May 16, 2013

The Eradication of Smallpox is a Blueprint for Polio’s Demise

The year 2018 has recently been declared our new target year for eliminating polio from the world by the World Health Organization, the Gates Foundation and Rotary International

By Rebecca Kreston | May 15, 2013 1:34 pm
 It is clear that the next five years will pose no small challenge; we have spent over 60 years vaccinating millions of children and adults since Salk and Sabin’s discovery of viable polio vaccines, and we have long struggled in particular with three countries where the virus is endemic: Afghanistan, Pakistan and Nigeria.
Photograph of a man receiving the smallpox vaccination by jet gun injector during the Smallpox Eradication and Measles Control Program in Niger, W. Africa in February of 1969. Image: Dr. JD Millar/CDC.

Our difficulties in eradicating polio from these countries can be attributed to many factors – their geographic enormity, melange of cultures and religious sects, long histories of warfare and social turmoil, long-lasting simmering political resentments, and the freshly inflamed paranoia about government plots behind vaccination campaigns, just to name a few heavyweight contenders.
Of course, the people residing in these countries now have every reason to be wary of health officials vaccinating their children thanks to the CIA’s sham vaccination campaign that was used to ferret out Osama Bin Laden in Abottabad, Pakistan. We now have to come to grips with this ugly hiccup that has damaged both the credibility and ethos of the global public health industry. As Gates noted in his Richard Dimbleby lecture this past January, “stopping these last cases of polio in these last countries … is among the most difficult tasks the world has ever assigned itself. The fight to eradicate polio is a proving ground, a test. Its outcome will reveal what human beings are capable of, and suggest how ambitious we can be about our future.” (1)
A nomadic Tuareg girl in Mali receives a smallpox vaccination in 1967 during the Smallpox Eradication and Measles Control Program. Image: CDC.
We have only one blueprint to follow in our quest to eradicate human diseases: the global smallpox campaign in the 1960s and ‘70s. This ancient virus has been a pestilence on mankind for centuries. If the infection didn’t kill, then it disfigured. Thankfully, it is no longer the frightful menace that it was thanks to a worldwide smallpox eradication campaign that the World Health Assembly embarked upon in 1966.
A crowd of people in Niger, West Africa awaiting vaccination during the Smallpox Eradication and Measles Control Program in the late 1960s or early 1970s. Image: Dr. JD Millar/CDC.
I was entranced when I stumbled upon a series of photos documenting the 1969 smallpox campaign in central and west Africa, showing public health officials of various nationalities vaccinating villages in one of the biggest public health battlefields. From 1966 to 1970, the Centers for Disease Control (CDC) worked with several west African governments to surveil and contain localized outbreaks of smallpox (2). Rather than using the tactic of mass vaccination within the community, surveillance of existing cases and the vaccination of close contacts and the potentially exposed was employed in a technique known as “ring vaccination.” Nigeria was the birthplace of this new strategy and surely will be used again as we seek to eradicate polio (3).
The recently deceased US Surgeon General Dr. C. Everett Koop remarked in a lecture given to the CDC in 1987 that
the campaign could properly be described as heroic. In 1966, smallpox was raging through South America, Asia, and Africa, [and] two and a half million people were reported as infected in 30 countries, a figure estimated to be about one percent of the actual incidence, but hundreds of public health practitioners – white and black, Arab and Jew, Russian and American – worked side by side to rid humanity of the scourge.
In the African campaign, it is estimated they worked with about 4,000 local health workers, and, I might add, the smallpox campaign would not have worked were it not a grassroots campaign, it was essential that indigenous public health workers be involved in the campaign if it was to gain the cooperation of local people necessary for success. (4)
Public health authorities hunted the virus down in Kenya, Ethiopia and Somalia until the last case of endemic smallpox occurred in a young Somalian cook on October 26, 1977. After two years of surveillance, the world was declared free of smallpox.
A former Ghanian official receiving his smallpox vaccination via a jet injector gun. The photograph was taken during the West African Smallpox Eradication and Measles Control Program at the International Trade Fair, held in Accra, Ghana, on February, 1967. Image: Dr. JD Millar/CDC.
These black and white photos harken back to a period in time in which vaccines were almost uniformly viewed as an axiomatic good, a lifesaving elixir that millions of people clamored for access to. The photos speak of a hard-won global achievement, one of our finest feats in medicine and public health based upon trust, collaboration and indigenous support for a local and global public health good. I suspect there’s a lesson there.
See more great images from the smallpox campaign, as well as some superb public health posters, at the CDC’s Public Health Image Library.
timeline of the history of smallpox and its vaccine.
A Wiki article on Ali Maow Maalin, the young man who contracted the last case of naturally occurring smallpox in the world. His experience led him to work on the polio eradication campaign decades later in Somalia.
A report on the epidemiology of tracking down Mr. Maalin and his contacts,an obituary of sorts on the world’s last case of smallpox.
The WHO has a series of photo galleries on the vaccination, prevention, surveillance and public health posters throughout the smallpox eradication campaign.
1) Agence France-Presse (Jan 30, 2013) “Bill Gates urges polio eradication by 2018.” Accessed online May 14th, 2013 here.
2) MO Kirk & the Task Force for Child Survival and Development (Feb 28, 2008) “Capturing an Oral History of the 1960s Smallpox Eradication Campaign in West Africa”. Task Force for Child Survival and Development.Robert Wood Johnson Foundation. Accessed online May 3, 2013 here.
3) CW Choo (Sept 2007) The World Health Organization Smallpox Eradication Programme. Unpublished manuscript. Accessed online May 13, 2013 here.
4) CE Koop (Oct 29, 1987) Remarks for the Smallpox Eradication Celebration Presented to the Centers for Disease Control. Smallpox Eradication Celebration. Lecture conducted from Atlanta, Georgia. Accessed online May 13, 2013 here.

