Post Polio is a condition that affects up to 80 ∞ of persons who survive paralytic polio; can develop as late as, 30, 40 years after the initial recovery; symptoms vary from mild weakness to severe fatigue and disability .
A child receives 2 drops of the oral polio vaccine (OPV). Photo: WHO/S.RamoKabul 30 January 2017 – The Ministry of Public Health, WHO and UNICEF launched today the first polio subnational immunization days campaign of 2017. Over 5.6 million children will be vaccinated against polio in all provinces in the southern and south-eastern regions, most districts in the eastern region, as well as selected high-risk districts across the country, including Kabul city.
“The campaign will build on strong progress seen in 2016. Last year Afghanistan had only 13 cases of polio nationwide, down from 20 in 2015. This was made possible through hard work by thousands of frontline health workers and a renewed emphasis on monitoring and oversight,” said Dr Maiwand Ahmadzai, Director of the National Emergency Operations Centre for Polio Eradication at the Ministry of Public Health, speaking at a joint press conference held in Kabul.
This week’s campaign is carried out by over 31 000 trained polio workers and it runs until 3 February when vaccinators revisit children who were missed when the vaccinators first visited. These vaccinators and other polio workers are trusted members of the community and they have been chosen because they care about children.
“We have seen significant progress in our polio eradication efforts over the past year. Most of Afghanistan is now polio-free, the circulation of the poliovirus is restricted to small areas in the eastern, southern and southeastern parts of the country and we have seen huge improvements in vaccination campaign quality,” said Dr Hemant Shukla, director of the polio programme at WHO. “Our focus is now on reaching every single child during every vaccination campaign to stop the transmission of polio.”
“With our collective efforts, we will be able to eradicate polio from the world. Vaccines are the right of every child and no child should be missed during polio campaigns,” said Ms Melissa Corkum, UNICEF Polio director in Afghanistan. “Thousands of frontline workers visit every house in the country during campaigns. That’s not an easy task. Due to the hard work of these dedicated frontline workers, we are closer to polio eradication than ever.”
In 2016, new initiatives have been implemented to strengthen the polio eradication programme in Afghanistan. All polio eradication activities have been brought under one leadership as Emergency Operations Centres have been established at the national and subnational level. The surveillance system has been strengthened and the circulation of wild poliovirus is unlikely to be missed in Afghanistan. The quality of campaigns, routine immunization and rapid response to polio cases have improved tremendously over the past year.
In 2016, 13 polio cases were registered: 7 cases in Paktika, 4 cases in Kunar, one case in Kandahar and one in Helmand province. Afghanistan remains one of 3 polio-endemic countries together with Pakistan and Nigeria.
On the sixth anniversary of the last case of wild poliovirus in the South-East Asia Region, World Health Organization commends countries in the Region for their continued efforts to protect children against this crippling virus and maintain the Region’s polio-free status, despite challenging conditions.
Poliovirus Image/CDC
Amid a global shortage of injectable inactivated polio vaccine (IPV), countries in the WHO South-East Asia Region are opting to use fractional doses of IPV, an evidence-based intervention that not only ensures continued protection of children against all types of polioviruses, but also helps save vaccine – a move bound to positively impact global vaccine supply in the coming years.
India became the first country globally to introduce fractional doses of IPV in childhood immunization programme in eight of its 36 states / union territories in early 2016. The initiative is now being scaled up nationwide. Sri Lanka followed suit in July 2016. Bangladesh has decided to introduce fractional IPV doses this year. Other countries in the Region are also considering a shift to the use of fractional IPV doses in their immunization schedule.
Studies have confirmed that two fractional doses (one fractional dose is one-fifth of a full dose) of IPV, given twice to infants – first at the age of six weeks and then at 14 weeks – provide the same protection against all polioviruses as does one full dose of IPV.
By using fractional IPV, countries are saving vaccine and vaccine cost, without compromising on the protection that the vaccine provides to children against polio.
Since polio-free certification on 27 March 2014, all countries in WHO South-East Asia Region have been working towards timely implementation of the global polio end game strategy to achieve a polio-free world.
South-East Asia was the first WHO Region to complete the polio vaccine switch from the traditionally used trivalent oral polio vaccine (tOPV) to the bivalent vaccine (bOPV) to prevent any paralysis caused by type 2 poliovirus strain in tOPV.
