Concerted effort needed to stop polio transmission in Asia by 2006

BMJ 2005; 330 doi: (Published 10 February 2005) Cite this as: BMJ 2005;330:327
  1. Ganapati Mudur
  1. New Delhi

The numbers of poliomyelitis cases in India, Pakistan, and Afghanistan almost halved last year. But stopping transmission of the poliovirus in Asia by the end of 2005 will require intensified immunisation campaigns in all three countries, public health officials said last week.

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Children with polio play at the Amar Jyoti Rehabilitation Centre in Delhi, India


The three countries—containing Asia's last pockets of polio—reported 186 cases in 2004 compared with 336 in 2003. Health officials from the subcontinent met at the World Health Organization last week and outlined plans for 21 additional immunisation campaigns this year.

“This is the year to rid Asia of polio,” said Bill Sargeant, chairman of Rotary International's PolioPlus Committee, a partner in the 16 year old global polio eradication initiative.

Polio is currently at its lowest ever levels in Asia. India reported 132 children paralysed by the poliovirus in 2004; Pakistan detected 50 and Afghanistan reported four.

But officials cautioned that “final success” would hinge on reaching “underserved children” in parts of Uttar Pradesh and Bihar in India. “Up to 10% of children are still being missed in the highest priority districts in these areas,” said Steve Stewart, a spokesman for the US Centers for Disease Control and Prevention in Atlanta, Georgia. He said that the quality of supplementary immunisation activities, which complement routine programmes, also needed to be improved in Pakistan's Sindh province and in southern Afghanistan.

But Thekekarra Jacob John, former head of virology at the Christian Medical College in Vellore, has warned that persistent transmission of polio in Uttar Pradesh may be the result of a “high force of transmission” of the virus, brought about by low income and literacy, poor sanitation, and inadequate health infrastructure. “Conventional interventions that had worked in other poor communities may not work where the virus has a high force of transmission,” he said.

Mr Stewart said that it was technically feasible to stop polio transmission in Asia by 2005 and in Africa by mid-2006. But in 2003-4 polio spread from Nigeria to 13 African countries and has re-established transmission in Burkina Faso, the Central African Republic, Chad, Côte d'Ivoire, and Sudan.

“These importations threaten the goal of ending transmission in Africa this year,” he said.

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