Jun 15, 2014

Un brands Polio outbreak in Syria and Iraq 'most challenging in history'

Syria polio
Syrian refugee Mohammed Sammor is vaccinated against polio at a clinic in Lebanon. The UN fears the disease could spread. Photograph: Bilal Hussein/AP
A UN agency has described the eruption of polio in Syria as perhaps "the most challenging outbreak in the history of polio eradication" after the number of cases in the war-ravaged country reached 38 and the first case was confirmed in neighbouring Iraq.
According to the World Health organisation (WHO), the Iraqi case – found in a six-month-old unvaccinated child in Baghdad – is related to the outbreak in Syria, fuelling fears that the virus is spreading around the Middle East.
"The current polio outbreak in Syria – now with one confirmed case in Iraq – is arguably the most challenging outbreak in the history of polio eradication," said a spokesman for the UN relief and works agency for Palestine refugees (UNRWA).
"Seriously damaged health infrastructure, poor health access and utilisation because of insecurity inside Syria, and massive movements of vulnerable and at-risk populations in and out of Syria – all make controlling the outbreak and rendering health protection to Palestine refugees in Syria and across the region very challenging."
The same factors, he added, made it hard to guarantee 100% immunisation coverage and to maintain the cold chain needed to protect vaccines from heat.
The UNRWA is part of the team, led by the WHO and Unicef, that has fought to contain the virus since it was detected in Syria for the first time in 14 years last October. Until this week, Iraq had not reported a case since 2000.
In the five months since polio was confirmed, more than 22 million children in seven countries – Syria, Lebanon, Jordan, Turkey, Iraq, Egypt and Palestine – have been vaccinated as part of the largest vaccination campaign in the history of the Middle East.
"Since we got the confirmation of the outbreak at the end of October last year, the response was as rapid as possible," said Juliette Touma, a spokeswoman for Unicef.
"Have we reached every child we wanted to reach? The answer is no, we haven't, and this is largely because of access restrictions. The severity of the conflict makes people move all the time and we have displacement on a daily basis, so the ability to control the disease is a challenge."
The aim, said Touma, was to vaccinate children several times: six times in Syria and three in the wider region. But she added that there was no way to guarantee that the spread of the disease could be arrested.
"As long as we don't have unhindered access inside Syria to areas that are under siege and that are hard to reach, polio will not be contained," she said. "We always say with polio that there's no borders; there's no checkpoints. The virus doesn't need a passport – it just travels."
Sona Bari, a spokeswoman for the organisation's Global Polio Eradication Initiative, said the WHO had detected the virus in sewage in Egypt and Israel more than a year ago and issued an international high-risk alert despite an absence of confirmed cases.
"In October [last year], before cases even were confirmed in Syria – as soon as there was the first cluster of suspected cases – we issued another alert," said Bari. "When the cases in Syria were confirmed, an international emergency was declared and these seven countries put together a co-ordinated response plan to cover about 22 million children."
She said the WHO had been heartened by the increasing numbers of children being vaccinated in Syria, adding that the most recent round of vaccinations had probably reached about 3 million children.
Bari brushed off the criticisms of a US paediatrician who had accused the WHO of acting too late and failing to effectively vaccinate children at risk.
"The thing to note is that neither the opposition groups nor the government is stirring these allegations about WHO," she said. "I think those allegations are motivated by a desire to do something for the children of Syria; I think the motivation is absolutely laudable. [But] I think targeting WHO doesn't really achieve anything; what we need to do is actually all concentrate together on vaccinating Syrian children."
Post Polio Litaff, Association A.C _APPLAC Mexico

