Sharp rise in non polio Acute Flaccid Paralysis after polio-free status
Not a single case of polio in the last three years has helped India to attain the ‘polio-free’ status given by the World Health Organization (WHO). After polio-free status, by March India will be certified as a polio-free nation. This implies that polio causing virus is no longer circulating in India. Any new case of polio after this would mean the transference of the virus from other endemic country. You feel proud after reading this but like everything there is another side of this story as well. Country’s polio surveillance system has shown a sharp rise in another similar paralytic condition. It is the non-polio Acute Flaccid Paralysis (NPAFP). A minimum of 53,563 cases of NPAFP have been reported in the last 13 months. India has the highest number of NPAFP cases in the world. This is a big question on the polio-free status of India.
Acute Flaccid Paralysis is a symptomatic of polio and a disease caused by virus. Children display muscle weakness and as a result of this they are not able to move on their one or both the limbs. AFP can also arise because of other reasons such as Guillain Barre Syndrome and nerve lesions along with infection from non polio pathogens.
According to the World Health Organization data, in India there were near about 8,000 non polio AFP cases in 2003 and the next year the number was more than 12,000. In 2005, India had 25,000 cases of NPAFP, in 2007 the number crossed 40,000 and in 2011 there were 61,000 cases of this disease. National rate of NPAFP is 12 per 100,000 children whereas the global point of reference set by the WHO is 2 per 100,000. Global rate in 2011 was 5.48 whereas for India it was 15.06 per lakh children below 15 years of age. Annualised non-polio AFP rate in Bihar is 34 whereas in Uttar Pradesh it is 23. Overall rate for the country is bit more than 12. Uttar Pradesh and Bihar have the highest number of NPAFP cases. The two states responsible for 61% of the 53,000-odd non-polio AFP cases found out in 2012.
In 2004 polio surveillance was intensified further to find out all the cases of polio across the country. Non polio AFP was included to this and health professionals were also trained for the same. Since then number of such cases were on rise. So the problem was there but it came out only after survey.
Experts believe that an increased dosage of polio drops is leading to an increase in the non polio AFP cases. The relationship between the two has been found out by Neetu Vashisht and Jacob Puliyel, doctors from Delhi. They found this while compiling data from the national polio surveillance project. Their findings pointed out a decrease in the cases of AFP in 2010 when polio drops had been reduced from 10 to 6. In Kerala cases of AFP are low along with less immunization rounds of polio drops as compared to UP and Bihar. These two north Indian states show the maximum number of non polio AFP cases. At the same time the states also have the maximum immunization rounds of polio drops for maximum coverage.
But it was countered by the WHO Country Office. It stated that in 2004 the largest number of oral vaccine was given to children in India but the year had the minimum number of non polio AFP cases. Also there is a vague picture of AFP cases in India because it is not being monitored properly either by health care system of the state or the polio eradication programme.
Not only AFP cases but a threat of polio striking back is also there if not taken care. So every child in India must be immunized properly. All the cases of polio must be identified accurately for appropriate immunization measures. In polio surveillance system AFP cases among children should be picked up to check these for poliovirus infection. Though polio eradication programme can be considered successful in India but lot more needs to be done in this regard.