Friday, February 24, 2012

Polio Eradication in India: Big Challenge for Government

Additional Secretary, Health Anuradha Gupta has said that India is inching closer to the goal of polio eradication and hopes to be free of the deadly viral infection by 2014. She was pointing to the fact that over 90 per cent environmental samples taken from sewage disposal sites across migration hubs of India to determine the presence of the virus in the air had been found to be negative since November 2010.
She added that India’s success will arguably be its greatest public health achievement and will provided a global opportunity to push for the end of polio.
With oral vaccines, India appears to have achieved what was once thought a Herculean task — decisively breaking the circulation of wild polio viruses that paralyzed countless children. But the use of oral vaccines, which contain live but weakened strains of the virus, can be a bit like riding a tiger. Discontinuing them, without risking a resurgence of polio that would undo all that has been achieved, is going to be a tricky exercise.
The Outbreak
The outbreak response actions were carried out jointly by the Center, State, the World Health Organization’s (WHO)-National Polio Surveillance Project, UNICEF and Rotary along with some stakeholders who identified 36 high risk blocs/municipalities and 222 high risk Gram Panchayats/wards to focus activities on. This was followed by enhanced by coordination by the local administration at all levels and 25 experienced additional Surveillance Medical Officers were deployed at each district for intensive monitoring. The vaccinators and supervisors were imparted training to improve skills trainings to improve skills & performance of vaccinators and supervisors. Approximately 9,096,609 children were vaccinated in January of 2011 which was followed by special immunization rounds on February 6 (990,586), February 13 (1,422,549), February 27 (8,996,193) and the figure remained upwards of 4,100,100 in the subsequent months.
Government’s Initiatives
The federal government is likely to step up surveillance at airports to rule out chances of cases coming in from Pakistan, Afghanistan and Nigeria, where polio is endemic. Thus far, such surveillance is happening only in case of children entering India via rail or road.
Strategies to combat the virus will be discussed at the two-day Polio Summit to be held this weekend. Prime Minister Manmohan Singh will open the summit, which will be attended by health ministers of Pakistan and Nigeria.
For India, the challenge is to prevent new polio cases and block imported ones. “We already have surveillance points along borders with Pakistan. These are at Wagah, Attari and in Rajasthan. But we have to create similar surveillance points at airports. Polio can also be imported via air route. We further want to strengthen polio surveillance across borders,” Additional Secretary, Health, Anuradha Gupta said today while briefing reporters about the Polio Summit.
The India Polio Advisory Group, which advises the government on strategy, is meeting on March 16 to flag new challenges.
The summit will celebrate India’s huge polio success - of reduced infection cases, from two lakh annually in 1988 to zero last year. The last child who got wild polio virus 1 was Rukhsar from Howrah. Today, she is a motivator for the United Nations Children’s Fund (UNICEF), going door to door, asking parents to get children for polio drops. Rukhsar, infected on January 13, 2011, had never received polio drops.
So far as India’s hopes of eradication go (For WHO’s eradication status, nations must be able to remain polio-free for three consecutive years), they are real.
There has been a new case since Rukhsar’s and results of all environmental samplings have been negative since November 2010.
Environmental samples have been taken from sewage disposal sites in four migration hubs of India — Delhi, Mumbai, Kolkata and Patna. This has been done to gauge presence of virus in the air.
In 2009, most Mumbai samples tested positive. But in 2011, all samples across four sites were negative. This means the virus is not circulating in the environment.
In 2009, India had reported 741 cases, half of the global burden of polio. But now, it appears on track to be rid of polio.
For the 12th Plan, the Ministry has sought Rs 4,400 crore as against Rs 5,500 crore sought in the previous plan. This because of lesser burden, Gupta explained.
Globally, however, Rotary International projects a deficit of $520 million for the polio eradication initiative.
Facts About Polio
* Last wild polio virus 1 case: January 13, 2011 (Howrah, West Bengal)* Last wild polio virus-3 case: October 22, 2010 (Pakur, Jharkhand)
*Last wild polio virus 2 case: October 1999 (Aligarh, Uttar Pradesh)
*Last polio-positive case came to surface after environmental sampling in November 2010
*Polio drops given to 17.4 crore children in one round.

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