Pulse Polio Immunization Programme in India

A detailed study on the social marketing campaign on the pulse polio immunization programme do boond
zindagi ki.
Pulse Polio

Pulse Polio is an immunization campaign established by the government of India in 1995-96 to eradicate poliomyelitis (polio) in India by vaccinating all children under the age of five years against polio virus. This project deals with the ways to fight poliomyelitis through a large scale immunization programme, co-operating with various international institutions, state governments and Non Governmental Organizations. In India, vaccination against Polio started in 1978 with Expanded Program in Immunization (EPI). By 1984, it was successful in covering around 40% of all infants, giving 3 doses of OPV to each. In 1985, the Universal Immunization Program (UIP) was launched to cover all the districts of the country. UIP became a part of child safe and survical motherland program (CSSM) in 1992 and Reproductive and Child Health Program (RCH) in 1997. This program led to a significant increase in coverage, up to 95%. The number of reported cases of polio also declined from 28,757 during 1987 to 3,265 in 1995. In 1995, following the Polio Eradication Initiative of World Health Organization (1988), India launched Pulse Polio Immunization Program along with

Universal Immunization Program which aimed at 100% coverage.

Key objectives The Pulse Polio Initiative (PPI) aims at covering every individual in the country. It aspires to reach even children in remote communities through an improved social mobilization plan. Not a single child should miss the immunization, leaving no chance of polio occurrence. Cases of Acute Flaccid Paralysis (AFP) to be reported in time and stool specimens of them to be collected within 14 days. Outbreak Response

Immunization (ORI) to be conducted as early as possible. Maintaining high level of surveillance. Performance of good mop-up operations where polio has disappeared. India to be polio-free by 2005

Steps involved Setting up of booths in all parts of the country.[1] Initializing 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. Immunizing children with OPV on National Immunization Days. Identifying missing children from immunization process.

Polio's days are numbered! Poliomyelitis is still around

Make no mistake; it still can be found. For survivors lamed, Crippled may shout, Vaccinate now! Vaccinate now! Polios days are numbered The fight is on, the battle sure Protect your child For theres no cure Polio kills! Polio cripples! No future regrets, Protect them now!

Come join the battle, just fight the bug. The time is near, then no more fear, just vaccinate, vaccinate!

PULSE POLIO
Do Boond Zindagi Ki

Polio What is it?

Polio virus, the causative agent of poliomyelitis. Poliovirus is composed of an RNA genome and a protein capsid. Poliovirus infects human cells by binding to an immunoglobulin-like receptor, CD1555 on the cell surface. The Polio is an incurable disease which if not stopped at the initial stages of vaccinations; it can affect the person to their life time. Handicap permanently paralyzed and losing control over the body parts are some of the results of this Pulse Polio.

The virus is transmitted through contaminated food and water, and multiplies in the intestine, from where it can invade the nervous system. POLIO INFECTION

ANALYSIS
Polio remains endemic in four countries Afghanistan, India, Nigeria and Pakistan Four countries known to have or suspected of having re-established transmission of poliovirus. Angola, Chad and Democratic Republic of the Congo, Sudan Several more countries had ongoing outbreaks in 2010 due to importations of poliovirus.

Number of children affected by polio reducing from 1000 per day to around 4 per day. In June 2011, the World Health Organization reports that there were 1,349 cases of wild polio in 20 countries in 2010. Reported cases of polio are down 95% in Nigeria and 94% in India

Polio cases 2000-2007

Number of missed out children

Poliomyelitis eradication
The global eradication of poliomyelitis begun in 1988 and led by the World Health Organization, UNICEF and The Rotary Foundation. The goal of Poliomyelitis eradication was attract the attention on lethal disease. India launched the Pulse Polio Immunization program in 1995 as a

result of World Health Organization's Global Polio Eradication Initiative. Oral polio vaccine is used which highly effective and inexpensive and its availability has bolstered efforts to eradicate polio.

Communication Message
Amitabh Bachchan is the brand ambassador and other famous celebrities are endorsing Pulse polio. The communication messages: 1. Polio is a disease which mostly affects the children under the age of 5.

2. Come to polio booth with your child have to two drops that can save your childs life. 3. Two drops of Polio vaccine can give confidence to you and your to enjoy the life and face it. 4. Polio dont have any relation with poor or rich it can affect on every one not matter child is Hindu or Muslim.

Analysis of Advertisement
Having Amitabh Bachchan as brand ambassador is a good move to influence millions of people and list of celebrities increased with the time celebrity like Sachin Tendulkar, Shahrukh Khan Jaya Bachchan, Ashwarya Rai and Indian Cricket Team all done very well and results that came out was marvelous.

A advertisement with Ashwarya Rai had created a controversy that advertisement hurting their emotions.

Communication vehicles
Radio Print media Digital Media

Target Audience
Elder members of family Elder Sibling Teacher Religious leaders

Recommendations

Folk songs and folk dance may be a very powerful way to reach to the target audience in rural area. We can use Graam Panchyat to educate the people. Put pulse polio banners at place area like school, near the mall and public place. Puppet show can be use to educate the effect of polio virus and how it can change the life . Keep the Written Message Simple

Pulse Polio Immunization India is polio-endemic country. The main defence against poliomyelitis is prophylactic immunization, as public health measures only play a very small and subsidiary role in prevention. The World Health Organization (WHO) wanted a polio-free world by 2000. The Government of India wanted a polio-free India by 2002. Even in 2004, 69 cases have been confirmed till October. The revised target date for polio eradication in India is 2005. For a healthier future generation, it is important that this disease is completely wiped out.

