1. Epidemiologi Polio
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Epidemiologi Poliomyelitis dan Aspek Imunisasi
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Transcript of 1. Epidemiologi Polio
Epidemiologi Poliomyelitis
dan Aspek Imunisasi
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
POLIOMYELITISKerusakan sel motorneuron (cornu anterior) di Medula Spinalis akibat suatu peradangan yang disebabkan oleh virus polio, dengan manifestasi KELUMPUHAN.
Cornu anterior
Medula spinalisPenampang horisontal
Virus Polioagent penyebab Poliomyelitis
X-ray Crystallography • Virus RNA, ±7500 nucleotide• Diameter 27-30 nm• Genus Enterovirus• Fam. PicornaviridaeTahan terhadap:
asam,sabun,ether, chloroformInaktivasi 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
0
20
40
60
80
100
120
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
(10%)
Laju inaktivasi menurun 90%
Laju Inaktivasi Virus Polio Liar Berdasarkan Musim
0
20
40
60
80
100
120
hari
(%)
Air Laut Air Bersih Air Limbah
10%
26
Laju inaktivasi menurun 90%
Laju Inaktivasi Virus Polio Liar Berdasarkan Jenis Air
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
• 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.
Virus Polioepidemiology
VIRUS POLIO MASUK KE ANAK LAIN MELALUI MULUT
ANAK TERINFEKSI VIRUS POLIO, BAB
TIDAK CUCI TANGAN DENGAN
BAIK SETELAH BAB
MAK-MIN TERKONTAMINA
SI
ANAK SAKIT POLIO
PENYEBARAN VIRUS POLIO DI LINGKUNGAN
Exkresi virus polio liar melalui tinja
63-96%
35 – 75%
<50%
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.
HOSTFaktor 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
PoliomeylitisMelalui 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
29
67
31
50
89
52
65
96
67
0
10
20
30
40
50
60
70
80
90
100
Poliovirus type 1 Poliovirus type 2 Poliovirus type 3
Dose 1
Dose 2
Dose 3
Pe
rce
nt
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.
MANFAATImunisasi 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 divaksinasi
Anak Divaksinasi lebih 100 hr yl
Anak divaksinasi Kurang dari 100 hr yl
Transmisi (+)sakit (+)
Transmisi (+)sakit (-)
Transmisi (-)sakit (-)
=Vaksin
= VPL
EPIDEMIOLOGI YANG RELEVAN UNTUK ERADIKASI
1. Virus hanya hidup di manusia
2. Daya hidup di lingkungan singkat
3. Virus diekskresi
4. Kekebalan intestinal
5. Tipe 2 yg pertama punah
Memungkinkan dibasmi
Waktu pengambilan spesimenOPV jadi vaksin pilihan
Perkembangan ke arah eradikasi
POLIOMYELITISFaktor Resiko
• Waktu
• Tempat
• Orang
• 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
POLIOMYELITIS (Lanjutan) Faktor Resiko
Kasus Polio di Kab. Sukabumi, Jawa Barat, Maret-April 2005
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 (-)
• 11 kasus, spesimen lab tunggu
120 spesimen kontak lab tunggu
4 desa imunisasi polio masal balita 24-25 April 2005
Cicurug
Bj.Genteng
TEMPAT (2)
Wild Poliovirus Cases Indonesia March 2005 – 6 April 2006
#S
#S
#S
#S##SS
#S
##SS
#S
#S
#S#S
#S
#S
#S#S
#S
#S
#S
#S
#S
##SS
#S
#S
#S
##SS#S
#S
#S #S
#S
#S ##########SSSSSSSSSS#S #S
#S
##SS#S#S
#S
###SSS
##
#SS
S
#S #S#S #####SSSSS##SS
#S
#S#######SSSSSSS
#S########################SSSSSS SSSSSSSSSSSSSSSSSS######SSSSSS
#S#S#S#S###SSS
#S
##################################################################################################SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS####################################################SSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSSS
######################SSSSSSSSSSSSSSSSSSSSSS#S
#########SSSSSSSSS
#
SUME NEP
#
PAME KASAN
#
SAMP ANG
#
BANG KALAN
#
SITU BOND O
BOND OWOSO
JE MBER
BANYU WA NGI
PROB OLIN GGO
LU MAJAN G
G AY O L U ES
AC E H TE N G G A R A
LA N G K AT
KA R O
AC E H TI MU R
#
SUME NEP
#
PAME KASAN
#
SAMP ANG
#
BANG KALAN
#
SITU BOND O
BOND OWOSO
JE MBER
BANYU WA NGI
PROB OLIN GGO
LU MAJAN G
G AY O L U ES
AC E H TE N G G A R A
LA N G K AT
KA R O
AC E H TI MU R
= 1 WPV CaseTotal infected district s: 47Total infected provinces : 10
Data as of 6 April 2006
TEMPAT (3)
0
10
20
30
40
50
60
70
80
90
100
110
120
130
140
150
J-06 F M A M J J A S O N D
J-07 F M A M J J A S O N D
J-08 F M A M J J A S O N D
J-09 F M A M J J A S O N D
J-10 F M A
Num
ber
of w
pv c
ases
.
