polio eradication :pulse polio program (nursing) by mujahid

1. welcome

2. Presented by
Shaikh Mujahid
Bsc nursing 4th year
Dept. of Community Health Nursing

3. SEMINAR
ON
PULSE POLIO
PROGRAME
Mr . SHAIKH MUJAHID
Medical Student

4. • Poliomyelitis , commonly shortened to polio, is
an infectious disease caused by the poliovirus. In
about 0.5 percent of cases, it moves from the gut
to affect the central nervous system and there is
muscle weakness resulting in a flaccid paralysis.
This can occur over a few hours to a few days.
Poliomyelitis

5. • Polio is transmitted through contaminated water or
food, or contact with an infected person.
• Many people who are infected with the poliovirus
don't become sick and have no symptoms. However,
those who do become ill develop paralysis, which can
sometimes be fatal.
• Treatment includes bed rest, pain relievers and
portable ventilators.

7. There are two vaccines used to protect against polio disease,
oral polio vaccine and inactivated poliovirus vaccine. The
oral poliovirus vaccine (OPV) is used in many countries to
protect against polio disease and has been essential to the
eradication effort.
• Oral polio vaccine (OPV)
Inactivated polio vaccine (IPV)

8. Oral vaccination is best suited for ending this crippling disease
because:
• It is easy to administer
• It is cheap
• It then reaches the intestine directly & prevents the
multiplication of diseases causing polio virus.
• When the vaccine gets flushed out of the child with the stool ,
it may spread to other children who may not have be
immunized strategies for polio eradication in india
Oral vaccine

10. • In India, vaccination against polio started on 1985
with Expanded Program on Immunization (EPI). By
1999, it covered around 60% of infants, giving three
doses of OPV to each.
HISTORY

11. In 1985, the Universal Immunization Program (UIP) was
launched to cover all the districts of the country. UIP
became a part of child survival and safe motherhood
program (CSSM) in 1992 and Reproductive and Child
Health Program (RCH) in 1997 This program led to a
significant increase in coverage, up to 5%. The number of
reported cases of polio also declined from thousands
during 1987 to 42 in 2010.

12. • In 1995, following the Global Polio Eradication
Initiative of the World Health Organization (1988),
India launched Pulse Polio immunization program
with Universal Immunization Program which aimed at
100% coverage.
•
The last reported cases of wild polio in India were in
West Bengal and Gujarat on 13 January 2011.On 27
March 2014, the World Health Organization (WHO)
declared India a polio free country, since no cases of
wild polio been reported in for five years.

13. • Following the global polio eradication initiative of
WHO in 1988, the indian government launched the
pulse polio immunization (PPL) programme in 1995.
• Under this program all children under 5 years are to
be administered 2 doses of OPV in December and
January , until polio is eradicated
• 6.5 lac polio booths
• 125 Million kids were administered on each
immunization day
INTRODUCTION

14. • Polio eradication , the permanent global cessation of
circulation by the poliovirus and hence elimination of
the poliomyelitis (polio) it causes, is the aim of a
multinational public health effort begun in 1988, led by
the World Health Organization (WHO), the United
Nations Children's Fund (UNICEF) and the Rotary
Foundation.

15. These organizations, along with the U.S. Centers for Disease
Control and Prevention(CDC) and The Gates Foundation,
have spearheaded the campaign through the Global Polio
Eradication Initiative (GPEI). Successful eradication of
infectious diseases has been achieved twice before,
with smallpox and bovine rinderpest.

16. • Prevention of disease spread is accomplished by
vaccination. There are two kinds of polio vaccine oral
polio vaccine (OPV), which uses weakened poliovirus,
and inactivated polio vaccine (IPV), which is injected.

17. The OPV is less expensive and easier to administer, and
can spread immunity beyond the person vaccinated,
creating contact immunity. It has been the predominant
vaccine used.
However, under conditions of long-term vaccine virus
circulation in under-vaccinated populations, mutations
can reactivate the virus to produce a polio-inducing
strain, while the OPV can also, in rare circumstances,
induce polio or persistent asymptomatic infection in
vaccinated individuals, particularly those who are
immune deficient

18. Being inactivated, the IPV is free of these risks but
does not induce contact immunity. IPV is more costly
and the logistics of delivery are more challenging.

