Pulse Polio Immunization Programme

Poliomyelitis (Polio) is a viral infectious disease that can cause flaccid paralysis by affecting the central nervous system in about 0.5% of cases.

Etiopathogenesis of Poliovirus

1. Causative Agent:

• Poliovirus is an enterovirus belonging to the Picornaviridae family.
• There are three serotypes: PV1, PV2, and PV3 (PV1 is most commonly associated with paralysis).

2. Mode of Transmission:

• Fecal-oral route (primary)
• Oral-oral route (less common)

3. Pathogenesis:

• Entry: Virus enters through the mouth and multiplies in the oropharynx and gastrointestinal tract (lymphoid tissue like tonsils and Peyer's patches).
• Viremia: Virus enters the bloodstream and may spread to other sites.
• CNS Invasion: In <1% of cases, the virus crosses the blood-brain barrier or is transported via peripheral nerves to the central nervous system (CNS).
• Neuronal Damage: The virus targets anterior horn cells of the spinal cord, causing motor neuron destruction, leading to flaccid paralysis.
• Outcomes:
• Asymptomatic (90–95%)
• Minor illness (4–8%) – fever, sore throat
• Non-paralytic poliomyelitis (<1%) – aseptic meningitis
• Paralytic poliomyelitis (<0.5%)

Pharmacotherapy of Poliovirus

There is no specific antiviral treatment for poliovirus. Management is primarily supportive and preventive:

1. Supportive Treatment:

• Bed rest, analgesics for pain
• Physical therapy to prevent deformities and improve mobility
• Ventilatory support (iron lung or modern ventilators) in case of respiratory muscle paralysis

2. Preventive Pharmacotherapy (Vaccination):

• OPV may rarely cause vaccine-associated paralytic polio (VAPP) or circulating vaccine-derived poliovirus (cVDPV).
• IPV is introduced to mitigate VAPP and cVDPV risks.

Pulse Polio Immunization in India

• Launched in 1995 as part of the global polio eradication initiative following the 1988 World Health Assembly resolution.
• Targets children aged 0–5 years with polio drops during national and sub-national rounds.

Key Milestones

• 1995: Pulse Polio Programme launched
• 2009: India reported half of the global polio cases
• 2011: Last polio case in India
• 2012: WHO removed India from the list of endemic countries
• 2014: India declared polio-free

Aims and Objectives

• Immunize every child, especially in remote areas
• Ensure no child is missed during immunization
• Timely reporting of acute flaccid paralysis (AFP) cases and stool sample collection
• Rapid outbreak response immunization (ORI)
• Maintain strong surveillance systems

Steps to Maintain Polio-Free Status

• Annual high-quality immunization rounds
• Surveillance for any virus importation or circulation
• Environmental surveillance through sewage sampling

Polio Eradication and Preparedness Efforts in India

Rapid Response and Emergency Plans

• All States/UTs have Rapid Response Teams (RRTs) and Emergency Preparedness and Response Plans (EPRPs) to handle any polio outbreaks.

Preventing Importation

• Continuous Vaccination Teams (CVTs) deployed at international borders to vaccinate eligible children around the clock.
• As of August 31, 2015, approximately 7.8 million children vaccinated with OPV.
• Since March 2014, mandatory polio vaccination for international travelers to and from India and affected countries like Afghanistan, Nigeria, Pakistan, etc.
• A rolling stock of OPV is maintained for emergency response.

Introduction of IPV in Routine Immunization

• In line with the Polio Eradication & Endgame Strategic Plan 2013–2018, India introduced the Inactivated Poliovirus Vaccine (IPV) in 2015.
• IPV is given with the third dose of OPV at 14 weeks of age for infants.

Programme Outcomes

• Over 17.4 crore children under 5 years receive polio drops annually.
• Last polio case reported on 13 January 2011 in Howrah, West Bengal.
• WHO removed India from the list of polio-endemic countries on 24 February 2012.

