India declared polio free; no new case in 3 years

Children in the country will, however, continue to be vaccinated against the disease to maintain immunity

 
By Vibha Varshney
Last Updated: Monday 17 August 2015

POLIO

India has finally been declared free of polio after years of efforts to get rid of the crippling disease. The declaration was made after it was ensured that no new case of polio was reported in the past three years. The last case was reported on January 13, 2011 when Rukhsar from Howrah district was infected with type-1 poliovirus (see 'The last of polio cases in India). The virus has not been detected even in sewage samples in the country since then.

Till 2009, India accounted for more than half the world’s polio cases (see table). Three countries, Nigeria, Pakistan and Chad still continue to be polio-endemic. Polio (poliomyelitis) is an infectious disease caused by a virus that invades the nervous system through the mouth (faecal-oral route). This results in fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs.

Irrespective of its polio-free status, children in the country will continue to be vaccinated against the disease. Efforts would be made to maintain high population immunity against polio through mass polio immunisation campaigns and increased routine immunisation coverage, health officials said. Two national immunisation and three sub-national immunisation days are scheduled in 2014. The next national immunisation day falls on January 19.

World Health Organization (WHO) representative in India, Nata Menabde, said there can be no room for complacency. “We have in fact redoubled our efforts to maintain the highest level of vigil as the risk of polio virus importation persists from polio endemic and re-infected countries,” she said. The country’s machinery would be in a state of readiness to respond to any poliovirus importation. To ensure that polio does not enter the country again, all travellers from polio endemic and re-infected countries should receive oral polio vaccine at least four to six weeks before their departure to India, she added.

Southeast Asia readies for polio-free tag

The South-East Asia Region of WHO, too, is readying for polio-free tag by the end of March 2014. The South-East Asia Regional Certification Commission is scheduled to meet in New Delhi in March 2014. If the commission finds there are no reports of wild polio virus in the region and the surveillance is good, it will certify the South-East Asia Region of WHO as polio-free. It would be the fourth region to be declared so. GPEI estimates that ending the disease entirely by 2018 can be achieved at a cost of approximately $5.5 billion.

Re-emergence of the disease is quite possible. British medical journal, The Lancet, had published an article that confirmed the outbreak of at least 10 cases in Syria while a few samples of wild-type poliovirus 1 (WPV1) have been isolated from sewage and faeces from asymptomatic carriers in Israel since February this year. WHO had confirmed this on October 29.

OPV v IPV

India's achievement has brought the debate on oral polio vaccine (OPV) and inactivate polio vaccine (IPV) once again to the forefront. At present, India uses OPV in its immunisation programme, but this vaccine is linked to high incidence of vaccine-associated paralytic poliomyelitis (VAPP). There are demands that India move to inactivated polio vaccine. Experts have prepared a roadmap that IPV be introduced in India's universal immunisation programme and thereafter withdraw OPV nationally, synchronously. But inactivated vaccine is costly. The total cost of polio immunisation programme in 2013 cost India $ 256.74. Unless funding is ensured in future, focus on the disease could reduce and the disease could re-emerge.
 

The last of polio cases in India
 
Last wild poliovirus type 1 (WPV1) case: January 13, 2011, Howrah, West Bengal
Last wild poliovirus type 2 (WPV2) case: October 24, 1999, Aligarh, Uttar Pradesh
Last wild poliovirus type 3 (WPV3) case: October 22, 2010, Pakur, Jharkhand

The decline of polio
Year       No. of cases
1998 1,934
1999 1,126
2000 265
2001 268
2002 1,600
2003 225
2004 134
2005 66
2006 676
2007 874
2008 559
2009 741
2010 1
2011 0
2012 0
2013 0
Source : http://www.npspindia.org/bulletin.pdf

 

The war on infectious diseases
 
Smallpox is the first, and, so far, the only infectious disease of humans to have been eradicated. The global eradication of smallpox was certified by a commission of scientists on December 9, 1979, and endorsed by the World Health Assembly on May 8, 1980.

The virus causing smallpox, Variola vera, has two variants: variola major, and variola minor. The last case due to variola major was diagnosed in October 1975 in Bangladesh, and the last case due to of variola minor was diagnosed in October 1977 in Somalia.

Efforts are also being undertaken to eradicate dracunculiasis or guinea worm disease. There is no vaccine or drug therapy for it. Eradication efforts have been directed towards making drinking water supply safe as the disease spreads through consumption of infected water. Only four countries—South Sudan, Mali, Ethiopiaand Chad — reported cases of guinea worm disease in 2012. Yaws is another disease with eradication goals. This is a disfiguring disease caused by a bacterium spread through skin to skin contact. No cases of have been seen in India since 2004.

Eradicating poliomyelitis: India's journey from hyperendemic to polio-free status

Fatigue and fear with shifting polio eradication strategies in India: A study of social resistance to vaccination

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