India may be getting wise to polio

[rlneub]

Times Of India Editorial.
Drop that paralyses
Anant Phadke

http://timesofindia.indiatimes.com/a...ow/2122225.cms
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Blinded by a narrow biomedical approach, the temptation of eradicating polio, and perhaps guided by the interests of oral polio vaccine (OPV) manufacturers in the US, our experts believe that polio can be eradicated with OPV even in absence of improvements in nutrition, public sanitation and social backwardness.
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Union health secretary Prasanna Hota's glorification of the polio eradication programme (TOI, October 6) takes no cognisance of some basic facts. Polio is not such a priority issue as to spend hundreds of crores every year.

Yet the Union government's 2006-07 Budget has the following provisions Rs 1,004 crore for pulse polio, Rs 327 crore for routine immunisation, and Rs 184 crore for tuberculosis control.

And, the context: 1.5 crore TB cases and four lakh annual TB deaths compared with an estimated 20,000 polio cases and less than 500 deaths annually when the polio eradication drive was launched.

This lopsided priority is justified on the grounds that once polio is eradicated, like small pox, polio vaccination would be stopped; this would save thousands of crores in future. However, worldwide eradication of polio is not our priority, but that of the developed countries.

Though polio has disappeared in those countries many years back, they must continue polio vaccination till polio is eradicated worldwide. Polio eradication would mean an annual saving on vaccination of $333 million and $230 million for European Union countries and the US, respectively.

Blinded by a narrow biomedical approach, the temptation of eradicating polio, and perhaps guided by the interests of oral polio vaccine (OPV) manufacturers in the US, our experts believe that polio can be eradicated with OPV even in absence of improvements in nutrition, public sanitation and social backwardness.

This OPV-based eradication strategy has three fundamental problems. First, it is virtually impossible to vaccinate every child in each developing country, given that there are various forms of social backwardness and social conflict.

Second, it is impossible to ensure that in developing countries all children who receive OPV would develop immunity against polio. During last few years, 30-60 per cent of polio cases have received more than three doses of OPV. The wild virus would continue to circulate among this pool of vaccinated but unprotected population.

Unlike in the case of smallpox, for every clinical case, there are a thousand subclinical polio infections, which are the source of wild virus for this unprotected population. That is why polio reappeared in more than 10 countries after bringing down the incidence to zero.

Hota is silent on the reversion pheno-menon. Tamed, attenuated but live viruses in the OPV tend to revert to virulent viruses, which cause Vaccine Associated Paralytic Polio (VAPP). Leading Indian expert on polio Dr Jacob John tells us: "VAPP is now becoming more frequent than polio attributable to wild polio virus infection".

Thanks to the repeated rounds of pulse polio, VAPP cases went up. During 1998-2001, out of 5,495 polio cases, 1,770 were VAPP cases. In 2005, out of 26,070 paediatric para-lysis cases, 66 had natural polio, but 1,645 showed vaccine virus in their stool culture.

Though OPV reduces the incidence of natural polio, it also generates vaccine-derived virulent polio viruses. Hence, vaccination cannot be stopped even if the incidence of wild virus polio is reduced to zero. The claim of 97 per cent reduction in polio cases in India is partly due to terminological jugglery.

Up to 1996 all reported cases of acute limb paralysis were labelled as polio. From 1997 onwards, such cases are labelled as polio only after thorough investigations. As a result, in 1999, only 29 per cent of such cases were labelled as polio, whereas earlier all such cases were labelled as polio.

In sum, polio eradication has predictably failed, is not our priority and Indians have been forced to pay for the financial and health consequences of this eradication drive. Due to the workload of repeated rounds of pulse polio, the emaciated public health service has faltered.

Vaccination coverage for other programmes has declined. The following needs to be done: Shift back to polio control strategy; stop additional rounds of national, state immunisation days; and adequately compensate VAPP cases for being made to sacrifice their limbs for the (mistaken) goal of polio eradication.

To avoid VAPP, the option of shifting to injectable polio vaccine should be consi-dered again by manufacturing IPV in the public sector. The budget for public sanitation should be increased many times over to control polio and other food and water-borne diseases.

In the West, polio declined appreciably long before polio vaccines became available during the late 1950s. An independent commission should be set up to investigate the launching of the eradication programme with OPV.

The writer is with Medico Friend Circle.

[Gitti]

[QUOTE]In the West, polio declined appreciably long before polio vaccines became available during the late 1950s.[/]
Like as soon as they outlawed DDT?

An independent commission should be set up to investigate the launching of the eradication programme with OPV.

But we do not give OPV in the Western world, do we? Or did they go back to giving it?

[Mommy To Baby Roni]

Gitti, I think they mean an investigation of the program in India.

30-60 per cent of polio cases have received more than three doses of OPV.

Isn't the point of using OPV, supposedly, because your body responds quicker and requires only one dose? And isn't that the point of not using IPV?

[aniT]

Originally Posted by Mommy To Baby Roni

Gitti, I think they mean an investigation of the program in India.


Isn't the point of using OPV, supposedly, because your body responds quicker and requires only one dose? And isn't that the point of not using IPV?

I am pretty sure my oldest daughter had three doses of OPV in 93/94

[mamakay]

Originally Posted by Mommy To Baby Roni

Isn't the point of using OPV, supposedly, because your body responds quicker and requires only one dose? And isn't that the point of not using IPV?

No, the point of OPV is that it's supposed to stop the subclinical spread of the virus. IPV only protects against the viral meningitis, not "polio the asymptomatic infection or mild stomach bug" it is 99.9% of the time.

Honestly, I'm wondering why OPV isn't working better in India.
It looks like either the vaccine is no longer as effective as it was in the West when we began our eradication programs with OPV, or....something else.
Like, maybe the idea that OPV prevents subclinical infection needs to be reevaluated.