83% offf allllll new pollliiioo cccasssesss arrre now fffound iiin IIInddiiia... Today there is simply no moral or economic justification for any child anywhere in the world to be crippled by polio. -Dr. Gro Harlem Brundtland , DirectorGeneral WHO - Frontline, April-May 2003 This case is about how India is fighting this dreadful disease through massive and simultaneous immunization program launched by the Government of India assisted by international agencies and in cooperation with state governments and non-government/ voluntary organizations. radication Initiative faced an increase in global cases in 2002 over 2001. In 2002, 1919 cases were reported (as of 16 April 2003), compared to 483 in 2001. This increase can be attributed to an

epidemic in India,and a further increase in cases in Nigeria. 637 69 33 20 3 1 0 100 200 300 400 500 600 700 Number of Polio Cases -October 2004 Nigeria India Pakistan Niger Afghanistan Egypt Country Current Status of Polio Eradication

Major Polio-endemic Countries 2004 Present status Out of 851 cases of polio cases reported worldwide, 763 are from polio-endemic countries and out of these, 69 cases are from India. Impact Performance Metrics a. Coverage b. Proportion of zero dose children c. Reasons for non-compliance d. Surveillance Results are the indicators to measure impact. Assessment Methodology Prior to October 1997, surveillance for polio in India was by passive reporting of clinically suspect polio cases. In October 1997, the National Polio Surveillance Project (NPSP) came into being resulting in active surveillance of

AFP at district, state and national levels. Evaluation/ Reviews/ Surveys A number of evaluation studies have been conducted. Some of them are: a. UNICEF sponsored Institute for Research in Medical Statistics Delhi (IRMS) Evaluation on the Reach of PPI in 2001 b. MOHFW -WHO-UNICEF-Rotary International Survey of PPI Booths 1995 c. MOHFW -UNICEF Action Research 1999 on PPI Non-acceptors d. Process Evaluation of PPI in Delhi e. AIIMS IndiaCLEN Program Evaluation 21

Findings a. Coverage Coverage by doses in 1999-2000 is shown in Figure 9. Children who missed immunization in 1999-2000 is shown in Figure 10. Nationwide IPPI coverage in 1999-2000 is shown in Booth-based coverage and House-toHouse coverage is shown in Figure 11. Observed PPI coverage by number of doses 1999-2000 Children missing PPI 1999-2000 22 23 PPI-Booth Vs H-H Approach Reasons for non-compliance a. Lack of attitude among parents b. Unaware of date and time c. Unaware of need for additional doses d. Child ill/ too young

e. Not convinced f. Apprehensions about side effects of polio drops Fever, Loose Motion Death Infertility (among Muslims and Lower Sections) Polio drops cause polio g. Traditional Ba rriers-Elders' discouragement, Caste/ Religion, Purdah System h. Attitudinal Barriers-Frequent occurrence of Ids, Complacency, Preference to Private Doctors The Gujarat Incident Immunization officers inquiring into seven cases of polio reported in 1998 in Bhavnagar district found that 96 children in the village of 2,000 had missed the previous pulse polio campaign. Health workers were first prevented from entering the village. Even when they eventually set up a

booth, none of the parents brought their children for vaccination. Parents justified their actions saying that on earlier occasions, some children had developed polio paralysis even after immunization. The West Bengal Incident Health officers visiting a village where two children had developed polio found an angry community waiting, because they contracted the virus after taking the vaccine. In another instance, parents of a two-and-a-half-year-old child who developed cellulites in the heel were convinced it had been caused by the vaccine administered a week earlier. The entire village gheraoed the doctor who had administered the vaccine and forced him to pay for the child's treatment.

Beneficiaries' Perceptions a. Polio is acknowledged as a dreadful disease b. Known prevention-polio drop with cleanliness and healthy food c. People want more information on polio d. IEC activities-TV most effective in urban and IPC in rural; Others Rallies by school children, wall paintings, puppet shows e. Repeat dose in same round (Delhi & MP)

Service Providers' Perceptions a. Training Gap b. Resistance from beneficiaries c. Poor participation by Doctors, Nurses and NGOs d. Dissatisfaction e. Difficulty in procuring & maintaining vaccine f. Difficulty in procuring vehicle g. Inadequate support from community h. Lack of recognition

Surveillance Surveillance is a major step in the polio eradication strategy. It is the intelligence network that underpins the entire polio eradication initiative. Surveillance (active search) involves Identification of every possible case of Acute Flaccid Paralysis (AFP) Collection and testing of stool samples Outbreak response immunization if required Reporting a. As per WHO estimates, in India, 1,934 cases were detected in 1998; followed by 1,186 in 1999; 265 in 2000; and 211 in 2001. However, there was a stupendous increase in 2002, when 1,556 cases were reported in India, most of them in Uttar Pradesh. b. In 2000, reported polio cases are confined to a few states, and polio-free areas

have emerged in the south of the country. The surveillance system has also improved in these two years. c. The national non -polio acute flaccid paralysis (AFP) rate went from 0.22/100,000 in 1997 to 1.83/100,000 in 1999, meeting international standards for surveillance. The rate of 'adequate stool collection' from AFP cases rose from 34% to 72% in the same period. d. A network of reporting units and national polio laboratories were also established to isolate the poliovirus in samples, and to identify the type of virus found. Finally, 1999 reported more than 90% of results reported within 28 days.

Case Report on AFP & ORI (Son of a serving soldier) Family quarters of 550-acre area in Ferozepur Cantonment. Reported on 28th February 2002 with acute onset of fever and paralysis of left lower leg for last 7 days. A diagnosis of AFP was made. On investigation it was revealed that child had not taken any routine immunization in first 1 years, whereas he had taken few irregular doses in the Pulse Polio Program for last two years. Last dose was taken on 21 January 2002. The AFP case was notifie d within 6 hours to Civil Surgeon, District Immunization Officer, Surveillance Medical Officer and Armed Forces 25 Central Epidemiological Investigation Cell through proper channel. 2 samples of stools were collected 24 hours apart, labeled and transported

in reverse cold chain by courier to the Central Research Institute (CRI), Kasauli (a WHO accredited laboratory for isolation of wild polio virus). An Outbreak Response Immunization (ORI) was planned & vaccine was procured, based on the estimated target population. Cold chain, ice packs, vaccine carriers were prepared. Houses in the identified locality were numbered. ORI took place next Sunday to ensure presence of maximum children in their houses. All 0-59 month children were given one dose of OPV irrespect ive of their previous immunization status while going house to house. Strategy Revision Strategy for 1996 and 1997 included all children below 5 years of age. Strategy for year 2000-2001 was revised as follows.

