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Vaccine 27 (2009) 3130

Contents lists available at ScienceDirect

Vaccine

journa l homepage: www.e lsev ier .com/ locate /vacc ine

etter to the Editor

redibility of polio data from India

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∗ Tel.: +91 1412314774; fax: +91 1412203738.E-mail address: dryashpaul2003@yahoo.com

PSP data

The National Polio Surveillance Project (NPSP) conducts theolio eradication programme in India. NPSP is the only source forolio related data in India.

The author had raised the issue regarding some discrepanciesn data with the Project Manager, National Polio Surveil-ance Project (NPSP) India. “According to the data available onttp://www.npspindia.org, there were 226 confirmed polio cases

n Bihar, 265 in Uttar Pradesh and 509 polio cases in India as on5th November 2008. On 22nd November, number of confirmedolio was 228 in Bihar, i.e., increase of 2 cases; 274 cases in Uttarradesh, i.e., increase of 9 cases, but total number of polio cases forndia increased from 509 to 518, i.e., increase of 9 cases, why theotal cases of polio in India did not increase by 11?”

The Project Manager, NPSP stated in his letter dated December0, 2008: “this is in reference to your letter dated November 28,008 regarding the number of polio cases in the polio bulletinss on 15 November and 22 November 2008. The two polio caseshich are not reflected in the bulletin as of November 22, 2008 are

he cases that were reported from Karnataka. The laboratory hasetested the original stool specimens of these two Karnataka casesnd has reported these as negative for wild polio virus. The retest-ng of these samples was undertaken by the laboratory becausef a suspicion of cross-contamination. These two cases have beenemoved from the total polio case count.”

This explanation prompted the author to look at some moreata on polio. The author found some more discrepancies in theata which are given here. As on October 18, 2008 there were threeonfirmed polio cases detected in Maharashtra, in later bulletinsumber was changed to two. As on November 22, 2008 there were74 polio cases in Uttar Pradesh, 56 by P1 in 12 districts and 218y P3. As on December 13 number of polio cases had increased to87, i.e., increase by 13 cases. But, as on December 13 number ofolio cases by P1 was reduced to 53 in 11 districts from 56, andumber of polio cases by P3 during this period increased from 218o 234, i.e., increased by 16. It suggests that subsequently cultureeports from three stool samples were changed from P1 to P3. Asn November 22, 2008 there were 65 Polio cases by P1, but as on

ecember 13, 2008 there had been 63 polio cases by P1. Similarlys per November data 54 polio cases had occurred in the month ofeptember 2008, but as per December data only 49 polio cases hadccurred in September 2008.

264-410X/$ – see front matter © 2009 Elsevier Ltd. All rights reserved.oi:10.1016/j.vaccine.2009.03.031

The author had raised the issue of misclassifications of acuteflaccid paralysis (AFP) cases in the past [1,2]. The author had alsoraised these issues at the eighth meeting of the National Certi-fication Committee for Polio Eradication which was held in NewDelhi from May 9 to 11, 2003. Documents were presented that insome cases the Surveillance Medical Officer (SMO) of the NationalPolio Surveillance Project had specifically stated that the stool sam-ples were either not adequate or not in good condition (code 2).Thus, chances of virus recovery from these stool samples werenot good, still such cases had been discarded as non-polio casesbecause wild polioviruses had not been detected in the stool sam-ples. During the year 2002, after receiving negative reports forwild polioviruses in the stool samples, many AFP cases had beendiscarded as non-polio even without 60 days evaluation of neuro-logical status.

With such credibility of reporting from WHO accredited nationallaboratories, inaccurate tabulations and clinical classification of AFPcases NPSP data become suspect.

Acknowledgement

Conflict of interest: Author is member, Polio Eradication Commit-tee, 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

10 March 2009Available online 3 April 2009