Polio’s Tenacity a Constant Battle

By Neal Lineback and Mandy Lineback Gritzner, Geography in the NewsTM
Polio’s Tenacity a Constant Battle
Just as the eradication of the crippling polio disease seemed within reach, it is advancing againand new questions are rising. Ignorance of science and medicine by the general public, migration from war-torn regions and possibly a new strain of the virus are to blame.
The recent discovery in California and elsewhere of a mystery virus, perhaps somehow related to the polio virus, is perplexing scientists, although the symptoms appear milder and perhaps of less duration in victims. The virus called EV68 is an enterovirus belonging to the family of polio viruses. According to Time magazine (Mar. 10, 2014), 20 children have suffered polio-like symptoms in California in the past 18 months, with a dozen paralyzed in one or more limbs. Heath officials don’t know whether the EV68 is to blame, as these are apparently not full-blown polio cases, but it is certainly cause for worry.
Until the real poliovirus is contained in every country where there is a single case, the threat of an outbreak spreading to other countries remains a distinct possibility. Today, polio is endemic in three countries, Afghanistan, Nigeria and Pakistan. The term endemic means that the disease is imbedded in the population and is currently uncontrolled. With international travel into and out of these countries, the virus is hitching rides to West Africa and the Horn of Africa. Particularly threatened are the Central African Republic, Cote d’Ivoire, Kenya, Liberia, Mali, Niger, Somalia and Uganda, according to the World Health Organization (WHO).
Map by Maps.com and Geography in the News. Permission granted to print by Maps.com.
Boundaries and names shown do not necessarily reflect the map policy of the National Geographic Society.
Polio is a terrible childhood disease that was on track to be eradicated by January 2005. The virus suddenly escaped from Northern Nigeria, where health organizations did their best to contain and eradicate the disease. The resulting analysis tells an interesting, but tragic story involving cultural dominance, religious fanaticism and geographic diffusion.
For Americans growing up in the 1940s and 1950s, just the word polio brought fear to entire communities. The disease was highly contagious, but mostly children under age 5 contracted it, tragically leaving many of those with symptoms crippled for life.
The scientific community in Europe first identified poliomyelitis in 1789, but the disease dates back to antiquity. It was described as a childhood disease that affected the spinal cord, leading to paralysis. Its origin is unknown, but a major outbreak occurred in Europe in the early 1800s, followed by the first outbreak in the United States in 1843. A 1916 U.S. epidemic killed an estimated 6,000 people and left 27,000 more paralyzed.
During the next century, cases of the disease increased worldwide. During the 1950s, there were more than 20,000 polio victims each year in the United States alone. The disease peaked in 1952 with 52,000 American children diagnosed with the disease. Immunologists had determined that the disease was transmitted through personal contact and contaminated water, entering the victim by mouth. Without an antidote or a preventative, the best the medical community could do was to quickly isolate infected individuals and provide assistance to those incapacitated by the disease.
Almost as soon as children were diagnosed with any polio-like symptoms, including gastrointestinal stress, sore throat, leg pain, equilibrium difficulties, difficulty breathing and general malaise, they were quickly separated from their families and placed in isolation. The most severe cases, those so paralyzed they could not breathe on their own, were placed in iron lungs. These bulky machines provided the mechanical chest compression rhythm necessary for paralyzed patients to live. Many were destined to spend the remainder of their lives lying on their backs in their iron lungs.
Finally, in 1955, Dr. Jonas Salk developed a polio vaccine that turned the tide on the disease. While the last polio case in the United States was in 1979, other countries continued to suffer the disease. As recently as 1988, wild polio viruses were prevalent in South and Central America, Africa, Southern Europe and Asia. By 1991, however, a polio eradication program led by the Pan American Health Organization had eliminated polio in the Western Hemisphere.
Two vaccines have been used around the world to try to eliminate polio. The oral polio vaccine (OPV) is no longer recommended because it contains a live virus and can occasionally result in the patient contracting polio (about one in 2.4 million). The second is the inactivated poliovirus (IPV) vaccination, which does not carry a risk and is recommended by the Centers of Disease Control. IPV can provide permanent immunity.
Thanks to epidemiologists, polio was nearly eliminated in Africa by early 2004. But the mainly Muslim region of Northern Nigeria refused to participate in the vaccination of its children, wrongly fearing that there was a Western plot to infect them with HIV, the virus that causes AIDS. Not only did the polio virus resurface, but an outbreak spread in Northern Nigeria, currently diffusing geographically across northern Africa and southern Asia.
Polio is a disease difficult to contain, given the reluctance of societies, particularly in developing countries, to accept proven science. The WHO’s international travel and health guidelinesrecommend that all travelers to and from polio-infected areas be fully vaccinated against the disease well before travel.
How medical professionals can overcome cultural bias is a constant battle. The discovery of the EV68 virus in the U.S. population, however, presents a new concern.
And that is Geography in the NewsTM.
Sources: GITN #1204, Polio Returns with a Vengeance, Maps.com, June 21, 3013; GITN #749, An Awful Scourge: The Revival of Polio, Oct. 8, 2004; Time magazine, “Polio’s Scary Specter,” Mar. 10, 2014;  http://www.polioeradication.org/Infectedcountries.aspx:http://www.tradearabia.com/news/HEAL_236471.html
Co-authors are Neal Lineback, Appalachian State University Professor Emeritus of Geography, and Geographer Mandy Lineback Gritzner. University News Director Jane Nicholson serves as technical editor. Geography in the NewsTM  is solely owned and operated by Neal Lineback for the purpose of providing geographic education to readers worldwide.
Nearly 900 of the 1200, full-length weekly articles Geography in the News (with Spanish translations) are available in the K-12 online education resource Maps101.com, including maps and other supporting materials and critical thinking questions.

