World Polio Day

HEALTH

World Polio Day marks significant milestone in 

India’s campaign against Polio Eradication

·     The country was taken off the list of Polio endemic nations by WHO earlier this year

·         Experts emphasize on the need for Injectable Polio Vaccine (IPV) to achieve Polio-Free status

Mumbai, October 23, 2012: City experts say continued efforts on both a local and national level will ensure India is declared Polio-Free for the first time in 2014. India has not reported a single case of Polio since January 2011 and will need to maintain this record until 2014 to be granted Polio-Free status. A country needs to have reported no cases of Polio for at least three years before the World Health Organization (WHO) can grant it Polio-Free status. Barring India, Pakistan, Afghanistan and Nigeria, all other countries around the world are Polio-Free.

In February this year, India was officially struck off the list of polio-endemic countries by the World Health Organization (WHO), having gone more than one year without reporting any cases of wild poliovirus. This is considered one of India’s greatest public health achievements. The two polio-endemic states of Uttar Pradesh and Bihar have not reported any case of polio since April 2010 and September 2010, respectively.

As recently as 2009, India accounted for nearly half of all cases of polio, and was long considered one of the most difficult places in the world to eradicate the crippling disease¹. When the Pulse Polio Immunisation Programme was launched in India in 1995 an estimated 150,000 polio cases were reported across the country each year. Concerted efforts by the Government of India and the medical community through intense and focused measures with tailored tools and strategies have ensured the maximum possible protection to children in the highest-risk areas and among the highest-risk populations.

According to Dr. Y K Amdekar, Medical Director, B J Wadia Hospital For Children, Parel, Mumbai  “India’s fight against Polio eradication has been successful so far and the country is well on its way to achieving Polio-Free status. Not a single case of Polio has been reported in Mumbai in the last 3 years.  However we should not be complacent about our achievement so far. It is necessary to thrust a final blow to wild polio virus by using double protection with IPV and OPV in sequential format.”

Polio is a communicable disease caused by the poliovirus that attacks nerve cells of the brain and spinal cord. Victims, usually infants, develop neurological complications, likes stiffness of the neck and back, weak muscles, pain in the joints, and paralysis of one or more limbs or respiratory muscles. Polio may be fatal in severe cases due to respiratory paralysis. Symptoms of Polio include fever, headache, sore throat, and vomiting.

There are three prevalent forms of poliovirus i.e type 1 (PV1), type 2 (PV2), and type 3 (PV3) . OPV (Oral Polio Vaccine) which uses the live attenuated polio virus has been used in polio eradication efforts since the beginning of the program and has successfully led to the elimination of the virus from the country but carries the risk of vaccine-associated paralytic polio (VAPP) and vaccine-derived polio virus (VDPV) which is unacceptable in the current scenario. The sequential usage of an IPV (Injectable Polio Vaccine) and OPV schedule offers double protection as IPV does not contain a 'live' virus thus eliminating the risk of VAPP. Several countries have shifted from all-OPV to sequential OPV-IPV schedules and many countries have reported success in the elimination of the wild polio virus with an all-IPV schedule.

Public health experts also estimate that 100–180 children in India develop VAPP each year, a rare but serious side effect of the OPV they had received to protect them from the wild poliovirus. As opposed to VDPV infection, VAPP affects the vaccinated children themselves².

The Government of India has introduced mechanism to ensure the polio eradication programme also reaches the block and village level.

Quick facts on India’s Polio success story¹:

·         Every year on National Immunization Day (NID) nearly 2.3 million vaccinators under the direction of 155,000 supervisors visit 209 million houses to administer OPV to around 172 million children under 5 years of age across the country

·         An intense surveillance network for Polio by the Government of India ensures rapid detection of polioviruses for a timely response

• The transmission of the most dangerous WPV1, which caused 95 per cent of polio in India until 2006, dropped to record low levels in 2010. Uttar Pradesh, the epicenter of most polio outbreaks in the country, has not reported any WPV1 cases since November 2009

While India continues with robust efforts to achieve Polio-Free status its strategy will need to include the sequential IPV-OPV to protect children from falling prey to this disease until global eradication is achieved. Sensitive surveillance for poliovirus and high-quality immunization activities together with increased awareness levels will help India achieve this milestone. India’s success is proof positive that eradication can be achieved, even in the most challenging of environments.

1: http://www.unicef.org/india/health_3729.htm

2: Human Vaccines & Immunotherapeutics 8:7, 1–3; July 2012