The Present State of Polio Cases and Sub Pin Implementation in Pakuan Raya, Bogor City

Bogor City Health Office. (Ist)

BOGOR – The discovery of the Polio case in Purwakarta on March 14 2023 has attracted the attention of all regions in West Java, including the city of Bogor. Head of the Bogor City Health Service, dr. Sri Nowo Retno MARS, gave a written statement and conveyed 23 points related to the discovery of the Polio case. This is the submission from the Bogor City Health Office.

1. Poliomyelitis or better known as polio is a disease that attacks the nervous system in the body. Polio is a disease that can cause permanent paralysis in sufferers. Polio disease is caused by a viral infection called poliovirus.

2. The poliovirus found can be in the form of vaccine/sabin poliovirus, wild poliovirus/WPV (Wild Poliovirus) and VDPV (Vaccine Derived Poliovirus). VDVP is a vaccine/sabin polio virus that has mutations and can cause paralysis. Polio can strike at any age, but polio mainly affects children in the age range 0-15 years.

3. Polio is spread by person-to-person contact. When a child is infected with wild poliovirus, the virus enters the body through the mouth and multiplies in the intestines. This is then discharged into the environment via faeces where it can spread rapidly through the community, especially in situations of poor hygiene and sanitation. The incubation period for poliovirus is usually 3-6 days, and paralysis occurs within 7-21 days.

4. Risk Factors for Polio Events
– Data on polio immunization coverage, at the puskesmas level, infected villages/kelurahans and surrounding villages/kelurahans at risk for the last 3-5 years, and vaccine cold chain management
– Community nutritional status
– Slums or crowded areas or refugee areas
– Population mobility to and from poliomyelitis endemic areas
– Poor AFP Surveillance sensitivity
– Contacts are children aged < 5 years who interact at home or play with cases since paralysis occurs until 3 months later.

5. There is no cure for polio, there are only treatments to relieve symptoms. If you have been exposed to Polio, the actions taken, namely case management, are more emphasized on supportive measures and prevention of disability, so that the limbs are endeavored to function as normal as possible and the patient is hospitalized for at least 7 days or until the patient goes beyond the acute period.

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6. Immunization is the most effective measure in preventing polio. The polio vaccine given many times can protect a child for life. Prevention of polio can be done by increasing public awareness of the importance of giving polio immunization to children.

7. Indonesia became 1 of 11 South East Asia Regional Office (SEARO) countries that successfully received a Polio Free certificate from the World Health Organization (WHO). However, in the period from November 2022 to March 2023, polio cases have been found in 2 regions, one of which is Kab. Purwakarta West Java Province. As for the determination of KLB criteria based on Permenkes 1501 of 2010, Polio in Kab. Purwakarta is included in the outbreak category because it fulfills the criteria “Emergence of certain infectious diseases that previously did not exist or were not known in an area”.

8. In supporting polio eradication activities in Indonesia, AFP Surveillance has been carried out since 1997. Each case with acute paralysis can be managed by laboratory tests to prove whether or not the polio virus is causing paralysis.

9. In 2022, Bogor City’s Non Polio AFP Rate for Bogor City is 2.38, with details of finding 9 AFP cases with negative Polio laboratory results. With the discovery of Polio cases in Pidie Aceh, the AFP Surveillance indicator in 2023 increases to Non Polio AFP rate ≥3/100,000 population under 15 years of age or find at least 17 cases of AFP in 2023.

10. Coverage of Polio Immunization in Bogor City from 2020 to 2022 is as follows, 2020 OPV 4 (83.5%) and IPV (18.2%), 2021 OPV 4 (102.2%) and IPV ( 84.3%) and 2022 OPV 4 (95.8%) and IPV (95.8%)

11. Based on the data above, by 2022 the City of Bogor has succeeded in achieving the target for Polio Immunization (target: 95%). If coverage is spread by sub-district, then there are still several sub-districts with low polio immunization coverage. This can be used as a risk factor for polio cases.