House-to-house strategy was successful in reaching 18 percent previously unreached children in high-risk states of UP, Bihar, Delhi and WB. India was divided into 3 zones to modify the IPPI strategy. High-burden zone, comprising of States of Delhi, Bihar, UP and West Bengal, where in year 2000, 2 NIDs (10th December 2000 and 21st January 2001) and 2 SNIDs (24th September 2000 and 5th November 2000) were conducted. Middle-burden zone, comprising of the States of Punjab, Haryana, Rajasthan, Gujarat, MP, Orissa and Assam, where 2 NIDs and 1 SNIDs were conducted. Low-burden zone, which consists of all other States, where only 2 NIDs were conducted. Extensive Mop-up immunization was conducted in low- and middle -burden zones

immediately after isolation of case of wild poliovirus. The house -to-house component was extended to 7 days in high-burden zone states. 25 million children are born in India every year, and there is an interval of 11 months between two PPIs. So the total of 10-15 percent missed children in each PPI (as reported in Action Research) + birth cohort of 25 million becomes a very large susceptible pool of children where wild poliovirus can maintain its circulation and multiply.

Feedback Machinery/ Mechanism for eliciting feedback Periodic evaluation/ reviews of PPI and IPPI programs Workshops organized by the Indian Academy of Pediatrics (20, 21 May 2000 at New Delhi) Task Force Meeting of Experts for Polio Eradication (India) Media/ Journalistic Reports

Institutional mechanism for acting on feedback Before a WHO region can be certified polio -free, three conditions must be satisfied: (a) At least three consecutive years of zero polio cases due to wild poliovirus; (b) Excellent certification standard surveillance; 26 (c) Each country must illustrate the capacity to detect, report and respond to imported polio cases.

Policy Support and Systemic Changes Implemented Nature of policy support extended It is the policy of the Government of India to eradicate polio and make India polio-free by 2005. Many organizationsnational and international are assisting the Government of India in this program technically and financially.

Infrastructure/ Systems Support The existing network of Health and Family Welfare Units at Central and State Governments, the Cold Chain [Walk-in Cold Rooms and Walk-in Freezer Rooms at Regional Level, Ice-lined Refrigerators and Deep Freezers (ILR & DF) at District Level, Twin Set of ILR and DF at PHC Level, Cold Boxes for Transportation] are supporting the PPI initiative. The surveillance mechanism is a major element of infra structure that was added in 1997.

The National Polio Surveillance Project (A collaborative Project of GOI-MOHFW and WHO) National Polio Surveillance Unit NPSU (Logistical & Technical Backup) 243 Surveillance Medical Officers 9 Polio Laboratories (Virological Investigation of AFP Cases) 7 Regional Coordinators Sub-Regional Coordinators (UP, Bihar, MP, Orissa, Rajasthan and West Bengal) Rotary International, DFID, USAID, and

The Government of Italy. $ NPSP Organization The National Polio Surveillance Project (NPSP) has been tasked with the job of building and maintaining surveillance of AFP in India until certification of polio eradication is achieved in the South-East Asia Region of the World Health Organization. Data is made available on the location of confirmed and virus positive polio cases to help in planning the immunization activities of the Government of India in high-risk areas. In addition to surveillance, NPSP is involved in planning, training and monitoring of pulse polio immunization and moppingup. From 2004, NPSP operations are expanding to cover support and monitoring of

routine immunization services, an important pillar of polio eradication. 27 Infrastructure gaps Cold chain equipment needs replacement. Training of mechanics is needed for their maintenance.

HR & Capacity Building Measures Training offered under Reproductive and Child Health Programs cover immunization aspects.

Change Management Strategy There are four core strategies to stop transmission of the wild poliovirus. High infant immunization coverage with four doses of oral polio vaccine in the first year of life; Supplementary doses of oral polio vaccine to all children under five years of age during national immunization days (NIDs); Surveillance for wild poliovirus through reporting and laboratory testing of all cases of acute flaccid paralysis (AFP) among children under fifteen years of age; Targeted mop-up campaigns once wild poliovirus transmission is limited to a specific focal area. All the above are being addressed in the Indian initiative for polio eradication. Deployment Model

The global eradication of polio involves both halting the in cidence of the disease and the worldwide eradication of poliovirus that causes the disease. The polio eradication strategy is based on the premise that poliovirus will die out if it is deprived of its human host through immunization.

Information and Communication Model

An allocation of Rs. 14501.199 lakhs was made to States/ Union Territories during 1999-2000 for conducting IEC activities and social mobilization for the Intensified Pulse Polio Program (Rs.4806.565 lakhs for IEC activities, Rs.542.80 lakh s to Gram Panchayats and Rs. 9141.834 lakhs for social mobilization of volunteers posted at polio booths and door-to-door campaigns). Video spots on Pulse Polio Immunization on National Door Darshan Network were telecast at prime time including appeals fro m Prime Minister and MOHFW. AIR broadcasted PPI Jingles through its Regional Kendras. Directorate of Field Publicity organized special programs and plays to sensitize people about PPI. PIB provided the media coverage. Intensive print media coverage through

advertisements in national newspapers before the scheduled immunization days and appeal to doctors to cooperate and participate in PPI were given. The Song and Drama Division organized special programs to sensitize people about PPI. A booklet with appro priate graphs and visuals was produced and distributed all over the country to sensitize District Health Officers about PPI. A similar booklet was produced and distributed to sensitize Zilla Panchayat and Gram Panchayat leaders about PPI. The Indian Academy of Pediatrics extended its full support to IPPI. More than 12,000 members of IAP convinced parents of their patience in taking these additional doses; kept their clinics open to serve as polio booths; and played a

major advocacy role by giving interviews and writing articles for local newspapers and magazines. 28 An evaluation of media coverage of the PPI based journalistic reports, comments, interviews, campaign material reveals that the polio eradication campaign is a poorly understood subject as far as journalists are concerned.

