Africa declared free of wild polio in 'milestone' - BBC News
Africa declared free of wild polio in 'milestone' - BBC News |
- Africa declared free of wild polio in 'milestone' - BBC News
- Africa Celebrates the End of the Wild Poliovirus (but Not the End of All Polio) - The New York Times
- TO YOUR GOOD HEALTH / By DR. KEITH ROACH | Vaccines are OK for those who have had polio - Kilgore News Herald
| Africa declared free of wild polio in 'milestone' - BBC News Posted: 25 Aug 2020 05:11 AM PDT  Image copyright AFP Africa has been declared free from wild polio by the independent body, the Africa Regional Certification Commission. Polio usually affects children under five, sometimes leading to irreversible paralysis. Death can occur when breathing muscles are affected. Twenty-five years ago thousands of children in Africa were paralysed by the virus. The disease is now only found in Afghanistan and Pakistan. There is no cure but the polio vaccine protects children for life. Nigeria is the last African country to be declared free from wild polio, having accounted for more than half of all global cases less than a decade ago. Wild polio cases in Nigeria2000-2020 The vaccination campaign in Nigeria involved a huge effort to reach remote and dangerous places under threat from militant violence and some health workers were killed in the process. What is polio and has it now been eradicated in Africa?Polio is a virus which spreads from person to person, usually through contaminated water. It can lead to paralysis by attacking the nervous system. Two out of three strains of wild polio virus have been eradicated worldwide. On Tuesday, Africa is to be declared free of the last remaining strain of wild poliovirus. More than 95% of Africa's population has now been immunised. This was one of the conditions that the Africa Regional Certification Commission set before declaring the continent free from wild polio. Now only the vaccine-derived polio virus remains in Africa with 177 cases being identified this year. This is a rare form of the virus that mutates from the oral polio vaccine and can then spread to under-immunised communities. The World Health Organization (WHO) has identified a number of these cases in Nigeria, the Democratic Republic of the Congo, Central African Republic and Angola. How did Africa eliminate wild polio?Without a cure a vaccine developed in 1952 by Dr Jonas Salk gave hope that children could be protected from the disease. In 1961, Albert Sabin pioneered the oral polio vaccine which has been used in most national immunisation programmes around the world. In 1996 poliovirus paralysed more than 75,000 children across the continent - every country was affected. That year Nelson Mandela launched the "Kick Polio Out of Africa" programme, mobilising millions of health workers who went village-to-village to hand-deliver vaccines. It was backed by a coalition of groups including Rotary International which had spearheaded the polio vaccination drive from the 1980s. Since 1996 billions of oral polio vaccines have been provided, averting an estimated 1.8 million cases of wild poliovirus. What have the challenges been?The last communities at risk of polio live in some of the most complicated places to deliver immunisation campaigns. Nigeria is the last country in Africa to have reported a case of wild polio - in Borno state in Nigeria's remote north-east, and the epicentre of the Boko Haram insurrection, in 2016. At the time it was a frustrating set-back as the country had made huge progress and had gone two years without any cases being identified. Outside Nigeria, the last place to have seen a case of polio was in the Puntland region of Somalia in 2014. Conflict with the Islamist militant group Boko Haram has made parts of Nigeria particularly difficult to reach, Borno state in particular. More than two million people have been displaced by the fighting. Frontline workers, 95% of whom were women, managed to navigate areas of conflict like Lake Chad by boat and deliver vaccines to remote communities. Widespread rumours and misinformation about the vaccine have also slowed down immunisation efforts. In 2003, Kano and a number of other northern states suspended immunisations following reports by Muslim religious leaders that the vaccine was contaminated with an anti-fertility agent as part of an American plot to make Muslim women infertile. Laboratory tests by Nigerian scientists dismissed the accusations. Vaccine campaigns resumed the following year, but the rumours persisted. In 2013 nine female polio vaccinators were killed in two shootings thought to be carried out by Boko Haram at health centres in Kano. It has taken decades to achieve eradication and overcome suspicion around the vaccine. How polio survivors made a differenceWinning the trust of communities has been key. Misbahu Lawan Didi, president of the Nigerian Polio Survivors Association, says that the role of survivors has been crucial in persuading people to accept the campaign. "Many rejected the polio vaccine, but they see how much we struggle to reach them, sometimes crawling large distances, to speak to them. We ask them: 'Don't you think it is important for you to protect you child not to be like us?'" From polio survivors, to traditional and religious leaders, school teachers, parents, volunteers and health workers, a huge coalition developed to defeat polio. Working together they travelled to remote communities to immunise