The progress towards eradication of poliovirus globally is one of the greatest success stories of the global health community. When the Global Polio Eradication Initiative started in 1988, polio paralysed
The Expanded Programme on Immunisation (EPI), Sindh, has decided to refocus the routine immunisation efforts to realise the goal of making Sindh a polio free province.
As doctors struggle to eradicate polio worldwide, one of their biggest problems is persuading parents to vaccinate their children.
The health ministry is planning an emergency mop-up operation that will vaccinate three lakh children living in and around Kirti Nagar against polio to contain further spread of the deadly P1 strain of the virus in Delhi. The decision was taken after the country's first PI strain of wild polio virus sprung up this year from Darbangia Colony in Kirti Nagar. Since this is the first P1 polio case in Delhi after August 2006, which had made officials declare the city free of the virus last year, shocked state polio eradication experts have now identified 2,500 high risk clusters, mostly occupied by migrants from Uttar Pradesh and Bihar
Officials with the National Polio Surveillance Programme today said the first polio case detected in the Capital this year could have come from Bihar. The 14-month-old Baby Gulnaaz from Kirti Nagar was detected with the P1 strain poliovirus, known for its propensity to cause large outbreaks. According to government records, Gulnaaz was taken to Moti Nagar Colony Hospital on February 15 when it was found that her right limb was immobile. "She had high fever and investigations confirmed that she has polio. Though we are yet to do any genetic analysis, it seems that that the virus has travelled from Bihar,' said a senior official with the National Polio Surveillance Programme. Till date this year, 106 polio cases have been isolated in India but all of them have been P3 strains. This is the first P1 polio case in Delhi after August 2006. The neighbouring cities of Ghaziabad and Faridabad have been put on high alert, the official said. "If such a case is reported from an area, what follows is an immunisation drive. The government will try to do that as soon as possible,' a Delhi government official said. In the present case, the patient is a resident of Darbhanga jhuggis, a slum populated mostly by migrant labourers from Bihar. Officials said Gulnaaz was administered 11 doses of polio vaccine in the last two national immunisation rounds in January and February this year. While Delhi recorded seven cases of polio P1 virus in 2006, the state government had last year, claimed the Capital was free of the P1 virus. However, there has been an outbreak of the dreaded P1 virus in Bihar this year with 83 cases being reported from the state. Gulnaaz's family reportedly came to the Capital from Bihar six months back. With focus on the polio scare in the country, particularly in Bihar and Uttar Pradesh, Finance Minister P Chidambaram allocated Rs 1,042 crore for a revised strategy on the crippling disease. India recorded 864 cases in 2007 as against 676 cases the previous year. The poliovirus enters the body through the mouth when people eat food or drink water contaminated with faeces. The virus then multiplies in the intestine, enters the bloodstream and may invade certain types of nerve cells, which it can damage or destroy.
The first reported case of a deadly polio strain in a girl from a Delhi slum underscores how the challenge of health has become similar to a war in more ways than one. The public policy response needed is much more complex than that to the danger posed by an outbreak of bird flu in the country's poultry population. The polio problem requires an ongoing effort that cannot be divorced from the state of health delivery in the country. The virus has escaped eradication in those states which have some of the worst health indicators, rickety delivery systems and huge numbers of the desperately poor who form the bulk of the country's job migrants. It is hard for the health administration to track a poor and mobile population with a high likelihood of being carriers of communicable diseases like polio. Until now, the government machinery in the states or at the Centre has shown precious little awareness of this facet of the problem. True, the Union Budget for 2008-09 has allocated as much as Rs 1,042 crore to the cause of polio eradication. The finance ministry has not been stingy. Saving the tiger has got only a fraction of that sum. But will the money be used effectively? The polio problem offers a striking parallel with the Naxalite menace in large parts of India. Just as the police posts charged with the task of law-and-order across hundreds of sq km of Indian forests have little idea where the next militia attack will come from, the country's sad-looking primary medical centres have very little knowledge of how polio is spreading among population groups in geographical areas left unmonitored. It is a very large country. Despite heavier spending and more national taskforces, efforts to tackle polio would have limited success unless the entire health delivery system is padded up in the country, just as policing methods have been spruced up for new challenges. The difficulty here is not the funds, but the lack of any clear political dividend from the adoption of such steps. More jobs mean more votes, but what about better health? Also, health problems require active cooperation from the afflicted population groups, and thus outreach plans and persuasion methods are important. So long as nobody seems to have a direct stake in the success of these efforts, their quality will remain indifferent.
Taking notice of resistance by some parents to immunisation of their children against polio, District Nazim Kanwar Naveed Jamil has constituted a three-member committee to ensure that polio drops are administered to all children up to five years of age throughout the district during a three-day anti-polio campaign beginning on Tuesday. The committee comprises the DCO, the EDO health (focal person) and the SP City. The decision was taken at a meeting held at the district nazim secretariat here to finalise arrangements for the campaign. Speaking on the occasion, Mr Jamil said that due to the attitude of some parents who were resisting the administration of anti-polio drops, 297,000 children in the district could not be placed at risk. He said that at the request of the district government, prayer leaders, public representatives and social workers had tried to persuade such parents to get their children immunised but some of them were still adamant. The district nazim said that such a state of affairs could not be tolerated. He directed the EDO Health to prepare a list of the resisting parents and said that come what may, their children would be administered anti-polio drops. He directed the officers of the health department to collect information about such parents. He directed the employees of all the departments of the district government not only to ensure that their own children were administered anti-polio drops but the children of their neighbours were also immunised. He directed the EDO health to include maximum number of female workers in the anti-polio teams to ensure success of the campaign. He appealed to social activists, civil servants and public representatives to make sure that each and every locality was visited by health workers during the drive. He said that even after the latest round of the campaign, the drive would continue in all the hospitals and anti-polio centres, specially at main entrance of the district, would be activated.
