Polio Free Does Not Mean Paralysis Free

January 3, 2013

03 Jan (THE HINDU) -There is no room for complacency that India has eliminated this crippling disease as Uttar Pradesh and Bihar have recorded a high incidence of a condition symptomatic of it. Identifying children who suddenly display muscle weakness, often not moving one or more of their limbs as a result, forms the cornerstone of polio surveillance.

Such children could have “acute flaccid paralysis” (AFP) that is symptomatic of polio, a disease caused by a virus. But AFP can also arise for other reasons, including infection by non-polio pathogens.  No child in India has been diagnosed with polio for nearly two years now and all the indications are that the virus responsible for it is no longer circulating here. However, the country’s polio surveillance system has indicated a sharp increase during recent years in the number of non-polio AFP cases.


Accute Flaccid ParalysisData published by the World Health Organisation show that close to 8,000 non-polio AFP cases were identified in India during 2003. They went up to over 12,000 the following year, more than 26,000 in 2005 and crossed 40,000 by 2007. In 2011, there were more than 60,000 non-polio AFP cases.

A good polio surveillance system ought to pick up all AFP cases among children so that they can be screened for poliovirus infection. On average, only about one child out of every 200 children carrying the poliovirus develops AFP. Such cases must be identified so that appropriate immunisation measures can be undertaken.

India’s polio surveillance shows that the country is polio-free. But it also indicates that the country now has the world’s highest rate of non-polio AFP cases. According to data published in WHO’s Weekly Epidemiological Record, India’s annualised non-polio AFP rate for 2011 stood at 15.06 per one lakh children below 15 years of age, compared to a global rate that year of 5.48.

Moreover, most of the country’s non-polio AFP cases occur in just two States — Bihar and Uttar Pradesh. They accounted for about 61 per cent of the 53,000-odd non-polio AFP cases identified in the country in 2012, according to data from WHO’s National Polio Surveillance Project. As a result, the two States have far higher annualised non-polio AFP rates than other States — around 34 for Bihar and about 23 for Uttar Pradesh. The rate for the country as a whole is slightly over 12. 

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