India launches massive polio vaccine programme

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India launches massive polio vaccine programme

Ganapati Mudur New Delhi

India launched its largest poliomyelitis immunisation campaign last week, attempting to vaccinate 165 million children in a bid to combat a growing polio epidemic that swept northern India last year.

Health workers and volunteers set up immunisation booths and visited households in cities and rural areas throughout the week seeking to immunise all children aged under 5 years.

India reported 1556 confirmed cases of polio during 2002, accounting for 85% of polio around the world, nearly three times the 537 cases reported globally by the World Health Organization during 2001.

Most cases appeared in the northern state of Uttar Pradesh, but public health officials are worried that the infection is also moving into other states. The poliovirus from Uttar Pradesh has already established local circulation in at least two other states—Gujarat and West Bengal.

India’s national immunisation programme had gained substantial momentum during the early 1990s, and most of the country remains free of polio. However, routine immunisation services have deteriorated in northern India in recent years, and public health specialists have blamed state governments for low priority to local public health infrastructure and vaccine delivery services.

Infectious disease experts have also pointed out gross discrepancies between the claimed and actual number of children immunised in some states. "There’s clearly been over-reporting of immunisation targets achieved—some districts that reported 100% immunisation coverage are actually far from that target," Dr Thekakkara Jacob John, adviser to the Kerala Institute of Virology and Infectious Diseases in southern India, told the BMJ.

Unicef officials say that northern India has traditionally been a "high intensity transmission area," where high population densities, poor sanitation, and low routine immunisation coverage make the eradication of polio particularly challenging.

"In some pockets of Uttar Pradesh, routine immunisation coverage is as low as 27%," said Dr Marzio Babille, chief of health with Unicef India.

"The local circulation of the wild poliovirus from Uttar Pradesh in parts of Gujarat and West Bengal is a danger signal that routine immunisation services might be slipping in those states too," said Dr John.

The polio eradication initiative is also facing a funding gap of nearly $100m (£61m; €93m) in India. Rotary International has intensified its fundraising efforts, setting a goal of raising $80m by June 2003.

The mass immunisation campaign, which takes place over a period of a few days, complementing routine immunisation, is one of an ongoing series in which every child below the age of 5 years is vaccinated. India has conducted several such campaigns, known as pulse campaigns, in the past and more will be needed if polio is to be eradicated.

The poliovirus is now circulating in only seven countries, down from 125 since the launch of the global polio eradication initiative in 1988. From the highest to lowest risk, these countries are India, Nigeria, Egypt, Pakistan, Afghanistan, Niger, and Somalia.

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