WPV 1 monthly onset, with targeted SIAs, NIGERIA 2006 – 2010
Continuous arrow = National IPDsBroken arrows = Sub-national IPDs* mOPV1 was used only in 4 southern states in October
tOPV mOPV1 bOPV
*
WAKTU (1)
0
100
200
300
400
500
600
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
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Total AFP, Polio*, Non Polio and Pending Cases by Onset of Paralysis, Indonesia 2005
Data as of 29 January 2006* WPV, Compatible, and VDPV Cases
WAKTU (2)
24-35 mths33%
12 - 23 mths34%
< 12 mths6%
60+3%
48 - 595%
36 - 47 mths18%
Unknown0%
6
Unknown0%
60 + mths8%
12 - 23 mths28%
24 - 35 mths34%
36 - 47 mths15%
48 - 59 mths9%
< 12 mths6%
Age group of WPV cases 2008/2009, NIGERIA
Age’09 (n=388)
68% < 3 yrs
Age’08 (n=782)
73% < 3 yrs
ORANG (1)
0 dose38%
'1-2 dose47%
3+ dose15%
Characteristics of Wild Polio Cases, Indonesia 2005
0-11 Month5%
>60 Month18%
36-60 Month22%
12-35 Month55%
Group of Age OPV Dose*
Data as of 29 January 2006
*do not include missing data
ORANG (2)
EPIDEMIOLOGITURUNAN VIRUS
POLIO
Kelumpuhan yang disebabkan oleh:
• Virus vaksin
• VDPV
• VPL
Secara klinis disebut Poliomyelitis
Secara klinis disebut VAPP
- Vaccine Associated Paralytic Polio
- Vaccine Derived Polio virus
VAPPVaccine Associated Paralytic Polio
• 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
Batasan
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
MENGAPA TERJADI VAPP?
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 Day
1 : 6 juta dosis
• 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
VDPV (Vaccine-derived Polio Virus)
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
Philippines 2001
3 cases
Hispaniola 2000-1
22 cases
Madagascar2002/20054/3 cases
Egypt 1988-9332 cases
Indonesia On-going46 cases
V1
V2
Nigeria2005-2010
307 cs
India2009-2010
12 cs
Congo2008-2009
16 cs
Ethiopia2008-2009
4 cs
Note:
VAPP VDPV
Akibat respon imun yang rendah dari individu
Tidak ada kasus lain (tidak menular)
Akibat rendahnya imunitas masyarakat
Menjadi KLB
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.
