Eradication of the Poliomyelitis Virus
Introduction
The polio virus has rarely been associated with the term ‘global health emergency’ ever since its birth about five thousand years ago. The pathogen is on a decades-long decrease trend, such that almost less than one thousand cases remain globally and extremely few in the developed world, yet in 2012, the World Health Assembly that governs the World Health Organization made a declaration that called for the 194 WHO member nations to help fund global polio eradication initiatives. This implies that the threat of polio is still very real and the initiative to eradicate it permanently is more important than the disease itself (http://www.theatlantic.com/international/archive/2012/05/why-polio-just-became-a-global-health-crisis-and-a-global-governance-crisis/257761/).
Background
Poliomyelitis is a contagious pathological illness that is mostly known to infect young children. This virus is transferred from one person to the other via faecal-oral passages or by a conventional viral transmitter such as contaminated water or food. It multiplies inside the intestines and invades the central nervous system, thus leading to paralysis. The early symptoms include fever, fatigue, headache, vomiting, neck stiffness, and limb pain which eventually result in permanent paralysis. There are three types of infections, subclinical, nonparalytic, and paralytic. Sub-clinical infection is the most common type of infection, where patients don’t experience any symptoms, and there is no significant effect on the central nervous system; non-paralytic infections produce mild symptoms and do not affect the nervous system; paralytic infections are the most severe types and result in full or partial paralysis of the spine, the brainstem or both. There is no known cure for polio; therefore, people are encouraged to undergo immunization at a young age especially because children below five years are the most susceptible to viral infection ("Polio", 2016).
In 1789, Polio was first described as an impediment of the lower appendages by Michael Underwood, an obstetrician and British pediatrician. Underwood and his colleagues alarmingly discovered that children were increasingly becoming crippled. The disease, however, predates longer than that, to the Biblical era depicted in Bible stories and Egyptian art. Jakob von Heine, a German orthopedist, isolate the disease from similar crippling conditions and hypothesized that it was contagious. Karl Oscar, a Swedish pediatrician, also keenly noted that the disease attacked infants the most. In the course of the fifty years that followed, polio would come to be known as a ‘crippler’ illness and be responsible for killing many people who suffered respiratory muscles collapse (Lahariyaa, 2007). Various doctors unsuccessfully tried to devise ingenious ways to treat the disease, and one prevailed. The iron lung was developed as a negative pressure ventilator, and polio victims were kept alive inside the metallic coffin. The greatest hindrance to this invention was the issue of power outage, in which case the iron lung was manually pumped to keep the patient alive. In 1948, American scientists John Enders, Thomas Weller and Fredrick Robbins grew the polio virus in living cells and won the Nobel Prize for Medicine. Jonas Salk, another American, later developed the vaccine for polio at the peak of paralysis in America. Numerous campaigns were conducted to vaccinate people against polio with great success in depleting the viral contagion over the years (Gulli, 2015).
Definitions
OPV – oral polio vaccine, also known as trivalent oral polio vaccine or Sabin vaccine. It produces antibodies to all three polio strains and protects against paralysis.
IPV – inactivated polio vaccine, also known as Salk vaccine. Given through intramuscular injection and also produces antibodies against all three polio strains
WHO – the World Health Organization that directs and coordinates health systems, preparedness, surveillance and response, and fights against diseases on a global scale.
AFP – acute flaccid paralysis is a clinical syndrome that leads to weakness, including that of respiratory muscles and swallowing, and progresses to maximum severity within weeks of infection
cVDPP – circulating vaccine-derived paralytic polio is initiated when OPV strains in circulation mutate to cause paralysis. It’s also known as cVDPV- circulating vaccine-derived poliovirus.
International Eradication of Polio
The number of children affected by poliomyelitis suppressed from about a thousand per day in 1988 to five each day in 2006. This shows a momentous feat by the WHO, even though it falls short of the year 2000 target to eradicate the deadly virus. The WHO through the Global Health Assembly invested a lot of funds to save many countries from the infection during this period. Between 2002 and 2005, polio resurged and was experience in over 21 countries in a worldwide outbreak that has proven elusive for the past decade (Arya & Agarwal, 2013). Variants of the pathogen, known as ‘wild poliovirus’, were discovered in countries such as Nigeria (Kano) and India (Moradabad) resulting in some concerns over new strains and how they would affect individuals (Famulare, 2015). The primary explanation offered was that the virus broke out in ‘four year cycles’ as noted between 1998 and 2002. The statistics experienced in 2006 were the highest in 2000, and especially in Nigeria and Afghanistan. This circumstance called for some immediate action to prevent the history repeat of previous years. This paper seeks to understand the current strategies in place for polio eradication and suggests new methods to counter the virus.