As a part of the global polio endgame strategy, countries in the Region have introduced IPV to supplement the oral polio vaccine (OPV), and ensure protection against all types of polioviruses, while the programme globally strives towards stopping poliovirus transmission and cessation of OPV use.
The date – 13 January – the last time that wild poliovirus crippled a child in WHO South-East Asia Region in the year 2011, should be a reminder to all countries of the continued need to reach every child with polio vaccines and to strengthen disease surveillance so that poliovirus does not return to cripple children in our Region.
There is likely no bigger accomplishment in medicine and public health that has saved so many lives and prevented so much misery over the decades as the introduction of vaccines.
The World Health Organization (WHO) defines vaccine as follows: a biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe, its toxins or one of its surface proteins. The agent stimulates the body’s immune system to recognize the agent as foreign, destroy it, and “remember” it, so that the immune system can more easily recognize and destroy any of these microorganisms that it later encounters.
Below are five communicable diseases that were once rampant in the United States until the introduction of a vaccine against that particular disease. Let’s look at these five diseases–then and now.
1. Measles
The first measles vaccine was licensed for use in the US in 1963. An average of 549,000 measles cases and 495 measles deaths were reported annually in the decade prior to the live measles vaccine.
Measles rash Image/CDC
In 1989, a second-dose vaccination schedule was recommended by the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians (AAFP).
By 2000, endemic measles was declared “eliminated” from the United States.
According to the Centers for Disease Control and Prevention (CDC), from 2001-2011, 911 measles cases were reported. The median number of measles cases reported per year was 62 (range: 37-220 cases/year).
The majority of measles cases were unvaccinated (65%) or had unknown vaccination status (20%). Of the 911 reported measles cases, 372 (40%) were importations (on average 34 importations/year), 239 (26%) were epidemiologically linked to these importations, 190 (21%) either had virologic evidence of importation or had been linked to those cases with virologic evidence of importation, and 110 (12%) had unknown source.
The first 11 months of 2014 saw 610 measles cases in 24 states. The federal health agency notes that the majority of the people who got measles are unvaccinated and travelers continue to import measles into the country.
2. Pertussis
Before pertussis vaccines became widely available in the 1940s, about 200,000 children got sick with it each year in the US and about 9,000 died as a result of the infection. Now we see about 10,000–40,000 cases reported each year and unfortunately about 10–20 deaths, according to CDC numbers.
Since the early 1980s, there has been an overall trend of an increase in reported pertussis cases. Pertussis is naturally cyclic in nature, with peaks in disease every 3-5 years. But for the past 20-30 years, we’ve seen the peaks getting higher and overall case counts going up.
Waning immunity of the pertussis vaccine is a main reason for this phenomenon. The CDC explains:
When it comes to waning immunity, it seems that the acellular pertussis vaccine (DTaP) we use now may not protect for as long as the whole cell vaccine (DTP) we used to use. Throughout the 1990s, the US switched from using DTP to using DTaP for infants and children. Whole cell vaccines are associated with higher rates of minor and temporary side effects such as fever and pain and swelling at the injection site. Rare but serious neurologic adverse reactions including chronic neurological problems rarely occurred among children who had recently received whole cell vaccines. While studies have had inconsistent results that the vaccine could cause chronic neurological problems, public concern in the US and other countries led to a concerted effort to develop a vaccine with improved safety. Due to these concerns, along with the availability of a safe and effective acellular vaccine, the US switched to acellular pertussis vaccines.
3. Diphtheria
The horrible disease, diphtheria, was once a major cause of illness and death in children.
The U.S. recorded 206,000 cases of diphtheria in 1921, resulting in 15,520 deaths. Before there was treatment (diphtheria antitoxin and antibiotics) for diphtheria, up to half of the people who got the disease died from it.
In the past decade, there were less than five cases of diphtheria in the U.S. reported to CDC. However, since the disease is still seen in many countries around the world, maintaining vaccination status is key when traveling abroad (for diphtheria and other vaccine preventable diseases).
4. Polio
Polio is a disease that struck fear into the hearts of Americans just more than a half-century ago. Images of children in an “iron lung” or those with horrible defomities was enough to scare any parent.
Iron lung/CDC
Polio also affected many famous Americans including actor Alan Alda, “Tarzan” Johnny Weissmuller and of course, former US President Franklin D Roosevelt.
