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Conquering poliomyelitis in India
THE LANCET 1 2
3
4
5
OACI. Manuel de médecine aéronautique civile, 2nd edn, 1985. Colin J, Auffret R, Bergot G. Médecine Aérospatiale Société Française de Médecine Aérospatiale Expansion Scientifique Française, 1990. Gourbat JP, Martel V. Comment décider de l’aptitude au vol aéronautique? AMC Pratique 1995; 4: 10. Bourgneres F. Difficultés de l’expetise du médecin agréé en ophtalmologie. Médecine Aéronautique et Spatiale 1995; 133: 19–22. Bulletin d’Information des Médecins Agréés, no 6. Octobre 1995. Edité par le Conseil Médical de l’Aéronautique Civile.
Conquering poliomyelitis in India
Number of cases
SIR—On Dec 7, 1996, and Jan 18, 1997, the Indian government conducted national poliomyelitis immunisation days. 121 million children aged under 5 years were targeted to receive oral poliovirus vaccine on each of these days. 117·4 million children were immunised on Dec 7, and 127·3 million on Jan 18. This figure exceeded the previous year’s effort when 93 million children aged under 3 years were immunised on Jan 29, 1996, representing at that time the largest single-day immunisation event ever.1 This record-breaking success required extensive planning and coordination by the government and partner agencies, including WHO, United Nations Children’s Fund, Rotary International, Danish International Development Agency, British Overseas Development Agency, Japanese International Cooperation Agency, Centers for Disease Control and Prevention in Atlanta, USA, and the US Agency for International Development. The total cost, not including operational costs covered by state governments, was about US$45·7 million. Over 2·6 million health workers and volunteers staffed more than 650 000 vaccination posts nationwide. Between 1995 and 1996, the number of poliomyelitis cases reported in India fell by 68%, from 3142 to 1005 (figure). India has consistently reported more than 50% of the world’s poliomyelitis cases, so the success of the
1200 1000 800 600 400 200 0 1994
1995
1996 Year
1997
Reported cases of paralytic poliomyelitis in India between Jan 1, 1994, and Feb 28, 1997 Arrows=national immunisation days.
1630
national immunisation days in India is critical for the worldwide polio-eradication initiative.2 Improving surveillance of acute flaccid paralysis and wild poliovirus is needed to evaluate accurately the impact of the immunisation days. To that end, field surveillance for vaccine preventable diseases is being accelerated in 1997 by the implementation of a national plan of action which includes nationwide retraining of state and district immunisation officers, procedures for reporting, investigation, and monitoring cases of acute flaccid paralysis, and the expansion of the Indian polio laboratory network from five to eight laboratories. *Kaushik Banerjee, Jon Andrus, Gary Hlady Ministry of Health and Family Welfare, Nirman Bhavan, New Delhi; *Regional Office for South-East Asia, WHO, New Delhi, India 11002; and WHO’s Country Office for India, New Delhi
1 2
WHO. National immunization days: India. Wkly Epidemiol Rec 1996; 22: 169–71. Andrus JK, Banerjee K, Hull BP, Smith JC, Mochny I. Polio eradication in the World Health Organization South-East Asia region by the year 2000: midway assessment of progress and future challenges. J Infect Dis 1997; 175 (suppl 1): S89–96.
The when and how of advocacy SIR—I cannot agree with the ideas expressed in your March 29 editorial.1 I can understand the desire behind it— the desire for a better world—but to suggest that one should set aside normal scepticism or fail to point out the limits of one’s data to achieve this is surely to abandon the whole enterprise of science. For if one has to misrepresent one’s case in order to persuade others of something that is believed to be desirable, one has to ask on what grounds this view is held. Perhaps it is a sincere ideological belief, held as a result of one’s own moral framework. History is full of examples, however, of such opinions being subsequently shown to be false or causing immense harm. The Lancet, like most other biomedical journals, roundly condemns scientific fraud, and yet in many cases this may be no more than scientists putting aside their normal scepticism to present results that show something they sincerely believe to be true. Scientists’ strength is their integrity, and they, more than anyone else, should take great care to separate their work, which they can be (reasonably) impartial about, and their concerns as a human being and a member of society. The deliberate
amalgamation of these two functions, even if done with the best of intentions, can only lead to a decrease in the standing of the scientific community. Alison Round Department of Public Health Medicine, North and East Devon Health Authority, Ex eter EX 1 1PQ, UK
1
Editorial. The when and how of advocacy. Lancet 1997; 349: 891.