SEARO, New Delhi, 2012
Immunization and VaccineDevelopment (IVD) SEARO
Protecting People from Vaccine Preventable Diseases
Weekly AFP and VPD Update for Week 40, 2012
Data as of 08 October 2012
48
Wild Polio VirusIndia, 2011
*Dots are randomly placed within blocks (Sub-districts)
= Most recent P1 Wild polio case
101
1
P1 Wild13-Jan-2011; District Howra, West Bengal
P3 Wild -
Date and location of most recent case
Wild Polio Cases, 2011Total P1 Wild cases
Total polio cases
Total districts with wild cases
Total P3 Wild cases
Districts with cases in 2011
Districts with cases in current week
Data as of 08 Oct 2012
49
Wild Polio Cases by Type (P1, P3) and Month of OnsetIndia, 2007-2012
Data as of 08 Oct 2012
0
20
40
60
80
100
120
140
160
180
200
220
Jan
Fe
bM
ar
Ap
rM
ay
Jun
Jul
Au
gS
ep
Oct
No
vD
ec
Jan
Fe
bM
ar
Ap
rM
ay
Jun
Jul
Au
gS
ep
Oct
No
vD
ec
Jan
Fe
bM
ar
Ap
rM
ay
Jun
Jul
Au
gS
ep
Oct
No
vD
ec
Jan
Fe
bM
ar
Ap
rM
ay
Jun
Jul
Au
gS
ep
Oct
No
vD
ec
Jan
Fe
bM
ar
Ap
rM
ay
Jun
Jul
Au
gS
ep
Oct
No
vD
ec
Jan
Fe
bM
ar
Ap
rM
ay
Jun
Jul
Au
gS
ep
2007 2008 2009 2010 2011 2012
Po
lio C
ase
s
P1 P3
P1 P3 P1 P3 P1 P3 P1 P3 P1 P3 P1 P3Jan 15 9 1 111 7 7 2 14 1 0 0 0Feb 6 8 2 51 2 3 1 2 0 0 0 0Mar 8 6 1 39 3 13 0 0 0 0 0 0Apr 3 11 0 40 4 9 1 1 0 0 0 0May 7 25 1 33 4 19 2 0 0 0 0 0Jun 1 29 3 35 8 71 1 1 0 0 0 0Jul 10 54 7 46 6 83 3 2 0 0 0 0Aug 10 67 21 46 11 108 4 3 0 0 0 0Sep 4 77 17 32 19 126 3 0 0 0 0 0Oct 3 95 5 27 11 118 0 1 0 0Nov 8 194 8 16 3 57 0 0 0 0Dec 5 216 9 8 1 47 1 0 0 0
Sub-Total 80 791 75 484 79 661 18 24 1 0 0 0Total*
2011
1
2007 2012
0
20102009
740*Note: Wild polio mixtures (P1+P3) not included in the graph or table.
871 559 42
Month2008
50
Monthly Distribution of AFP CasesSEAR, 2011 – 2012
Data as of 08 Oct 2012
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
Date of last report
Au
g-1
2
Oct
-12
Sep
-122011
total AFP
2012 AFP to
date Mar
-12
No
v-11
Jan
-12
Dec
-11
AFP cases by month of paralysis onset, last 14 months (data from weekly case-based reports)
Jul-
12
Jun
-12
Feb
-12
Ap
r-12
Oct
-11
Country
Sep
-11
May
-12
51
Primary culture results from AFP cases 2011
Data as of 08 Oct 2012
<=14 days
>14 days
Vac
cin
e
Wild
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
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
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
63465 2870 534 15575 44486 0 0 127217 96.5 19.5 1620 96 01 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.
AFP specimens Specimens from other
sources 2
Positive Culture
Positive Culture +
NPEV
NPEV Only
Results
Received by lab
% Primary Culture Reports Within 14
days
% N
PE
V
Number received by
lab
Primary culture results from AFP cases 2011
SEAR
India
Indonesia
Pending1
Country Polio Laboratories
Number of AFP cases with
specimens received in Lab
Negative
AFP cases
52
Week35 34035 11 3 22 64 4980 35049 1 5 0 0 24 4975 37091 0 1 0 0 5 5465 Week35Week36 35519 13 3 22 64 5141 36630 1 5 0 0 24 4998 38963 0 1 0 0 5 5809 Week36Week37 36931 14 3 22 64 5298 38240 1 5 0 0 24 5392 40752 0 1 0 0 5 5725 Week37Week38 38221 15 3 22 64 5310 39807 1 5 0 0 30 5007 42727 0 1 0 0 5 5873 Week38Week39 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 Week40Week41 42410 16 3 23 79 5291 44495 1 5 0 0 30 6058 Week41Week42 43648 16 3 23 79 5276 46066 1 5 0 0 30 5925 Week42Week43 44907 16 3 23 96 4861 47442 1 5 0 0 30 5992 Week43Week44 46065 16 3 23 96 5166 48458 1 5 0 0 30 5606 Week44Week45 46989 17 3 23 96 4969 49744 1 5 0 0 33 5179 Week45Week46 47987 17 3 23 96 5063 51035 1 5 0 0 33 5130 Week46Week47 48994 17 3 23 108 4746 52590 1 5 0 1 33 5510 Week47Week48 50093 17 3 23 108 4860 53994 1 5 0 1 43 5277 Week48Week49 51171 17 3 24 108 4958 55203 1 5 0 1 43 4993 Week49Week50 52172 17 3 24 108 5125 56340 1 5 0 1 43 5001 Week50