Leadership/ Champion Attributes Nature of project leadership

The ability to involve all sections of society and making PPI as a peoples' movement. Key factors which led to success/failure The Pulse Polio campaign in India is by far the greatest success story in healthcare in recent times. It owes its success to the countrywide mobilization of parents, religious organizations, health workers, administrators, local community leaders, star personalities and voluntary and professional associations. Impediments It was difficult to cover children during NID: In urban slums, remote rural areas and areas controlled by militant groups (Assam)/dacoits Of migrant populations (in Gujarat), of people working at quarries, brick kilns, construction sites and fields

Standard Operation Procedures

Manuals, Guidelines, operation procedures developed The National Quality Control Laboratory at Kasauli does statutory testing of vaccines. In addition samples of OPV are picked up at various levels of storage and sent to designated laboratories for potency testing to ensure effectiveness of the cold chain system. Potency test reports indicate that 91 % of samples are satisfactory. Before October 1977, surveillance for polio in India consisted of passive reporting of clinically suspected cases among children below 5 years. In 1998, less than a year after National Polio Surveillance Project (NPSP) was established, AFP surveillance indicators almost reached the international standards required for certification. What is an AFP case?

A case where there is acute onset of flaccid paralysis without obvious cause (such as severe trauma or electrolytic imbalance) in a child aged less than 15 years or if there is paralytic illness in which polio is suspected in a person of any age. Information needed to classify an AFP case as polio or non-polio The epidemiological, clinical (including initial investigation and 60-day follow-up examination to assess the presence of residual weakness) and laboratory information is collected and used to classify AFP cases as either polio or non -polio. Two adequate stools are defined as Two stool specimens collected from an AFP case at least 24 hours apart, within 14 days after the onset of paralysis,

And received by a WHO-accredited laboratory in sufficient quantity (>5 g) and in good condition, i.e. specimens must arrive at the laboratory with adequate documentation, no leakage or desiccation, and evidence that the cold chain was maintained.

When an AFP case is polio? When one of the following applies. 1. Wild poliovirus is isolated in the stools or 2. In the absence of two adequate stool samples, residual weakness is present for 60 days after the onset of paralysis or if the patient dies or is otherwise unavailable for the 60-day follow-up. When an AFP case is non -polio? When one of the following applies. 1. Cases where two adequate stool samples have given negative results in respect of wild poliovirus even if there is residual weakness at the 60-day follow-up examination. 2. In the absence of two adequate stool samples, cases with no residual weakness at the 60-day follow-up examination.

Polio Surveillance System Performance Indicators 1. A reported annual non-polio AFP rate of 1/100000 children aged < 15 years 2. 80% of AFP cases with adequate stool collection 3. Isolation of non-polio enterovirus from 10% of stool specimens 4. 80% of laboratory results reported within 28 days of receipt of specimens

Resource Procurement/ Mobilization Project fund requirements It costs approximately US$ 14 million per day of pulse polio immunization (vaccine cost) and another US$ 14 million for staffing. Manner in which funds were mobilized Financing of immunization is the responsibility of the Government of India, which releases funds to state governments. The estimated cost of India's first PPIDs was $30.3 million and included contributions from India ($18.0 million), the British Overseas Development Agency ($6.1 million), Rotary International ($5.0 million), and the United States Agency for International Development ($1.2 million). 30 The external funding is shown in the following table.

Year Agency Funding (US$ million) 1995-96 Rotary International 0.5 1996-97 CDC, DANIDA, JICA, DfID, UNICEF 34.95 1997-98 Rotary, DANIDA, JICA, DfID, UNICEF 37.87 Expenditure on Polio Eradication in 1998-99 - Rs. Million (US $ Million) Government of India Direct Costs 1,410 (30.0) Government of India Indirect Costs 1,246 (26.5) UNICEF 118 (2.5) DANIDA 273 (5.8) JICA 132 (2.8) DFID 973 (20.7) KFW 658 (14.0) Total 4,810 (102.3) The pulse polio budget this year (20032004) will be a huge Rs.600 crores; up from Rs.450 crores last year. Over the eight years roughly Rs.2,500 crores has

been spent on PPI.

Three year-Immunization Strengthening Project 2000-2003 Government of India, Ministry of Health & Family Welfare and the Governments of Assam, Bihar, Gujarat, MP, Orissa, Rajasthan, UP and West Bengal have started implementing this project. Costing Rs. 1118.40 crore (US $ 142.6 million) of which Rs. 709.99 crore is the World Bank's (IDA credit) contribution, the project has a polio eradication component of US $ 100.20 million. The project would provide support for about 50% of polio vaccine and social mobilization required to carry out the NIDs and sub -NIDS in states where polio transmission is significant. Social mobilization activities would include orientation and training, transport, IEC, surveys and evaluations, managing polio booths and other activities necessary to assure coverage of the target population. The

number of NIDs and sub-NIDs in states with significant transmission would be determined annually, based on surveillance data of polio cases that occur during the summer transmission season. At about the end of each summer, WHO, with assistance from the International Certification Committee, would review the surveillance data and provide advice to GOI and the Bank regarding activities required for the next 12-month period. Domestic inputs into Polio campaigns are estimated at US$30 million for expenditures relating to booth management, transportation, anganwadi workers, schoolteachers and other NGO activities. An additional US$26.5 million is estimated for indirect GOI inputs including staff and management. Social Mobilization includes small-scale activities carried out over a large number

of administrative blocks including activities such as rallies, managing polio 31 booths, house-to-house visits by community volunteers, community information dissemination.

