In 1996, India had nearly 75,000 cases of polio. The figure came down drastically over the years to touch 66 in 2005. But in the last eight months, polio cases have shot up to 296, forcing the Union health and family welfare ministry to redraw its polio eradication campaign.
A vigorous healthcare campaign across the country, with the solid backup from the World Health Organisation, launched in 1997 considerably reduced the incidence of polio.
But last month, a WHO bulletin said: 'The outbreak of polio in the Moradabad district of Uttar Pradesh is rapidly spreading and cases are confirmed in central Uttar Pradesh, Haryana, Chandigarh and West Bengal.'
"There is a surge in polio cases this year because many children were not given the vaccinations last year in districts like Moradabad because many primary health care centres there do not have any staff," an official at the Union health ministry said.
According to the ministry records, Moradabad and surrounding districts now account for over half of India's polio cases in 2006 (158 of 296 cases). By comparison, for the same period, only 29 cases have been confirmed in the entire country.
Early this year, WHO carried out a study that said Moradabad and its surrounding areas is the only place in the world actively exporting the polio virus to other countries -- polio originating from this area has recently been detected in a number of previously polio-free countries, including as far away as Namibia, the Democratic Republic of the Congo, Bangladesh and Nepal.
This year, the government carried out supplementary immunisation activities in Moradabad in June and July. Officials say the key problem is that more than 40 percent of government medical officer positions in key districts of western UP remain vacant.
The health ministry has now asked the Uttar Pradesh government to fill the vacancies to ensure that the polio immunisation drive reaches every child in the state.
WHO officials, who held a series of meetings with top Indian health officials, have now advised the Indian government to conduct a more extensive immunisation campaign in October or November limit the spread of polio in India.
On Monday, Union Minister for Health and Family Welfare Dr Anbumani Ramadoss again pledged that the government plans to eliminate polio from the country by 2007. But the minister admitted that polio cases have shown increase in eight states in 2006.
Officials at the Union health ministry say polio cases have been reported in Uttar Pradesh (269), Bihar (17), Haryana (5), Madhya Pradesh (1), Jharkhand (1), West Bengal (1), Uttaranchal (1) and Maharashtra (1).
Health experts and officials put forward various reasons for the spurt in polio cases. "It is because polio eradication is a daunting task in states like Uttar Pradesh. There has to be more emphasis on the eradication campaign in Uttar Pradesh and Bihar," says pediatric expert Dr R Ravi, who runs the Kochi-based Children's Medical Centre.
Dr Ravi, who has authored a research paper on polio eradication strategies in south and north India, points out that the task of eradicating polio in states like Uttar Pradesh and Bihar is huge mainly because of high population density and low sanitation infrastructure. "Polio is virtually gone from the south because of better health care infrastructure facilities in villages," he said.
"For instance," Dr Ravi says, "Uttar Pradesh has a population of more than 180 million. And every month more than 500,000 children are born in the state. It requires solid health care infrastructure to completely eradicate polio there."
Health ministry officials say one reason why the number of polio cases has risen alarmingly this year is because there was a "marginal increase in missed children during the immunisation drive in late 2005."
Though India has made tremendous progress in polio eradication, thanks to the consistent implementation of immunisation campaigns, the 296 cases this year make it the country with the second largest polio cases in the world.
The largest number of polio cases is in Nigeria with 803 this year, according to WHO.