Friday, January 16, 2009

Polio Eradication

India has already earned itself the dubious distinction of having the world’s highest number of polio cases. According to the Global Polio Eradication Initiative data, released recently, India has recorded 82 polio cases in the past one month. In comparison, three other countries where polio is still endemic—Nigeria, Pakistan and Afghanistan—have together recorded just 23 cases in the same period. However, as by the end of 2008, India has 517 confirmed polio cases of which have P3 strains and P1 infections.
This has now made the Union Health Minister Anbumani Ramadoss virtually admit that the country’s polio programme is failing to achieve its purpose. Unhappy with the failure to stop polio from crippling children across the country, the Government has decided to review the National Polio Control Programme (NPCP).
Tail-end Outbreak
The cases recorded in 2008 are the tail-end of the polio outbreak that occurred in India in 2007 and crippled 864 children compared to 676 in 2006, while the year 2005 witnessed 66 cases. An increase in vaccination coverage in 2007 was expected to reduce the number of cases in 2008. Also, Rs. 1,050 crore was set aside for the pulse polio programme.
Cases of the Type 1 polio virus that spreads faster and causes death from paralysis in many instances declined in 2008 because the Government used a monovalent vaccine targeting this strain alone. In 2008, of the 106 cases, only one was Type 1, reported in Delhi.
But the focus on vaccination for Type 1 led to a surge in Type 3 cases in Bihar—it reported 89 cases in 25 districts—and Uttar Pradesh, where 15 cases have been found across nine districts. Haryana reported one case of Type 3. The Type 2 polio virus was eradicated in 1999.
The cases recorded from January to March are from 2006 outbreak. Fresh infections usually occur in Uttar Pradesh from July and in Bihar from August, after the flood waters have receded. Bihar also saw the worst flood in the last 30 years in August, which badly hit the immunisation rounds.
Bihar, which reported 193 fresh cases of the crippling disease in 2007, has been exporting polio strains across the country. Experts have now marked out 72 blocks in the State as high risk. In 2008, 90 per cent of P1 cases were found in these blocks along the Kosi river.
Chain Shortcomings
Why, instead of so many mass oral polio vaccine immunization campaigns, has the dreaded disease continue to be reported especially from States like Bihar, Uttar Pradesh, Andhra Pradesh and Karnataka.
Some communities refused immunization fearing harmful health hazards for their children in future. Cold chain shortcomings in certain areas compromised the effect of the vaccine and in other places figures of vaccine coverage were fudged by field workers.
The political and State health leadership worked hard and removed the shortcomings uncovered. At present, efforts are on by strengthening surveillance, case reporting and follow-up community-based measures to interrupt wild poliovirus transmission in particular from western Uttar Pradesh and Bihar.
Let us hope that by the last quarter of 2009 no paralytic polio case is reported and similar status, if maintained for three more years, the Advisory Committee Poliomyelitis Eradication ( ACPE ) that poliomyelitis stands eradicated from India.

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