Aug 13, 2013

Standing up Against Polio in DRC

GOMA, 13 August 2013 (IRIN) - When Linda Lukambo, 21, asked his parents why they had neglected to get him the polio vaccine, “they told me, ‘we did’. So why have I got polio?” he told IRIN in North Kivu in the Democratic Republic of Congo (DRC). “Maybe they took me for vaccinations, but maybe not for polio.” 

Lukambo first started having difficulty walking while at a pre-school in Tchambucha Village, near the North Kivu town of Walikale. After six months he was, he says, “still walking a little bit. And then I started to move on my bottom, and then on my knees, and it got worse and worse.” By the time he was in primary school he was “crawling on all fours”. 

Polio, or poliomyelitis, a highly infectious, viral disease causing paralysis and in some cases death, has been eradicated in most countries through large-scale vaccination programmes. According to the UN Children’s Fund (UNICEF) only Nigeria, Pakistan and Afghanistan still have endemic polio transmission. UNICEF, the largest buyer of children’s vaccines in the world, recommends children receive at least three doses of the oral polio vaccine to ensure full immunity against the disease. 

DRC is considered an “importation country”, meaning it experiences outbreaks of the disease because of low levels of immunity among the population. Polio eradication campaigns face myriad obstacles, including large-scale population displacements caused by DRC’s persistent conflicts, poor access to isolated communities, religious objections to the vaccine and weak infrastructure.  

In 2007, Lukambo had a series of year-long leg-straightening operations at Goma’s public hospital, paid for by local NGO L´Association Congolaise Debout et Fier. (ACDF). ACDF then provided free leg braces, which enabled him to walk upright. He remembers being “very happy - I did not like the ground,” he said. 

He has since become the caretaker at the ACDF centre, where polio survivors come for leg brace fittings or to just hang out or sleep over in a non-judgmental environment, as society often treats the disabled with suspicion and prejudice. 

Learning to walk 

Claudine Muhombe, 7, from Rugare near Masisi, arrived at the centre in April. She now scampers around the centre’s yard, uses the window frames as a climbing frame, and is quickly discovering how to walk with the aid of crutches and braces, also called callipers. 

“It’s not difficult to walk,” she told IRIN. “I like walking. My Dad came [in June] to visit. He was very happy when he saw me, and I was happy to see my Dad happy.” 

Joseph Kay of StandProud, the international and fundraising arm of ACDF, told IRIN that Claudine’s rapid progress meant she would probably not stay at the centre for long. 

Learning to walk with the callipers and crutches can take weeks or months, requiring intensive physiotherapy to regain strength and balance. But even then, not all are able to. 

"It was difficult to learn to walk with leg braces. It took a lot of time to learn. I had no strength in my lower back"
Lukambo’s transition from crawling on the floor to standing on his feet was not as swift as Claudine’s. After his leg-straightening operations, the wounds from the surgery continued to weep and would not heal. He had to undergo a skin graft, with skin taken from his thighs for his knees. 

The years of crawling also damaged his hip, and an operation was performed to correct it. When he was finally ready to don callipers, it took nearly four months of daily practice to walk upright. 

“It was difficult to learn to walk with leg braces. It took a lot of time to learn. I had no strength in my lower back, so I had to wear a corset,” he said. 

After a few months of walking, the muscles in his lower back recovered and the corset was discarded, but Goma’s broken streets were an “obstacle course.” 

“It’s something you have to get used to… But I am at the same level now as other people,” Lukambo said. 

Polio campaigns 
The first polio vaccination campaigns in the country began in the mid-1980s. At one stage, after no cases were recorded between 2001 and 2005, polio was considered eradicated in DRC. 

In 2008, after an “epidemiological situation evolved in the central African region,” resulting in dozens of new infections in the country, the government and donors announced a polio vaccination programme targeting seven million children.

Emmanuel Nomo, UNICEF’s DRC polio team leader, recently told IRIN there had been no registered cases of polio in the country since December 2011. 

“Authorities, vaccination teams and parents are doing the best they can to reach all children everywhere, including in the Kivus, despite the challenge of insecurity and lacking access,” he said. 

This August, during the country’s National Immunization Day (NID), officials will hold a second round of vaccinations targeting 1,374,836 children up to five years old in North Kivu and 1,144,750 in South Kivu. According to independent monitoring by the World Health Organization (WHO), 3.5 percent of targeted children in North Kivu were missed in the July first round of vaccinations, while in South Kivu the number was 5 percent. 

“During the July NID, insecurity - active fighting in some health zones - did not allow the vaccination teams to do their job” in the North Kivu health zones of Kamango, in three health areas in Binza, and three health areas in South Kivu’s Molungu, said Nomo. 

