Poliomyelitis commonly known as polio is a highly infectious viral disease which mainly affects young children. The virus transmits through contaminated food & water and also multiplies in the intestine from where it can also invade the nervous system. Further when this virus infects the nerve cells it results into acute flaccid paralysis leading to absence of muscle tone in one or both limbs and tendon reflexes. This disease is amongst one of the dreaded diseases which have been affecting our country for the last many decades. Polio mainly affects the children below the age of five years. But now it has almost been one complete year in India, without any polio cases caused by natural (wild) poliovirus. This is taken as a great milestone as far as polio eradication in the country is concerned. We may now feel a bit relieved as for many years our country has been fighting with this dreaded disease which was refusing to die down. The people in the medical world feel that India has achieved a big challenge which was looming on the healthy lives of its citizens and especially children. India's success in its fight against polio has proved that it can also be eradicated from many other countries of the world too with the same dedication and response. It is also seen as a success road which may help humanity in achieving the Global Polio Eradication Initiative (GPEI) started against this disease. From the largest number of cases in the world to zero has truly been a fascinating story of success for our country. India has to overcome many problems in order to achieve this milestone in the world. The battle against polio in India was started in the 1970s with the launch of the Expanded Immunization Programme. In 1985, a Universal Immunization Programme was also launched throughout the country in order to overcome the growing number of polio cases in India. It was then in 1995-96, when the National Pulse Polio Initiative (PPI) was started in the country in order to target and cover every child with the Oral Polio Vaccine (OPV) when two National Immunization Days one each in December and January were followed throughout the country.
The road to reach this milestone has not been so easy and would not have been achieved without the help of millions of frontline workers from the private health sector, members of Rotary International, volunteers, anganwadi workers besides the massive public health workforce. As per the latest figures which are available, the Union Ministry of Health in India has spent more than Rs.12000 crore on PPI, which somewhere represents the true dedication on the part of the government to fight with this disease. In these PPI drives, teams of almost 24 lakh vaccinators spread over the country visit over 20 crore households to ensure that nearly 17.2 crore children, which are under the age of 5 years, are immunized with OPV. With these oral vaccines India appears to have achieved what was once thought a Herculean task, decisively breaking the circulation of wild polio viruses that paralyzed countless children in the country. Apart from blocking the polio virus from invading nerve cells and causing paralysis, the oral vaccine, by duplicating a natural infection, is said to raise immunity in the mucosal lining of the gut. That makes it more difficult for the virus to replicate there and spread through feces to others. But the oral vaccine has its drawbacks also. In rare cases, the live but attenuated viral strains in the vaccine can themselves cause polio. Besides it, these viruses can revert to virulence, resulting in what are known as vaccine – derived polioviruses (VPDV). In order for complete eradication of polio, incorporation of inactivated polio vaccine (IPV), which is administered as an injection, in the immunization programme is needed. However it is believed that the transition will only be visible when IPV is used to immunize the children as it has already been done by wealthy nations. Since this debate of using the IPV also involves the cost factor involved in it because the IPV is more costly as compared to OPV.
Though we have achieved a remarkable position , the journey is still long as we need to maintain a zero cases record for the next three years in order to totally eradicate polio. Only one third of the journey is completed till now and time needs us to stay on this track for next three years also. India needs to secure further progress from this stage and for this it needs to protect children through polio campaigns and through improved coverage to all areas especially rural India. In order to achieve the target, we need to see that continued vigilance is kept across the country to check any detection of polio cases. We should also be prepared and ready to deal with emergency cases in the near future.
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