Overview/Definition
Definition:
• Pulse Polio Campaign is mass immunization strategy using oral polio vaccine (OPV) to achieve high population immunity and interrupt wild poliovirus transmission
Launched in India in 1995 as part of Global Polio Eradication Initiative, targeting all children under 5 years regardless of previous vaccination status.
Epidemiology:
• India achieved polio-free status in 2014 after last wild poliovirus case in 2011
Campaign covered 172 million children under 5 years in peak years
High-risk areas included Uttar Pradesh, Bihar, West Bengal
Current focus on maintaining polio-free status and surveillance for vaccine-derived poliovirus.
Age Distribution:
• Target population: All children 0-5 years (0-59 months) regardless of vaccination status
Newborns: Can receive OPV from birth during campaigns
Infants and toddlers: Primary target group for achieving population immunity
Older children: Included to ensure comprehensive coverage and herd immunity.
Clinical Significance:
• Essential topic for DNB Pediatrics and NEET SS examinations covering public health principles, vaccination strategies, and disease eradication concepts
Understanding campaign logistics, vaccine administration, adverse events, and surveillance systems crucial
Knowledge of polio epidemiology and prevention strategies mandatory.
Age-Specific Considerations
Newborn:
• Neonates (0-28 days): OPV can be administered from birth during pulse campaigns
Birth dose not counted toward routine immunization schedule
Maternal antibodies may interfere with vaccine response but not contraindication
Safe in breastfed infants, no feeding restrictions required.
Infant:
• Infants (1-24 months): Most critical age group for polio prevention
Higher vaccine take rates due to developing immune system
Multiple OPV doses ensure immunity despite interference from maternal antibodies
Excellent safety profile with rare adverse events
Integration with routine immunization important.
Child:
• Children (2-5 years): Continue to receive OPV during campaigns despite previous vaccination
Boosts immunity and maintains high population immunity levels
Lower risk of vaccine-associated paralytic polio (VAPP) compared to first doses
Important for maintaining herd immunity in community.
Adolescent:
• Adolescents (>5 years): Not included in routine pulse polio campaigns after 2014
May receive OPV during outbreak response or special campaigns
Adult-like immune response to vaccination
Travel-related vaccination may be recommended for high-risk areas.
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Clinical Presentation
Symptoms:
• Post-OPV symptoms typically absent or minimal
Mild gastrointestinal symptoms possible: Loose stools (5-10% children), mild abdominal discomfort
Fever rare (<1%) and usually low-grade
Serious adverse events extremely rare: Vaccine-associated paralytic polio (VAPP) 1 case per 2.4 million first doses.
Physical Signs:
• Normal physical examination expected post-vaccination
No local reactions as OPV is oral vaccine
Mild pharyngeal irritation possible immediately after administration
Signs requiring evaluation: Fever, rash, neurological symptoms (extremely rare)
Normal growth and development patterns maintained.
Severity Assessment:
• Mild reactions: No intervention required, resolve spontaneously
Moderate reactions: Medical evaluation if persistent symptoms
Severe reactions: VAPP requires immediate neurological assessment and supportive care
Outbreak response: Enhanced surveillance for adverse events and wild poliovirus.
Differential Diagnosis:
• Gastrointestinal symptoms: Viral gastroenteritis, dietary indiscretion, concurrent illness
Fever: Intercurrent viral/bacterial infections unrelated to vaccination
Neurological symptoms: Guillain-Barré syndrome, viral encephalitis, non-polio AFP (acute flaccid paralysis).
Diagnostic Approach
History Taking:
• Vaccination history: Previous OPV doses, routine immunization status, participation in previous campaigns
Illness history: Recent fever, diarrhea, antibiotic use affecting gut immunity
Travel history: Recent travel to polio-endemic areas
Contact history: Household immunocompromised individuals.
Investigations:
• Routine investigations not required for OPV administration
Stool examination if persistent diarrhea after vaccination
Neurological investigations if VAPP suspected: CSF analysis, viral culture, PCR for poliovirus
Surveillance specimens: Stool samples from AFP cases within 14 days of onset.
Normal Values:
• No specific laboratory monitoring required post-OPV
If investigations needed: Normal stool microscopy, absence of poliovirus in stool culture
CSF normal: Cells <5/μL, protein <45 mg/dL, glucose >50% of blood glucose
Normal neurological examination expected.
Interpretation:
• Vaccine virus shedding: Expected in stool for 3-6 weeks post-vaccination, not harmful
Poliovirus isolation: Differentiate vaccine virus from wild poliovirus through genetic sequencing
AFP surveillance: Any child 0-15 years with acute flaccid paralysis requires investigation.
Management/Treatment
Acute Management:
• Pre-vaccination screening: Check for illness, fever, severe malnutrition
OPV administration: Two drops orally, ensure child swallows vaccine
Post-vaccination monitoring: 30 minutes observation not required for OPV
Document administration: Update immunization cards, maintain campaign records.
Chronic Management:
• Campaign planning: Multiple rounds annually in endemic areas, timing based on epidemiology
Quality assurance: Cold chain maintenance, vaccine potency monitoring
Coverage monitoring: House-to-house verification, missed child tracking
Integration: Coordinate with routine immunization services.
