Indian Pediatrics - Editorial

Letters to the Editor

Indian Pediatrics 2003; 40:1100-1101

Polio Eradication in India

This refers to the special article by Dr. Jacob John entitled ‘Polio Eradication in India: What is the Future’(1). Dr. Jacob John had stated that OPV must be discontinued as early as possible, but there should be no vaccum of immunity while it is being withdrawn. The observations made in this statement are correct, but ‘Milestones on Our Future Path’ suggested by him are not realistic. Dr. Jacob John and the members of the Polio Eradication Committee of IAP have overlooked two vital issues: (a) vaccine failure with OPV and (b) misclassification of AFP cases. The members of the Committee are not correct in their assessment that failure to eradicate wild poliovirus is due to inadequate vaccine coverage only. Wild poliovirus elimination can not be achieved by the end of year 2003. The Committee is trying to raise false hopes. There are many cases where children have developed polio even after taking more than 8 doses of OPV(2). Unless reasons for vaccine failure are found, and appropriate remedial measures taken, wild virus elimination can not be achieved.

Study of AFP line list for year 2002 from Rajasthan showed that some AFP cases had been discarded as non-polio cases even without 60 days follow up because stool samples were negative for wild polioviruses. There may be similar misclassifications from other parts of the country also. Thus there is under reporting of polio cases.

According to the proposed timetable, IPV is to be introduced in year 2006. Dr. Jacob John had written about the VAPP burden of India. It is really baffling that he wants this unacceptable burden to continue for some more years. VAPP can be eliminated by stopping OPV altogether and starting IPV. Switch over from OPV to IPV can not be done overnight, but incidence of VAPP can be reduced by introducing IPV right now, for those who need it specifically or for those whose parents desire administration of IPV.

Can polio be eradicated by the National Polio Eradication Program in its present form? It depends on the answer to the following question. Has any child developed polio after taking age appropriate number of OPV doses? If the answer is no, then we should find means for better and vigorous implementation of the present program. But, if the answer is yes, then there is a need for re-appraisal of the present program.

The Committee should take three steps to move towards the cherished goal of polio eradication:

1. Find the reasons for high incidence of vaccine failure with OPV to take appropriate remedial measures.

2. Introduce IPV on selectives basis with immediate effect to reduce the incidence of VAPP.

3. Develop some modalities or methodology so that correct case classification of AFP cases is done and correct number of polio cases are known.

If these or some other similar measures are not taken soon, polio eradication will remain a distant dream and we will have to postpone the deadline for polio eradication again and again on one or other pretext.

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

References

1. John TJ. Polio eradication in India: What is the future? Indian Pediatr 2003; 40: 455-462.

2. Paul Y. Accuracy of the National Polio Surveillance Project data in Rajasthan. Indian J Pediatr 2002; 69: 667-673.