Reference 

Malviya K, Sahoo S, Dasadiya D, Acharya V. Social and Preventive Pharmacy. 1st ed. Pee Vee (Regd.); 2021

NPCB 1976

Definition of Blindness:

• NPCB: Inability to count fingers from 6 meters (vision ≤ 6/60).
• WHO: Vision ≤ 3/60.

Major Causes of Blindness:

• Cataract (62%)
• Refractive Errors (20%)
• Glaucoma (6%)
• Posterior Segment Disorders (5%)
• Post Capsular Opacification, Corneal Blindness, Surgical Complications (1% each)
• Others (4%)

Types of Blindness:

• Economic: Vision ≤ 6/60.
• Social: Vision ≤ 3/60 or visual field ≤ 10°.
• Absolute: No light perception.
• Manifest: Vision 1/60 to light perception.
• Curable: Reversible with treatment (e.g., cataract).
• Preventable: Avoidable with preventive care (e.g., xerophthalmia).
• Avoidable: Includes both preventable and curable blindness.

Introduction:

• Launched in 1976 as the world's first national-level blindness control programme.
• Goal: Reduce blindness prevalence from 1.4% to 0.3%.
• Progress: Reduced to 1.1% in 2001-02 and 1.0% in 2006-07.
• Decentralized in 1994-95 with the formation of District Blindness Control Societies (DBCS).
• Aligns with Vision 2020: The Right to Sight.

Visual Acuity:

• Defined as the sharpness of vision, measured by comparing what a person can see to what a person with normal vision can see.

Objectives:

1.     Identify and treat blindness at all levels (primary to tertiary).

2.     Strengthen eye care services and deliver quality care.

3.     Upgrade Regional Institutes of Ophthalmology (RIOS).

4.     Improve infrastructure and human resources.

5.     Raise community awareness on eye health.

6.     Promote research in blindness prevention.

7.     Involve NGOs and private practitioners.

Strategies:

• Focus on free cataract surgeries through public and private sectors.
• Expand scope to include other conditions:
  Diabetic Retinopathy, Glaucoma, Corneal Blindness, Vitreo-retinal diseases, Childhood Blindness, etc.

Key Initiatives & Activities:

·        Active Screening: Focus on screening people over 50 years for cataract to reduce backlog.

·        Capacity Building: Train eye care providers and upgrade infrastructure.

·        IEC Activities: Awareness programs on eye care for the community.

·        Strengthening Institutions: Upgrade RIOS, medical colleges, and district hospitals with equipment, staff, and funds.

·        Primary Eye Care: Establish Vision Centers at PHCs and strengthen primary eye services.

·        Mobile Ophthalmic Units (MDMOU):

• Screen patients in remote areas
• Transport patients to hospitals
• Conduct on-spot refraction & provide free glasses
• Detect conditions like diabetic retinopathy & glaucoma
• Display health messages & involve local governance

·        School Eye Screening: Identify and treat refractive errors in primary and secondary school children, with focus on underserved areas.

·        Community Focus: Special emphasis on illiterate rural women, integrating with women & child development schemes.

·        Dedicated Facilities: Build Eye Wards and Eye OTs in district hospitals as needed.

·        Private Sector Involvement: Encourage participation of private practitioners and NGOs.

 Components of NPCB:

1.     Cataract surgery – Core focus of the program.

2.     Eye screening – For early detection of visual impairments.

3.     Eye donation – Promoted through Eye Donation Fortnight (Aug 25–Sep 8).

4.     Voluntary organization participation – NGOs support eye care services.

5.     Vitamin A prophylaxis – Oral syrup for all preschool children.

6.     IEC Activities – Awareness programs like World Sight Day (2nd Thursday of October).

   Integrated Initiatives:

• Free cataract surgeries, medicines, and spectacles (for postoperative care and poor students).
• Free transport for patients from remote areas.
• Coverage of all school children for screening and Vitamin A & immunization.
• Establishment of Eye Banks and one Regional Institute of Ophthalmology (RIO).
• Modern eye care services at Medical Colleges & District Hospitals (DHHs).

