India: Polio cases cross 200 mark; Bihar tops

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Re: India: Polio cases cross 200 mark; Bihar tops

Source: http://www.hindu.com/thehindu/holnus...0810261111.htm

Deadly polio strain from Bihar creating havoc in UP

New Delhi (IANS): Uttar Pradesh has once again emerged as a hotbed for P 1, the most deadly polio strain, which was slowly being eliminated in India. But Uttar Pradesh, the country's most populous State, is again seeing a surge in the paralytic disease thanks to the virus being imported from neighbouring Bihar.

Though Uttar Pradesh was earlier described as the "world's most tenacious reservoir of P 1 poliovirus" by World Health Organisation (WHO) Director-General Margaret Chan, the state remained free of the most dangerous and fast travelling virus for a record one-and-a-half years.

But it resurfaced in Uttar Pradesh when the strain was imported from Bihar this year. And as the strain moves fast it has so far infected 47 people till Oct 17.

"All the cases in UP this year have been caused by an importation from Bihar and none by continuing transmission in the state," Hamid Jafari, Project Manager, WHO-NPSP (National Polio Surveillance Project), told IANS.

Jafari said as a "local circulation of this imported virus got established in western UP", the subsequent polio cases were traced to the same family of P 1 poliovirus that got introduced from Bihar.

This year, till Oct. 17, a total of 486 polio cases were reported, of which 55 were infected with P 1 and the rest suffered from P 3 virus.

Apart from infecting 47 people in Uttar Pradesh, the deadly strain was also reported from Bihar (2), Delhi (2), Orissa, West Bengal, Assam and Punjab where one case each was registered.

But the maximum cases of the strain, 648, were seen in 2006. It declined to 83 in 2007. In 2006, a total of 676 cases were reported in the country, while in 2007, the figure was 874.

India is one of the four countries in the world where polio is endemic. According to the Global Polio Eradication Imitative, Nigeria reported 728 polio cases this year, pushing India to second place, followed by Pakistan (81) and Afghanistan (22).

Jafari said the India Expert Advisory Group on polio eradication had said during its recent meeting that there was a risk of the country's most endemic region, western Uttar Pradesh, getting re-infected with P 1 as the virus transmission persists in Bihar. They had recommended rapid and intense mop-ups to eradicate the virus.

Following the suggestion of the expert committee, monovalent oral polio vaccine type 3 (mOPV3), which targets P 1, is being carried out in Bihar to stop its circulation and prevent re-importation, he added.

The WHO official said the transmission of the most dangerous polio virus and which is the focus of the eradication programme in India is at a historic low following intense immunisation campaigns.

"The most impressive progress has been in Uttar Pradesh, which for the first time in history stopped P 1 transmission in November 2007. The core endemic areas of western Uttar Pradesh - Moradabad and adjoining districts, the epicentre of all polio outbreaks, - remained free of this strain for a record one-and-a-half-year period up to mid 2008," Jafari said.

Health ministry officials said a P 1 case was reported in May this year from the Badaun area of Uttar Pradesh.

"A genetic sequencing traced it to Bihar. As the strain travels fast and there is a susceptible population, it spread again," the official with the NPSP, which plans and implements the polio immunisation activities in the country, told IANS.

The only silver lining for health workers seemed to be that Bihar, the other endemic state of the country, reported only two P 1 cases this year.

"It is a historic achievement. This progress follows aggressive immunisation campaigns combined with intense efforts to bridge operational gaps in the access-compromised Kosi river districts, the only area in the country by 2007-end where P 1 transmission continued," Jafari said.

He said by 2007-end, P 1 virus stopped in all but the Kosi river districts of Bihar.

However, officials and health workers continue to worry about the continued reporting of P 3 strain in the country, which was also exported to Angola. The virus had travelled from Uttar Pradesh.

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Re: India: Polio cases cross 200 mark; Bihar tops

Source: http://timesofindia.indiatimes.com/L...ow/3670473.cms

Does UP cradle polio virus?
4 Nov 2008, 0202 hrs IST, Shailvee Sharda, TNN

LUCKNOW: There seems to be more forces backing the virulent polio virus in Uttar Pradesh. Or else why would children suffer from the crippling
disease despite being ?highly immunised? against it. A child is said to be highly immunised against polio if he has been administered polio vaccine
for more than seven times.

