1 Dr.

RAMESH KUMAR
SPECIAL ARTICLE ON A WORLD WITHOUT POLIO CRIPPLING DISEASE IN A CRIPPLING GLOBALIZED WORLD ORDER Why to study this topic in detail Recently Taliban killed social workers who were giving polio vaccine to children India is a polio free nation from past two years. It will get the certificate in January 13, 2014. So frequently Polio is coming in news. So we have to study about polio in detail. What is virus o Viruses are communicable agents that cannot replicate without the presence of the host cell. Penetrating the host cell, reproducing and staying away from the defense system of the body are the main survival points of viruses. What is DNA DNA or deoxyribonucleic acid is the major storage for genetic codes that contains information for the functioning and advancement of all living organism. What is DNA virus A DNA virus is a virus that has DNA as its genetic material. The nucleic acid is usually double-stranded DNA (dsDNA). What is RNA RNA or ribonucleic acid is a nucleic polymer acid that performs a significant role in translating the genetic code from the DNA to protein products. It is found in the nucleus and cytoplasm.

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What is RNA virus An RNA virus is a virus that has RNA (ribonucleic acid) as its genetic material This nucleic acid is usually single-stranded RNA (ssRNA) Difference between DNA virus and RNA virus DNA Virus RNA virus No of Strands double-stranded single-stranded Stability More stable Less stable Mutation rate Low High Remember that DNA is less susceptible to mutation. Also mutation occurs slowly over long period of time [means 1000s of years]. But RNA is more susceptible to mutation within short span of time.

How Virus is different from Bacteria Infection produced Treatment VIRUS Systematic Viral diseases have never been treated, but we can make vaccines for them. Smaller Antibiotics cannot kill viruses BACTERIA Localized o But Bacteria diseases are treatable; while Larger But antibiotics can kill bacteria Living Can reproduce independently

Size Use of antibiotics Living / non- Non living living Reproduction Occurs only inside the host cells Cannot reproduce independently [ thats why it is called non living] Growth Do not feed, excrete and grow Both do not contain nucleus

Feed, excrete and grow

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What is Polio o It is an acute, viral, infectious disease spread from person to person, primarily via the fecal-oral route o Poliovirus only infects humans. What about Polio Virus o Poliovirus, the causative agent of poliomyelitis, is a human enterovirus. o Poliovirus is a RNA virus How Wild Polio virus differs from Vaccine Polio virus o Natural polioviruses are called wild to distinguish them from vaccine polioviruses that constitute OPV. o Vaccine viruses are attenuated from wild viruses which means they have lost most of their virulence, the ability to cause paralysis and the ability to spread fast among children. These two are the dreaded qualities of wild polioviruses. Why Polio virus has many subtypes There are three known types of polioviruses (called 1,2, and 3), each causing a different strain of the disease Type 1 is the cause of epidemics and many cases of paralysis, which is the most severe manifestation of the infection Why to worry too much about Polio virus Generally we have to worry more about a disease when it carries high infectivity [ spreading fast in short span of time]. Poliovirus is a highly contagious virus that causes the medical condition polio. When a person is infected with this virus, it is expected that polio transmission among susceptible household contacts will occur in nearly 100 percent of children and more than 90 percent of adults How the disease spreads

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In simple language, First Polio virus enters the gut via mouth [ faeco oral route] reaches blood reaches central nervous system or simply brain from here, virus spreads to nerves which are supplying muscles damages the nerves and muscles become unable to contract now because of muscle weakness deformities occurs

How Polio virus varies according to climatic conditions It is more common during summer months in temperate climates. In tropical climates [ example India], there is no seasonal pattern. Why Polio is called as Paralyzing disease [ reason mentioned above]

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Although approximately 90% of polio infections cause no symptoms at all, affected individuals can exhibit a range of symptoms if the virus enters the blood stream. In about 1% of cases, the virus enters the central nervous system, preferentially infecting and destroying motor neurons, leading to muscle weakness and acute flaccid paralysis

What are all the steps taken by India to become a Polio free nation o Intensified Pulse Polio Immunization Programme o Under expanded programme of immunization [ EPI] Age group affected by Polio

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o Polio (poliomyelitis) mainly affects children under five years of age. Polio Endemic Nations o In 2012, only three countries (Afghanistan, Nigeria and Pakistan) remain polio-endemic, down from more than 125 in 1988. [In the diagram given below, remove India from the list]

