Double vaccines ‘could hasten the end of polio’

This is an interesting piece on the current global fight against Polio, written by James Gallagher Health editor, BBC News website.

Using both types of polio vaccine could speed up efforts to free the world of the disease, research suggests.
The oral vaccine is leading the fight to eradicate polio, but trials in India show an additional injection of inactivated virus boosts immunity.
The World Health Organization said the findings, published in the journal Science, were “truly historic”.
The disease, which is spread through contaminated faeces, can cause paralysis and even death.
Fighting polio has been one of the biggest success stories in global health.
In 1988, there were 350,000 cases of polio in more than 125 countries.
The disease is now widespread in just three countries – Nigeria, Afghanistan and Pakistan – and cases have fallen by more than 99%.

Vaccines
Two drops of the oral vaccine, which contains a weakened polio virus, is the preferred tool in eradication efforts because it is cheap and gives resistance in the digestive tract to lower transmission of the virus.
The injected vaccine works largely in the bloodstream.
“But the oral vaccine is less effective in exactly those places we’d like it to work,” one of the researchers, Prof Nicholas Grassly, of Imperial College London, told the BBC.
It is thought other infections may interfere with the vaccine.
The solution has been multiple vaccination. As part of India’s successful eradication campaign, some children received 30 doses by the age of five.
Trials in India showed using an injection of inactivated virus as a booster jab was more effective than multiple drops.
However, the biggest challenge in banishing the disease for good is not the choice of vaccine, but getting to children in conflict-ridden areas.
The security issues can be huge and vaccination programmes are even used as a political weapon.
In 2012, the Taliban said vaccinations in the North and South Waziristan regions of Pakistan were banned until the US ended drone strikes.
Prof Grassly argues: “If you have limited access, you want the biggest return. If you can go in with inactivated and oral polio vaccine, you will achieve a lot more than if you just have brief access with oral polio vaccine.”
The double-vaccine approach is already being used in parts of Nigeria and will soon be introduced into Pakistan also.
Dr Bruce Aylward, the World Health Organization assistant director general for polio, said: “The results of this study are truly historic in the context of global polio eradication.
“This study has revolutionised our understanding of inactivated polio vaccine and how to use it in the global eradication effort to ensure children receive the best and quickest protection possible from this disease.”

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The End of Polio: Polio’s last percentage – Bill and Melinda Gate’s Foundation

I came across this on the internet and as an agent of social change, fighting inequity across the globe, I felt duty bound to spread the message. It reads as follows:
Polio – a disease which has disabled millions and pulled people further into poverty – has been reduced by 99% over the past 25 years.
Global efforts have delivered incredible progress: immunising more than 2 billion children and saving more than 8 million children from life-long paralysis or death. In January, the world reached a remarkable milestone in the fight to eradicate polio – 12 months without a case of polio in India for the first time in history.
But progress towards eradication is at risk: with the critical work of the Global Polio Eradication Initiative constrained by a funding gap of almost US$1 billion for 2012/13 – threatening international polio eradication efforts.
That’s why the Global Poverty Project is working with partners to support the Global Polio Eradication Initiative, and make the end of polio reality.

We can all play a role in ensuring that polio is eradicated.

Last year, more than 20,000 ordinary people made their voices heard and helped convince five world leaders, together with Bill Gates, to announce an additional $118 million in funding for the Global Polio Eradication Initiative. This year, we’re calling on delegates to the United Nations General Assembly to announce further funding for polio eradication, closing the funding gap that’s currently leaving millions of children vulnerable to polio.

Global PEI under threat: A Ban on Polio Vaccination in Parts of Pakistan Puts the Entire World at Risk

I came a cross a colleagues link on this from TIME magazine and decided to share the story:
Thousands of public-health workers fan out across Pakistan today in the first day of a three-day campaign to vaccinate the country’s children against polio, an estimated 250,000 won’t be receiving the potentially lifesaving dose, the social-affairs secretary for Pakistan’s Federally Administered Tribal Areas, Aftab Akbar Durrani, told VOA’s Urdu Service yesterday. Last month, militant leaders in two of the most lawless districts of Pakistan’s Federally Administered Tribal Areas (FATA) declared that the vaccination teams would not be allowed to conduct their campaign, declaring that the locally run program was merely a ruse to allow American spies to penetrate the region. “In the garb of these vaccination campaigns, the U.S. and its allies are running their spying networks in FATA, which has brought death and destruction on them in the form of drone strikes,” wrote Mullah Nazir, one of South Waziristan’s major militant commanders, in a pamphlet that was widely distributed on June 25. His screed echoed that of a commander in North Waziristan, Hafiz Gul Bahadur, whose own pamphlet from a week earlier was even more direct: “We don’t want benefits from well-wishers who spend billions to save children from polio, which can affect one or two out of hundreds of thousands, while on the other hand the same well-wisher (America) with the help of its slave (Pakistan’s government) kills hundreds of innocent tribesmen including old women and children by unleashing numerous drone attacks.” The ban on vaccinations, he continued, would not be lifted until the drone strikes stop.