Lifestyle Modifications:
• No activity restrictions post-OPV administration
Normal feeding and daily activities
Hand hygiene important due to vaccine virus shedding in stool
Isolation not required unless child has intercurrent illness
Continue routine immunization schedule as planned.
Follow Up:
• Campaign follow-up: Coverage assessment, mop-up operations for missed children
Adverse event monitoring: Report serious adverse events to surveillance system
Routine immunization: Ensure completion of scheduled vaccines
Long-term surveillance: AFP surveillance and environmental monitoring.
Age-Specific Dosing
Medications:
• Oral Polio Vaccine (OPV): Standard dose 2 drops (0.1 ml) orally for all children 0-5 years regardless of age or weight
Contains live attenuated poliovirus types 1, 2, 3 (trivalent OPV) or types 1, 3 (bivalent OPV)
Same dose for all ages in target group.
Formulations:
• Vaccine presentation: Multi-dose vials (10 or 20 doses), single-use containers
Dropper bottles for easy administration
Color coding: Different colors for different vaccine types
Temperature indicators: Vaccine vial monitors (VVM) to assess heat exposure.
Safety Considerations:
• Contraindications: Immunodeficiency disorders, severe illness with fever >38.5°C
Precautions: Household immunocompromised contacts (use IPV instead)
Vomiting: Re-administer if child vomits within 10 minutes
Storage: Maintain cold chain 2-8°C, protect from light.
Monitoring:
• Campaign monitoring: Daily coverage reports, vaccine utilization, cold chain maintenance
Adverse event surveillance: Passive and active surveillance systems
Quality control: Vaccine potency testing, cold chain monitoring
Population immunity: Serosurveys and AFP surveillance.
Prevention & Follow-up
Prevention Strategies:
• Primary prevention: Mass immunization campaigns achieving >95% coverage
Routine immunization strengthening: IPV integration into UIP schedule
Surveillance: AFP surveillance system for early detection
Environmental sanitation: Improved sewage disposal, water quality.
Vaccination Considerations:
• Campaign schedule: National Immunization Days (NIDs) typically twice annually
Sub-national campaigns in high-risk areas
Timing: Avoid during religious festivals, harvest seasons
Integration: Vitamin A supplementation, growth monitoring during campaigns.
Follow Up Schedule:
• Immediate post-campaign: Coverage assessment within 7 days
Mop-up operations: Target missed children within 2 weeks
Surveillance: Continuous AFP surveillance throughout year
Annual assessments: Coverage surveys, population immunity studies.
Monitoring Parameters:
• Coverage indicators: Administrative coverage, survey coverage, missed child rates
Quality indicators: Cold chain maintenance, vaccine wastage rates
Impact indicators: AFP rates, poliovirus circulation, population immunity levels
Surveillance indicators: Stool adequacy, reporting timeliness.
Complications
Acute Complications:
• Vaccine-Associated Paralytic Polio (VAPP): Extremely rare (1:2.4 million first doses), higher risk with immunodeficiency
Vaccine-Derived Poliovirus (VDPV): Circulation in under-immunized populations
Mild gastrointestinal upset: Self-limiting, no treatment required
Allergic reactions: Extremely rare.
Chronic Complications:
• Chronic VDPV circulation: Requires outbreak response with multiple campaign rounds
Long-term disability from VAPP: Requires supportive care and rehabilitation
Community transmission: Spread to susceptible contacts
Vaccine hesitancy: Due to rare but serious adverse events.
Warning Signs:
• Acute flaccid paralysis: Sudden onset weakness in one or more limbs within 14 days of vaccination
Fever, altered consciousness: Suggest serious intercurrent illness
Severe allergic reaction: Rash, breathing difficulty (extremely rare)
Persistent vomiting, diarrhea beyond expected duration.
Emergency Referral:
• Immediate referral for acute flaccid paralysis, altered consciousness, severe allergic reactions
Neurological consultation for any neurological symptoms post-vaccination
Infectious disease consultation for suspected VDPV circulation
Public health authorities notification for serious adverse events.
Parent Education Points
Counseling Points:
• OPV is safe and effective vaccine preventing polio paralysis
Mass campaigns supplement routine immunization to maintain high population immunity
India achieved polio-free status through successful campaign efforts
Continued vigilance needed to maintain elimination status.
Home Care:
• Normal activities after vaccination, no special precautions needed
Hand hygiene important due to vaccine virus shedding in stool for 3-6 weeks
Report any unusual symptoms to healthcare provider
Maintain updated immunization records including campaign participation.
Medication Administration:
• Campaign administration by trained health workers only
No medications needed post-vaccination unless adverse events occur
Complete routine immunization schedule as recommended
Vitamin A supplementation often given simultaneously during campaigns.
When To Seek Help:
• Seek immediate medical attention for sudden weakness or paralysis in arms or legs
High fever, altered consciousness, severe allergic reactions
Persistent vomiting or diarrhea beyond 2-3 days
Any parental concerns about child's health post-vaccination.