Three years ago on August 30, Prashuna (name changed) of Rautahat, who was 1 year and 10 months old then, was diagnosed with polio. Now she is four and struggles to cope with the crippling disease. Prashuna is the last reported case of polio and as a success in halting the spread of the disease, Nepal is at the juncture of eradicating the infectious disease.

On January 13 this year, India too marked its success in stopping new cases of polio in children. Rukhsar Khatoon of Shahapar village, West Bengal, became the last child to have caught the disease on January 13, 2011. Many say Khatoon is a symbol of hope that no other child would be inflicted by the disease.

India and Nepal share an open boarder, making cross-border transmission of diseases including polio possible. India reported 741 polio cases in 2009 which came tumbling down to just one in 2011. It now shares the seat with Southeast Asian countries in polio control. While neighbours Nepal and India are newcomers in taming polio, nine other members of the World Health Organisation—Bangladesh, Bhutan, Democratic People’s Republic of Korea, Indonesia, Maldives, Myanmar, Sri Lanka, Thailand and Timor-Leste—have been able to halt the disease for more than five years.

The WHO is assessing the polio status of all its 11 members in Southeast Asia in February verifying that there are no children under the age of five with polio. With a positive report, Nepal and other nations will qualify for polio-free status after eradicating smallpox.

“India’s commitment to eradicate polio has contributed to our success,” said Dr Yasobardhan Pradhan, public health expert and former director general of the Department of Health Services.

Polio is a highly infectious disease caused by a virus that invades the nervous system, and can cause total paralysis in a matter of hours.

The virus enters the body through the mouth and multiplies in the intestine.

Initial symptoms are fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. WHO states that one in 200 infections leads to irreversible paralysis (usually in the legs) among which 5 to 10 percent die when their breathing muscles stiffen.

Not just Nepal, the success in halting the spread of this disease has been phenomenal worldwide. The first initiative was taken by WHO in 1988 which adopted a resolution for the worldwide eradication of polio. The Global Polio Eradication Initiative led by national governments and supported by the WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), Unicef, and supported by key partners including the Bill and Melinda Gates Foundation began.

Ever since, according to the WHO, polio cases have decreased by over 99 percent since 1988, from an estimated 350,000 cases in more than 125 endemic countries then, to 223 reported cases in 2012. In 2013, only parts of three countries—Pakistan, Afghanistan and Nigeria—in the world remain endemic for the disease.

Following the 1988 resolution, Nepal introduced polio vaccination under the government’s routine immunisation programme with nine other vaccines administered to children below five. Polio gets particular focus on the National Immunisation Day marked since 1996.

Beginning from December 21, the government is running a national polio vaccination programme aimed at covering 4.2 million children under the age of five.

The first phase of vaccination ran on December 21 and 22 in 68 districts. The second phase will take place on January 25 and 26. “These campaigns and regular immunisation against polio have helped us achieve the status,” said Dr Sinendra Upreti, director of the Child Health Division.

He said that on the second day of the campaign, they have been reaching out to some two to three percent children that do not visit the vaccination centres. “This ensures that all children are vaccinated,” said Dr Upreti.

Dr Upreti attributes the success to the surveillance conducted from over 10 sites across the country. Each

site has surveillance medical officers who look into the children affected by polio.

Despite the success, officials see challenges ahead. Dr Shyam Raj Upreti, former director of the CHD, believes that despite priority, people have started losing their interest in vaccinating their children against polio.

“We need to bring innovative approaches so that people will be aware that no matter how many times they immunise their children against polio, it will do no harm,” said Dr Shyam.

He said that vaccinating children in urban populations has also been pretty tough.

Polio cases

1999    2

2000    4

2005    4

2006    5

2007    5

2008    6

2010    6

What is polio?

Polio (or poliomyelitis) is a disease caused by poliovirus. It can cause lifelong paralysis (can’t move parts of the body), and it can be deadly. But, the polio vaccine can protect against polio.

What are the symptoms of poliovirus infection?

Most people who get infected with poliovirus do not have any symptoms. A small number of people (4 to 8 people out of 100) will have flu-like symptoms. These symptoms usually last 2 to 5 days then go away on their own. In rare cases, poliovirus infection can be very serious. About 1 out of 100 people will have weakness or paralysis in their arms, legs, or both.  This paralysis or weakness can last a lifetime.

How serious is polio?

The risk of lifelong paralysis is very serious. Even children who seem to fully recover can develop new muscle pain, weakness, or paralysis as adults, 30 or 40 years later. About 2 to 5 children out of 100 who have paralysis from polio die because the virus affects the muscles that help them breathe.

How does polio spread?

Poliovirus is very contagious. The virus lives in an infected person’s throat and intestines. It spreads through contact with the faeces (stool) of an infected person and through droplets from a sneeze or cough. You can get infected with polio if you have stool on your hands and you touch your mouth. Also, if you put objects, like toys, that have stool on them into your mouth, you/your baby can get infected. An infected person may spread the virus to others immediately before and usually 1 to 2 weeks after developing symptoms. The virus may live in an infected person’s faeces for many weeks. It can contaminate food and water when people do not wash their hands.

(Source: US Centers for Disease Control and Prevention)