MULTAN, March 14: Pakistan will not able to fulfil its international commitment again to completely eradicate polio because a P1 case of the disease has been reported from Rajanpur.

The previous target to wipe out the disease from the country was December 2001. The target could not be achieved as incidence of wild virus of the disease were recorded from various parts of the country, specially south Punjab, by Nov 11 last year and the ‘fight against polio’ drive had to be extended for another year.

Health department sources told Dawn that a P1 case was reported from Rajanpur as a child of Narri village had fallen prey to the disease.

According to the World Health Organization (WHO) estimates, a case of P1 polio may represent 200 while the P3 type 1,000 infected children.

When contacted, paediatricians of state-run health facilities in Dera Ghazi Khan, Rajanpur and Muzaffargarh said that the health department authorities had directed them not to report polio cases anymore. They, however, said that some 14 cases of various types of polio had been observed in the district during the first two months of the current year.

They said that the hilly and riverine areas, the worst-hit in former Dera Ghazi Khan division, remained uncovered mainly because of the poor supervision.

During a recent visit to Dera Ghazi Khan, the Punjab governor reportedly warned the health official of strict action for their failure to run the NIDs successfully.

The figure only included numbers of patients who were brought to the state-run health facilities. The cases handled by private medical practitioners, general practitioners, quacks and other traditional healers could not be counted owing to absence of surveillance system.

There are around 100 state-run health facilities in Dera Ghazi Khan division. Survey reports of the project wing of the health department revealed that the state-run health facilities hardly provide one-fourth of the total health coverage in the Punjab.

Punjab Health Minister Prof Dr Mahmood Chaudhry had said that the private sector had been catering to the needs of 65 per cent patients in the province.

The department has been observing national immunization days (NIDs) for the last several years by administering vaccination against acute flaccid paralysis (polio).

Punjab Health Services Director-General Dr Yaqoob Jaffar had told Dawn on March 8 that the three-day anti-polio vaccination campaign failed to cover all children in the Punjab. The vaccination drive was extended for another two days on the directive of Punjab Governor Khalid Maqbool who himself monitored the campaign.

Health department sources said that the all remaining children could not be covered despite extension in the campaign because of poor supervisory system.

Dera Ghazi Khan, Rajanpur and Muzaffargarh districts are being considered the hot spot of polio incidence in the province. Specially, the Rajanpur district is said to be a victim of the poor supervisory system of the health department. Some independent agencies have reported a 25 per cent coverage of anti-polio vaccination in the district.

The Punjab health department, owing to high incidence of polio case in former Dera Ghazi Khan division, laid a special focus on its former districts during the March 5-9 campaign.

A team of the World Health Organization, led by Dr Ahmad Dervish of Egypt, had also visited the polio-hit districts of former Dera Ghazi Khan division ahead of the campaign.

A number of paediatricians alleged that the health department officers concerned neither succeeded in maintaining the cold chain nor properly supervised the polio immunization campaigns.

The polio virus has three stains — P1, P2 and P3. In P3 type of infection, 90 per cent of the affected children have no signs of illness. Most of them are not aware that they have been affected with polio virus. But they are a potential threat for others as despite being asymptomatic the polio virus remains in their stools.

“These asymptomatic polio-carriers might cause the disease to unprotected or not immunized children,” a paediatrician said.

The world wide experience in polio eradication is that the first polio virus which disappears is P2 followed by P1 and P3, respectively.

A senior paediatrician at Nishter Hospital, Multan, said that P3 polio virus was difficult to be eliminated. Reported cases of the paralytic disease owing to P1 virus and its asymptomatic carriers could widely spread the disease than other types of the disease.

A number of paediatricians have demanded that the Punjab task force on immunization, headed by the wife of the governor, should visit the polio-affected districts to have first hand knowledge of the situation there.