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Pokok Bahasan

• Epidemiology poliomyelitis
– Agent
• Agent penyebab
• Cara penularan
– Host (Faktor Resiko)
• Imunitas – cara pencegahan
• Umur
– Environment (Faktor Resiko)
• Waktu
• Tempat
• Relevansinya untuk dapat dieradikasi.

• Turunan virus polio


• Batasan VAPP dan VDPV  Resiko terjadi VAPP &VDPV
• Terjadinya VAPP dan VDPV  Pencegahan VDPV
POLIOMYELITIS
Kerusakan sel motorneuron (cornu anterior) di
Medula Spinalis akibat suatu peradangan yang
disebabkan oleh virus polio, dengan manifestasi
KELUMPUHAN.
Medula spinalis
Penampang horisontal

Cornu
anterior
Virus Polio
agent penyebab Poliomyelitis

X-ray Crystallography • Virus RNA, ±7500 nucleotide


• Diameter 27-30 nm
• Genus Enterovirus
• Fam. Picornaviridae
Tahan terhadap:
asam,sabun,ether,
chloroform
Inaktivasi dg:
pemanasan,formalin, UV,
chlorine, pengeringan
Lama Virus Polio Bertahan Hidup
berdasarkan Suhu

Suhu Beku : Beberapa tahun

Suhu Lemari Es : Beberapa bulan

Suhu Kamar : Beberapa hari

Suhu 50 oC atau lebih : Cepat Rusak


Laju Inaktivasi Virus Polio Liar
Berdasarkan Musim
120
100 Laju inaktivasi menurun 90%
80
(%)

60
40
20
(10%)
0
1 1.5 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
hari

Musim Panas Musim Dingin


Laju Inaktivasi Virus Polio Liar
Berdasarkan Jenis Air
120
100 Laju inaktivasi menurun 90%
80
(%)

60
40
20
10%
0
26
2. 5

5. 5

11

13

15

17

19

21

23

25
1

hari
Air Laut Air Bersih Air Limbah
Laju inaktivasi melambat bila ada bahan organik.
Virus Polio (Lanjutan)

• 3 Jenis enteroviruses
– Tipe 1 (Brunhilde), Tipe 2 (Lansig) dan Tipe 3
(Leon)

• Sangat menular
• Semua tipe menyebabkan kelumpuhan
• Tipe 1 : penyebab paling sering,
kemudian Tipe 3 dan Tipe 2
• Sekali terinfeksi, penderita akan
menularkan ke semua orang yang tidak
imun di sekitarnya.
Virus Polio (Lanjutan)

• Setelah Imunisasi dengan tOPV


– Tipe 2 yang pertama dieradikasi,
diikuti Tipe 3, kemudian Tipe 1
– Perbandingan yang lumpuh diantara
yang terinfeksi, diperkirakan:
• Tipe 1  1:100
• Tipe 3  1:1000
Virus Polio
epidemiology
• Reservoir: manusia
• Penularan:
– Fecal – oral: >>>
• Masa virus dalam tinja lebih lama, beberapa
saat/hari sebelum lumpuh - maks. 100 hr setelah
lumpuh.
• Kebersihan lingkungan rendah:
– Tinja dapat mencemari air dan makanan
– Lalat  virus dari tinja ke mak-min
– Oral – oral: sedikit
• Masa virus dalam air ludah pendek, maks. 2 minggu
• Kebersihan lingkungan baik.
PENYEBARAN VIRUS POLIO DI LINGKUNGAN
VIRUS POLIO
ANAK TERINFEKSI MASUK KE ANAK
VIRUS POLIO, BAB LAIN MELALUI
MULUT

ANAK SAKIT
POLIO
MAK-MIN
TIDAK CUCI TANGAN TERKONTAMINASI
DENGAN BAIK
SETELAH BAB
CARA BERPIKIR EPIDEMIOLOGI

KUMAN INANG
PENYAKIT

LINGKUNGAN
Exkresi virus polio liar melalui tinja

63-96% 35 – 75%

Penurunan ekskresi rata-rata 10-15% per minggu


Masa Inkubasi
• Inkubasi pendek: 7-14 hr (terpendek 4 hr),
range 3-35 hr
• Eksresi virus melalui tinja secara intermiten
sampai 6-8 minggu atau melalui air ludah 1-2
setelah lumpuh.
• Eksresi virus terbanyak pada:
– Beberapa saat sebelum lumpuh – 2 minggu
setelah lumpuh
– Eksresi virus sangat menurun setelah 4
minggu lumpuh
PATHOGENESIS
• Virus masuk melalui mulut (oral)
• Replikasi pada lapisan tonsil dan usus, serta kelenjar
limfe.
• Viremia melalui darah  Susunan saraf pusat  melalui
sel saraf ke medula spinalis
• Motor neuron, pada Cornu anterior medula spinalis, rusak
karena replikasi virus  lumpuh
• Berat-ringan kelumpuhan tergantung banyaknya motor
neuron yang rusak.
HOST
Faktor Resiko

- Tidak mempunyai kekebalan


terhadap polio
- Incident terbesar pada anak < 3
tahun, dan sangat jarang ditemukan
pada anak umur 15 th >
IMUNISASI
MENCEGAH SAKIT POLIO
KEKEBALAN
thd Poliomeylitis
Melalui pemberian imunisasi/infeksi

Kekebalan terhadap satu tipe tidak menyebabkan


kekebalan pada tipe lain.

