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Eradicating polio one step at a time

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Sita Devi says she is committed to keeping India polio-free

 

A few years ago, India accounted for half the world’s cases of polio. Today it is officially clear of the disease. This remarkable feat is largely down to an army of women who, one step at a time, have crisscrossed the country on foot to give the under-fives polio vaccines.

Sita Devi is one of India’s “polio aunties”. The 57-year-old often walks miles in the searing heat to find children in remote villages and communities who need vaccinating.

She is one of the hundreds of thousands of women working in Aanganwadis – health care centres – in India which provide free basic services to those who cannot afford to pay.

They are part of the Pulse Polio Initiative that was started in 1995 with the aim of eradicating the disease from the country.

Feet walking
Sita Devi often walks long distances in the heat to reach families in need of the vaccine

Since then, 12.1 billion doses of polio vaccine have been administered here.

In 2006 India still accounted for half of all global cases of polio – but earlier this year it recorded three years without a new reported case.

This achievement allowed the World Health Organization (WHO) to finally declare its entire South East Asia region polio-free.

‘New problem’

Countries in WHO SE Asia region

  • Bangladesh
  • Bhutan
  • Democratic People’s Republic of Korea
  • India
  • Indonesia
  • Maldives
  • Myanmar
  • Nepal
  • Sri Lanka
  • Thailand
  • Timor-Leste

But now Ms Devi is worried. She doesn’t know if she can persuade the families she works with in the rural areas around Allahabad in northern India to have their children immunised again.

She airs her concern at a morning meeting of Aanganwadi workers in one of Allahabad’s regional health offices.

It’s 45C (113F) outside and a rusty fan isn’t doing much to cool the room down.

Ms Devi’s worry is partly down to the success of the eradication programme – the next round of immunisations is due in June but many families do not see the logic in repeated vaccinations now that India is polio-free.

“This is a new problem. We must deal with it carefully so that people understand why we are giving the anti-polio drops,” she tells Rajesh Singh, the regional health officer.

As a chorus of similar worries erupts, Mr Singh encourages the Aanganwadi workers to tell the families regular immunisation is important to keep the disease away.

Meeting of Aaganvadi workers
Aanganwadi workers play a crucial role in India’s fight against polio

He has to speak loudly to be heard among the debate and the creaking of the fan.

But his pep talk seems to work as the women enthusiastically prepare to leave for their respective areas.

‘Committed to the cause’

“These women often cover more than 500 houses a day and they walk for miles. It’s not money that drives them. These women work tirelessly because they feel committed to the cause,” Mr Singh explains.

After the meeting Ms Devi steps out into the heat of the day and walks to the main road to find a public bus.

As we move slowly through the traffic towards a slum area, she says she mostly works in poorer areas to educate families about polio.

I immediately signed up because I had seen how this disease destroys life”

Sita Devi

Money was never her motivation, she says.

Aanganwadi workers earn less than a pound on every visit to a field area, in addition to a monthly salary of just 4,000 rupees (£40).

But she has seen the impact of polio first-hand. She watched her own nephew grow up with the disease, unable to walk or manage basic activities.

“In 1998, I heard about the polio programme and asked the local health centre if they could treat my nephew. But they told me that the immunisation would only prevent the disease,” she recalls.

Child being given polio drops
India’s Pulse Polio Initiative started in 1995 and in 2014 India recorded three years without a new polio case

It was a terrible disappointment that they couldn’t help him, but it made her decide to join the fight against polio.

“I immediately signed up because I had seen how this disease destroys life. One family member always had to be with my nephew and we could never go out as a family.

“He has grown up now but still faces difficulty in moving around because India is not a disability-friendly country,” she says.

‘Polio aunty’

When we reach our destination, Ms Devi points out the lack of basic facilities like sanitation, electricity and even drinking water – typical of many Indian villages.

As she moves from house to house, I start to understand how the programme succeeded in the daunting task of eliminating the disease in a country of more than a billion people.

Her friendly nature helps villagers open up about their lives and problems.

