PESHAWAR: The Khyber Pakhtunkhwa government is introducing injectable vaccination along with oral polio vaccine to boost immunity level of the recipients against polio virus and do away with the crippling childhood ailment, according to officials.

They said that the decision to introduce injectable polio vaccine (IPV) in combination with oral polio vaccine (OPV) was taken at a meeting, held on October 10 and chaired by provincial minister for health.

Initially, the IPV will be started in Peshawar and Bannu districts, which recorded 14 and 12 polio cases respectively of the total 43 cases in the province. Federally Administered Tribal Areas (Fata) recorded 139 cases, the highest by any province of the total 209 cases recorded in the country in 2014 so far.

Sources said that provincial government took the decision after IPV showed promising results in Bajaur Agency during a demonstration project implemented by Aga Khan Medical University between 2011 and 2014. Vaccination coverage for routine immunisation, including polio, had shot up to 79 per cent from 28 per cent in the militancy-hit Bajaur Agency.

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Sources said that national immunisation target was 80 per cent. Currently, Khyber Pakhtunkhwa has 54 per cent fully immunised children, according to health department’s statistics.

The provincial government has also requested the Global Alliance for Vaccine and Immunisation (GAVI) to make IPV part of its expanded programme on immunisation (EPI) to improve immunisation for all vaccine-preventable diseases, including polio, in the light of the Bajaur’s success story.

It will take more than four months for GAVI to entertain the request and make funds available and order manufacturing of IPV. It is a lengthy process.

However, the federal government has agreed to provide IPV for Peshawar and Bannu districts immediately. The health department faces problems of refusal against the OPV and inaccessibility to children. Additionally, in some cases in the province, the polio victims had received doses of OPV. Even there were about four per cent children who refused IPV in Bajaur Agency but still the results were highly encouraging.

When given in combination with OPV, the IPV scaled up children’s immunity level where they didn’t risk polio. In normal circumstances, a child needs at least 10 doses of the OPV to stay safe from polio but a single dose of the IPV after about three doses of OPV enhances their immunity level.

Sources said that Peshawar and Bannu had large population of displaced children from North Waziristan Agency and Khyber Agency who had not been vaccinated for the past two years.

North Waziristan Agency has recorded 69 polio cases, Khyber Agency 49 cases, South Waziristan Agency 17 cases and FR Bannu four cases in 2014. “We want to administer IPV to displaced children from infected Fata’s regions to enhance their immunity against polio,” officials said. The health department has already been administering OPV to displaced children and IPV will prove fruitful for them. Every child should be given a dose of IPV after four weeks of the OPV, they said.

Sources said that in Khyber Pakhtunkhwa majority of the infected children received some doses of OPV but they were tested positive for polio. “We desperately need to implement the Aga Khan University model in two districts with the start of low transmission season in December,” they said.

The health department had planned earlier to introduce IPV but the measles-related deaths a few months ago forced it to delay implementation of the decision.

“Both the vaccines didn’t have much efficacy if given separately. Only a combination can strengthen the children immunity,” sources said. The only way to eradicate polio was OPV but IPV was required to boost up children’s immunity, they added.

Sources said that IPV cut almost by half the four-month virus shedding period of the infected people. An infected child can transfer the virus to others within four weeks but if a child receives IPV after OPV, he or she can infect children only till two weeks. “It also reduces infectivity of the virus,” sources said.

Published in Dawn, October 20th, 2014