Ada dua jenis kekebalan: intestinal dan humoral

Kekebalan berlangsung seumur hidup

Bayi yg lahir dari ibu yg mempunyai antibodi tinggi akan


terlindungi selama beberapa minggu pertama.
Imunisasi dengan OPV
(Oral Polio Vaccine)

• OPV yang direkomendasikan oleh WHO


diproduksi memakai Strain Sabin
• Setiap dosis OPV berisi 3 type virus polio
dengan titer:
tipe 1 : ( 10 5.5 – 10 6.5)
tipe 2 : (10 4.5 – 10 5.5)
tipe 3 : (10 5.0 – 10 6)
• OPV: kekebalan intestinal dan humoral
Pembentukan Kekebalan
setelah 3 Dosis OPV
100 96
89
90
80
65 67 67
70
60 52 Dose 1
50
Percent

50 Dose 2
40 31 Dose 3
29
30
20
10
0
Poliovirus type 1 Poliovirus type 2 Poliovirus type 3
John TJ, Devararjan LV, Balasubramanyan A. Immunization in India with trivalent and
monovalent oral poliovirus vaccines of enhanced potency. Bull WHO 1976;54:115-7.
MANFAAT
Imunisasi dengan OPV
• Membentuk kekebalan
– 4 dosis tOPV (3 serotypes) pada bayi
sebelum umur 1 tahun.

• Memutus transmisi virus polio


– Mop-up/Sub PIN/PIN, tanpa melihat status
imunisasi sebelumnya.

• Mempunyai community effect


Anak tidak pernah Anak Divaksinasi Anak divaksinasi
divaksinasi lebih 100 hr yl Kurang dari 100 hr yl
Transmisi (+) Transmisi (+) Transmisi (-)
sakit (+) sakit (-) sakit (-)

=Vaksin
= VPL
EPIDEMIOLOGI YANG RELEVAN
UNTUK ERADIKASI
1. Virus hanya hidup di Memungkinkan
manusia dibasmi
2. Daya hidup di
lingkungan singkat

3. Virus diekskresi Waktu pengambilan


spesimen
4. Kekebalan
intestinal OPV jadi vaksin pilihan

5. Tipe 2 yg pertama Perkembangan ke


punah arah eradikasi
POLIOMYELITIS
Faktor Resiko
• Waktu
• Tempat
• Orang
POLIOMYELITIS (Lanjutan)
Faktor Resiko

• Waktu - MUSIM
– M. hujan, di negara tropis
– M. dingin/ awal m. semi di negara 4 musim
• Tempat
– Di daerah dengan:
• Cakupan imunisasi rendah
• Sanitasi lingkungan buruk
• Perkotaan kumuh (PADAT)
• Orang:
– Tidak mempunyai kekebalan
– Anak < 3 th: resiko tertular paling tinggi
– Umur 15 th >: sangat kecil kemungkinan tertular
TEMPAT (2)
Kasus Polio di Kab. Sukabumi, Jawa Barat, Maret-April 2005

Cicurug

Bj.Genteng

13 kasus AFP, dg onset lumpuh


antara 13-03-2005 s/d25-04-
2005:
• 1 ks dg Virus Polio Liar (+)
• 1 ks dg Virus Polio Liar (-)
4 desa imunisasi
• 11 kasus, spesimen lab tunggu polio masal balita
120 spesimen kontak lab tunggu 24-25 April 2005
TEMPAT (3)
Wild Poliovirus Cases Indonesia March 2005 – 6 April 2006

##
SS
S
# ACEH TIMUR

S #
#
GAYOL UES

S LANGKAT

S#
# S
#
ACEH TENGGARA

S
#S
S##
S KARO

S S
# #
S S
# #
#
S
S
#

#S
S
S
##
S
#
##
S
S
#
S
##
S
S###
S
#S#
S
#S
#S
#
#S
S #
S
#S
S #
S
#S
S ##
#
SS
#
S
S
#
#
S#
##
#
S#
S
#
SS
#
S
##
S
S##
##
S
S
##
SSS#S
#
S
#
S
#
S#S
#
S
#
S
S
#
S#
#S
S#
#S
S#
#
S
#
S#
S#S
S#S
##S
S S
#
#S
S #S
S#
#S
S# S#
S
BANG KALAN SAMP ANG PAME KASAN SUME NEP

#
S
#
S#
S
#
S
#S
S #S
#
S ###
S #
S# SS#
##
# # # #

S
# S#
S
SITU BOND O

S#
PROB OLIN GGO #

#
BOND OWOSO

U MAJAN G
L
JE MBER

BANYU WA NGI

= 1 WPV Case
Total infected district s: 47
Total infected provinces : 10

Data as of 6 April 2006


WAKTU (1)
WPV 1 monthly onset, with targeted SIAs, NIGERIA 2006 – 2010
*

150
140
130
120
.

