Management of Poliomyelitis Eradication in the Border Areas of Myanmar and Bangladesh

Transcription

1 SEA-Polio-23 Distribution: General Management of Poliomyelitis Eradication in the Border Areas of and Bangladesh Report of a Meeting Yangon,, June 2000 WHO Project: MMR VAB 051 World Health Organization Regional Office for South-East Asia New Delhi March 2001

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3 World Health Organization 2000 This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization. The document may, however, by freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or for use in conjunction with commercial purposes. The views expressed in documents by named authors are solely the responsibility of those authors.

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5 CONTENTS Page 1. INTRODUCTION ORGANIZATION OF THE MEETING PROGRESS TOWARDS THE ERADICATION OF POLIOMYELITIS COUNTRY PRESENTATIONS Bangladesh RECOMMENDATIONS Group A: Policy and Coordination of Activities Group B: Surveillance Group C: Immunization Activities...14 Annexes 1. List of Participants Programme Proposed Discussion Points for Group Seminars Progress of Polio Eradication in...25 Page iii

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7 1. INTRODUCTION This report summarizes the proceedings of "The Meeting on Management of Poliomyelitis Eradication on the Border Areas" held between Bangladesh and, to address coordinated actions for the eradication of poliomyelitis in the border areas between these two countries. This meeting has been convened in response to the documented transmission of wild poliovirus in the border area between May 1999 and February ORGANIZATION OF THE MEETING The first meeting on management of poliomyelitis eradication in the border areas of Bangladesh and was held in Yangon,, on June 2000 and was attended by forty participants from national, province/state, and township/county levels of these two countries, as well as representatives of IOCH, UNICEF, and WHO. The meeting brought together representative of the Ministry of Health (MOH), Ministry of Home Affairs (MHA), Ministry of Foreign Affairs (MOFA) from the two countries, as well as representatives from related ministries and departments, including the Ministry of Immigration and Manpower (). List of participants is provided at Annex 1. The meeting was chaired by H.E. Prof. Dr Mya Oo, Deputy Minister, Ministry of Health, and co-chaired by Mr Mohammed Janibul Haq, Joint Secretary, MHA, Bangladesh. Dr Ye Myint, Director Disease Control, Department of Health, Ministry of Health,, Dr Zakir Hussain, Director MOH, Bangladesh, Dr Jos Vandelaer, Medical Officer, WHO and Dr Rownak Khan, Programme Officer, EPI, UNICEF Bangladesh served as rapporteurs. The opening session was addressed by H.E. Major- General Ket Sein, Minister of Health,. Brief statements were made by H.E. Professor Mya Oo, Deputy Minister, Ministry of Health,, Mr Mohamed Janibul Haq, Joint Secretary, MHA, Bangladesh, Mr B. Mendis, UNICEF Representative to, Dr A. Borra, WHO Representative to, and Dr Wann Maung, Director-General, Department of Health, MOH,. Page 1

8 Laboratory Diagnosis of HIV Opportunistic Infections The participants of the meeting were updated on the status of polio eradication activities across the border. Presentations were made by the representatives from Bangladesh and. Following these plenary presentations, three working groups were convened. These groups discussed (1) Policy and Coordination Issues (2) Surveillance and (3) Supplemented Immunization Activities. The programme is given in Annex 2. Annex 3 summarizes the proposed discussion points and the participants for each group. 3. PROGRESS TOWARDS THE ERADICATION OF POLIOMYELITIS COUNTRY PRESENTATIONS 3.1 Bangladesh Bangladesh was one of the first countries in the WHO South-East Asia Region to conduct National Immunization Days (NIDs) in February and March of Bangladesh has conducted seven NIDs since 1995, reaching 90% of the targeted children with polio vaccine each time, and by so doing, has substantially reduced the amount of wild poliovirus circulation in the country. Before NIDs, at least children developed polio each year. In 1999, wild poliovirus was isolated from 29 children with the sudden onset of acute flaccid paralysis (AFP) in Bangladesh. (See Fig. 1) In 2000, not one wild poliovirus has yet been isolated from any child with AFP as of epidemiologic week 24, June The tremendous reduction of wild poliovirus circulation in Bangladesh in 2000 is attributable to the intensification of NIDs at the end of The sixth NIDs, conducted in November and December 1999, included a child-to-child search component for four consecutive days following each of the fixed site sessions. At least one million additional children (5% of the target) were reached as a result of the child-tochild search. This was followed up by two additional rounds of Intensified NIDs in April and May. Survey data from the seventh NIDs indicate coverage of 94% in the first round and 92% in the second round. First round coverage includes 7% of children reached through the child to child campaign and second round coverage includes 11% additional children from the child to child campaign. In all, 97% of children were reached with at least one dose, and 88% received both doses. (See Fig. 2) Page 2

