Acute Flaccid Paralysis in India March 2012 - Dec 2013

[Ronan Kelly]

Crof.
This seems like a silly scare article. Dr. Day's comment at the bottom gives an indication of the number of AFP cases in India, as well as some of the causes. In our rolling report thread, there are many examples of AFP cases mostly being reported from Bihar.

2 wks after eradication, 'polio' resurfaces
Soumen Datta & Subhendu Maiti, Hindustan Times
Baruipur/Kolkata, March 13, 2012 Email to Author

First Published: 01:11 IST(13/3/2012)
Last Updated: 01:12 IST(13/3/2012)

Barely two weeks after World Health Organisation (WHO) declared India as a polio-free nation, an 18-month-old female child was admitted to a state-run hospital in Kolkata with suspected polio on Monday.

The child, Sumi, a resident of Indrabala village near Baruipur in South 24 Parganas district, was admitted with symptoms of paralysis with disability in movement and fever.

The child?s stool samples have been sent to the National Institute of Virology in Pune and School of Tropical Medicine in Kolkata for confirmatory tests. The reports are expected next week.

?It is a suspected case of polio. In medical parlance, the symptoms are called acute flaccid paralysis. The patient is under observation,? Kumar Kanti Das, superintendent of Baruipur subdivisional hospital (BSH), said.

...
If Sumi is indeed afflicted with polio, it will raise questions about the efficacy of the pulse polio drives that the administration organises with fanfare.

http://www.hindustantimes.com/India-news/Kolkata/2-wks-after-eradication-polio-resurfaces/Article1-824438.aspx

Comment by Dr Abhijit Dey
Another foolish story by HT... Dont Panic... this was case of Acute Flaccid Paralysis (AFP)... there are 40 such case in 2012 already reported in 24 Parganas (S) only. The child is completely ok now.. it was a case of transient flaccidity. stool is being collected (like any other AFP case). Dont Panic...
there will be atleast 1 AFP case/1lakh under15 population/year even after polio eradication (cause- traumatic neuritis, GB, Transverse myelitis, other viral neuritis etc)

[Ronan Kelly]

Re: Acute Flaccid Paralysis in India

NEW DELHI, March 16, 2012
?Reports on polio resurfacing inaccurate, misleading'

AARTI DHAR

Acute flaccid paralysis is only a possible symptom of polio and not a conclusive trait, says health administrator

Less than 24 hours after a prominent national newspaper sparked off worldwide concern by reporting that polio had reappeared in India just a fortnight after it had been reported as eradicated, a top health administrator has lashed out at the media for misreporting the issue.

?Incorrect and unsubstantiated information can be a major setback for any programme,? said Anuradha Gupta, Additional Secretary, Ministry of Health and Family Welfare, who is in charge of polio eradication. ?These reports are not only inaccurate, but also misleading and de-motivating for the polio workforce, who are working extremely hard to make India polio-free,? she said.

...

Ms. Gupta's said the child's case was one of over 8,000 AFP cases to have been investigated by the National Polio Surveillance Project (NPSP) with the support of local health authorities since January 1 this year. Every one of these AFP cases had tested negative for polio.

?It is important to understand that polio is one of the several causes of AFP and not the only cause for AFP. It is incorrect to call an AFP case a polio case until confirmed by laboratory test,? she said. Over 35,000 reporting units across the country reported 60,782 children with AFP cases, which were followed up and investigated by the laboratories in the year 2011. Only one tested positive for polio, in Howrah district of West Bengal in January, 2011.

