Jun 29, 2017

Mutant Strains Of Polio Vaccine Now Cause More Paralysis Than Wild Polio

Nurses give the oral polio vaccine to a Syrian child in a refugee camp in Turkey. The oral polio vaccine used throughout most of the developing world contains a form of the virus that has been weakened in the laboratory. But it's still a live virus.
Carsten Koall/Getty Images
For the first time, the number of children paralyzed by mutant strains of the polio vaccine are greater than the number of children paralyzed by polio itself.
So far in 2017, there have been only six cases of "wild" polio reported anywhere in the world. By "wild," public health officials mean the disease caused by polio virus found naturally in the environment.
By contrast, there have been 21 cases of vaccine-derived polio this year. These cases look remarkably similar to regular polio. But laboratory tests show they're caused by remnants of the oral polio vaccine that have gotten loose in the environment, mutated and regained their ability to paralyze unvaccinated children
"It's actually an interesting conundrum. The very tool you are using for [polio] eradication is causing the problem," says Raul Andino, a professor of microbiology at the University of California at San Francisco.
The oral polio vaccine used throughout most of the developing world contains a form of the virus that has been weakened in the laboratory. But it's still a live virus. (This is a different vaccine than the injectable one used in the U.S. and most developed countries. The injectable vaccine is far more expensive and does not contain live forms of the virus.)
Andino studies how viruses mutate. In a study published in March, he and his colleagues found that the laboratory-weakened virus used in the oral polio vaccine can very rapidly regain its strength if it starts spreading on its own. After a child is vaccinated with live polio virus, the virus replicates inside the child's intestine and eventually is excreted. In places with poor sanitation, fecal matter can enter the drinking water supply and the virus is able to start spreading from person to person.
"We discovered there's only a few [mutations] that have to happen and they happen rather quickly in the first month or two post-vaccination," Andino says. "As the virus starts circulating in the community, it acquires further mutations that make it basically indistinguishable from the wild-type virus. It's polio in terms of virulence and in terms of how the virus spreads."
In June, the World Health Organization reported 15 cases of children paralyzed in Syria by vaccine-derived forms of polio. These cases come on top of two other vaccine-derived polio cases earlier this year in Syria and four in the Democratic Republic of the Congo.
"In Syria, there may be more cases coming up," says Michel Zaffran, the director of polio eradication at the World Health Organization. He says lab work is still being done on about a dozen more cases of paralysis to confirm whether they're polio or something else.
The cases in Syria are all in the east of the country near the border with Iraq.
It has become fairly common each year for there to be one or two small outbreaks of vaccine-derived polio. These outbreaks tend to happen in conflict zones where health care systems have collapsed.
"These outbreaks are occurring only in very rare cases and only in places where children are not immunized," says Zaffran. The regular polio vaccine protects children from vaccine-derived strains of the virus just as it protects them from regular polio. Vaccine-derived outbreaks, he says, "occur where there are large pockets of unimmunized children, pockets sufficiently large to allow for the circulation of the virus."
WHO is staging a massive response to the Syrian outbreak. WHO plans to work with local health officials and aid groups to vaccinate a quarter of a million children in early July. The goal is to reach every child younger than 5 in the area with two doses of two different types of polio vaccine, spaced one to two weeks apart. This would be a logistical challenge in most parts of the world, never mind in war-torn Syria.
"The access in these areas is a bit limited because of the presence of ISIS," Zaffran says in what seems like an understatement. Eastern Syria is home right now to Syrians who've fled from Raqqa (the ISIS capital in Syria), other parts of the country and even Iraq. "Also there's a risk that the fighting might actually move to this area."
Zaffran is confident that the rogue vaccine-derived virus circulating in eastern Syria right now can be wiped out with a massive blast of more vaccine.
"We knew that we were going to have such outbreaks. We've had them in the past. We continue to have them now. We know how to find them, and we know how to interrupt them. We have the tools to do that," Zaffran says. "So it's hiccup ... a very regrettable hiccup for the poor children that have been paralyzed, of course. But with regards to the whole initiative, you know it's not something that is unexpected."
WHO is attempting to phase out the use of live oral polio vaccine to eliminate the risk that the active virus in the vaccine could mutate into a form that can harm unvaccinated children.
But for now, the live vaccine continues to be the workhorse of the global polio eradication campaign for a couple of reasons. First it's cheap, costing only about 10 cents a dose versus $3 a dose for the injectable, killed vaccine. Second, it can be given as drops into a child's mouth, which makes it far easier to administer than the inactivated or "killed" vaccine, which has to be injected. Third, there simply isn't enough killed vaccine on the market to vaccinate every child on the planet, and vaccine manufacturers don't have the capacity to produce the quantities that would be needed if such a switch happened immediately.
And finally, the live vaccine stops transmission of the polio virus entirely in a community if sufficient numbers of people are vaccinated. The killed vaccine doesn't fully block the virus from spreading because a person who is immunized can still carry and spread the polio virus. And this is an important difference between these two types of vaccines when the goal is to exterminate the polio virus.
"The fact is this [the live oral polio vaccine] is the only tool that we have that can eradicate the disease," says Zaffran.
That eradication effort has been incredibly successful. In 1988, when the campaign began, there were 350,000 cases of polio around the world each year compared with the six so far this year.
Zaffran credits the oral polio vaccine with getting the world incredibly close to wiping out a terrible disease.
"Four regions of the world have totally eradicated the disease with the use of the oral polio vaccine," he notes. "Of course we need to recognize that there have been a few cases of children paralyzed because of the vaccine virus, which is regrettable. But, you know, from a public health perspective, the benefits far outweigh the risk."