Five young children smiling at the camera
The children love their “polio aunty” who brings them sweets as well as anti-polio drops

“It is easier for people to trust me once they have shared some details about themselves with me.

“After speaking about their lives for a while, I can explain how they can protect their children against polio, which would be an additional burden to them,” she explains.

As she walks through the slum, the children run barefoot after her, calling out to “polio aunty” for more sweets.

The high corruption levels in India make it difficult for people to trust government initiatives but Ms Devi insists that the polio programme is different.

One family is not keen on immunising its young ones, so she brings out the vaccination kit and explains how the drops are safe from contamination in the cool box.

She gives the children chocolates before she carries on.

Two women talking, one with a large ice box
Most polio workers carry large ice boxes to protect the vaccine

“I often get tired walking for eight to 10km [four to six miles] in the blistering heat to reach them.

“But I will continue to work as long as my health allows,” says Ms Devi, smiling as she watches me wipe the sweat off my brow.

‘We cannot afford to rest’

Her story is typical of many Aanganwadi workers who travel for miles to reach the areas they work in.

One of her colleagues, Ritu Tripathi, works 70 kilometres (41 miles) from home and stays away during the week.

She only sees her two young children on weekends, with her mother taking care of them in her absence.

It would be nice if the government pays us more for our efforts, but even if they do not, I will continue to work.”

Ritu TripathiAanganwadi worker

“I cannot afford to travel by train very often and would rather invest my energy in the anti-polio campaign and other welfare programmes run by the government.”

Poor wages are a real problem for the workers, and earlier this year there were Aanganwadi strikes in parts of India – but it was business as usual in her area.

“It would be nice if the government pays us more for our efforts, but even if they do not, I will continue to work,” says Ms Tripathi.

By late afternoon I am exhausted from following Ms Devi as she works, and can barely imagine maintaining this routine every day for years.

But she is determined not to give up.

“We have fought hard to beat polio. But we cannot afford to rest if we want to remain free from the disease.”

via BBC News – Eradicating polio one step at a time.

World now 80% polio free, World Health Organization says

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Polio is still a problem in Pakistan

 

The World Health Organization has declared its South East Asia region polio-free.

The certification is being hailed a “historic milestone” in the global fight to eradicate the deadly virus.

It comes after India officially recorded three years without a new case of polio.

The announcement means 80% of the world is now officially free of polio, although the disease is still endemic in Afghanistan, Nigeria and Pakistan.

Other countries in the WHO South East Asia region, such as Sri Lanka, Maldives and Bhutan, have been free of the virus for more than 15 years.

Countries in WHO SE Asia region

  • Bangladesh
  • Bhutan
  • Deomcratic People’s Republic of Korea
  • India
  • Indonesia
  • Maldives
  • Myanmar
  • Nepal
  • Sri Lanka
  • Thailand
  • Timor-Leste

However, despite the “huge global significance” of the announcement, the WHO admits there are still major challenges to overcome if the world is the reach the goal of eradicating polio everywhere by 2018.

There have also been outbreaks in conflict-hit countries such as Syria, which had previously managed to stamp out the virus.

Polio mainly affects children under five years old. The virus is transmitted through contaminated food and water, and multiplies in the intestine. It can then invade the nervous system, causing paralysis in one in every 200 infections.

South East Asia is the fourth of six WHO regions to be declared polio-free after the Americas, Western Pacific and Europe regions. Eastern Mediterranean and Africa have yet to gain a similar status.

Dr Poonam Khetrapal Singh, WHO South East Asia regional director, said: “This is very significant because before this region was certified polio-free, we had half the world’s population polio free.

“With the South East Asia region being added we now have 80% of the population polio free.

“This was a problem the region was struggling with for a long time, but now finally, we are polio free.”

Rise in polio cases

Many experts thought India would be the last country in the world to get rid of polio says Deepak Kapur, of Rotary International’s India National Polio Plus Committee.

He said India faced several enormous challenges including its large population.

He said: “India has close to 170 million children under five who needed to be immunised.

Polio virus
The polio virus can be deadly

“Then there’s the existence of insanitary conditions which helped the polio virus to proliferate – and impure drinking water because polio is a water borne disease.”

