Continued...

Other Reasons:


Apart from high poverty and low levels of literacy, certain factors responsible for dissemination of other water-borne diseases such as over-crowding, poor sanitation and bad hygienic conditions and unavailability of safe drinking water are also operating in UP and Bihar. Additionally, waning media interest, fatigue owing to prolonged repetitive exercises, a dwindling public involvement, and lack of commitment of all sectors of local administration have hampered the progress of this mass-campaign in the most populous and political sensitive states of north India.

What can be done?


The first and foremost objective for this year is to urgently stop the wild virus transmission in the remaining reservoir areas while maintaining high level of immunity in children throughout the country.

India Expert Advisory Group on Polio (IEAG) has charted out plan to tackle specific problem with specific intervention.4 The issue of high force of transmission will be tackled by high speed and higher efficacy of SIAs. Now there will be 8 SIAs (NIDs And SNIDs) in endemic areas, meaning thereby, at least 8 doses of OPV are assured to a child during first year of life. The issue of low vaccine efficacy is being tackled by improving the immune responses in vaccinees in order to enhance impact of SIAs. The use of monovalent-OPV type1 (m-OPV1) in place of trivalent OPV starting from June this year in all reservoir and surrounding areas is perhaps the most significant intervention. The issue of quality gaps in SIAs will be dealt by improving the quality of these rounds. More emphasis will be given to cover the transient and migrant population. A specific microplan is being prepared to search and reach these clusters, which pose a great risk to the program especially in high-risk areas. Already the intervention has resulted in good performance during the January round in which around 1 million additional children were immunized by special vaccination teams at bus-stops, railway stations and at fairs.

This year, it is presumed that the proposed intervention of using mOPV1 will work in the field. However we can ill afford to just wait and see the results, rather the situation demands to keep other alternate options in place in the eventuality of not able to achieve expected target during the year. One most essential pre-requisite before using mOPV1 is to first ensure that no Type 3 wild poliovirus is circulating in the community. However finding of a new P3 case in last week of December 2004 has given us some concerns. What could be the other options, then? Targeted use of IPV in focal endemic areas could be one alternative, worth trying. IAP has already recommended to Government of India to give permission for licensing of IPV in India and also to introduce IPV in a phased manner starting from states like Kerala.

Targeted use of IPV in focal endemic areas:

For the first time, WHO has seriously considered IPV as an option in 'pre-eradication phase' in developing countries. This is a major shift in the policy of WHO that till quite recently seen discouraging any large scale use of IPV in poor developing countries for a variety of reasons. Palpably, it reflects the urgency to break the 'deadlock' of persistence of wild virus transmission in focal endemic areas. In a recently concluded meeting of Ad Hoc Advisory Committee on Polio Eradication (AACPE) in Geneva, the committee has urged the WHO to review historical data on use of IPV in 'outbreak response' situations.

Improvement of Routine Immunization:

The current strategy has put almost all the reliance and emphasis on SIAs. It seems the strategists are not having much faith on the effectiveness of routine immunization (RI), and by increasing frequency of SIAs, they have left nothing for the RI. This is indeed a major flaw. Even if transmission is broken and zero polio status is achieved through too closely spaced SIAs, it is ultimately RI that would determine the herd immunity and would thwart any incidence of re-introduction of the disease in the community.

To enthuse new life to moribund state of RI in most of endemic districts, it would not be a bad idea to try a 'combo' of DPT-IPV in these areas for routine coverage. Though there are logistic problems of using IPV apart from financial, availability, immunogenicity issues that may discourage strategist to exercise this intervention, but ultimately we will have to bridge the gap between RI and SIAs, sometimes somewhere. And this is the one exciting option that can be considered seriously.

We need some drastic measures:

The problem of persistence of wild virus transmission in endemic regions of UP and Bihar demands some drastic measures. The measures successful elsewhere may not work here, considering the peculiar environmental, demographic and geopolitical setting of the region especially the western UP. Here, even reaching 90% of population is not seemingly working. We need to take some drastic, harsh, and unconventional measures to break the deadlock otherwise we shall be facing the similar situation next year.


These are few additional measures suggested to incorporate in the ongoing initiative. But major thrust should be on already implemented strategies where we are lacking. Though anticipated interruption of wild polio transmission could not be achieved in 2004 but there is no reason to panic. We must be open to all alternatives but is not time to find faults in strategies. It is time to collaborate our efforts and focus on west UP and Bihar where it is clear there are still gaps in implementation of programme. If we can reach to all children particularly of minority community during coming SIAs there is no reason why interruption of wild virus transmission cannot be achieved in first half of 2005 itself.

Also See Article On "POLIOMYELITIS (POLIO)" For More Information

References:

1. www.npspindia.org accessed on 10-3-2005
2. Thacker N, Vashishtha VM. Polio eradication: Current Scenario and End Game Strategies. In: Gupte S (Ed,) Recent Advances In Pediatrics-15, Jaypee Brothers, New Delhi 2005; 244-257.
3. Thacker N, Shendurnikar N. Current status of polio eradication: .In: Shendurnikar N, Thacker N (Eds,) Current issues In Pediatrics, Paras Medical Publisher, Hyderabad. 2005; 203-212.
4. The Twelfth meeting of the India Expert Advisory group for Polio Eradication. Delhi. 2-3 December 2004. AFP Alert, Vol 8,No.3, 2004.

Last updated on 01-05-2005 Vol 2 Issue 5 Art # 22

How to cite this url

Thacker N, Vashishtha V M,Shah N K.Polio Eradication : How Far Is India To Eradication?.Pediatric Oncall [serial online] 2005 [cited 2005 May 1];2. Art # 22. Available from: