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Credibility of polio data from India
Vaccine 27 (2009) 3130
Contents lists available at ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
Letter to the Editor Credibility of polio data from India
a r t i c l e
i n f o
Keywords: Polio data NPSP data
The National Polio Surveillance Project (NPSP) conducts the polio eradication programme in India. NPSP is the only source for polio related data in India. The author had raised the issue regarding some discrepancies in data with the Project Manager, National Polio Surveillance Project (NPSP) India. “According to the data available on http://www.npspindia.org, there were 226 confirmed polio cases in Bihar, 265 in Uttar Pradesh and 509 polio cases in India as on 15th November 2008. On 22nd November, number of confirmed polio was 228 in Bihar, i.e., increase of 2 cases; 274 cases in Uttar Pradesh, i.e., increase of 9 cases, but total number of polio cases for India increased from 509 to 518, i.e., increase of 9 cases, why the total cases of polio in India did not increase by 11?” The Project Manager, NPSP stated in his letter dated December 10, 2008: “this is in reference to your letter dated November 28, 2008 regarding the number of polio cases in the polio bulletins as on 15 November and 22 November 2008. The two polio cases which are not reflected in the bulletin as of November 22, 2008 are the cases that were reported from Karnataka. The laboratory has retested the original stool specimens of these two Karnataka cases and has reported these as negative for wild polio virus. The retesting of these samples was undertaken by the laboratory because of a suspicion of cross-contamination. These two cases have been removed from the total polio case count.” This explanation prompted the author to look at some more data on polio. The author found some more discrepancies in the data which are given here. As on October 18, 2008 there were three confirmed polio cases detected in Maharashtra, in later bulletins number was changed to two. As on November 22, 2008 there were 274 polio cases in Uttar Pradesh, 56 by P1 in 12 districts and 218 by P3. As on December 13 number of polio cases had increased to 287, i.e., increase by 13 cases. But, as on December 13 number of polio cases by P1 was reduced to 53 in 11 districts from 56, and number of polio cases by P3 during this period increased from 218 to 234, i.e., increased by 16. It suggests that subsequently culture reports from three stool samples were changed from P1 to P3. As on November 22, 2008 there were 65 Polio cases by P1, but as on December 13, 2008 there had been 63 polio cases by P1. Similarly as per November data 54 polio cases had occurred in the month of September 2008, but as per December data only 49 polio cases had occurred in September 2008.
0264-410X/$ – see front matter © 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.vaccine.2009.03.031
The author had raised the issue of misclassifications of acute flaccid paralysis (AFP) cases in the past [1,2]. The author had also raised these issues at the eighth meeting of the National Certification Committee for Polio Eradication which was held in New Delhi from May 9 to 11, 2003. Documents were presented that in some cases the Surveillance Medical Officer (SMO) of the National Polio Surveillance Project had specifically stated that the stool samples were either not adequate or not in good condition (code 2). Thus, chances of virus recovery from these stool samples were not good, still such cases had been discarded as non-polio cases because wild polioviruses had not been detected in the stool samples. During the year 2002, after receiving negative reports for wild polioviruses in the stool samples, many AFP cases had been discarded as non-polio even without 60 days evaluation of neurological status. With such credibility of reporting from WHO accredited national laboratories, inaccurate tabulations and clinical classification of AFP cases NPSP data become suspect. Acknowledgement Conflict of interest: Author is member, Polio Eradication Committee, Indian Academy of Pediatrics. Funding: None. References [1] Paul Y. Accuracy of the National Polio Surveillance Project Data in Rajasthan. Indian J Pediatr 2002;69:667–73. [2] Paul Y. Need for re-appraisal of acute flaccid paralysis (AFP) case classification. Vaccine 2004;22:301–2.