9 Report of a Meeting Figure 1. Districts with Wild Poliovirus, Bangladesh 1999 Sl. No. District Thana Municipality Result 1. Brahmanbaria Sadar P1W 2. Chandpur Haim Char P1W 3. Chittagong Banshkhali P1W 4. Chittagong Satkania P1W 5. Comila Dividwar P1W 6. Comila Dividwar P1W 7. Comila Daudkandi P1W 8. Comila Daudkandi P1W 9. Comila Brahmanpara P1W 10. Lakshimpur Raipur P1W 11. Lakshimpur Sadar P1W 12. Noakhali Begumganj P1W 13. Dhaka DCC P1W 14. Dhaka DCC P3W 15. Dhaka DCC P1W Sl. No. District Thana Municipality Result 16. Faridpur Boalmari P1W 17. Faridpur Bhanga P3W 18. Kishoreganj Hossainpur P1W 19. Madaripur Sadar P1W 20. Madaripur Sadar P1W 21. Madaripur Shibchar P1W 22. Mymensing Gouripur P1W 23. Narshingdhi Sadar P1W 24. Sariatpur Sadar P1W 25. Magura Sadar P1W 26. Moulavibazar Sadar P1W 27. Nowabganj Shibganj P1W 28. Gaibanda Sadullapur P1W 29. Barguna Barguna P1W Page 3

10 Management of Poliomyelitis Eradication in the Border Areas of and Bangladesh Figure 2. Percentage of children reached through NIDs, by survey, Bangladesh Percent % at home 11% at home st ND (1995) 3rd NID(96-97) 4th NID(97-98) 5th NID(98-99) 7th NID(2000) st Round 2nd Round Both Rounds Source: National Coverage Evaluation Survey EPI, DGHS, MOHFW In addition to NIDs, Bangladesh has conducted mop-up campaigns in two upazilas (Teknaf and Ukhia, Cox s Bazar) along the border in September 1999 and March These upazilas were also included in the Intensified NIDs in November and December and again in April and May. (See Fig. 3) 88 Bangladesh has made steady progress in detecting children with AFP, and its national polio laboratory has been significantly strengthened to evaluate large numbers of stool specimens and to reliably isolate wild poliovirus. In addition, all stool specimens have been sent to the Centres for Disease Control and Prevention in USA for parallel testing since July The non-polio AFP rate increased from 0.14 to 0.33 to 0.87 in 1997, 1998, and 1999 respectively. (See Fig. 4) The percentage of stools collected within 14 days of paralysis onset has decreased from 59% to 49% from 1998 to (See Fig. 5 and 6) This is because of delayed reporting of AFP cases. Although 83% of cases were investigated within 48 hours of report, only 56% were reported within 10 days of paralysis onset in To strengthen AFP surveillance, WHO has recruited a total of 32 Surveillance Medical Officers. Page 4

11 Report of a Meeting STOP Teams from the US Centres for Disease Control and Prevention will continue to support Bangladesh. USAID-funded IOCH has assigned 18 Operations and Surveillance Officers to support hospital-based surveillance and surveillance training. Five JOCV volunteers are also continuing to support polio eradication activities. SMOs will provide refresher orientation at the upazila level and below, especially for village doctors and local healers. Bangladesh also plans to use mass communication methods and NGOs more extensively to improve AFP case reporting. Figure3. Discarded, clinically confirmed, and laboratory confirmed polio cases, Southeast Chittagong Division, 1999 Page 5

12 Management of Poliomyelitis Eradication in the Border Areas of and Bangladesh Figure 4. Total non-polio AFP reporting rate (/1,00,000 per year) by division, Bangladesh * National DHAKA CTG SYL RAJ KHU BAR * Figure 5. AFP cases by month of Paralysis onset, Bangladesh * Jan Feb Mar Apr May Jun Jul Aug 1997 (n = 243) 1998 (n = 475 ) 1999 (n = 761) 2000 Page 6