110
Number of wpv cases

100
90
80
70
60
50
40
30
20
10
0
J-06

J-07

J-08

J-09

J-10
J
J

J
J

J
J

J
J
N
D

N
D

N
D

N
D
O

O
F

F
M

M
A

A
S

A
S

A
S

A
S

A
Continuous arrow = National IPDs
Broken arrows = Sub-national IPDs mOPV1 bOPV
tOPV
* mOPV1 was used only in 4 southern states in October
WAKTU (2)
Total AFP, Polio*, Non Polio and Pending Cases by Onset of Paralysis,
600 Indonesia 2005

500

400

300

200

100

0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Total AFP 67 54 90 122 482 382 190 172 143 82 60 55


Pending 0 0 0 0 0 0 0 1 2 1 4 12
Non Polio 66 54 88 100 393 254 139 123 100 64 53 39
Polio 1 0 2 22 89 128 51 48 41 17 3 4

* WPV, Compatible, and VDPV Cases


Data as of 29 January 2006
ORANG (1)
Age group of WPV cases 2008/2009, NIGERIA

Age’08 (n=782)
Age’09 (n=388)
60+ Unknown < 12 mths Unknown
< 12 mths
3% 0% 6% 0%
60 + mths 6%
48 - 59 8%
5%
48 - 59 12 - 23
12 - 23 mths mths
36 - 47
mths 9% 28%
mths
34%
18%

36 - 47
mths
6 15%

24-35 mths
33%
24 - 35
mths
34%

73% < 3 yrs 68% < 3 yrs


ORANG (2)
Characteristics of Wild Polio Cases, Indonesia 2005

Group of Age OPV Dose*

>60 Month
18% 0-11 Month 3+ dose
36-60 Month 5% 15%
22%
0 dose
38%

'1-2 dose
47%
*do not include missing data
12-35 Month
55%
Data as of 29 January 2006
EPIDEMIOLOGI
TURUNAN VIRUS POLIO
Kelumpuhan yang
disebabkan oleh:

• Virus vaksin  Secara klinis disebut


VAPP
• VDPV
 Secara klinis disebut
• VPL Poliomyelitis
- Vaccine Associated Paralytic Polio

- Vaccine Derived Polio virus


VAPP
Vaccine Associated Paralytic Polio

Batasan
• VAPP adalah bentuk KIPI dari OPV.

• WHO: suatu kelumpuhan layuh akut yang terjadi


pada:
– 4-30 hari setelah menerima OPV
– 4-75 hari setelah kontak dg penerima OPV
– dg kelainan neurologi sampai pada 60 hari/lebih setelah
onset
– atau meninggal.

* Global burden VAPP: 250-500 kasus per tahun


MENGAPA TERJADI VAPP?

 Vaksin mengandung virus HIDUP

 Mutasi/Reversi virus vaksin (REVERTANTS) < 1%


 Mutasi virus terjadi karena replikasi lama di usus

 Merupakan suatu respon IMUN LAMBAT

 Resiko meningkat pada IMMUNODEFICIENCY

 Pada umumnya PERMANENT


Risiko VAPP menurut WHO
(Background rates of AEFI:WHO/V&B/00.36)

Dosis pertama OPV 1 : 1.4 – 3.4 juta dosis

Dosis berikutnya 1 : 5.9 juta dosis

Kontak 1 : 6.7 juta dosis

National Immunization
1 : 6 juta dosis
Day
VDPV
(Vaccine-derived Polio Virus)

• Virus vaksin ber-replikasi didalam usus manusia,


diekskresi melalui tinja biasanya 2-3 bln

• Pada saat replikasi terjadi mutasi/reversion virus


vaksin.

• Replikasi dan mutasi yang berulang diantara anak


yang TIDAK IMUN dan suatu saat bergabung dengan
C enterovirus maka akan terjadi recombinant dalam
bentuk VDPV yang bersifat neuro-virulent.

• Kesimpulan:
VAPP & VDPV adalah konsekuensi dari imunisasi
dengan OPV
3 Jenis VDPV
• iVDPV = VDPV berasal dari pasien immune-
deficiency.

• cVDPV = VDPV yang bersirkulasi;


• memiliki sifat VPL, yaitu neurovirulen dan
transmissable,
• semua virus yg menyebabkan wabah terbukti
merupakan recombinant dg C – Enterovirus

• aVDPV = ambiguos VDPV yaitu:


– tak ada bukti sirkulasi,
– tak ada hubungan dg pend. imun.def
– berasal dari sample lingkungan yg tak ada
hubungan dg kasus AFP.
Faktor risiko penyebaran VDPV

• Cakupan imunisasi OPV yang rendah


dalam waktu lama sehingga terjadi
akumulasi orang-orang yang tidak/belum
kebal terhadap polio

• Tidak adanya sirkulasi virus polio liar ??

• Sanitasi buruk
Pencegahan penyebaran VDPV
1. Imunisasi OPV: Cakupan tinggi dan merata
(dipertahankan!!)

