THE CITY of Karachi has been declared polio-free, as no fresh case has been reported from the provincial metropolis and its periphery in 2005. Only three cases have been confirmed in Sindh of the total 17 reported from across the country during the current year.
According to an updated report of the World Health Organisation (WHO) 1,219 new cases were confirmed from 10 different countries across the globe till mid-September this year.
Pakistan has been placed at sixth position among the countries where poliovirus still persists, others being Afghanistan, India, Egypt, Niger and Nigeria that are battling with the disease with varied successes.
Experts say as Pakistan is in the last leg of polio eradication, extremely cautious approach is required to ensure that all children up to five are vaccinated without fail. They believe until the entire country attained zero polio prevalence and the same status is maintained for three consecutive years, the task of absolute eradication could not be ensured.
By December 31, 2005 the 17-year long anti-polio campaign that started in 1988 will come to a close, bringing an end to the disease. It will be the first disease of the 21st century to have been eradicated. It has been one of the largest public health efforts not just in Pakistan but across the 125 countries where the Global Polio-eradication Initiative (GPI) was launched.
Before the Expanded Programme on Immunisation (EPI) started, in 1997 about 500 new cases of polio were reported. The international community set the turn of the 20th century, as the deadline for a complete halt to polio, but then revised it to 2005. Since the target was established, an effective global coalition has been built to work towards this goal.
Among the international community, WHO, the US Centre for Disease Control and Prevention, Unicef, Rotary International and the Japanese government are spearheading the GPI with support from respective governments to eliminate the disease. Over the years these partners have provided not only funding, but also technical expertise, advocacy and volunteers.
Now almost on its last leg, another challenge that the health authorities are facing is the immunisation of those children who were not administered polio drops even during the special campaigns. Experts say if these children don't get immunised, all efforts will go in vain as they will eventually infect other children.
But the campaigners, for their part, have not left any stone unturned. So far, the EPI is covering around 95 percent of target children - under five years of age - making up the 24 million children population in the country. When the programme was initiated perhaps no one imagined the enormity of it all, or the huge logistical challenge involved in administering polio drops to some 17 percent of Pakistan's population.
Vaccination teams set up centers in schools, community halls and health clinics to ensure that the area's children are vaccinated.
In Pakistan, the highest number of polio cases is reported from the Frontier province. One of the reasons cited is that many parents refuse to get their infants under six months vaccinated.
Another reason given for a high prevalence rate in the NWFP is because of cross-border transmission between Pakistan and Afghanistan. Yet another reason is routine immunisation coverage that remains between 30-70 percent which is why many children may not receive any or all of their scheduled vaccination doses through the EPI.
Polio is characterised by a sudden onset of paralysis. The child starts off with a mild fever, soar throat, muscle pain and a spasm for two to three days, which is then followed by sudden paralysis. Although any part of the body can be affected it is generally the lower limbs, while sometimes the upper limbs can also be paralysed. The pattern is quite irregular and the paralysis is flaccid. The muscles are floppy without tone. The most common deformity includes foot drop, hyperextension of the knee and in some cases pelvic tilt.
However, more painful is the helplessness of the child and the sorrow of the parents when the child gets affected with polio.
According to health experts, to impede the polio vaccine, the wild poliovirus must be prevented from circulating in the environment. If their movement is curtailed, the virus will die out.
Vaccinating the most susceptible population (children under five) is the most effective way to block the spread. In 1961, cheap, effective oral vaccine (OPV) was developed that could be administered as drops directly into a child's mouth. OPV is ideal for widespread immunisation efforts in the developing world.
If mass vaccination is done every four to six weeks, the virus will eventually disappear. However, according to WHO experts three or even four doses may not give 100 percent protection. Thus unvaccinated or under-vaccinated children are likely to spread the poliovirus.