DISEASES

Medic-ALL (09:01:2015)

POLIO: The "PAN" and the "PAIN" by Kayode Kuku

Just a few years ago “P-A-I-N’ was the acronym popularly used among medical students to recall the countries where Polio was endemic, but that changed a couple of years ago when the “I” which referred to the nation with the 2^nd largest population in the world, India, left the likes of Pakistan, Afghanistan and Nigeria (P-A-N) on the list of countries that have never stopped Polio.

                            Nigeria aims to follow in the footsteps of India through increased government 

                           commitment and stakeholders support. Source: Global Polio Eradication Initiative website

It had been a much-anticipated moment as the World Health Organization notified the national authorities in India on 25 February 2012 that the country was officially removed from the list of countries with active transmission of endemic polio. This came weeks after India marked 12 months in which no Indian child had been paralyzed by polio. India has not seen a case since a 2-year-old girl in the state of West Bengal developed paralysis on 13 January 2011.

It is interesting to note that, as recent as 2009, India had the highest burden of polio cases in the world (741), more than the three other endemic countries combined. But the government resorted to extraordinary measures to reach children with the vaccine so much that the Polio eradication efforts became a most widely-recognized brand in India, with a Bollywood megastar as its public face.

Polio remains endemic in three countries – Afghanistan, Nigeria and Pakistan. Until poliovirus transmission is interrupted in these countries, all countries remain at risk of importation of polio, especially vulnerable countries (Cameroon, Equatorial Guinea, Ethiopia, Iraq, Somalia, Syrian Arab Republic) with weak public health and immunization services and travel or trade links to endemic countries. The circulating vaccine-derived poliovirus is causing an outbreak in Madagascar.

Polio (poliomyelitis) is a highly infectious disease caused by a virus. It invades the nervous system and leads to irreversible paralysis in a matter of hours. It can affect any age, but is commonly seen in children under-5 years of age. Polio is a crippling and potentially fatal infectious disease which spreads via person-to-person contact especially in conditions of poor hygiene and sanitation. The disease has no known cure, but there are safe and effective vaccines to protect against it. In the presence of adequate vaccination of a sufficient number of children against the polio virus, the virus is unable to find susceptible hosts to infect and subsequently dies out. The Polio vaccine, given multiple times, almost always protects a child for life.

The greatest challenge facing the countries yet to do away with Polio is probably the inability to reach children in certain parts of the country with the vaccine. For, instance the wild poliovirus (WPV) transmission in Nigeria is limited to a few states in the northern part of the African nation with the world’s 7^th largest population. The country’s government is however eager to see the nation go in the way of India soon, as the last reported case of the wild poliovirus was in July 2014 while a single case of circulating vaccine-derived poliovirus type 2 has been reported in 2015 (May).

On the other hand while most parts of Afghanistan remain polio-free, most of the cases reported in the past year were due to poliovirus imported from neighboring Pakistan (which has 29 WPV1 cases reported this year, mainly in the Federal Administered Tribal Areas (FATA)) and presently there is ongoing transmission going on in Afghanistan, with a total number of wild polio virus 1 (WPV1) cases this year standing at eight.

                           Everyone has a unique role to play to protect the children 

                                   from polio. Source: Global Polio Eradication Initiative website

The progress observed in Nigeria is the result of incredible efforts from the National Polio Eradication Programme which is support by partners of the Global Polio Eradication Initiative. For years, Nigeria posed one of the greatest challenges to global eradication, with many children missed during vaccination campaigns in hard to access areas and low levels of campaign quality.  More children than ever before are being immunized, with data indicating that as many as more than 90% of children having received more than three doses of oral polio vaccine, including in traditional high-risk areas. 

The issue of increased insecurity in the northern part of the country has posed a significant challenge to eradication efforts in the past. In some areas, access remains an issue and strategies focus during and in-between campaigns to enhance immunity, including through special outreach in hard-to-reach communities, focus on internally-displaced person’s camps and providing additional health services in health camps.

Ending polio in Nigeria will be a victory for the country and for children everywhere and bring the world much closer to being polio-free. High quality surveillance and aggressive vaccination campaigns will continue to be key in the bid to eradicate the poliovirus in Nigeria as well as in Pakistan and Afghanistan.

 Refs: Global Polio Eradication Initiative. 

Medic-ALL. Inc 2015