2. Deteksi dini adanya VDPV dengan


peningkatan kinerja surveilans AFP

3. Screening semua isolat virus polio dengan


kombinasi metode antigenik dan molekuler ,
yaitu: uji ITD (Intratypic Strain Differentiation) dg
ELISA & Probe-hybridization.
Sirkulasi VPVD yang
Dilaporkan

Nigeria
2005-2010 India
Hispaniola 307 cs 2009-2010
Egypt 12 cs
2000-1
22 cases 1988-93 Indonesia
Ethiopia
32 cases On-going
2008-2009
4 cs 46 cases
Congo
Philippines
Madagascar 2008-2009
Note: 16 cs 2001
2002/2005
3 cases
V1 4/3 cases

V2
VAPP VDPV

 Akibat respon imun  Akibat rendahnya


yang rendah dari imunitas masyarakat
individu
 Tidak ada kasus lain  Menjadi KLB
(tidak menular)
Studi pada penerima
vaksin polio oral
• Tipe-3 paling cepat mengalami mutasi/reversi, diikuti tipe-2
dan tipe-1, rekombinasi antara serotipe vaksin sering
terjadi
• Pendeknya waktu ekskresi dan tingginya kekebalan
penduduk membatasi penyebaran virus revertant
• Sebagian besar isolat dari penerima OPV maupun
kontaknya berhubungan erat dg strain Sabin

• Perbedaan sekuens >1 % dibanding Sabin menunjukan


replikasi berkepanjangan, disebut VDPV
• Perbedaan sekuens VP1 1% berarti replikasi virus vaksin
telah terjadi paling sedikit 1 tahun
VDPV di Madura
• Dari Madura, ditemukan > 30 kasus AFP dg
vi.polio positif oleh Lab. BLK Surabaya
• Bf mendapatkan isolat dg hasil ITD yg
Discordant yi:
Elisa: NSL=Wild, Probe : SL
• Sequencing Mumbai: 31 kasus AFP + 2 kontak
dg VDPV + , sekuens nukleotida menunjukan
perbedaan >1% dibandingkan dg SL.
Weekly AFP and VPD Update for
Week 40, 2012
Data as of 08 October 2012

Immunization and Vaccine


Development (IVD) SEARO

Protecting People from Vaccine


Preventable Diseases

SEARO, New Delhi, 2012


Wild Polio Virus
India, 2011
Wild Polio Cases, 2011
Total P1 Wild cases 1
Total P3 Wild cases 0
Total polio cases 1
Total districts with wild cases 1
13-Jan-2011; District Howra,
Date and location of P1 Wild
West Bengal
most recent case
P3 Wild -

Districts with cases in 2011


Districts with cases in current week

= Most recent P1 Wild polio case

49
*Dots are randomly placed within blocks (Sub-districts) Data as of 08 Oct 2012
Wild Polio Cases by Type (P1, P3) and Month of Onset
India, 2007-2012
2007 2008 2009 2010 2011 2012
Month
P1 P3 P1 P3 P1 P3 P1 P3 P1 P3 P1 P3
Jan 15 9 1 111 7 7 2 14 1 0 0 0
Feb 6 8 2 51 2 3 1 2 0 0 0 0
Mar 8 6 1 39 3 13 0 0 0 0 0 0
220 Apr 3 11 0 40 4 9 1 1 0 0 0 0
May 7 25 1 33 4 19 2 0 0 0 0 0
200 Jun 1 29 3 35 8 71 1 1 0 0 0 0
Jul 10 54 7 46 6 83 3 2 0 0 0 0
180 Aug 10 67 21 46 11 108 4 3 0 0 0 0
Sep 4 77 17 32 19 126 3 0 0 0 0 0
160 Oct 3 95 5 27 11 118 0 1 0 0
140 Nov 8 194 8 16 3 57 0 0 0 0
Polio Cases

Dec 5 216 9 8 1 47 1 0 0 0
120 Sub-Total 80 791 75 484 79 661 18 24 1 0 0 0
Total* 871 559 740 42 1 0
100 *Note: Wild polio mixtures (P1+P3) not included in the graph or table.

80

60

40

20

0
May

May

May

May

May

May
Nov

Nov

Nov

Nov

Nov
Mar
Apr

Mar
Apr

Mar
Apr

Mar
Apr

Mar
Apr

Mar
Apr
Aug

Aug

Aug

Aug

Aug

Aug
Oct

Oct

Oct

Oct

Oct
Dec

Dec

Dec

Dec

Dec
Jul

Jul

Jul
Jan
Feb

Jun

Sep

Jul

Jul
Jan
Feb

Jun

Sep

Jan
Feb

Jun

Sep

Jan
Feb

Jun

Sep

Jan
Feb

Jul
Jun

Sep

Jan
Feb

Jun

Sep
2007 2008 2009 2010 2011 2012
P1 P3

50
Data as of 08 Oct 2012
Monthly Distribution of AFP Cases
SEAR, 2011 – 2012

AFP cases by month of paralysis onset, last 14 months (data from weekly case-based reports)

2011 2012

Aug-12
May-12
Nov-11
Sep-11

Sep-12
Dec-11

Feb-12

Jun-12
Mar-12

Apr-12
Jan-12
Oct-11

Oct-12
Jul-12
Date of last
Country total AFP to
report
AFP date

Bangladesh 1610 1230 154 142 92 103 122 112 135 169 141 145 146 113 143 4 08-Oct-12
Bhutan 6 7 1 1 0 0 1 1 1 2 0 1 0 1 0 0 08-Oct-12
DPR Korea 129 92 12 7 13 10 8 8 12 7 14 22 10 8 3 0 02-Oct-12
India 60542 46058 6854 5802 5403 5025 4621 4149 4225 4328 5074 5064 5510 7176 5911 0 05-Oct-12
Indonesia 1720 1413 137 178 171 134 164 160 173 199 203 163 188 107 56 0 05-Oct-12
Maldives 3 4 0 1 1 0 1 0 0 1 0 0 2 0 0 0 30-Sep-12
Myanmar 418 315 53 52 38 25 18 9 11 22 37 42 43 54 79 0 05-Oct-12
Nepal 567 541 63 43 48 45 51 51 47 51 60 69 72 90 50 0 05-Oct-12
Sri Lanka 88 62 12 4 8 4 8 5 10 5 12 5 5 4 8 0 04-Oct-12
Thailand 249 199 24 27 22 24 22 24 25 7 20 15 30 30 26 0 05-Oct-12
Timor-Leste 0 3 0 0 0 0 1 0 0 2 0 0 0 0 0 0 30-Sep-12
TOTAL 65332 49924 7310 6257 5796 5370 5017 4519 4639 4793 5561 5526 6006 7583 6276 4