But he said the fact that India had managed it and now the whole of South East Asia could be declared polio free sent a powerful and optimistic message to the three remaining polio-endemic countries.

The world signed up to eradicating polio in 1988. The Global Polio Eradication Initiative was launched, which is a partnership between governments and organisations such as Unicef, the WHO and Rotary International. The aim was to banish polio once and for all.

In 1988 there were 350,000 recorded cases. By 2012 cases had fallen to 223. But last year there was a rise in cases to 406 new infections.

“Every child is still at risk”

The increase is largely down to vaccination campaigns being interrupted by conflict. In October 2013, Syria reported its first case of polio since 1999. By March 2014 there were 25 cases.

An outbreak in the Horn of Africa, which started in May 2013, has seen 217 new cases in Somalia, Kenya and Ethiopia.

Rise and fall in endemic countries

  • Afghanistan: 2012, 37 cases 2013, 14 cases
  • Nigeria: 2012, 122 cases. 2013, 53 cases
  • Pakistan: 2012, 58 cases 2013, 93 cases
  • Source: Global Polio Eradication Initiative

While Thursday’s announcement clearly marked an important milestone, there was still a long way to go, said Mr Kapur.

“Every child in the world is at risk of contracting polio until such a time as the wild polio virus is completely eradicated from every part of the world,” he said.

“Until then no child – be it in North America or Europe – will be free of polio potentially hunting them down all over again.

“The only way to ensure the wild polio virus no longer exists in any part of the world is to wipe it out of every community in the world.

“It is not good enough to wipe it out on one continent and not the rest of the world because today the world is just one global village.

“The only way to keep polio away is through immunisation.”

He said if every child on the planet were immunised, there would be nowhere for the virus to flourish and spread.

“Today’s a big occasion for the entire global polio eradication initiative because if India – which had the most difficult of situations – can do it, others around the world can do it too,” Mr Kapur said.

“So Pakistan, Afghanistan and Nigeria need to replicate the example of India and go after this virus.

“Global eradication could and should be achieved in the very near future.”

Crossing Continents: Syria: The Silent Enemy is broadcast on 27 March at 11:00 GMT and 31 March at 20:30 GMT on BBC Radio 4.

Assignment: Syria: The Silent Enemy is broadcast on 27 March at 08:06 GMT, 14:32 GMT, 19:06 GMT, 23:32 GMT, and 28 March at 03:32 GMT on BBC World Service.

via BBC News – World now 80% polio free, World Health Organization says.

Middle East attempts to ward off scourge of polio

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Vaccination campaigns have been stepped up

 

Polio scourge threatens Middle EastIt’s just a drop in the mouth but it’s the drop on which high hopes are pinned, universally.

Only vaccination can prevent infection with poliomyelitis (polio), a viral and highly contagious disease that paralyses children.

It was close to being eradicated worldwide, but has re-emerged in several parts of the world, most recently in Syria.

The outbreak sent shockwaves around the region, especially across Syria’s western border in Lebanon, where an intensive vaccination campaign was launched.

According to the World Health Organization (WHO), the first cases of polio in Syria were reported last October in the eastern province of Deir al-Zour, 14 years after Syria was declared free of the disease.

 BBC News outlines the struggle against polio – in 60 seconds

The latest WHO update says that 17 cases of polio have been confirmed in Syria – 15 of them in Deir al-Zour, one in rural Damascus, and one in Aleppo.

The news prompted strong reaction across the region, the fear of the virus spreading focusing minds.

But for some experts, it should have all been anticipated, and perhaps prevented.

“It was of no surprise to public health and medical practitioners in the region that a communicable disease outbreak such as polio would eventually occur in Syria,” said Dr Adam Coutts, a public health researcher based in Lebanon, who has been monitoring the health situation in Syria for 18 months.

“Questions remain as to why WHO did not better prepare for this, given their own recognition about the risk of outbreaks.”

It is not the first time that the virus has reappeared in regions that were previously declared polio-free: in 2011 the virus spread from Pakistan to China.

What is polio?

