Monday, December 3, 2007

Time to introspect

Its time to introspect and reflect upon the strategies that have been taken up towards polio eradication. World Health Organizations’ (WHO) commitment to global eradication of poliomyelitis by the year 2000 has failed leaving India as one of the four countries where the deadly polio virus is still prevalent making polio –free India a distant dream.

In spite of combined and consistent endeavors by UNICEF, National Polio Surveillance Project, Indian Academy of Pediatrics and Rotary International, our nation still reels under this vaccine preventable disease. We must therefore learn and implement the measures that have been taken by the industrialized countries to achieve zero polio status.

Health experts from Indian Academics of Pediatrics (IAP) and the World Health Organization (WHO) have recommended the use of Inactivated Polio Vaccine (IPV) used in industrialized countries, in combination with Oral Polio Vaccine for better immunization against the dreaded polio disease. The major advantage of using IPV being that it does not carry the risk of VAPP (vaccine-associated paralytic polio) which is caused by the administration of OPV. OPV being made of live virus carries with itself the danger that the attenuated form can revert to its virulent form and result in paralysis which can cripple the affected individual for life. Though there is a small chance of an infant being infected with polio while receiving OPV drops, however, the more the OPV drops, the greater the risk.

Other than the risk of acquiring VAPP, oral polio vaccine loses its effectiveness in conditions of poor sanitation and thus this is the primary reason why polio still persists in Uttar Pradesh. Poor hygienic conditions perpetuate diarrhea and this high occurrence of diarrhea interferes with OPV administration making it difficult for the body to retain the oral polio vaccine long enough to develop immunity. Moreover, there is an aversion towards OPV administration amongst some sections in Uttar Pradesh because of the myth that it leads to impotency. The latter is resulting in a crisis since a majority of children are being missed out owing to spread of this myth as the houses are either found locked or the health workers are not welcomed when the surveillance teams come for administration.

Keeping in mind, the repercussions of using OPV alone, there is a dire need to move to a combination of both IPV and OPV. IPV not only carries away the risk of acquiring VAPP but also provides individual immunity. It provides better humoral immunity compared to OPV and triggers and excellent immune response and long lasting immunity to all the 3 types of polio virus strains. Moreover, it can stay effective even without proper cold storage facility for a longer time span. According to health experts, in the endemic areas, 2 doses of IPV would be more effective than 10 doses of OPV as immunization with IPV triggers an excellent immune response in most IPV recipients. They also state that that OPV (Oral Polio Vaccine) should not be administered to a child with immunodeficiency or to a child who is in close contact of a person with immunodeficiency and instead should be given IPV.

Thus, its time to focus and change our strategies, that is, make use of IPV per say to be able to achieve zero polio status like other countries because we cannot wait for a catastrophe to happen. It is suggested by health experts that IPV alone should be made use of in states which have been polio free for 3-6 years while a combination of OPV and IPV should be used in polio-ridden states. The time has come to make the right choice and protect our children from this crippling disease.

1 comment:

Uday said...

I would really like to know the expert opinion on this. Is it really true? Has it been tested ? Do we have conclusive results on this?