Strategies for eradication of poliomyelitis--the Indian experience

Substantial progress has been made towards achieving global eradication of poliomyelitis by the end of the year 2000; the goal set by the World Health Assembly in May 1988. The basic strategies to eradicate polio are: attaining high routine coverage with at least three doses of OPV; conducting national immunization days (NIDs) in polio endemic countries; establishing a sensitive system of acute flaccid paralysis (AFP) surveillance to track wild poliovirus circulation; and conducting "mopping-up" immunization when polio is reduced to focal transmission. By the end of 2000. India was in the midst of the sixth National Immunization Days (NIDs). Surveillance system for Acute Flaccid Paralysis (AFP) continued to achieve the recommended non-polio AFP rate of at least 1 per 100,000 population < 15 years per year (1.88 for week 51 ending 23rd December 2000), the adequate stool specimen collection rate was 83% that met the target of > 80%. Some States in the south and west have started to implement mopping-up immunization campaigns as the end-stage strategy to eliminate the last remaining foci of transmission. While most of India appears to be well placed to eradicate polio by the end of 2000 or shortly thereafter, concerns remain about low coverage in parts of the densely populated northern States of Uttar Pradesh and Bihar where high intensity transmission persists. The Government of India has embarked upon an intensified strategy that relies on extra rounds of NIDs; house-to-house immunization to reach previously missed children; and aggressive mopping-up campaigns including pre-emptive mopping-up in the known reservoirs in Uttar Pradesh and Bihar. Extensive microplanning and supervision of the supplementary immunization activities is critical to achieve the target of polio eradication.