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|Year : 1984 | Volume
| Issue : 1 | Page : 1-4
Effectiveness of polio vaccination coverage in reducing the incidence of paralytic poliomyelitis in a highly endemic area of Bombay city.
Desai VP, Kowli SS, Chaturvedi RM, Sunder SS, Kumar RR, Bhalerao VR
100% oral polio vaccine coverage was sought through household visits by health center personnel in a slum area in northwestern Bombay. Children up to and including 3 years of age comprised the target population. In the 2 1/2-year period following initiation of the vaccination campaign in September 1980, 83% of children in the target population were covered and no cases of paralytic poliomyelitis were reported from the area. This coverage rate of 83% stands in contrast with the 64% rate obtained in Bombay's Ward B, a residential area for middle and upper-income people, and the 70% rate in Ward E, another slum district where household visits were not conducted. This experience demonstrates that it is possible to abolish paralytic poliomyelitis through adequate vaccination coverage even in slum areas located in the middle of highly endemic areas. Experience further demonstrated that it is not necessary to withhold oral polio vaccine from children with minor illnesses such as diarrhea or immediately before or after breastfeeding. These 2 contraindications have in the past increased the difficulty of obtaining adequate vaccine coverage rates among young children.
|How to cite this article:|
Desai V P, Kowli S S, Chaturvedi R M, Sunder S S, Kumar R R, Bhalerao V R. Effectiveness of polio vaccination coverage in reducing the incidence of paralytic poliomyelitis in a highly endemic area of Bombay city. J Postgrad Med 1984;30:1-4
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Desai V P, Kowli S S, Chaturvedi R M, Sunder S S, Kumar R R, Bhalerao V R. Effectiveness of polio vaccination coverage in reducing the incidence of paralytic poliomyelitis in a highly endemic area of Bombay city. J Postgrad Med [serial online] 1984 [cited 2020 Feb 21];30:1-4. Available from: http://www.jpgmonline.com/text.asp?1984/30/1/1/5494
Oral polio vaccine has been in use in the city of Greater Bombay since 1963. In spite of this, the annual incidence of paralytic poliomyelitis in the entire city has increased from 500 cases in 1974 to 900 cases in 1982. The annual incidence, however, varies in different geographical wards of the city, varying, from 5.4 per hundred thousand of the population in B ward to 17.13 per hundred thousand of the population in E ward. B ward is at the southern end of Bombay, is an office-cum-residential area, and houses largely higher middle and higher Socio-economic groups of the population. E ward, on the other hand, is in the centre of the city, is overcrowded, has lone of the red-light areas of the city, and houses lower middle and poor socio-economic groups of population [Fig. 1].
In 1977, Seth G.S. Medical College and K.E.M. Hospital, a twin institution run by the Municipal Corporation of Greater Bombay (M.C.G.B.), adopted for comprehensive health care a village by name Malavani, situated in P ward which is in the north-west zone of Bombay [Fig. 1]. The comprehensive health care programme offered to this village comprises (A) promotive services in the form of mother craft clinic, under fives' clinic, school health clinic, parent craft clinic and community kitchen gardening; (B) preventive services in the form of immunization of children under five years of age and of pregnant women, and control of endemic diseases such as tuberculosis, leprosy and scabies; (C) curative services in the form of medical outpatient department and referral camps run by specialists; (D) rehabilitative services in the form of cataract surgical camps and rehabilitation of the physically and socially handicapped; and (E) multisectoral services including community gardening and creche service. We have already published the details of this programme in the form of a booklet.
The Malavani Health Centre, from which all the activities of the above programme are run, is under the charge of the Head of the Department of Preventive and Social Medical (PSM), Seth G.S. Medical College. The clinic is manned by medical internes, student nurses, three qualified medico-social workers and menial staff, who work under the supervision of the staff of the P.S.M. department. The health centre has maintained continuous records of the population which was 63,000 in 1977 and 70,000 in 1982. Malavani village houses almost exclusively slum dwellers who belong to the poor socio-economic class. One of the services offered by the centre has been oral immunization against poliomyelitis.
