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Intriguing silence: On the case of polio in India
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Context
The recent case of acute flaccid paralysis (AFP) in a child from Tikrikilla, Meghalaya, has brought renewed attention to polio in India. The State government reported this case on August 14, and it raises questions about the source of the virus, whether it is vaccine-derived or wild poliovirus, given the global eradication status of wild poliovirus types 2 and 3.
Current Situation:
- Virus Source: The case has not yet been officially confirmed as either vaccine-derived or wild poliovirus. Since wild poliovirus types 2 and 3 were eradicated globally, the case could be due to imported wild poliovirus type 1 or vaccine-derived poliovirus.
- Genetic Analysis: Genetic sequencing of the April 2022 environmental sample in Kolkata identified a likely immunodeficiency-related vaccine-derived poliovirus (iVDPV). The Meghalaya case’s genetic details remain pending, complicating the determination of the virus type and its origin.
- Global Polio Status: With the switch in 2016 from trivalent to bivalent oral polio vaccine in India, only types 1 and 3 are present in the vaccine. However, type 2 vaccine-derived poliovirus (cVDPV2) continues to circulate globally, posing risks of its importation.
Implications and Urgent Actions:
- Vaccine Implications: The delay in confirming whether the Meghalaya case is caused by iVDPV or cVDPV is significant. cVDPV indicates community circulation, while iVDPV is restricted to an individual with immunodeficiency.
- Public Health Measures: India’s reliance on oral polio vaccine (OPV) continues despite the availability of inactivated polio vaccine (IPV). OPV can cause polio in immune-deficient children, highlighting the need for a transition to IPV.
- Policy Recommendations: The case underscores the necessity for India to switch to IPV exclusively, as most developed countries have done, to avoid risks associated with OPV and ensure better control over polio.
Mains Question:
Q. Discuss the significance of the recent case of acute flaccid paralysis in Meghalaya in the context of India’s polio eradication efforts. Evaluate the implications of the ongoing use of oral polio vaccine (OPV) versus inactivated polio vaccine (IPV) and suggest policy measures to address potential vaccine-derived poliovirus risks.
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