Post Polio Litaff, Association A.C _APPLAC Mexico

Jun 28, 2017

Circulating vaccine-derived poliovirus type 2 – Democratic Republic of the Congo

Emergencies preparedness, response

Disease outbreak news 
13 June 2017
In the Democratic Republic of the Congo (DRC), two separate circulating vaccine-derived poliovirus type 2s (cVDPV2s) have been confirmed. The first cVDPV2 strain has been isolated from two acute flaccid paralysis (AFP) cases from two districts in Haut-Lomami province, with onset of paralysis on 20 February and 8 March 2017. The second cVDPV2 strain has been isolated from Maniema province, from two AFP cases (with onset of paralysis on 18 April and 8 May 2017) and a healthy contact in the community.

Public health response

The Ministry of Health, supported by WHO and partners of the Global Polio Eradication Initiative (GPEI), has completed a risk assessment, including evaluating population immunity and the risk of further spread. 
Outbreak response plans are currently being finalized, consisting of strengthening surveillance, including active case searching for additional cases of AFP, and supplementary immunization activities (SIAs) with monovalent oral polio vaccine type 2 (mOPV2), in line with internationally-agreed outbreak response protocols. 
Surveillance and immunization activities are being strengthened in neighbouring countries. 

WHO risk assessment

WHO assesses the risk of further national spread of these strains to be high, and the risk of international spread to be medium. 
The detection of cVDPV2s underscores the importance of maintaining high routine vaccination coverage everywhere, to minimize the risk and consequences of any poliovirus circulation. These events also underscore the risk posed by any low-level transmission of the virus. A robust outbreak response as initiated is needed to rapidly stop circulation and ensure sufficient vaccination coverage in the affected areas to prevent similar outbreaks in the future. WHO will continue to evaluate the epidemiological situation and outbreak response measures being implemented.

