Sunday, November 6, 2011

Polio-free India and prevention of outbreaks in the rest of the world..

India, a country on which polio has always had a terrible impact, has not reported a single polio case in over 200 days. The country's only polio case reported this year was on January 13 from West Bengal. Along with the absence of new cases, the program responsible for detecting polioviruses in the sewage systems (The National Polio Surveillance Project, or NPSP) in three main areas of the country isn't detecting any either. The sewage surveillance is considered an extremely important component of the early warning system. When polioviruses are found to be circulating in sewage, cases of paralytic polio often follow up.
According to Hamid Jafari, project manager of WHO-NPSP, "Both Type 1 and Type 3 polio viruses were detected in the sewage samples from Delhi during 2010," but since August 2010, when viruses were last seen in the sewers of New Delhi, and early November 2010, when they were last found in the sewers of Mumbai, no more cases of sewage-circulation poliovirus have been detected. Despite these promising news, India is still at a high risk of being a victim of the importation of viruses from elsewhere, especially its neighboring countries such as Pakistan.

Pakistan has recently been confirmed by the World Health Organization (WHO) as a main "exporter" of poliovirus, something that could really be destroying all of India's efforts to remain polio-free if not controlled properly. A cautious New Delhi has therefore intensified surveillance at the India-Pakistan border in Wagah to minimize the import of the virus as efficiently as possible since September 13. In the past month, India has reported the vaccination of 115 children, all below five years of age, who entered the country from Pakistan with the bivalent polio vaccine. Dr. Balwinder Singhm, one of Punjab's immunization officers, reported to "Times of India" about a month ago that "active searching operations" are being carried out at the borders and that "all hospitals near the border have confirmed that there has not been one missed case of acute flaccid paralysis (AFP) to spot any signs of polio being imported. Information boards at Wagah and Attari in three languages - English, Hindi and Urdu - are asking all those coming from Pakistan to immediately contact the health booth if their children aged below five years feel sudden weakness in any part of the body or have been feeling it over the past six months."

Currently, the Global Polio Eradication Initiative (GPEI) says that about 16 countries are facing outbreaks owing to the import of the poliovirus, which is a significant number. Pakistan is amongst the top exporters, having a recorded 136 total cases of paralytic polio to date this year, with over 100 cases caused following the transmission of the P1 strain. It is also the only Asian country this year to have reported the P3 virus, which is on the verge of elimination elsewhere on the continent.
On another sad note, earlier this fall, China reported that viruses from Pakistan had triggered China's first polio outbreak in over 10 years. To date, China has reported 18 cases. (For more information, visit the Global Polio Eradication Initiative website, which provides great information and the most recent updates on the number of polio cases)

The WHO has said: "travelers to and from Pakistan should be fully vaccinated, and travellers to the country who in the past have had three or more doses of oral polio vaccine (OPV) should have another one before they travel. Some countries require travelers from Pakistan to be fully immunized against polio before they grant an entry visa."
Similarly to the WHO's recommendations, the UK has required all travelers coming from countries where polio is endemic to show proof of having received the oral polio vaccine at least 6 weeks prior to travel, and the Kingdom of Saudi Arabia has issued vaccination requirements for travelers of all ages undertaking the Umrah and the Hajj pilgrimages. This should be an effective contradiction to what a great number of Muslim populations believe of the vaccine (especially in Pakistan where so many people refused immunization), as Elena has described in detail below, and will hopefully act as an effective message to increase the number of vaccinations in countries such as Pakistan.

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- Julie Saffarian

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