Polio vigil must continue
News that the World Health Organisation (WHO) will certify India as a polio-free country since no incidence of the disease was reported for three years, as of this week, is cause for satisfaction. It is particularly noteworthy as this achievement comes in four years of India having had been on the books as home to half of the world’s new polio patients. India was taken off the list of polio-endemic countries early last year after no fresh polio cases were reported in 2010 and 2011. (The last confirmed polio case was in January 2010 of a two-year-old girl from Howrah District adjoining Kolkata.) But there was a scare two weeks after WHO took India off the polio-endemic list last January, as an 18-month old child from South 24 Parganas District, also abutting Kolkata, was hospitalised with polio-like paralysis. Her mother reported several babies in their locality who were also given polio vaccine, had similar symptoms which doctors described as flaccid paralysis, not the dreaded disease.
Polio or poliomyelitis is a viral disease of the nerves spread by faeces or saliva which one in 200 infections partially or permanently paralyses mainly the legs. Among those paralysed, 5% to 10% die when their breathing muscles become immobilised. Although it has no cure, vaccination prevents the disease for life. From 350,000 cases of polio in 1988 when WHO initiated polio eradication as a public-private partnership campaign, it fell to 40 cases in 2012. This largest ever internationally-coordinated public health effort brought together governments, WHO, Rotary International, US Centers for Disease Control and Prevention (CDC) and UNICEF, and supported by partners like the Bill and Melinda Gates Foundation. It created a global network of more than 20 million volunteers worldwide who have collectively immunised more than 2.5 billion children. In India, for instance, in just one round of the national immunisation days, there were 640 000 vaccination booths, 2.3 million vaccinators, 200 million doses of vaccine, 6.3 million ice packs, 191 million homes visited and 172 million children immunised.
Although the Kolkata scare last January passed and no polio cases were since reported, India has reason to be vigilant because two of the three countries where the disease is endemic and where anti-polio efforts are stalled by religio-political zealots, are in our neighbourhood. The risk of people from these countries – Afghanistan and Pakistan — travelling and passing the infection indirectly if the vaccination levels are inadequate in some places in the region, is real. [There are three strains of polio virus. If the virus cannot find an unvaccinated person to infect in a short time, it will die.] WHO reported 83 polio cases in Pakistan for 2013 against 58 for 2012. Afghanistan had 11 compared to 35 the year before. All were Type-1 the most common strain of the virus and the most associated with paralysis. A total of 369 (218 in 2012) cases, including those from Pakistan, were reported from endemic and non-endemic countries around the world last year. The number of cases reported in non-endemic countries was 224 in 2013, compared with six in 2012. “Non-uniform routine immunisation coverage in several areas, mostly in the northwest part of (Pakistan), is a prime reason behind the increase in the cases,” the WHO reported. The challenge for India now is to sustain our polio prevention programme without flagging in any part of the country so that we leave no vulnerable area through which the disease may re-appear.
From 350,000 cases of polio in 1988 when WHO initiated polio eradication as a public-private partnership campaign, it fell to 40 cases in 2012