Artifacts - Associated supplementary details, Software Project Design Documentation Details of the Immu nization Strengthening Project can be found on the World Bank Website listed under references. Detailed Project Implementation Plan Government of India MOHFW Website provides details of PPI Status Report on Project Implementation Government of India MOHFW Website has Annual Reports and Demand for Grants Evaluation, Assessment Reports Some websites are listed under references. Seven video clips on Polio can be downloaded from: http://www.vaccineinformation.org/video /polio.asp

http://www.onlypunjab.com/fullstory110 4 -insightIndia+inches+closer+to+eradicatingstatus-22-newsID-3432.html

Research problems: Intensified Pulse Polio Programme started in India in 1994 officially, but it was spread through out the country in 1995 with the main aim of eradicating polio by 2000AD. According to it there is no need of giving oral polio vaccine to the children after 2000 AD. But this was not successful and so was extended up to 2005 with a vision of declaring India a polio free state by 2005. But this also failed. According to National Plan of Action 2005 developed by Departmaent of women and child development 2007 the objective under child survival is to certify by 2007 the eradication of polio, which is not possible under present conditions with almost 1000 cases of polio being reported from different states of India. What is polio vaccine? Polio is a disease caused by virus which attacks

mainly children below 5 years and causes a type of paralysis and also leads to some nervous disorders and physical disability. Polio vaccine consists of half dead virus and is given to children orally. The dosage is 2 drops 4 times below 5 years mainly at the individual's age of 1 month, 2 month, 3 month and a booster dose at 18 months(optional). The main reason behind giving the vaccine 3 or 4 times is because the mothers milk can restrict the child from getting immunity against the disease particularly those who were given colostrums. Booster dose is given so that by that time the child stops drinking mother's milk. Actually speaking one perfect dose is enough if it works, to protect the child from polio. It gives life long immunity for that person as like other anti viral vaccines. Now a days due to pulse polio programme every child in his life is being

given a total of 15 doses minimum (5*2 = 10 doses +4 regular+ one dose at birth). But during the start of the programme it was said that polio vaccine can be given for not more than 12 times according to some standards. But in India it exceeds. With several side affects seen when the vaccine is given to children, is it safe to give the vaccine for that many times, that too a vaccine which is related to nerves? Is this vaccine responsible for the stress related problems in the present generations? Does this vaccine related to virus family is responsible for the spread of other viruses in humans like HIV and bird flu etc., My view is that as mosquitoes are responsible for the spread of malaria, prevention of mosquitoes is necessary then injecting medicine to the people. similarly the spread of polio virus is only through oral fecal contact only so why

can't we prevent the spread by improving the hygienic conditions One thing is clear that polio is spread only by fecal-oral contact only either directly or through flies. When we stop this then there is no polio. Why are we not thinking of prevention by improving hygiene and spending money on improving hygiene rather than vaccination.

The following questions need to be answered by any responsible person before blindly taking the programme into the people and taking the children into a high risk zone. 1. How many times could this vaccine be given for a child in his life time? Is there any limit to the number of doses to be given? (Scientifically tested or not) 2. If there is no limit is there any side effect by giving the vaccine more number of times? 3. Is the pulse polio programme tested in our country on any sample or in any other country at least? 4. What is the use of pulse polio programme while normal polio eradication programme( through UIP ) is going on in the country? 5. As the vaccine is related to nerves does it cause any side

affects or nervous disorders or early nervous problems? 6. What is its effect on brain and central nervous system? (If given a number of times)? Has the brain research institute, Delhi, has any details? 7. Does it effect the next generation if given number of times? Is there any research done? 8. Polio virus attacks even the elders above 5 yeas. Has any research been done on "the effect of existing polio effected people" over children? 9. With more number of cases being reported, does it seem pulse polio programme successful in India? 10. How many more years are required to declare India as a polio free state?(as new cases being reported the vaccination

should be extended further to a minimum of 5 years from now) 11. Is the government or other agencies assure that "after declaration of polio free state, there is no need of giving polio drops to children".(regular doses of polio vaccine under UIP) 12. Is there any research done in this matter or on the success of the programme particularly( if so what are the scientific results) 13. Is this vaccine responsible for the spread of viral infection or viral diseases including HIV? 14. Many experts do say that it can be given any number of times? Shall we give it daily for one or two months or can we give a glass full of vaccine at a time? 15. Is there any data on how many countries are undertaking this intensified pulse polio programme? (Giving more than 5

drops and twice on national immunization days) what are the results there? How they differ form other nations where only 3 times vaccination is done? 16. Is there any other alternative way to vaccinate all the children by providing incentives but only four doses compulsory instead of spending a lot of money on many doses even funded by international agencies ( an approximate of 250 million us dollars every year)?

As an active participant of the programme some time ago I really agree that the programme has reduced the number of cases. But I also think that there are several other reasons for the reduction like more usage of toilets (instead of open air road side toileting), avoidance of used needles and syringes for all (previously all health staff used to inject dpt, tt, and other vaccines or medicines with same syringe which resulted in child to child transfer) and many more reasons.( if you want I can list out and send). One more thing is it even affects a person above 5 years. Kindly consider the above questions for the best interests of the children of India. Save the children and future generations from severe neuro-related problems. Stop this programme which involves so much risk in the health of the children which also will never be successful in India.

