Resistance of polio to its eradication in Pakistan
Background
This study is based on EPI (Expanded Program on Immunization) immunization surveys and surveillance of polio, its challenges in immunization and the way forward to overcome these challenges.
Methods
Several Government documents, survey reports and unpublished program documents were studied and online search was made to find information on EPI Pakistan. SPSS 16 and Microsoft Excel 2007 were used for the statistical analysis.
Results
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Immunization against polio is higher in urban areas as compared to rural areas. Marked variation in vaccination has been observed in different provinces of Pakistan in the last decade. Secondly 10-20% of the children who have received their first dose of trivalent polio vaccine were deprived of their 2nd and 3rd dose because of poor performance of EPI and Lack of information about immunization.
Conclusion
In spite of numerous successes, such as the addition of new vaccines and raising immunization to over 100% in some areas, EPI is still struggling to reach its polio eradication goals. Inadequate service delivery, lack of information about immunization and limited number of vaccinators were found to be the key reason for poor performance of immunization and for large number of cases reported each year due to the deficiency of second and third booster dose.
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Introduction
Many epidemics are caused by poliovirus in the last three centuries. About 100,000 new polio cases are reported each year worldwide. Europe and North America were the targets of Epidemic poliomyelitis in 1890s. Now a day most of these cases occur in Asia and Africa. German physician Jakob Heine recognized Poliomyelitis as a distinct condition for the first time in 1840. Poliovirus was identified by Austrian physicians Karl Landsteiner and E. Popper in 1908. The three serotypes 1, 2, and 3 infect cells via a specific receptor, PVR (polio virus receptors): CD-155. These receptors are only present in human cell that is why humans are the only reservoirs of this virus. The serological relationship is present between serotype 1 and serotype 2. This is conferred by significant protection against type 2 by the antibodies which were produced against serotype 1. Immunologically Type 2 is broad and it is the first serotype to disappear during vaccination campaigns. Albert Sabin and Jonas Salk developed effective vaccines against Polio virus in the early 1960s with different approaches. The Sabin oral vaccine which contains live attenuated polio virus is superior to the Salk inactivated vaccine in two ways, firstly it is easily administered; secondly it provides a long-lasting immunization. Pakistan use trivalent OPV that contain all the three serotypes in attenuated form.