13 Report of a Meeting Figure 6. Percent of AFP cases with laboratory results within 28 days of reception, by quarter, Bangladesh Total 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr Regarding routine EPI coverage, crude OPV3 coverage has increased for three consecutive years from 77% to 78% to 82% in the 1997, 1998, and 1999 national coverage evaluation surveys. (See Fig. 7) Three valid OPV doses by 12 months, however, are received by only 66% of infants. Figure 7. Crude Vaccination coverage among month old children, National Weighted Average, by year, Bangladesh BCG OPV3/DPT3 Measles Fully Immunized 1997 survey 1998 survey 1999 Survey Page 7

14 Management of Poliomyelitis Eradication in the Border Areas of and Bangladesh 3.2 The Union of has implemented all basic strategies for polio eradication. Annex 4 summarizes data related to the polio eradication programme in. Reported routine OPV3 coverage in is above 85 percent, but some pockets of low coverage or unreached areas continue to exist. In these areas, which include certain area along the -Bangladesh border, special "crash programmes" have been conducted. Crash programmes are on average carried out thrice a year, targeting children 0-3yrs of age. Five years of NIDs have been successfully completed, with reported national coverage exceeding 95% in all five years. (See Fig. 8) The fourth and fifth year NIDs were successfully coordinated with China along the major crossing points on the -China border. In order to coordinate efforts at these points, local level counterparts met one week before each round of the fourth year NIDs to make appropriate preparations. Page 8

15 Report of a Meeting carried out mop-up campaigns in 30 townships in Oct/Nov 1999, four of which were in Rakhine State. A second mop-up, targeting all 17 townships in Rakhine (and Paletwa) was organized in Feb/March 2000, and coverage was above 90 %. The national annualized total AFP rate for 1999 is 1.14 per population aged below 15 years and the annualized non-polio AFP rate is (See Fig. 9) In 1999, the AFP surveillance system was able to detect four cases of wild virus positive poliomyelitis in Rakhine State. Another two wild virus cases were found in Rakhine in early Key strategies for AFP surveillance include: (a) frequent supervisory visits to peripheral levels, (b) advocacy meetings held with clinicians in hospitals and with NGOs, (c) initiation of active hospital surveillance in 32 major hospitals nation-wide; (d) training on AFP surveillance at all levels, e) active searches for AFP cases during house-to-house enumeration done in preparation for the NIDs, as well as during house-to-house search for leprosy cases, and mop-up rounds, f) the offer of small incentives to the community for reporting bonafide AFP cases, done at the local initiative of certain communities, g) weekly zero reporting from over 2000 reporting sites, and h) soon-to-be established team of 10 AFP surveillance officers. Page 9

16 Management of Poliomyelitis Eradication in the Border Areas of and Bangladesh The National Health Laboratory has been fully accredited in Poliovirus isolates will continue to be sent to National Institute for Health in Nonthaburi, Thailand for intra-typic differentiation. The National Certification Committee (NCC) for Polio Eradication has been active in 1999 and 2000 in monitoring the performance of AFP surveillance. The NCC regularly makes site visits. Members of the NCC have been oriented on the use of a AFP surveillance monitoring checklist which they administer to health facilities, health personnel and to non-health sites and sectors. These site visits have further helped to motivate health personnel and raise awareness of AFP reporting in the non-health sector. AFP surveillance in Rakhine state has been relatively good since In contrast, routine EPI coverage in townships along the -Bangladesh border (Maungdaw, Buthidaung), has been shown to be low. NIDs and mopup aim at interrupting transmission, and at raising immunity levels. The area is known to be densely populated, with cultural problems existing between different ethnic groups.of the six wild poliovirus cases that were detached in 1999 and 2000, genetic sequencing on four of them showed a familiarity with the virus found in Bangladesh. (See Fig. 10 and 11) Page 10

17 Report of a Meeting 4. RECOMMENDATIONS The following section details the meeting's recommendations based on the discussions during the plenary sessions and the three working groups. 4.1 Group A: Policy and Coordination of Activities It is the considered view of the group that in order to achieve the target of polio eradication, (1) Routine EPI also needs to be strengthened in and Bangladesh. (2) In order to facilitate and coordinate management of poliomyelitis eradication along border areas, each country should form a Central Coordination Committee for Cross-Border Issues consisting of decisionmakers and representatives from various levels of health and other ministries. The focal person for this committee in would be the Director, Disease Control, and in Bangladesh, the Director, Primary Health Care. The terms of reference of the committee would be: Page 11

