World Polio Day falls on 24th October. This is a day of reckoning of the scourge called Polio, of all the bitter memories it has left in its wake, and the many lives claimed by the disease. Yet, amidst the somber thoughts, the sweet taste of success brought by focused global strategies in significantly cutting the rate of disease, offers a glimpse of the light at the end of the tunnel.
'Eradicate Polio from the Face of the Earth'
Global eradication programmes, since 1988, which have employed poliovirus vaccines in many parts of the world has significantly reduced the worldwide occurrence of polio by 99%. The western regions can today boast of a complete polio- free environment.
According to the latest figures, there is a significant reduction of 58% in polio cases as compared to 2006 statistics. Only 613 cases have been reported globally in 2007. In the congratulatory note to India, the WHO Director General Margaret Chan, said, 'I am confident that India will soon become polio-free and attain a historic milestone.'Under the aegis of UNICEF and WHO noteworthy strides have been made across the world, especially in polio endemic regions of Iraq and Afghanistan.
Nevertheless, it is not time to rest on laurels, yet. Afghanistan, Pakistan, certain areas in India and Africa are not completely free from the virus. India had reported 676 cases of polio in 2006. This year, 2007, the number has reduced to 281. Most of the victims belong to parts of Uttar Pradesh and Bihar, from regions that lack hygiene and proper sanitation. Recently, two cases, one in Delhi and the other in Orissa have been reported.
Moving forward in full throttle, this year too, will embrace the goals of polio prevention in endemic areas with a concerted plan of action towards completely eradicating the disease. Importantly, the objectives will seek to plug the lacunae in areas where despite measures, polio has raised its ugly head.
Polio is a historical disease which had plagued many a nation since centuries. The infamous polio epidemic in the United States in 1916 had left nearly 27,000 crippled while also killing more than 6000 people.
Polio or Poliomyelitis is an infectious viral disease of the highest order. The virus attacks the nervous system; its virulent forms can virtually paralyze the nervous system within just a few hours. Children below the age of five are susceptible to the disease.
There are three types of Polio virus delineated as Type 1, 2 and 3. Type 1 and Type 3 continue to be a challenge in parts of Afghanistan, Africa and in endemic areas. Type 2 is fortunately eliminated.
Route of Transmission
Polio virus makes its way into the human intestine through the fecal-oral route after contact with a contaminated surface. The spread of the virus gathers momentum with person-person contact, unhygienic surroundings, and consumption of unclean water. The illness could last for 2 weeks but its irreparable damage to the nerves is life long in acute cases.
Polio - Symptoms
It is important to know that in nearly 90 to 95% of the cases, polio does not portray any symptoms, medically termed as Asymptomatic Polio. In the 5-10% of the cases where there are symptoms, also called as Symptomatic polio, the illness can be of three types.
• Abortive polio: Polio manifests as flu like symptoms; sore throat, respiratory infection, diarrhea and a general feeling of being indisposed are some of the common symptoms.
• Non-paralytic polio: Afflicting nearly 1 to 5% of the sufferers, the condition is marked by neurological symptoms like stiff neck or sensitivity to light.
• Paralytic polio: This is a severe form of polio accounting for 0.1 % to 2% of cases. The virus causes paralysis of the muscle. Breathing problems along with restricted movement of the limbs is a common fallout of this disease. In worst cases, this form of polio can also be fatal.
Doctors evaluate the symptoms portrayed by the patient. To confirm the diagnosis, laboratory tests are conducted on the samples taken from stool, cerebrospinal fluid or the secretions from the throat to ascertain the presence of the poliovirus.
Prevention - Immunization, the Only Way
Since there is no known cure for the disease, the best strategy is to prevent it. The only way to prevent Polio is by way of immunization. Multiple immunizations at prescribed intervals and en-masse vaccinations, sacrosanct to the Pulse Polio initiatives offer herd-immunity, which has been the best bet in beating the virus.
Of course, proper hygiene and sanitation in the environment assists in curbing the spread of the disease.
Two types of vaccines against Polio have been employed in the vaccination programmes.
• Inactivated Polio Vaccine or IPV used since 1955, contains the inactivated polio virus. The vaccine is administered as a shot in the leg or the arm.
• Oral Polio Vaccine or OPV, employed since 1961, contains a mild form of the live polio virus and is administered as 'drops' orally. The use of OPV has become controversial in medical circles due to a rare but serious side effect associated with the use of the vaccine - vaccine related paralytic poliomyelitis.
This has led to a ban on the use of OPV in the United States, which employs only IPV for vaccination. In India, OPV still forms the backbone of all pulse programme initiatives.
Mode of Administration
According to the directives of the Polio immunization programme, children need to be administered four doses of Polio vaccine during the period from infancy till 5 years of age.
• First dose is given at 2 months
• Second dose is at 4 months
• Third dose is between 6 to 18 months of age.
• The final dose, labeled as the booster dose is given between 4-6 years of age.
The Indian Initiative
The initiative against polio began in 1978 under the project called, the Expanded Programme on Vaccination (EPV) . This programme brought more than 40% of the infants under its cover to avail 3 doses of Oral polio Vaccine. Upon success of the first en-masse initiative, this programme was expanded to include many districts in the country.
To further intensify the drive against polio and to leave no stone unturned, the Pulse Polio Immunization (PPI) Programme commenced in 1995-96 to include all children below age of 3.
Despite the success of the PPI programme, and its extensive reach, even this was not fool proof, as polio re-surfaced in some parts during 1998 and 1999. Upon analysis, it became evident that nearly 5-6% of the children were still missing the vaccination. The PPI initiative thus took a newer turn for the better to include house-to-house search. Surprisingly, more than 2.3 crore children, who had missed vaccination, were administered the dose in their homes.
World Polio Day Message
It is imperative that all children receive polio immunization as per the schedule, which will give them life-long protection against a debilitating disease. The overriding message on World Polio Day is to spread the importance of timely immunization against Polio for all children below 5, which is the only way to a polio free world.