Polio, India’s latest cross-border threat

Stamping out a disease from the face of the earth may not sound as spectacular as, say, Mars landing, but the sheer cussedness and the budget needed to get the job done are comparable. With infections down to 536 this year from last year’s 1,352, the world is closer to eradicating polio,

a crippling viral disease that affects the nervous system and causes total paralysis within hours. It affects children under 5 years, causing symptoms of fever, fatigue, headache, vomiting, and pain in the arms and legs. One in 200 infections causes irreversible paralysis and, sometimes, death.

India has reported just one polio case this year – on January 13 in the Howrah district in West Bengal — bringing the country the closest ever to eradication. The fact that the number has stubbornly stayed at one despite infection usually peaking from October through December is causing understandable glee among public health experts worldwide. And, unlike, the pernicious superbug NDM-1 that keeps cropping up everywhere in India, wild poliovirus has not even been found even in sewage water this year.

What worked for India is the blanket-bombing of all children under 5 years with the polio vaccine, and switching from the milder, old vaccine that worked against all three strains of polio virus, to a new double-strain vaccine that induces stronger immunity against the two remaining serotypes (type 1 & 3 poliovirus). No Type 3 poliovirus has been reported in over one year.

Around 5 million children are immunised by transit and mobile vaccination teams four times a year in Uttar Pradesh and Bihar alone. The result is that there have been no cases in Uttar Pradesh since April and in Bihar since September last year.

In 2010, India had 40 cases, the lowest since 66 in 2005. The worst year was 2009, when India topped the charts with almost half—46% or 741 cases—of the global total of 1,604 infections.

The polio virus thrives in just four countries – India, Afghanistan, Nigeria and Pakistan – with infection occurring locally in four more this year (Angola, Chad, Democratic Republic of the Congo and Sudan). Polio infections in the other eight countries are all due to “importations”, jargon for people getting infected in another country and bringing the virus back home.

These unwanted importations have become India’s biggest worry this year, with its two large neighbours, China and Pakistan, reporting an increase in polio cases this year. After remaining polio-free in 2010, China has had 18 cases, the last one on September 11 this year. The real worry is Pakistan, with 154 cases from across the country, where the virus has spread from its three strongholds in Karachi, Quetta and the north-west tribal areas.

To prevent smuggling of infection across the border to India, all children crossing over by road and train are being vaccinated at Wagah and Attari in Punjab, and Munabo in the Barmer district of Rajasthan. Children are also being immunised at 81 transit points along the Indo-Nepal border.

Vaccinations have to go on for at least another year before India can breathe easy. Re-emergence of infection is common. In Nigeria, polio jumped fourfold to 44 this year from last year’s 11, leading to outbreaks in three neighbouring countries.

The Global Polio Eradication Campaign, which started in 1998, has a colossal budget of $2.2 billion for the current year. Failing to zap out polio will make its eradication, in the words of public health experts at the World Health Organisation, “the most expensive public health failure in history.”

Through HT

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