Both Nazir and Bahadur reiterated to TIME through a special correspondent in Peshawar yesterday that they would not reconsider the ban on vaccination teams, citing the ongoing drone campaign in the country’s tribal regions.

(MORE: The Taliban Halts Polio Vaccines — and Pakistan’s Kids Will Pay)

As my colleague Jeffrey Kluger wrote in the wake of the first pamphlet,

Using children as medical poker chips is indefensible under any circumstances, but the Pakistanis do have other reasons to be suspicious of Westerners bearing vaccines. In the months leading up to [Osama] bin Laden’s killing in May 2011, a local doctor who was also working for the CIA ran a hepatitis-vaccination campaign in and around Abbottabad, where bin Laden was holed up. The real purpose was to try to obtain DNA samples that would confirm bin Laden or his family members were indeed in residence. That, surely, figured in the Taliban’s decision.

But the militant’s math — “one or two out of hundreds of thousands” — demonstrates an egregious misunderstanding of the sinister swath that polio can cut through a population of healthy, active kids, according to Kluger:

For every clinical case of polio, there are 200 subclinical ones that can present themselves merely as a bad summer cold; but that’s 200 active carriers who can and do spread the wild virus. Even people who are infected with what will turn out to be a crippling strain of the disease do not know they’re sick for a week or more, as the virus makes the long journey from the throat to the gut to the bloodstream — multiplying explosively all the way — and finally to the anterior horns of the spinal cord and the medulla oblongata of the brain, where it wipes out the cells that signal the muscles, paralyzing them forever.

(MORE: Polio’s Back. Why Now?)

The vaccination campaigns take place every six weeks or so; each child under the age of 5 requires three doses to ensure that he or she is truly immune. So not only will the militants’ ban leave the very young vulnerable, it will also negate the effects of previous vaccination campaigns. That too will have long-term consequences, not just for the children but for the worldwide campaign to eradicate polio for good, according to Kluger:

Until very recently, polio appeared to be at the very brink of eradication — which would make it only the second disease ever to be wiped out in the wild, following smallpox, which was finally vaccinated out of existence in 1977. As recently as 1988, there were 350,000 cases of polio worldwide, distributed across 125 countries. Thanks to an aggressive, 24-year eradication campaign headed by UNICEF, WHO, the CDC and Rotary International, however, there were only 650 cases worldwide last year and only 73 so far this year — confined to just three countries: Afghanistan, Pakistan and Nigeria.

Afghanistan’s 10 cases this year have occurred in the country’s south, along the border with Pakistan, where ongoing fighting has prevented vaccination teams from accessing the children. Pakistan’s 22 cases, however, have occurred in all four of the country’s provinces, a worrying sign of the disease’s spread. Nigeria, with 52 cases of paralysis this year, will still be the most difficult country to tackle, though numbers have plummeted over the past four years. (There have been 11 new cases in Nigeria in the three weeks since Kluger wrote his story, which explains the discrepancy.)

Still, with so few cases worldwide, the prospect of global eradication is tantalizingly close. The longer the Pakistani militants’ ban on vaccination goes on, the more difficult it will be to reach that goal. They might think they are making a point, instead they are holding the lives of Pakistan’s, and the world’s, children hostage. When challenged on that point, both Nazir and Bahadur argued that they were looking out for the long-term good of their people. It’s hard to see how.

MORE: Bill Gates: ‘We’re Making Progress’ at Eradicating Polio

Why polio just became a global health crisis!

Another interesting piece on Polio Eradication to share.

Though only 650 cases were recorded last year, the World Health Organization declared the disease an emergency, but its importance goes beyond public health.

Few people probably associate the phrase “global health emergency” with polio, a disease that has been around for 5000 years and is on a decades-long decline so steep that there are less than a thousand recorded cases left on Earth, and it no longer even seems real to many in the developed world. “Global health emergency” might sound applicable to HIV/AIDS, malaria, or cancer, but polio?

