Introduction

The article sheds light on a recent polio-related health concern in Tikrikilla, Meghalaya, where a child has been diagnosed with acute flaccid paralysis (AFP). This condition, which can lead to severe muscle weakness and paralysis, is often linked to polio, a disease caused by polioviruses. The government reported this case on August 14, 2024, raising concerns about the potential re-emergence of polio, which had been largely controlled in India.

Article Explanation

Understanding Polio and Its Global Eradication Efforts

Polio is a crippling disease caused by the poliovirus, and it comes in three types: wild polioviruses type 1, 2, and 3. Thanks to global vaccination efforts, wild poliovirus type 2 was eradicated worldwide in 2015, followed by the elimination of type 3 in 2019. Wild poliovirus type 1, the only remaining strain, has not been detected in India for several years, marking a significant achievement in the fight against this disease. However, the recent case in Meghalaya has sparked concerns about the potential reintroduction of the virus, either from within the country or from international sources.

The Meghalaya Case and Its Uncertainties

The case in Meghalaya is particularly alarming because it is not yet clear whether the AFP in the child is caused by a wild poliovirus or a vaccine-derived poliovirus (VDPV). Vaccine-derived polioviruses can occur in rare instances where the weakened virus used in the oral polio vaccine (OPV) mutates and regains its ability to cause disease.

In a similar incident in April 2022, a vaccine-derived poliovirus was detected in an environmental sample from Kolkata. This virus was likely shed by an immune-deficient individual and was identified as immunodeficiency-related vaccine-derived poliovirus (iVDPV). In the current Meghalaya case, the uncertainty lies in determining whether the virus is iVDPV, which would mean it is limited to the immune-deficient child, or circulating vaccine-derived poliovirus (cVDPV), which would indicate the virus is spreading in the community.

Key Questions About the Virus Type

Another critical question that remains unanswered is the specific type of poliovirus involved in the Meghalaya case. Since 2016, India has switched from using a trivalent oral polio vaccine, which included all three types of polioviruses, to a bivalent vaccine that contains only type 1 and type 3.

This means that the child should not have contracted a type 2 virus from the vaccine currently in use in India. However, the possibility that a type 2 vaccine-derived poliovirus was imported from another country cannot be entirely ruled out. Globally, there have been reports of vaccine-derived poliovirus cases in 2024, including 68 cases of type 2 and 4 cases of type 1, emphasizing the need for vigilance.

The Need for Faster Confirmation and a Shift to Safer Vaccines

Despite the seriousness of the situation, there has been a significant delay in confirming crucial details about the virus involved in the Meghalaya case. Samples from the child were sent to a specialized lab (ICMR-NIV in Mumbai), which is part of a global network of polio laboratories. This lab conducts research on diseases like poliomyelitis and acute flaccid paralysis. However, the delay in getting definitive results is concerning. This situation highlights the ongoing risk of polio in India and the need for quicker identification and response.

Moving Forward: The Case for Switching to IPV

The article concludes by emphasizing the urgent need for India to transition from the oral polio vaccine (OPV) to the inactivated polio vaccine (IPV). While OPV is effective, it carries a small risk of vaccine-derived poliovirus, especially in immune-deficient children. IPV, on the other hand, does not carry this risk and has been widely adopted in developed countries. Given the recurring instances of vaccine-derived poliovirus, the article argues that India should make the switch to IPV as soon as possible to ensure better protection for its population.

In summary, the case of acute flaccid paralysis in Meghalaya underscores the ongoing challenges in eradicating polio and the need for swift action to prevent its re-emergence in India. The article calls for faster confirmation of polio cases and a nationwide shift to safer vaccination methods to protect against future outbreaks.

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