The World Health Organization (WHO) reports that India has recorded no cases of polio for one full year - a significant benchmark for the South Asian nation and an encouraging development for health professionals fighting to eradicate the stubborn disease worldwide.
Experts however caution declaration of the victory too soon to prevent parents from slacking the pace by stopping the immunization of their children. That would increase the risk of another outbreak. India will not be officially certified as polio-free until at least three years have passed without a new case and 26 million babies are born here each year.
“It's an incredible milestone for polio eradication,” said Rod Curtis, a New Delhi-based specialist with UNICEF. “But complacency is perhaps the biggest threat to the program today. You could get down to the last three children in the world, but unless you [immunize] those kids, it could explode again.”
The last Indian victim, 2-year-old Ruksana Khatun, fell ill near Kolkata in West Bengal state on Jan. 13, 2011. It would take health agencies a few more weeks to confirm that it has been a polio-free year. They would process January data on nationwide paralysis cases and sewage test results over the next few weeks.
Sona Bari is external relations officer for WHO’s Global Polio Eradication Initiative. She welcomed this milestone, but noted it is not the end of the road for India. Rather, she said, it is the start of a process. “The next few weeks will be nail-biting weeks as we wait for the data on the last 12 months to come in. Every stool sample from a suspected case of polio, every sewage sample will have to test negative," said Bari. "But, when that happens, India will no longer be considered polio endemic. And, this map that the WHO puts out every month will have India un-shaded for the first time in history.”
Two countries surrounding India - Pakistan and Afghanistan are endemic to polio. And China on its northern border was re-infected in 2011. WHO reports an alarming increase in the number of polio cases in Pakistan and Afghanistan in 2011, with Pakistan recording 192 cases and Afghanistan 76 cases. In Africa, WHO says active polio transmission continues in Nigeria, which had 52 cases last year, in Chad and in the Democratic Republic of Congo. Outbreaks in West and Central Africa also occurred in the past 12 months.
“The potential risks are huge,” said Deepak Kapur, chairman of Rotary International's India National Polio Plus campaign, who has been working on the program for more than a decade. “It's only a flight away, maybe a bus ride away. Or it could come from Afghanistan, Nigeria or anywhere.”
Polio affects the nervous system especially in children younger than 5 and within hours polio can lead to irreversible paralysis, muscular atrophy, deformation and death. The disease tends to spread where sanitation is poor, although it can be arrested with a few drops of an inexpensive oral vaccine.
WHO calls this achievement particularly significant, as India always has been considered the toughest place on earth to stop the polio virus. This is due to a combination of factors, including a poor health system and a large migrant community, compounded by high population density and poor sanitation.
When the global eradication effort was launched in 1988, with a goal of eradication by 2000, India had nearly half of the estimated 350,000 cases worldwide, and as recently as 2009 it had the highest number of cases in the world with 741.
Government officials welcomed the news. “We are excited and hopeful, at the same time, vigilant and alert,” Health Minister Ghulam Nabi Azad said in a statement Thursday. Experts credit new, more effective vaccines provided under a $300-million annual eradication program and a focus on India's 107 most vulnerable districts, concentrated in the northeastern states of Bihar, Uttar Pradesh and West Bengal.
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