children. How serious is polio?Polio, or poliomyelitis, mainly affects children aged under five. Initial symptoms include fever, fatigue, headache, vomiting, stiffness of the neck and pains in the limbs. It also invades the nervous system and can cause total paralysis in a matter of hours. One in 200 infections leads to irreversible paralysis. Among those paralysed, 5% to 10% of people die when their breathing muscles become immobilised. Could wild polio return?Polio can be easily imported into a country that is polio free and from there it can spread rapidly among under-immunised populations. This happened in Angola, which despite decades of civil war, defeated polio in 2001. The country remained free from polio for four years until 2005 when a number of cases were thought to have been brought in from outside the country. The WHO says that it is important countries remain vigilant and avoid complacency until there is global eradication. If they let down their defence by failing to vaccinate, then wild polio could once again begin to spread quickly. For all types of polio to be eliminated, including vaccine-derived polio, vaccination efforts will need to continue alongside surveillance, to protect children from being paralysed by the disease in the future.  |
| Africa Celebrates the End of the Wild Poliovirus (but Not the End of All Polio) - The New York Times Posted: 24 Aug 2020 09:21 AM PDT  DAKAR, Senegal — Africa is set to announce that it has stamped out wild poliovirus after a three-decade campaign against a disease that once paralyzed 75,000 children on the continent every year. The achievement is a major step toward ridding the globe of the virus that causes the disabling — and sometimes deadly — disease of polio: Only Afghanistan and Pakistan are still reporting cases. "Future generations of African children can live free of wild poliovirus," Dr. Matshidiso Moeti, the World Health Organization's director for Africa, said in a briefing on Monday. She said 1.8 million cases of polio-related paralysis had been prevented over the past 24 years. But the victory has a hollow note. Every year, hundreds of people across Africa are still being infected with circulating vaccine-derived poliovirus, which can infect people in areas where there is only partial vaccination. African cases of the vaccine-derived strain, which results in the same symptoms as the wild kind, increased to 320 last year from 68 in 2018, and could rise again in 2020 because many vaccination campaigns were paused during coronavirus lockdowns. The polio-free certification applies to what the World Health Organization calls the Africa region — one of its six global zones of operation — and it excludes North Africa. But no North African country has recorded a case of wild poliovirus since 2004, so the whole continent is now considered free of it. The 46 presidents of the region (there would have been 47, but the president of Mali was recently deposed in a coup) will celebrate along with supporters of polio eradication efforts, among them the Microsoft founder Bill Gates and the Nigerian billionaire Aliko Dangote, on a video conference call on Tuesday. The United States has been free of wild polio since 1979. The Global Polio Eradication Initiative started in 1988, with the aim of eradicating polio worldwide by the year 2000. Nigeria was a major sticking point on the African continent. After northern Nigeria boycotted the vaccine in 2003 because of rumors about its safety, an outbreak there spread to 20 countries in five years. A huge effort was initiated to change minds about the vaccine, and by 2015, it seemed that the situation was under control and rumors sufficiently squashed. But then, in 2016, four new cases of wild poliovirus were reported. The state they came from, Borno, in northeastern Nigeria, was the site of a vicious insurgency by the extremist group Boko Haram, and getting to the people living there was extremely difficult, both because of the danger and because the Nigerian authorities frequently denied access for aid workers. But after the four cases surfaced, the global health infrastructure swung into action. Nigeria's president instructed the military to work with the vaccination teams. A mammoth effort began, using satellite imagery, data analysis and daring methods of getting to seemingly impossible-to-reach children. Image  Dr. Pascal Mkanda, the World Health Organization's polio eradication coordinator for the Africa region, said: "There's no program like the global eradication program. There's no program which uses so much data, so much innovation." Vaccinators in Borno adopted a "hit and run" strategy. When the military told them an area was safe, they would start a campaign there within 48 hours. More than 800,000 children were vaccinated this way in 2016. Others were vaccinated at markets on the edge of Boko Haram-occupied territory, when they came to buy provisions. When they went back to their communities, Dr. Mkanda said, the vaccine went through their digestive systems and out into the environment, and other children, who had not been inoculated, could then pick it up and also become immune. Circulating vaccine-derived poliovirus spreads in the same way, except that the virus mutates over time and causes polio. For example, say vaccinators go to a village to inoculate children. The children line up by the church or market and get some drops squeezed into their mouths. The drops include a live