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Pakistan: Punjab: 7 polio campaigns launched in 2020 | The News International.

[January 1, 2021]

LAHORE:Punjab polio eradication efforts are on right track after finishing off the year on an impressive note. As per a handout released by the Punjab polio programme on Thursday, 2020 proved to be a difficult year on account of challenges posed by the pandemic. But due to extra-ordinary efforts of the polio teams, polio programme was able to implement seven campaigns in the year. On average over 20 million children were vaccinated in the three national drives, reaching an aggregate of over 95 per cent coverage. While three were sub-national campaigns were conducted in selected districts of Punjab.

On account of rising polio cases and high prevalence of the virus in environmental samples in Punjab, one special fractional Inactivated Polio Vaccine campaign was held in the end of the year in December. In the campaign, over 0.9 million children were vaccinated. The year started with a promising National Immunization drive in February. However, the efforts were derailed in the wake of Covid-19 pandemic in March. The polio programme was able to return to full scale campaigns in September when NID was held amid skepticism about the results. Despite challenges Punjab has been able to control widespread fallout of suspension in campaigns limiting the polio cases to 14 compared to 12 in 2019. National tally of polio cases stands at 83. Environmental samples have also started turning negative after hitting 62.8 percent positivity rate.

LGH: Principal Post Graduate Medical Institute & Ameer Uddin Medical College Prof Dr Sardar Muhammad Al-freed Zafar paid a surprise visit to the guest houses set up on the instructions of the Punjab Government at Lahore General Hospital and reviewed the facilities being provided there to the patients’ attendants. Talking to the media, Prof Dr Sardar M Al-freed Zafar said that the best facilities are being provided to the families of patients in the guest houses.

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Doctors in England despair over disregard for Covid restrictions | The Guardian.

[Thu 31 Dec 2020 17.57 GMT] Helen Pidd writes:

If people clapped for us now, excuse my language but I would probably just tell them to fuck off,” said the exhausted junior doctor facing January in Britain on an overcrowded intensive care unit. “The majority of people, even people I know who are supposed to be sensible, are all doing things they shouldn’t be and still bubbling with their 80-year-old mother. It feels like almost everyone is breaking the rules in a dangerous way.”

The doctor, who asked not to be named, was training in a hospital in the West Midlands. Like many medics she said she felt increasingly frustrated at the behaviour of people who might have applauded the NHS on their doorsteps in the spring. It had been a hard year watching patients struggle for breath and, ultimately, life.

“It’s not just elderly people, but people in their 50s, people in their 30s with no comorbidities, who haven’t made it,” she said. ‘“We’ve had two pregnant women in ICU. We had one couple come in, neither were that old but both very ill, and I had to tell one of them that their partner had died. It has been really tough.”

The West Midlands, like much of England, is now in tier 4, the highest level of coronavirus restrictions. Yet outside the hospital, she said, too many people were behaving recklessly.

“I cannot go to the shops because it makes me so upset and so angry. I needed milk the other day and I didn’t get it because I couldn’t face going into the shop near me – seeing people without masks on and with their masks around their chins just drives me mad. It feels like a complete slap in the face.”

In London, Hugh Montgomery, a professor who works in intensive care at the Whittington hospital in London, went further. Anyone not social distancing or following the rules had “blood on their hands”, he said.

He told BBC 5 live: “They are spreading this virus. Other people will spread it and people will die. They won’t know they have killed people, but they have.”

In Greater Manchester, also in tier 4, hospital admissions for Covid are creeping back up again. At one emergency department this Thursday a woman in her 90s was admitted. “She’d caught Covid from her family on Christmas Day,” said a consultant, who added that she feared her hospital could be overwhelmed within a few weeks.

Although hospitals in the north-west of England were not yet under the same pressure as their London counterparts, ward space was already running out, said the consultant. Ambulances are backing up, corridors are filling with patients on trolleys and it is becoming increasingly difficult to separate Covid cases from people with other illnesses.

“Our greatest fear is we will become overwhelmed,” the consultant said. “At the moment we are treating everybody. It might not be in the safest, most socially distant way, but if you come in with a serious problem you will be treated and it will be fine, though a few people might get Covid. But it’s getting to the stage where if we have a massive influx of Covid patients our ability to manage that is going to be really seriously compromised.”

The consultant said she did not mind that people were no longer out on their doorsteps clapping every Thursday to show support for the NHS, but wished they would think more about how their behaviour could affect others.

