Dec 21, 2019

Polio Outbreaks Confirmed in 14 African Countries

December 15th, 2019 – The US Centers for Disease Control and Prevention (CDC) increased the polio outbreak Travel Alert for 14 African countries.
The CDC said in a new Level 2 Travel Alert published on December 11, 2019, that ‘there are confirmed polio outbreaks in various countries primarily located in central and eastern Africa.’
Additionally, the Global Polio Eradication Initiative (GPEI) reported ‘polio-endemic countries, which have never stopped the transmission of indigenous wild poliovirus, can also be affected by outbreaks of circulating vaccine-derived poliovirus.’
This ‘Practice Enhanced Precaution’ Travel Alert is an important reminder to all travelers visiting the African countries listed below, to ensure they have previously completed the full polio vaccination series.
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The CDC and the World Health Organization (WHO) both recommend visitors to infected areas for more than 4 weeks should receive an additional dose of oral polio vaccine (OPV) or inactivated polio vaccine (IPV) within 4 weeks to 12 months of travel.
And, adults should discuss with a healthcare provider if it’s appropriate to receive a single booster dose of the polio vaccine.
The CDC and the GPEI have reported the following outbreak information for these 14 African countries:  
  • Angola - There are 71 cVDPV2 cases from seven outbreaks reported in 2019.
  • Benin - There are six cVDPV2 cases in 2019 linked to the Jigawa outbreak in Nigeria.
  • Cameroon - Affected by circulating vaccine-derived poliovirus type 2 (cVDPV2).
  • Central African Republic - There are 16 reported cases in 2019 from six different outbreaks of cVDPV2 in 2019.
  • Chad - There is one cVDPV2 case in the country linked to the Jigawa outbreak in Nigeria.
  • Democratic Republic of the Congo - There are 53 cVDPV2 cases in 2019 and 20 in 2018.
  • Ethiopia - Five cVDPV2 cases reported in Ethiopia in 2019, four of them are linked to the outbreak in neighboring Somalia and the fifth case is part of a newly reported Ethiopian outbreak this week.
  • Ghana - Nine cVDPV2 cases in 2019 linked to the Jigawa outbreak in Nigeria.
  • Mozambique - Circulation of cVDPV2 has been confirmed in Mozambique.
  • Niger - There are nine cVDPV2 cases in 2019 linked to the Jigawa outbreak in Nigeria.
  •  Nigeria - There are 18 cVDPV2 cases reported in 2019. There were 34 cVDPV2 cases in 2018.
  • Somalia - A total of 15 cVDPV cases (eight type 2, six type 3 and one co-infection of both type 2 and type 3) since the beginning of the outbreaks.  
  • Togo - There are three cVDPV2 cases in 2019 in the country linked to Jigawa outbreak in Nigeria.
  • Zambia - There is one cVDPV2 case from the first outbreak in the country.
According to the CDC, the United States has been polio-free since 1979, and the IPV has been the only polio vaccine offered in the USA since 2000. 
IPV is given by a shot in the leg or arm, at 4 different times, depending on the patient’s age. IPV vaccination has not been known to cause serious problems, but side effects are a potential risk, says the CDC.
In the USA, there are various IPV vaccines available, such as Kinrix and Pediarix.
Once vaccinated, your doctor should provide you with an International Certificate of Vaccination or Prophylaxis yellow card. This will serve as your official documentation of polio vaccination.
Polio is a crippling and potentially deadly disease that affects the nervous system. Because the virus lives in the feces of an infected person, people infected with the disease can spread it to others when they do not wash their hands well after defecating. 
People can also be infected with polio if they drink water or eat food contaminated with infected feces.
In rare cases, polio can be fatal if the muscles used for breathing are paralyzed or if there is an infection of the brain, says the CDC.
Recently, there was some good news regarding the elimination of 2 out of 3 polio types.
An independent commission of experts concluded during October 2019, that wild poliovirus type 3 (WPV3) has been ‘eradicated’ around the world. This announcement follows the earlier eradication of wild poliovirus type 2 during 2015.
Additionally, global leaders affirm their commitment to eradicate polio and pledge $2.6 billion on November 19, 2019, as part of the 1st phase of the funding needed to implement the Global Polio Eradication Initiative’s Polio Endgame Strategy 2019-2023.
Prior to traveling abroad, medication and vaccine counseling appointments can be scheduled with a travel specialist at Vax-Before-Travel.
Polio vaccine news published by Vax-Before-Travel.

