KARACHI, Feb 17: The detection of Pakistan’s sixth and Sindh’s first polio case in 2009 in Karachi has established that the threat of the poliovirus continues to exist in the city and its eradication requires a coordinated prevention campaign that goes beyond the administration of the supplementary oral polio vaccine, doctors and other health experts have said.

The most recent case of polio in Sindh was reported from a suburban residential area in Gadap Town (Karachi). The onset of paralysis had begun on Jan 21, 2009, and the authorities confirmed the case on Monday (Feb 16). Those responsible for the eradication of polio are now contemplating launching a fully-fledged ‘mop up’ operation at the earliest.

Over the years, the health authorities in Sindh have come close to eliminating the virus several times, but have never succeeded in doing so.

In 2005, just five cases were reported, but the number grew to 12, 11 and 18 in 2006, 2007 and 2008, respectively.

This latest case is the first case to be detected in 2009, and has occurred in a month that usually sees very little virus transmission. A source privy to the immunisation activities said personnel working in both local and international health agencies responsible for polio campaigns should be aware that this has happened in the country’s largest city, which is equipped with the best human and financial resources as well as amenities.

According to an estimate, for every polio immunisation campaign aimed at reaching about 22.5 million children under the age of five in Karachi, about Rs7.5 million is spent in operational costs, in addition to Rs500,000 for the orientation of about 6,100 vaccination teams, Rs1 million for social mobilisation and another Rs1 million for mobility support in the city.

Victim is migrant from Waziristan

The latest case is Hassan, the 16-month-old son of Usman, living in Hazrat Noman Colony of Jonejo Goth in UC-4 of Gadap town. His family migrated from militancy hit Waziristan about five months ago, and he has no history of routine immunisation, including the BCG and Polio vaccines, in the first 12 months of his life.

The boy, part of a family that already has one two-and-a-half-year-old child, was provided with four OPV during the supplementary immunisation campaigns for prevention of the dreaded polio disease in Karachi. “Since the boy is active, we can say that he will overcome the paralysis after due treatment in the time to come,” said a doctor visiting him on Tuesday.

A university student living in the nearby regular settlements near Al-Asif Square, Sohrab Goth, said that mere vaccination would not help stop the transmission of the poliovirus. “I have visited the families living in the polio-affected area and can say that they are having a very hard time, with little health and sanitation facilities,” he said, adding that children come across stinking sewers and human faecal contents flowing at their doorsteps.

Hassan’s mother did not have access to a recognised healthcare centre or maternity home in Waziristan due to the security situation there, otherwise the family would have known about the routine poliovirus vaccination, the university student said.

A source said that health managers visiting the area were convinced that the child had been provided with the oral polio vaccines doses, but failed to develop the required immunity due to the fact that he was not given any routine immunisations. They said he contracted the virus from his environment, and could not fight it due to his lack of immunity.

The quarters concerned expressed the view that the government should ensure that a well-thought-out and consolidated campaign is carried out in areas of Karachi facing the problem of migration to and from the NWFP and other northern parts of the country.

To ensure special attention is given to nomadic and moving populations, small children and minorities regularly, efforts should be made to improve hygiene and sanitation conditions in their vicinities.

‘Loopholes in management’

If we succeed in diverting a little amount of what is being spent in the name of polio campaigns or the expenditure incurred on foreign trips of our health professionals and the bureaucratic hierarchy for the sake of orientation and studies in the subject of polio diseases and its eradication, we can have at least a standard sewer and sanitary disposal system installed for 100 or so houses in the irregular areas, along with each vaccination campaign, other university students remarked, saying that in view of the migration of people from the militancy hit areas and Afghanistan, these refugees and internally displaced people should be given due consideration and should be provided with health and sanitation facilities as well guidance regarding healthcare, irrespective of their origin and ethnic connections.

According to an analysis of polio vaccination related data from 2007 in the province, there were 115 union councils which fell in the high risk category for various reasons, including low routine immunisation, highly mobile population, seasonal migrants, low socio-economic status, low literacy rate, environmental issues, poor sanitary conditions, managerial issues and unwilling workers, including vaccinators and women health workers, at the district and UC levels.

Following the repeated emergence of polio cases in Sindh in the first four months of 2008, the provincial minister for health, Dr Sagheer Ahmad, in May had noted that there had been some loopholes in the management of supplementary vaccination campaigns and there was a lack of coordination and collaboration between different departments and wings of the government at local levels.

At the time, he said that the increase in polio cases was mainly due to the use of polluted water and the district government would be directed to look after the quality of drinking water.

The provincial manager of the Expanded Programme on Immunisation, Dr Mazhar Khamesani said on Tuesday that the demand had been made for supply of OPV1 vaccines for a planned ‘mop up’ campaign for all of Karachi, and the administration of oral vaccine would be carried out as soon as the vaccines were available.

The town health officer of Gadap, Dr Khjalil Ansari, told Dawn that a special seven-day campaign aimed at providing routine immunisation to the left over children and measles and OPV drops to children up to five years of age living in UC-4 of Gadap was launched on Tuesday. He estimated that there were about 7,000 deserving children who would be given the supplementary drops during the week.