18 Management of Poliomyelitis Eradication in the Border Areas of and Bangladesh (a) To review progress of polio eradication along border areas (b) To facilitate the coordination of polio eradication activities along border areas, and (c) To facilitate the exchange of information on polio eradication activities across the borders. (3) The Central Coordination Committee of both countries should hold joint meetings as and when needed, with the next meeting to be held possibly in Bangladesh in early (4) Each country should form Local Coordination Committees for Cross- Border Issues (LCCs) in Upazilas/Townships along the - Bangladesh border. In, the committee will include Medical Officers of bordering townships, and representatives of the local administration and relevant departments, with the Township Medical Officer of Maungdaw acting as the focal person. In Bangladesh, the focal person would be the Upazila Health and Family Planning Officer of Taknaf and the committee would be headed by the Upazila Nirbahi Officer (local administrator), Upazila Health and Planning Officers of other bordering upazilas and include other relevant officials. In such meetings, the delegation will be led by the State Health Director, Rakhine and the Bangladesh delegation will be led by the Civil Surgeons of Cox s Bazar and Banderban districts. These LCCs should meet before every supplementary immunization campaign (see recommendation 4.3(2)), and at that time also exchange AFP data (see recommendations 4.2(6), 4.3(3)). They should also meet after the detection of wild poliovirus or of clusters of AFP cases (see recommendation 4.2(7)). (5) By August 2000, the Ministry of Health in each country is requested to formally approve the formation of the central and local coordination committees, their terms of reference, and the designation of the focal persons. Each country should then share the name and other particulars, such as designation, phone and fax numbers of the focal persons, central and local, with the other country. (6) By August 2000, the Ministry of Home Affairs in Bangladesh is requested to issue the necessary directives to the immigration authority/border Security Force (BDR) of the relevant border checkpost on the border authorizing them to provide temporary border pass to concerned officials from for a period of 72 hours, as and when requested for joint polio eradication activities. The Ministry of Immigration and Page 12

19 Report of a Meeting Population and the Ministry of Home Affairs in will issue a similar directive to the Department of Immigration and Registration in Sittwe to that effect. The visiting health officials should submit a request to the concerned local immigration authority, which should include the names and other particulars of the officials at least one day prior to the actual visit. (7) Irrespective of the nationality or legal status of an AFP case in border areas, each country will respect the right of any child with AFP to receive full investigation, treatment and follow-up examination, and for all children to receive immunization. (8) International partners have a role in facilitating and coordinating international cross-border meetings, providing technical and other necessary assistance, and facilitating the monitoring of polio eradication activities in border areas. (9) Cross-border activities are resource intensive and will require additional funds. Government and development partners should work together to mobilize adequate resources. 4.2 Group B: Surveillance (1) General information regarding the polio-eradication initiative in each country should be shared on a regular basis through the exchange of locally published newsletters and/or bulletins. (2) Detailed information on AFP cases should be shared between and Bangladesh at the central and the local level. This information will be in the form of an exchange of case investigation forms, which may need to be adapted to also include information on travel history, contact history, actions taken following the detection of a case (immunization response, active case search), and dates of most recent campaigns, if these are not already there. (3) Case investigation forms will, at the local level, be routed through the Township Medical Officer in Maungdaw and the Upazila Health and Family Planning Officer in Teknaf. Their addresses are as follows: Township Medical Officer (TMO), Township Hospital, Maungdaw Upazila Health and Family Planning Officer (UHFPO, Upazila Health Complex, Teknaf, Bangladesh Page 13

