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EDITORIAL
Year : 2002  |  Volume : 20  |  Issue : 2  |  Page : 59-60
 

The eradication of poliomyelitis: Will history repeat itself?


Jhaveri Microbiology Centre LV Prasad Eye Institute, LV Prasad Marg, Banjara Hills, Hyderabad - 500 034, India

Correspondence Address:
Jhaveri Microbiology Centre LV Prasad Eye Institute, LV Prasad Marg, Banjara Hills, Hyderabad - 500 034, India
sreedhar@lvpeye.stph.net



How to cite this article:
Athmanathan S. The eradication of poliomyelitis: Will history repeat itself?. Indian J Med Microbiol 2002;20:59-60


How to cite this URL:
Athmanathan S. The eradication of poliomyelitis: Will history repeat itself?. Indian J Med Microbiol [serial online] 2002 [cited 2014 Nov 22];20:59-60. Available from: http://www.ijmm.org/text.asp?2002/20/2/59/8347


For time immemorial, microbes have been in the game of outwitting man. The havoc caused by  Yersinia More Details pestis, Mycobacterium tuberculosis, smallpox virus and more recently HIV can hardly be erased from memory! Poliomyelitis has been a constant scourge, and the number of children in the world crippled by this disease is large. The humanitarian and financial benefits achieved would be enormous when the poliovirus is eradicated.
A remarkable success story has been the eradication of smallpox from the face of the earth. Is it possible to repeat the performance with reference to poliomyelitis? If the answer is “Yes”, polio will be the second infectious disease to be eradicated.
Great strides have been made in the eradication of poliomyelitis by virtue of immunization. Today, four of every five of the world's children receive polio vaccine. Since 1988, polio cases have been reduced by at least 85 percent. More than 150 nations are now polio free. However, it is estimated that thousands of new cases occur each year in more than 60 countries, primarily in Africa and Asia.
The global initiative to eradicate poliomyelitis by the end of year 2000 (at present it is 2005) is the largest international disease control effort ever initiated by the World Health Assembly.
The four basic strategies for polio eradication are:
1. Routine immunization of infants with atleast 3 doses of oral polio vaccine (OPV)
2. National Immunization days (NIDs)
3. Surveillance of Acute Flaccid Paralysis (AFP) to identify reservoirs of wild polio virus transmission and
4. House to house mopping up immunization campaign in the final stages in areas where wild poliovirus transmission persists.
Remarkable progress has been made since the initiative began in 1988. The number of global polio cases declined from an estimated > 350,000 cases to just over 7000 in 1997. The poliovirus transmission has been interrupted in Europe (including Russia), Western Hemisphere, western pacific region (including china) and most of the Middle East and large part of southern and northern Africa. Virus transmission is now limited to four foci in 10 countries located in southern Asia and central/western Africa.
Globally, 10 priority countries account for most of the world's polio cases. Five of these India, Bangladesh, Pakistan, Nigeria and Ethiopia are considered global virus reservoirs where transmission is particularly intense. The other five countries include Afghanistan, Angola, DR Congo, Somalia and Sudan (All these five countries are affected by conflict, making it more difficult to conduct effective immunization!)
In India, vaccination against polio was initiated in 1978 under the extended programme of immunization (EPI) and the coverage achieved was 40% of all infants with 3 doses of OPV, by 1984. The Universal immunization programme was launched in 1985, and in a phased manner, covered all districts in the country by 1989-90. By 1990-91 the coverage was >95% and is sustained at >90% since then. The number of reported cases of polio declined from 28,757 during 1987 to 3265 in 1995.
Nevertheless, India consistently accounts for >50% of the polio cases reported worldwide annually. The recommended strategies for polio eradication were implemented by India quite late (in 1995) when compared to the rest of the world. In pursuance to the World Health Assembly Resolution of 1988, the Pulse Polio Immunization Programme was launched in 1995-96 to cover all children below the age of 3 years. The age of the target children was increased to 5 years during 1996-97. This resulted in further decline in number of polio cases to 1005 reported during 1996.
Despite good coverage, 5-6% of children were missed even in the PPI programme. A house to house search of missed children and vaccinating them on the next 2-3 days following each National Immunization Days, was undertaken. This resulted in the vaccination of 2.3 crore children who had never been vaccinated before.
As of 2000, 186 cases of polio have been detected, most parts of the country have become polio free and widespread transmission is restricted only to the states of Bihar (42 cases) and UP (121 cases). India, however, remains as the largest polio endemic country in the world accounting for 20% of the cases reported globally during 2000 (till July 2000) mainly on account of the situation in UP and Bihar.
The target date for polio eradication at present, is 2005. Intensified strategies are being planned to be executed in the coming years. Many organizations including Health Ministries and their workers, Rotary International, WHO, UNICEF, donor governments, NGOs and thousands of volunteers have joined hands to achieve this goal.
WHO has earlier estimated that it would cost $ 120 million for the special measures needed to eradicate polio by the year 2000. Probably it is a sound investment, since the global savings would exceed $ 1.5 billion every year, when polio Immunization is no longer needed.
The World stands on the threshold of victory. We hope that polio will join small pox as the second major disease to be wiped out from the face of the earth. Will history repeat itself?

 ~ Further reading Top

World Health Assembly. Polio eradication by the year 2000. Resolution of the 41st World Health Assembly. Geneva, Switzerland. WHO, 1988 (Resolution 41.28).
Department of vaccines and Biologicals. The Polio eradication initiative: Strategic plan of action, 2001-2005. Geneva, Switzerland: WHO, 2000 (Document 00.05).
Surveillance for polio eradication: status and lessons learnt - India, 1999. www.jimaonline.org/jan2k/surv-polio.html.
Polio eradication. www.delhihealth.com/family/pulsepolio.html. 5. The Eradication of polio. A Gift to the children of the 21st century. www.worldindia.com/ppi/eradication.html. 

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