Rotary.org: News - Oral polio vaccine remains tool of choice in eradication

 Oral polio vaccine remains tool of choice in eradication

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Oral polio vaccine. Photo by Rotary Images

Rotary and its spearheading partners in the Global Polio Eradication Initiative remain committed to reaching all children with the oral polio vaccine (OPV).

Experts with the World Health Organization (WHO) say a recently reported outbreak of vaccine-derived polio in northern Nigeria is an extremely rare occurrence that happens when the weakened form of the virus used in the oral vaccine mutates to a point where it regains its ability to spread and to paralyze children. Such outbreaks are most likely to occur in communities with low childhood immunization rates and poor sanitation, circumstances that give the virus more opportunities to mutate as it circulates among unprotected children.

“Some recent media reports have been misinterpreted as implying that oral polio vaccine has paralyzed 69 children in northern Nigeria,” WHO says in a statement. “In fact, these children were paralyzed by a vaccine-derived poliovirus to which they were vulnerable because they were not sufficiently vaccinated.”

“This is a reflection of low vaccine coverage in this part of Nigeria,” explains Dr. David Heymann, WHO’s representative of the director-general for polio eradication. He notes that of the children paralyzed, 60 were either unvaccinated or insufficiently vaccinated.

“The only solution is to step up our efforts to immunize all of Nigeria’s children,” says Robert S. Scott, chair of The Rotary Foundation Trustees and the International PolioPlus Committee. “It would be tragic if parents kept their children from receiving the vaccine based on unwarranted fears about its safety. OPV is the best, most effective weapon we have to fight our real enemy: the wild poliovirus.”

According to WHO, “only OPV is proven to rapidly provide very high immunity in the (human) gut and stop polio transmission in a tropical, developing-country setting.”

Nigeria is one of only four countries where spread of the wild poliovirus has not been stopped. Since the outbreak was identified in August 2006, four mass immunization campaigns have been completed, and more are scheduled.

For more information, please see Rotary's official statement.


