Polio eradication setbacks in endemic countries

 

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Polio vaccination campaign in Jalalabad province, Afghanistan Photo: Reuters

Polio is a highly infectious disease for which there is no cure. The virus is transmitted through contaminated food and water, multiplies in the intestine and, from where, can invade the nervous system. In approximately 95% of cases the disease remains asymptomatic and in many instances (abortive polio and non-paralytic polio) it goes into spontaneous remission without any serious aftermath. However, one in 200 infections leads to irreversible paralysis.  Among those paralyzed, 5% to 10% die due to respiratory paralysis. Although no cure exists, polio can be prevented through multiple administrations of polio vaccine, which can protect a child for life.

Global efforts to control and eliminate polio disease through mass population immunization have been successful in most areas of the world.  Nowadays, endemic viral transmission with polio is only present three countries: Afghanistan, Nigeria, and Pakistan. 2013 has seen a large decrease in the number of reported polio cases in endemic countries (149 to 91- year-to-date comparison), but mass immunization efforts are being constantly hampered by conflicts in these areas.

In Pakistan, for example, Taliban militant groups have rejected vaccination as a Western plot to sterilize Muslims and banned polio vaccine in some areas. Around “200,000 children have been missed [by polio immunization drives] as a result of the ban in North and South Waziristan”, said Mazhar Nisar, Health Education Adviser at the Prime Minister’s Polio Monitoring and Coordination Cell in Islamabad. Unfounded rumors are being spread that the vaccine causes sterilization, contains pork or is contaminated with HIV. As a result, parents are lead to believe that polio vaccine is harmful for their children and they are reluctant to seek immunization services. Those who seek the vaccine despite the imposed ban face serious threats to their lives, and often have to travel long distances with their children in order to get it.

Moreover, militants who oppose the vaccination campaigns target workers administering the vaccine under suspicion of being U.S. spies. In Pakistan, immunization efforts took a turn for the worse after the disclosure that CIA used a sham hepatitis vaccination program to gather information on Osama Bin Laden. This Monday, a bomb exploded near a health clinic in Budh Bher suburb of the north-western city of Peshawar, Pakistan killing two people accompanying the anti-polio vaccination team. Similar attacks have been carried out in Nigeria, where gunmen killed nine polio health workers in February 2013. These attacks have a significant impact on the efforts to eradicate polio. Immunization campaigns are being disrupted forcing hundreds of thousands of children to miss vaccinations. This creates a reservoir of unvaccinated children that may substantially contribute to the increase of polio cases.

In addition, endemic countries have a high rate of internal and external migration. Children of migrants often escape polio vaccination programs, which puts them at higher risk of getting infected or spreading the disease. Between August 2008 and December 2009, wild polio virus (WPV) is thought to have been taken from northern Nigeria, through intermediate countries, to 10 countries in West Africa and two countries in Central Africa, resulting in 178 cases in 2009. In the same year, WPV3 transmission was reported in the Central Africa Republic as a result of being imported from Chad (originating from Nigeria). In Nigeria, National Stop Transmission of Polio (N-STOP) program recognized this issue and started a census of Fulani nomads, as part of their emergency action plan against polio. Likewise, Pakistani children crossing the border to Afghanistan are being tracked and given oral polio vaccine through a program implemented by Rotary International. However, many migrant children continue to be missed by polio vaccination programs, which constitutes a significant barrier to the eradication of polio in endemic and non-endemic countries.

Due to the fact that poliovirus can rapidly spread from one endemic region or country to another and thus jeopardize the success in polio elimination so far, it is imperative that health workers, civilians, and leaders work together in order to carry out regular vaccination campaigns to prevent children from becoming disabled or even dying from this preventable disease.

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