KARACHI, May 13: Sindh, which has planned another mop-up campaign in 14 of its districts after reports of seven confirmed polio cases during the current year, is also anxious to learn more about the efficacy of oral polio vaccines (OPVs) administered to thousands of children up to five years old in the province during national and sub-national campaigns.

Sources privy to the expanded immunization activities said that officials and polio field workers, who had been stressing the need for the stability of oral vaccines at different temperatures, now wanted the World Health Organization (WHO) to conduct a study about the potency of the vaccines.

It was learnt that at a recent internal planning and review meeting organised by the Expanded Programme on Immunisation (EPI), Sindh, it was decided to have a fact sheet focusing on reasons behind the repeated emergence of polio cases in the province, particularly when most of the new polio-affected cases had been given polio vaccines sufficiently. The WHO team leader, based in Islamabad, has been requested to provide a fact sheet on the efficacy of vaccines and use of repeated doses on a priority basis, said a source.

The tally of new polio-affected children reached seven on May 7, when the National Institute of Health confirmed the polio virus in a three-year-old boy of a northern Sindh district. The latest case also increased the number of polio virus-affected districts to seven, against five last year.

In one of the cases, belonging to Naushehro Feroze, it was learnt that the minor boy had received 15 OPV doses but no routine immunisation. Similarly, another six-month-old boy of Jacobabad, who had received one routine vaccination dose, was administered 20 OPV doses.

According to a source, the review meeting that was held on May 9 also drafted a future work-plan to meet the emergency situation resulting from the outbreak of polio in Sindh.

The reported plan calls for the reactivation of the provincial steering committee on polio, meeting with the communication core group to ensure correct and sustained media support, high profile advocacy visits by WHO/Unicef representatives to Sindh and the need of additional human resources in the province, including an increase in national programme officers.

It was also recommended at the meeting that at least all high-risk districts should have a district support officer from Unicef. As an outbreak response measure, a mop-up operation has also been planned in 14 districts located in the southern part of the province.

Giving details of the mop-up campaign, the project director of EPI Sindh, Dr Mazhar Khamisani, told Dawn that about four million children would be targeted using MOPV 1 vaccine from May 26 to 28. Efforts are also on for additional human resources to monitor the campaign, he added.

However, according to him, Karachi district, as well as a few other districts of southern Sindh, cannot be included in the coming special campaign due to the non-availability of vaccines and also in view of the fact that the next supplementary immunisation activities will be launched on June 3 using MOPV 1.

Grave situation

In the meantime, EPI Sindh has apprised the provincial health department that the existing polio scenario in Sindh, which had reported the only polio cases of the year within the country, presented a grave situation and called for urgent attention and action at all levels of the government.

To date in 2008, Pakistan has reported seven polio cases, all from Sindh (Hyderabad, Nawabshah, Shikarpur, North Karachi, Mirpurkhas, Naushehro Feroze and Jacobabad). Sindh also reported the highest number of polio cases among all provinces in 2007 (12 out of 32 cases reported countrywide).

The EPI dispatch to the health department said that there were no security, accessibility or refusal issues, while public acceptance to vaccinations was also very high. Experts had expressed confidence that Sindh had a very strong opportunity to stop the spread of polio in 2008.

“Evidence shows that the quality of immunization activities can improve dramatically when district EPI teams take ownership and oversight of the immunization programme, personally monitor progress and directly address the issues which stand in the way of achieving the targets. The role of the executive district officers (health), town health officers and district coordination officers, therefore, (is) pivotal for ensuring programme success in 2008,” said an EPI update sent to the health department.

A source said it was largely believed that management issues continued to hamper the quality of campaigns. There is also a need to convene a task force to address issues specific to Karachi, while on the other hand EDOs (health) should be held accountable for the routine immunization performances of each of the districts in the province.