POLIO FREE INDIA

Poliomyelitis (Polio) is a highly infectious viral disease which will affect the children
mainly under 5 years of age. The virus is transmitted through contaminated food and
water, and multiplies in the intestine, from where it can invade the nervous system.
Many infected people have no symptoms, but excrete the virus in their faeces, hence
transmitting infection to others. Initial symptoms of the polio are fever, fatigue,
headache, vomiting, and stiffness in the neck and pain in the limps.
India made great success in eliminating this virus from the country, when moved from
749 cases in 2009 to 1, two years later. India achieved this landmark by passing
through many challenges. The year 2000 was the target set by Global Polio
Eradication Initiative (GPEI) in 1988. By 1988 itself nearly 70 countries had achieved
the elimination of the wild polio virus transmission through their routine national
immunisation programmes, by using Inactive Polio Virus Vaccine (IPV) or Oral Polio
virus Vaccine (OPV).
There are mainly three types of polio viruses present. Among these three type 2 was
globally eradicated in 1999 with last case in Uttar Pradesh. But other two remained as
a big problem in 4 countries. (India, Pakistan, Afghanistan and Nigeria). The WHO
recommended the use of OPV for these countries. OPV is very popular because of its
low cost and ease of inoculation by mouth as two drops.
But the fact is that many countries using OPV could not control the polio with routine
immunisation. Countries with low income, overcrowding, high birth rates and high
child mortality faced low effectiveness of OPV, where as those with the IPV had high
vaccine effectiveness.
In India we used trivalent OPV (tOPV) whose power to eradicate the type 1 and type
3 viruses was very low. The type 2 virus disappeared in 1999. In 2005 and thereafter,
a new monovalent type 1 OPV (mOPV 1) was used in UP and Bihar. It was three
times effective than tOPV. But gaps in immunity were created aginst type 3;
consequently, type 3 outbreaks occurred in 2007-2009. Then a bivalent vaccine
(bOPV with 1 and 3). From early 2010 bOPV was been widely used in UP and Bihar
during campaigns, while tOPV is used everywhere for routine immunisation.
The Oral Vaccine has its drawbacks also. In some cases the live but viral strains in the
vaccine can themselves cause polio. Moreover these viruses can revert to virulence,
resulting in what are known as vaccine derived polio viruses (VDPV). A high
proportion of those who immunised with OPV excretes revertant virus. In India seven
cases of paralysis caused by VDPV was found during 2011. Such VDPV can readily
circulate and spread. Many experts believe that the transition will have to be handled
by introducing IPV, injectable vaccine that wealthy nations already use to immunise
children.
For India a sensible option would be to introduce IPV in its immunisation programme
alongside the oral vaccine. OPV could be withdrawn as IPV immunisation levels
picked up. Money should not be a barrier for the public health.
(Courtesy: Civil Service Chronicle, Vol: XXIII No.9)