In the January 2004 issue of the Bulletin of Polio Eradication Committee of IAP Dr. Jacob John had stated: "it is still possible to see the last case of wild-virus polio in 2003 itself. If that does not happens then it should happen in the first quarter of 2004". The India Expert Advisory Group concluded at the 26-27 March, 2004 meeting that the transmission of wild polioviruses can be stopped in the country within months. The prophesy turned out to be incorrect as can be seen in Table I.

Representative period

First 3 months

First 6 months

First 7 months

Virologically confirmed

10

33

54

Compatible

45

95

121

It would be relevant to state that many polio cases are being missed because of the following two reasons(1): (i) AFP cases where vaccine polioviruses are found in stools are discarded as non-polio. (ii) Wild polioviruses not detected in stool samples of AFP cases. Many such cases are discarded as non-polio even without 60 days follow up.

High incidence of vaccine failure: According to the official data polio incidence in children who had received four or more of doses of OPV was as follows: In year 2000: 58%, in 2001: 60%, in 2002: 44%, and in 2003: 51%. According to Kohler, et al. out of 181 VAPP cases during 1999, 78 children had received five or more doses of OPV before onset of paralysis(2).

High incidence of VAPP: The expected number of VAPP cases every year was 60-75. According to revised data made available by the NPSP the number of VAPP cases were as follows: 1998 : 124, 1999 : 206, 2000 : 151, 2001 : 120, 2002 : 203. According to my estimates about 300 cases occur every year(1).

It can be said that present eradication program ensures that polio is not eradicated. Polio cases will continue to occur because of vaccine failure and due to mutant vaccine polioviruses. Infected immunocompromised children will continue to spread for prolonged period in the community wild as well as mutant vaccine polioviruses.

It is suggested that following three measures be considered: (i) new guidelines for AFP classification be formulated so that no polio case is missed, (ii) IPV be made available for those children who are immuno- compromised or have immunocompromised close contacts, and (iii) the reasons for vaccine failure be determined and appropriate remedial measures, if feasible be taken, otherwise some alternate strategy for polio eradication be formulated.

Yash Paul,
A-D-7, Devi Marg,
Bani Park,
Jaipur-302 016, India.
E-mail : [email protected]

1. Paul Y. Need for re-appraisal of acute flaccid paralysis (AFP) case classification. Vaccine 2004; 22: 3829-3830.

2. Kohler KA, Bannerjee K, Hlady WG, Andrus JK, Sutter RW. Vaccine associated paralytic poliomyelitis in India during 1999: decreased risk despite massive use of oral polio vaccine. Bull WHO 2002; 80: 210-226.