While Sindh has become a key battleground for the eradication of polio from the country, its newly inducted Health Minister Dr Sagheer Ahmed on Thursday declared that an increase in polio cases was mainly due to the use of polluted water. The minister asked the district governments to ensure supply of clean drinking water to their respective populations. According to official sources, Dr Ahmed has taken serious notice of the reports pertaining to the detection of polio cases across the province and ordered immediate mitigation measures. He expected that staffers involved in vaccination activities would discharge their duties honestly to make the province free of polio virus at the earliest. On May 14, Sindh reported its eighth polio case since January 2008. Last year, as many as 12 cases of polio were detected in the province. Experts are of the view that the areas affected by the polio virus, including Karachi, Hyderabad, Nawabshah, Jacobabad, Mirpurkhas, Shikarpur, Naushehro Feroze and Dadu, may prove a major risk to the efforts of interrupting the polio virus transmission and are a threat to polio free areas throughout the country. They stressed the need for high quality vaccination activities in the coming days. International and national monitors should focus sincerely on the anti-polio campaign activities conducted in Sindh, otherwise a zero reporting of polio cases would prove to be a far cry in 2009 as well, they said. Fortunately, no cases of polio have been reported from other parts of the country, which has also caused embarrassment to the health managers of Sindh and their foreign supporters representing international donors and health agencies involved significantly in the anti-polio campaigns. A source privy to the immunisation activities in the province said that the detection of eight polio cases during the current year had not only made the funding of around 70 rounds of polio vaccinations carried out in Sindh since 1994 but also the entire exercise involving thousands of vaccinators and polio workers under the supervision of the local health officials and their foreign counterparts questionable. In a statement, the provincial minister for health said that a special campaign would be launched from May 26 in the areas which had reported confirmed polio cases in the recent months, while the district governments would be directed to care for the quality of drinking water. There was a need for making concerted and coordinated efforts by all the stakeholders and the relevant government departments and agencies, he remarked. The minister hoped that no polio cases would be reported in the province beyond 2008. He asked the Sindh Expanded Programme on Immunisation's project director, Dr Mazhar Khamisani, to check the performance of the vaccination centres and lady health workers and to make sure that every child under five years was being administered the routine and supplementary immunisation doses. He also directed that arrangements should also be made to give polio oral drops to children coming to Sindh from other provinces of Pakistan. Questioning the efficacy of oral polio vaccine in some cases, Dr Ahmed also called for a proper handling and storage of the vaccines. Experts largely feel that the polio viruses are not associated with waterborne transmission to the same extent as many other enteric viruses, but they are typically transmitted by the faecal-oral route, which implies that the risk of infection by exposure to the viruses in water cannot be underestimated. The risk appears particularly high among the rural communities, which are living without any access to proper hygienic facilities.