19. • The Polio Eradication and Endgame Strategic Plan
2013-2018 represents a major milestone in polio
eradication and describes specific steps to take to
successfully achieve eradication.
• The plan has four objectives:
Polio Eradication and Endgame Strategic Plan
1. Virus detection
and interruption
2.RI strengthening and OPV
withdrawal
3.Containment and
certification
4. Legacy planning

20. • Under this endgame plan to achieve and sustain a polio
free world, the use of oral polio vaccine (OPV) must
eventually be stopped worldwide , starting with OPV that
contains type 2 poliovirus (OPV type 2). At least one dose
of inactivated polio vaccine (IPV) must be introduced as a
risk mitigation measure.
• 1. By end 2015, introduce at least 1 dose of IPV into all
routine immunization systems, at least 6 months before
the switch from trivalent oral polio vaccine (tOPV) to
bivalent oral polio vaccine (bOPV, containing types 1 and
3 poliovirus).

21. • 2. During 2016 , switch from tOPV to bOPV, which
does not contain type 2 virus , in routine
immunization and polio campaigns, as before that
bOPV was only licensed for use in Supplementary
Immunization Activities SIAs.
• 3. Plan for the eventual withdrawl of all OPV.

22. • In India NIDs have become the largest public health
campaigns ever conducted in a single country .
Government of India conducted the first round of PPI
consisting of two immunization days 6 weeks apart on
9th December 1995 and 20th January 1996. The first
PPI conducted targeted all children under 3 years of
age irrespective of their immunization status. Later on
,as recommended by WHO, it was decided to increase
the age group from under 3 to under 5 years.
Pulse Polio Immunization Program

23. • The term “pulse” has been used to describe this sudden,
simultaneous, mass administration of OPV on a single
day to all children 0-5 years of age, regardless to
previous immunization. PPIs occur as two rounds
about 4 to 6 weeks apart during low transmission
season of polio, i.e. between November to February . In
India, the peak transmission is from June to September
.

24. The dose of OPV during PPIs are extra doses which
supplement, and do not replace the doses received during
routine immunization services. The children including
0-1 year old infants should receive all their scheduled
doses and PPI doses. There is no minimum interval
between PPI and scheduled OPV doses .

25. • An important in PPI during 1998 has been the use of
vaccine vial monitor. Colour monitors or labels are put on
vaccine bottles. Each label has a circle of deep blue colour.
Inside it is a white square which changes colour and
gradually becomes blue, if vaccine bottle is exposed to
higher temperature. when the colour of the white square
becomes blue like that of surrounding circle, the vaccine
should be considered ineffective .

26. • Thereby, the health worker can easily ascertain that the
vaccine being given is effective or not.This mechanism has
been made mandatory in all vaccine procurements since
1998. This quality assurance will ensure that the children
will have better protection against polio in 1999 and
thereafter. Following recommendation from the india
Expert advisory group on polio eradication (IEAG), several
strategies. Were utilized during 2005 and early 2006 to
improve the impact of SIAs
Cont…

27. i. Development and licensure of monovalent OPV1
(mOPV1) and mOPV3 for targeted use during SIAs based
on surveillance data;
ii. Development of additional peronnel to assist with
intensified SIAs in the states of bihar and UP and in
Mumbai City;
iii.Social mobilization targeted at reaching population
groups missed during previous SIAs;
iv.Use of mobile teams to vaccinate children at transit
points(e.g. railway and bus stations)and moving trains;

28. • From the beginning of the polio eradication initiative , india
has been the world’s longest polio endemic country before
the introduction of National immunization day (INDIA) in
1995 , an estimated 35,000 children were paralysed by polio
in india each year.
• Significant reduction in cases were seen mainly as a result of
the implementation of NIDs in the following years,
• But in 2002, 1000 cases were reported in a major outbreak
the originated in western UP. And spread into many other
states, most of which had been polio free for more than one
year.

29. • The polio partnership in india under the leadership of
government of india mounted an appropriate response to
the outbreak.
• The number of supplemental immunization activities
(SISs) was increased and improvements made in asia
quality and community acceptance of the vaccine through
enhanced social mobilisation efforts including a special
underserved strategy for areas of western U.P.

30. • The outbreak was controlled and disease curtailed in just
two years from 1600 cases in 159 districts in 2002 to
134 cases in 44 districts in 2004.
• The programme has continued to build on these
achievements and also introduced the monovalent oral
polio vaccine (MOPV) which has further reduced the
number of polio cases to 66 in 2005.

