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Polio and Vaccination: A Memoir of What We’ve Forgotten | The Tyee.

[1st November 2018]

What I learned from getting polio 70 years ago? Amnesia is a traitor that lets old enemies through the gates.

Iron-Lung.jpgThe iron lung in 1960, once a common treatment option for patients with polio. Photo by Don Pinder, Creative Commons licensed.

Crawford Kilian writes:

We’re seeing reports of a “polio-like” disease turning up in Canada and especially in the U.S. Acute flaccid paralysis is leaving kids partially or completely paralyzed, and parents are understandably scared. The U.S. reportedly has 60 cases so far this year, and Canada has perhaps 30.

AFP and its subtype, acute flaccid myelitis, are even becoming a political issue: the right-wing American Association of Physicians and Surgeons warns about the “public health threat from uncontrolled immigration” and suggesting that the “caravan” of asylum seekers might be bringing AFP with them.

As literally a one-in-a-million disease, AFP is a faint echo of poliomyelitis itself. But it comes at a time when we’ve forgotten how deadly childhood diseases can be, and many have even begun to question the vaccines that saved both them and their parents from death or lifelong impairment.

Seventy years ago this month, I was seven years old, running a fever, and unable to touch my chin to my chest. Every parent in 1948 knew those were likely symptoms of polio, and that same afternoon I was in a downtown hospital for tests. They showed I was indeed one of over 20,000 polio cases in the U.S. that year.

My memories of the next two weeks are fragmentary but vivid. I’m carried on the shoulder of a tall black man to undergo a spinal tap — not a funny phony band, but my first experience of real pain. I’m in a ward with other kids, each of us in a crib — a crib! — learning to use bedpans and suffering the further indignity of having our temperatures taken rectally. Drop a comic book through the crib slats to the floor, and it’s gone forever.

Every day we lie on our stomachs in our cribs while “hot packs” — steaming-hot blankets — are piled on us. This is state-of-the-art therapy for polio patients.

Toward the end of my hitch, I’m taken from my crib in a wheelchair, plunked into a bathtub and sloshed with green disinfectant soap. Then I’m taught how to walk again. After two weeks in a crib, it’s not easy.

Finally back home, I begin to understand that I am really lucky. Other kids have died, or been trapped for life in iron lungs that keep them breathing. When I’m back in school, I see a girl with a brace on one leg from her own case of polio. She’s not the last.

If anything united Americans and Canadians in those days, it was the wish for a polio vaccine, and when it arrived in the mid-1950s, no one fretted about its possible hazards. We trooped down to the local high school gym, lined up, and popped vaccine-laced sugar cubes into our mouths. Even polio survivors did — you could catch it again, and a high-school classmate of mine did just that.

Post-epidemic amnesia.

Epidemics and pandemics have a little-known consequence: mass amnesia. My grandparents never talked about the flu pandemic of 1918-20, though they and their own children could have died in it. Just a decade ago, the H1N1 pandemic killed an estimated 201,200 people worldwide. Unless you caught it, you likely haven’t thought about it since then.

But amnesia is a traitor that lets old enemies through the gates. We used to have “chickenpox parties” for kids, so they’d catch it from some other kid; now as seniors we’re dealing with shingles, an intensely painful sucker punch from the chickenpox virus that hid out in our bodies for decades.

Measles was considered another routine childhood illness, except in the families that lost their children to it. After the mid-1960s, measles vaccine saved millions of lives but trivialized the genuine threat of the disease. Now the European Centre for Disease Control reports ongoing outbreaks in Greece, Ireland, Romania and Slovakia, with 33 deaths so far this year. In the U.S., the Centers for Disease Control has recorded 142 cases so far this year. Here in B.C. we had a brush with measles in 2014 among members of a Fraser Valley religious community.

Failure to vaccinate is the chief cause of measles outbreaks, often starting with communities with religious objections to vaccination. But while outbreaks may start there, they can spread into the larger community if it has a vaccination rate below 95 per cent. This creates “herd immunity”: the virus can’t spread to susceptible people because so many immunized people are in its way. The same is true for other diseases like seasonal influenza — the more vaccinations, the smaller the chance of infecting those most vulnerable to it, like the elderly and the immunocompromised.

