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India polio-free for a year: ‘First time in history we’re able to put up such a map’

-The Telegraph

The World Health Organisation has deleted India from its list of polio endemic countries, acknowledging the absence of any new instance of illness caused by the wild polio virus for more than a year since a child was diagnosed with the disease in Howrah in January 2011.

“This is the first time in history we’re able to put up a map like this one,” Bruce Aylward, an assistant director-general for polio in the WHO, told a conference here today. He presented a map displaying polio cases over the past year in Africa, Pakistan, Afghanistan and China but none in India.

Indian health authorities had recorded 741 patients paralysed by the wild polio virus in 2009 and 42 patients in 2010, but have detected no new patients since January 2011.

“But the big risk is to think we’ve finished,” Aylward said. India will need to remain free of any paralysis caused by the wild polio virus for three years from the last case before it can seek WHO certification for having eradicated polio — in January 2014.

Aylward cautioned that India and countries that reported polio over the past year should continue to pursue aggressive immunisation to protect children from the polio virus which, history has shown, can reappear in areas from where it had vanished.

He said the world’s polio eradication effort currently faces a funds shortfall of about $1.09 billion to cover immunisation-related activities over the next two years. “If we can’t find funds to finish the job, the virus may return to India,” he said.

The funds are needed for the immunisation of children across Afghanistan, Pakistan and Nigeria — the last three countries where polio is still endemic. “But India also has to reach all its children through routine immunisation,” Aylward said.

Prime Minister Manmohan Singh told the conference that the completion of a year without polio being reported from anywhere in the country “gives us hope that we can finally eradicate polio not only from India but from the face of the Earth”.

“Our ultimate objective is to achieve full immunisation of all our children. We must ensure that every Indian child, rich or poor, whether living in Ladakh or in Delhi, has equal access to the best immunisation,” Singh told the conference, Polio Summit 2012, organised by the Union health ministry and Rotary International, a non-government organisation.

Public health experts say countries without polio face a risk of the disease re-entering them through the movement of people from countries where polio still persists. The number of polio cases in Pakistan and Nigeria has gone up in the past six months.

A virus from Pakistan, for example, had surfaced in China’s western province of Xinjiang in mid-2011 after being carried across the Karakoram mountains, leading to China’s first new polio in more than ten years. The virus paralysed 21 people — the youngest aged four months and the oldest, 53 years — but a quick immunisation response by Chinese authorities stamped out the infection.

Aylward said the WHO was looking for Indian vaccine-making companies that might be able to take up local manufacture of a new version of the injectible, inactivated polio vaccine (IPV), which might eventually replace the oral polio vaccine (OPV), which is now used in the programme.

If all goes according to plan, Aylward told The Telegraph, the WHO may tweak its polio eradication strategy and recommend the introduction of the IPV as a single additional dose with the OPV, but not before 2014.

The OPV, which is based on a live but weakened virus, has been used for decades and has helped other countries eradicate polio. But it carries a small risk of causing paralysis either through vaccine-derived poliovirus paralysis, or vaccine-associated polio paralysis.

Some paediatricians and infectious disease experts have long argued that the IPV will eventually need to be introduced for the true eradication of all polio paralysis, caused by the wild polio virus as well as the vaccine-linked polio.