Polio drops alone won’t do for your child

MUMBAI: Even after your child has got his or her doses of oral polio vaccine, there’s danger lurking. Experts say it’s best to go in for an injectable vaccine too.

The statistics should be able to convince you: Till June, 290 cases of polio have been reported from different parts of the country. India has also missed it’s third rescheduled deadline of 2008 to eradicate the deadly virus. Questions are now being raised about the weapon being used to wipe out poliomyelitis.

Recently, some advisers to the Union government as well as medical experts questioned the potency of the oral polio vaccine (OPV), calling it a uni-dimensional approach to beat the virus. They are of the opinion that while OPV has controlled the wild polio virus to a large extent, it lacks the potential to eradicate it.

Talking to DNA from Vellore, Dr T Jacob John, chairperson of India Expert Advisory Group (IEAG) of the World Health Organisation (WHO), confirmed OPV has efficacy problems. “Zero-polio status can be achieved only through a combination of inactivated polio vaccine (IPV) and OPV or by replacing oral vaccine with the injectable one,” he said.

Paediatricians in the city too are advocating IPV in conjunction with OPV. “We have started recommending IPV to parents who can afford it. A single IPV dose costs around Rs280-300 and the market is flooded with the vaccine," says Dr YK Amdekar, immunisation incharge, Indian Academy of Paediatricians.

Other experts claim the union government’s decision to eradicate polio with oral vaccine alone may bleed the country of resources for another couple of years. Besides, the rise this year in the number of cases of the P3 strain, which was on the brink of eradication, has left the government red-faced.

They are blaming it on the government’s decision to concentrate on the monovalent vaccine that immunised children only against P1 and not P3.

India had focussed on eradicating the P1 strain as it spreads faster and causes paralysis in one out of every 200 children, while P3 is a slow moving virus with low virulence and causes paralysis in one out of every 800-1,000 infections. However, this strategy seems to have backfired. Cases of P3 virus were reported from 8-10 states this year, though it was confined only to Uttar Pradesh earlier.  Also, of the 290 cases reported so far, there were only five cases of P1.

“This is because children developed immunity gap as they have not been immunised against P3 since 2005,” said Dr Naveen Thacker, member, advisory committee, National Polio Surveillance Programme.

“It was a risk taken by the government but we never thought the idea could actually backfire,” said a member of the core committee, national polio immunisation programme.

But this scenario could have been avoided, say experts, had IPV been used.
According to Jacob, who is also a co-adviser to the national polio immunisation programme, the government’s own technical committee had, on several occasions, called for IPV to be incorporated in the national programme. “But it was a political decision and not a technical one to use just OPV and not a combination,” he added.

Interestingly after the government realised the vaccine was not 100% successful in providing mass immunity, they started giving multiple doses, says John. So while globally children get about three to five doses of the oral vaccine, children in India get about 10 doses while those in Uttar Pradesh and Bihar about 15.

Meanwhile, there is also concern that the oral vaccine may not be effective in immunising HIVAIDS positive children from the wild polio virus. “The HIVAIDS affected children run a huge risk of contracting polio, as they are immuno-deficient, and then spreading it on a mass scale,” said Dr YK Amdekar, immunisation incharge, Indian Academy of Paediatricians.