WHO advice

It is important that all countries, in particular those with frequent travel and contacts with polio-affected countries and areas, strengthen surveillance for AFP cases in order to rapidly detect any new virus importation and to facilitate a rapid response. Countries, territories and areas should also maintain uniformly high routine immunization coverage at the district level to minimize the consequences of any new virus introduction.
WHO’s International Travel and Health recommends that all travellers to polio-affected areas be fully vaccinated against polio. Residents (and visitors for more than four weeks) from infected areas should receive an additional dose of OPV or inactivated polio vaccine (IPV) within four weeks to 12 months of travel. As per the advice of the Emergency Committee convened under the International Health Regulations (2005), efforts to limit the international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC). Countries affected by poliovirus transmission are subject to Temporary Recommendations. To comply with the Temporary Recommendations issued under the PHEIC, any country infected by poliovirus should declare the outbreak as a national public health emergency and consider vaccination of all international travellers.

Post Polio Litaff, Association A.C _APPLAC Mexico

Painless patch could replace flu jab: study

Despite recommendations for universal vaccination, less than half the population in the United States currently gets a flu jab, and influenza kills some 48,000 people in the US every year (AFP Photo/TIMOTHY A. CLARY)

Paris (AFP) - Vaccines delivered via a painless, throw-away patch could one day eliminate the need for needle-and-syringe flu injections, researchers said Wednesday after completing a preliminary trial.
Equipped with micro-needles, the patches vaccinated against influenza just as effectively as a standard flu jab, they reported in the medical journal The Lancet.
"This bandage-strip sized patch of dissolvable needles can transform how we get vaccinated," said Roderic Pettigrew, director of the US National Institute of Biomedical Imaging and Bioengineering, which funded the study.
The new technology can be self-administered and stored without refrigeration, making it significantly cheaper that traditional vaccines.
"It holds the promise for delivering other vaccines in the future," Pettigrew added.
A hundred tiny needles -- just long enough to penetrate the skin -- embedded in each patch dissolve within minutes when exposed to moisture from the body.
Adhesive holds the patch close the skin while the vaccine is released, and can be peeled away after 20 minutes and discarded.
In phase I clinical trials, researchers from Emory University in Georgia and the Georgia Institute of Technology randomly divided 100 adults into four groups.
Three received the micro-needle patches: one delivered by a healthcare provider; one self-administered; and the third -- delivered by a nurse -- a placebo without any active ingredients.
The fourth group received a classic flu jab with a syringe.
All the active flu vaccines worked equally well for at least six months, regardless of whether they were delivered by professionals or the patient, or whether they were administered by a syringe or a micro-needle.
The manufacturing cost for the patches is expected to be about the same as for pre-filled syringes.
But the patch is expected to be cheaper because it can be sent through the mail and self-administered.
In addition, it is stable for a year at 40 degrees Celsius (104 degrees Fahrenheit), and does not require refrigeration, the researchers said.
"These advantages could reduce the cost of the flu vaccine and potentially increase coverage," said lead author Nadine Rouphael, an associate professor at Emory. "Our findings now need confirming in larger trials."
Mark Prausnitz, a professor at the Georgia Institute of Technology, led the design of the small coin-sized patch, and is co-founder of a company that is licensing the technology.
Despite recommendations for universal vaccination, less than half the population in the United States currently gets a flu jab. Influenza kills some 48,000 people in the US every year.

Post Polio Litaff, Association A.C _APPLAC Mexico

Jun 25, 2017

How to Make Your Home Wheelchair Friendly

If you are a wheelchair user or live with someone who uses a wheelchair, you may know how difficult it is to movea wheelchair throughout the house if there are not enough space or accessible areas. There are many ways to make it easier to live at home with a wheelchair that are easy to accommodate. Below are 5 ways to adjust your home to be wheelchair friendly.

1. Install ramps
When you have steps that lead you to the doorway, installing a ramp is a great way to eliminate the hassle of using the steps. It is a big improvement for wheelchair user to enter the house quickly. Before installing ramps, check your area if it is required to install rails at a certain height.

2. Enlarge doorways

Navigating through narrow doorways is a big problem for wheelchair users. In order to fix this issue, you would have to have your doorways enlarge by cutting a large opening to make it wider.