And yet, that is exactly what happened late last Friday afternoon in Geneva, when the World Health Assembly, the governing body of the World Health Organization, declared polio a public health emergency, calling for the 194 member states to fully fund the Global Polio Eradication Initiative, and fill the currently $945 million gap in its budget for 2012-13. But this is about much more than just filling a budget shortfall: polio’s threat is still very real, and the mission to finally stamp it out forever is a crucial one for reasons even bigger than the disease itself.

Since the world decided to come together to eradicate polio in 1988, the disease has been almost entirely eliminated. It killed or paralysed more than 350,000 children each year in the 1980s, but there were just 650 recorded cases in 2011. In January, India celebrated its first polio-free year in history, leaving the disease endemic in just three countries: Nigeria, Pakistan and Afghanistan. The latest figures from the World Health Organization show only 60 cases so far in 2012.

But polio is a different type of emergency than the ones we usually hear about in the news. Its biggest danger isn’t the current number of cases, but the implications for failure: not only because a failure to eradicate could allow for a resurgence that could kill or disable thousands of children each year, but because of what it holds for the effectiveness of our global health systems itself.

Part of the risk has to do with money. Over the past quarter century, $9.5 billion has already been spent on polio eradication, driven by international organizations — primarily the WHO and UNICEF — as well as private donors such as the Gates Foundation and Rotary. The WHO’s strategic advisory group of experts on immunization have said that failure to eradicate polio would be “the most expensive public health failure in history.” A failure to make all that money achieve its intended goal could make it tougher to solicit donations from countries and individuals for future eradication campaigns.

The other element is symbolic. In a sense, polio will be a marker of either what the world can or cannot achieve in global health. “If we finish polio eradication, what it will prove is that with a relatively modest investment in the grand scheme of things, you can achieve real health outcomes,” says Bruce Aylward, the Canadian epidemiologist who heads the WHO’s eradication efforts.

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The Global Polio Eradication Initiative

It was in 1988 at the 41st World Health Assembly (WHA), comprising of delegates from 166 member countries that a resolution for the worldwide Polio eradication was adopted. Considered as a milestone, it marked the launch of the Global Polio Eradication Initiative under the leadership of the WHO and supported by US CDC, Rotary International and the United Nations Children’s Fund (UNICEF). This followed the certification of the eradication of smallpox in 1980, progress during the 1980s towards elimination of the poliovirus in the Americas, and Rotary International’s commitment to raise funds to protect all children from the disease. The launch of the Global Polio Eradication Initiative resulted in significant drop in the number of polio cases (> 99 per cent) seen across the globe.

In Nigeria, the northern part f the country has persistently been reporting pockets of polio virus transmission. Furthermore, there are also reported cases of the polio virus along the border between Afghanistan and Pakistan and these areas still remain key epidemiological challenges towards eradication of the polio virus. In the case of India, there is sustained level of commitment and if such is maintained, indicators has it that a milestone could be reached within the first quarter of 2012.

It is possible to achieve total polio eradication within the remaining 3 countries especially considering the fact that:

• In 1994, WHO certified 36 countries of the Americas as polio-free,
• In 2000, WHO certified 37 countries in the Western Pacific region including China in and
• In 2002, WHO certified 51 countries in the European region.

With a hind-sight, 2010 was a year when the European region suffered its first importation of polio (after its certification) and in 2011 was a reported case of imported polio in the Western Pacific region.
In my next blog post, I hope to discuss the objectives and strategies of the PEI.

An overview

Polio, a highly infectious disease caused by a virus, has no cure but can only be prevented (life-long) using a polio vaccine given couple of times to under-five children. Infection is by faeco-oral route and gets multiplied in the intestine finally invading the nervous system which resultant paralysis within hours.

Although symptoms are protean in nature, they include fever, fatigue, headache, vomiting, neck stiffness and pain in the limbs. In every 1 in 200 infected cases, irreversible paralysis (usually affecting the legs) ensues. In those paralysed, there is a mortality rate of about 5-10 per cent especially when the diseases affected their breathing muscles.

Significant achievements have been recorded due to the intensified efforts to ensure global eradication of the disease. The global case load of the disease have decreased by over 99 per cent from an estimated 350,000 cases in more than 125 endemic countries in 1998 to 1349 reported cases in 2010. Furthermore, case numbers of wild polio virus type 3 are down to the lowest recorded level in history. It is equally important to add that as at 2011, only parts of four countries (Nigeria, Afghanistan, India and Pakistan) in the world remain endemic for the disease and this is considered as the smallest geographic area in history.

In my next blog post, I intend to discuss global Polio Eradication Initiative (PEI).