Bihar floods bring new worries about polio

India needs to make extraordinary efforts to immunise children against polio in Bihar, as massive flooding disrupts pulse polio drive in many parts of the state. India with a population of 1.1 billion has the world's highest number of polio cases, with 139 being reported in 2007 out of a global total of 345. In India, Bihar has the second highest number of polio cases after the most populous state of Uttar Pradesh. Most of Bihar's cases were reported from districts hit by flooding. A spike in the cases in 2006 in India — mostly in these two states — sparked global concern as the Indian strain of the virus reinfected several other countries. An attempt to eradicate the paralysing disease in India is vital in the global war against the virus. Polio is transmitted through the fecal-oral route in unhygienic conditions, and the virus reaches the intestine and multiplies there. In Bihar, where 20 cases of the virulent type-1 polio were reported this year, nearly 15 million people — including millions of children — have been affected as one of the worst monsoon floods hits the state. The World Health Organisation said with thousands of marooned or homeless children living in crowded makeshift camps in the state of 90 million people — often in extremely unhygienic conditions — the transmission of the virus could become easier as the huge population mixes in unusual fashion. Campaigns are under way in areas health workers could access, but there are operational challenges in reaching children in flood-hit areas and going house-to-house to vaccinate them. Officials are planning to deploy boats in some areas where there is no let-up in flooding. The Indian Health Secretary said that the government planned polio immunisation rounds in Bihar in the coming weeks as a major national round had to be cancelled on August 5 in several districts due to widespread inundation. As India beats back the type-1 virus in the western parts of Uttar Pradesh, with no cases reported this year, similar steps have to be taken in Bihar such that the progress in Uttar Pradesh is not undermined by gaps in Bihar due to the flooding. And with diarrhoea and intestinal infections following floods, the efficacy of the polio vaccine should not go down with them. Hence, extraordinary efforts are needed to plug the gap.