...

http://www.thehindu.com/health/article2999838.ece

[Ronan Kelly]

Re: Acute Flaccid Paralysis in India

Support for children identified with acute flaccid paralysis under the Global Polio Eradication Programme in Uttar Pradesh, India: a qualitative study
Rie R Yotsu, Katharine Abba, Helen Smith and Abhijit Das

BMC Public Health 2012, 12:229 doi:10.1186/1471-2458-12-229
Published: 22 March 2012

Abstract (provisional)
Background
Cases of polio in India declined after the implementation of the polio eradication programme especially in these recent years. The programme includes surveillance of acute flaccid paralysis (AFP) to detect and diagnose cases of polio at early stage. Under this surveillance, over 40,000 cases of AFP are reported annually since 2007 regardless of the number of actual polio cases. Yet, not much is known about these children. We conducted a qualitative research to explore care and support for children with AFP after their diagnosis.

Methods
The research was conducted in a district of western Uttar Pradesh classified as high-risk area for polio. In-depth interviews with parents of children with polio (17), with non-polio AFP (9), healthcare providers (40), and key informants from community including international and government officers, religious leaders, community leaders, journalists, and academics (21) were performed.

Results
Minimal medicine and attention were provided at government hospitals. Therefore, most parents preferred private-practice doctors for their children with AFP. Many were visited at homes to have stool samples collected by authorities. Some were visited repetitively following the sample collection, but had difficulty in understanding the reasons for these visits that pertained no treatment. Financial burden was a common concern among all families. Many parents expressed resentment for their children's disease, notably have been affected despite receiving multiple doses of polio vaccine. Both parents and healthcare providers lacked information and knowledge, furthermore poverty minimised the access to available healthcare services. Medicines, education, and transportation means were identified as foremost needs for children with AFP and residual paralysis.

Conclusions
Despite the high number of children diagnosed with AFP as part of the global polio eradication programme, we found they were not provided with sufficient medical support following their diagnosis. Improvement in the quality and sufficiency of the healthcare system together with integration of AFP surveillance with other services in these underprivileged areas may serve as a key solution.

The complete article is available as a provisional PDF. The fully formatted PDF and HTML versions are in production.

http://www.biomedcentral.com/1471-2458/12/229/abstract

[Ronan Kelly]

Re: Acute Flaccid Paralysis in India

Lab Reports Confirm WB case is not Polio
The 18-month old girl from West Bengal, reported as a polio case in a section of media earlier this month, has tested negative for polio. Both the stool samples of the child were found negative for polio in the Institute of Serology Kolkata. As thorough investigation were being carried out, a section of media flashed Sumi?s case as a ?polio case? and reporting it as a huge setback to India?s polio eradication program.

The child Sumi Naskar from Baruipur, 24-Parganas South,was admitted to a hospital in Kolkata earlier this month from where she was picked up by the polio surveillance network for investigation. As part of surveillance for polio, any child less than 15 years of age who suddenly develops floppiness or weakness or paralysis in any part of the body is investigated thoroughly. These cases are called Acute Flaccid Paralysis (AFP) cases.Polio is one of the several causes of AFP and not the only cause for AFP.

Two stool samples of the girl were collected on 13 March and 14 March and sent to the Institute of Serology Kolkata for investigation.Stool samples are collected from all AFP cases and tested to rule out polio as a cause of the illness.

Sumi is one of the many AFP cases detected this year and investigated for polio. In 2012 so far, around 9,000 AFP cases have been investigated by NPSP with the support of local health authorities. All the stool samples of these AFP cases have tested negative for polio. An update of the Acute Flaccid Paralysis (AFP) cases under investigation and the laboratory results is available on the website of the National Polio Surveillance Project. The information is updated every week and can be accessed at www.npspindia.org.

India has not reported any case of polio since 13 January 2011 and has been struck off the list of countries with active endemic wild polio transmission in February 2012. But the job is not yet done. As the risk of polio persists, the surveillance for polio continues to be of the highest sensitivity, detecting and investigating all cases of AFP to rule out polio. An AFP case cannot be reported as polio until confirmed by a laboratory.