but weakened version of the virus, which attaches to receptors in the intestines and is absorbed. The weakened virus cannot cause paralysis but teaches the child's immune system to create antibodies that will fight the real thing if it were to come along. If some children do not get the message that day, or their parents distrust the vaccine and keep them home, or the vaccinators have to leave early, they may still benefit. If any stool from vaccinated children contaminates local drinking water — or even a puddle that a child might splash in and then ingest — the virus can immunize other children, too. Very rarely, however, the vaccine virus can mutate back into something resembling the wild kind. If that vaccine-derived mutation keeps spreading because nearby villages are not fully vaccinated, it can, in a few cases — about one infection in 200 — paralyze people. The name of the polio strain may give the impression that people contract it from vaccinations, but that is not the case. "It's not very well-named," said Heidi Larson, director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine. There has been talk of altering the name to something less misleading, she said, but any change would probably take too long. While there has been success in Africa, there has been an increase in cases of wild poliovirus since 2018 in Afghanistan and Pakistan, where vaccinators are threatened with violence, and often killed. "We need to look immediately at the most difficult circumstances, the most disadvantaged people, the most vulnerable people, the hardest to reach people — because that's where we end up with the struggles at the end," said Dr. Moeti, the W.H.O. director for Africa. There is a parallel to be drawn with the coronavirus pandemic, she said. "Those people who have the hardest life circumstances for one reason or another are the worst affected in terms of the mortality due to Covid-19," she said, "and we are learning this lesson repeatedly."  |
| Posted: 21 Aug 2020 10:01 PM PDT  DEAR DR. ROACH: I am a woman in my late 70s, a 1949 polio patient. For forever I have been told that because of poliomyelitis I cannot tolerate any preventive inoculations, including flu, pneumonia, shingles, etc. I was allowed to get flu shots when they first became available; however, when additives were included later on, I was instructed not to get it any longer. My concern is if I will be able to safely partake of the coronavirus inoculation when it becomes available. Most present-day doctors have no experience with polio, and often input is vague. — P.G. ANSWER: Poliomyelitis was, for many years, a terror that parents feared every summer. Until a vaccine became available in 1955, polio could strike without warning. Although the vast majority of people had only mild symptoms, about 1 person per thousand with polio developed poliomyelitis, a serious complication of the nervous system that was sometimes fatal and two-thirds of the time led to permanent weakness. Why some people got terribly ill and died while others had no symptoms remains a mystery, although we know some risk factors for developing poliomyelitis, such as older age, excess exercise while infected and tonsillectomy. I am surprised to hear the recommendations against standard vaccines for you. I haven't read that before and I have taken care of quite a few polio survivors. Experts confirm that standard vaccines, including flu, pneumonia and shingles, are recommended for those with a history of poliomyelitis. There are no additives in the vaccines placing polio survivors at increased risk. It is too early to speculate on a coronavirus vaccine. Although many groups are working on a vaccine, efficacy and safety testing is extensive before a vaccine is approved and the process must not be rushed. However, I doubt that a history of polio will prevent you or the many other polio survivors from getting the vaccine when one is approved. There are many places for you to get more information: Post-polio.org is one I often use. It has reliable information from experts, which is increasingly important as the number of physicians who have taken care of polio survivors decreases. DEAR DR. ROACH: Will you please explain how a person who is not sick, or has no symptoms, tests positive for COVID-19? How do doctors know he has it? The symptoms they tell us are the same symptoms we knew made us sick when we were young. Our mother put us to bed, gave us some medicine, and we were good to go in a couple of days. Don't we carry a lot of germs? — L.J.T. ANSWER: The majority of COVID-19 infections have minimal or no symptoms. People without symptoms may be tested due to concerns about exposure or as part of a program to identify the prevalence in the population. The test is specific for the genetic material of the virus. It is true that for many people, the symptoms are similar to the common cold or another of the many germs (bacteria and viruses) we are exposed to. However, some people get terribly ill due to COVID-19. As of this writing, there have been over half a million deaths worldwide, and will be higher still when this is published. Why some people get ill and die while others have no symptoms is a mystery, although we know some risk factors for becoming seriously ill, such as older age, being male and a history of high blood pressure or diabetes. Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.  |
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