POLIO - A global view and need for immunization

(HN, June 23, 2010) -- Beginning in February, a soccer ball signed by Archbishop Emeritus Desmond Tutu traveled through 22 African countries to draw on the excitement of the World Cup to mobilize the public to raise awareness for polio eradication. Rotary International kicked off their campaign, “Kick polio out of Africa” (www.kickpoliooutofafrica.org) in Cape Town and the ball ended its journey last week in Egypt. Along the way, the ball was received at highly attended ceremonies and signed by the President of Ethiopia, the President of the Ivory Coast, the President of Chad, multiple health ministers, soccer players and Bill Gates even added his signature when he was in Abuja last Monday.

While Polio has been eradicated in most of the world there are still cases of polio in Afghanistan, Nigeria, India and Pakistan – four countries that are classified by the World Health Organization (WHO) as polio-endemic. In addition, an outbreak of polio is currently ongoing in the Republic of Tajikistan. This outbreak represents the first importation of polio in the World Health Organization (WHO) European Region since it was certified polio-free in 2002.

This past spring, the Tajikistan Ministry of Health reported 432 cases of acute flaccid paralysis, the most common sign of polio. Of these cases, 239 were confirmed to be polio (as of June 15 by the World Health Organization). Of the confirmed polio cases, 107 were in children 5 years old or younger and a total of 12 deaths have been reported. The outbreak in Tajikistan represents more than two-thirds of the global total so far this year.

Uzbekistan had also reported several cases of acute flaccid paralysis. These cases occurred near the country’s border with Tajikistan.

Nearly two months after the polio outbreak was first confirmed in neighboring Tajikistan, Uzbekistan is still free of the disease. The second round of a massive immunization campaign in Uzbekistan targeted nearly three million children under the age of five with oral polio vaccines. Launched jointly by UNICEF, the Uzbek Ministry of Health and the World Health Organization (WHO), these coordinated rounds of immunization and action against the debilitating virus at the country’s borders are preventing the spread of the disease, experts say.

TAJIKISTAN UPDATE

To date the fourth round of a national immunization campaign against polio has been completed in Tajikistan, targeting almost 3 million children under the age of 15.

As part of the campaign, Deputy Minister of Health Dr. Azam Mirzoyev led a multi-agency field visit to the Tursunzade district in western Tajikistan on 16 June. The purpose of the visit was to monitor how immunization is conducted in urban and rural health facilities on the ground. The UNICEF Representative in Tajikistan, Hongwei Gao and representatives of the country and regional offices of the US Centers for Disease Control, USAID and the World Health Organization participated in the monitoring exercise.

“We are thankful to our international partners for their support of the polio immunization drive in Tajikistan,” said Dr. Mirzoyev. “Three vaccination rounds have already reduced the number of reported suspected cases here. This round aims at sustaining and accelerating progress achieved during the previous rounds.”

For the first time since the beginning of the immunization campaign, local and regional journalists joined the field visit to monitor the latest five-day vaccination drive.

The success of the campaign so far has been the result of a massive effort led by the Ministry of Health, with some 3,200 vaccinators immunizing children nation-wide. UNICEF has supported the effort by procuring and delivering almost 10.3 million doses of oral polio vaccine.

UNICEF has also led a communication and social mobilization effort to inform the public about polio immunization and to encourage communities to support the campaign. In the run-up to the recent round of vaccination, more than 2 million leaflets and tens of thousands of posters and banners in Tajik, Uzbek, Russian and Dari were produced and distributed through health centers, schools, markets and mosques across the country.

The social mobilization campaign focused specifically on remote, isolated and under-served populations, including Central Asian Roma communities and Afghan refugee enclaves.

“Tajikistan is confronting a very serious polio outbreak with more polio cases than the rest of the world combined,” said Ms. Hongwei of UNICEF. “However, there has been an impressive and well-coordinated effort to immunize Tajikistan’s children against polio.”

UNICEF and its partners have expressed readiness to support Tajikistan in planning and implementing two additional polio immunization rounds in September and October.  But while this immunization campaign helps to protect children from the debilitating virus, a strong immunization system is key to making Tajikistan free of polio again.

“In order to rid the country of polio and help Tajikistan’s children to survive and develop,” said Ms. Hongwei, “we must strengthen routine immunization in the country.”

CONTRACTING POLIO – SYMPTOMS

Poliomyelitis (polio) is a highly infectious disease caused by a virus that invades the nervous system. It invades the nervous system, and can cause total paralysis in a matter of hours. The virus enters the body through the mouth and multiplies in the intestine. Initial symptoms are fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs.

Up to 95% of persons infected with polio will have no symptoms. About four to eight percent of infected persons have only minor symptoms such as fever, fatigue, nausea, headache, flu-like symptoms, stiffness in the neck and back, and pain in the limbs which often resolves completely. Less than one percent of polio cases result in permanent paralysis of the limbs (usually the legs). Of those paralyzed, 5-10% die when the paralysis strikes the respiratory muscles.

Polio is a disease that is most often spread through contact with the stool (bowel movement) of an infected person. Polio germs can also be spread through food and water. The disease mainly affects children under 5 years old, but unvaccinated people of any age are at risk.

There is no cure for polio, it can only be prevented. Polio vaccine, given multiple times, can protect a child for life.

NEED FOR MORE FUNDING – BUILDING ON SUCCESS

A Strategic Plan 2010-2012, launched by the Global Polio Eradication Initiative, aims to build on success in endemic countries, such as Nigeria, where the number of polio cases have dropped by more than 99 percent – from 312 cases last year to three in 2010.

In the past six months India’s two remaining endemic states have, for the first time ever, not reported any new cases.

In addition, 10 of the 15 previously polio-free African countries that were re-infected in 2009 have successfully stopped their outbreaks. They are Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Côte d'Ivoire, Guinea, Kenya, Togo and Uganda.

Last month the World Health Assembly welcomed the new plan, which hinges on activities at the field level, while expressing deep concern about the $1.3 billion funding shortfall – out of a budget of $2.6 billion – over the next three years.

“The next three years, and especially the next 12 months, are critical to the polio eradication initiative and, by extension, the entire international public health agenda,” said WHO Director-General Margaret Chan, calling on the international community to support the new effort.

The Global Polio Eradication Initiative is spearheaded by World Health Organization (WHO), the UN Children’s Fund (UNICEF), national governments, Rotary International, and the US Centers for Disease Control and Prevention.

Sources: Centers for Disease Control (CDC), World Health Organization (WHO), UN Children’s Fund (UNICEF), UN News, Rotary International