51
Data as of 08 Oct 2012
Primary culture results from AFP cases 2011
Primary culture results from AFP cases 2011
Specimens from other
AFP cases AFP specimens
Number of AFP sources 2

% NPEV
cases with Pending1 Results
Country Polio Laboratories Positive % Primary Culture Number
specimens received Positive NPEV Received by

Vaccine
Culture + Negative Reports Within 14 received by

Wild
in Lab Culture Only <=14 lab
NPEV >14 days days lab
days

Bangladesh IPH, Dhaka 1587 30 2 349 1206 0 0 3166 93.0 18.0 412 23 0
Bhutan NIH, Bangkok 4 0 0 0 4 0 0 7 71 0 0 0 0
DPRK NPL, Pyongyang 117 1 0 11 105 0 0 270 99 9.7 0 0 0
BJMC, Ahmedabad 7618 381 37 1423 5777 0 0 15282 100.0 15.5 179 10 0
NIV, Bangalore 4818 325 92 1497 2904 0 0 9654 97.9 27.5 25 0 0
IoS, Kolkatta 7121 278 38 1057 5748 0 0 14238 98.2 11.5 44 4 0
KIPM, Chennai 9266 337 69 1968 6892 0 0 18533 99.6 17.2 40 2 0
India
NCDC, Delhi 5782 256 25 485 5016 0 0 11580 78.7 6.5 64 3 0
CRI, Kasauli 1783 84 4 306 1389 0 0 3576 100.0 14.7 30 2 0
SGPGI, Lucknow 16629 771 196 6465 9197 0 0 33328 99.2 28.6 107 10 0
ERC, Mumbai 5775 341 68 1647 3719 0 0 11645 93.2 24.7 143 5 0
India Sub Total 58792 2773 529 14848 40642 0 0 117836 96.6 20.0 632 36 0
Biofarma, Bandung 523 12 0 46 465 0 0 1044 98 8.1 0 0 0
Indonesia NIHRD, Jakarta 640 5 1 65 569 0 0 1275 100 8.9 5 0 0
PHL, Surabaya 528 13 0 58 457 0 0 1057 100 9.6 5 0 0
Indonesia Sub Total 1691 30 1 169 1491 0 0 3376 99.2 8.9 10 0 0
Maldives MRI, Colombo 1 0 0 0 1 0 0 2 0 0 0 0 0
Myanmar NHL, Yangon 417 10 2 70 335 0 0 834 92 14.0 0 0 0
Nepal NIH, Bangkok 539 17 0 108 414 0 0 1078 100 16.1 208 16 0
Sri Lanka MRI, Colombo 82 1 0 2 79 0 0 175 99 1.2 358 21 0
Thailand NIH, Bangkok 235 8 0 18 209 0 0 473 100.0 6 0 0 0
Timor-Leste PHL, Surabaya 0 0 0 0 0 0 0 0 0.0 0 0 0 0
SEAR 63465 2870 534 15575 44486 0 0 127217 96.5 19.5 1620 96 0
1
Calculation based on date specimen received in laboratory subtracted from date data received in SEARO as shown in Table 1.
2
Stool samples collected from contact and healthy children survey.

52
Data as of 08 Oct 2012
Weekly Bulletin Comparison,
India, 2010-2012
Weekly Comparison of AFP, Wild, VDPV, Compatible & Classification Pending, India, 2010-2012
2010 2011 2012
Week Number

Week Number
Compatible

Compatible

Compatible
P1 (WPV)

P1 (WPV)

P1 (WPV)
Pending

Pending

Pending
(VDPV)

(VDPV)

(VDPV)

(VDPV)

(VDPV)
(WPV)

(WPV)

