Polio Eradication in India - Epidemiology Overview

This PowerPoint presentation was part of a March 2007 United Nations Children's Fund (UNICEF)-hosted meeting dedicated to examining polio communication efforts, in the context of the final global push towards polio eradication. State-specific presentations for India's polio-endemic states (Uttar Pradesh and Bihar) were given by in-country communication and health practitioners. These were assessed by an external Technical Advisory Group (TAG) panel of experts who provided communication strategy recommendations based on evidence presented and data gathered on field-visits to endemic states. Communication strategies presented at this meeting were primarily focused on:

1. Analysing the results of programmes implemented to March 2007.
2. Detailing activities on national and sub-national levels, specific to social mobilisation, community engagement, underserved areas and media and political advocacy strategies.
3. Suggesting a planned communication programme for the next 6- to 12-month period, designed to support India's polio eradication efforts in the event of a resurgence of cases or population/programme fatigue.

This presentation was given by the World Health Organization (WHO) and details the epidemiological history and trends of wild poliovirus in India. It shows a drastic decline in paralytic polio cases following the introduction of oral polio vaccine (OPV) into India's routine immunisation programme in 1978. In the thirty years following, OPV has resulted in a decrease of polio disease burden of 99%, attributable in part to recent strengthening of supplementary immunisation activities (SIAs) and increases in national and sub-national immunisation days (NIDs/SNIDs). In the last several years the poliovirus has followed a predictable four-year cycle in India, with recent outbreaks occurring in 1998, 2002 and 2006. These outbreaks have been steadily decreasing in magnitude, and are concentrated in the northern states of Uttar Pradesh (UP) and Bihar.

The following factors contribute to persistent disease in areas of northern India:

• Population numbers and density
• Poor health service delivery infrastructure (eg. Medical officer vacancies)
• Poor sanitation

A regression model clearly illustrated increased polio susceptibility in relation to population density, diarrhea and OPV3 coverage rates in UP and Bihar, as compared to other Indian states. These factors indicate that more doses of OPV and increased quality of SIAs are required in these areas to stop transmission.


To summarise the epidemiologic trends of the disease in India, the following points were offered:

• A multi-year cycle of accumulation of susceptible individuals has been seen in outbreak states.
• Polio is a disease of the very young (85% of cases in children 3 yrs old)
• In the last phase of elimination, polio disease is still often seen in children where multiple doses of OPV have been administered.
• A higher proportion of cases occur within the Muslim minority community.

2007 is seen as the best opportunity yet to interrupt WPV transmission, based on higher natural population immunity due to the recent 2006 outbreak and increased public awareness. Coupled with a high level of programme quality, the initiative is currently well-positioned to achieve eradication. According to the presentation, future steps to ensure this should include:

1. Use of OPV1 in key areas, which has been shown to be up to three times more effective than OPV3 against P1.
2. Planning 2 NIDs in early 2007, along with 6 SNIDs for 2007. These should be supplemented in UP and Bihar with additional rounds every 3-4 weeks.

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