AF
P
P1
(WP
V)
P2
(VD
PV
)
P3
(WP
V)
Co
mp
atib
le
Pen
din
g
AF
P
P1
(WP
V)
P2
(VD
PV
)
P3
(WP
V)
P3
(VD
PV
)
Co
mp
atib
le
Pen
din
g
AF
P
P1
(WP
V)
P2
(VD
PV
)
P3
(WP
V)
P3
(VD
PV
)
Co
mp
atib
le
Pen
din
g
Week1 29 0 0 0 0 29 15 0 0 0 0 0 15 2 0 0 0 0 0 2 Week1Week2 427 0 0 0 0 427 345 0 0 0 0 0 345 417 0 0 0 0 0 417 Week2Week3 1151 0 0 3 0 1008 1024 0 0 0 0 0 925 1230 0 0 0 0 0 1141 Week3Week4 1864 0 1 3 0 1313 1848 0 0 0 0 0 1274 2230 0 0 0 0 0 1585 Week4Week5 2564 1 1 7 0 1262 2888 0 0 0 0 0 1526 3154 0 0 0 0 0 1590 Week5Week6 3352 2 1 10 0 1518 3773 1 1 0 0 0 1709 4039 0 0 0 0 0 1633 Week6Week7 4197 2 2 14 0 1600 4662 1 1 0 0 0 1687 5115 0 0 0 0 0 1748 Week7Week8 5031 2 2 14 0 1742 5522 1 1 0 0 0 1720 6117 0 0 0 0 0 1872 Week8Week9 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 Week10Week11 7325 3 3 16 0 1993 8281 1 2 0 0 0 2209 8912 0 1 0 0 0 1985 Week11Week12 8097 3 3 16 0 2038 9024 1 2 0 0 0 2150 9985 0 1 0 0 0 2361 Week12Week13 9135 3 3 16 0 2038 9949 1 2 0 0 0 2319 11057 0 1 0 0 0 2525 Week13Week14 9919 3 3 16 0 2338 11026 1 2 0 0 0 2687 12042 0 1 0 0 0 2778 Week14Week15 10751 3 3 16 0 2465 11914 1 3 0 0 0 2779 12944 0 1 0 0 0 2578 Week15
Wee
k N
um
ber
Weekly Comparison of AFP, Wild, VDPV, Compatible & Classification Pending, India, 2010-2012
Wee
k N
um
ber
2010 2011 2012
Weekly Bulletin Comparison, India, 2010-2012
Data as of 08 Oct 2012
53
Data (NPSP) as of 05 Oct 2012
Wild poliovirus detected in sewage samples, 2010-2011
Wild poliovirus type 1
Wild poliovirus type 3 Result pending
Negative for wild poliovirus Scheduled but sample not collectedX
Sampling not scheduled
2010Mumbai
Week
F ward
G ward
M ward
DelhiWeek
Red cross hospital
Bhalaswa lake
Wazirpur JJ colony
Swarn cinema
Batala house (Okhla)
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
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 X
X X X
X X
X X X X X
Mumbai
Delhi
2010Mumbai
Week
F ward
G ward
M ward
DelhiWeek
Red cross hospital
Bhalaswa lake
Wazirpur JJ colony
Swarn cinema
Batala house (Okhla)
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
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 X
X X X
X X
X X X X X
Mumbai
Delhi
2011Mumbai
Delhi
Patna
Kolkata
Week
F ward
G ward
M ward
Week
Red cross hospital
Bhalaswa lake
Wazirpur JJ colony
Swarn cinema
Batala house (Okhla)
Sonia vihar
Nangloi
Week
Choti pahari
Dujara
Transport nagar
Week
Ward 8, MM
Ward 135, KMC
49 50 51 5245 46 47 4841 42 43 4437 38 39 4033 34 35 3629 30 31 3225 26 27 2821 22 23 2417 18 19 2013 14 15 169 10 11 125 6 7 81 2 3 4
XX XXX
XXX
XXXXXXX
X XXXX
X XXXX
XX
X
XXX
X XXXXXX
X
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
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
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 39 4033 34 35 36 5245 46 47 48
X
49 50 5141 42 43 4437 38