(WPV)
AFP

AFP

AFP
P2

P3

P2

P3

P3

P2

P3

P3
Week1 29 0 0 0 0 29 15 0 0 0 0 0 15 2 0 0 0 0 0 2 Week1
Week2 427 0 0 0 0 427 345 0 0 0 0 0 345 417 0 0 0 0 0 417 Week2
Week3 1151 0 0 3 0 1008 1024 0 0 0 0 0 925 1230 0 0 0 0 0 1141 Week3
Week4 1864 0 1 3 0 1313 1848 0 0 0 0 0 1274 2230 0 0 0 0 0 1585 Week4
Week5 2564 1 1 7 0 1262 2888 0 0 0 0 0 1526 3154 0 0 0 0 0 1590 Week5
Week6 3352 2 1 10 0 1518 3773 1 1 0 0 0 1709 4039 0 0 0 0 0 1633 Week6
Week7 4197 2 2 14 0 1600 4662 1 1 0 0 0 1687 5115 0 0 0 0 0 1748 Week7
Week8 5031 2 2 14 0 1742 5522 1 1 0 0 0 1720 6117 0 0 0 0 0 1872 Week8
Week9 5548 2 2 16 0 1532 6381 1 1 0 0 0 1893 7112 0 1 0 0 0 2054 Week9
Week10 6515 3 2 16 0 1862 7375 1 1 0 0 0 2118 8156 0 1 0 0 0 2296 Week10
Week11 7325 3 3 16 0 1993 8281 1 2 0 0 0 2209 8912 0 1 0 0 0 1985 Week11
Week12 8097 3 3 16 0 2038 9024 1 2 0 0 0 2150 9985 0 1 0 0 0 2361 Week12
Week13 9135 3 3 16 0 2038 9949 1 2 0 0 0 2319 11057 0 1 0 0 0 2525 Week13
Week14 9919 3 3 16 0 2338 11026 1 2 0 0 0 2687 12042 0 1 0 0 0 2778 Week14
Week15 10751 3 3 16 0 2465 11914 1 3 0 0 0 2779 12944 0 1 0 0 0 2578 Week15

Week35 34035 11 3 22 64 4980 35049 1 5 0 0 24 4975 37091 0 1 0 0 5 5465 Week35


Week36 35519 13 3 22 64 5141 36630 1 5 0 0 24 4998 38963 0 1 0 0 5 5809 Week36
Week37 36931 14 3 22 64 5298 38240 1 5 0 0 24 5392 40752 0 1 0 0 5 5725 Week37
Week38 38221 15 3 22 64 5310 39807 1 5 0 0 30 5007 42727 0 1 0 0 5 5873 Week38
Week39 39914 16 3 23 79 5212 41496 1 5 0 0 30 5289 44390 0 1 0 0 5 5829 Week39
Week40 41245 16 3 23 79 5382 43223 1 5 0 0 30 5782 46058 0 1 0 0 5 5782 Week40
Week41 42410 16 3 23 79 5291 44495 1 5 0 0 30 6058 Week41
Week42 43648 16 3 23 79 5276 46066 1 5 0 0 30 5925 Week42
Week43 44907 16 3 23 96 4861 47442 1 5 0 0 30 5992 Week43
Week44 46065 16 3 23 96 5166 48458 1 5 0 0 30 5606 Week44
Week45 46989 17 3 23 96 4969 49744 1 5 0 0 33 5179 Week45
Week46 47987 17 3 23 96 5063 51035 1 5 0 0 33 5130 Week46
Week47 48994 17 3 23 108 4746 52590 1 5 0 1 33 5510 Week47
Week48 50093 17 3 23 108 4860 53994 1 5 0 1 43 5277 Week48
Week49 51171 17 3 24 108 4958 55203 1 5 0 1 43 4993 Week49
Week50 52172 17 3 24 108 5125 56340 1 5 0 1 43 5001 Week50

53
Data as of 08 Oct 2012
Wild poliovirus detected in sewage samples, 2010-2011
Mumbai
Mumbai
2010 F ward
Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
X X X X X

G ward

M ward

Delhi
Delhi
Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Red cross hospital X X X

Bhalaswa lake X X X

Wazirpur JJ colony X X X

Swarn cinema X X

Batala house (Okhla) X X X X X

Mumbai
2011 F ward
Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52

G ward

M ward

Delhi
Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Red cross hospital X X X X X X

Bhalaswa lake X X X X X X

Wazirpur JJ colony X X X X X X X

Swarn cinema X X X X X X

Batala house (Okhla) X X X X X X X

Sonia vihar X X X X X

Nangloi X X X

Patna
Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Choti pahari

Dujara

Transport nagar

Kolkata
Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Ward 8, MM

Ward 135, KMC

Wild poliovirus type 1 Negative for wild poliovirus X Scheduled but sample not collected
Wild poliovirus type 3 Result pending Sampling not scheduled

54
Data (NPSP) as of 05 Oct 2012
Wild poliovirus detected in sewage samples, 2012
Mumbai
Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
F ward X X X X

G ward

M ward

Delhi
Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Red cross hospital

Bhalaswa lake

Wazirpur JJ colony

Swarn cinema

Batala house (Okhla)

Sonia vihar

Nangloi

Patna
Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Choti pahari X X X X

Dujara X X X X

Transport nagar X X X X X

Kolkata
Week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Ward 8, MM

Ward 135, KMC

Ward 29, KMC

Ward 66, KMC


`

Wild poliovirus type 1 Negative for wild poliovirus X Scheduled but sample not collected
Wild poliovirus type 3 Result pending Sampling not scheduled

55
Data (NPSP) as of 05 Oct 2012
Vaccine Preventable Diseases
SEAR, 2011
Vaccine Preventable Diseases reported to SEARO for year 2011 (data upto Dec 2011)
Routine Reporting of clinically suspected
Suspected measles outbreaks Classification of Outbreaks 1 Number of Cases
measles cases
Timeliness and Completeness of reports
received in SEARO, 2011 3
Lab confirmed Measles Lab confirmed Rubella Lab confirmed Mixed
Country Outbreaks Outbreaks Outbreaks
Serology Serology Number of Neonatal Number of
Tested for Number of Number
Cases Deaths +ve +ve Outbreaks Deaths Tetanus Diphtheria Pertussis Encephalitis Cases of
serology Outbreaks of Cases Number Number of
measles Rubella Investigated * Number of Number of Number of Number of Number (NNT) AEFI 2 Date of last % %
of reports
Outbreaks cases Outbreaks cases
Outbreaks
of cases report Complete Timely
expected