Yash Paul ∗ A-D-7, Devi Marg, Bani Park, Jaipur 302016, India ∗ Tel.:
+91 1412314774; fax: +91 1412203738. E-mail address: [email protected] 10 March 2009 Available online 3 April 2009
Contents lists available at ScienceDirect
Vaccine journal homepage: www.elsevier.com/locate/vaccine
Letter to the Editor Credibility of polio data from India
a r t i c l e
i n f o
Keywords: Polio data NPSP data
The National Polio Surveillance Project (NPSP) conducts the polio eradication programme in India. NPSP is the only source for polio related data in India. The author had raised the issue regarding some discrepancies in data with the Project Manager, National Polio Surveillance Project (NPSP) India. “According to the data available on http://www.npspindia.org, there were 226 confirmed polio cases in Bihar, 265 in Uttar Pradesh and 509 polio cases in India as on 15th November 2008. On 22nd November, number of confirmed polio was 228 in Bihar, i.e., increase of 2 cases; 274 cases in Uttar Pradesh, i.e., increase of 9 cases, but total number of polio cases for India increased from 509 to 518, i.e., increase of 9 cases, why the total cases of polio in India did not increase by 11?” The Project Manager, NPSP stated in his letter dated December 10, 2008: “this is in reference to your letter dated November 28, 2008 regarding the number of polio cases in the polio bulletins as on 15 November and 22 November 2008. The two polio cases which are not reflected in the bulletin as of November 22, 2008 are the cases that were reported from Karnataka. The laboratory has retested the original stool specimens of these two Karnataka cases and has reported these as negative for wild polio virus. The retesting of these samples was undertaken by the laboratory because of a suspicion of cross-contamination. These two cases have been removed from the total polio case count.” This explanation prompted the author to look at some more data on polio. The author found some more discrepancies in the data which are given here. As on October 18, 2008 there were three confirmed polio cases detected in Maharashtra, in later bulletins number was changed to two. As on November 22, 2008 there were 274 polio cases in Uttar Pradesh, 56 by P1 in 12 districts and 218 by P3. As on December 13 number of polio cases had increased to 287, i.e., increase by 13 cases. But, as on December 13 number of polio cases by P1 was reduced to 53 in 11 districts from 56, and number of polio cases by P3 during this period increased from 218 to 234, i.e., increased by 16. It suggests that subsequently culture reports from three stool samples were changed from P1 to P3. As on November 22, 2008 there were 65 Polio cases by P1, but as on December 13, 2008 there had been 63 polio cases by P1. Similarly as per November data 54 polio cases had occurred in the month of September 2008, but as per December data only 49 polio cases had occurred in September 2008.
0264-410X/$ – see front matter © 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.vaccine.2009.03.031
The author had raised the issue of misclassifications of acute flaccid paralysis (AFP) cases in the past [1,2]. The author had also raised these issues at the eighth meeting of the National Certification Committee for Polio Eradication which was held in New Delhi from May 9 to 11, 2003. Documents were presented that in some cases the Surveillance Medical Officer (SMO) of the National Polio Surveillance Project had specifically stated that the stool samples were either not adequate or not in good condition (code 2). Thus, chances of virus recovery from these stool samples were not good, still such cases had been discarded as non-polio cases because wild polioviruses had not been detected in the stool samples. During the year 2002, after receiving negative reports for wild polioviruses in the stool samples, many AFP cases had been discarded as non-polio even without 60 days evaluation of neurological status. With such credibility of reporting from WHO accredited national laboratories, inaccurate tabulations and clinical classification of AFP cases NPSP data become suspect. Acknowledgement Conflict of interest: Author is member, Polio Eradication Committee, Indian Academy of Pediatrics. Funding: None. References [1] Paul Y. Accuracy of the National Polio Surveillance Project Data in Rajasthan. Indian J Pediatr 2002;69:667–73. [2] Paul Y. Need for re-appraisal of acute flaccid paralysis (AFP) case classification. Vaccine 2004;22:301–2.
Yash Paul ∗ A-D-7, Devi Marg, Bani Park, Jaipur 302016, India ∗ Tel.:
+91 1412314774; fax: +91 1412203738. E-mail address: [email protected] 10 March 2009 Available online 3 April 2009