Deadly polio strain from Bihar creating havoc in Uttar Pradesh

By Kavita Bajeli-datt, New Delhi, Oct 26 : Uttar Pradesh has once again emerged as a hotbed for P 1, the most deadly polio strain, which was slowly being eliminated in India.

But Uttar Pradesh, the country's most populous state, is again seeing a surge in the paralytic disease thanks to the virus being imported from neighbouring Bihar.

Though Uttar Pradesh was earlier described as the "world's most tenacious reservoir of P 1 poliovirus" by World Health Organisation (WHO) Director-General Margaret Chan, the state remained free of the most dangerous and fast travelling virus for a record one-and-a-half years.

But it resurfaced in Uttar Pradesh when the strain was imported from Bihar this year. And as the strain moves fast it has so far infected 47 people till Oct 17.

"All the cases in UP this year have been caused by an importation from Bihar and none by continuing transmission in the state," Hamid Jafari, Project Manager, WHO-NPSP (National Polio Surveillance Project), told IANS.

Jafari said as a "local circulation of this imported virus got established in western UP", the subsequent polio cases were traced to the same family of P 1 poliovirus that got introduced from Bihar.

This year, till Oct 17, a total of 486 polio cases were reported, of which 55 were infected with P 1 and the rest suffered from P 3 virus.

Apart from infecting 47 people in Uttar Pradesh, the deadly strain was also reported from Bihar (2), Delhi (2), Orissa, West Bengal, Assam and Punjab where one case each was registered.

But the maximum cases of the strain, 648, were seen in 2006. It declined to 83 in 2007. In 2006, a total of 676 cases were reported in the country, while in 2007, the figure was 874.

India is one of the four countries in the world where polio is endemic. According to the Global Polio Eradication Imitative, Nigeria reported 728 polio cases this year, pushing India to second place, followed by Pakistan (81) and Afghanistan (22).

Jafari said the India Expert Advisory Group on polio eradication had said during its recent meeting that there was a risk of the country's most endemic region, western Uttar Pradesh, getting re-infected with P 1 as the virus transmission persists in Bihar. They had recommended rapid and intense mop-ups to eradicate the virus.

Following the suggestion of the expert committee, monovalent oral polio vaccine type 3 (mOPV3), which targets P 1, is being carried out in Bihar to stop its circulation and prevent re-importation, he added.

The WHO official said the transmission of the most dangerous polio virus and which is the focus of the eradication programme in India is at a historic low following intense immunization campaigns.

"The most impressive progress has been in Uttar Pradesh, which for the first time in history stopped P 1 transmission in November 2007. The core endemic areas of western Uttar Pradesh - Moradabad and adjoining districts, the epicentre of all polio outbreaks, - remained free of this strain for a record one-and-a-half-year period up to mid 2008," Jafari said.

Health ministry officials said a P 1 case was reported in May this year from the Badaun area of Uttar Pradesh.

"A genetic sequencing traced it to Bihar. As the strain travels fast and there is a susceptible population, it spread again," the official with the NPSP, which plans and implements the polio immunisation activities in the country, told IANS.

The only silver lining for health workers seemed to be that Bihar, the other endemic state of the country, reported only two P 1 cases this year.

"It is a historic achievement. This progress follows aggressive immunisation campaigns combined with intense efforts to bridge operational gaps in the access-compromised Kosi river districts, the only area in the country by 2007-end where P 1 transmission continued," Jafari said.

He said by 2007-end, P 1 virus stopped in all but the Kosi river districts of Bihar.

However, officials and health workers continue to worry about the continued reporting of P 3 strain in the country, which was also exported to Angola. The virus had travelled from Uttar Pradesh.