POLIOMYELITIS in India
The Fight Goes on

Polio has been in the news. The widely publicised Polio Plus programme is now a house-hold name, and an example of how the Government, Media and Developmental sector can work together to achieve impressive goals. But are these goals only small steps towards the eradication of Polio? We explore here the evil called Polio, its journey through the times and finally, the massive public campaign of Polio Plus Programme.

The words Polio(grey) and myelon (marrow, indicating the spinal cord) are derived from Greek. It is the effect of poliomyelitis virus on the spinal cord that leads to the classic manifestation, paralysis. Although records from antiquity mention crippling diseases compatible with poliomyelitis, it was Michael Underwood from England who, in 1789, first described a debility of the lower extremities in children that was recognizable as poliomyelitis. The first outbreaks in Europe were reported in the early 19th century, and outbreaks were reported in the United States a few years later. For the next hundred years, epidemics of Polio were reported from developed countries in the northern hemisphere each summer and fall. These epidemics became increasingly severe, and the average age of persons affected rose. The increased age of primary infection increased both the disease severity and number of deaths from Polio.

The virus enters through the mouth and primary multiplication of the virus occurs at the site of implantation in the pharynx and gastrointestinal tract. The virus is usually present in the throat and in the stool before the onset of illness. One week after onset there is little virus in the throat, but virus continues to be excreted in the stool for several weeks. The virus invades local lymphoid tissue, enters the blood stream, and then may infect cells of the central nervous system. Replication of poliovirus in motor neurons of the anterior horn and brain stem results in cell destruction and causes the typical manifestations of poliomyelitis. The incubation period for poliomyelitis is commonly 6 to 20 days with a range from 3 to 35 days.

At one time poliovirus infection occurred throughout the world. Transmission of wild poliovirus ceased in the United States in 1979, or possibly earlier. The Global Polio Eradication Program has dramatically reduced poliovirus transmission throughout the world. Poliovirus transmission now occurs primarily in the Indian subcontinent, the Eastern Mediterranean, and Africa.

ORAL POLIOVIRUS VACCINE (OPV)

Live attenuated polioviruses replicate in the intestinal mucosa and lymphoid cells, and in lymph nodes that drain the intestine. Vaccine viruses are excreted in the stool of the vaccinated person for up to six weeks after a dose. Maximum viral shedding occurs in the first 1-2 weeks after vaccination.

POST-POLIO SYNDROME HIGH   MILD   FREE

Post-Polio Syndrome (PPS) is a condition that can strike polio survivors anywhere from 10 to 40 years after their recovery from polio. PPS is caused by the death of individual nerve terminals in the motor units that remain after the initial polio attack. Symptoms include fatigue, slowly progressive muscle weakness, muscle and joint pain, and muscular atrophy. The severity of PPS depends upon how seriously the survivors were affected by the first polio attack. Doctors estimate the incidence of PPS at about 25 percent of the survivor population. The only way to be sure a person has PPS is through a neurological examination aided by other laboratory studies (for example, magnetic resonance imaging (MRI), neuroimaging, electrophysiological studies, and muscle biopsies or spinal fluid analysis).

The PolioPlus programme started in 1985 .The initiative is an aggressive public private partnership to assist International Health Agencies and Governments in eradicating polio and certifying the world Polio free by 2005. Rotary International has already contributed $ 407 million for the programme . By 2005, Rotary's financial commitments will reach half a billion US dollars. Apart from financial commitments, Rotary volunteers assist in vaccine delivery, social mobilization and logistic management in cooperation with the national Health Ministries of various countries, the World Health Organisation, UNICEF and the U.S Centers for Disease Control and Prevention.

It was in 1986 that the PolioPlus program made a formal debut in India when Rotary International provided a US $ 2.6 million grant to Tamil Nadu for the purchase of Polio vaccine. The nation-wide focus on PolioPlus began a year later, when US $ 20 million were made available for the purchase of Oral Polio Vaccine, surveillance activities, social mobilization and Cold Chain support.

The History of Polio over the years

Between 1991 and 1994, immunisation drives in the form of Shishu Suraksha Diwas (Child Protection Days) were organized all over India by Rotary Clubs and Rotarians in their respective areas. The Govt. of the National Capital Territory of Delhi took the initiative of launching the first Pulse Polio Immunisation in 1994. The Govt. of India followed suit a year later in 1995-96, by designating two National Immunisation Days(NIDs) in December and January. Seven series of NIDs have since been conducted. In 1999, this programme was intensified in order to meet the global deadline. The number of NIDs were increased and "House to House" strategy was adopted to reach every child. In 2001 the strategy of intensive Mop-up immunisation was also introduced to interupt the wild Polio virus circulation in endemic districts. In 2001-02 as many as 159 million children between the ages of 0 to 5 were immunised.

1908 : Karl Landsteiner determines that polio is a virus rather than a bacteria.
1916 : One of the largest epidermics of the century occurs, paralyzing 27,000 people and killing 9,000.
1952 : An estimated 5,58,000 people contract polio.
1954 : First inactivated polio vaccine announced by Dr Jonas Salk, 1.8 million school children participate in the trials.
1961 : Dr Albert Sabins Oral Polio Vaccine approved for use by the American Medical Association.
1974 : 49,293 cases of polio reported worldwide.
1979 : Rotary clubs of Manila, Philippines fund immunization activities. Small Pox eradicated !
1985 : Rotary International launches Polio Plus.
1988 : 160 member countries of the World Health Assembly set 2005 as target year for eradicating polio.
1994 : The Americas are certified polio-free.
1995 : Nearely 300 million children receive OPV during NIDs conducted in 51 countries including China and India.
1996 : 26 sub-Saharan African countries hold coordinated NIDs.
1997 : More than 260 million children are vaccinated in nine countries in Asia.
1999 : 150 countries polio free, 85% reduction in polio cases since 1998.
2001 : Over 100,000 Rotary members and their families join the Indian Government in immunizing over 150 million children in a single day - signaling the largest public health event in the world.

Polio Cases Worldwide Since 1975