Polio is an infectious disease that affects the central nervous system and can cause temporary or permanent paralysis, that is, loss of control or feeling in part or most of the body. Though the disease can strike at any age, it mainly affects children under the age of three. Pakistan is a country where a lot of people have been affected by polio. It is in this context that polio education assumes vital importance.
Polio is a lethal disease that needs to be eradicated from our society
Public health efforts: Polio epidemics caused panic every summer during the ‘40s and ‘50s in the industrialized countries. However, as no drug has so far proven effective against the disease, treatment is entirely symptomatic and the role of prevention is critical. It was not until 1961 that an oral polio vaccine (OPV) was formally declared as the immunization of first choice against the crippling diseases. In 1974, in the wake of success in smallpox eradication, the World Health Assembly resolved to create the Expanded Programme on Immunization (EPI) to bring basic vaccines against six infectious diseases, including polio, to the world’s children. It took somewhat longer for polio to be recognized as a major problem in the developing countries, and during the ‘70s routine immunization with OPV became part of the Expanded Programmes on Immunization, helping to control the disease in many developing countries. The last case of smallpox occurred in Somalia in 1979, signalling a major public health victory.
In 1988, the World Health Assembly (WHA) resolved to launch the Global Polio Eradication Initiative at a time when wild polio virus was endemic in more than 125 countries on five continents, paralyzing more than 1,000 children everyday. Today, polio is endemic only in Nigeria, India, Pakistan, Niger, Afghanistan and Egypt. The Global Polio Eradication Initiative (GPEI), spearheaded by national governments, the World Health Organization (WHO), Rotary International, the US Centres for Disease Control and Prevention (CDC) and Unicef, is the largest public health initiative the world has ever known. Since 1988, some two billion children around the world have been immunized against polio, thanks to the unprecedented cooperation of more than 200 countries and 20 million volunteers.
Current position: The comparative position of wild polio virus cases globally can be viewed at a glance in a table given here, indicating that the percentage of cases contributing to the global burden of polio have decreased from nearly 28 per cent in 2000 to less than two per cent in the first five months of 2005. Global figures recently show re-infection and limited outbreaks due to imported cases or re-establishment of wild virus circulation in a few countries. The main reason for that is inadequacy of routine immunization activities. We should learn from that experiment and try to avoid the same. We should combine high quality NID campaigns at the same time with advocacy campaigns to make routine immunization of our children a demand of all the parents. This cannot happen in a short time only with the efforts of the ministry of health or even the government, but will happen if all medical community, including the private sector and NGOs, all those who have some role to play in community education, including religious leaders, social workers, universities, mass media (newspapers, magazines, radio and TV channels), teachers, women organizations, all political parties start owning these national causes (polio eradication campaigns and routine immunization) and move ahead hand to hand with the government at all levels of service. They should also make an effort in bringing about organized health education and transfer proper knowledge to the parents, especially mothers so that timely immunization of children could be ensured.
Position in 2005: As of July 12, a total of 764 cases have been identified, out of which 326 cases have appeared in Yemen alone, which was polio-free years ago, but where routine polio immunization is virtually non-existent. Similarly, Indonesia has reported 20 cases transmitted from imported cases, and Ethiopia 13. Amongst the polo endemic countries, Sudan has re-established transmission and has reported 25 cases so far. The position of polo cases in 2005 can be seen in the following table.
Situation in Pakistan: Pakistan, which has yet to interrupt wild polio virus transmission, has reported 12 cases so far, seven of which are in Punjab, two each in Sindh and the NWFP and one in Balochistan. In Punjab four cases have been reported from Dera Ghazi Khan, two from Khanewal and one from Multan. In Sindh one cases each from Sanghar and Larkana. In the NWFP one case each from Peshawar and Tank. In Balochistan one case from Sibbi.
An informal consultation on Pakistan was held in Geneva from May 30 to June 1, 2005, where the experts involved concluded that Pakistan could stop wild polio virus transmission in 2005, as the past year has seen marked improvements in the ability of immunization campaigns to reach every child and in the surveillance of the Acute Flaccid Paralysis, including polio. Pakistan’s cases are 37 per cent less than what they were in the same period last year, and only due to wild polio virus type 1. The surveillance system is performing better, with AFP detection rates at their best. More children are being reached during campaigns, thanks to strong local government engagement and commitment. Wherever the civil administration has been involved, the quality of work has significantly improved. This engagement will need to be sustained and expanded, particularly in the high priority areas for further improvements.
Furthermore, more focused strategies must be developed to address a worrying gap in immunity between children in districts in the high-risk zones and children in other districts. The clustering of cases in a few areas also suggests that children under one year of age are still being missed, especially in high-risk areas. The proportion of polio cases in this age group is increasing, and the consultation recommended specific actions to reach this group, including increased community mobilization and greater use of women vaccinators and locally influential persons.
Some population groups and areas are still completely missed, both by surveillance and supplementary immunization rounds, and these groups and areas are sustaining virus transmission. The consultation recommended to quickly identify these specific communities and map out ways to reach their children. These may include populations in areas where access is restricted due to security issues, those of Afghan origin, nomadic or migrant populations, or very conservative communities. Full national immunization days (NIDs) should take place in August, and September 2005, followed by a large-scale sub-national immunization round in November 2005.
Sindh-specific problems: While it is encouraging to not that Sindh, which accounted for 53 per cent of the polio cases in Pakistan during 2004, has brought down the figure to 16.7 per cent through intensive monitoring and supervision, there is still no room for complacency. The following table indicates the number and proportion of wild polio virus cases in Sindh as against the entire country.
Apart from the issues mentioned above, avoiding frequent administrative changes at the district level, addressing spotty coverage in certain areas, providing adequate cover to minority areas, personal supervisory role of the District Coordination Officers, mobilizing community leaders and involvement of other line departments are all facts which can contribute to achieving our target of interrupting wild polio virus transmission by end of 2005.
The way forward: After polio virus transmission stopped in the remaining polio-endemic countries, the future phase of the Global Polio Eradication Initiative aims to achieve certification of global polio eradication, to develop products for the global cessation of oral polio vaccine and to ensure that the infrastructure and knowledge that have been gained through the initiative are transferred to address other important public health programmes.
Polio is an infectious disease that affects the central nervous system and can cause temporary or permanent paralysis, that is, loss of control or feeling in part or most of the body. Though the disease can strike at any age, it mainly affects children under the age of three. Pakistan is a country where a lot of people have been affected by polio. It is in this context that polio education assumes vital importance.
In 1988, the World Health Assembly (WHA) resolved to launch the Global Polio Eradication Initiative at a time when wild polio virus was endemic in more than 125 countries on five continents, paralyzing more than 1,000 children everyday. Today, polio is endemic only in Nigeria, India, Pakistan, Niger, Afghanistan and Egypt. The Global Polio Eradication Initiative (GPEI), spearheaded by national governments, the World Health Organization (WHO), Rotary International, the US Centres for Disease Control and Prevention (CDC) and Unicef, is the largest public health initiative the world has ever known. Since 1988, some two billion children around the world have been immunized against polio, thanks to the unprecedented cooperation of more than 200 countries and 20 million volunteers.