20 Management of Poliomyelitis Eradication in the Border Areas of and Bangladesh (4) It will be the responsibility of the TMO in Maungdaw and the UHFPO in Teknaf to further inform the other relevant townships/ upazilas about the reported case(s). (5) Cases from the following Townships and Upazilas need to be reported to counterparts in the neighbouring country: (a) : Maungdaw, Buthidaung, Rathedaung, Kyauk Taw, Paletwa (b) Bangladesh: Teknaf, Ukhia, Cox s Bazar Sadar, Ramu (Cox s Bazar District) and Naikhongchori (Bandarban District). (6) At the central level, WHO can facilitate the exchange of information sheets (case-investigation forms) between the two countries. (7) The planned pre-campaign joint local level (LCC) meetings should be used as a forum to exchange updated information on AFP surveillance and local level authorities should be informed before that about the recommendations of the first -Bangladesh Border Coordination Meeting on the Management of Poliomyelitis (see recommendation 4.1(4)). (8) Joint LCC meetings should be urgently convened after the identification of a wild poliovirus or a cluster of AFP cases in any of the abovementioned townships and upazilas. At least one national central representative should participate in these meetings. Such a meeting would provide a forum to further exchange information and plan for joint immunization, including mop-ups, NIDs and SNIDs, and communication activities. (9) and Bangladesh should each provide a detailed map of the border areas within to WHO within three months for compilation and sharing with both countries. Such a map of the border area will be useful in planning polio activities, and should include border crossing points, population density, health facilities (including rural health sub centres), roads. 4.3 Group C: Immunization Activities (10) and Bangladesh would routinely exchange information on supplementary immunization activities (NIDs, SNIDs and Mop Up Campaigns), as well as routine immunization activities (a) Such exchange should be made: As soon as possible after a campaign activity; Page 14

21 Report of a Meeting At least once a year for routine immunization during the joint meeting of the local coordination committee (see recommendation 4.1(4)); (b) Type of data to be exchanged would include: For campaigns, target population and total number of children reached, problems during the campaign; areas and groups that may have been missed; For routine immunization, target population <12 months old, number of children reached with OPV3; When surveys are conducted, results should be shared with counterparts across the border. (11) Close coordination between the two countries is necessary for joint preparation for NIDs, SNIDs, and mop up campaigns along border areas, and should be implemented through a meeting near the border several months before the campaign with participation of the local committees and representation of national authorities. Issues to be resolved would include (a) Synchronization of dates of activities along borders; (b) Determination of geographic extent of coordinated border activities; (c) Determination of target age groups for the campaign; (d) Identification of the locations and patterns of population movements at border crossing points; (e) Providing vaccination teams for specific border crossing points; (f) Common social mobilization strategy activities and development of common IEC materials that with input from local communities on both sides of the border to ensure that they are clearly understood; (g) Fixation of dates of subsequent meetings between local counterparts, TMOs and UH&FPOs) before campaigns to discuss and coordinate preparation status before the next round and to resolve any identified obstacles before subsequent rounds. The local committee meeting should also be used as a forum to exchange surveillance data from the respective border upazilas and townships (see recommendation 4.2(2)); (12) Adequate budget allocations should be made available by the respective governments for all border area meetings. Page 15

22 Management of Poliomyelitis Eradication in the Border Areas of and Bangladesh Annex 1 LIST OF PARTICIPANTS Bangladesh Mr Mohammed Janibul Haq Joint Secretary Minister of Home Affairs Bangladesh Mr Ashraf Uddin Director Ministry of Foreign Affairs Bangladesh Dr Zakir Hussain Director PHC & DC and Line Director (ESP) DGHS Bangladesh Dr E.G.P. Haran Deputy Country Representative IOCH Bangladesh Dr Rownak Khan Programme Officer, EPI UNICEF Bangladesh Dr Mohd. Mahbubur Rahman Programme Manager Child Health and Limited Curative Care and Deputy Programme Manager EPI Bangladesh Dr David Sniadack Medical Officer WHO Bangladesh Professor Dr. Mya Oo Deputy Minister for Health Dr Wann Maung Director-General Department of Health Ministry of Health Dr Soe Aung Deputy Director-General Department of Health Ministry of Health Dr Ohn Kyaw Chief International Health Division Ministry of Health Dr Ye Myint Director Disease Control Dept. of Health Ministry of Health Dr Ye Hla Deputy Director Dept. of Health Ministry of Health Dr Than Htein Win Assistant Director, EPI Dept. of Health Ministry of Health Participants U Tin Hlaing Director General Administration Department Ministry of Home Affairs Dr Daw Sann Myint Director National Health Laboratory. Page 16