Cranks and charlatans.

The anti-vaxxer movement is energetically attacking vaccination as a pillar of public health. The movement seems to think medical experts are some kind of self-serving elite, and prefers to heed populist politicians and celebrities — who are a true self-serving elite.

Such cranks and charlatans have always flourished on the margins of society; I well recall the anti-fluoridation movement of the 1950s. But such critics couldn’t get much traction until the rise of social media. Now they infest Facebook and Twitter, reaching anxious, poorly informed individuals and merging them into politically significant numbers. As groups they enjoy an ironic “herd immunity” to scientific evidence, and the problem goes on.

Living with a real and present danger to their children, the parents of the 1940s and 1950s had no time for quacks. They got the vaccine at the first opportunity, taking the first steps to eventual eradication of the disease.

Now polio is in retreat worldwide. Even in the tribal areas of Pakistan, vaccination teams have been saving a generation of kids - at the risk of being shot dead in the street by suspected Pakistani Taliban supporters who think the vaccine is a foreign conspiracy. Despite the violence, they are getting close: the World Health Organization says wild poliovirus cases have fallen by 99 per cent since 1988.

But WHO warns that, “Failure to eradicate polio from these last remaining strongholds could result in as many as 200,000 new cases every year, within 10 years, all over the world.”

If that happens, rest assured that the cranks and charlatans will build another anti-vaccine campaign into their business plans, just as they will if we develop a vaccine against EV-D68, the virus that causes AFP. As long as a reservoir of stupidity exists, in the tribal areas of Pakistan or the suburbs of Vancouver, preventable diseases will threaten our children.


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World failing in efforts to stop polio | CAJ News Africa.

[29 October 2018]

Macoumba Beye writes:

THE emergence of polio in a number of countries has raised doubts over prospects of eliminating the disease.

It was hoped that vaccination efforts and early detection of cases would result in global eradication of the disease by 2018.

However, an epidemic has been declared in the Democratic Republic of Congo (DRC). Polio is also endemic in Afghanistan, Nigeria and Pakistan.

As the world marked Polio Day on Wednesday this week, some 25 civil society organisations issued a stern warning on the diminishing impact of global efforts to eradicate the disease.

“The prevailing political crisis in these countries has led to significant migration between countries, and is indeed a real risk that can enhance the spread,” said Ferdinand Tabi on behalf of the organisations.

Speaking from Senegal, the organisations are also concerned by the ending of the Global Polio Eradication Initiative funding in 2020 as it will result into a drastic reduction in financial resources.

However, efforts to eradicate polio have received a major boost after the Bill and Melinda Gates Foundation pledged to increase their donations by US$100 million (R1,45 billion) over the next two years.

Polio is a highly infectious disease that most commonly affects children under the age of five.

It causes disability.


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CDC confirms 10 new cases of rare polio-like neurological condition | Reuters.

[OCTOBER 30, 2018]

Saumya Sibi Joseph writes:

(Reuters) - The U.S. Centers for Disease Control and Prevention said on Tuesday it has confirmed 10 more cases of an extremely rare, polio-like condition, across 24 states.

The CDC had earlier this month confirmed about 62 cases of acute flaccid myelitis that causes the muscles and reflexes in the body to become weak. Most of the cases reported so far are people under 18 years of age.

The agency said in a health advisory on its website that it recently received increased reports of patients with symptoms of the disease over the last three months.

While the CDC still does not know the cause, the condition does not appear to be transmissible from human to human, agency director Robert Redfield said in an interview with “CBS This Morning” on Monday.

Acute flaccid myelitis or AFM is not new, but cases have been on the rise since 2014. The condition affects a person’s nervous system, specifically the spinal cord, causing weakness in one or more limbs.

The condition remains very rare. The CDC estimates it affects only 1 out of 1 million people in the United States, with most cases involving children.

Since Aug 2014, the CDC has confirmed a total of 396 confirmed cases of AFM across the United States. Scientists are investigating a number of causes, including viruses, environmental toxins and genetic disorders.

