Polio: A war almost won

By R. Ramachandran

, by Frontline

India seems to have arrived at the threshold of polio eradication, but should it lower its guard?

ON January 13, India achieved what had only two years ago seemed impossible in the immediate term. The country, which, given the epidemiological data in the new millennium, had come to be regarded by health experts around the world as one that would be the last to achieve freedom from polio (poliomyelitis), recorded no case of polio caused by the wild polio virus (WPV) over a period of one year beginning January 13, 2011. In 2009, the figure was 741 and then one saw a sharp decline to 42 in 2010. Even then no one expected this to happen because one has seen such low figures in the past, which proved to be illusory in the end. This happened in 2002 and then again in 2006 ( Frontline, January 2, 2004, and May 19, 2006).

India was named “priority No. 1 country” in the Global Polio Eradication Initiative (GPEI) of the World Health Organisation (WHO), which in 1988 set the target year for eradication as 2000. This was later pushed to 2005, but with India, Pakistan, Afghanistan and Nigeria witnessing continued transmission beyond 2005, such targets began to lose their meaning. The remarkable turnaround in India this time seems for real. The indicators: Uttar Pradesh and Bihar, the two holdout States that have been frustrating the national programme aimed at polio eradication all along with persistent transmission of the virus, have reported no cases of polio since April 2010 and September 2010 respectively. The last case of January 2011 was actually detected in a two-year-old girl in Howrah in West Bengal, where the transmission got reintroduced through the import of a strain that was traced to Bihar. The last positive detection of the WPV in the monthly sewage sampling conducted in Delhi, Mumbai and Patna, which is indicative of such importation through migrant and mobile communities, was in November 2010. The final assault could, therefore, be mounted around this solitary case in West Bengal before transmission could entrench itself in this hitherto zero-transmission region of the country.

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