3. Floor choices

Not all flooring styles are wheelchair friendly. Carpet and rugs can make it difficult for wheelchair user to move around due to the rough or thick surface. It is best to use soft carpeting or hard floors, such as wood and tile, in your house.

4. Install grab bars

Grab bars is a great tool for wheelchair users to have stability to prevent the risk of falling. They are best installed in the bathroom especially beside the toilet and in the shower. In general, grab bars are useful in other parts of the houses when stability is needed.
Assist Rail 
Bed Rail

5. Adaptive equipment

Adaptive equipment comes in different shapes and sizes. These equipment help wheelchair user do certain tasks independently when they are in the kitchen or in the bathroom. For example, you can design a kitchen with equipment to allow wheelchair user to independently move or grab objects. You can also add a shower chair in the bathroom. Click here for more details about shower equipment.

Shower Chair with Back Support

Shower Chair

For more detail suggestions on how to make your home to be wheelchair friendly, check out the image below. The image provides great advice for each room. Click on the image for a clearer view.

Post Polio Litaff, Association A.C _APPLAC Mexico


 Keah Brown, a writer and activist who has cerebral palsy, breaks down the pervasiveness of ableism in the media—and how to do better.

It’s hard living in a world that sees your body as a thing to be horrified of. No one chooses disability. The only choice in disability is to adapt—not in spite of it, but because we deserve to live as well as possible. When Lorde likened celebrity and its restrictions to an autoimmune disease earlier this week, I was taken aback. She’s since apologized, and though it was short, I believe she was sincere. The problem with her initial comment is it exposes a deeper and larger problem in our popular culture and society today. Lorde isn’t the first person to conflate disabilities with unpleasant or unwanted situations, and she won’t be the last.

There is a pervasive belief in our society that disabled people are too much work, are burdens, and that we don’t like ourselves or our bodies. Popular culture upholds this falsehood while often showing only one type of disabled body— a white male wheelchair user, like in Me Before YouThe Fundamentals of Caring and ABC’s Speechless. On critically acclaimed shows like CW’s Jane The Virgin, the idea of disability and paraplegia is met with shock and borderline horror. When Michael (Brett Dier) was shot by a crime lord, his family and loved ones were informed the surgery may have paralyzed him. The minute the words left the doctor’s mouth, the atmosphere on the show shifted. The family’s concern wasn’t that Michael would have to adjust to life as a full-time wheelchair user, or how best to help him, but that even the possibility of disability was too much to handle. In the Netflix series Man To Man, a cop is intentionally run over by a semi truck. When the subject of possible paraplegia is brought up, it is met with quiet horror from the character’s family members. 
"Lorde isn’t the first person to conflate disabilities with unpleasant or unwanted situations, and she won’t be the last."
Lorde’s comparison of disability to negative situations or, rather, inconvenient ones, is inaccurate and harmful. The idea that those of us with autoimmune diseases can be equated to an inconvenience affects not only our self-esteems, but promotes a negative narrative of disabled people echoed in films like Me Before You and Million Dollar Baby. In these movies, disability is met with anger and frustration, the wish for death and ultimately, the fulfillment of that wish, sending the message that disabled bodies are inconvenient and not worth living in. It’s difficult to watch these movies receive praise, because that tells real-life disabled folks that resentment and death are the only ways to function in our bodies. 
Emilia Clarke and Sam Claflin in Me Before You
EverettDesign by American Artist
While I believe Lorde’s comment warranted an apology, we have to remember it’s part of a larger issue—that society treats disability like the worst possible thing. As someone who loves popular culture, this truth is heartbreaking, and a large part of the reason I spent most of my adolescent and teenage years hating my body and myself. I’m sure some people think, “Relax, it’s just one comment,” but statements like Lorde’s help shape culture and public perception of certain lived experiences. We can’t continue to move forward in society unless the disability community feels properly seen and heard.
"Films like Me Before You and Million Dollar Baby send the message that disabled bodies are inconvenient and not worth living in."

Post Polio Litaff, Association A.C _APPLAC Mexico

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