Do not go flying in short sleeves SIR—I woke up in a hotel bed (single), unaware of time, the day after a 14 h two-stop flight from northern Scandinavia to southern California. When I picked up the toothbrush to clean my teeth, I felt a strange numbness in my right thumb and forefinger. Did I have a headache or neck pain? No. Had I carried exceptionally heavy luggage the day before? No. Any fever or malaise? None. After 5 days of hectic impressions of tumour-suppressor genes, chromosomal rearrangements, loss of heterozygosity, and hecatombs of posters on p53, cytokines, and cyklins, I still had this enervating numbness in my right thumb and forefinger. Was my balance affected? Any signs of early dementia, or other defects? None. My finger went straight to my nose when I kept my eyes closed. On the return flight, I sat by the left window again, with a marvellous view of the polar night sky, northern lights, and the comet, and Boccherini, Borodin, and Ravel on the headsets. And all the time a heavy stream of air filtered down from the ceiling. I had to seek support from my left hand when I drank my coffee. Then I remembered from my practice a youngster who presented with a peripheral facial paralysis after a day of intense snow scootering with cold draught. On consulting Lord Brain’s Diseases of the nervous system, radial palsy seemed the most likely diagnosis and prognosis is good. I am looking forward to being able to play the piano again. Torgny Rasmuson Department of Oncology, Umeå University Hospital, S-901 85 Umeå, Sweden
DEPARTMENT OF ERROR Vaccine failures after primary immunisation with Haemophilus influenzae type-b conjugate vaccine without booster—In this article by Booy and colleagues (April 26, p 1197–202), the heading for the second column of table 1 should read “Number of previous doses of tetanus toxoid”.
Vol 349 • May 31, 1997
3
4
5
OACI. Manuel de médecine aéronautique civile, 2nd edn, 1985. Colin J, Auffret R, Bergot G. Médecine Aérospatiale Société Française de Médecine Aérospatiale Expansion Scientifique Française, 1990. Gourbat JP, Martel V. Comment décider de l’aptitude au vol aéronautique? AMC Pratique 1995; 4: 10. Bourgneres F. Difficultés de l’expetise du médecin agréé en ophtalmologie. Médecine Aéronautique et Spatiale 1995; 133: 19–22. Bulletin d’Information des Médecins Agréés, no 6. Octobre 1995. Edité par le Conseil Médical de l’Aéronautique Civile.
Conquering poliomyelitis in India
Number of cases
SIR—On Dec 7, 1996, and Jan 18, 1997, the Indian government conducted national poliomyelitis immunisation days. 121 million children aged under 5 years were targeted to receive oral poliovirus vaccine on each of these days. 117·4 million children were immunised on Dec 7, and 127·3 million on Jan 18. This figure exceeded the previous year’s effort when 93 million children aged under 3 years were immunised on Jan 29, 1996, representing at that time the largest single-day immunisation event ever.1 This record-breaking success required extensive planning and coordination by the government and partner agencies, including WHO, United Nations Children’s Fund, Rotary International, Danish International Development Agency, British Overseas Development Agency, Japanese International Cooperation Agency, Centers for Disease Control and Prevention in Atlanta, USA, and the US Agency for International Development. The total cost, not including operational costs covered by state governments, was about US$45·7 million. Over 2·6 million health workers and volunteers staffed more than 650 000 vaccination posts nationwide. Between 1995 and 1996, the number of poliomyelitis cases reported in India fell by 68%, from 3142 to 1005 (figure). India has consistently reported more than 50% of the world’s poliomyelitis cases, so the success of the
1200 1000 800 600 400 200 0 1994
1995
1996 Year
1997
Reported cases of paralytic poliomyelitis in India between Jan 1, 1994, and Feb 28, 1997 Arrows=national immunisation days.
