Polio-free Bangladesh

Bangladesh has found its own solution to become polio-free, analysts say.

Along with other 10 Asian countries, Bangladesh was declared polio-free by the World Health Organisation’s (WHO) on Thursday.

Bangladesh has been free of the disease over the past seven years, but it was only on Thursday that was formally recognised.

WHO issues a certificate for a region when all of its countries remain polio-free for three consecutive years. India was the region's last country to report a case of polio in Jan 2011.

Bangladesh could achieve the feat by a strategic mix of routine immunisation campaigns, quality surveillance, regular observance of National Immunization Day (NIDs) and facilitation of strong multi-sectoral collaboration, said WHO.

“We looked for even a remote house so that no one is missed out,” Dr Jahan Afroz said on Thursday when Bangladesh was officially conferred polio-free status.

Dr Afroz worked with the EPI that oversees national immunisation for more than two decades since 1991.

“Even we used to go to the remote places from Dhaka so that our workers are backed up and get encouraged,” she told bdnews24.com.

Bangladesh is one of the world leaders in vaccination.

WHO says the country’s success in protecting its people from diseases that can be prevented by vaccines has its roots in the late 1950s with campaigns against tuberculosis.

The Extended Program on Immunization (EPI) began in 1979 when Bangladesh was gripped by such diseases.

Polio came as an additional challenge to the already fragile healthcare system.

More and more children were diagnosed with paralysis in late 1980s.

EPI boosted its routine immunisation campaign.

The routine immunisation of oral polio vaccine started in 1985. Before that, only 2 percent of Bangladesh's children under 5 years old were immunized.

But this number jumped to 60 percent within 10 years after routine immunization was introduced and steadily intensified.

Polio cases came down drastically to one case in 2000 from 16 in 1996.

Since 2000, there has been no case of polio in Bangladesh but in 2006 it appears to have made its way from neighbouring India.

After 6 months of extensive operations, which included 6 rounds of special immunization days and mop-ups, polio was, once again, eradicated by Nov 2006.

Bangladesh has been enjoying polio-free status ever since.

WHO says routine immunization had always been the foundation to popularize oral polio vaccines among parents in Bangladesh.

The former EPI official, Dr Afroz said persuading parents was the key element of their strategy.

“If you do not give the vaccine, your child can be paralysed for the entire life” is what parents were told.

“Sometimes it was difficult, but our workers could do it. They have that confidence,” she said.

The confidence that motivated them increased as the campaign was given top priority by the state with prime ministers inaugurating immunisation campaign.

Dr Afroz said when a child is born the EPI workers would make sure it was given a polio vaccine.

Apart from routine campaign, Bangladesh has to date observed 21 National Immunization Days for polio.

WHO says the latest of such specialised campaign in Jan this year confirmed 100 percent coverage.

“Home-grown solutions and micro planning”

WHO says Bangladesh has followed the principle of “Think Globally, Act Locally,” with an importance on micro planning, the process of mapping the community down to the most basic level to ensure all children were reached.

Micro planning was done in each sub-district with the active participation of field workers, non-governmental organization (NGO) workers, municipal workers and supervisors.

A former EPI Programme Manager Dr Lutfor Rahman told bdnews24.com that they divided a small ward of a union into eight blocks.

“It was to reach every child,” he said.

WHO also noted that focus had also been given to develop “a strong, quality surveillance system to detect wild polio-virus cases”.

Bangladesh has implemented acute flaccid paralysis (APF) surveillance since 1996 to develop the desired surveillance system from primary healthcare to tertiary care levels, ensuring certification standards.

In 2013, 1,412 AFP cases were detected, but none of those were found to be caused by wild polio-virus or vaccine derived polio-virus.

No complacency

Dr Poonam Khetrapal Singh, Regional Director for the WHO South-East Asia Region, said it was a “momentous victory” for the millions of health workers who have worked with governments, nongovernmental organizations, civil society and international partners to eradicate polio from the Region.

“It is a sign of what we can bequeath our children when we work together,” she said.

She however sounded a word of caution so that vigilance is not compromised.

“Until polio is globally eradicated, all countries are at risk and the Region’s polio-free status remains fragile,” she said.

“High immunization coverage can prevent an imported virus from afflicting someone not properly immunized.

“A sensitive surveillance system, able to quickly detect and identify any importation and guide a programmatic response, is critical,” she added.

Dr Thushara Fernando, WHO Representative to Bangladesh, also observed that: “Now it is important to strengthen the surveillance and further improve routine immunization to sustain our (Bangladesh’s) progress”.