Nepal's health officials say sixth polio case in 9 months means virus is being transmitted locally

From Republica:

KATHMANDU, Nepal -- To the utter dismay of health officials, a new case of polio has been detected in Nepal. The sixth case of polio detected in the last nine months is, as in the past, indigenous. This means that it was transmitted locally, not imported from Indian villages.

National Health Institute (NHI), the Bangkok-based laboratory where the government has been sending cases of Acute Flaccid Paralysis (AFP) regularly to detect polio, confirmed the new trace of acute infectious viral disease this week. The government, however, is yet to announce the new polio case. According to sources at the Department of Health Services (DoHS), polio has affected a 22-month old child in Jowaha village of Rautahat.

Five cases of polio have been detected in 2010 alone. Of them, five were detected in Rautahat while one in Mahottari. Initially, two polio cases were imported from India. Later, all four cases were transmitted locally. "Alarmingly, most of polio cases have been found in Muslim communities," said a government official.

The trace of new polio case has come as a serious jolt the government because it has surfaced despite several rounds of its special campaigns. Since the first case in March, the Health Ministry has carried out three mop-up campaigns against polio -- the first in eight districts, second in 18 districts including the valley and last again in eight Tarai districts. However, the polio epidemic has not been eliminated. Instead, it has become more dangerous.

With the new case traced, the Health Ministry has decided to carry out new mop-up campaign against polio. But, this time around, the special vaccination drive will take place only in Rautahat and two adjoining districts -- Bara and Sarlahi. According to Krishna Chand, immunization chief at the DoHS, the campaign will be conducted between September 30-31 and October 2-3.

The detection of frequent polio cases despite several rounds of mop-up campaigns is due to the failure of the government´s strategy, say some government officials. They say the government must urgently review its strategy.

It has been learnt that the World Health Organization (WHO) and the United Nations Children Fund (UNICEF) have recently asked the government to revise its polio-strategy. "We recently did a presentation in the presence of high-level government officials," said a doctor, involved in mop-up campaigns, adding, "The aim of our presentation was to convince them of a new strategy."

According to him, the mop-up, supposed to be a sweeping campaign, has failed to cover all children below five years of age. "Only in Mahottari, public health officials carried out door-to-door vaccination program against polio, which prevented its further transmission," he said. "Elsewhere, even in Rautahat, the epicenter of the current epidemic, officials did not cover all children. They just installed booths in major intersections and waited for children. It does not effectively prevent polio."

Another doctor, involved in the WHO´s immunization programs, stressed on the need for social mobilization to increase the coverage of mop-up campaigns. "A decade ago, we used to conduct awareness programs massively," he said. "Today, awareness programs mean just some advertisements in radio and newspapers. Hence, the coverage of mop-up is low."

The efficacy of polio drops is never cent per cent, thanks to the poor status of sanitation and nutrition. Public health experts say polio drops do not work in malnourished children. And, its transmission is rapid in villages where people care less for sanitation.

However, overlooking these crucial facts, the government has so far focused only on mop-up programs.