Review of Related Literature on the Polio Vaccine OPV is usually provided in vials containing 10-20 doses of vaccine. A single dose of oral polio vaccine (usually two drops) contains 1,000,000 infectious units of Sabin 1 (effective against PV1), 100,000 infectious units of the Sabin 2 strain, and 600,000 infectious units of Sabin 3. It is prepared by using monkey kidney cells. The vaccine contains traces of antibiotics- neomycin and streptomycin-but does not contain preservatives.( Wikipedia) In 1960, it was determined that the rhesus monkey kidney cells used to prepare the poliovirus vaccines were infected with a virus called SV40 (or Simian Virus-40). SV40, also discovered in 1960, is a naturally occurring virus that infects monkeys. In 1961, SV40 was found to cause

tumors in rodents. More recently, the virus was found in certain forms of cancer in humans, for instance brain and bone tumors, mesotheliomas, and some types of non-Hodgkin's lymphoma. Recent opposition to vaccination campaigns have evolved, often relating to fears that the vaccine might induce sterility.(Wikipedia) OPV can cause paralysis in children because of mutant neurotoxic vaccine polioviruses known as vaccine-derived wild-like polioviruses (VDWL viruses). (Indian journal of medical ethics, oct 2005)

AIDS and polio vaccine. OPV theory relates to a different polio vaccine. It proposes that an experimental polio vaccine called CHAT, developed at the Wistar Institute in Philadelphia, initiated the Aids pandemic by introducing simian immunodeficiency virus (SIV) from the common chimpanzee into some of the million Africans who were given the vaccine between 1957 and 1960. Chimpanzee SIV is now widely recognised as the direct ancestor of the strain of HIV (HIV-1 Group M) that has caused approximately 99 per cent of infections to date.(Edward Hooper, The River, London review bookshop) WHO article in Science, is that individuals with compromised immune systems may constitute reservoirs for polio. With the increase in the incidence of AIDS around the world, it is not unreasonable to expect that an immunocompromised patient, inadvertently vaccinated with

OPV during the eradication campaign, could continue secreting pathogenic poliovirus for years.

Polio is Not Smallpox The WHO plan is based on the model used to fight smallpox. Unfortunately, the two viruses differ dramatically in both biology and history. The smallpox vaccine consists of a preparation of Vaccinia virus, a relative of the virus which causes smallpox. Since the vaccine is not directly derived from the wild virus, there is no way it can mutate back into a pathogenic form and cause an outbreak. There are potential complications of smallpox vaccination, but it cannot cause smallpox. OPV, on the other hand, is a preparation of three mutant strains of wild poliovirus, representing the three serotypes of the virus. IPV is the wild-type virus itself, inactivated in the laboratory before injection into the patient.( Dr. Vincent Racaniello of Columbia University) Continuation with OPV, either alone or in combination with IPV, is not feasible because it could invariably lead to the

reestablishment of poliovirus transmission globally and negate the achievements of polio eradication. (http://www.who.int/wer)

Streptomycin and Neomycin usage and their affect on the human body Streptomycin( a component of OPV) cannot be given orally, but must be administered by regular intramuscular injection. An adverse effect of this medicine is ototoxicity. It can result in temporary hearing loss.(Wikipedia) "If you have an autistic child you might consider that one of the components of the MMR is Neomycin. This is an antibacterial drug that is used to suppress gastrointestinal bacteria before surgery to avoid infection This antibiotic interferes with the absorption of Vitamin B6 (2). An error in the uptake of Vitamin B6 can cause a rare form of epilepsy and children become mentally retarded "Neomycin is too toxic for parenteral administration and can only be used for infections of the skin or mucous membranes or to reduce the bacterial population of the colon proir to bowel

surgery or in hepatitic failure."--BNF 5 (1983) Neomycin( a component of OPV) impairs absorption (and may also increase excretion) of a broad variety of nutrients including carbohydrates, fats, calcium, iron, magnesium, nitrogen, potassium, sodium, folic acid, and vitamins A, B12, D, and K. (Faloon WW, et al. Ann N Y Acad Sci. 1966 Jun 14;132(2):879-887; Hardison WG, Rosenberg IH.J Lab Clin Med. 1969 Oct;74(4):564-573; Robinson C, Weigly E. 1984, 46-54; Roe DA. 1985, 157-158.) Orally administered neomycin may inactivate vitamin B6. Orally administered neomycin impairs absorption of both beta-carotene and vitamin A. (Tuckerman M, Turco S. 1983, 215-222; Robinson C, Weigly E. 1984, 46-54; Barrowman JA, et al. Clin Sci. 1972 Apr;42(4):17P; Favaro RM, et al. Int J Vitam Nutr Res. 1994;64(2):98-

103.) Orally administered neomycin impairs vitamin B12 absorption and has been shown to decrease vitamin B12 levels. (Tuckerman M, Turco S. 1983, 215-222; Robinson C, Weigly E. 1984, 46-54; Cullen RW, Oace SM. J Nutr. 1989 Oct;119(10):1399-1403..) Neomycin, taken orally, impairs vitamin K absorption and has been shown to decrease vitamin K levels. Extended use of neomycin internally would also exert a detrimental effect upon the probiotic intestinal flora responsible for vitamin K synthesis. (Robinson C, Weigly E. 1984, 46-54; Olson JA. Am J Clin Nutr. 1987 Apr;45(4):687-692; Salet J, et al. Arch Fr Pediatr. 1968 Oct;25(8):961.) Neomycin impairs calcium absorption when taken orally. (Roe DA. 1985, 157-158.) Neomycin impairs magnesium absorption as a result of maldigestion when taken orally. (Roe DA. 1985, 157158.) Neomycin causes fat malabsorption when taken internally,

especially due to mucosal damage in the small intestine. Diarrhea is a common consequence. Further, over an extended period this effect could also result in decreased absorption of fat soluble nutrients such as vitamins A, D, E and K. (Hardison WG, Rosenberg IH. J Lab Clin Med. 1969 Oct;74(4):564-573; Roe DA. 1985, 157-158; Ratnaike RN, Jones TE. Drugs Aging 1998 Sep;13(3):245-253.) Neomycin impairs lactose absorption when taken orally. (Roe DA. 1985, 157158.) Neomycin impairs sucrose absorption when taken orally. (Roe DA. 1985, 157-158.) During the course of eliminating disease-causing bacteria, antibiotics taken internally will also usually destroy normally-occurring beneficial bacterial flora that form an integral part of the healthy intestinal ecology and assist digestive and immune functions. Diarrhea and yeast infections, including vaginal yeast, are common side-effects of the disruption of intestinal