[Gitti]

OK, I had misread the article. I was in a hurry.

Though polio has disappeared in those countries many years back, they must continue polio vaccination till polio is eradicated worldwide.

That will never happen. First, because polio is not caused by a virus per se. It has several causes and I do not know how it is diagnosed in India. Do they do Lab testing for the virus?
Second, as long as they use the OPV, there will always be some shedding.
Third, they spray DDT, which is one of the causes of polio.
etc. etc.

Honestly, I'm wondering why OPV isn't working better in India.
It looks like either the vaccine is no longer as effective as it was in the West when we began our eradication programs with OPV, or....something else.
Like, maybe the idea that OPV prevents sub-clinical infection needs to be reevaluated.

The vaccine was not effective in the West either. Polio was not eradicated because of the vaccine. There were many reasons why polio is no longer a threat. One was because the disease was renamed. But there are others.

The budget for public sanitation should be increased many times over to control polio and other food and water-borne diseases.

That will do the trick and stop spraying the crops when kids are playing in the area. Educate about those poisonous sprays.

[Spy]

Originally Posted by Mommy To Baby Roni

Isn't the point of using OPV, supposedly, because your body responds quicker and requires only one dose? And isn't that the point of not using IPV?

Nope. In fact, I was just reading a 'user manual' promoting IPV, with the big selling point that it is so much more effective than OPV, that 5 doses are not necessary, 4 are enough . And that's from the same country that never hesitated to give 8th, 9th, 10th, etc... doses of OPV to people 'fully vaccinated' with the same thing, during 'immunisation campaigns'. It doesn't look like any number of doses is enough!

The one and only point of NOT using IPV is the fact that each dose of IPV costs 100 times more than OPV.

[Momtezuma Tuatara]

Originally Posted by Spy

Nope. In fact, I was just reading a 'user manual' promoting IPV, with the big selling point that it is so much more effective than OPV, that 5 doses are not necessary, 4 are enough . And that's from the same country that never hesitated to give 8th, 9th, 10th, etc... doses of OPV to people 'fully vaccinated' with the same thing, during 'immunisation campaigns'. It doesn't look like any number of doses is enough!

The one and only point of NOT using IPV is the fact that each dose of IPV costs 100 times more than OPV.

http://www.ibnlive.com/article.php?id=7987&section_id=3

INEFFECTIVE POLIO DROPS: Over 100 children have contracted polio even after being enrolled in the immunisation programme

Kids contract polio despite drops
Jajati Karan
CNN-IBN

Posted Saturday , April 08, 2006 at 18:46
Updated Saturday , April 08, 2006 at 19:28
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Orissa: As the Government claims that it is almost on the verge of eradicating polio from this country there also lay a flip side to this success story.

In what seems to be a gross negligence during mass immunisation of polio, more than 100 children in a single block in Ganjam district of Orissa have been affected by polio even after taking regular polio drops under the immunization programme.

The children are all aged between four and ten. Their parents claim they were on regular doses of polio drops in government health centres.

Neelima was infected with the disease when she was just two years old. "If we would had not given polio drops to our children then we would have been responsible for this. But even after giving regular drops if our child suffers we definitely hold government responsible for this negligence," says her mother, Golapi Behera.

Dr Rabi Kumar Satpathy a reputed paediatrician in the district, has been treating most of the victims of polio and he suspects improper handling of the polio vaccines

"The vaccines are supposed to be preserved in 0 degree celsius and properly handled otherwise it tends to become ineffective," says he.

Ironically Ganjam district's Chief Medical Officer, Umakant Tripathy, has been declaring the district polio free for the last two years - even though many patients have been in treatment for over three years now.

The Chief District Medical Officer seems to be blissfully unaware .

"There are no such reports of polio with me right now but I will definitely enquire into it," says Tripathy.

These innocent children continue to suffer because their parents are too poor to fight any legal battle to get compensation. Seeing their plight, It seems that the government simply does not care.

and this:

http://www.ibnlive.com/article.php?id=7992&section_id=3

Shan-e-Ali had been given 15 doses of polio vaccine since his birth, yet he suffers from polio.

Only vaccination will not curb polio
Meetu Jain
CNN-IBN

Posted Saturday , April 08, 2006 at 19:09
Updated Monday , April 10, 2006 at 10:43
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Moradabad: Shan-e-Ali had been given 15 doses of polio vaccine since his birth. There was no chance that he would suffer from polio. However, the one-and-a-half-year-old is now paralysed below the waist.

"He didn't miss it a single time," says Shan-e-Ali's mother, Shannu.

What is surprising is that all the cases of polio that have been detected in India in the past few years, have contracted it despite being vaccinated.

The polio vaccine is meant to target three strains of polio - P1, P2 and P3. In 2005, 66 new cases of polio were detected, 62 of which were of the P1 strain.

It was then that the government introduced the monovalent vaccine, which targets this particular strain. But despite the introduction of the new vaccine, 16 new cases of polio were detected in 2006. All of these were of the P1 type.

"In the areas where these cases were detected, we have not been given the monovalent vaccine and now the problem is not there anymore," Health Minister, Dr Anbumani Ramadoss said.

Most of the cases of polio are reported from the high risk endemic areas of UP and Bihar. This is a clear indicator of the fact that in the effectiveness of the vaccine is under question where issues of nutrition and sanitation are not being addressed alongside.

Associate Professor, JNU Ritu Priya, says, "You need a twin approach. Vaccination plus sanitation, nutrition and clean drinking water. Only vaccination will not curb polio."

More than Rs 3,000 crore have already been spent on the pulse polio programme. India has pushed the target of complete polio eradication by a year to 2007. But the question is - will this deadline be met?