“Even though the situation remains difficult in both Kivus, the second [round] of the NID is scheduled to take place throughout both provinces,” he said. 

Nomo said issues with maintaining the cold chain, the system of temperature controls required to keep vaccines potent, were being addressed through the introduction of solar fridges by the government, with support from UNICEF, the Global Alliance for Vaccines and Immunization (GAVI), and the World Bank. Currently, only 30 percent of the country’s health centres have a functioning refrigerator. 

“Providing good quality vaccines at the beneficiary level remains a challenge,” he said. 

Calliper production 

StandProud (founded in 1998) has established centres in Bunia, Butembo, Goma, Kalemie, Lubumbashi and Kinshasa. 

“We've made thousands and thousands of callipers. Hard to know exactly how many since 1998, but there are at least 5,000 individuals who have benefited over the years,” Kay said. 

"I have made a lot [of leg braces]. I don’t know how many, but many, many, many"
Louis Nwande-Muhala, a calliper technician at the Goma centre, says it takes about two days to construct the custom-made leg braces - if there is electricity and the materials are available. The braces are made of steel, with leather used for the joints and hip support. The workshop also does repairs on braces, which have to deal with the country’s broken streets. 

Nwande-Muhala’s left leg was paralysed at the age of five, not from polio, but from a quinine injection into his hip muscles, an old treatment for malaria that is still practised by some nurses despite the availability of safer treatments. 

He first encountered the NGO when he wanted to acquire a leg brace. After being fitted for the brace, he decided to give up his tailoring job to make callipers. “I have made a lot [of leg braces]. I don’t know how many, but many, many, many.” 
Post Polio Litaff, Association A.C _APPLAC Mexico

Aug 9, 2013

A Recently Digitized TV News Archive Highlights the Big Points of the 1950s and 1960s

A recently digitized TV news archive highlights the big points of the 1950s and 1960s: Civil Rights and the polio vaccine.
School Polio Shot, 1955
School Polio Shot, 1955 A boy grimaces as he receives one of the first polio shots ever dispensed in Roanoke, Virginia. WSLS-TV footage archived by the University of Virginia Library
In 1955, days after officials introduced the "new, wonder vaccine" against polio to Roanoke, Virginia, local news station WSLS-TV asked some parents in the street about it. Of the four adults they interviewed, three said they planned to get their children vaccinated. "I do think it's a worthwhile project and I hope it's going to be a success," one woman said.
Another woman, however, seemed a bit more skeptical—a sentiment that some modern parents might recognize. "I think I shall wait until I see some of the results from the other children," she said.
That old footage is now available online, thanks to a new project by the University of Virginia Library. In 2010, the National Endowment for the Humanities gave the library a little more than a quarter of a million dollars to preserve and make digital copies of WSLS-TV broadcasts dating from 1951 to 1971, along with printed anchors' scripts. The library released the archive this week.
You can keyword search the archive, but the library has highlighted some of the coolest stuff. There are reports on the desegregation of local schools and the Civil Rights movement. And there's a page dedicated to the introduction of the polio vaccine to Roanoke, which served as a distribution center for the shot for most southwestern Virginia counties. The development of a successful polio vaccine was big news throughout the U.S.
Anchor Script for a 1955 Polio Vaccine News Spot
Anchor Script for a 1955 Polio Vaccine News Spot:  WSLS-TV, archived by the University of Virginia Library
Interestingly, the archive shows that at the beginning, scientists didn't know everything about the vaccine they were giving out. A decade after the first Roanokans received shots, a 1965 WSLS-TV broadcast carried the city health commissioner's call for locals to begin or finish their immunization program. Re-immunization was important, he said, "Because the length of time a person is protected by either [the Salk or Sabin forms of the vaccine], is still a matter of conjecture." The U.S. Centers for Disease Control and PreventionPost Polio Litaff, Association A.C _APPLAC Mexico

Communication In Action Polio News Africa

Aisha may not be able to read, but she never forgets a name, or a child. Her own tragedy was too great.
"Where are Hassan, Hassana and the other kids?" Aisha asks the woman of the house from the doorway.


Kano State, northern Nigeria, where more than one-third of all children still remain under-immunized once again finds itself at the centre of the countries polio outbreak, currently with 62 cases. Along with other high-risk states, Kano embarked on a massive door-to-door polio immunization campaign between 7-10 July. Government, traditional and religious leaders, media, community health workers, and a wide range of stakeholders, collaborated to make this exercise a success.


