Status of Polio Eradication - Uttar Pradesh

This PowerPoint presentation was part of a December 2006 meeting hosted by the India Expert Advisory Group (IEAG) and held in New Delhi, India. Participating organisations included the World Health Organization (WHO), Rotary International, the United States Centres for Disease Control and Prevention (CDC) and the United Nations Children’s Fund (UNICEF).

This presentation gave an overview of the epidemiology of wild poliovirus (WPV) cases in Uttar Pradesh, as of December 2006. Cases were illustrated by age, oral polio vaccine doses (OPV) and religious community. Uttar Pradesh reported a total of 481 polio cases in 2006.

The key recommendations of the previous IEAG meeting were outlined, and included the following:

• Improving oversight of polio eradication activities in the highest risk districts of western Uttar Pradesh.
• Enhancing the impact of supplementary immunisation activities (SIAs) and focusing on areas with low coverage.
• Reaching all children under five years of age in high-risk areas with monovalent OPV.
• Maintaining sensitive acute flaccid paralysis (AFP) surveillance in the state.
• Strengthening routine immunisation (RI) in high priority districts to minimise the risk of reintroduction of WPV.

The government of Uttar Pradesh has made significant efforts to strengthen the health infrastructure, including appointing over 1,000 new doctors, 750 nurses and the involvement of over 60,000 trained healthcare workers in the RI programme. The presentation emphasised the government’s continued political and administrative commitment to the programme, including periodic review at the highest level in the state and enhanced monitoring efforts.

Following this, a description of strategies for reaching missed houses (houses in which no rounds of vaccination had taken place) was presented. This was closely linked to the reduction of resistance within communities, largely through involvement and support from Muslim leaders and influencers. The percent coverage through booths, transit teams and house-to-house activities was also detailed.

RI achievements in Uttar Pradesh in the areas of RI monitoring, reported coverage and immunisation week coverage were summarised. Overall, full immunisation coverage was stated to have increased from 33.8% to 43.9% from 2005 to 2006.

Communication responses in Uttar Pradesh involved a modified approach that highlighted more religious themes, dissemination of an illustrated booklet on frequently asked questions surrounding RI and polio, and a push for celebrity endorsements, including cricketers, musicians, film stars and writers. In order to reach the underserved more effectively, the following strategies were discussed:

• Intensive engagement of Muslim leaders in priority districts.
• Identification of local influencers, madrassah students, and Imams who can work with the teams to influence family decisions.
• Securing of positive fatwas to promote local Muslim support.

In conclusion, the response to the early 2006 outbreak in the state (which spread to over 33 districts) was discussed. Multiple rounds of SIAs have been conducted, with the overall quality of SIAs having improved over the last few rounds. Uttar Pradesh is currently experiencing its lowest number of missed houses reached, with continued strong political and administrative support to counter the last few remaining pockets of polio left.

For the full presentation, please see contact details below.