Polio

 
IS THE POLIO CAMPAIGN IN CRISIS?
 
In 1985, 350,000 new cases of polio were diagnosed annually with symptoms of illness, paralysis and sometimes death. In 2013, just 416 polio cases were diagnosed in the world. We are 99.9% there, truly “This Close” to eradicating polio.
 
On May 5, WHO reported the findings of its Emergency Committee that included representatives from Afghanistan, Cameroon, Equatorial Guinea, Ethiopia, Israel, Nigeria, Pakistan, Somalia and Syria.  The Committee stated that the spread of polio in the last few months was an “extraordinary event” posing a threat to formerly non-infected areas and thus constitutes a “Public Health Emergency of International Concern.”
 
 
 
Some concerns mentioned were 1) the increased number of cases with the high season not starting until May, 2) the number of fragile and/or conflict ridden, formerly polio free areas where immunization services have been compromised or discontinued, and 3) the realization that adult travelers are contributing to the spread of the poliovirus. 
 
The WHO Emergency Committee recommendations are in short:
 
In all infected countries-
Afghanistan, Cameroon, Equatorial Guinea, Ethiopia, Iraq, Israel, Nigeria, Pakistan, Somalia and Syria-
  • The head of state to officially declare “that the interruption of  poliovirus transmission is a public health emergency”.
  • To continue routine immunizations, poliovirus surveillance and supplemental immunization campaigns as needed.
  • To “encourage” all residents and long-term visitors to receive a dose of OPV (active) or IPV (inactive), 4 weeks to 12 months prior to international travel and carry documentation of such.
In Pakistan, Cameroon and Syria, which have exported the wild poliovirus, the same recommendations were issued but are required vs. suggested. Without documentation, travelers are to be given the vaccine at the transit locations.
 
Pakistan is a major concern. The FATA (Federally Administered Tribal Areas) have refused to allow immunizations of any kind since 2012 even as Islamic leaders have been urging all Muslim children everywhere be inoculated. In 2012, 58 cases were found in Pakistan. But in 2013 that rose to 93 cases. And now as of May 21, 2014, 66 cases have been counted in Pakistan as compared to 8 this time last year. Plus another 6 polio cases are from the Pakistan poliovirus strain, likely passed on by traveling adults to Afghanistan (4), Syria (1) and Iraq (1).
 
10 other cases have been recorded through May 21, 2014, in Nigeria (3), Cameroon (3), Equatorial Guinea (3) and Ethiopia (1), all of the Nigerian poliovirus strain.
 
If countries enforced a travel ban, unless proof of inoculation were shown, it is thought transmission of the virus could be close to stopped (or contained in areas refusing the vaccine.) Several countries now require Pakistanis crossing through their border checkpoints to have proof of polio inoculation to enter.  (The US does not require any polio inoculation documentation for entry.)
 
But if only 10% of poliovirus carriers exhibit any symptoms and only .05% show paralysis, then just one case could represent 200 poliovirus carriers. Thus the WHO Committee determined that the increased number of poliovirus cases in the last six “low transmission” months, meets the conditions for a “public health emergency of international concern.”
 
Is this a campaign crisis? What do you think?
 
Want to learn more? To see a transcript or hear the actual WHO Committee recommendations, vs media interpretations, go to www.WHO.org and click on the Media Centre.
 
Submitted by Peg Johnston, District 5450 Polio Committee Chair, (Denver Rotary) Peg.Johnston@yahoo.com