May 15, 2012

The WHO document on polio prepared for the WHA



México a la vanguardia en el Síndrome de Post Polio

May 13, 2012

Why Polio Isn't Going Away?

As the number of cases of the paralytic disease fall, world health officials have to grapple with a vexing problem: a component of the most widely used polio vaccine now causes more disease than the virus it is supposed to fight | May 14, 2012 | 5

CONTINUED TOLLAlthough polio has disappeared from the Western Hemisphere and Europe, the virus still permanently cripples children in Africa and Asia every year.Image: Joao Henriques/Redux Pictures

In Brief

  • The global campaign to eradicate polio began in 1988. Since then, naturally occurring cases worldwide have dropped to, at last count, around 650 in 2011.
  • Completely eliminating polio requires a change in the current vaccination program because one component in the most widely used vaccine now causes more cases of polio than it prevents.
  • The World Health Assembly is expected to approve a plan this May that should decrease the number of vaccine-linked cases of polio and may speed up overall eradication efforts.
  • Yet questions have arisen over the safety of making the change rapidly. If health officials do not manage this transition correctly, polio could continue to cripple children for years to come.
The shadows lengthen in a guesthouse cafeteria on the sprawling campus of christian Medical College, Vellore, in India. Wrapped up as he is in an issue that has possessed him for years, T. Jacob John notices neither the dying light nor the gathering mosquitoes. He is talking about the oral polio vaccine.
A slight man who speaks and moves with a speed that belies his 76 years, John is one of India’s leading polio experts. Trained as a pediatrician, virologist and microbiologist, he is also a longtime critic of the continued reliance on the oral polio vaccine—OPV in polio speak—used by the nearly 25-year-old international campaign to rid the planet of the paralyzing and sometimes fatal disease. The vaccine is at once an excellent and an imperfect tool. Inexpensive and easy to administer (each dose consists of a few drops of serum on the tongue), it has brought the world to the point where polio eradication is visible on the horizon. Indeed, the World Health Organization announced this past January that there have been no cases of naturally occurring polio in India for a year. But if the distribution of the vaccine is not choreographed with exquisite care, its continued use—at least as it is currently formulated—could actually keep the world from eliminating polio.
Today John is talking with a reporter about a problem raised by a specific component of the oral vaccine, which uses weakened viruses to elicit immunity against the three strains of polio—known as types 1, 2 and 3. (An expensive, alternative vaccine, popular in wealthy nations, consists of an injected formulation that is made up of completely inactivated, or “killed,” viruses; it is known as IPV.) The issue: type 2 poliovirus no longer exists in nature; the last case stemming from naturally circulating virus was reported 13 years ago.
Ongoing vaccination against type 2 would not be worrisome if the viruses in the oral vaccine were perfectly benign. In rare cases, however, the weakened viruses from the vaccine can revert to disease-causing pathogens and provoke the very illness they are meant to prevent. In places where wild polioviruses are still a threat, the risk from natural infection is greater than the small hazard the vaccine poses. But if the only risk of paralysis from type 2 polio comes from the strain in the vaccine itself, then that strain’s continued usage could well be considered unproductive at best and quite possibly unethical. As long as the oral vaccine contains the type 2 virus, however, children in more than 100 countries around the globe must—paradoxically—be vaccinated against type 2 polio to protect them from the type 2 virus in the vaccine.
In 2004 John wrote a letter to the medical journal the Lancet, urging the international community to remove the type 2 component from the oral vaccine, thus making it a “bivalent” vaccine that would protect against types 1 and 3 polioviruses. Like other complaints John has made about the oral polio vaccine, however, the suggestion went nowhere—until now.
The Global Polio Eradication Initiative—a partnership of the WHO, UNICEF, Rotary International and the Centers for Disease Control and Prevention—is marshalling support for an initiative to drop the type 2 component from the oral vaccine. The proposal is part of a substantial overhaul of the plan to eventually phase out the oral polio vaccine altogether once all types of wild polioviruses are demonstrated to have been extinguished. The WHO’s governing council, the World Health Assembly, will be asked to approve the early withdrawal of the oral vaccine’s type 2 component at its annual meeting in May.
If the policy change passes—and the assembly is expected to vote in its favor—the move would eliminate an ethical problem that has been bedeviling the eradication effort for years. It could also speed the job of wiping out the remaining two strains of polio in the three countries where they remain endemic (Afghanistan, Pakistan and Nigeria); a 2010 Lancet study showed that the two-target vaccine is at least 30 percent more effective than the one that has to protect against three strains of polio. And yet the poliovirus has a nasty habit of eluding efforts to contain it. Last year, for example, China reported its first cases—genetic tests traced their origin to Pakistan—in more than a decade. Adjusting the oral polio vaccine, some fear, could have unintended consequences and thus disrupt an eradication campaign that is already 12 years past its original deadline and counting. Read More 
México a la vanguardia en el Síndrome de Post Polio

May 11, 2012

Southeast Asia approaches Polio-free certification?


Bangkok, May 11 : With India entering the final stages of eliminating polio and closing to earn itself the coveted 'polio-free status certificate' in next two years, the global community has sought renewed commitment in the crusade against the dreaded disease, calling for further resource mobilization and renewed fund support.

This was conveyed at the 103rd Rotary International Convention held in Thailand that was attended by more than 35,000 Rotarians from 23 countries, Royal Princess of Thailand Chulabhorn and other dignitaries.

"India, once the world's largest global exporter of polio cases, will become the last country in Southeast Asia to be certified polio-free if it remains polio-free for three years. This will be a major achievement as more focussed strategy can be adopted towards battling resurgence threats from wild polio virus," said Kalyan Banerjee, Chairman, Rotary International.

Amidst celebration, speakers reminded the festive assembly that the work is far from complete, because the ultimate goal is yet to be reached as three countries continues to remain polio endemic and the Global Polio Eradication Initiative (an alliance of WHO, CDC, Rotary and UNICEF) was facing a significant funding shortfall of over USUSD 1 billion for activities in 2012-2013.

Bruce Aylward, Assistant Director-General for Polio, Emergencies and Country Collaboration, World Health Organization, said India's removal from the polio-endemic list is "perhaps the most important milestone ever on the long road to eradication."

But an upsurge in cases of paralysis from polio in Nigeria, Pakistan, and Afghanistan and recent polio outbreaks in China, the Congo, and Tajikistan have also prompted what he called an "unprecedented push" to finally end the disease.

He said 192 ministers of health will meet soon and declare polio a public health emergency.

Calling corporates to play more active role in community service, Rajashree Birla, Chairperson, Aditya Birla Centre for Community Initiatives and Rural Development, said, "Corporate indirectly stimulate their own business development if they push their energies and help resolve social sector issues through engagement. There is much to be gained when business leaders take giving to heart, and set the mandate of making a difference by caring for people in their community."

The three day convention also witnessed Princess Chulabhorn representing King Bhumibol Adulyadej at the opening ceremony and thanking Rotarians for their work around the world.

Other dignitaries present on the occasion included Sukhumbhan Boribhat, Bangkok Governor; Hugh Evans, Anti-poverty crusader and Cofounder of the Global Poverty Project; Gillian Sorensen, Senior Adviser and national advocate at the United Nations Foundation; Angelique Kidjo, UNICEF Goodwill Ambassador; Leymah Gbowee, Nobel Peace Prize laureate, and Microcredit pioneer Muhammad Yunus also a Nobel Peace Prize laureate.

The Rotary International convention in Bangkok is estimated to inject more than USD 100 million into the Thai economy. (IBNS)

México a la vanguardia en el Síndrome de Post Polio

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