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The withered, twisted limbs of polio victims are common among the teenagers and adults of Tilkeshwar. One boy, who looks 10 but says he is 17, clings to a bamboo stick, his right leg bent and shriveled from the polio he got as a 6-month-old.

Lalti Kumari, a shy 3-year-old, limps alongside her grandmother. She had been vaccinated 12 times, but still caught the disease in March 2009, likely because malnourishment or diarrhea made the doses ineffective.

“I don’t know how it happened,” said her mother, Sharmila Devi.

Kumari’s case is vexing but also represents hope _ she is one of the last people to have come down with polio here.

The battle against polio dates back to the development of modern sanitation in the 19th century. This public health triumph stopped the spread of many fatal illnesses, but also turned polio from a relative rarity into a raging menace.

As contact with polio-laced sewage became less frequent, people no longer contracted the disease in early infancy, when side effects were rare. Suddenly, older children began succumbing to polio, which invaded their central nervous system and cursed its victims to a lifetime on crutches or in wheelchairs.

In the United States, families lived in fear of the summer, when the disease ran rampant. Parents kept their children out of public pools and movie theaters. Schools delayed opening until the outbreaks had subsided. Thousands were paralyzed or killed every year.

In 1953, Jonas Salk developed an injectable vaccine from dead polio virus. A few years later, Albert Sabin developed an oral vaccine from weakened, live virus that was even easier to administer. In the U.S. alone, cases plunged from 21,000 in 1952 to 61 in 1965.

In the 1980s, public health officials, giddy from their triumph in eradicating smallpox, turned their sites on polio.

The World Health Assembly started a global effort in 1988 to eradicate the virus by 2000. It was wiped out across the Americas by 1991; the Western Pacific by 1998; Europe by 1999.

But the drive stalled in Africa and south and central Asia. About 1,000 people a year fell prey to the disease, a huge drop from 350,000 before the campaign, but far short of eradication.

Polio proved to be far more elusive than smallpox, which brings a rash that makes those infected easy to locate. With polio, fewer than 1 percent of the infected fall ill, but they still spread the virus in their stool.

And the four countries where polio remains endemic presented other challenges. In Afghanistan and Pakistan, lawlessness and conflict made it difficult for vaccinators to reach children. In northern Nigeria, Muslim religious leaders boycotted the vaccine as a Western plot to sterilize their children. In India, malnutrition and chronic diarrhea made children too weak to properly process the vaccine.

Donors were losing patience with a program that has already cost nearly $9 billion, and requires another $750 million each year. But even as skepticism soared, victory suddenly seemed within reach in India.

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