LAHORE: The provincial health department is faced with the uphill task of conducting a polio campaign in Lahore among other areas after traces of the virus were found in a sewage sample in the Outfall area.

According to officials of the health department, the virus has been present in the area since June, but a sample collected from Multan Road in December 2017 had also revealed some virus strains.

In 2016, Punjab was declared polio free -- a case had surfaced in 2017, but so far in 2018 nothing had been recorded yet. The province has also been the first to conduct the rotavirus vaccination campaign in 2016, and its anti-polio initiatives have been appreciated by the World Health Organisation. In that context, the traces found in the sewage may be worrying.

Deputy Superintendent of Police Malik Naveed, in-charge of the Polio Control Room, says that sample tests were usually carried out every 15 days, especially from disposal pumps – sites where wastewater is deposited.

“The problem is not centred around the Outfall area because the sewage is coming from a number of places,” he says, explaining that eventually the sewage converges there and perhaps more dangerously goes on to be deposited in the Ravi.

“We have five drainage points, including three that converge in the Outfall area, one in Sabzazar and one at Gulshan-i-Ravi,” he says. “In December 2017 also, a polio virus strain was found in the Sabzazar area.”

Samples are sent to Islamabad’s National Institute of Health (NIH) which then sends back a technical report. The virus strains can also be genetically identified, such as in the current sample, the Islamabad report stated that the virus may have emerged from Fata or Kabul.

Naveed says that this situation coincides with a three-day nationwide polio campaign that concluded on Wednesday, and Dr Munir, the health services director general, confesses that until the whole country is rid of the virus, no single province can be declared polio free.

But a polio campaign alone cannot solve the problem, as there is obvious excretion of the virus by carriers.

“Technically, everyone under 15 years of age should be focused on as carriers, while children under five should get regular doses of the vaccine,” says Naveed. At present, he says, there are 1.7 million children under the age of five who have been covered in the polio campaign that began on Monday.

“We try to cover as much as possible,” he says. “But there is a lot of migration. The carrier could come from anywhere from Peshawar to Pindi. He or she may have been infecting many other places too.”

A polio campaign must be part of a simultaneous drive and a long-term plan to properly dispose of sewage and domestic waste where polio virus is mainly found.

Lady Health Worker Khadija Bibi in Lahore says that while she usually faces no difficulty in the city going door to door during campaigns unlike many other health workers in volatile areas, the challenging part is targeting the children who are constantly on the move.

“The Afghan families that live in my area know me well and I have access to their children and have always seen to it that they receive their dosage. But some children are bound to be missed because families either do not give access to their children, or those who keep moving from one place to the other,” she says. “This is not necessarily restricted to Afghan families, but gypsies and others also.”

The people frequently moving within districts, regions and provinces are known as the high-risk mobile population because they are seen as potential carriers of the virus. Though once the virus is found in water or sewage, especially in a polio-free zone, a red alert should be issued, but Dr Munir says that they hope to track down families on the move through their mobile teams, especially in places like stations and intercity areas.

Families that refuse vaccination can be booked by police.

Pakistan is one of only three countries in the world along with Afghanistan and Nigeria that suffers from endemic polio, a childhood virus that can cause paralysis or death.

Published in Dawn, August 18th, 2018