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In
the spring of 1988, representatives from virtually
every country on earth met at the World Health
Assembly in Geneva to make a commitment to the
eradication of polio by the year 2000. Included
among these countries were all ten-member countries
of the WHO South-East Asia Region. Polio is
endemic to the countries of the Indian sub-continent,
which has been the world's largest reservoir
of wild poliovirus: in the recent past, 70%
of the world's polio cases have originated from
India, Bangladesh, Pakistan, and Nepal. The
world has made spectacular progress against
polio since 1988: polio was eradicated from
the Western Hemisphere in 1991, and much of
the
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Highlights
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After 2000 no polio
case was identified in spite of high quality
surveillance and polio compatible cases
were also not identified during this period.
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rest
of the world has become polio-free since then.
The remaining polio-endemic areas of the world
include the Indian sub-continent and sub-Saharan
Africa. Dramatic progress has also been achieved
in Bangladesh.
What
is polio?
- Polio is a viral disease that affects the
human nervous system;
- 12% of the victims die, and the remainder
become permanently crippled;
- Most polio victims are children under five
years of age;
- Poliovirus is transmitted through the fecal-oral
route: poor sanitation and high population
density, as found in Bangladesh, facilitate
poliovirus transmission;
Before the polio vaccine was introduced, poliomyelitis
was a major cause of disability in Bangladesh:
an estimated 11, 500 children were crippled
or died every year from polio.
Objectives
- Interrupt transmission of Wild Poliovirus
in by conducting yearly Intensified National
Immunization Days (NIDs) the last to be conducted
in either 2004 or 2005 depending on the circulation
of virus in India
- Attain and sustain certification-standard
AFP surveillance
- Maintain polio-free status until certification
by continuing supplementary immunization activities
Strategies
· Strong routine immunization programme
· National immunization Days (NIDs)
· Acute flaccid paralysis surveillance
THEN
· Laboratory containment of poliovirus
· Polio-free certification
· Stopping polio immunization
Status of Polio Eradication in Bangladesh
Before 1986, when EPI intensification
began to provide polio vaccine to
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children throughout Bangladesh,
an estimated 11,500 children developed
polio every year. Thanks to routine EPI,
that number was reduced to approximately
2,300 in 1994.
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In 1999, the number
of clinically confirmed polio cases
was 324, an 87% decrease from the
1994 estimate. This decrease was
a result of 5 annual NIDs from 1995-1999.
NIDs are vaccination campaigns in
which all children under 5 years
old receive polio vaccine regardless
of previous immunization status
in 2 rounds 4-6 weeks apart. Bangladesh
has been intensifying its NIDs strategy
since the 6th NIDs conducted in
November and December, 1999. The
intensified NID strategy as developed
in Bangladesh places greater attention
on micro-planning, mapping, supervision,
and a house-to-house search for
left-out children for 4 consecutive
days following each round of the
fixed site NIDs. Bangladesh also
accelerated polio eradication efforts
by conducting twice yearly NIDs
in 2000 and 2001.
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Intensified NID strategy
has produced remarkable results. In 1999,
29 laboratory-confirmed cases of polio
were identified from 18 districts in all
6 divisions of Bangladesh. In 2000, with
improved surveillance for AFP, only 1
laboratory confirmed case has been identified.
Along with that 36 cases were identified
as compatible with polio, meaning that
these cases were similar to polio cases,
but as adequate stool specimens could
not be collected timely the National Expert
Review Committee on poliomyelitis could
not be sure if these cases were polio
or not.
After 2000 no polio case
was identified in spite of high quality
surveillance and polio compatible cases
were also not identified during this period.
Surveillance of Acute
Flaccid Paralysis (AFP) has been steadily
improving with regard to the ability to
identify children that may have polio
and in the timeliness of reporting such
children. Bangladesh has satisfied all
10 performance indicators set by WHO for
good quality surveillance since 2000.
The non-polio AFP reporting rate, the
most important indicator of the ability
of a country to identify possible cases
of polio, has well exceeded the minimum
target of 1 per 100,000 children <15
years old per year. Immediate reporting
of any child under 15 years old that suddenly
develops floppy paralysis of one or more
limbs (i.e. AFP) is essential for health
authorities to take quick and effective
action. Every reported AFP case is quickly
investigated to determine if extra measures
are needed to "mop up" polio
from that area.
Non-Polio AFP reporting
Rate (/1000,000 per year),
by division, Bangladesh 1998-2003
Global progress in polio eradication
- NIDs have been conducted in over 120
countries;
- In 1999, NIDs reached 450 million
children who were vaccinated against
polio;
- Number of polio cases has fallen dramatically
in ten years-from 350,000 in 1988 to
6,400 in 1999;
- Number of polio endemic countries
in the world in 2003 has come down to
seven; Nigeria, India, Pakistan, Afghanistan,
Niger and Egypt.
- Polio -free regions include the Western
Hemisphere (last case 1991), the Western
Pacific Region (last case 1997), and
Europe (last case 1999).
- In the South-East Asia Region, all
countries except India reached '0' polio
status. Polio is still circulating in
India where number of cases in 2002
was 1600 and 101in 2003 up to 20 August.
Pakistan is also polio-endemic.
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Admin Guide Handbook (EPI)
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