While we celebrate a polio-free year, the vaccine seems to have triggered another killer disease, reports Shonali Ghosal
PARALYSIS IS the first sign of trouble. As paralysis threatened 18-month-old Sumi Naskar’s tiny body, it also threatened to end India’s polio-free run. This, after we celebrated with great pomp and show, on 12 January 2012, India’s first polio-free year.
Sumi had developed Acute Flaccid Paralysis (AFP), more simply put: signs of floppiness, weakness or paralysis but who’s to say that was because of polio? The procedural stool exam showed that she had tested negative for the Wild Polio Virus (WPV). The dream run continues.
Or does it?
What happened to Sumi if it wasn’t polio? She then fell into the category of Non-Polio Acute Flaccid Paralysis (NPAFP). According to an article published in the Journal of Medical Ethics, there seems to be an epidemic of flaccid paralysis. But polio is just one of the several causes of AFP, as clarified by the Ministry of Health and Family Welfare (MHFW). Either way, residual paralysis may ensue.
No polio would mean no reason to worry, if only it weren’t for information received by C Sathyamala from the Council for Social Development through an RTI. The National Polio Surveillance Project (NPSP) figures for 2006 show residual paralysis in 266 of the 434 WPV cases, against 351 of the 1,207 NPAFP cases followed up. Where 14 (3.2 percent) of the WPV cases reported death, 94 (7.8 percent) of the non-polio AFP children died, indicating that NPAFP carried twice the risk of death compared to WPV.
It is alarming that India has reported an additional 47,500 NPAFP cases in 2011, over and above the background rate of 1-2 per 100,000 children under 15 years.
According to surveillance criteria laid out by WHO, a sensitive surveillance for AFP should record at least 1 NPAFP case per 100,000 children under 15 years. The WHO’s own records for 2010 show a rate of 0-2 other than the odd Afghanistan (8.98) or even India with 7.53. The paper published in the Indian Journal of Medical Ethics suggests that the number of children suffering from NPAFP goes up when more doses of OPV are administered. Ajay Khera, Deputy Commissioner, Child Health and Immunisation for MHFW, dismisses this concern. “It’s not an alert sign but indicative of the quality of the surveillance,” he says.
But, a closer observation reveals a connection in the rise in NPAFP cases to increased pulse polio rounds. In UP and Bihar, for example, which have pulse polio rounds almost every month, the NPAFP rate is nearly 25 to 35 times higher. “The correlation is even more evident where six or more doses of Oral Polio Vaccine (OPV) were given. Population density, however, did not show any association with the NPAFP rate,” says Dr Jacob Puliyel, senior paediatrician at St Stephen’s Hospital, one of the authors of theEthics paper.
Dr SK Mittal, former Professor and Head of Paediatrics, Maulana Azad Medical College, points to the case of the five-month-old boy from Murshidabad who got infected with the virus after taking the OPV. “Did they misclassify NPAFP when they denied that the increase in vaccine doses is related to the increase in NPAFP cases?” he asks.
On the other hand, Khera only reiterates that more figures only means the system is working well. “All cases of paralysis get reported. Field workers are equipped to rule out only polio. There isn’t a protocol to follow-up on NPAFP cases, it’s not in our purview,” he says.
A recent Press Information Bureau release by the MHFW states that “in 2012 so far, over 8,000 AFP cases have been investigated by NPSP with the support of local health authorities. All the stool samples of these AFP cases have tested negative for polio”. No mention is made of the NPAFP cases.
There is also no delegated authority to address issues that crop up in the functioning of the NPSP. Does this mean that the rising cases of both AFP and NPAFP merit no investigation? “This has to be a concern for programme planners, even if it is not caused by polio virus,” says Dr Onkar Mittal, President of Society for Action and Community Health (SACH).
Perhaps it is time to dim the celebrations and acknowledge that the greater issue is that of children being paralysed and that the vaccine may be playing a part in the problem. After all, paralysis was the first sign of trouble, not polio.
Shonali Ghosal is a Correspondent with Tehelka.