Bangladesh 2993 1 2683 1445 267 333 333 11863 11 91 2802 89 4744 48 1572 98 11 44 708 1197 14-Aug-12 12 100 100
Bhutan 98 1 98 10 3 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 10-Jan-12 12 67 58
DPR Korea 70 0 70 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 06-Jan-12 12 58 50
India NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 12 0 0
Indonesia 23282 0 4694 1175 1808 356 286 4993 14 251 3747 60 586 23 415 114 816 10-Sep-12 12 100 92
Maldives 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 22 15-Jan-12 12 75 75
Myanmar 1605 3 1547 879 87 38 38 895 3 36 873 2 22 0 0 32 7 5 0 7 15-May-12 12 100 100
Nepal 733 0 514 71 112 64 63 1579 5 22 797 31 545 4 68 13 1336 6 14-Mar-12 12 100 100
Sri Lanka 574 0 254 6 140 10 10 369 0 0 0 10 369 0 0 0 0 55 165 5511 14-Feb-12 12 100 100
Thailand 3056 0 272 67 13 12 11 269 0 9 22 0 1 0 0 1 29 10 500 18-Jan-12 12 83 33
Timor-Leste 1 0 0 0 0 1 1 763 0 1 763 0 0 0 0 4 0 4 25 4 02-Jul-12 12 25 17
Total 32412 5 10132 3653 2430 814 742 20731 33 410 9004 192 6267 75 2055 262 863 118 2734 6751
1 2 3
At least 5 blood samples should be collected and tested from each outbreak. Adverse Events Following Immunization; Sri Lanka AEFI data do not reflect cases but events. Monthly VPD and AEFI reports due to SEARO/IVD on or before 15th of each month. NR=No Report
* Total suspected outbreaks may not add to total lab confirmed outbreaks because some outbreak samples are in process with results pending and/or outbreak reports are not received from the field (investigation in process).

56
Updated on 24 Sep 2012
Vaccine Preventable Diseases
SEAR, 2012
Vaccine Preventable Diseases reported to SEARO for year 2012 (data upto Jul 2012)
Routine Reporting of clinically suspected
Suspected measles outbreaks Classification of Outbreaks 1 Number of Cases
measles cases
Timeliness and Completeness of reports
received in SEARO, 2012 3
Lab confirmed Measles Lab confirmed Rubella Lab confirmed Mixed
Country Outbreaks Outbreaks Outbreaks
Serology Serology Number of Neonatal Number of
Tested for Number of Number
Cases Deaths +ve +ve Outbreaks Deaths Tetanus Diphtheria Pertussis Encephalitis Cases of
serology Outbreaks of Cases Number Number of
measles Rubella Investigated * Number of Number of Number of Number of Number (NNT) AEFI 2 Date of last % %
of reports
Outbreaks cases Outbreaks cases
Outbreaks
of cases report Complete Timely
expected

Bangladesh 1290 0 1209 543 129 167 146 4727 1 33 1092 57 2273 15 494 37 8 7 117 1121 12-Sep-12 8 100 100
Bhutan 67 0 65 13 14 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 10-Sep-12 8 100 100
DPR Korea 44 0 44 0 1 0 0 0 0 0 0 0 0 0 0 0 0 8 0 0 31-Aug-12 8 63 50
India NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR NR 8 0 0
Indonesia 8473 2 1807 172 429 78 62 1099 1 35 582 20 246 3 48 65 742 14-Sep-12 8 88 38
Maldives 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 9 20-Sep-12 8 88 63
Myanmar 911 0 907 743 10 41 40 1189 16 40 1189 0 0 0 0 17 13 2 0 0 17-Sep-12 8 100 88
Nepal 397 3 328 64 84 64 63 1366 7 14 244 28 482 5 119 7 630 13 14-Sep-12 8 100 100
Sri Lanka 91 0 45 0 19 1 1 30 0 0 0 1 30 0 0 0 0 62 161 3210 10-Sep-12 8 100 100
Thailand 3558 0 1272 558 36 4 4 93 0 4 25 0 0 0 0 0 21 9 310 23-Aug-12 8 50 0
Timor-Leste 12 0 0 0 10 0 8 11 0 0 7 1 1 0 0 3 1 0 0 0 14-Aug-12 8 13 13
Total 14843 5 5677 2093 732 355 324 8515 25 126 3139 107 3032 23 661 129 785 88 1218 4356
1 2 3
At least 5 blood samples should be collected and tested from each outbreak. Adverse Events Following Immunization; Sri Lanka AEFI data do not reflect cases but events. Monthly VPD and AEFI reports due to SEARO/IVD on or before 15th of each month. NR=No Report
* Total suspected outbreaks may not add to total lab confirmed outbreaks because some outbreak samples are in process with results pending and/or outbreak reports are not received from the field (investigation in process).

