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Surveillance for polio eradication: current status and lessons learnt--India, 1999
K Banerjee1, S Bandyopadhyay, W G Hlady
1National Institute of Communicable Diseases, Delhi.
Journal of the Indian Medical Association
|October 4, 2000
Summary
India enhanced its polio surveillance system by establishing active acute flaccid paralysis (AFP) surveillance with trained officers and reporting units. This led to increased detection of non-polio AFP cases and a decrease in wild poliovirus cases, though transmission persisted.
Area of Science:
- Public Health
- Epidemiology
- Vaccine-Preventable Diseases Surveillance
Background:
- India's Universal Immunisation Programme launched in 1985 aimed to provide childhood immunisation nationwide by 1990.
- Vaccine-preventable diseases (VPD) surveillance, including polio, began concurrently with monthly reporting.
- The Pulse Polio Immunisation campaign initiated in 1995 aimed for polio eradication, initially relying on passive reporting of clinical polio cases.
Purpose of the Study:
- To establish an active surveillance system for acute flaccid paralysis (AFP) cases across India.
- To improve the detection and reporting of polio and other vaccine-preventable diseases.
- To support the national objective of polio eradication through enhanced surveillance mechanisms.
Main Methods:
- Development of an acute flaccid paralysis (AFP) surveillance scheme in 1996.
- Recruitment, training, and deployment of Surveillance Medical Officers (SMOs) starting in 1997, with numbers increasing over time.
- Establishment of a nationwide network of 10,069 reporting units by November 1999 for weekly reporting of AFP cases, timely investigation, stool specimen collection, and laboratory linkages.
Main Results:
- Annualised rates of reported non-polio AFP increased significantly from 0.22 per 100,000 children (<15 years) in 1997 to 1.57 in 1999.
- The number of polio cases associated with wild poliovirus isolation decreased from 1404 in Q3 1998 to 664 in Q3 1999.
- Despite improvements, widespread transmission of wild polioviruses persisted throughout the country.
Conclusions:
- The implementation of active AFP surveillance significantly enhanced the detection capacity for paralysis cases in India.
- The enhanced surveillance system contributed to a reduction in wild poliovirus cases, indicating progress towards polio eradication.
- Continued efforts and vigilance are necessary to address the persistent wild poliovirus transmission.