Post Polio Litaff, Association A.C _APPLAC Mexico

May 13, 2013

NanoPass Technologies Supports a CDC-Sponsored Phase 3 Study of Polio Vaccine

NES ZIONA, IsraelMay 13, 2013 /PRNewswire/ --
NanoPass Technologies Ltd. ("NanoPass"), a pioneer in intradermal (into-the-skin or ID) vaccine delivery solutions, is collaborating with the US Center of Disease Control and prevention (CDC) in conducting a large phase 3 trial of polio vaccine in infants in South East Asia.
This collaboration is a part of NanoPass's long-term commitment to improve Global Health by providing access to its vaccine delivery devices.
The study is a phase 3, open-label, randomized clinical trial comparing immune response after receiving one of five different combinations of polio vaccines delivered as oral drops or as injections into the muscle or the skin. Two of the vaccine regimens include a low (20%) dose vaccine delivered intradermally using the MicronJet device. The study is currently enrolling infants 6 weeks of age and aims to enroll over 1,200 participants.
In the pre-vaccine era, poliomyelitis was the leading cause of permanent disability. Two polio vaccines are used throughout the world to combat poliomyelitis (or polio); injected inactivated poliovirus (IPV) and live attenuated oral vaccine. IPV administration is needed globally to achieve polio eradication, but it is currently unaffordable for most of the developing world. Intradermal delivery may dramatically reduce the dose required for vaccination by several folds, thereby reducing the cost and increasing the affordability, of polio vaccines.
Yotam Levin , CEO of NanoPass, said, "We are delighted to support CDC as part of NanoPass's long term commitment to Global Health. We see an important opportunity for significantly reducing the dose of vaccination and hence its cost, by combining our device approach with polio vaccines. We will continue to provide access to our technology to public and private vaccine developers for Global Health applications, as we have to date with some of our partners including the Infectious Disease Research Institute ( The MicronJet600 device is the shortest microneedle device presently registered with FDA, and since it is about half a millimeter long it is applicable for infants as well as adults.
NanoPass is involved in another Polio study in 231 HIV positive adults. The study is sponsored by the Eastern Virginia Medical School and aims to determine whether a lower dose of inactivated polio vaccine (IPV) injected ID can work equally well or better than the standard dose injected into the muscle. The study is enrolling participants infected with HIV because they are known to respond less well to vaccines than other groups.
NanoPass has also supported a pandemic flu phase I study sponsored by IDRI and Medicago, which investigated multiple strategies including intradermal delivery to improve immune responses and reduce doses for vaccination for the H5 pandemic flu vaccine.

Post Polio Litaff, Association A.C _APPLAC Mexico

May 11, 2013

Vaccines to be Juggled in Final Assault Against Polio

All 194 countries that belong to the World Health Organization will next week initiate a new plan for juggling different polio vaccines on a global scale that could finally eradicate the crippling virus.
The stakes are high, says Oliver Rosenbauer of the WHO. With most of the world polio-free, global immunity is spotty. Models predict that if the eradication drive is abandoned while the virus persists, the rebound could cause 200,000 cases of paralysis a year for 10 years. But without a clear end to the campaign in sight, countries could abandon the effort.
The original deadline of eliminating polio by 2000 has repeatedly slipped, with the virus clinging on in India, Nigeria, Afghanistan and Pakistan. However, there have been no cases in India since 2011, cases in the other three are at an all-time low, and four other reinvaded countries are all but clear again.
But problems loom. People who reject vaccination on religious or political grounds have murdered 19 vaccinators in Pakistan and Nigeria. And aprediction in 2000 has come true: the vaccine has become its own enemy.
Until now, the eradication drive has only used an oral vaccine containing weakened live virus, as it is cheap, easy to give and extremely effective. But the vaccine viruses can sometimes revert to causing disease – and spread. In 2012, for the first time, more countries reported cases of the disease caused by vaccine-derived polio viruses (cVDPV) than wild virus.

Killed vaccine

The original plan was for every country to stop using live vaccine simultaneously when wild polio disappeared, switching instead to a killed polio vaccine that would protect children as any lingering cVDPV died out. But if wild polio or cVDPV return after that, countries will need intense surveillance to spot it and live vaccine to contain the spread, fast. Both exist during the eradication drive, says Bruce Aylward, head of WHO's polio programme; but neither will exist afterwards, as countries refocus on other threats and companies stop making live vaccine.
The new plan is to switch to killed vaccine before eradication is over. The WHO predicts that wild virus will be largely gone by 2015.
At that point the WHO wants the 140 countries at most risk of a polio resurgence to start giving killed vaccine. But this may not be enough to keep resurgence at bay. So they will also use a live vaccine, but one that is effective against only two of polio's three strains. Virtually all cVDPV is type 2, which was eradicated in 1999.
By using live polio vaccine containing only types 1 and 3, countries can maintain immunity to any persisting wild polio, while cutting off the source of cVDPV.
It must be done all at once, however, because if one country stops using type 2 live vaccine, while a neighbour continues, the first is at risk from type 2 cVDPV. That means, says Aylward, that killed vaccine "will have to be introduced in 140 countries within a one to two-month time window. Nothing like that has ever been done before."

Post Polio Litaff, Association A.C _APPLAC Mexico

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