57
Updated on 24 Sep 2012
Measles and Rubella Serology (IgM) Results
SEAR, 2011-2012
Measles and Rubella Serology (IgM) Results - Monthly Reporting, SEAR, 2011 (data up to Dec 2011)
Positive Results 1
Number of Serum % Measles Results
Number Tested for Date of Last Report
Country Laboratories Samples Measles Rubella Reported with in 7
Measles & Rubella Received in SEARO
Received Days
# % # %
Bangladesh Dhaka 4417 4381 1934 44.1 711 16.2 68.5 09-May-12
Bhutan Thimphu 98 98 9 9.2 7 7.1 100.0 06-Jan-12
DPR Korea Pyongyang 70 70 0 0.0 0 0.0 100.0 06-Jan-12
Ahmedabad 302 302 234 77.5 2 0.7 97.7 04-Jan-12
Bangalore 208 208 120 57.7 44 21.2 100.0 02-Jan-12
Chennai 157 157 88 56.1 34 21.7 92.4 03-Jan-12
India Hyderabad 180 177 106 59.9 8 4.5 89.3 05-Mar-12
Jaipur 103 103 77 74.8 4 3.9 99.0 04-Jan-12

2011 India Total from six labs


Kolkata
Pune
326
617
1893
326
617
1890
193
448
1266
59.2
72.6
67.0
39
43
174
12.0
7.0
9.2
91.1
81.5
90.4
02-Jan-12
19-Mar-12

BANDUNG 1015 1015 539 53.1 284 28.0 98.7 11-Jun-12


JAKARTA 2640 2637 857 32.5 888 33.7 47.3 11-Jun-12
Indonesia
SURABAYA 1582 1582 708 44.8 412 26.0 50.0 11-Jun-12
YOGYAKARTA 2248 2042 365 17.9 922 45.2 50.0 11-Jun-12
Indonesia Total from four labs 7485 7276 2469 33.9 2506 34.4 55.8
Maldives Male 2 501 501 1 0.2 11 2.2 99.8 08-Jan-12
Myanmar Yangon 1907 1769 1248 70.5 97 5.5 83.9 09-Aug-12
Nepal Kathmandu 1101 1047 176 16.8 350 33.4 88.0 08-Jan-12
Sri Lanka Colombo 254 247 6 2.4 140 56.7 89.5 05-Jan-12
Thailand Bangkok 362 319 96 30.1 37 11.6 99.4 09-Mar-12
Timor-Leste Dilli 109 109 84 77.1 8 7.3 100.0 13-Jun-11
Total 18197 17707 7289 41.2 4041 22.8 70.5
Source: Reported by SEAR Measles Laboratory Network NR=No Report
1
Percentages may not add to 100%; Equivocal results not included and some samples are in process with results pending. Some countries test samples for both Measles and Rubella.
2
497 samples were received for Rubella testing from the hospital (routine Antenatal cases).

Measles and Rubella Serology (IgM) Results - Monthly Reporting, SEAR, 2012 (data up to Aug 2012)
Positive Results 1
Number of Serum % Measles Results
Number Tested for Date of Last Report
Country Laboratories Samples Measles Rubella Reported with in 7
Measles & Rubella Received in SEARO
Received Days
# % # %
Bangladesh Dhaka 2073 2073 693 33.4 442 21.3 38.0 06-Sep-12
Bhutan Thimphu 56 56 1 1.8 1 1.8 80.4 10-Sep-12
DPR Korea Pyongyang 44 44 0 0.0 1 2.3 100.0 31-Aug-12
Ahmedabad 111 111 38 34.2 23 20.7 100.0 04-Sep-12
Bangalore 119 119 16 13.4 59 49.6 100.0 04-Sep-12
Chennai 252 220 85 38.6 19 8.6 60.9 07-Sep-12
India Hyderabad 14 14 0 0.0 7 50.0 100.0 03-Sep-12
Jaipur 67 67 40 59.7 0 0.0 89.6 01-Aug-12
2012 Kolkata
Pune
142
3
142
3
53
3
37.3
100.0
17
0
12.0
0.0
95.1
33.3
08-Aug-12
10-Sep-12
India Total from six labs 708 676 235 34.8 125 18.5 84.9
BANDUNG 302 298 32 10.7 169 56.7 100.0 05-Sep-12
JAKARTA 1392 1384 282 20.4 339 24.5 95.1 05-Sep-12
Indonesia
SURABAYA 874 769 198 25.7 203 26.4 100.0 05-Sep-12
YOGYAKARTA 1168 954 45 4.7 282 29.6 100.2 05-Sep-12
Indonesia Total from four labs 3736 3405 557 16.4 993 29.2 98.1
Maldives Male 2 296 296 0 0.0 1 0.3 99.0 09-Sep-12
Myanmar Yangon 1287 1240 1065 85.9 10 0.8 21.3 07-Sep-12
Nepal Kathmandu 852 852 193 22.7 289 33.9 57.2 10-Sep-12
Sri Lanka Colombo 45 45 0 0.0 19 42.2 68.9 06-Sep-12
Thailand Bangkok 282 281 133 47.3 22 7.8 98.9 10-Sep-12
Timor-Leste Dilli - - -
Total 9379 8968 2877 32.1 1903 21.2 68.5
Source: Reported by SEAR Measles Laboratory Network NR=No Report
1
Percentages may not add to 100%; Equivocal results not included and some samples are in process with results pending. Some countries test samples for both Measles and Rubella.
2
292 samples were received for Rubella testing from the hospital (routine Antenatal cases).

58
Updated on 17 Sep 2012