  • Polio (poliomyelitis) mainly affects children aged under five
  • It is a highly infectious disease caused by a virus that invades the nervous system
  • Symptoms include fever, fatigue, headache, vomiting, stiffness in the neck, and limb pain
  • One in 200 infections leads to irreversible paralysis
  • Between 5-10% of those who suffer paralysis die because their breathing muscles are immobilised
  • Cases have fallen hugely, from around 350,000 in 1988 to 223 in 2012
  • However, polio remains a major problem in Afghanistan, Nigeria and Pakistan

Source: World Health Organization

However, Oliver Rosenbauer, a WHO spokesman in Geneva, said the immunisation operations were more complicated than they appeared, despite the WHO having access to all areas in Syria since 2010.

He said: “It’s about the nature of the disease that spreads with moving populations that makes it so hard to contain it. The virus is really good in finding susceptible children.

“In places of high risk like Syria, immunisation campaigns alone are not sufficient. A better level of routine vaccination and monitoring is required, and this is very difficult in dangerous areas.”

Regional emergency

Far from being just another Syrian crisis, the outbreak of polio is considered as a regional emergency in the Middle East.

Large vaccination campaigns have been launched in Jordan, Egypt, southern Turkey, Iraq and Lebanon.

 Rajesh Mirchandani visits the polio vaccination programme in the Dadaab refugee camp in Kenya

All these countries have taken a large number of Syrian refugees – but none took as many as Lebanon.

Large numbers of Syrians enter Lebanon every day, and the chances are high that an infected child could pass it on.

Insanitary and crowded conditions, coupled with low immunisation rates, decrease the odds.

The Lebanese authorities and international organisations have pledged to vaccinate all children under five on Lebanese soil.

Schools, nurseries and medical centres have all strived to reach every child in the country but it is a difficult task.

Authorities estimate that more than a million refugees live in Lebanon but there is no official database about their whereabouts or movement in the country.

The most difficult to reach remain those living in tented settlements.

There are more than 100,000 of them and they are spread all over the country, wherever they find an empty spot of land on which to erect their tent.

Reaching this group is often a matter of chance.

“We’re trying to get to each and every child among the Syrian refugees but we constantly discover new mini-camps hidden in one place or another,” said Dr Melhem Harmouch of Beyond, an organisation working in partnership with Unicef.

“Every time we spot a new settlement, we just pop in and ask whether the kids have been vaccinated.”

‘No strategy’

But polio is just one of countless health problems from which Syrian refugees, like some Lebanese, are suffering.

“The whole health system is collapsing, and there is no health strategy for the refugees,” said Dr Fouad Mohamad Fouad, a Syrian physician and professor of public health at the American University of Beirut.

Vaccination campaign
Some are concerned that polio has too high a profile

“Polio is somehow fashionable these days, so everyone is so concerned about it. But other illnesses are also dangerous and totally ignored.”

Dr Fouad said there were countless numbers of refugees suffering from cancer in Lebanon.

“What about those with diabetes, or those with kidney problems who need regular dialysis? What about those with heart problems or the disabled? And who’s taking care of the people with mental problems?”

The UNHCR offers a range of treatments for the refugees but is unable to expand the coverage to specialist healthcare assistance for all chronic disease. In Lebanon, medical care is mostly private and expensive.

“Syrians who are internally displaced and refugees have been dying and disabled in far greater numbers for the past two years and from conditions other than polio or infectious diseases,” said Dr Coutts.

“War injuries, chronic and non-communicable diseases are silently killing Syrians without much media attention.”

Or, as Dr Fouad puts it: “I guess media and the world are much more interested in gory deaths than in latent and slow ones.”

via BBC News – Middle East attempts to ward off scourge of polio.

Polio outbreak fears in war-ravaged Syria

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Polio can be prevented but not cured

 

Experts are concerned that polio may have made a return to war-torn Syria.

The World Health Organization says it has received reports of the first suspected outbreak in the country in 14 years.

Syrian’s Ministry of Public Health is launching an urgent response, but experts fear the disease will be hard to control amid civil unrest.