23 Report of a Meeting U Tun Myint Deputy Director Cultural Section Consulate Department Ministry of Foreign Affairs Daw Tin Tin Myint Deputy Director Population Department Ministry of Immigration and Man Power Dr Tun Tun Aung State Health Director Rakhine State Dr Soe Lwin Virologist NHL Dr Soe Lwin Nyein Epidemiologist Central Epidemiology Unit Department of Health Ministry of Health Dr Aye Aye Aung Medical Officer, EPI Dept. of Health Ministry of Health Dr Nu Nu Kyi Medical Officer, EPI Dept. of Health Ministry of Health Dr Ni Ni Hlaing Medical Officer Central Epidemiology Unit Dept. of Health Ministry of Health Dr Thuzar Chit Tin Team Leader SDCU Rakhine Dr Hla Tun Township Medical Officer Maungdaw Rakhine Dr Nyan Zaw Township Medical Officer Buthidaung Rakhine Dr Tin Win Aung Township Medical Officer Paletwa Township Chin. Dr Hla Maung Township Medical Officer Kyauktaw Township. U Nyi Nyi Director Development of Progress Border Area and Development of Indigenous races UN Agencies in Dr Agostino Borra WR Dr Jos Vandelaer Medical Officer WHO Dr Myo Paing National Programme Officer WHO Dr Lin Aung National Programme Officer WHO Dr John Bertrand Mendis UNICEF Representative Page 17

24 Management of Poliomyelitis Eradication in the Border Areas of and Bangladesh Dr Pirkko Heinonen Chief Health and Nutrition UNICEF Dr Le Le Yi EPI Programme Officer UNICEF Dr Kyaw Kyaw Aung Programme Officer Rakhine UNICEF Mr Peter Chen Information and Communication Officer UNICEF WHO Regional Office ( SEARO ) Dr Arun Thapa Medical Officer EPI-VAB, WHO/SEARO New Delhi India Page 18

25 Report of a Meeting Annex 2 PROGRAMME Monday 26 June :30-09:00 Registration 09:00 10:00 Opening Ceremony 10:30-11:00 Business Session Address by H.E. Maj. Gen. Ket Sein, Minister of Health Self-introduction of participants Nomination of Chairperson, co-chairperson, rapporteur Brief address by representatives of: - Dr Mya Oo Ministry of Health, - Mr Janibul Haq Ministry of Health, Bangladesh - Mr Bertrand Mendis UNICEF - Dr Agostino Borra WHO - Dr Wann Maung DG Dept. of Health 11:00-11:45 Update on AFP Surveillance and Immunization Activities in Bangladesh, with special focus on Chittagong Dr. Mahbubur Rahman, Dy. Programme Manager, EPI and Ag. Program Manager, Child Health and Limited Curative Care, DGHS, Bangladesh 11:45 12:30 Update on AFP Surveillance and Immunization Activities in, with special focus on Rakhine State - Dr Ye Hla, Deputy Director Epidemiology; Dr Than Htein Win, Assistant Director EPI. 12:30 13:00 Discussions 14:00 14:30 Introduction of Group Seminars Group 1: Policy and Coordination of Activities Group 2: Surveillance 14:30 16:00 Group Seminar Group 3: Supplemental Immunization Activities Page 19

26 Management of Poliomyelitis Eradication in the Border Areas of and Bangladesh Tuesday 27 June :00-10:45 Group seminar (continuation) 11:00 12:30 Group Presentations 13:30 14:00 Wrap Up and recommendations 14:00 Closing Remarks 14:30 Adjourn Page 20

27 Report of a Meeting Annex 3 PROPOSED DISCUSSION POINTS FOR GROUP SEMINARS 1. Group 1: Policy and Coordination of Activities Mechanisms of intercountry communication Facilitation of local level coordination between countries Operationalizing travel and communication procedures across borders Legal status of migrants with AFP Coordination of future supplemental immunization activities Role of international partners Steps to secure financial support 2. Group 2 : Surveillance Structure and organization of surveillance systems in each country. (1) Central: Communications and reporting between countries and regions Sharing of case information, reporting of cross-border cases Sharing of line-lists of cases between and Bangladesh Assigning exact location of cases that occur in border areas First and second line coordination (2) Local: Coordination of AFP case follow-up Coordination of stool specimen collection from cases and (when indicated ) contacts Active case-finding and ORI across Borders Page 21