It was, therefore, decided to study the impact of oral polio vaccination on annual incidence of paralytic poliomyelitis in Malavani village and compare it with the incidence in the other areas of Bombay city, which are served by the same Municipal Corporation but do not have the intensive health care programme as Malavani.
The sources of information used in this study were the records of the Malavani Health Centre, the records of the office of the Executive Health Officer (E.H.O.), the records of the Enterovirus Research Unit (ICMR) of Haffkine Institute, and the report of a W.H.O. expert submitted to the Government of the State of Maharashtra and the Government of India.
Oral polio vaccination was carried out in the under fives' clinic, in the outpatient department of the Malavani Health Centre, and by house to house visits by the clinic staff. This vaccination was done in all the children upto and including the age of 3 years. The above activity was strengthened by a mass drive which began in September 1980, and is continuing till date.
In March 1989, under the guidance of a W.H.O. expert invited by the Government of India, we, jointly with the Health Department of the M.C.G.B., carried out a survey of the coverage of under 3, child-population by oral polio vaccine, using the standard, 30 cluster, sampling technique, in B and E wards of the city mentioned above and a total house to house survey for the same in Malavani. The Malavani survey also included a survey of children upto the age of three years for lameness as indicative of paralytic poliomyelitis. Information about the annual incidence of paralytic poliomyelitis in wards B, E and P (Malavani forms a part of P ward) was obtained from the records of E.H.O. and Enterovirus Research Unit (ICMR) of Haffkine Institute.
[Table - 1] shows the immunization coverage in three areas studied.
As the table shows, the coverage for the first dose was similar in Wards B and E but was higher in Malavani. Further, in Wards B and E, it dropped progressively for the 2nd and 3rd doses. In contrast, in Malavani, it was maintained upto the third dose.
[Table - 2] shows the incidence of paralytic poliomyelitis in various areas of the Bombay city.
Finally, the survey showed 16 cases of lameness among 1403, under three children examined in Malavani but none of them was due to paralytic poliomyelitis.
The present work demonstrates that even in a slum area like Malavani which houses people belonging to very poor economic groups and which is located in the middle of a highly endemic area, it is possible to abolish paralytic poliomyelitis by adequate vaccination coverage of children below the age of three years.
An attempt was made to achieve 100% coverage by house to house visits, but it resulted in only 83% coverage in spite of the extensive and intensive efforts by a team of doctors and paramedical personnel. However, the efforts appear to be worthwhile as shown by the zero polio incidence for three successive years and zero lameness due to polio as brought out by this survey.
In the past, it was thought that minor illnesses including diarrhoea were temporary contraindications to the administration of oral polio vaccine. Further, it was also thought that oral polio vaccine should not be administered immediately before or after a breast feed. These recommendations increased the difficulty of adequate coverage of child population. The recent recommendation, however, is that oral polio vaccine need not be withheld in either of the above situations. This would make coverage easier because it is now thought permissible to hand over the oral polio vaccination programme to non-medical personnel including community health volunteers. Finally, the old recommendation to restart a complete schedule of three doses if the child does not complete the course in recommended period of 3 months is no longer thought necessary.
We thank the Executive Health Officer, for giving us the necessary data. We are also thankful to the Director, Enterovirus Research Unit, I.C.M.R., Haffkine Institute, for extending the help. Lastly, we are thankful to the Dean, Seth G.S.M. College and K.E.M. Hospital, Bombay, for allowing us to publish the hospital data.
|1.||Civic Health Bulletin: Published by Executive Health Officer, Public Health Department, M. C. G. B., for the years 1980, 1981, 1982. |
|2.||Malavani Health Care Delivery System: A Review, December 1977 to December 1982. Published by the Seth G.S. Medical College, Bombay, 1983. |
|3.||Records of Enterovirus Research Unit, I.C.M.R., Haffkine Institute, Parel, for the years 1980, 1981, 1982. |
|4.||Robinson, D.A. and Kauer, B.: Report of a visit to Expanded Programme of Immunization, India, 3rd Nov. - 8th Dec. 1982. Submitted to the Executive Health Officer, Municipal Corporation of Greater Bombay. |