Expanded Programme on Immunization (EPI) and the Polio Eradication Initiative

File photo
File photo
LAHORE: The federal government has integrated the two major health programmes -- Expanded Programme on Immunization (EPI) and the Polio Eradication Initiative (PEI) – due to security threats to polio workers in the country.
The government has made the anti-polio drive part of the routine immunisation largely to prevent the polio staff from attacks by some elements who believe the ‘anti polio drops’ are a conspiracy against the children. The PEI has suffered a setback in the wake of some killings of polio workers in Karachi, Fata and KP.
Most of the countries had eliminated the crippling disease – wild poliovirus – under the Global PEI programme launched by the World Health Assembly in 1988 by passing a resolution. However, this programme could not get required results due to some factors, including security issues, in Pakistan.
The EPI is a disease prevention activity aimed at reducing illness, disability and mortality from nine childhood diseases preventable by immunization. The global target of the programme is to immunize over 95 per cent of infants and child-bearing-age females.
A senior government official told Dawn, under this first initiative of its kind taken by the Ministry of National Health Services, Regulations and Coordination, no separate or exclusive drives will be launched for polio eradication.
He said all the stakeholders concerned, including the World Health Organization, Unicef, and the provincial health ministries, have categorically been told to implement this new scheme from the first week of the coming month. It is being expected that under the EPI prgoramme, the staff will be able to reach millions of missed and not-available children in the inaccessible localities.
He said the Punjab health department has started implementation in phases and identified five districts where the campaign will be launched from May 5. The districts are Lahore, Multan, Muzaffargarh, DG Khan and Rahim Yar Khan.
The official said the two programmes were merged under a strategy and the WHO and Unicef would continue to provide technical and communication support to the provincial governments.
From now on the slogan ‘anti-polio drive’ will not be used before or during the campaign. The officials of the WHO and the Unicef will use the words like ‘drive against preventable diseases’ during the awareness campaigns.
“The integration of the two programmes will help strengthen the EPI activities and achieve the above 95 per cent target of immunization coverage to the children”, Punjab Health Director-General Dr Zahid Pervez told Dawn.
He said his department was presently facing shortage of field staff to implement the new strategy.
“Initially, we are going to launch the integrated programmes in five districts and the department has conveyed this to the Ministry of Health and Regulations”, he said.

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