Author and professor Gareth Williams writes in his book, Paralyzed with Fear, In 1949, the US Surgeon General, Leonard Scheele warned that this would be the nation’s worst year yet for polio and that the future looked even grimmer. He was right on both counts: 1949 saw 42,000 Americans paralyzed and 2,700 deaths from polio, rising in 1952 to 58,000 paralyzed and 3,000 fatalities.
Following introduction of vaccines—specifically, trivalent inactivated poliovirus vaccine (IPV) in 1955 and trivalent oral poliovirus vaccine (OPV) in 1963—the number of polio cases fell rapidly to less than 100 in the 1960s and fewer than 10 in the 1970s, according to the CDC.
Polio has been eliminated from the United States thanks to widespread polio vaccination in this country. This means that there is no year-round transmission of poliovirus in the United States. Since 1979 no cases of polio have originated in the United States.
5. Mumps
Before the U.S. mumps vaccination program started in 1967, about 186,000 cases were reported each year. That has decreased some 99% since the introduction of vaccines. From January 1 to November 29, 2014, 1,078 people in the United States have been reported to have mumps.
Despite the incredible numbers and success due to mumps vaccination, the CDC does acknowledge it’s shortcomings: Although the measles-mumps-rubella (MMR) vaccine is very effective, protection against mumps is not complete. Two doses of measles-mumps-rubella (MMR) vaccine are 88% effective at protecting against mumps; one dose is 78% effective.
The numbers are remarkable and really speak for itself.
Efforts are underway to ensure it will stay eradicated
Smallpox is so far the only human infectious disease to have
been eradicated from the world. With eradication, smallpox virus was consolidated into a limited number of biomedical facilities. In 1978, an accident in a biomedical research laboratory in Birmingham, United Kingdom, resulted in the inadvertent release of smallpox virus, two persons developing disease, and one of them dying of the disease despite having been vaccinated as a child. This triggered countries to further reduce the number of facilities retaining smallpox virus to the two official repositories of today.
The world is on the brink of another eradication: that of polio – the second human disease to be eradicated in history.
Polio can be caused by infection with any one of three different types of poliovirus. One of these types, wild poliovirus type 2, has officially been declared eradicated by an independent commission in September of this year. While wild poliovirus type 2 has been eradicated and is no longer circulating in the human population, it continues to exist in a number of laboratories and vaccine manufacturing facilities around the world.
Why retain virus?
Retaining polioviruses in certain settings is critical. For one, the virus is needed to make vaccines that will continue to be given to children as part of immunization programmes in countries worldwide. And as importantly, poliovirus is critical for medical research, for example, showing encouraging potential for developing treatment against cancer. This and other crucial research work will need to continue under safe and secure conditions.
Safely retaining virus
Facilities retaining polioviruses must thus ensure that these viruses are not released back into the community or the environment, to again cause paralysis or death.
This involves identifying which facilities hold polioviruses, knowingly or unknowingly. Only those facilities where poliovirus is needed to serve critical national and international functions, such as vaccine production and indispensable research, should be allowed to hold polioviruses. These laboratories and facilities should be named by their hosting countries as poliovirus-essential facilities (PEFs), if they demonstrate to take appropriate measures to handle and store poliovirus safely and securely in a defined space – this is called containment. All other polioviruses that are not needed for these critical functions should be properly destroyed.
It is urgent to ensure the appropriate containment of the eradicated poliovirus type 2. The ultimate goal, however, is to contain all polioviruses in poliovirus-essential facilities as soon as the other two poliovirus types (1 and 3) are also declared eradicated.
Call to action
All countries are being called to action. They should implement the measures that are outlined in the WHO global action plan for containing polioviruses. The ministries of health of all 194 WHO Member States endorsed this plan in May 2015 and committed to its implementation, which can only be completed through the full engagement of each and every stakeholder.
Now that poliovirus type 2 has been certified as eradicated, this virus type will only exist in laboratories and facilities that are designated and meet the certified level of containment. These laboratories and facilities, and their hosting countries, hold the critical responsibility of making sure that no poliovirus type 2 is ever released into communities. This is the only way to truly ensure that no child will ever again, for all future generations to come, become paralysed by or die from this terrible disease.
New expert groups
To support this work, WHO is establishing two new groups: the Containment Working Group (CWG) and the Containment Advisory Group (CAG).
The CWG, under the Global Commission for the Certification of Poliomyelitis Eradication (GCC), will review the national containment certification of poliovirus-essential facilities (PEFs) and make recommendations to the GCC.
The CAG will make recommendations on technical issues associated with GAPIII.
