Polio Eradication - Endgame Strategies - Polio Type 2 Withdrawal: National tOPV-bOPV Switch Plan

This guidance document was designed to prepare Sri Lanka's National Switch Coordination Committee (NSCC) and other stakeholders for the April 30 2016 switch day - the day on which, as per the Polio Eradication and Endgame Strategic Plan 2013-2018 (see Related Summaries, below), the country would join others in switching from trivalent oral polio vaccine (tOPV), which contained Sabin vaccine viruses of type 1,2, and 3, to bivalent OPV (bOPV), which only contains Sabin vaccine viruses of type 1 and 3. (The use of tOPV has led to the eradication of wild poliovirus type 2 (WPV2), with the last case occurring in 1999. But the type 2 component of tOPV has, in rare cases, caused circulating vaccine-derived polio virus (cVDPV) and vaccine-associated paralytic polio (VAPP) and also interferes with the immune response to poliovirus types 1 and 3.) The document explains the rationale behind the switch and offers concrete guidance as to how it is to be implemented in the country.

Opening sections provide context for the switch, such as the fact that Sri Lanka has achieved high population-level polio immunity and is maintaining a polio-free status. Polio vaccination in the National Immunization Programme consistently reaches >90%, and no polio supplementary vaccination campaigns have been conducted since 2003. The public health service, including immunisation, is provided by the Ministry of Health (MoH) through well-established public health infrastructure facilities. The National Switch Coordination Committee (NSCC) will be established by identifying resources from the National Polio Eradication programme for the planning, preparation, and implementation of the switch, and the National Certification Committee for Polio Eradication (NCCPE) will function as the National Switch Validation Committee (NSVC) for the validation procedure.

It is noted that "Relevant guidelines will be developed for the switch procedure, monitoring of the switch plan, advocacy, awareness, communications, and remaining tOPV withdrawal after the switch. Training materials will be developed and training will be carried out for relevant health care staff on the procedures of the switch. Other relevant health categories such as Paediatricians, Microbiologists, academic staff, staff of private sector health institutions, General Practitioners, Professional Colleges will be made aware on the switch procedures to get the fullest support in the Polio Virus type 2 withdrawal procedure."

To accomplish these tasks, various committees were formed as outlined in the third section of the report on management, coordination, and validation mechanisms. For example, the NSCC planned to meet frequently to discuss aspects of the switch such as coordination of national- and district-level activities on staff awareness and training for the synchronised work for the switch, as well as dissemination of information and communication, including the proper media communication. There was to be a District Switch Committee (DSC) and District Operations Centre (DOC) whose remit was also to include communication-oriented activities such as training and information dissemination, including among healthcare staff, including the private sector. Speaking of the private sector, it is noted that the the NSCC and the Epidemiology Unit will formally communicate with private health institutions through the Director/Private Health Sector Development to make them aware of the need to, following the switch, confirm the absence of the availability of tOPV procurement agents. "The NSCC will get the opportunity to make communications with the College of Paediatricians and assure the messages reach the private sector correctly....In addition, NSCC will work to get the support of specific organizations and Forums (e.g. Vaccine Forum) who are involved in private sector health care and vaccinations for this endeavor." The validation procedure after the switch was to involve reporting and documentation to assure the removal of tOPV from the country, with the final report to be submitted to the MoH, Sri Lanka. "The NSCC and Epidemiology Unit will ensure issuing relevant guidelines and timely communication with all relevant stakeholders. The planning on recording and reporting system will be developed and communicated at all levels."

In preparation in terms of communication, the guidance document stresses that all relevant information and scientific facts aboutt the switch are already (as of this writing) being communicated with relevant authorities and stakeholders at different levels, as well as the media and general public. A new immunisation schedule with changes will be displayed, and national guidelines will be prepared and disseminated to all relevant authorities: professional bodies, hospitals, academic institutions, and private institutions. All relevant information including guidelines will be displayed on the Epidemiology Unit website and be published in the Weekly Epidemiological Report. Training materials will be prepared as fact sheets, guidelines, circulars/circular letters, leaflets, posters, information sheets, and PowerPoint presentations - also for display online. National training materials and information will be shared with private health institutions.