How to prevent Polio o There is no cure for polio, it can only be prevented. Polio vaccine, given multiple times, can protect a child for life. Why recently in news The World Health Organization (WHO) and UNICEF join the Government of Pakistan and the provinces of Sindh and Khyber Pakhtunkhwa in condemning the multiple attacks that have killed nine health workers recently

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January 13, 2013 marked two years since a child was paralyzed by wild poliovirus in India, a country once considered the most complex challenge to global polio eradication. Global Polio Eradication Emergency Action Plan It aims to boost vaccination coverage in Nigeria, Pakistan and Afghanistan, the three remaining polio endemic countries, to levels needed to stop polio transmission. Situation of Polio in 1980s In India In the 1980s, only three decades ago, 200,000 to 400,000 children, all under 5 years, were afflicted with polio paralysis annually in India. That was a daily average of 500 to 1000 cases. By the age of six, eight among 1,000 children already had polio paralysis; two would have died. In other words, one per cent of infants born were destined to develop polio. Why India started Pulse Immunization programme o By 1988, diphtheria, whooping cough and neonatal tetanus had declined to control levels as a result of EPIs efforts. But polio did not come under control showing that OPV was not as effective in India as in the West or in China. There, just three or four doses protected all children. In India, we had to give many more doses for equal effect. From 1994, India began nationwide OPV campaigns (called pulse immunisation) two per year to give additional doses to all under-five children irrespective of the number of doses already given. That resulted in effectively controlling polio by 2000. One of the three types of polioviruses, wild type 2, was even eradicated by October 1999 when the average number of OPV doses had reached six per child. The type 2 component of OPV was not only more effective against that type, but it also inhibited the effect of types 1 and 3. When we can say that Polio is under control o Control status required at least 95 per cent reduction.

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When we can say that a nation is free from polio No new case occurred for THREE years. Then WHO certifies that India is free from Polio. Why should we wait for three to declare a nation as polio free nation Even all nations of world may be announced Polio virus free nations. but Virus may present in inactivated form for maximum upto three years. After that it will not be able infect humans. Thats why India monitors Polio for three years before getting polio free nation certificate. Under expanded programme of immunization [ EPI] In 1978, India launched the Expanded Programme on Immunisation (EPI) with BCG and DPT vaccines. The oral polio vaccine (OPV) was introduced the next year Why India should fear about Pakistan o India may be in a solid position in terms of military capability when comparing it to Pakistan. But Pakistan has one special weapon called Polio virus. Because it is one of focus country, ie it is one of the endemic country affected by Polio virus [ other 2 nations are Afghanistan and Nigeria] because Polio virus is highly contagious virus. So it can reach india and once reaches it has the ability to spread fast. o India has five points of border-crossing with Pakistan: two in JammuKashmir, two in Punjab, and one in Rajasthan. At every point, individuals are given one dose of tOPV when they enter India Is it worth to spend 1000s of crore rupees on one disease [ Polio] every year o Many have questioned the wisdom of spending such large amounts on one childhood disease. Was polio worth eradicating? From a humanitarian viewpoint as well as human rights angle no child deserved to be paralysed by a preventable disease

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o The disability-determined productivity loss may be taken as about half of the gross domestic product per capita. o Controlling diseases that affect productivity is indeed a development activity. Eradicating polio is an investment. The absence of polio is both a measure of, and a means to, development. Role of National Polio Eradication certification Committee o The National Polio Eradication Certification Committee will confirm eradication of wild viruses and review the secure containment of laboratory storage of wild poliovirus strains or specimens likely to contain them before certifying India free of wild viruses. The Committee will wait for three years from the last virus detection before certification procedures, expected after January 2014 Need for a World without even single Wild polio virus Even if one wild polio virus survives, it replicates rapidly and within few years, it has the capacity to spread to the entire world. India itself spends thousands of crore rupees every year to control Polio. Entire world spends lakhs of crore rupees to control Polio. Because it mostly affects children under the age of five. If it is not controlled, the future generations will born with deformities. Then sustainability of the world will become questionable. In order not to create any polio immunity vacuum, the inactivated poliovirus vaccine will be introduced and sustained for at least five years. Polio eradication will then mean no infection with any poliovirus, wild or vaccine.