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Reporting by Saumya Sibi Joseph in Bengaluru; Editing by Shailesh Kuber


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Characterization of Household and Community Shedding and Transmission of Oral Polio Vaccine in Mexican Communities With Varying Vaccination Coverage | Clinical Infectious Diseases.

[Open Access] [Published: 30 October 2018]

Abstract.

Background.

The World Health Assembly 2012 Polio Eradication and Endgame Strategic Plan calls for the eventual cessation of all oral polio vaccines (OPVs), to be replaced with inactivated polio vaccine (IPV); however, IPV induces less robust mucosal immunity than OPV. This study characterized household and community OPV shedding and transmission after OPV vaccination within primarily IPV-vaccinated communities.

Methods.

Households in 3 IPV-vaccinated Mexican communities were randomized to receive 3 levels of OPV vaccination coverage (70%, 30%, or 10%). Ten stool samples were collected from all household members over 71 days. Analysis compared vaccinated subjects, household contacts of vaccinated subjects, and subjects in unvaccinated households. Logistic and Cox regression models were fitted to characterize transmission of OPV by coverage and household vaccination status.

Results.

Among 148 vaccinated children, 380 household contacts, and 1124 unvaccinated community contacts, 78%, 18%, and 7%, respectively, shed OPV. Community and household contacts showed no differences in transmission (odds ratio [OR], 0.67; 95% confidence interval [CI], .37–1.20), in shedding trajectory (OR, 0.61; 95% CI, .35–1.07), or in time to shedding (hazard ratio, 0.68; 95% CI, .39–1.19). Transmission began as quickly as 1 day after vaccination and persisted as long as 71 days after vaccination. Transmission within unvaccinated households differed significantly across vaccination coverage communities, with the 70% community experiencing the most transmissions (15%), and the 10% community experiencing the least (4%). These trends persisted over time and in the time to first shedding analyses.

Conclusions.

Transmission did not differ between household contacts of vaccinees and unvaccinated households. Understanding poliovirus transmission dynamics is important for postcertification control.


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Polio this week as of 30 October 2018 | GPEI

  • World Polio Day activities garnered global attention. Partners, donors, and popular public figures around the world brought attention to the cause of polio and the efforts to eradicate polio. A quick overview of some of the World Polio Day highlights
  • Summary of new viruses this week: Afghanistan – Three new cases of wild poliovirus (WPV1) and four WPV1 positive environmental samples. Pakistan – No new case of wild poliovirus (WPV1) and seven WPV1 positive environmental samples. Papua New Guinea – three new cases of circulating vaccine-derived poliovirus type 1 (cVDPV1) and three cVDPV1 positive environmental samples. Democratic Republic of Congo – one new case of circulating vaccine-derived poliovirus type 2 (cVDPV2). Nigeria- two new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2). Somalia- four new cVDPV2 positive environmental samples. See country sections [in source article] for more details.
  • The Every Last Child project series was launched by UNICEF, which covers over 30 wide-ranging profiles of governments, front-line workers, and the stakeholders involved in the collective polio eradication efforts across Nigeria, Afghanistan, and Pakistan.
  • Featured on polioeradication.org: Coffee with Polio Experts – Dr Arlene King, Chair of the RCC for the Americas, and GCC Containment Working Group talks to WHO about the importance of safe and secure containment of polioviruses, in places where needed, and the accompanying risk and responsibility that come with retaining the pathogen.

NA: Onset of paralysis in most recent case is prior to 2017. Figures exclude non-AFP sources. In 2018, cVDPV includes all three serotypes 1, 2 and 3.

For Somalia: 1 cVDPV2 and cVDPV3 isolated from one AFP case.

cVDPV definition: see document “Reporting and classification of vaccine-derived polioviruses” at [pdf].


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Nigeria: Rotary club of Ogudu vaccinates children in Lagos community against polio | The Guardian Nigeria.