12. On March 14 2023, a case of Polio was found in Kab. Purwakarta, 4 years 5 months old, female, with positive laboratory results for type 2 polio virus VDVP, with initial symptoms coming to the health facility, there is weakness in both legs. The polio case has a history of never being immunized.

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13. Based on the cases above, the Ministry of Health coordinates with West Java Province to carry out follow-up plans including:
– The implementation of the Sub PIN in the context of tackling the Polio VDPV2 outbreak in the West Java Province area was carried out in 2 rounds, starting on April 3 2023.
– Each round of Sub PIN is carried out within 7 days and 5 days of sweeping with a minimum distance between rounds of one month. The coverage target is at least 95% for each round
– If based on epidemiological studies a risk of transmission is still found, then the next round of sub PINs or mop-ups can be carried out.
– Mapping the targets of Sub PIN in 27 Regencies and Cities where the targets are all children aged 0 to 59 months, including migrants, regardless of previous immunization status.

14. The target for implementing Polio Sub PIN in Bogor City is 84,983 children with an age range of 0-59 months spread across 68 sub-districts.

15. Implementation of the Polio Sub PIN was carried out in 981 Posyandu, 22 Hospitals, 96 in Education Units (PAUD & Kindergarten), and 3 in other Service Posts. The total number of Polio Sub PIN implementation posts in Bogor City is 1102 posts.

16. There are 567 vaccinating health workers (doctors, nurses and midwives) and 3195 cadres involved in the implementation of Bogor City Polio Sub PIN. Meanwhile, there are approximately 93 supervisory staff from the Health Office whose function is to carry out monitoring and evaluation during the implementation of Bogor City Polio Sub PIN.

17. The type of vaccine used in the Polio Sub PIN is nOPV 2 produced by PT. Biopharma is given by 2 drops into the mouth and can be given together with routine immunizations. The nOPV 2 vaccine is only used during Type 2 Polio Outbreak Sub PIN.

18. From a security perspective, the PP KIPI National Committee has guaranteed security regarding the use of the nOPV 2 vaccine which will be given in the Polio Sub PIN. This is based on the implementation of the Polio Sub PIN in Prov. Aceh and Prov. North Sumatra where more than 2 million doses of nOPV2 have been administered in the implementation of the Polio Sub PIN. There are no reports of AEFI in implementation at Sub PIN Polio Prov. North Sumatra and 3 cases of AEFI reported in Prov. Aceh is a coincidental case (not related to the vaccine).

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19. Various literacy and studies show that nOPV2 is safe and can be tolerated by the age group of infants and children. If during the implementation of the Polio Sub PIN, the child is sick, the vaccine can be given during the sweeping activity.

20. If side effects are found after administration of the vaccine, there is an AEFI Working Group for the City of Bogor and a Referral Hospital that has been prepared as a form of anticipation.

21. As a response to the Polio Outbreak in Kab. Purwakarta, Bogor City Health Office makes follow-up plans including outreach and cross-program and cross-sectoral coordination regarding the implementation of the Polio Sub PIN, preparing target numbers, logistical needs and resources and implementation schedules through micro planning mapping. And the last is increasing the sensitivity of AFP case detection through Puskesmas and Hospitals.

22. Cross-sectoral participation, community leaders, religious leaders are highly expected for the implementation of the Polio Sub PIN in the form of participating in disseminating Polio Sub PIN, disseminating information related to security, effectiveness and halalness, and finally participating in mobilizing the community that is the target of the Polio Sub PIN so that come to the immunization service post

23. The Bogor City Health Office also appealed to the public to participate in Polio Sub PIN activities as a form of protection against the dangers of polio for children and to implement Clean and Healthy Behavior and consume food with balanced nutrition. Next, identify the typical symptoms of polio, namely acute flaccid paralysis and report to the nearest health facility for management so that the chain of transmission can be stopped. (ADV)

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