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In 1995 Government of India launched the Pulse
Polio Immunization (PPI) for the eradication of poliomyelitis. In
1999, a vastly intensified pulse polio campaign entailing enormous
economic and logistic burdens was conducted with the aim to give a
final push to eradication. Instead of achieving the hoped-for zero
polio status in 2002, the number of cases actually increased many
fold. Type 1 wild virus had survived in Uttar Pradesh and Bihar in
2001 and caused this outbreak, which spilled over to several states
that had been polio-free for a few years. Independent surveys
indicate that this was due to woefully inadequate routine
immunization coverage compounded by the failure to reach all
children during the pulse immunization. Also, of concern to us is
the decline in the routine immunization achievements in many states.
The Indian Academy of Pediatrics (IAP), along with other partners
involved in polio eradication efforts, are disappointed, but are
reinvigorating our efforts to catch up with the eradication
programme and to improve routine immunization. The IAP Committee on
Polio Eradication met on 4th January 2003 in Mumbai and after
deliberations on various issues, the following recommendations were
approved (participants of the meeting are listed in Annexure). We
submit them to the Government of India and to the governments of the
states affected by the spread of wild polioviruses in 2002.
Suggestions to improve routine immunization
1. District Task Forces on immunization
should be formed in all the districts of the affected states.
Professional bodies (including IAP, Indian Medical
Associa-tion) and community leaders, particularly from
minority communities should be represented on them. The
District Task Force should meet every month round the year and
should monitor progress in strengthening routine immunization
and consequent achievements.
2. Intensive Information, Education,
Communication (IEC) campaign should be launched to create
awareness and demand for routine immunization. Make use of
audio-visual, print and electronic media to propagate routine
immunization round the year.
3. Government should ensure that at least
one day a week, such as every Wednesday is kept sacrosanct for
immunization outreach programs by the staff, no matter what
other programs are highlighted for the season, including
preparation for pulse immunization for polio eradication.
4. Fix accountability of the public sector
health care provider responsible for routine immunization in a
specific area.
5. Specific action plans and monitoring
mechanisms should be developed to provide routine immunization
to children living in urban slums.
6. All vacant posts of health workers
relevant to primary health care, especially those concerned
with immunization, should be immediately filled up.
7. Hospital based immunization clinics
should become user friendly. Make immunization available every
day in large or busy clinics and hospitals; both in public
sector and private sector establish-ments and at least one day
a week in smaller clinics, health centers and small hospitals.
Instead of limited time periods in the day, immunization
session should continue during the whole working hours.
8. Vaccination should be offered to
children accompanying mothers for Reproductive and Child
Health (RCH) clinics.
9. In every institutional birth, the infant
should be given one dose of OPV before discharge.
Suggestions to improve quality of Supple-mental Immunization
Activities (SIA)
l. Monitoring of Polio Eradication Program
should be done from the level of Chief Minister and Chief
Secretary.
2. Emphasis should be on improving the
quality of National Immunization Days (NIDs) rather than
increasing the numbers.
3. There is a need to involve all local
area practitioners of medicine actively right from the
planning stage of SIA.
4. In UP only one immunization card per
child should be used to record routine as well as pulse polio
doses. Immunization cards should have a column for NID and
SNID along with other vaccines and proposed due dates filled
in as declared every year. It should be clearly printed in
bold letters in immunization cards "immunization is not
complete if any pulse polio dose is missed up to the age of 5
years, just as in the case of routine immunization where not a
single dose should be missed from the immunization schedule."
5. As house-to-house immunization
follow-ing booth-based pulse immunization is adversely
affecting the routine immuniza-tion services; house-to-house
immuniza-tion should be discontinued as part of NID in all
states except the high-risk states. There is need for having a
fresh look at the need for house-to-house strategy in these
states also.
6. Mop-ups should not be conducted in the
states going for SNIDs.
We request the governments and con-cerned
authorities to consider and implement these recommendations.
The Committee had also made specific
recommendations to the Branches and members of IAP, which may be
found in the Editorial titled "Setback in polio eradication in India
in 2002: Reasons and Remedies" in the March 2003 issue of Indian
Pediatrics.
Indian Academy of Pediatrics through its Polio
Eradication Committee, network of Regional and District Polio
Coordinators, lAP districts branches and 14000 members will continue
to help in achieving polio eradication in India.
ANNEXURE
Participants of Polio Eradication Committee Meeting on 4th
January, 2003 at Renaissance Hotel, Mumbai
C.P. Bansal (Zonal coordinator), Swati Y. Bhave
(Invitee), A.P. Dubey (Member), Ajay Gaur (Invitee), Virudha Giri
(Invitee), Mahesh Kumar Goel (Joint-State Coordinator UP), J.K. Jain
(District Coordinator), T. Jacob John (Chairman), V.K. Kapoor
(District Coordinator), S.A. Krishna (Zonal Co-ordinator), Rajeev
Kumar (State Coordinator – Uttranchal), Rajesh Mehta (Invitee),
Dilip Mukherjee (Invitee), MKC Nair (President-Elect IAP), R.S.
Panwar (Regional Coordinator–UP), Ashok Rai (Joint-State Coordinator
UP), HPS Sachdev (Ex-officio member), Vineet Kumar Saxena (District
Coordinator–UP), Raju C. Shah (Invitee), R.N. Srivastava (Invitee),
Naveen Thacker (Convener), Vipin M. Vashishtha (Co-convener).
Correspondence to:
Naveen Thacker,
Convener,
Polio Eradication Committee of IAP,
208, Sector 1-A, Gandhidham, Kutch,
Gujarat 370 201, India,
E-mail:
naveen@wilnetonline.net
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