learn more about the switch and access all available materials, please visit: http://www.who.int/immunization/diseases/poliomyelitis/endgame_objective2/en/ For more information, please visit our website or send an email to: polio2@who.int

Unknown gunmen on Saturday the 28th of December 2013 opened indiscriminate fire on entering a hospital and fled from the scene. Subsequently, one polio worker, Zahid Gul, was killed on the spot whereas ward orderly Niqab Khan and a woman sustained severe injuries. Meanwhile, policemen reached the site of incident and cordoned off the area while a search operation went underway to apprehend those responsible. Polio workers, including females, have been targeted in Matni earlier as well. No group claimed responsibility for the attack, but militants have killed several polio workers and police protecting them in recent months. Earlier, on Dec 21, unknown militants gunned down a polio worker in the Jamrud Tehsil area of Khyber Agency. Gunmen had attacked two separate polio teams in northwestern Pakistan, killing one polio worker and two police guards. Meanwhile, earlier on November 23, militants had also kidnapped teachers for supporting a polio drive, but they were later released following a jirga intervention. Pakistan is one of only three countries in the world where the polio virus is still endemic, but efforts to stamp out the crippling disease have been hit by repeated attacks on health teams. Officials blame the violence and suspicions about the vaccine for a surge in cases. According to the World Health Organisation, Pakistan recorded 72 cases of polio this year compared to 58 in 2012. Pakistan is one of only three countries in the world where the highly infectious crippling disease remains endemic. But opposition from militant groups has hampered efforts to immunise children, with vaccination teams murdered in some cases. Officials said the violence and suspicions about the vaccine were the reason for the increase in cases. Pakistan has reported 72 polio cases which is the highest in comparison to two other countries with the disease, as Nigeria has 50 cases and Afghanistan reported only nine during 2013. According to a global update for polio cases, Pakistan had 58 cases last year while Nigeria had 110 and Afghanistan 31. Six cases this year have been reported in the eastern province of Punjab, six in Sindh in the south and 10 in northwestern Khyber Pakhtunkhwa. But by far the bulk of the infections – 50 – were in the lawless tribal areas along the Afghan border. The Pakistani Taliban banned polio vaccinations in the tribal region of Waziristan last year, alleging the campaign was a cover for espionage. Polio teams successfully immunised over 33 million children during the recent vaccination campaign, while 2.3 million children were recorded missed during the campaign. In most cases children were missed in the areas where the law and order situation was unfavourable, and where vaccination teams faced security threats. More than 47,000 children missed vaccination because of parental refusals. In August, health officials warned of the danger of a serious polio outbreak in the northwest, saying more than 240,000 children had missed vaccination because of the Taliban ban.

Wild Polio virus type 1 (WPV1) stills exists in Quetta as samples collected from the city's sewage system suggested persistence of the virus in the environment. The detection of polio virus has rung alarming bells with potential threat for millions of children of below the age of five in the city. The fresh sewage samples collected by the World Health Organisation (WHO) experts from Sur Pul area of Kharotabad were found positive for the wild polio virus type 1. Quetta the capital city of Balochistan is still under the looming threat of endemic polio virus though WHO, UNICEF and the government of Balochistan were striving hard to eliminate the crippling disease by putting all resources available.The International donor agencies like UNICEF,WHO collect samples from across the country on routine basis and dispatch to the National Institute of Health (NIH) in Islamabad. Samples gathered from the localities in Quetta including Jamia Salfia Airport Road, Takhtani Bypass and Kharotabad were negative for the polio virus, however, sample collected from some other areas were found positive ringing alarming bells for the millions of children below the age of five.Though there was a massive decline in the cases of polio in Balochistan, Threats still persisted as evident from the recent report. Detection of polio virus form the environment was though a matter of great concern. “However, concerned authorities are committed to eradicating the menace from Balochistan and a concerted strategy of the government has brought the dreaded virus to almost its end.” Giving overview of the polio cases and endeavors jointly made by the government, UNICEF and WHO,the previous year only four cases were reported, three in Quetta and one in Shirani district against the number of 58 cases detected in 2011.Due to the comprehensive response in line with international outbreak response guidelines, no case has been reported in the prevailing year.” Three special anti-polio campaigns have been launched in Quetta, Qilla Abdullah and Pishin district considered to be the most affected areas to control the virus. Anti-polio drive is being carried out permanently in all 30 districts to further bring the situation under control.Due to the attacks on polio teams in parts of the province, Balochistan government decided to continue work while remaining low profile. Acceptance of immunisation in rural parts of the province has increased after engagement of tribal and political leaders in campaigns against polio. While in the year of 2012 ten cases of the new virus, named “Sabin-like type 2 poliovirus”, were reported in two Pakhtun-dominated districts of the province over the past three weeks. The districts are frequented by people from the troubled areas of Fata. The situation was grim because of refusal by parents to get their children vaccinated against the crippling disease as the areas are under the influence of extremist groups opposed to the anti-polio drive. Some extremists belonging from banned outfits had established their cells in Balochistan and warn people against vaccination of theirchildren.Some teams had visited Pishin and Qilla Abdullah meet the local people and it was revealed that extremists had established their camps and were involved in killing people from Punjab.The people mostly coming from Khyber Pakhtunkhwa and other tribal areas brought the virus with them.The Federal Government declared ‘red alert’ against the poor state of polio eradication drive in Balochistan and asked the administration to launch an emergency campaign in the province. The situation in Quetta block, which includes Killa Abdullah and Pishin,was aggravated by the continued resistance to and intransigence of the district health authorities and supervisory cadre of vaccinators. New polio virus had not only affected 10 children in Pakistan but also paralysed two children in Afghanistan’s Kandahar province.The PM Office also expressed concern over the low level of routine immunisation and asked the provincial government to immediately hold three rounds of anti-polio campaign in Qilla Abdullah. The concerned authorities called for urgent steps to institute the WHO’s direct disbursement mechanism across the board for payment to the polio team staff. Measures should also be taken to improve the routine immunisation coverage in Qilla Abdullah on an emergency basis with clear targets and milestones given to district health teams. Stubbornness of the provincial health department and government supervisors for polio eradication in Balochistan is one of the biggest reasons behind dismal performance of the polio programme that has resulted in detection of new strain of poliovirus in Pakistan and threatens to impose travel restrictions on citizens that may put the country in an extremely embarrassing situation in the near future. Meanwhile polio virus that crippled at least 13 Syrian children last month was originated in Pakistan, according to the World Health Organization (WHO).This demands to carry out some new strategies to cope up with the situation to save Pakistan from dreadful situation in future.

I guess some of you would have followed recent developments around wild polio virus circulation in Syria where they are now clinical cases being reported. see http://www.who.int/csr/don/2013_10_29/en/index.html I am trying to gather guidances, publications, reports of polio intervention among refugees groups coming from countries with evidence of WPV circulation to polio-free countries (e.g. including supplementary immunisation campaigns, serology testing, timing of interventions, logistics, how to prevent further spread among refugees etc..) I thought some of you are/have been involved in similar activities. I am grateful if you could share any practical information you may have on lessons to consider when welcoming refugees from countries with established WPV circulation to non-endemic countries..and in the case of poliovirus in particular! Many thanks Tarik Derrough European Centre for Disease Prevention and Control Stockholm, Sweden