 Outcomes & Achievements:

• IOL (Intraocular Lens) surgeries rose from 20% (1997–98) to 95% (2013–14).
• 15.3 million cataract surgeries conducted, preventing blindness.
• 70–80% of targeted school children receive free spectacles yearly.
• Increased eye donation due to awareness campaigns.
• Free treatment provided for diabetic retinopathy, glaucoma, childhood blindness, keratoplasty, etc.

Overview

1. Definition of Blindness

• NPCB: Vision ≤ 6/60 (can’t count fingers at 6 m).
• WHO: Vision ≤ 3/60.

2. Major Causes of Blindness in India

• Cataract – 62%
• Refractive Errors – 20%
• Glaucoma – 6%
• Posterior Segment Disorders – 5%
• Others (incl. PCO, Corneal, Surgical) – 7%

3. Types of Blindness

• Economic: Vision ≤ 6/60
• Social: Vision ≤ 3/60 or field <10°
• Absolute: No light perception
• Manifest: Vision 1/60 to light perception
• Curable: Reversible (e.g., cataract)
• Preventable: Avoidable through prevention
• Avoidable: Curable + Preventable

4. Programme Overview

• Launched: 1976
• Goal: Reduce prevalence from 1.4% to 0.3%
• Vision 2020: “The Right to Sight”
• Decentralized in 1994-95 via District Blindness Control Societies (DBCS)

5. Objectives

• Identify/treat blindness at all levels
• Strengthen eye care services & RIOs
• Develop infrastructure & human resources
• Promote community awareness
• Encourage research & NGO participation

6. Key Strategies

• Free cataract surgeries, medicines, spectacles
• Mobile units (MDMOU) for screening & transport
• Vision Centers at PHCs
• Eye screening for school children
• Vitamin A supplementation for preschoolers
• IEC activities: World Sight Day (2nd Thursday of Oct)
• Focus on rural, illiterate women
• Construct Eye Wards & Eye OTs in districts

7. Programme Components

1.     Cataract Surgery

2.     Eye Screening

3.     Eye Donation (Aug 25–Sep 8)

4.     Voluntary Organizations

5.     Vitamin A Prophylaxis

6.     IEC Campaigns

8. Integrated Initiatives

• Free surgery, transport, drugs, and glasses
• Coverage of all schools and remote areas
• Establish 2 Eye Banks + 1 RIO
• Advanced care at Medical Colleges & DHHs

9. Achievements

• IOL surgeries: 20% (1997-98) to 95% (2013-14)
• 15.3 million cataract surgeries done
• 70–80% of school vision targets met yearly
• Rise in eye donation rates
• Free treatment for DR, Glaucoma, Childhood Blindness, Keratoplasty

Reference

Malviya K, Sahoo S, Dasadiya D, Acharya V. Social and Preventive Pharmacy. 1st ed. Pee Vee (Regd.); 2021.

NPPCD

Deafness.

Anatomy of the Ear

The ear is divided into three main parts:

1. External Ear

• Pinna (Auricle): Captures sound waves and directs them into the ear canal.
• External Auditory Canal: Carries sound to the tympanic membrane.

2. Middle Ear

• Tympanic Membrane (Eardrum): Vibrates in response to sound waves.
• Ossicles (Tiny Bones):
• Malleus (hammer)
• Incus (anvil)
• Stapes (stirrup)
  These bones amplify and transmit vibrations from the eardrum to the inner ear.
• Eustachian Tube: Equalizes pressure between the middle ear and atmosphere.

3. Inner Ear

• Cochlea: Spiral-shaped organ responsible for converting sound vibrations into nerve impulses.
• Vestibular Apparatus (Semicircular Canals, Utricle, Saccule): Helps maintain balance.
• Auditory Nerve (Cochlear Nerve): Transmits signals from the cochlea to the brain.

