The Sindh health department is expected to place the issue of vulnerability of children beyond five years to polio in a meeting of international experts on polio eradication scheduled to be held in the city on June 24 and 25. Sources in the health department said that prior to the emergence of cases of polio among children above five years of age, the authorities had no clue to the pattern of the disease in this age group, and now they were considering raising the age-limit for polio vaccination from five to 10 years, to provide protection to children in this age bracket as well. As there was a constant decline in polio cases from 2002 to 2005, the anti-polio strategists and operational staff in the province had breathed a sigh of relief, but once again they are finding themselves in trouble due to an upsurge in lab-confirmed polio cases, the sources added. The situation can be viewed as a grave one, particularly in view of the fact that of the 10 cases reported so far in the province during 2008, four pertained to individuals of more than five years of age. The latest case was reported from Sanghar district where a nine-year-old boy was tested positive for polio-virus in May. According to an expert, it is correct that detection of P1 polio-virus strain in all affected children of Sindh during the year has forced health officials to rethink their policy, but it is also a point to ponder whether a one or two time administration of protective polio vaccine, if suggested by the TAG (technical advisory group on polio eradication for Pakistan), would be able to result in an up-to-the-mark coverage in the desired age group. Another view was that detection of cases in children of nine years and above age groups reflected that polio eradication initiatives launched in 1994 had not been fully scientific and in line with population patterns, their living-style and geographical requirements of the country and provinces. Sindh health secretary Shafiq A. Khoso told Dawn that since TAG consultation was being held (on June 24 and 25) to address the operational challenges, affecting the province's implementation of polio-eradication activities, it would be relevant if the issue of onset of paralysis and other symptoms in children above five years was also taken up at the international moot. In reply to a question, he said he personally felt that there had never been a problem of efficacy of vaccines, but its acceptability by all and reach of the health staff. Had there been an honest execution and delivery of routine immunisation as per internationally recognised standards, there would not have been the question of inadequate immunity level among children at any stage, he said, adding, "efforts are being redirected towards a 100 per cent routine immunisation in all areas of the province.' He said he was going to hold a meeting with EDOs of 10 districts in Larkana in a couple of days to discuss improvements in the health-care delivery system and protection of children against polio-virus.