SBS/ls
(Release ID :81952)

http://pib.nic.in/newsite/erelease.aspx?relid=81952

[Ronan Kelly]

Re: Acute Flaccid Paralysis in India

http://www.npspindia.org/bulletin.pdf

[Ronan Kelly]

Re: Acute Flaccid Paralysis in India

AFP Surveillance Bulletin - India
Report for week 18, ending 5 May 2012

http://www.npspindia.org/bulletin.pdf

[Ronan Kelly]

Re: Acute Flaccid Paralysis in India

http://www.npspindia.org/bulletin.pdf

[Ronan Kelly]

Re: Acute Flaccid Paralysis in India

Suspected polio cases reported from Sabarkatha
Radha Sharma, TNN | Jun 19, 2012, 08.50PM IST

AHMEDABAD: The health teams of Sabarkantha district administration are running from pillar to post after three children resident of Umedgadh village were suspected of polio.

Officials said that the blood samples of the three kids have been collected and sent to Ahmedabad for detailed analysis. According to the officials, the three have been suffering from acute flaccid paralysis.
The three children who have been suffering from AFP are from Umedgadh village in Idar Taluka of Sabarkantha district.
...

http://timesofindia.indiatimes.com/city/ahmedabad/Suspected-polio-cases-reported-from-Sabarkatha/articleshow/14275872.cms

[Ronan Kelly]

Re: Acute Flaccid Paralysis in India

BIHAR
BHOJPUR
AFP villege -sandesh ,PHC-sandesh,Bhojpur 1 0 17/06/2012 2012-06-21 12:18:20 1876 A case reported by MOIC child age is11 year,Taken all dose of polio vac.case attended by SMO. stool sample collected send for test.result is awaited. RRT visitted plase investigation is going on. Investigation Open situation under control

AFP vill-gaundi,PHC-barhara,Bhojpur 1 0 26/05/2012 2012-06-21 12:07:44 876 AFP case reported by ANM, DIO and SMO visited the plase. Stool samle collected for test.Result is nagative. Direction for RI Stranthen Investigation Closed situation under control.

MUNGER
Provisional Acute Flaccid Paralysis (AFP) Vill-Kesopur, Gage No. 6 Dharahara Road Jamalpur, Munger(Bihar) 1 0 11/06/2012 2012-06-21 14:07:30 900 Case of Acute Flaccid Paralysis (AFP) reported from PHC Tetiabamber ,there wasnot any case found sinc last four months,Active case search done to find new cases. Information sent for stool test. Health education given regarding hygiene and sanitation. Stool sent for Test:-01, Result Awaited RRT visited the affected area. House to house survey done. Daily surveillance done. Investigation Open NO

Provisional Acute Flaccid Paralysis (AFP) Vill- Ghorghat, Premtola, near middle School, Bariyarpur, Munger(Bihar) 1 0 11/06/2012 2012-06-21 14:11:16 800 Case of Acute Flaccid Paralysis (AFP) reported from PHC Tetiabamber ,there wasnot any case found sinc last four months,Active case search done to find new cases. Information sent for stool test. Health education given regarding hygiene and sanitation. Stool sent for Test:-01, Result Awaited RRT visited the affected area. House to house survey done. Daily surveillance done. Investigation Open NO

http://idsp.nic.in/idsp/Disease_outbreak/Disease_outbreak_3day_report.jsp

[Ronan Kelly]

Re: Acute Flaccid Paralysis in India

ASSAM
JORHAT
AFP Block: Nakachari PHC Vill- Kakojan T.E. 1 0 04/06/2012 2012-06-22 11:37:57 3420 1. Area: Rural 2. Sex: Male 3. Age group :6-15:1 1. Type of sample : stool 2. No. of sample collected :2 nos. 3. Sample sent for test: Regional Polio Surveillance Centre, Dibrugarh 4. Result: Awaited 1. Active search in community doen 2. Surveillance4 for detection of any fresh cases in the area is going on. Investigation Open No. any other fresh cases were reported as on 21.6.12 2. Hard copy recieved on 21.6.12