[01 November 2018]

Adaku Onyenucheya writes:

As part of efforts to ensure Nigeria is declared polio free, Rotary Club of Ogudu GRA at the weekend vaccinated over 200 children in Ogudu community, Lagos State against the spread of the virus.

Polio, also known as poliomyelitis and infantile paralysis, is a highly contagious viral infection that can lead to paralysis, breathing problems, or even death. It most commonly affects children under five years old.

Although, polio has been eradicated in every country of the world except for Nigeria, Pakistan and Afghanistan, efforts are been made to ensure its total eradication in Nigeria by 2019.

Speaking during the medical outreach, the President, Rotn. Ojinika Okeke said in line with Rotary’s commitment to health this year, they brought healthcare professionals to the community to provide free immunisation to the children, to ensure that by August 2019, the World Health Organisation (WHO) would certified the country as polio free.

Okeke stated that through the outreach, the club intends to provide free immunisation to over 200 children in the community, adding that with persistence and more awareness in the drive against the virus, there is possibility of achieving the targeted date of polio eradication in Nigeria.

Also speaking, the Project Coordinator, Rotn Gbemileke Afolabi, who is also a pharmacist said with Rotary spearheading the eradication of polio across the world, Nigeria is very close to being satisfied polio free by ending of 2019.

He explained that the awareness walk done with the vaccination is to ensure that “we generate enough awareness in our locality here and to contribute towards humanity and also ensure that polio is kicked out of Nigeria completely.

“We have already generated a lot of awareness about the very serious childhood infection, so a lot of babies and children are vaccinated today, including other childhood diseases vaccines were given; a lot of antigens, apart from oral polio virus, other activities would be done to ensure that the baby is healthy and well balanced.”

He said Rotary club would continue to create and drive awareness across communities until Nigeria is totally free of polio.

“Once polio is out of the whole location, you can be assured that the burden of one of the major diseases affecting children is definitely reduced.”


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Securing the Eradication of All Polioviruses | Clinical Infectious Diseases | Oxford Academic.

[Open Access] [Published: 30 October 2018]

Opening Paragraph:

The Global Polio Eradication Initiative (GPEI) has been making great strides. In 2017, the number of children reported with paralysis caused by wild-type poliovirus was just 22, and during 2017–2018 transmission has only been detected for serotype 1, in Afghanistan and Pakistan (as of July 2018). Serotypes 2 and 3 wild poliovirus have not been detected since 1999 and 2012, respectively. However, the polio endgame is complex and challenging. The oral poliovirus vaccine (OPV) used in mass campaigns to stop transmission of wild polioviruses is genetically unstable and on rare occasions can evolve to regain wild-type virulence and transmissibility [1] . This has resulted in outbreaks of poliomyelitis caused by vaccine-derived polioviruses, which have gained in significance over time relative to the declining burden of wild-type disease. To prevent these outbreaks, the GPEI concluded in 2003 that vaccination with OPV must stop [2].


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Pakistan: Two more polio cases discovered in Bajaur | DAWN.

[November 01, 2018]

Sirajuddin writes:

Two polio cases have been found in Khyber Pakhtunkhwa's Bajaur area, the Emergency Operation Centre (EOC) for polio in the tribal districts confirmed on Thursday.

They said that laboratory reports of children's stool samples confirmed they had polio, adding that neither child exhibited visible indicators of polio at the time of stool collection.

According to the Health Department, the virus was confirmed in a five-year-old girl from Kut Kot Union Council and a seven-year-old boy from Largatkolay area. The department said that the girl had been administered the anti-polio vaccine seven times.

Babar Bin Atta, the prime minister's focal person for polio eradication, said that they would soon meet with the KP Governor Shah Farman to devise a strategy and take special measures for prevention of the disease.

According to Health Department officials, a three-day immunisation campaign will begin in the tribal districts on Nov 12. The campaign seeks to immunise over 300,000 children.

Five cases of polio have been discovered in KP, according to Health Department officials. Two more polio cases were confirmed in Karachi last month, while three others were reported in Balochistan's Dukki district earlier this year.

According to World Health Organization data, Pakistan is among just three countries in the world that have failed to eradicate endemic transmission of polio.


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