“People don’t realise or maybe care that what they do as an individual, the risks they are prepared to take, doesn’t just affect them – they think ‘well, it’s up to me’. But they might be asymptomatic and could give it to somebody who could die.”

On Wednesday, she said, she had ducked into a hairdresser for a trim before the shutters came down under tier 4, and was horrified to see how many people were bending the rules. “There were two places doing takeaway food and drink and they were basically running an outdoor bar. It seemed to me everyone where I live was going there, buying alcohol and having a night out. I had to fight my way past literally 15 people, all outside the door of the hairdressers, all without masks on because they were drinking. I was thinking, are you crazy?”

She added: “It might feel nice now but it’s just not caring. I try not to say anything because people are already on edge, but it’s so frustrating. These are people who really should know better.”

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UK: Covid vaccine: chief medical officers defend rescheduling of second doses | The Guardian.

[Thu 31 Dec 2020 19.46 GMT] Nicola Davis and Linda Geddes write:

The UK’s chief medical officers have defended plans to delay giving the second dose of a Covid vaccine to more than 500,000 people who have received the first jab, saying they believed the public would “understand and thank us for this decisive action” despite an outcry among doctors.

Recipients of the Pfizer/BioNTech vaccine had previously been told there would be a three-week gap between doses, with many already booked in for their second jab.

But the government announced a change to its Covid vaccination strategy on Wednesday, saying second doses of the newly approved Oxford/AstraZeneca vaccine and the previously approved Pfizer/BioNTech jab would now be given up to 12 weeks after the first dose.

The move applies to people scheduled to have their second dose of the Pfizer jab after 4 January, as well as those yet to receive either jab. The government said it hoped the approach would free up more doses and mean as many people as possible would soon get their first jab and have some protection against the disease.

The new regime was backed by the chief medical officers of the four UK nations, with instructions given to health service leaders in England by NHS bosses on Wednesday to postpone many of the scheduled second Pfizer/BioNTech jabs.

The announcement caused controversy, however. Pfizer and BioNTech warned that two doses of their vaccine were required for maximum protection against Covid and that they did not have evidence that the first dose alone offered protection after three weeks.

Azeem Majeed, a professor of primary care and public health at Imperial College London and a practising GP, said he was shocked by the change of plan.

“We’ve got thousands or perhaps tens of thousands of people who have already booked their second jabs, and these are people who are all elderly, so they often have to make special arrangements for their care or have someone to bring them down. Someone is going to have to ring all these patients to cancel their appointments and rebook them, so it is going to create a lot of work for people as well,” he said.

“Clearly the people making these rules are not the ones having to enforce them. I understand the rationale that the government wants to increase the vaccine supply to make sure more people are immunised, but I think that could have been done for people starting from now, rather than cancelling the ones who have already been booked in, which is very disruptive.”

In a joint statement on Thursday night, Chris Whitty, the chief medical officer of England, and his counterparts in Wales, Scotland and Northern Ireland stood by their decision, although they acknowledged that it would “distress patients who were looking forward to being fully immunised”. They added: “However, we are all conscious that for every 1,000 people boosted with a second dose of Covid-19 vaccine in January (who will as a result gain marginally on protection from severe disease), 1,000 new people can’t have substantial initial protection which is in most cases likely to raise them from 0% protected to at least 70% protected.”

They added: “We have to follow public health principles and act at speed if we are to beat this pandemic which is running rampant in our communities, and we believe the public will understand and thank us for this decisive action.”

Earlier, one doctor who spoke to the Guardian on condition on anonymity said they hoped to continue with the original schedule for the second dose rather than cancelling appointments, saying that to do otherwise would put their most vulnerable patients at risk and break promises to patients.

Alison Bolam, a GP at Horfield health centre in Bristol, said her practice would take a similar approach. If we try to ring and cancel 1,000 80-year-olds, and then ring 1,000 75-year-olds and ask them to come in instead, we risk wasting vaccine because we don’t have the staff capacity to do that with the bank holiday in the way,” she said. “If anyone gets the first vaccine now, the second one will be 10 to 12 weeks later, but for anybody who has already had it, they will get their second vaccine as originally scheduled.”

The British Medical Association said it was unreasonable and unfair to expect practices to cancel and rebook appointments for patients to have their second dose.

The chair of the BMA’s GP committee, Dr Richard Vautrey, said: “Local leaders are telling us that is unprofessional and impractical to amend the appointments for thousands of frail, elderly patients, particularly those booked and who have already made arrangements to have their second vaccination in the next two weeks.”