The call for nominations for the CWG is now open. Applications for CAG membership will open shortly.
Romania saw 15 measles cases in 2015. Since 2016, this number has blown-up to 2,165, including 13 fatalities. This is largely due to bogus claims from anti-vaccination campaigns in the country, according to a La Vanguardia report (computer translated).
Image/TDH
President of the Romanian Society of Microbiology, Alexandru Rafila directly points the finger at the anti-vaxx movement and says, “Incorrect information, often tendentious, not based on scientific methods or real data should end so that they do not affect the health of our children”.
Mercury in vaccines, vaccines introduce foreign elements and vaccines cause asthma are some of the arguments made by the anti-vaccination movement.
This misinformation has resulted in vaccination rates in the measles-mumps-rubella (MMR) vaccine falling from 95% of children in 2013 to 80% in 2016, and it continues to drop.
Campaigns led by the Christian Orthodox Pro Vita Federation, author of the 2012 book “Vaccines: Prevention or Illness” Christei Todea-Gross and the Coalition for the Family have spread the anti-vaccination message through a number of outlets.
The Ministry of Health has been denouncing “the irresponsible campaigns against the vaccination of children” for months; however, there are many parents who do not vaccinate their children for lack of confidence towards the authorities.
Walter A. Orenstein, THE COMMITTEE ON INFECTIOUS DISEASES
The American Academy of Pediatrics strongly supports the Polio Eradication and Endgame Strategic Plan of the Global Polio Eradication Initiative. This plan was endorsed in November 2012 by the Strategic Advisory Group of Experts on Immunization of the World Health Organization and published by the World Health Organization in April 2013. As a key component of the plan, it will be necessary to stop oral polio vaccine (OPV) use globally to achieve eradication, because the attenuated viruses in the vaccine rarely can cause polio.
The plan includes procedures for elimination of vaccine-associated paralytic polio and circulating vaccine-derived polioviruses (cVDPVs). cVDPVs can proliferate when vaccine viruses are transmitted among susceptible people, resulting in mutations conferring both the neurovirulence and transmissibility characteristics of wild polioviruses. Although there are 3 different types of wild poliovirus strains, the polio eradication effort has already resulted in the global elimination of type 2 poliovirus for more than a decade.
Type 3 poliovirus may be eliminated because the wild type 3 poliovirus was last detected in 2012. Thus, of the 3 wild types, only wild type 1 poliovirus is still known to be circulating and causing disease. OPV remains the key vaccine for eradicating wild polioviruses in polio-infected countries because it induces high levels of systemic immunity to prevent paralysis and intestinal immunity to reduce transmission. However, OPV is a rare cause of paralysis and the substantial decrease in wild-type disease has resulted in estimates that the vaccine is causing more polio-related paralysis annually in recent years than the wild virus. The new endgame strategic plan calls for stepwise removal of the type 2 poliovirus component from trivalent oral vaccines, because type 2 wild poliovirus appears to have been eradicated (since 1999) and yet is the main cause of cVDPV outbreaks and approximately 40% of vaccine-associated paralytic polio cases.
The Endgame and Strategic Plan will be accomplished by shifting from trivalent OPV to bivalent OPV (containing types 1 and 3 poliovirus only). It will be necessary to introduce trivalent inactivated poliovirus vaccine (IPV) into routine immunization programs in all countries using OPV to provide population immunity to type 2 before the switch from trivalent OPV to bivalent OPV.
The Global Polio Eradication Initiative hopes to achieve global eradication of polio by 2018 with this strategy, after which all OPV use will be stopped. Challenges expected for adding IPV into routine immunization schedules include higher cost of IPV compared with OPV, cold-chain capacity limits, more complex administration of vaccine because IPV requires injections as opposed to oral administration, and inferior intestinal immunity conferred by IPV. The goal of this report is to help pediatricians understand the change in strategy and outline ways that pediatricians can help global polio eradication efforts, including advocating for the resources needed to accomplish polio eradication and for incorporation of IPV into routine immunization programs in all countries.
A child receives 2 drops of the oral polio vaccine (OPV). Photo: WHO/S.RamoKabul 30 January 2017 – The Ministry of Public Health, WHO and UNICEF launched today the first polio subnational immunization days campaign of 2017. Over 5.6 million children will be vaccinated against polio in all provinces in the southern and south-eastern regions, most districts in the eastern region, as well as selected high-risk districts across the country, including Kabul city.