A special campaign against polio will be launched on March 4 and anti-polio drops will be administered to 6.52 million children. A statement on Sunday said as many as 19,000 teams would participate in the drive. The EPI will confer awards on officers of the health department, doctors and other relevant staff in recognition of their outstanding work for the eradication of polio. An award distribution ceremony in this connection will be held on March 5. Caretaker Sindh Chief Minister Justice (retd) Abdul Qadir Halepota will be the chief guest on the occasion.
Aiming to achieve historic success by total eradication of polio from Pakistan, the government is intensifying schedule of supplementary immunisation activities to include four rounds of National Immunisation Days (NIDs) and four sub-national activities in 2008. The next campaign will commence from March 4. This was stated by the Extended Programme of Immunisation (EPI) manager, H.B. Memon, as he briefed the media persons here at an event organised by the United Nations Children Fund (Unicef). The strategy works in Pakistan, still one of the four countries globally that are still polio endemic, Mr Memon said. He said: "Before initiation of the programme the number of cases of polio was estimated to be about 25,000 to 30,000 a year. Some 230,000 children were saved from paralysis after NIDs were introduced in 1994. The number of cases dropped to 1,147 in 1997, 40 cases in 2006, 32 in 2007 and only two in 2008 (Nawabshah and Hyderabad).' Informing about the upcoming sub-national campaign, a total of 16.79 million children under five years of age would be targeted in 54 districts of the country. A total of 43,033 vaccination teams, 7,922 area supervisors and 1,296 zonal supervisors would participate in the campaign. The campaign activities will also be monitored by more than 500 national monitors. Stressing on increasing geographical restriction of wild polio virus, the EPI representative said the majority of districts had been polio free for almost two years. Sixty per cent of the cases in 2006 were from six districts only. There had been no cases from the Federally Administered Northern Areas (Fana) since 1998, Azad Jammu and Kashmir since 2000 or Islamabad since 2003. The vast majority of population, in both Pakistan and Afghanistan, lived in polio free areas, as wild polio virus transmission is currently focal in two main areas
This year's first P1 wild polio virus strain has been isolated in Delhi. Fourteen-month-old Gulnaz from Darbangia colony in Kirti Nagar area is the victim. Daughter of a rickshawpuller, the girl's family migrated from Bihar just six months ago. She was supposedly administered 10 doses of oral polio vaccine in the last two national immunization rounds in January and February this year. Till now this year, 106 polio cases have been isolated in India but all of them have been P3 strains. This is the first P1 polio case in Delhi after August 2006. P1 has been India's major enemy with the global advisory committee on polio giving top priority to its eradication. The Union health ministry successfully contained its spread in 2007 with just 36 cases. For the first time since 1999, the number of P3 cases had outnumbered the number of infections caused by P1 strain. P1 travels faster and infects more children, which is why the emphasis was on eradicating type 1 first. P3 is a very slow moving virus with low virulence. P1 causes paralysis in one out of every 200 children, as compared to P3, which causes paralysis in one out of every 1,000 infections. Health ministry sources told TOI that a polio vaccination round is scheduled to take place in Delhi this month. But states can undertake an emergency mopup operation whenever a P1 strain crops up. Polio has been crippling India, with 864 cases in 2007 compared to 676 cases in 2006. This made finance minister P Chidambaram allocate Rs 1,042 crore just for polio in the Union Budget for 2008-09, most of which will be spent to contain the virus in Bihar and Uttar Pradesh. Bihar, which reported 193 fresh cases of the crippling disease in 2007, has been exporting polio strains across India. An alarmed health ministry has now marked 72 blocks in Bihar as high risk. These blocks or the ones adjacent to them accounted for three-fourths of the total polio cases in the state in the past five years. In 2007, 90% of P1 cases were found in these blocks. According to experts, polio immunisation activities are being intensified in these blocks. A special immunization drive was conducted on January 13 in these 72 blocks. A ministry official told TOI:
Nagaland Governor K Sankaranarayanan inaugurated the second phase of pulse polio at Naga Hospital Kohima Nagaland recently, stated a press release. The simple yet significant event for concern to eradicate polio was also graced by SK Tripathy Advisor to the Governor, Lalhuma Chief Secretary Nagaland Principal Director of Health Services, senior doctors, nurses and was chaired by Menukhol John Commissioner & Secretary Department of Health. The Governor said that pulse polio programme was launched to ensure total eradication of polio from the world with sustained efforts. The Governor pointed out that immunization has saved 20 million lives in the last two decades from the six major vaccine preventable diseases of pertussis, childhood tuberculosis, tetanus, polio, measles and diphtheria. The Governor expressed the need to ensure cent per cent coverage to all the children in immunization against these six diseases. The official report said that during this second phase of pulse polio immunization all over Nagaland the department has set up 2011 pulse polio booths to immunized the children and around Kohima town 31 polio booths has been set up.