Post Polio Litaff, Association A.C _APPLAC Mexico

Eradicating polio includes preparing for its possible return

If poliovirus were detected in your country, what actions would be taken to prevent its spread? Who would inform the public and coordinate a campaign to vaccinate vulnerable children? How many vaccine doses would be needed? How would they be procured and stored?
These questions and many more were part of polio outbreak simulation exercises (POSEs) conducted in the past month in Albania and Ukraine to review the countries’ national polio outbreak response plans and identify any gaps in preparedness.
Dr Oleksandr Zaika, Manager of Ukraine’s National Immunization Programme, explained: “This is an important and timely exercise. Critical review of the plan by experts from the Ministry of Health, the Public Health Centre, academia, and other institutions from national and oblast levels with facilitation by WHO/Europe is crucial in ensuring the preparedness of the country to a potential polio outbreak.”

The WHO European Region is polio free – why simulate an outbreak?

In October 2019, wild poliovirus type 3 was declared eradicated. This global milestone signified that, of the three wild strains, only poliovirus type 1 continues to spread anywhere in the world. However, the number of cases caused by this remaining wild strain in Afghanistan and Pakistan has increased sharply in the past year – from 33 in 2018 to 117 in 2019, as of 11 December.
A second concern is the increased detection of circulating vaccine-derived poliovirus (cVDPV) globally, with 216 human cases detected in 16 countries as of 11 December this year (up from 104 cases in 7 countries in 2018). This global trend underlines the urgency of ensuring that countries in all parts of the world are alert and ready to respond if needed.
The Global Polio Eradication Initiative’s standard operating procedures for responding to a poliovirus event or outbreak call for all countries to plan for the eventuality of a poliovirus importation or local detection. They also encourage countries to develop a preparedness plan and test it in a polio outbreak simulation exercise to ensure that public health personnel and emergency systems are prepared to react quickly and effectively if any poliovirus isolate is detected.

Lessons learned in Ukraine

The need for quick action to prevent the re-establishment of polio in Ukraine, and thereby the European Region as a whole, was demonstrated with the detection of 2 cases of cVDPV in Ukraine in 2015. The lessons learned in responding to that outbreak, which was stopped within 6 months with no further cases detected, were a main focus of the POSE conducted in Kyiv on 9–11 December 2019.
Many of the participants responsible for disease surveillance, immunization, outbreak response, vaccine regulation, communication or laboratory services were part of the response in 2015–2016 and could share valuable insights with their colleagues while reviewing the current preparedness plan.
Based on a proposed (fictitious) polio outbreak scenario, participants identified the plan’s strengths and gaps and tested its alignment with international standards. The outcome is a compilation of proposed revisions as well as a timeline and action points for their incorporation into the updated national document.

Actual earthquake during simulated outbreak in Albania

A desktop POSE was also conducted in Tirana, Albania, on 26–27 November 2019 to draft a national polio outbreak response plan and improve understanding of the critical actions needed to respond to a polio-related event or outbreak.
Participants included national policy-makers and senior technical staff from the Ministry of Health and Institute of Public Health. Their dedication to ensuring that the country is fully prepared for a polio outbreak was profoundly demonstrated during the 2-day event, as they continued with the exercise while simultaneously responding to a 6.4-magnitude earthquake that shook the country in the early morning of 26 November.

Post Polio Litaff, Association A.C _APPLAC Mexico

Dec 16, 2019

Nigerians living in poverty rise to nearly 61%

El petróleo se produce en el sureste y algunos grupos militantes allí quieren mantener una mayor parte de la riqueza que proviene de sus pies. Los ataques de militantes contra instalaciones petroleras provocaron una fuerte caída en la producción de Nigeria durante la última década. Pero en 2010, una amnistía del gobierno llevó a miles de combatientes a dejar sus armas.
Los nigerianos que viven en la pobreza aumentan La pobreza ha aumentado en Nigeria, con casi 100 millones de personas viviendo con menos de $ 1 (£ 0.63) por día, a pesar del crecimiento económico, según las estadísticas.

La Oficina Nacional de Estadísticas dijo que el 60.9% de los nigerianos en 2010 vivían en "pobreza absoluta"; esta cifra había aumentado del 54.7% en 2004.
La oficina predijo que esta tendencia al alza probablemente continuaría.
Nigeria es el mayor productor de petróleo de África, pero el sector ha sido contaminado por acusaciones de corrupción.