54
Data (NPSP) as of 05 Oct 2012
Wild poliovirus detected in sewage samples, 2012
Wild poliovirus type 1
Wild poliovirus type 3 Result pending
Negative for wild poliovirus Scheduled but sample not collectedX
Sampling not scheduled
Mumbai
Delhi
Patna
Kolkata
Week
F ward
G ward
M ward
Week
Red cross hospital
Bhalaswa lake
Wazirpur JJ colony
Swarn cinema
Batala house (Okhla)
Sonia vihar
Nangloi
Week
Choti pahari
Dujara
Transport nagar
Week
Ward 8, MM
Ward 135, KMC
Ward 29, KMC
Ward 66, KMC
49 50 51 5245 46 47 4841 42 43 4437 38 39 4033 34 35 3629 30 31 3225 26 27 2821 22 23 2417 18 19 2013 14 15 169 10 11 125 6 7 81 2 3 4
X XX XX
XX XX
XX XX
X X X X
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
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
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 35 3629 30 31 32 5245 46 47 48 5141 42 43 44 49 5037 38 39 4033 34
`
Mumbai
Delhi
Patna
Kolkata
Week
F ward
G ward
M ward
Week
Red cross hospital
Bhalaswa lake
Wazirpur JJ colony
Swarn cinema
Batala house (Okhla)
Sonia vihar
Nangloi
Week
Choti pahari
Dujara
Transport nagar
Week
Ward 8, MM
Ward 135, KMC
Ward 29, KMC
Ward 66, KMC
49 50 51 5245 46 47 4841 42 43 4437 38 39 4033 34 35 3629 30 31 3225 26 27 2821 22 23 2417 18 19 2013 14 15 169 10 11 125 6 7 81 2 3 4
X XX XX
XX XX
XX XX
X X X X
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
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
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 35 3629 30 31 32 5245 46 47 48 5141 42 43 44 49 5037 38 39 4033 34
`
55
Vaccine Preventable Diseases SEAR, 2011
Updated on 24 Sep 2012
Vaccine Preventable Diseases reported to SEARO for year 2011 (data upto Dec 2011)
Number of Outbreaks
Number of cases
Number of Outbreaks
Number of cases
Number of
Outbreaks
Number of cases
Date of last report
Number of reports
expected
% Complete
% Timely
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 67511 At least 5 blood samples should be collected and tested from each outbreak. 2 Adverse Events Following Immunization; Sri Lanka AEFI data do not reflect cases but events. 3 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).
Cases
Classification of Outbreaks 1 Suspected measles outbreaksRoutine Reporting of clinically suspected
measles cases
Tested for serology
Serology +ve
measles
Serology +ve
Rubella
Number of Outbreaks
Investigated *
Lab confirmed Measles Outbreaks
Timeliness and Completeness of reports received in SEARO, 2011 3
Number of Cases of
AEFI 2
Lab confirmed Rubella Outbreaks
Pertussis
Country
EncephalitisNeonatal Tetanus(NNT)
Diphtheria
Lab confirmed Mixed Outbreaks
Number of Cases
DeathsNumber of Outbreaks
Number of Cases
Deaths
56
Vaccine Preventable Diseases SEAR, 2012
Updated on 24 Sep 2012
Vaccine Preventable Diseases reported to SEARO for year 2012 (data upto Jul 2012)
Number of Outbreaks
Number of cases
Number of Outbreaks
Number of cases
Number of
Outbreaks
Number of cases
Date of last report
Number of reports
expected
% Complete
% Timely
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 43561 At least 5 blood samples should be collected and tested from each outbreak. 2 Adverse Events Following Immunization; Sri Lanka AEFI data do not reflect cases but events. 3 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).
