The Deadly Cripple
Posted: Monday, November 03rd, 2008 | Posted by: Ashish Rao | Views: 31001
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On the surface it seems as though India's largest public health drive, the pulse polio immunization drive has paid off. But consider this, in 2008 there are still 1400 children worldwide suffering from the polio myelitis virus. This figure stands at 499 in India until Oct 31. Now, can we say that the pulse polio initiative has really administered what it set out to acheive? The figures seem quite small compared to the figures of 1988, but with a program like this - eradication of the virus is the only way success is measured. Although the district of South Kanara has not seen any case in the recent past, eradication of the virus nationwide still seems like its taking more time than it should.  For once lack of good governance and mis administration cannot be blamed. For the Indian government has allocated enough and more funds to administer the National Immunization drives (NID). Since this is a global initiative it is not enough if the project achieves a local target. It has to be eradicated on a global scale. Poliomyelitis (polio) is a highly infectious disease caused by a virus. It invades the nervous system, and can cause total paralysis in a matter of hours. It can strike at any age, but affects mainly children under three (over 50% of all cases). The virus enters the body through the mouth and multiplies in the intestine.
Since its formative years of 1988 India has come a long way in this initiative. There are two aspects to wiping out the disease. First is the Surveillance, to detect the presence of the virus. This is done through Immunisation campaigns. Stopping poliovirus transmission has been pursued through a combination of routine immunization and supplementary immunization campaigns which are guided by high quality surveillance. The four key strategies for stopping poliovirus transmission are:
  • High infant immunization coverage with four doses of oral polio vaccine (OPV) in the first year of life - routine immunization with OPV
  • National immunization days (NIDs) to provide supplementary doses of oral polio vaccine to all children under five years of age
  • Surveillance for wild poliovirus through reporting and laboratory testing of all cases of acute flaccid paralysis (floppy) among children under fifteen years of age
  • Targeted "mop-up" campaigns once wild poliovirus transmission is limited to a specific focal area.
Since its inception, polio eradication program has seen lot of hard work. It is now in active transmission only in India, Pakistan, Afghanistan and Nigeria. In all other countries the virus only imports itself. The disease spreads amongst children and when families migrate from one country to another, the virus travels across countries. Thus the only way to prevent its spread is through an oral vaccine. There is also an injectible vaccine available.
The action of oralpolio vaccine (OPV) is two-pronged: OPV produces antibodies in the blood ('humoral' or serum immunity) to all three types of poliovirus. OPV gives immunity in the intestine first and also helps in humoral immunity. In the event of infection, this will protect the individual against polio paralysis by preventing the spread of poliovirus to the nervous system.
Administering the vaccine forms the biggest challenge to any nation. The aim of any immunization drive is to minimize the presence of the virus to zero. It is a continuous fight.  The virus must be eradicated from the face of the earth. Only then can we achieve a polio free world. Otherwise there  is always a risk of the disease coming back. Take for example Indonesia. In 2005 there was a child who migrated into Indonesia from Sudan. The quality of the response immunization drives were insufficient.  In four months the number of cases risen to 225.
In South Kanara district routine immunization is done by the Department of Health and Family Welfare with the association of hospitals ( government and private), Rotary clubs and private nursing schools. The highlight of the program are the National Immunization Days (NID). This is the day when the entire nation works simultaneously to two drops of vaccine to children below five years coming from far and wide.
The Hospitals aid in conducting Surveillance. They report cases of paralysis anywhere in the district amongst children below 15.  Thus a thorough search of the virus is conducted. During NID, it becomes the responsibility of every parent with children below 5 to bring them to the polio immunization booth and get them vaccinated. Not only this, if neighbors find that their friends are not participating then they must make them attend the pulse polio drives. The Primary Health Centers divide the areas depending on the houses and population. The geography of reach is also taken into consideration. Vaccination booths are then allocated to each area to ensure accessibility. The vaccine is provided by the Government of India and utmost care is taken that it is maintained at proper temperature until it is administered. Once the drive is over a house to house campaign is done in a specific focal area. In Andhra Pradesh at least three and a half million children were vaccinated recently. The National Immunization Day is usually conducted on a Sunday when there is booth activity. Even if one child is left unimmunised then there is a potential risk of spread of the virus. The District Commissioner and Department off Health and Family Welfare (DH&FW) have done phenomenal work in making the NIDs successful. There are many unsung heroes who are behind the success of this venture. Many rural anganawadi workers have dedicated their lives to work for the polio  program. Supporting the pulse polio drive are all rotary clubs from Mangalore. In India the annual budget of the pulse polio program is approximately 2000 crores per annum.
Globally the cost has been about 5 billion dollars. In South Kanara, the last case was diagnosed in 1999. Yet, if it exists on our planet then it means there is a potential risk of the virus spreading. In 1988, 126 countries had active transmission and that figure stands at 4 in 2008. In the late 80s globally three and a half lakh children were affected and in 2008 that figure is 1400. In India what was 50,000 in 1988 is now 499. But what is of utmost importance is community participation during the pulse polio drives. All citizens must be proactive and make sure they take children below 5 to get them immunized.

Every pulse polio drive is an emergency reaction to continued presence of polio virus in India.
The District of South Kanara faces a challenge in getting community participation. The parents must get to the nearest center when these pulse polio drives are conducted. Elsewhere like in Africa and Bihar the shear geographical topography poses the biggest challenge to getting the vaccine to where it is needed.
Nevertheless, doctors and staff go that extra mile and overcome any obstacles to reach the vaccine to the needy.
In the race to survival, the polio eradication program is surely making children survive rather than the virus.
Comments
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Very informative article.Just one case reported can cause a huge expense to the public health system and government and all organisation concerned with polio plus program.Strange are the ways the virus spreads.Hope more volunteers will spread the message and ensure that every child gets OPV on the designated day!
Posted By: Ramohan, Tuesday, November 04th, 2008