AFP Block: Kakojan BPHCSub- centre: Boloma SCVill: Teok T.E. Maajline 1 0 05/06/2012 2012-06-22 11:30:56 3495 1. Area: Tea-Garden area2. Sex: Female3. Age Group: 6-15: 14. Community : Tea-Tribe5. Immuniztion Status: OPV doses received through routine immunization EPI (before onset) 4OPV doses received through SIAs (before onset) 2Total OPV doses 6 1.Type of sample: Stool2. No. of sample collected: 2 nos.3. Sample sent for test: Regional Polio Surveillance Centre, Dibrugarh- Assam4. Result: Awaited 1. Active cse search in community done.2. Surveillance for detection of any fresh cases in the area is going on. Investigation Open No any other fresh cases from the area were reported as on 18.6.12Hard copy of the report recieved on 18.6.12

http://idsp.nic.in/idsp/Disease_outbreak/Disease_outbreak_3day_report.jsp

[Ronan Kelly]

Re: Acute Flaccid Paralysis in India


...
full report at http://www.npspindia.org/bulletin.pdf

[Ronan Kelly]

Re: Acute Flaccid Paralysis in India

ASSAM
BARPETA
Acute Flacid Paralysis 15 years of age( clinical) 1. Mandia PHC, jadavpur Sub Centre, Jadavpur Village. 2. Nityananda PHC, Borvitha Sub Centre, Pub Dalor Pathar Village. 2 0 14/07/2012 2012-07-19 12:59:24 4387 Attacked on leg of the patient Stool sample already collected from Additinal Office, oo JDH, Barpeta and sent to the Surveillance Officer, National Polio Surveillance Project, Bongaigaon, assam, on 16.7.12, Result awaited NIL Investigation Open 1 NO CASE REPORTED IN P FORM, 2NO CASESS REPORT COLLECTED FROM ADDITIONAL OFFICE, JDH, BARPETA.

http://idsp.nic.in/idsp/Disease_outbreak/Disease_outbreak_3day_report.jsp

[Ronan Kelly]

Re: Acute Flaccid Paralysis in India


...
full report at http://www.npspindia.org/bulletin.pdf

[alert]

Re: Acute Flaccid Paralysis in India

Hat-tip RoRo. This might be a vaccine-derived or even wild-type polio outbreak, and is worth watching:

PHC arrived polio symptoms found in children
Aug 31, 12:55 am

Shuklaganj (Unnao), reporter: Primary Health Centre in the city on Wednesday Fever brought for treatment in a nearly four-year-old polio symptoms are met.
11 hours had brought. Mr. Washarney said that as soon as the two days of the child's parents that their son was benign fever Kumar. Ashutosh charge of PHC doctors Washarney Said Shuklaganj The Sarvodaya Nagar neighborhood resident Sushil Kumar Rawat and his wife Sarah half*Four-year-old son last two days from benign Kumar Fever coming to PHC Wednesday forenoon at approximately On Wednesday morning, he had not been able to walk. Which was his checkup. Mr. Washarney told AFP in children during the check up (Flasid Acute Paralysis) Symptoms are met. He sent her stool test for Sjeepijiai Lucknow. Mr. Washarney informed that before the primary health center and we have had 17 cases of AFP cases. This is the 18th case. He examined 16 cases reported has come. Any of the symptoms of polio are found. Just two days ago Shuklaganj He belonged to the four-year-old girl Jayshree Gajikedha also had symptoms of AFP. The samples have been sent to the Sjeepijiai Lucknow.

http://in.jagran.yahoo.com/news/local/uttarpradesh/4_1_9618400.html

[Ronan Kelly]

Re: Acute Flaccid Paralysis in India

Polio programme: let us declare victory and move on
Neetu Vashisht1, Jacob Puliyel2


Abstract

It was hoped that following polio eradication, immunisation could be stopped. However the synthesis of polio virus in 2002, made eradication impossible. It is argued that getting poor countries to expend their scarce resources on an impossible dream over the last 10 years was unethical.