1630
national immunisation days in India is critical for the worldwide polio-eradication initiative.2 Improving surveillance of acute flaccid paralysis and wild poliovirus is needed to evaluate accurately the impact of the immunisation days. To that end, field surveillance for vaccine preventable diseases is being accelerated in 1997 by the implementation of a national plan of action which includes nationwide retraining of state and district immunisation officers, procedures for reporting, investigation, and monitoring cases of acute flaccid paralysis, and the expansion of the Indian polio laboratory network from five to eight laboratories. *Kaushik Banerjee, Jon Andrus, Gary Hlady Ministry of Health and Family Welfare, Nirman Bhavan, New Delhi; *Regional Office for South-East Asia, WHO, New Delhi, India 11002; and WHO’s Country Office for India, New Delhi
1 2
WHO. National immunization days: India. Wkly Epidemiol Rec 1996; 22: 169–71. Andrus JK, Banerjee K, Hull BP, Smith JC, Mochny I. Polio eradication in the World Health Organization South-East Asia region by the year 2000: midway assessment of progress and future challenges. J Infect Dis 1997; 175 (suppl 1): S89–96.
The when and how of advocacy SIR—I cannot agree with the ideas expressed in your March 29 editorial.1 I can understand the desire behind it— the desire for a better world—but to suggest that one should set aside normal scepticism or fail to point out the limits of one’s data to achieve this is surely to abandon the whole enterprise of science. For if one has to misrepresent one’s case in order to persuade others of something that is believed to be desirable, one has to ask on what grounds this view is held. Perhaps it is a sincere ideological belief, held as a result of one’s own moral framework. History is full of examples, however, of such opinions being subsequently shown to be false or causing immense harm. The Lancet, like most other biomedical journals, roundly condemns scientific fraud, and yet in many cases this may be no more than scientists putting aside their normal scepticism to present results that show something they sincerely believe to be true. Scientists’ strength is their integrity, and they, more than anyone else, should take great care to separate their work, which they can be (reasonably) impartial about, and their concerns as a human being and a member of society. The deliberate
amalgamation of these two functions, even if done with the best of intentions, can only lead to a decrease in the standing of the scientific community. Alison Round Department of Public Health Medicine, North and East Devon Health Authority, Ex eter EX 1 1PQ, UK
1
Editorial. The when and how of advocacy. Lancet 1997; 349: 891.
Do not go flying in short sleeves SIR—I woke up in a hotel bed (single), unaware of time, the day after a 14 h two-stop flight from northern Scandinavia to southern California. When I picked up the toothbrush to clean my teeth, I felt a strange numbness in my right thumb and forefinger. Did I have a headache or neck pain? No. Had I carried exceptionally heavy luggage the day before? No. Any fever or malaise? None. After 5 days of hectic impressions of tumour-suppressor genes, chromosomal rearrangements, loss of heterozygosity, and hecatombs of posters on p53, cytokines, and cyklins, I still had this enervating numbness in my right thumb and forefinger. Was my balance affected? Any signs of early dementia, or other defects? None. My finger went straight to my nose when I kept my eyes closed. On the return flight, I sat by the left window again, with a marvellous view of the polar night sky, northern lights, and the comet, and Boccherini, Borodin, and Ravel on the headsets. And all the time a heavy stream of air filtered down from the ceiling. I had to seek support from my left hand when I drank my coffee. Then I remembered from my practice a youngster who presented with a peripheral facial paralysis after a day of intense snow scootering with cold draught. On consulting Lord Brain’s Diseases of the nervous system, radial palsy seemed the most likely diagnosis and prognosis is good. I am looking forward to being able to play the piano again. Torgny Rasmuson Department of Oncology, Umeå University Hospital, S-901 85 Umeå, Sweden
DEPARTMENT OF ERROR Vaccine failures after primary immunisation with Haemophilus influenzae type-b conjugate vaccine without booster—In this article by Booy and colleagues (April 26, p 1197–202), the heading for the second column of table 1 should read “Number of previous doses of tetanus toxoid”.
Vol 349 • May 31, 1997