According to the national polio surveillance project report, 78 per cent of polio cases in UP belong to the ?highly immunised? category. The corresponding figures for India stand at a whopping 83 per cent. The trend was almost reverse in 1998 when the programme started. The percentage of highly immunised children in UP then was just four.

The ?why? behind the trend is intriguing but top brass of the health department looked for cover when this question was asked. However, in the words of eminent virologist and member of the global advisory council on polio, Dr T Jacob John, "It is a twin challenge for UP and Bihar when it comes to polio eradication."

"The virus is extremely virulent while the effectiveness of the vaccine is comparatively lower in this part of the world," he added.

Malnutrition and weak routine immunisation: A state planning commission report shows that every second child in UP is malnourished. World Health Organisation estimates show that more than 50 per cent of child mortality cases can be attributed to this social evil. The reason: a malnourished child is 7-8 times more likely to die of common ailments as compared to healthy children. Poor routine immunisation coverage is the weak link of the health department. It fails to save children from the threat of a bunch of diseases. Fact that about 70 per cent children in the state lack routine immunisation cuts a sorry figure.

Open defecation and poor sanitation: There is a great body
of scientific evidence to prove that the polio virus spreads the maximum through the fecal route. Officials say that a single polio affected or carrier child is a risk to thousand others around him. The reason: polio virus lives in the throat and intestines of the affected child. It enters the body of the other child mainly through hands contaminated with the stool of the infected child. Open defecation suspends the virus in the air and it may enter the body through nasal or oral route too.

The ?missed? houses: Sources in the health department claim that an average of six per cent houses identified for polio immunisation belong to the ?extremely resistant? category. In fact, volunteers believe that it is almost impossible to convince these persons. Notably, there is a four line set-up to cover every child in the state. It begins with the booth day. The activity is backed by first line and second line house to house teams. The remaining houses are to covered by a separate team comprising representatives of the district administration. But so far, there has been little progress in the number of missed houses.

Migration: The first case of P1 type of polio reported in Badaun district of UP in May last had its genesis in Bihar. GOI-NPSP has documented the trend. The girl, Uzma, was a malnourished child. She came to the district with her parents who were labourers from Bihar. They came to this conclusion after analysing the genetic sequence of virus strain isolated through Uzma?s stool sample. The sequencing clearly indicated the link of UP?s P1 virus with those in Bihar. "Minute digressions in the genetic structure of the virus indicated that it reached western UP early in January," said an officer.

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Re: India: Polio cases cross 200 mark; Bihar tops

Source: http://www.reuters.com/article/latestCrisis/idUSB548939

Rumours spark polio vaccine panic in south India
Mon Dec 22, 2008 6:21am EST

BANGALORE, India, Dec 22 (Reuters) - Thousands of parents and their children protested outside hospitals in the southern Indian city of Bangalore following false rumours that children had fallen sick after being given polio drops, police said on Monday.

Police said nobody had fallen ill from the vaccine and filed a complaint against a local TV station, saying it helped spread panic following the rumours of children contracting fever and vomiting.

Police used megaphones to cool tempers at a government hospital on Sunday night where more than 3,000 people had gathered, as traffic slowed to a crawl in parts of the infotech city.

Protesters pushed some doctors and smashed hospital windows, after their children were administered polio drops as part of a government immunisation drive launched more than a decade ago.

"They were all worried and aggressive," Bangalore's assistant commissioner of police, Ashok Kumar, told Reuters. "It was a difficult situation. They left only after doctors and police officials assured them of their children's safety."

A world effort to beat polio has succeeded in slashing the number of cases by 99 percent over the past two decades, but the disease is still endemic in India, Pakistan, Afghanistan and Nigeria.

Suspicions about polio vaccines worsened after a major outbreak in India in 2006, when some Muslims resisted polio drops for their children following rumours that it was part of a Western ploy to sterilise their offspring.

Polio, which is incurable, leads to irreversible paralysis.

India has had 535 polio cases in 2008 so far compared to 471 in the same period last year, according to data from the World Health Organisation (WHO). (Editing by Matthias Williams and Sugita Katyal)