Country
EncephalitisNeonatal Tetanus(NNT)
Diphtheria
Lab confirmed Mixed Outbreaks
Number of Cases
DeathsNumber of Outbreaks
Number of Cases
Deaths
Timeliness and Completeness of reports received in SEARO, 2012 3
Number of Cases of
AEFI 2
Lab confirmed Rubella Outbreaks
PertussisCases
Classification of Outbreaks 1 Suspected measles outbreaksRoutine Reporting of clinically suspected
measles cases
Tested for serology
Serology +ve
measles
Serology +ve
Rubella
Number of Outbreaks
Investigated *
Lab confirmed Measles Outbreaks
57
Measles and Rubella Serology (IgM) ResultsSEAR, 2011-2012
Updated on 17 Sep 2012
2011
2012
# % # %Bangladesh Dhaka 4417 4381 1934 44.1 711 16.2 68.5 09-May-12Bhutan Thimphu 98 98 9 9.2 7 7.1 100.0 06-Jan-12DPR 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-12Bangalore 208 208 120 57.7 44 21.2 100.0 02-Jan-12Chennai 157 157 88 56.1 34 21.7 92.4 03-Jan-12Hyderabad 180 177 106 59.9 8 4.5 89.3 05-Mar-12Jaipur 103 103 77 74.8 4 3.9 99.0 04-Jan-12Kolkata 326 326 193 59.2 39 12.0 91.1 02-Jan-12Pune 617 617 448 72.6 43 7.0 81.5 19-Mar-12
1893 1890 1266 67.0 174 9.2 90.4BANDUNG 1015 1015 539 53.1 284 28.0 98.7 11-Jun-12JAKARTA 2640 2637 857 32.5 888 33.7 47.3 11-Jun-12SURABAYA 1582 1582 708 44.8 412 26.0 50.0 11-Jun-12YOGYAKARTA 2248 2042 365 17.9 922 45.2 50.0 11-Jun-12
7485 7276 2469 33.9 2506 34.4 55.8Maldives Male 2 501 501 1 0.2 11 2.2 99.8 08-Jan-12Myanmar Yangon 1907 1769 1248 70.5 97 5.5 83.9 09-Aug-12Nepal Kathmandu 1101 1047 176 16.8 350 33.4 88.0 08-Jan-12Sri Lanka Colombo 254 247 6 2.4 140 56.7 89.5 05-Jan-12Thailand Bangkok 362 319 96 30.1 37 11.6 99.4 09-Mar-12Timor-Leste Dilli 109 109 84 77.1 8 7.3 100.0 13-Jun-11
18197 17707 7289 41.2 4041 22.8 70.5Source: Reported by SEAR Measles Laboratory Network NR=No Report1 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).
Total
Indonesia
Country Laboratories
Indonesia Total from four labs
India Total from six labs
India
Measles and Rubella Serology (IgM) Results - Monthly Reporting, SEAR, 2011 (data up to Dec 2011)
Measles RubellaDate of Last Report Received in SEARO
Number of Serum Samples Received
Number Tested for Measles & Rubella
Positive Results 1 % Measles Results Reported with in 7
Days
# % # %Bangladesh Dhaka 2073 2073 693 33.4 442 21.3 38.0 06-Sep-12Bhutan Thimphu 56 56 1 1.8 1 1.8 80.4 10-Sep-12DPR 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-12Bangalore 119 119 16 13.4 59 49.6 100.0 04-Sep-12Chennai 252 220 85 38.6 19 8.6 60.9 07-Sep-12Hyderabad 14 14 0 0.0 7 50.0 100.0 03-Sep-12Jaipur 67 67 40 59.7 0 0.0 89.6 01-Aug-12Kolkata 142 142 53 37.3 17 12.0 95.1 08-Aug-12Pune 3 3 3 100.0 0 0.0 33.3 10-Sep-12
708 676 235 34.8 125 18.5 84.9BANDUNG 302 298 32 10.7 169 56.7 100.0 05-Sep-12JAKARTA 1392 1384 282 20.4 339 24.5 95.1 05-Sep-12SURABAYA 874 769 198 25.7 203 26.4 100.0 05-Sep-12YOGYAKARTA 1168 954 45 4.7 282 29.6 100.2 05-Sep-12
3736 3405 557 16.4 993 29.2 98.1Maldives Male 2 296 296 0 0.0 1 0.3 99.0 09-Sep-12Myanmar Yangon 1287 1240 1065 85.9 10 0.8 21.3 07-Sep-12Nepal Kathmandu 852 852 193 22.7 289 33.9 57.2 10-Sep-12Sri Lanka Colombo 45 45 0 0.0 19 42.2 68.9 06-Sep-12Thailand Bangkok 282 281 133 47.3 22 7.8 98.9 10-Sep-12Timor-Leste Dilli - - -
9379 8968 2877 32.1 1903 21.2 68.5Source: Reported by SEAR Measles Laboratory Network NR=No Report1 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).
Measles and Rubella Serology (IgM) Results - Monthly Reporting, SEAR, 2012 (data up to Aug 2012)
Measles RubellaDate of Last Report Received in SEARO
Number of Serum Samples Received
Number Tested for Measles & Rubella
Positive Results 1 % Measles Results Reported with in 7
Days
Total
Indonesia
Country Laboratories
Indonesia Total from four labs
India Total from six labs
India