Según el informe, la pobreza absoluta se mide por el número de personas que solo pueden permitirse los elementos esenciales básicos de vivienda, comida y ropa.
División norte-sur
La NBS, una agencia gubernamental, dijo que había una paradoja en el corazón de Nigeria, ya que la economía iba cada vez más fuerte, principalmente debido a la producción de petróleo, pero los nigerianos se estaban empobreciendo.
"A pesar de que la economía nigeriana está creciendo, la proporción de nigerianos que viven en la pobreza aumenta cada año, aunque disminuyó entre 1985 y 1992, y entre 1996 y 2004", dijo el jefe de la oficina de la NBS, Yemi Kale.
La población de Nigeria en pobreza

1980: 17,1 millones
1985: 34,7 millones
1992: 39,2 millones
1996: 67,1 millones
2004: 68,7 millones
2010: 112,47 millones

Fuente: Oficina Nacional de Estadística de Nigeria.
El petróleo representa alrededor del 80% de los ingresos estatales de Nigeria, pero apenas tiene capacidad para refinar el petróleo crudo en combustible, que debe importarse.
El mes pasado, hubo una huelga nacional cuando el gobierno intentó eliminar el subsidio al combustible, enojando a muchos nigerianos que lo ven como el único beneficio que recibieron de la vasta riqueza petrolera del país.
La NBS dijo que la pobreza relativa era más evidente en el norte del país, con la tasa de pobreza del estado de Sokoto la más alta con 86.4%.
En el noroeste y el noreste del país, las tasas de pobreza se registraron en 77.7% y 76.3% respectivamente, en comparación con el suroeste en 59.1%.
El analista de la BBC África Richard Hamilton dice que tal vez no sea sorprendente que grupos extremistas, como Boko Haram, sigan teniendo un atractivo en las partes del norte del país, donde la pobreza y el subdesarrollo son más severos.
El informe también reveló que los nigerianos se consideran cada vez más pobres.
En 2010, el 93.9% de los encuestados se sintieron pobres en comparación con el 75.5% seis años antes.
Kale dice que publicar tales estadísticas de vez en cuando es crucial para una planificación gubernamental efectiva.
"Este tipo de datos les ayuda a saber lo que realmente está sucediendo para que puedan seguir sus políticas y programas", dijo al programa Focus on Africa de la BBC.
"Les da la oportunidad de ver lo que están haciendo ... y si hay áreas que necesitan cambiar, facilita la modificación de las estrategias", agregó.
Nigeria: una nación dividida

A pesar de sus vastos recursos, Nigeria se encuentra entre los países más desiguales del mundo, según la ONU. La pobreza en el norte está en marcado contraste con los estados del sur más desarrollados. Mientras se encuentran en el sureste rico en petróleo, los residentes de Delta y Akwa Ibom se quejan de que toda la riqueza que generan fluye por el oleoducto hacia Abuja y Lagos.

Los 160 millones de personas de Nigeria están divididos entre numerosos grupos etnolingüísticos y también en líneas religiosas. En general, los hausa-fulani del norte son en su mayoría musulmanes. Los yorubas del sudoeste están divididos entre musulmanes y cristianos, mientras que los igbos del sudeste y los grupos vecinos son en su mayoría cristianos o animistas. El Cinturón Medio es el hogar de cientos de grupos con diferentes creencias, y alrededor de Jos hay frecuentes enfrentamientos entre musulmanes que hablan causa y miembros cristianos de la comunidad de Berom.

La alfabetización femenina se considera la clave para elevar el nivel de vida de la próxima generación. Por ejemplo, un niño recién nacido tiene muchas más probabilidades de sobrevivir si su madre está bien educada. En Nigeria vemos un marcado contraste entre el norte principalmente musulmán y el sur cristiano y animista. En algunos estados del norte, menos del 5% de las mujeres saben leer y escribir, mientras que en algunas áreas de Igbo más del 90% saben leer y escribir.
Nigeria es el mayor productor de petróleo de África y uno de los más grandes del mundo, pero la mayoría de su población subsiste con menos de $ 2 por día. El petróleo se produce en el sureste y algunos grupos militantes allí quieren mantener una mayor parte de la riqueza que proviene de sus pies. Los ataques de militantes contra instalaciones petroleras provocaron una fuerte caída en la producción de Nigeria durante la última década. Pero en 2010, una amnistía del gobierno llevó a miles de combatientes a acostarse.

Nigeria's population in poverty

  • 1980: 17.1 million
  • 1985: 34.7 million
  • 1992: 39.2 million
  • 1996: 67.1 million
  • 2004: 68.7 million
  • 2010: 112.47 million
Source: Nigeria's National Bureau of Statistics

Post Polio Litaff, Association A.C _APPLAC Mexico

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

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

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