31. CASES STATES
30 BIHAR
29 WEST U.P
02 JHARKHAND
01 DELHI
01 UTTRANCHAL
01 PUNJAB
01 HARYANA
01 GUJARAT
Were reported 66 cases in 2005 of polio in
country

32. 100% coverage
• Not a single child should miss the
immunization and leaves any chance to polio
occurrence .
• Cases of acute flaccid paresis (AFP) be
reported completely in time and stool
specimens collected within 14 days and
outbreak Response immunization (ORI)
conducted as early as possible.
OBJECTIVES OF PPP

33. • Immunizing every child below 1 year with at least 3 doses of
OPV.
• National Immunization days during which every child below 5
years gets 2 additional doses of OPV on 2 days separated by 4 to
6 weeks .
• Surveillance of AFP (alpha-fetoprotein) to identify all reservoirs
of wild poliovirus transmission.
• Extensive house-to-house immunization mopping-up
campaigns in the final stages where wild poliovirus
transmission persists.
STRATEGIES ADOPTED

34. • To reach unreached children through improved social
mobilization, plan mop-up operations in areas where polio
virus has almost disappeared & maintain high level of
moral among public.
• Tremendous progress has been made since polio
eradication activities were fil introduced in 1995.
• India is recording the lowest levels of polio virus
transmission ever, and is poised completely interrupt
transmission in the very near future.
Aim:

35. The steps taken by the Government to achieve the target of
polio eradication and maintain the polio-free state are as
follows:
1. All states and union territories in the country have
developed a rapid response team (RRT) to respond to any
polio outbreak in the country . An Emergency Preparedness
and response plan (EPRP) has also been developed by all
states indicating steps to be undertaken in case of detection
of a polio case.
2. In the states of UP and Bihar every newborn child is being
identified and vaccinated during the polio immunization
campaigns and is being tracked for 8 subsequent rounds.

36. 3. In order to reach every eligible child during the pulse
polio round, apart from the strategy of vaccinating children
at fixed booths and house to house visit, efforts in
vaccinating children in transit at railway stations, inside
long distance trains, major bus stops, marker place,
religious congregations, major road crossing etc.
throughout the country have been intensified.

37. Cont…
Special booths are established in areas bordering
neighbouring countries like Wagah border and Attari
train station in Punjab and Munabo train station in
barmer district of Rajasthan, to ensure that all children
under 5 years of age coming from across the border are
given polio drops.

38. 4. An extremely high levels of vigilance through surveillance
across the country for any importation or circulation of
poliovirus and vaccine Derived Polio Virus (VDPV) is
continuing at four sites with establishment of two new sites
in 2012.
5. Government of India has identified 107 high risk blocks
for polio where a multi-prolonged strategy is being
implemented to ensure sanitation, hygiene and clean
drinking water in addition to vaccinating each and every
child oral polio vaccine (OPV).

39. 6. Migratory population from UP and Bihar are being
identified in the states of Punjab, Haryana, Gujarat, and
West Bengal and these migratory children are being
covered during the Sub National Immunization Day
(SNID) in UP and Bihar.
7. Social mobilization activities are being intensified by
involving the local influencers, community and religious
leaders to improve community participation and
acceptance of polio vaccine.

40. 8. A rolling emergency stock of oral polio vaccine (OPV) is
being maintained to respond to any wild polio vaccine (WPV)
or circulating vaccine derived polio virus (cVDPV) detection.
As part of the polio endgame strategic plan, India has
introduce IVP in the national immunization programme from
30th November 2015 and tOPV – bOPV switch was carried out
in April 2016.

41. The last case of polio in the country
was reported from Howrah of west
Bengal with date of onset of disease on
13th January 2011. Thereafter no polio
case has been reported in the country. On
27th March 2014, India was declared as
non-endemic country for polio.

43. CONCLUSION
At the end of this seminar On Polio eradication : Pulse
Polio Program, we can conclude that it reduces the
cases of polio virus. Its working well and the disease is
under controlled. Program that have the potential to
significantly improve healthy life expectancy in
developing countries.

44. REFERENCE:
1.Swarnakar’s, ‘Community Health Nursing’,3rd edition
,NR Brothers publication
2.Park’s, ‘Textbook of Preventive And Social
Medicine’,24th edition
3.https://nhm.gov.in
4.www.nrhmhp.gov.in
5.www.academia.oup.com
6.www.pubmed.ncbi.nlm.nih.gov.in