9 Comments:
At 6:46AM on 18 October 2007, Uday Pilani wrote: Dear John, I do not have your email ID hence replying through this blog. Further, your queries absolutely genuine and need to be addressed. Whether I am qualified to give the appropriate answer is a question in itself but I would like to share from my field experience. Rotary and WHO: Problem in Nigeria is low participation of Rotarians in the PEI. For whatever reasons ( and there are many conflicting views ), PEI effort is Nigeria has been confined to a 'chosen' few. Mass Participation by Rotarians has never been possible. Hence Rotary depends on partner agencies to deliver the goods. In such a situation, it becomes imperative for Rotary to 'toe' in with the partner lest that we disturb the arrangement. This might not be in the best interest of Rotary and those thousands of Rotarians going out of their way to support Rotary's initiative. A way out has to be worked out. Further, reports of VDPV have been in circulation in field reports for quite some time. An alarm was raised late last year too. However, it must have been felt ( though wrongly ) that the damage would not be much and that it might spur additional resistance to the PEI. What we need is 1) Independent Audit of our activities - To check whether what we do is effective, to establish the actual requirement, to cross check data coming in from the field. It is time that we test new ideas rather than sticking to the ones which have brought us so far but not leading us further 2) Accurate Mapping : Current Field maps, hand drawn, are unreliable. We need to integrate Air Photos with Actual Maps. This will help us identify each house that has a problem. We can then work towards MICRO Planning. 3) Strategy needs to be changed. Currently we really do not engage in actual Immunization except for a few pockets and during the visit of Overseas Rotarians. We accept that mass involvement of Rotarians is not very viable in the current situation. Hence we need to identify areas wherein our intervention will support the exercise being carried out by the partners. Maybe Incentive schemes for the field staff if their areas have high coverage, social and sanitation amenities to the areas that are endemic so that they participate, Data collection so that we can advise partners on the areas to concentrate etc. Lastly, it is very important that transperancy in the exercise is maintained. Charity and Service organisations can thrive and grow only if all their actions are above board. you can write to me on udaypilani@gmail.com Uday Pilani President Elect Rotary Club of Bompai ( Kano ) Nigeria.
At 12:37AM on 18 October 2007, John Puig wrote: I am a new Rotarian, and came into reading about this polio issue in Nigeria wile enthusiastically beginning to read all I can Rotary. Although new to Rotary, I have been involved in community, environmental, and humanitarian projects for some time and I have a few questions about what happened in Nigeria and what is the truth. My personal experience in life leaves me feeling responsible for what I am a part of, and I want nothing more to serve in the highest manor. With such a disposition I join Rotary wholeheartedly with all that Rotary embraces including eradicating polio in Nigeria and the world over. I have never and will never let my integrity fail, it is from here I face you today. I must inquire for all that is Rotary, and all that I stand for, what is the truth? I have read WHO and Rotary statements about what happened as my first independent study into Rotary. I was unsatisfied with what I read. I read more, the BBC New York Times, the AP wire and all else I could find. Feeling accountable for what happens with Rotary, I could not let the subject of what happened to cause the single largest outbreak of OPV derived paralysis in the history of the program rest. Several factors concern me. I do see the overall statistics are great, and want for the success of the program, Rotary, and the benefit of all. I hope to see these questions easily addressed and the integrity of the program stand proud. 1. Why are WHO statistics for primary infection and secondary infection of OPV derived polio combined into one statistic for all WHO and Rotary official statements? 2. Why do both WHO and Rotary fail to address that other news organizations have reported that 60 of the 69 cases have been caused by primary infection (children that were vaccinated with OPV)? 3. Why do Rotary International or WHO only address secondary infection causes when discussing what happened in Nigeria? 4. Why would the WHO official statement indicate that insufficient population vaccination is the cause of the outbreak and imply that Muslim hesitance to the vaccination and human migration frustrates the problem when other sources report from Nigeria that 87% of the cases of paralysis are primary infection in children that were vaccinated? 5. Would it not be reasonable for Muslim population to question the vaccination effort again if information portrayed is anything other than an honest truth in the best interest of the children’s safety and addresses all reports, including ones questioning what was done to mitigate damages after the first reports where know? 6. Who’s best interest would that be in? 7. It has been reported that WHO partially utilized an OPV from a new source in 2006, what damage control measures have been taken to assure quality control after the largest outbreak of OPV derived Paralyzes in the history of the program? 8. Have the feedstock of the OPV indicated in the cases of paralysis been contained? 9. WHO and Rotary Internationals official statements and press releases state the answer to the problem is more intensive vaccinations to reduce secondary infection from OPV, does this consider that 87% of the recent outbreak is reported to be primarily derived from an OPV? 10. It is reported that WHO officials knew of the outbreak for all of 2007, but felt it unworthy of a public statement until independent organizations reported on it and the WHO and Rotary were forced into a reactionary response about it. When did Rotary International and Polio Plus officials learn of this outbreak? 11. Would not all questioning be completely avoided through clear communications? I have almost 500,000 miles logged on my USCG Captains license and my time surviving at sea has taught me well. Things go wrong and accidents happen. What is ever so important to survive the day is to be trusted by your crew. A leader must forwardly face what happened, get accurate damage reports, and communicate clearly, commanding from a position of unquestionable integrity and authority. Our best lesson are learned by facing adversity with integrity. It is always our greatest challenges that upon overcoming become our finest hours. With that I understand that things can go wrong and we must move positively forward, but I wholeheartedly believe as we move forward we must face what went wrong and learn from it the best we can. I pray that asking out alienates me not, for my questions come from none other than the four way test and a sense of personal accountability. I believe all Rotarians deserve to know the whole story of what happened in Nigeria in 2006, for they support the program. Let the light of truth be our only weapon against darkness. Unfortunately I am leaving the country for a humanitarian mission, and will be without internet contact for a month. This issue will stay with me, and when I return I shall continue to seek to find my comfort in the truth of the situation. Captain John Francis Puig USCG 1600 Tons Master Oceans, Naples Florida
