January 08, 2009	Thursday	Muharram 10, 1430

KARACHI, Jan 7: Two new cases of polio were reported in the city during a single week during December, after three months without a case, shattering the relative complacency of managers and volunteers associated with the effort to eradicate the disease. This year’s campaign to eradicate polio from Sindh will begin on Jan 12, when authorities will launch the first phase of their new immunisation campaign.

Sources privy to the special immunisation activities against polio said that a total of 18 cases of the disease were reported during 2008 from 10 districts of Sindh, against 118 cases detected across the country, including 52 in the NWFP, 31 in Punjab, 11 in Balochistan and five in Islamabad.

A source indicated that more hard work is required on the part of the authorities. Currently, health authorities plan to hold national immunisation days every two months in 2009 for children under the age of five years.

The figures for Sindh in 2008 are high as compared to previous years, as the province had come close to controlling the virus in 2005, with just five cases reported.

In 2007, the province reported 11 cases in all, with five districts seeing those cases. In 2008, an almost a 67 per cent increase was seen, with the following districts reporting cases of polio: Karachi (five cases), Jacobabad (three), Hyderabad (two), Khairpur (two), Dadu (one), Sanghar (one), Naushhero Feroz (one), Shikarpur (one), Mirpurkhas (one) and Nawabshah (one).

Of the 18 victims (aged between five months and 11 years), six did not get routine immunisation, while another five had received either one or two doses of routine immunisation, against the five doses that are supposed to be administered to every child in his or her first year after birth.

The first 10 cases nationwide were all reported in Sindh during the first half of 2008, dashing the hopes of health officials for a polio-free year in 2008. The concerned authorities have been attempting to eradicate the disease completely after 2005, when the number of reported cases was at an all-time low.

Dawn’s sources said the non-seriousness of the authorities concerned as well as a lack of political commitment is to blame. They said the year 2008 was the year of rebirth of polio, rather than eradication of the disease, in Pakistan.

A polio official said that a city like Karachi is considered an intermediate reservoir of the virus, which can be attributed to the fact that the quality of polio campaigns had not been up to the mark. The official commented that the influx of migrants from the NWFP and Afghanistan had led to an increase in the incidence of the virus, but also said he was perturbed by the fact that children under the age of five cannot be immunised properly, despite a considerable number of oral drop campaigns in recent years.

A health official said that despite a long journey and considerable efforts, including a good number of foreign trips in the name of study tours and interactions with foreign health professionals and experts posted in the country, the complete eradication of the disease from Pakistan remains a distant goal.

There are two possible routes to bringing that goal closer. Either the monitoring and reporting of the polio campaign needs to be made better, with genuine follow-ups, or routine immunisation activities need to be made more effective, with the participation of parents, government vaccinators and supervisors, the official added. He added that when the routine immunization teams are also engaged in polio special campaigns, it becomes impossible for the employed vaccinators to discharge their original assignments fairly.

Sindh reported its 15th polio case of 2008 in August, while the 17th and 18th cases were reported in December.The Advisory Committee on Poliomyelitis Eradication held in November 2008 in Switzerland had, among other things, required further improvements in the quality of the campaigns and continued innovation to interrupt poliovirus transmission. It also recommended that finger-marking should be systematically used to independently monitor supplementary immunisation activity performance; all areas with less than 90 per cent coverage must be covered again.

Another report of an international health forum mentions that Pakistan will increase the number of nationwide supplementary immunisation activities to supplement mopping-up activities in known reservoir areas, such as Sindh province where coverage during SIAs is still suboptimal, despite good accessibility to children.

Local experts also feel that Sindh’s task has become bigger with the increase in the number of districts reporting polio cases in 2008. They also stressed the need to revisit the appointment of volunteers for polio drop administration to get rid of the problem of incapable appointments of workers under the political expediencies and ghost teams of volunteers and monitors as well.

Chairman of the provincial expert review committee on polio, Prof Iqbal Memon, said that despite some lapses, he was optimistic that cases would continue to subside further in Sindh. “There is a need to show dedication towards the special polio initiatives and ensure fair handling of the immunisation campaigns at least during the next six months, following which Sindh would not remain a poliovirus reporting province,” he said.

Prof Memon said that beside the quality polio campaigns, there was also a need to increase the coverage of routine immunisation, as he personally felt that the routine immunisation coverage was not more than 40 per cent in the country.

The provincial programme manager of the expanded programme on immunization (EPI), Dr Mazhar Khamesani, said that the quality of SIA had improved by engaging the provincial and district governments. He said the attitude and practices of the population in accepting or seeking out healthcare services also contributed to the quality of the campaign. Dr Khamesani added that at present, there was no compromise on areas in Sindh for security reasons, and that it was hoped that the entire target population would be reached by the campaign.

Dr Khamesani said that the first NID for 2009 was being conducted in two phases in the province, starting from January 12. In the first phase, a target population of 4.4 million children in 13 districts including Karachi, Hyderabad, Matiari, TM Khan, Tando Allahyar, Badin, Thatta, Jamshoro, Mirpurkhas, Tharparkar, Umerkot, Sanghar and Nawabshah would be administered the monovalent oral poliovirus vaccine, while in the second phase commencing on January 19, about two million children of the remaining districts would be administered trivalent oral poliovirus vaccines.