28 Management of Poliomyelitis Eradication in the Border Areas of and Bangladesh 3. Group 3: Local Level Supplemental Immunization Activities Routine Immunization and NID/ SNIDs at border areas in and Bangladesh: process of NIDs, problems encountered, populations missed, activities used for reaching unreached populations. NIDs/SNIDs plans for difficult areas and/or unreached populations in 2000 Proposed coordination for NIDs/SNIDs/Mop-Ups between Bangladesh and Management of border crossing points at the time of NIDs/SNIDs/Mopups Joint Social Mobilization activities between and Bangladesh Target age-groups for NIDs/SNIDs/Mop-Ups for and Bangladesh Involvement of WHO, UNICEF, and international partners Future Meetings at local level to coordinate preparations First and second line coordination 4. Proposed Group Participation: Group 1 : Policy and Coordination of Activities Prof. Mya Oo, H.E. Deputy Minister of Health, Dr. Wann Maung, DG, DOH, MOH,. Mr. Mohammed Janibul Haq, Joint Secretary ( Political ) MHA, Bangladesh Dr Soe Aung, Deputy DG, DOH, MOH, U Nyi Nyi, Director, Development of Progress of border area and development of Indigenous races, Dr.Ohn Kyaw, Chief International Health Division, MOH, U Tin Hlaing, Director, General Administration Department, Ministry of Home Affairs Page 22

29 Report of a Meeting U Tun Myint, Deputy Director, Cultural Section, Consulate Department, Ministry of Foreign Affairs, Mr. Ashad Uddin, Director, MFA, Bangladesh Dr. Rownak Khan, UNICEF Bangladesh Daw Tin Tin Myint, Deputy Director, Manpower Department, Ministry of Immigration, Mr. John Bertrand Mendis, Representative UNICEF, Dr. Agostino Borra, Representative, WHO,. Dr Myo Paing, National Programme Officer, WHO. Dr Arun Thapa, WHO SEARO Dr. Pirkko Heinonen, Chief Health and Nutrition, UNICEF Group 2 : Surveillance Dr Zakir Hussain, Director, PHC & DC & Line Director (ESP), DGHS, Bangladesh Dr. E.G.P. Haran, IOCH, Bangladesh Dr Ye Myint, Director Disease Control, DOH, MOH, Dr Daw Sann Myint, Director, National Health Laboratories, Dr Ye Hla, Deputy Director, DOH, MOH, Dr Soe Lwin, Virologist, NHL, Dr Soe Lwin Nyein, Epidemiologist, Central Epidemiology Unit, DOH, MOH, Dr Ni Ni Hlaing, MO, Central Epidemiology Unit, DOH, MOH, Dr Thuzar Chit Tin, Teamleader SDCU, Rakhine, Dr Hla Tun, Township Medical Officer, Maungdaw, Rakhine, Dr Hla Maung, Township Medical Officer, Kyauktaw Township, Dr Jos Vandelaer, Medical Officer, WHO, Dr. Le Le Yi, EPI Programme Officer, UNICEF,. Page 23

30 Management of Poliomyelitis Eradication in the Border Areas of and Bangladesh Group 3: Local level Supplemental Immunization Activities Dr. Mohd. Mahbubur Rahman, Programme Manager, Child Health and Curative Care, and Deputy Programme Manager EPI, Bangladesh Dr. David Sniadack, Medical Officer, WHO Bangladesh Dr Than Htein Win, Assistant Director, EPI, DOH, MOH, Dr. Soe Lwin Nyein, Epidemiologist, CEU, DOH, MOH Dr Aye Aye Aung, Medical Officer, EPI-DOH, MOH, Dr Nu Nu Kyi, Medical Officer, EPI-DOH, MOH, Dr Tun Tun Aung, State Health Director, Rakhine State, Dr Nyan Zaw, Township Medical Officer, Buthidaung, Rakhine, Dr Tin Win Aung, Township Medical Officer, Paletwa Township, Chin, Mr Peter Chen, Information and Communications Officer, UNICEF, Dr. Kyaw Kyaw Aung, Programme Officer Rakhine, UNICEF, Page 24

31 Report of a Meeting Annex 4 PROGRESS OF POLIO ERADICATION IN MYANMAR AFP Surveillance Performance Indicators,, Indicator Target Number of AFP cases reported Total AFP rate (annualized) Non-polio AFP rate (annualized) Units submitting weekly reports 80 NA Cases investigated within 48 hrs after being reported Percentages Cases with two stool specimens Collected within 14 days of paralysis onset Cases with follow-up after 60 days after onset of paralysis Specimens arriving at national Laboratory within <3 days since Collection Specimens arriving at laboratory in "good condition" Specimens with a turns-around time for receiving results < 28 days NA Page 25