Uttar Pradesh Indian state exporting polio, also re-infecting polio-free Indian states

The World Health Organisation and Unicef warn that, having met with spectacular success in 2005, India�s polio vaccination effort is in danger of falling victim to complacency.

Indians travelling abroad may be spreading the polio virus to other countries, a senior Unicef official has said. And the virus from the state of Uttar Pradesh is re-infecting people in polio-free states like Haryana and Maharashtra. This concern was voiced even as World Health Organisation (WHO) officials stated that complacency has crept into ongoing polio immunisation campaigns in western Uttar Pradesh and Maharashtra, resulting in polio staging a comeback in these areas.

�Investigations of strains of the polio virus and their genetic sequencing carried out in the African countries of Congo and Mozambique have revealed that they are of Indian origin,� said Buren Bayar, Unicef�s polio coordinator for Uttar Pradesh. �It may be possible that people going for Haj pilgrimage from the country could have transmitted the polio virus to people of other countries.�

Noting that India as a whole was not responsible for the spread of the disease in other parts of the world, Bayar held Uttar Pradesh largely responsible for the trend. �The state of Uttar Pradesh specifically is turning out to be the exporter of the disease,� he said, adding that cases of polio reported in Bangladesh were also of Indian origin.

India is among the countries with the highest number of polio cases and 2006 has seen a resurgence of the dreaded childhood disease after the country registered its lowest number of cases ever, 66, in 2005. About 280 cases have been reported so far this year, with Uttar Pradesh -- one of the last few places where the wild polio virus still exists -- leading the list with 254. The state reported only 29 cases last year.

In 2006, polio cases have been reported in as many as nine divisions of Uttar Pradesh, including Moradabad, Agra, Meerut, Saharanpur, Lucknow and Bareilly. Moradabad is the worst affected district with 56 cases, followed by Budaon (21), Muzaffarnagar (21), Meerut (20), J P Nagar (19), Rampur (17), Bijnore (17), Bareilly (12), Ghaziabad (9) and Lucknow (4).

Criticising the state administration for the �extremely poor shape� of its immunisation programme, with a reach of only 23%, Bayar said: �There does not exist any medical services in some areas in Moradabad, which has reported the highest number of polio cases, nor is there any routine immunisation programme.�

Of the 254 polio cases in Uttar Pradesh, five were found to be of the Type-III polio virus, which requires a different vaccine. However, the rest of the cases were of the Type-I polio virus, which can be dealt with in the current polio vaccination campaign, Bayar said.

Attributing the sudden spurt in polio cases in the state to children missed out during vaccination drives, Bayar said: �We could be missing out children, especially in the sensitive Moradabad district.�

Another reason could be the break in the cycle of administering polio drops, he said, adding that the slogan �Har bachhe ko har bar� (�Every time to every child�) was extremely important. He emphasised that the cycle must not be broken.

This, coupled with poor sanitation in the affected areas, leads to lower immunity levels among children and makes them more susceptible to the disease, Bayar added. �In Moradabad, we found a very high level, about 60 to 70%, of non-polio entero viruses among children, which hampered the working of the polio drops,� he noted. The non-polio entero viruses, which are in the stomach, do not allow polio vaccines to be effective and there was �no space left� for vaccines in such cases, Bayar said.

Refuting the Uttar Pradesh government�s claim that the indigenous vaccine was ineffective in controlling polio in the state, Bayar said: �The vaccines are safe. They were tested in May and June this year at Kasauli in Himachal Pradesh and were found to be safe and effective.�

The Unicef official said a special drive would be undertaken in October to administer the �monovalent polio vaccine� to Type-III cases. Another round of the pulse polio campaign was conducted in the state on September 10.

According to a report, around 40 million children in the state under the age of five need to be vaccinated in each round of the programme, and 500,000 more are born every month. Bayar said plans had been put in place to tackle the disease with the introduction of burst doses of polio vaccines. These doses, known as oral polio vaccine, are given to children within 72 hours of their birth to compete with non-polio entero viruses, he said.

Uttar Pradesh has not just exported the polio virus to areas outside India. Recently, Maharashtra reported its first polio case in two years in Beed district, which, according to WHO regional coordinator Devendra Khandait, was imported from Uttar Pradesh. UP�s neighbouring states of Haryana and Chandigarh also recently reported their first polio cases after being polio-free for some years.

Source: The Indian Express, September 11, 2006

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