As part of a ground-breaking public-private partnership to fight polio, Nigeria is harnessing the power of smartphones to monitor real-time performance of vaccination teams during door-to-door campaigns. Using GPS data, a specially designed android application helps map the location of communities in high-risk areas for polio, and for the first time enables monitoring of the quality and coverage of campaigns in real-time.

Summit County scientist joins effort to end polio once and for all

Not that long ago, polio (short for poliomyelitis) was a major scourge in this country, killing many and leaving many more with temporary or permanent paralysis in cases where the virus penetrated the central nervous system. In 1952, the incidence of paralytic polio peaked in the United States with more than 21,000 new cases. However, the subsequent introduction of polio vaccines resulted in a dramatic decline; the last case of wild-virus polio acquired in the U.S. was reported in 1979. Clearly, polio vaccines were a huge success, and today we sit on the cusp of completely eliminating this devastating virus worldwide.
One of the giants in the polio vaccine field died recently. Dr. Hilary Koprowski developed the world’s first polio vaccines comprised of a live but weakened virus. In a seminal study, Dr. Koprowski created a modified strain of the virus by repeatedly “passaging” the virus in cotton rats – a process that involves growing the virus in a rat, collecting it after several days, inoculating another rat and then repeating the process. The new strain became highly adapted to its new rodent host and at the same time was severely weakened in its capacity to infect humans and cause disease. Such weakened viruses can serve as potent vaccines since they elicit a powerful immune response to the virus without actually causing disease. But this type of vaccine comes with risks; if the virus is insufficiently weakened, it can revert to a more dangerous form in some individuals and cause the very disease it is designed to prevent. Dr. Koprowski was so confident in his procedures that he drank some of the vaccine to confirm its safety. He suffered no ill effects. Subsequent trials in the United States and abroad confirmed the vaccine’s efficacy and general safety.
Despite the success of the Koprowski vaccine, there nevertheless remained safety concerns and it was never adopted by the U.S. medical community. Instead, a killed form of the virus generated by Dr. Jonas Salk was introduced as an injectable vaccine in the mid-1950s. This was subsequently followed by a live but weakened virus developed by Albert Sabin in the late 1950s. The Sabin vaccine was delivered orally and was very similar to the vaccine developed by Dr. Koprowski, but even more severely weakened. Although Dr. Koprowski’s vaccine was never adopted here, there is no question that he paved the way to the highly effective Sabin polio vaccine by demonstrating the feasibility of this vaccine approach.
The success of the polio vaccine campaign in the U.S. was due largely to the efforts of President Franklin D. Roosevelt, who contracted polio as an adult and lost the use of his legs. He established the National Foundation for Infantile Paralysis, later renamed the March of Dimes Foundation, to finance the Salk and Sabin vaccines. Today, the two vaccines have eradicated polio from most countries in the world. Only Afghanistan, Pakistan and Nigeria still harbor transmission of the wild virus, and the number of new global cases fell to a record low of 223 in 2012, although there was a recently small polio outbreak in the horn of Africa. These impressive results are due to a wonderful collaborative effort of the United Nations, governments, foundations, businesses and Rotary International, which adopted this as a global cause (Rotary has contributed hundreds of millions of dollars for polio eradication). The successful battle against polio is an extraordinary example of what can be achieved through a cooperative global effort.
Recently, I joined 450 scientists from 80 countries to offer support for a final push against polio. The Global Polio Eradication Initiative involves a global public-private partnership that has vowed to eliminate polio in six years at a cost of $5.5 billion. This will be achieved through enhanced surveillance and vaccination strategies in affected countries. While the financial cost may seem high to some, this is cheap compared to the costs of dealing with a polio resurgence. It has been estimated that polio eradication efforts so far have saved more than 10 million people from paralysis and saved over $40 billion in medical costs in some of the world’s poorest countries.
Significant challenges remain in the countries where polio is still being transmitted. These include the lack of effective public health systems, distrust of vaccination (including the murder of volunteers administering the vaccine) and nomadic populations (which can serve as a viral reservoir). But as stated by the Global Polio Eradication Initiative, “ending one of the world’s most enduring diseases will create a ‘global public good,’ in that the benefits of a polio-free world will extend to all children everywhere, in perpetuity, protecting them forever from this debilitating, preventable disease.”
David L. “Woody” Woodland, Ph.D. is the Chief Scientific Officer of Silverthorne-based Keystone Symposia on Molecular and Cellular Biology, a nonprofit dedicated to accelerating life science discovery by convening internationally renowned research conferences in Summit County and worldwide. Woody can be reached at 970-262-1230 ext. 131 or Polio Litaff, Association A.C _APPLAC Mexico

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