Vautrey called on the government to publish a scientifically validated justification for the new approach, adding that rebooking appointments would cause huge logistical problems.

The Guardian understands a number of NHS clinical commissioning groups were holding meetings on Thursday on the issue, to decide how to proceed.

Dr Helen Salisbury, a GP and medical adviser to the health experience research group at the University of Oxford, tweeted that the health secretary Matt Hancock, should help to phone her elderly patients and explain why their second jab had been delayed. She said her primary care network needed to cancel and rebook 1,160 appointments.

“At 5 mins per phone call, that’s 193 hours’ work. Not to mention the grief & anger,” she tweeted.

Her comments unleashed a flurry of responses from other GPs, with some questioning whether it was ethical to delay a second dose when patients had given consent for the first dose on the premise that they would receive the second three weeks later.

The Doctors’ Association UK said it had sent a letter to Hancock and others involved in the change of strategy regarding the Pfizer vaccine. “A patient can’t consent for a treatment then have the treatment changed without their permission, especially when the evidence for change is lacking,” it said. Dr Vinesh Patel, a GP partner and spokesman for the DAUK’s GP committee, said using the Pfizer jab outside the trialled vaccination regime was a huge gamble.

Others, however, welcomed the change in approach. Dr Ed Turnham, a GP in Norwich, said the MHRA should be congratulated for its “brave, pragmatic decision”.

“I think most of our elderly patients will be happy that this will reduce the delay in protecting their friends and relatives, and reduce the risk of hospitals being overwhelmed,” he tweeted.

Prof Martin Marshall, chair of the Royal College of GPs, sympathised with GPs and their patients but said the new strategy had merits. The Joint Committee on Vaccination and Immunisation had “put forward a compelling case that this is the best way to protect as many people as possible from the virus, and this is the decision that has been made,” he said.

But he added: “NHS England’s guidance does allow for some clinical discretion for practices to go ahead with second vaccinations where necessary, and if a practice uses this it is important it is respected.”

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Chavan reviews preparations on pulse polio prog | Lokmat Times.

[December 31, 2020 08:45 PM]

The district collector and acting municipal commissioner Sunil Chavan today reviewed the preparations on pulse polio immunisation programme to be implemented in the city on January 17.

The medical officer and programme officer Dr Ujwala Bhamre apprised that the administration will give polio dosage to 1.98 lakh children of less than five years through 645 booths. Besides, 38 reporting units, seven core committee medical officers and 39 responsible medical officers, apart from 136 supervisors and 1,890 health workers, will be on the task.

The administration has also formed 562 teams to visit door-to-door, apart from 15 transit points like Railway Station, Central Bus Stand, Airport, Cidco Bus Stand, Siddharth Garden, Bibi Ka Maqbara, Panchakki, GMCH, MGM, Octroi Naka, Mukundwadi Railway Station, Prozone Mall, Reliance Mall, D"Mart, Private Travels Point, Jalgaon T-Point, Beed Bypass Road, Nakshatrawadi Bypass, Weekly Bazaars and Baba Petrol Pump, to administer the polio dosage.

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Poliovirus vaccine options: another step forward | The Lancet.

[Open Access] [Published: December 09, 2020] [Author: Kimberly M Thompson]

Opening Paragraph:

Now, more than 20 years after the initial target for polio eradication, the Global Polio Eradication Initiative (GPEI) remains off track in its mission to stop and prevent the transmission of all three types of wild-type polioviruses. The GPEI successfully certified global eradication of type 2 polioviruses in September, 2015, and type 3 in October, 2019, with the remaining most transmissible and virulent type 1 confined to Afghanistan and Pakistan. In April and May, 2016, the GPEI coordinated global cessation of type 2 oral poliovirus vaccine (OPV2) use. However, this effort did not lead to the end of all type 2 live poliovirus transmission, with the annual reported cases caused by these vaccine-derived polioviruses increasing from 71 in 2018, to 366 in 2019, and 739 in 2020 (as of Dec 3). Monovalent OPV2 remains the primary defence against type 2 circulating vaccine-derived poliovirus outbreaks. Increased demand and limited supplies in 2020 led the GPEI to procure the production of more monovalent OPV2 and trivalent OPV (containing all three OPV types), which both carry the risk of reversion that could seed the creation of new type 2 circulating vaccine-derived polioviruses. To mitigate these risks, the GPEI accelerated the development and production of novel OPV2 strains, and issued an addendum to its 2019–23 strategic plan.

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