The World Health Organization has published detailed information on the reported prevalence of poliomyelitis in various countries during 1997 and 1998(1). Of the global total of 5187 reports of confirmed polio cases in 1997, the South East Asia Region (SEAR) contributed 2828 (55%). Among the SEAR cases, 2274 (80%) were from India. China had no case. In 1998 also China had no case of polio. The global total in 1998 was 3228, of which 2867 (89%) were from SEAR. Among them 2489 (87%) were from India. These data how that India has indeed lagged very much behind the rest of the world in progress to- wards global eradication of polio.
In 1998, only 60% of acute flaccid paralysis (AFP) cases were investigated with ad- equate stool specimens. China and India have about one billion population each. China re- ported 4638 cases of AFP in 1998, none of which was polio. India on the other hand re- ported 8486 cases of AFP of which 2489 were stated as confirmed polio. Thus we had 5997 cases of what is considered non-polio AFP, as against 4638 cases in China. This suggests that .some among what is' called non-polio AFP in India may also be polio.
In summary, the situation has not improved in India between 1997 and 1998. The
actual numbers of poliovirus isolations were 522 in 1997 and 746 in 1998. By way
of comparison, Malaysia, Philippines, Viet Nam, Thailand, Indonesia, Sri Lanka and Myanmar have had no poliovirus isolation in 1998 and
only Thailand and Viet N am had just one isolation each in 1997. Other major countries with continuing poliovirus isolation are Nigeria, Sudan, Turkey, Pakistan, Afghanistan and Bangladesh. Among all of them, India has the worst case scenario.
The Ministry of Health and Family Welfare has requested the Indian Council of Medical Research for help and the latter has established a Task Force for investigating the deficiencies of our efforts and to suggest re- medial measures. Let us hope that the Task Force will appreciate the fact that the annual two dose pulse immunization is not sufficient for disrupting wild poliovirus in India but the original Indian model of annual three dose pulse might disrupt transmission within one or two years. We are consuming about 15 doses of OPV per capita among infants and preschoolers, suggesting that it is> not the quantity of vaccine that is deficient but the manner in which they are used to build up - 'herd effect' rapidly and forcefully enough to disrupt transmission. The earlier we eradicate polio the less expensive would the operation be. International experts who planned the eradication strategy for India had not under- stood the carefully documented elements of the epidemiology, surveillance strategy, and transmission pattern of polio viruses and how OPV affects them in India.
It is still not too late to put our eradication
efforts on the right track since there are more . than 20 months until the end of the year 2000, our current deadline to reach zero polio. Let us
.
hope that the ICMR Task Force will lead the
way now.
The lAP strongly urges the government
that every child with AFP must receive quality treatment and rehabilitation for the sake of up- holding ethical principles. After all they are participants in a global program, funded heavily by national and international sources. Will any donor country tolerate such callous attitude towards paralyzed children in their own community? Currently the policy of the government is to hospitalize each child with AFP for only one day for the purpose of collecting two stool samples. Ethics demand that every child with AFP must be given full and free treatment and rehabilitation. Ethics also
demand that every child with polio either due to vaccine viruses, or due to wild viruses in spite of taking 3 doses of OPV,
must be adequately compensated for damage or deficient service.
T. Jacob John,
2/91,E-2 KamaLakshipuram,
Vellore - 632 002,
Tamil Nadu,
India.