ecology and the creation of an environment more susceptible to proliferation of pathogenic levels of opportunistic yeast. (Matteuzzi D, et al. Ann Microbiol (Paris). 1983 MayJun;134A(3):339-349; Linzenmeier G, et al. Zentralbl Bakteriol . 1979 Apr;243(23):326-335.) http://home.caregroup.org/clinical/altme d/interactions/Drugs/Neomycin.htm Gastrointestinal immunity is then affected and a vicious cycle can commence. Antihistamines, sometimes used in cough mixtures and as anti-allergy medications, can result in respiratory disorders including respiratory arrest."--Dr Kalokerinos MD (Medical Pioneer of the 20th century p180) "Neurotoxicity (including ototoxicity) and nephrotoxicity following the oral use of neomycin sulphate have been reported, even when used in recommended doses."If treatment of a patient less than

eighteen years of age is necessary, neomycin should be used with caution"--http://www.medsafe.govt.nz/search.htm Vaccine contraindications "People should not get MMR who have had a life-threatening allergic reaction to gelatin, the antibiotic neomycin, or a previous dose of MMR" http://www.cdc.gov/nip/publications/VIS/ default.htm

Major Findings to be Considered. Polio vaccine can cause sterility. Polio vaccine can cause tumors and cancer. Polio vaccine can cause neuro-toxicity. Polio vaccine can cause AIDS. Polio vaccine can cause severe intestinal disorders and gastro related problems. Polio vaccine reduces the absorption of vitamins by the body. Polio vaccine can cause acute respiratory problems. There is a chance that polio would become an epidemic once again and the model of eradication adopted similar to small pox will not be successful.

Polio and its relation with Education At present government of India is going with the policy of inclusive education where all the children including the children who suffer from polio also become a part of schooling and they too receive the education along with the normal children. But what happens is that there is a high possibility that the children who were attacked by polio remain as reservoirs of polio and there is high risk of spreading polio. Also if you see the personal who are working with children particularly at anganwadis and schools like aayas and cooks (where mid day meal programme is undertaken) are polio paralyzed persons. Government is encouraging them to take up the activities in the name of employment to physically handicapped people. But the thing is that many of them still act as reservoirs of polio virus and generally secrete polio virus in their

stools. Due to lack of proper hygienic conditions and also lack of personal hygiene among these personal, there is high risk of spreading polio virus in the community particularly for young children. Its not only at government side but also if we consider crches, baby care centers, play schools, preprimary schools etc, the same aayas feed the children as well as clean their feces. There is high chance that if a polio child is present in the centre there is high possibility of other children getting polio if not vaccinated. So the government while recruiting them in such posts should test them of polio. Also government while issuing physically handicapped certificates also should analyze the stool samples of polio affected people. One more interesting thing is if a family has 5 members out of which one person is polio disabled, all other members uses toilets except polio affected person who goes for road side toileting and which is not at all

desired. Government should give subsidies to the polio affected persons to build toilets and suggest a good design that will be easier for the person to use. Impact of celebrity power towards eradication of polio: According to UNICEF, only one case of polio was reported in India this year, as against 41 cases last year. In 2009, there were 741 cases of polio. "I am happy and proud with the remarkable progress... we are close to eradicating polio in India. But despite all this, Polio still remains a threat. Everyone must continue to immunize their children upto five years," Bacchan told reporters here. "The design and campaign team felt that we were too soft in our attitude. They wanted me to adopt the angry young man image that I had in films. And I told them if it works then I will do it. And I am happy that my scolding, shouting has worked in a better way," he said.

The only case of Polio this year was reported from Howrah in West Bengal in January. Since then there have been no cases. For the first time, polio endemic states Uttar Pradesh and Bihar are concurrently free of polio for over a year. Both the states have not reported any case since April and September 2010 respectively. "We are very close to eradicating polio in India, now no child will be paralysed needlessly by polio. We must try to make polio history in India," Bachchan said. The megastar, speaking about the baby girl newly born to Aishwarya and Abhishek, said, "Goddess Lakshmi has arrived in our home and we will immune her with polio doses." When asked which other cause will he promote, Big B said, "UNICEF has approached me for save girl child campaign... we want to stop female foeticide."

Megastar Amitabh Bachchan is elated that his angry young man act for the polio campaign has led to a decrease in the number of polio cases this year. Happy with the response to his polio campaign, the 69-year-old actor urged people to make India polio free. He has been serving as the goodwill ambassador for UNICEF since a decade, in eradicating polio. According to UNICEF, only one case of polio was reported in India this year, as against 41 cases last year. In 2009, there were 741 cases of polio. I am happy and proud with the remarkable progress... we are close to eradicating polio in India. But despite all this, Polio still remains a threat. Everyone must continue to immunise their children upto five years, said Bachchan. The design and campaign team felt that we were too soft in our attitude. They wanted me to adopt the angry young man image that I had in films. And I told them if it works then I will do it. And I am happy that my scolding, shouting has worked in a better way, he said.

The only case of Polio this year was reported from Howrah in West Bengal in January. Since then there have been no cases. For the first time, polio endemic states Uttar Pradesh and Bihar are concurrently free of polio for over a year. Both the states have not reported any case since April and September 2010 respectively. We are very close to eradicating polio in India, now no child will be paralysed needlessly by polio. We must try to make polio history in India, Bachchan said. The megastar, speaking about the baby girl newly born to Aishwarya and Abhishek, said, "Goddess Lakshmi has arrived in our home and we will immune her with polio doses." When asked which other cause will he promote, Big B said, UNICEF has approached me for save girl child campaign... we want to stop female foeticide.