At 3:41PM on 15 October 2007, John Puig wrote: After reading the articles and Rotary’s statements on this, The Rotary statement softly implies the 69 children that contracted polio did not receive the vaccination. This information should be clearly portrayed. The statement that the area was not complete leaves on to believe there was research done into what went wrong with the out break. The first article I read on the matter implies the cases were children who received the vaccine. That is a huge difference in the view of the story. This is a very important subject, and when there are problems in a system they deserve the greatest of attention to assure continual success. This should be clearly addressed, as so should it be stated what was the response taken to the report and what measures are being taken to assure a safe vaccine. As a Rotarians we are responsible for quick and ethical responses protecting the children we are working to help from any risk they may be exposed to. I also would like everyone to know exactly what the problem in order to educate them about how to avoid the same problem in the future.
At 7:54AM on 15 October 2007, Uday Pilani wrote: I have done over 10 IPDs in Kano. Sometime late last year, I had initiated a debate on the number of vaccines claimed to be administered vis a vis the number of children that are reported to be in the entire population. This was done to sensitize the leadership on the fact that maybe coverage is not all that it looks. Further the point I was making was 1) The reports received from the field on the Immunization coverage are falsified and there is no mechanism to check the delivery standards. All agencies report excellent coverage including Rotary 2) There were cases of OPV induced Virus even last year and these highlighted but ignored 3) There is a fatigue creeping in. The parents, health workers and other partners are complaining that this is going on for too long. We need to re-strategise the way we do the Immunization. Agreed that Rotary is now a minor player but it can still make its point in the National Debriefing wherein all partners are present. What we need is a) Accurate Mapping b) Schemes to motivate field staff into performing better and with honesty c) Research on Data accuracy so that we can advise the partners on where additional effort is required d) Incentives to Populations in endemic areas to participate. Comments are welcome. Only when we have a healthy discussion and bring solutions, can we help in eradicating Polio Uday Pilani President Elect RC Bompai ( Kano ) Dist 9120
At 11:05PM on 14 October 2007, John Neely (Salem, MA, USA) wrote: I have read Rotary's official statement, dated October 5 plus the October 11 RI News story associated with this comment chain. In neither is there reference to the timing of the WHO announcement. Following is what The Boston Globe published on October 6 in an AP story written by Maria Cheng: "The CDC and the World Health Organization announced the cause of the polio outbreak last week, even though they knew about it last year. .... Dr. David Heymann, WHO's top polio official, said that because the organization considered the outbreak a problem for scientists and not something that would change vaccination practices, they thought it was unnecessary to immediately make it public." I can not imagine the CDC or WHO even considering the withholding of such information regarding an outbreak in a first-world country. Suspicion of the medical initiatives of first-world governments, NGOs, and pharmaceutical companies is widespread in Africa and is partly justified. That suspicion could frustrate the best efforts to contain polio, let alone eradicate it. Cultural sensitivity and respect are now likely more important than science in the battle against polio. What is chairman Scott’s view of the secrecy practiced by The CDC and WHO?
At 11:05PM on 14 October 2007, John Neely (Salem, MA, USA) wrote: I have read Rotary's official statement, dated October 5 plus the October 11 RI News story associated with this comment chain. In neither is there reference to the timing of the WHO announcement. Following is what The Boston Globe published on October 6 in an AP story written by Maria Cheng: "The CDC and the World Health Organization announced the cause of the polio outbreak last week, even though they knew about it last year. .... Dr. David Heymann, WHO's top polio official, said that because the organization considered the outbreak a problem for scientists and not something that would change vaccination practices, they thought it was unnecessary to immediately make it public." I can not imagine the CDC or WHO even considering the withholding of such information regarding an outbreak in a first-world country. Suspicion of the medical initiatives of first-world governments, NGOs, and pharmaceutical companies is widespread in Africa and is partly justified. That suspicion could frustrate the best efforts to contain polio, let alone eradicate it. Cultural sensitivity and respect are now likely more important than science in the battle against polio. What is chairman Scott’s view of the secrecy practiced by The CDC and WHO?
At 7:40AM on 13 October 2007, Jill Gordy wrote: as a new Rotarian, I am curious about the vaccinations 'life expectancy".....is it 1 vaccine 1 time in child's life or are there repeat vaccinations that are needed, thus the reason for the 'not sufficiently vaccinated'?
At 11:13AM on 12 October 2007, DR.S.SURESH BABU,RC-OOTACAMUND,RID 3200 wrote: OPV is a time-tested vaccine for the eradication of the wild polio virus.OPV confers not only gut-immunity but also humoral immunity as well.OPV induced paralysis is a very minimal risk.But it should not deter us from using it.
At 11:49PM on 11 October 2007, Ashok Bharti wrote: Sincere efforts are being made by Rotarians in India, & Afghanistan for eradication of polio, which needs to be highlighted. Moreover details of cases reported ( if any) should also be mentioned in such reports. This would motivate other rotarians to contribute funds and time in motivating children to take the polio vaccine

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