Furthermore, while India has been polio-free for a year, there has been a huge increase in non-polio acute flaccid paralysis (NPAFP). In 2011, there were an extra 47,500 new cases of NPAFP. Clinically indistinguishable from polio paralysis but twice as deadly, the incidence of NPAFP was directly proportional to doses of oral polio received. Though this data was collected within the polio surveillance system, it was not investigated. The principle of primum-non-nocere was violated.

The authors suggest that the huge bill of US$ 8 billion spent on the programme, is a small sum to pay if the world learns to be wary of such vertical programmes in the future.
...
The elephant in the room: the problem of non-polio Acute Flaccid Paralysis (AFP)

It has been reported in the Lancet that the incidence of AFP, especially non-polio AFP has increased exponentially in India after a high potency polio vaccine was introduced (25). Grassly and colleagues suggested, at that time, that the increase in AFP was the result of a deliberate effort to intensify surveillance and reporting in India (26). The National Polio Surveillance Programme maintained that the increased numbers were due to reporting of mild weakness, presumably weakness of little consequence (27). However in 2005, a fifth of the cases of non-polio AFP in the Indian state of Uttar Pradesh (UP) were followed up after 60 days. 35.2% were found to have residual paralysis and 8.5% had died (making the total of residual paralysis or death - 43.7%) (28). Sathyamala examined data from the following year and showed that children who were identified with non-polio AFP were at more than twice the risk of dying than those with wild polio infection (27).

Data from India on polio control over 10 years, available from the National Polio Surveillance Project, has now been compiled and made available online for it to be scrutinised by epidemiologists and statisticians (29).

This shows that the non-polio AFP rate increases in proportion to the number of polio vaccine doses received in each area. Nationally, the non-polio AFP rate is now 12 times higher than expected. In the states of Uttar Pradesh (UP) and Bihar, which have pulse polio rounds nearly every month, the non-polio AFP rate is 25- and 35-fold higher than the international norms. The relationship of the non-polio AFP rate is curvilinear with a more steep increase beyond six doses of OPV in one year. The non-polio AFP rate during the year best correlates to the cumulative doses received in the previous three years. Association (R2) of the non-polio AFP rate with OPV doses received in 2009 was 41.9%. Adding up doses received from 2007 increased the association (R2 = 55.6% p < 0.001) (30). Population density did not show any association with the non-polio AFP rate, although others have suggested that it is related to polio AFP (31).

The international incidence of non-polio AFP is said to be 1 to 2/100,000 in the populations under 15 (32, 33). The benchmark of good surveillance is the ability to detect one case of AFP per 100,000 children even in the absence of polio (34). In 2011, an additional 47,500 children were newly paralysed in the year, over and above the standard 2/100,000 non-polio AFP that is generally accepted as the norm. (32-33). It is sad that, even after meticulous surveillance, this large excess in the incidence of paralysis was not investigated as a possible signal, nor was any effort made to try and study the mechanism for this spurt in non-polio AFP. These findings point to the need for a critical appraisal to find the factors contributing to the increase in non-polio AFP with increase in OPV doses ? perhaps looking at the influence of strain shifts of entero-pathogens induced by the vaccine given practically once every month.

From India's perspective the exercise has been extremely costly both in terms of human suffering and in monetary terms. It is tempting to speculate what could have been achieved if the $2.5 billion spent on attempting to eradicate polio were spent on water and sanitation and routine immunisation. Perhaps control of polio, to the level of elimination, may well have been achieved as it has been in more developed countries. When the US was badly mired in Iraq in 2005, Joe Galloway suggested that the US must simply declare victory, and then exit (35). Perhaps the time is right for such an honourable strategy with regard to polio eradication.
...

http://www.issuesinmedicalethics.org/202co114.html

National Polio Surveillance India data 2000 -2010
NPSP Polio surveillance data on Acute Flaccid Paralysis (AFP) and non-polio AFP and Demographic data (PDF)

http://jacob.puliyel.com/download.php?id=248