Advocacy and Communications Team diagram of interrelated work streams, tools and processes

Strategic Communication Initiative Create Demand Not many of Indians know the fact that Article 21 of the Constitution guarantees protection of life and personal liberty by providing that no person shall be deprived of his life or personal liberty except according to the procedure established by law. Practice of hygiene and sanitation is always a subject of boredom and practiced only when forced upon. Health care is generally not relevant to the needs of every day life and is often neglected. Public health is a "public good", i.e. its benefits cannot be individually enjoyed or computed, but have to be seen in the context of benefits that are enjoyed by the public. In a small study where , 200 mothers were interviewed to elicit the reasons behind low coverage on NID at booths. The baseline information showed that 58.5% of interviewed mothers did not bring their children because they knew that a vaccination team would make house to house visit in the following week. 51.3% parents did not know the exact date of the NID and 47.0% were not aware about the location of the polio booth. This indicates a failure

 To promote participation and genuine involvement of communities in their own health development. To make health a priority in all sectors of society. Encourage people, to mail items representing polio eradication to government officials to urge them to support the initiative. Compile a list of people with polio and think of ways to use this list as a petition, advertisement or display. Organize Did you know? campaigns to educate the public that polio is still a major health problem, ready to be eradicated. Create a local Web site on polio eradication. Use the symbols and logos attached to the polio eradication initiative.

India Winning Polio Fight

By William Thomson, the Diplomat

India has closed out the first polio-free year in the countrys history. As noted by the World Health Organization (WHO), this marks significant progress for a country that as recently as 1994 was experiencing as many as 4,791 cases a year. The polio-free year means that India will no longer be considered a polio-endemic country, leaving its South Asian neighbors, Pakistan and Afghanistan, as well as Nigeria, as the only remaining nations holding this label. Given the public health challenges that India faces, this is a staggering achievement. With a population of about 1.18 billion, 42 percent of whom live on less than $1.25 day, India suffers from developmental challenges that make fighting health issues such as polio particularly challenging. India also has one of the lowest physician ratios in the world. Perhaps most challenging of all is that 69 percent of the population by some estimates suffers from unimproved sanitation. Additionally, 43.5 percent of children under the age of 5 are malnourished, the most important age bracket for fighting polio. This is the age when the vaccine is most effective, and is an

area in which India has achieved notable success. The lessons learned for fighting large scale public health issues shouldnt be overlooked by either Indian health officials or, perhaps more importantly, Indias neighbors. Indeed, the rest of South Asia could learn a great deal from Indias fight, particularly Pakistan. Indias neighbor to the west suffers from similar developmental shortcomings and, according to the Global Polio Eradication Initiative, experienced 198 cases of polio in 2011. Pakistan accounts for roughly 30 percent of polio cases worldwide. The lessons learned by India in its fight against polio are more significant than just as a model for how to fight public health issues in developing nations, though. Indias fight is also a model for how NGOs and international donor support can be best utilized by developing nations. The key to Indias success in the fight was to take ownership of the problem and the solution, allowing for locals to learn from the expertise of the international community while not becoming dependent.

As a recent Center for Strategic and International Studies report suggests, Indian efforts created local expertise and the logistical skills to execute the widespread education and inoculation efforts that were necessary. The Indian ownership of the effort has been so important because the primary obstacles to polio eradication are social and cultural resistance to vaccination, a problem faced by many other development endeavors. At the local level, theres no substitute for a member of the community being the face of any development effort, regardless of the good intentions of visiting NGOs. Community volunteers can better address and minimize resistance with educational efforts tailored to disabuse the population of its fears regarding vaccination. In addition to enabling a local to address local problems, taking possession of the problem allowed India to develop first class institutions. The most important of these institutions is the National Polio Surveillance Project (NPSP). As the backbone of the polio efforts in India, the NPSP is an organization staffed almost entirely by Indians that operate a network of surveillance medical

offices and WHO accredited laboratories for testing. Along with the Indian Ministry of Health, the NPSP has largely been responsible for designing and coordinating the activities of multiple local and international participants in the WHO Polio Eradication Initiative. The Indian institutions, such as the NPSP, have created valuable institutional knowledge, which cant be transferred from NGOs or donor nations as its something only earned through experience. The experience gained from addressing wide spread public health issues during the polio fight is invaluable, and will likely prove a boon to India in the future as it confronts similar challenges, from HIV/AIDS to tuberculosis and malaria. The lessons for the rest of South Asia and the developing world are clear: while NGOs and international aid have been keys to Indias fight especially the Bill and Melinda Gates Foundation and the Rotary Club success was achieved primarily because India took ownership of the problem and the solution. Not only has India been better able to address the local problems, but they have also built an infrastructure and developed

institutional knowledge that has great value to the nation going forward.

Scientists, health workers and community outreach officials in India believe theyre finally on the cusp of a major milestone, the defeat of polio throughout the country. The polio virus, which attacks the nervous system, has been largely eliminated in most other countries through immunizations. But it has remained a frustratingly significant threat in India, as well as in Nigeria, Afghanistan and Pakistan, largely because of unsanitary conditions. It wasnt too long ago that polio killed or crippled 100,000 children in India each year. In a nation that sees itself as a future superpower, the diseases continued widespread existence puts the spotlight on the side of India where most of its 1

billion population lives, far from the widely promoted Incredible India advertisement campaigns, expensive BMWs and glitzy shopping malls. Moradabad, in western Uttar Pradesh state, has for some time been among the worst-affected polio districts worldwide, because of poverty, dense living conditions, poor sanitation, entrenched superstition and transient population. The disease spreads when virus-infected fecal matter enters a persons digestive system, usually through contaminated food, water or hand-to-mouth contact. But now, as a result of a more effective vaccine, billions of dollars spent over many years and other factors, there are signs of success.