The Conventional Eradication Strategy
The primary and most prominent four-pronged eradication method used has been effective in polio eradication over the years from many parts of the world. The typical approach employs a method of maintaining necessary vaccinations with at least three appropriate OPV doses, hence offering additional prevention and establishing efficient means for surveillance of AFP. House to house OPV campaigns also contributed to the eradication of polio within limited geographical regions. The main reasons for the success of conventional eradication include high-level political advocacy and mass mobilization. In the mass vaccination programs, nonmonetary incentives were primarily used, including door to door campaigns and supplementary vaccination programs. Monovalent vaccines with various enhancements, vigorous supplemental immunization programs, and transit vaccinations also became additions to conventional eradication by 2006 (Salmon et al., 2006). This strategy saw the reduction of the number of endemic nations from 125 in 1988 to only four by the end of 2006. During reemergence of the virus, as much as nine countries were reported to experience the polio importation, and the exportation culprit of wild polio was discerned to be the district of Moradabad in India (Wassilak et al., 2014).
Additional Strategies That Can Be Added To Conventional Eradication
As much as the standard scheme is efficient, there need to be area-specific approaches and community programs to address polio-infected areas that have distinct contexts from general areas. The few endemic pockets that remain globally have different issues to address concerning polio infection, for example, myths and culture in some Indian societies and rebellion against vaccination programs by the church and the government in Nigeria. Poor sanitation and low degrees of hygiene have been credited with the viral spread in developing nations too. Local experts are required to cooperate with their counterparts at the global level and design custom solutions for these local communities. Sustained political advocacy to the local and national government will also be needed because new methods need approval at the local and national level. In countries like Saudi Arabia, compulsory OPV vaccination was enforced as legislation for all children below 15 years. This can be emulated in all countries, especially those with the rise in endemic cases. IPV use in the fight against poliomyelitis will also help in the prevention of circulation of resurgent cases. IPV provides collective and individual protection and its use in endemic regions will help counter wild polio virus from these communities (Hovi, 2001). Countries that have experienced new polio infections should strategize on immunization schemes, for example, three national immunization days with IPV, and compulsory vaccination that will guarantee the protection of children and infants. The use of IPV over OPV has some significant advantages such as addressing emergent cases in children who have been previously vaccinated, and it is easier to administer three doses of IPV to a child rather than ten doses of OPV. Additionally, using monovalent and trivalent OPV alternately during immunization exercises prevents type one and type three polio outbreaks respectively. This may also be a way to document the probability of an outbreak of CVDPP type two virus that occurs when vaccination is discontinued.
Conclusion and Discussion
For the longest time, poliomyelitis eradication has been going on, and even though the WHO seems to be winning this war, there are new virus strains that are emerging on a daily basis. As of February 2016, only 73 of wild polio cases were reported, 54 cases from Pakistan and 19 from Afghanistan. In this regard, we cannot rule out the virus as a health crisis until its various strains have been completely eradicated. This means that the use of OPV, IPV and sustained surveillance for AFP will continue at least for the next decade until complete eradication is achieved (Carvalho & Weckx, 2006). Eradication programs initiated by WHO have significantly contributed to a better comprehension of the biological, socio-political, and economic complexities of polio and development of new strategies (Ganapathiraju, Morssink & Plumb, 2015). Other considerations that should be made in this fight against polio include the refugee and migration crisis of the new world, and international coordination among countries with different belief systems.
I have come to understand the complexity of polio and how to protect my family and community by taking them to be vaccinated. There is still hope that a cure will be discovered in future, especially with the current technological advancements. Until then, immunization is our strongest ally in kicking out polio globally. Poliomyelitis is a past century problem, and we need to ensure that it isn’t carried forward to the future generations.
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