This document discusses strategies for eradicating polio in India, including conducting regular pulse polio immunization days, improving routine vaccination coverage and surveillance. Surveillance involves reporting all cases of acute flaccid paralysis, investigating cases, testing stool samples and monitoring efficacy. Pulse polio immunization is conducted as mass administration of oral polio vaccine to children under 5 on national immunization days. India has made significant progress and was removed from the list of polio-endemic countries in 2012 after passing one year without new cases.

1. ERADICATION OF POLIOMYELITIS
RISHI KASHYAP

2. WHY POLIO IS A CANDIDATE FOR ERADICATION
?
• MAN IS THE ONLY RESERVIOR
• NO LONG TERM CARRIER STATE
• ROUTE OF TRANSMISSION IS FAECO-ORAL
• HALF LIFE OF EXCRETED VIRUS IN SEWAGE
SAMPLE IN TROPICAL CLIMATE LIKE INDIA IS
48 HOURS.
• POTENT AND EFFECTIVE VACCINE.

3. Strategies for polio eradication in
India
 Conduct Pulse Polio Immunization days every
year until poliomyelitis is eradicated.
 Sustained high levels of routine immunization
coverage.
 Monitor OPV coverage at district level and below.
Improve surveillance capable of detecting all
cases of AFP due to polio and non polio etiology.

4. • Ensure rapid case investigation, including the
collection of stool samples for virus isolation.
• Arrange follow-up of all cases of AFP at 60
days to check for residual paralysis.
• Conduct outbreak control for cases confirmed
or suspected to be poliomyelitis to stop
transmission.

5. • Even a single case is treated as an outbreak
and preventive measures are initiated.
• The complete and timely reporting of cases is
an important element for the eradication of
poliomyelitis.

6. Line listing of cases
• Line listing of reported cases was started in
1989 to check for duplication of case.
• Line listing of cases made it possible to take
appropriate follow-up action from where the
cases had been reported.
• The line lists have also provided useful
epidemiological data for programme
purposes.

7. • All cases of acute flaccid paralysis must be
reported immediately to the chief medical
officer/district immunization officer with the
following details:
• Name, age and sex of the patient.
• Father’s name and complete address.
• Vaccination status
• Date of onset of paralysis and data for
reporting.

8. • Clinical diagnosis.
• Doctor’s name, address and phone number.

9. Mopping Up
• Mopping up activities are usually the last in
polio eradication.
• It involves door-to-door immunization in high
risk districts, where wild polio virus is known
or suspected to be still circulating.
• This strategy is being implemented in India.

10. Pulse Polio Immunization
• The term “pulse” has been used to describe
this sudden, simultaneous, mass
administration of OPV on a single day to all
children 0-5 years of age regardless to
previous immunization.
• PPIs occurs as two rounds about 4 to 6 weeks
apart during low transmission season of polio,
i.e. between November to February.

11. • In India, the peak transmission is from June to
September.
• An important improvement in PPI during 1998
has been the use of vaccine vial monitor.
• When the color of the white square becomes
blue like that of surrounding circle, the vaccine
should be considered ineffective.

13. STEPS INVOLVED
Setting up of booths in all parts of the country
Initialising walk-in cold rooms, freezer rooms, deep freezers, ice-lined refrigerators
and cold boxes for ensuring steady supply of vaccine to booths.
Arranging employees, volunteers and vaccines.
Ensuring vaccine vial monitor on each vaccine vial.
Immunising children with OPV on National Immunisation Days.
Identifying missing children from immunisation process.
Surveillance of efficacy.
13

14. ACUTE FLACCID PARALYSIS
Surveillance

15. A.F.P.
DEFINITION :
Sudden onset of
weakness of a limb or paralysis
over a period of 15 days
in a patient less 15 years of age .

16. WHAT IS SURVEILLANCE ?
• IT IS A CONTINOUS SCRUTINY
• OF ALL ASPECTS OF OCCURRENCE & SPREAD OF
DISEASE
• THAT ARE PERTINENT TO EFFECTIVE CONTROL.
• SURVEILLANCE INCLUDES
1. COLLECTION OF DATA
2. ANALYSIS OF DATA
3. INTERPRETATION OF DATA
4. DISTRIBUTION OF RELEVANT DATA SO THAT
NECESSARY ACTION CAN BE TAKEN

17. The AFP Surveillance System
Community
Hospitals
Clinics
Investigation
Non-Polio AFP Polio AFP

18. GOAL OF AFP SURVEILLANCE
• IDENTIFICATION OF ALL RESERVOIRS OF
CIRCULATING WILD POLIO VIRUS
• ( THAT COULD BE POLIO ) BY DOCUMENTING
ALL SUCH CASES,IT IS POSSIBLE TO SHOW
THAT NONE OF THESE “POLIO-LIKE” CASES
WERE CAUSED BY THE POLIO VIRUS,AND
THAT POLIO IS NO LONGER PRESENT OR
EXISTING.

19. WHY AFP SURVEILLANCE INSTEAD OF
POLIO SURVEILLANCE ?
• SURVEILLANCE OF A POLIO CASE ALONE IS NOT
SUFFICIENT BECAUSE IT IS IMPOSSIBLE TO
PRECISELY IDENTIFY ALL CASES OF POLIO CLINICALLY
DUE TO CONFUSING AND AMBIGUOUS CLINICAL
SIGNS AND VARIABLE CLINICAL KNOWLEDGE &
SKILLS OF DOCTOR.
• CLINICALLY POLIO IN ACUTE STAGE, IS DIFFICULT TO
DISTINGUISH FROM OTHER CAUSES OF ACUTE
ONSET OF FLACCID PARALYSIS.

20. WHAT TO REPORT
• Any Case of Acute Flaccid Paralysis < 15 Yrs
age.
• It May be Monoplegia, Paraplegia,
Hemiplegia,Facial Palsy, or Any Transient
weakness.
• Any case of Suspected Polio Clinically
Irrespective of any age.

21. WHAT IS NOT AFP ?
• TRAUMA
• ISOLATED FACIAL NERVE PALSY
• HYPOKALAEMIA
• ACUTE RHEUMATIC FEVER
• CONGENITAL FLACCID PARALYSIS

22. CONDITIONS SOMETIMES
PRESENTING WITH AFP
• TUMOR
• ENCEPHALITIS
• HYPOKALEMIC PARALYSIS [ DUE TO LOW
SERUM POTASSIUM USUALLY REVERSIBLE ]
• POTT’s DISEASE
• TB MENINGITIS
• OSTEOMYELITIS

23. Last Reported Polio Cases
Polio Virus Type Date of last case Location
P1 13 January 2011 Howrah (Panchla),
WB
P2 24 October 1999 Aligarh, UP
P3 22 October 2010 Pakur , Jharkhand
Source: WHO 23

24. • In 2012, WHO removed India from a list of
countries with active endemic wild polio
transmission after it passed one year without
registering any new cases.
• Completing three full years without reporting
any case of polio, India celebrated a landmark
achievement in public health on 11 February
2014 – the victory over polio.

25. Thank you