Intended for healthcare professionals

Rapid response to:

Feature Infectious disease

India, Pakistan, and polio

BMJ 2016; 353 doi: (Published 04 May 2016) Cite this as: BMJ 2016;353:i2417

Rapid Response:

India's journey from hyperendemic to polio free status - Paediatricians point of view

India's success in eliminating wild polio viruses has been recognized internationally. The success of the last case on January 13, 2011 has been sustained for 2 years. By early 2014 India could be certified free of WPV transmission, if no indigenous transmission occurs, the chance of which is considered zero. In the early 1990s India was hyperendemic for polio, with an average of 500-1000 children getting paralyzed daily. In spite of introducing trivalent oral polio virus vaccine in 1979, with the introduction of PULSE POLIO the burden of polio did not fall below that of the pre-EPI era for a decade.

One of the main reasons was the low vaccine efficacy (VE) of tOPV against WPV types 1&3. The VE of tOPV was highest for type2 and WPV type2 was eliminated in 1999 in certain states of India, as the average per capita vaccine coverage reached 6. The VE against Vaccine type 1 and 3 was lowest in Uttar Pradesh and Bihar, where the force of transmission of WPVs was maximum on account of the highest infant - population density. Transmission was finally interrupted with sustained and extraordinary efforts using government machinery and private public patrnership. During the year 2004 annual pulse polio vaccination campaigns were conducted 10 times each year, virtually every child was tracked and vaccinated - including in all transit points and transport vehicles. Since April 25, 2016 monovalent OPV types 1 and 3 were licensed and applied in titrated campaigns according to WPV epidemiology, and bivalent OPV (bOPV, with both type 1 and 3) was developed and judiciously deployed. Elimination of WPVs with OPV is only phase 2 with introduction of inactivated poliovirus vaccine (IPV, switch from tOPV to bOPV and final elimination of all vaccine-derived polioviruses. True polio eradication demands zero incidence of polio infection, wild and vaccine.

In my experience, the clinical spectrum of poliomyelitis in India during 1986-1993 was bulbar poliomyelitis and many varied presentations of wild virus paralytic poliomyelitis requiring a lot of clinical support and rehabilitation. In 1952 there were 20,000 cases of paralytic polio worldwide.

India owes a great debt to both Salk and Sabin and Sabin's strategy of pulse polio administration which has paid great dividends..

As a paediatrician who has seen and treated many cases of wild polio, it is my privilege to see the contribution of India in eradicating polio and it remains for us to eliminate all risks of polio due to wild polio, vaccine virus , including vaccine-derived virus.

1. Centers for Disease Control and Prevention (CDC). Progress toward interruption of wild poliovirus transmission - worldwide, January 2011-March 2012. MMWR Morb Mortal Wkly Rep. 2012;61:353–7. [PubMed]
2. India Officially Removed from the List of Polio-endemic Countries. [accessed on July 25, 2012]. Available from: .
3. Kew O. Reaching the last one per cent: progress and challenges in global polio eradication. Curr Opin Virol. 2012;2:188–98. [PubMed]

Competing interests: No competing interests

09 May 2016