In 1995 Government of India launched the Pulse Polio Immunization (PPI) for the eradication of poliomyelitis. In 1999, a vastly intensified pulse polio campaign entailing enormous economic and logistic burdens was conducted with the aim to give a final push to eradication. Instead of achieving the hoped-for zero polio status in 2002, the number of cases actually increased many fold. Type 1 wild virus had survived in Uttar Pradesh and Bihar in 2001 and caused this outbreak, which spilled over to several states that had been polio-free for a few years. Independent surveys indicate that this was due to woefully inadequate routine immunization coverage compounded by the failure to reach all children during the pulse immunization. Also, of concern to us is the decline in the routine immunization achievements in many states. The Indian Academy of Pediatrics (IAP), along with other partners involved in polio eradication efforts, are disappointed, but are reinvigorating our efforts to catch up with the eradication programme and to improve routine immunization. The IAP Committee on Polio Eradication met on 4th January 2003 in Mumbai and after deliberations on various issues, the following recommendations were approved (participants of the meeting are listed in Annexure). We submit them to the Government of India and to the governments of the states affected by the spread of wild polioviruses in 2002.
1. District Task Forces on immunization should be formed in all the districts of the affected states. Professional bodies (including IAP, Indian Medical Associa-tion) and community leaders, particularly from minority communities should be represented on them. The District Task Force should meet every month round the year and should monitor progress in strengthening routine immunization and consequent achievements.
2. Intensive Information, Education, Communication (IEC) campaign should be launched to create awareness and demand for routine immunization. Make use of audio-visual, print and electronic media to propagate routine immunization round the year.
3. Government should ensure that at least one day a week, such as every Wednesday is kept sacrosanct for immunization outreach programs by the staff, no matter what other programs are highlighted for the season, including preparation for pulse immunization for polio eradication.
4. Fix accountability of the public sector health care provider responsible for routine immunization in a specific area.
5. Specific action plans and monitoring mechanisms should be developed to provide routine immunization to children living in urban slums.
6. All vacant posts of health workers relevant to primary health care, especially those concerned with immunization, should be immediately filled up.
7. Hospital based immunization clinics should become user friendly. Make immunization available every day in large or busy clinics and hospitals; both in public sector and private sector establish-ments and at least one day a week in smaller clinics, health centers and small hospitals. Instead of limited time periods in the day, immunization session should continue during the whole working hours.
8. Vaccination should be offered to children accompanying mothers for Reproductive and Child Health (RCH) clinics.
9. In every institutional birth, the infant should be given one dose of OPV before discharge.
l. Monitoring of Polio Eradication Program should be done from the level of Chief Minister and Chief Secretary.
2. Emphasis should be on improving the quality of National Immunization Days (NIDs) rather than increasing the numbers.
3. There is a need to involve all local area practitioners of medicine actively right from the planning stage of SIA.
4. In UP only one immunization card per child should be used to record routine as well as pulse polio doses. Immunization cards should have a column for NID and SNID along with other vaccines and proposed due dates filled in as declared every year. It should be clearly printed in bold letters in immunization cards "immunization is not complete if any pulse polio dose is missed up to the age of 5 years, just as in the case of routine immunization where not a single dose should be missed from the immunization schedule."
5. As house-to-house immunization follow-ing booth-based pulse immunization is adversely affecting the routine immuniza-tion services; house-to-house immuniza-tion should be discontinued as part of NID in all states except the high-risk states. There is need for having a fresh look at the need for house-to-house strategy in these states also.
6. Mop-ups should not be conducted in the states going for SNIDs.
We request the governments and con-cerned authorities to consider and implement these recommendations.
The Committee had also made specific recommendations to the Branches and members of IAP, which may be found in the Editorial titled "Setback in polio eradication in India in 2002: Reasons and Remedies" in the March 2003 issue of Indian Pediatrics.
Indian Academy of Pediatrics through its Polio Eradication Committee, network of Regional and District Polio Coordinators, lAP districts branches and 14000 members will continue to help in achieving polio eradication in India.
ANNEXURE
Participants of Polio Eradication Committee Meeting on 4th January, 2003 at Renaissance Hotel, Mumbai
C.P. Bansal (Zonal coordinator), Swati Y. Bhave (Invitee), A.P. Dubey (Member), Ajay Gaur (Invitee), Virudha Giri (Invitee), Mahesh Kumar Goel (Joint-State Coordinator UP), J.K. Jain (District Coordinator), T. Jacob John (Chairman), V.K. Kapoor (District Coordinator), S.A. Krishna (Zonal Co-ordinator), Rajeev Kumar (State Coordinator – Uttranchal), Rajesh Mehta (Invitee), Dilip Mukherjee (Invitee), MKC Nair (President-Elect IAP), R.S. Panwar (Regional Coordinator–UP), Ashok Rai (Joint-State Coordinator UP), HPS Sachdev (Ex-officio member), Vineet Kumar Saxena (District Coordinator–UP), Raju C. Shah (Invitee), R.N. Srivastava (Invitee), Naveen Thacker (Convener), Vipin M. Vashishtha (Co-convener).
Correspondence to:
Naveen Thacker,
Convener,
Polio Eradication Committee of IAP,
208, Sector 1-A, Gandhidham, Kutch,
Gujarat 370 201, India,
E-mail: naveen@wilnetonline.net
Naveen Thacker,
Convener,
Polio Eradication Committee of IAP,
208, Sector 1-A, Gandhidham, Kutch,
Gujarat 370 201, India,
E-mail: naveen@wilnetonline.net
SOURCE-
IMAGE COURTESY- Google
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