Physiology of Hearing

1.     Sound waves enter the external ear.

2.     Tympanic membrane vibrates, moving the ossicles.

3.     Stapes taps on the oval window, creating fluid waves in the cochlea.

4.     Hair cells in the cochlea detect fluid movement and convert it into electrical signals.

5.     Auditory nerve carries these signals to the brain, where sound is interpreted.

Etiopathogenesis and Pharmacotherapy of Deafness – Summary

Etiopathogenesis of Deafness

Deafness is caused by damage or dysfunction in the auditory pathway and is broadly classified into:

1. Conductive Hearing Loss

Occurs due to obstruction or damage in the external or middle ear, preventing sound conduction.

• Causes:
• Impacted ear wax
• Otitis media (acute, chronic, secretory)
• Tympanic membrane perforation
• Otosclerosis
• Trauma or foreign body

2. Sensorineural Hearing Loss (SNHL)

Caused by damage to the cochlea, auditory nerve, or central auditory pathways.

• Causes:
• Congenital (genetic syndromes, birth injuries)
• Presbycusis (age-related)
• Noise-induced hearing loss
• Ototoxic drugs (e.g., aminoglycosides, cisplatin)
• Infections (e.g., rubella, meningitis)
• Head trauma

3. Mixed Hearing Loss

Involves both conductive and sensorineural components.

Pharmacotherapy of Deafness

Treatment depends on the underlying cause and type of deafness.

1. Conductive Hearing Loss

• Ear wax:
• Wax softeners: Carbamide peroxide, hydrogen peroxide, sodium bicarbonate drops
• Infections:
• Acute Otitis Media: Amoxicillin or amoxicillin-clavulanate
• Chronic Otitis Media: Topical antibiotics (e.g., ciprofloxacin drops)
• Otitis externa: Antibacterial or antifungal ear drops
• Inflammation:
• Steroid drops for allergic or inflammatory conditions

2. Sensorineural Hearing Loss

• Sudden SNHL:
• Systemic or intratympanic corticosteroids (e.g., prednisolone)
• Autoimmune causes:
• Immunosuppressive therapy (steroids, methotrexate)
• Infectious causes (e.g., syphilis):
• Specific antibiotics (e.g., penicillin)
• Ototoxicity:
• Discontinuation of offending drug
• Antioxidants under research (e.g., N-acetylcysteine)

3. Supportive Therapy

• Hearing Aids for irreversible hearing loss
• Cochlear Implants in profound SNHL
• Speech and language therapy
• Tinnitus management (e.g., ginkgo biloba, anti-anxiety meds)

National Programme for Prevention and Control of Deafness (NPPCD)
Objectives, Functioning, and Outcomes – Summary

Objectives:

1. Prevent avoidable hearing loss due to disease or injury.
2. Ensure early identification, diagnosis, and treatment of ear problems.
3. Provide medical rehabilitation for people of all age groups with hearing loss.
4. Strengthen inter-sectoral linkages for long-term rehabilitation.
5. Develop institutional capacity through training and equipment.
6. Reduce the overall burden of hearing impairment by 25% by the end of the 12th Five Year Plan.

Functioning:

• Training & Capacity Building:
  Training of ENT specialists to grassroot workers (e.g., ASHAs, AWWs, teachers). Strengthening PHCs, CHCs, and district hospitals with ENT kits and diagnostic tools.

• Service Provision:
  Audiometric assistants and speech instructors posted at district hospitals. Services include screening, treatment (medical/surgical), rehabilitation, and referral.

• Awareness Generation (IEC/BCC):
  Public campaigns to promote early detection and reduce stigma around deafness.

• Screening Camps & School Screening:
  Regular camps and annual screening of primary school children for ear conditions.

• Hearing Aids Distribution:
  Free hearing aids provided to children under 15, with one-year service support.

Outcomes:

• Expansion to 228 districts across 27 States/UTs.
• Over 6,380 hearing aids distributed.
• More than 335 screening camps conducted.
• Improved public awareness, early intervention, and infrastructure for ear and hearing care.