Immunisation is almost impossible to carry out in regions under intense shellfire.

As a result, vaccination rates have been waning – from 95% in 2010 to an estimated 45% in 2013.

At least a third of the country’s public hospitals are out of service, and in some areas, up to 70% of the health workforce has fled.

Outbreak risks have also increased due to overcrowding, poor sanitation and deterioration in water supply.


Polio

  • Caused by a highly-infectious virus
  • Mainly affects children under five years
  • Can lead to irreversible muscle paralysis
  • A course of vaccines against polio can protect a child for life
  • Global eradication efforts continue
  • The disease remains endemic in only a few countries – Afghanistan, Nigeria and Pakistan
  • Mass vaccination is needed to eradicate polio

More than four million Syrians who have relocated to less volatile areas of the country are mostly living in overcrowded, unsanitary conditions.

The WHO says it is already seeing increased cases of measles, typhoid and hepatitis A in Syria.

Dr Jaouad Mahjour, director of the department for communicable diseases at WHO’s regional office for the Eastern Mediterranean, said: “Given the scale of population movement both inside Syria and across borders, together with deteriorating environmental health conditions, outbreaks are inevitable.”

The cluster of suspected polio cases was detected in early October 2013 in Deir al-Zour province.

Initial results from a laboratory in Damascus indicate that at least two of the cases could indeed be polio.

A surveillance alert has been issued for the region to actively search for additional potential cases. Supplementary immunisation activities in neighbouring countries are currently being planned.

WHO’s International Travel and Health recommends that all travellers to and from polio-infected areas be fully vaccinated against polio.

Most people infected with the poliovirus have no signs of illness and are never aware they have been infected. These symptomless people carry the virus in their intestines and can “silently” spread the infection to thousands of others before the first case of polio paralysis emerges.

Polio is spread by eating food or drink contaminated with faeces or, more rarely, directly from person-to-person via saliva.

via BBC News – Polio outbreak fears in war-ravaged Syria.

Israel battles polio threat in children


An Israeli child receives vaccination against polio at a clinic in Jerusalem as the government took its polio vaccination campaign nationwide to curb the threat of an outbreak of the virus. (AFP/MENAHEM KAHANA)

Israel has ordered nationwide polio vaccination for children to curb the threat of an outbreak of the virus found in the Israeli sewage system

JERUSALEM: Israel has taken its polio vaccination campaign nationwide, saying a two week vaccination effort in the south was not enough to curb the threat of an outbreak of the virus.

“Beginning today, children born after 1.1.2004 will be vaccinated with two drops of a weakened live (attenuated) polio strain, throughout the country,” the health ministry said in a statement.

“The decision to vaccinate nationwide is due to the ongoing presence of the polio virus in the Israeli sewage system, and it reaching children.”

The ministry said that since the launch of the campaign in the south of the country two weeks ago, 60,000 children — or 60 percent of the children in that region — had already been vaccinated.

Health Minister Yael German said that while 98 percent of children in Israel had already been vaccinated as infants, “that does not prevent children vaccinated with a dead (inactivated) virus from being carriers and passing the disease on.”

She also chided parents who questioned the need to vaccinate their children with an attenuated virus in order to prevent the potential spread of the virus to others, calling the vaccination “a matter of mutual guarantee.”

“This attitude is not socially acceptable,” she told military radio. “We have an enemy in Israel, there is a virus and we must take it out.”

Meanwhile, the Izun Hozer group which according to its Facebook page promotes medical knowledge filed a petition to the High Court asking for a freeze on the campaign until questions are answered on the specific vaccine being used.

Dikla Baranes, a lawyer representing the group, said the vaccine in use was “not tested in any Western country,” only on a small group in India, and the results were “very significant” and raised serious question marks.

The health ministry has ordered one million doses of the vaccine, aiming to administer them until the end of November and urging parents to vaccinate their children before the school year starts.

On August 4, the ministry launched a campaign to vaccinate 200,000 children up to nine years old in the south after the virus showed up in routine tests at sewage treatment plants.

– AFP/sf

via Israel battles polio threat in children – Channel NewsAsia.

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