Tag Archives: Polio

Syria: Mass Polio Immunization Campaign

Syrian children receive vaccination against polio at a Syrian refugee camp in Lebanon, Nov. 7, 2013.

 

Syria 13 Nov 2013:
The The largest-ever immunization campaign in the Middle East is under-way to stop an outbreak of polio in Syria from spreading throughout the region.

 
In mid-October, 22 suspected cases of polio were detected in north east Syria.  The virus has left 10 children paralysed.  But U.N. health agencies warn hundreds of thousands of children across the region are at risk of contracting this crippling disease. 
 
Now, The World Health Organization and U.N. children’s agency are joining forces to immunize more than 20 million children in seven countries and territories during the coming six months.
 
WHO Polio Eradication Program Spokeswoman Sona Bari notes the virus has been circulating in the region for some time, notably in Egypt, Israel and the West Bank and Gaza.  But she says the outbreak in Syria, a country that had been polio-free for 14 years, has accelerated this emergency response in the region.
 
Bari says emergency immunization campaigns to prevent transmission of polio and other preventable diseases have vaccinated more than 650,000 children in Syria.  She says this includes 116,000 in the highly contested north-east Deir-ez Zor province where the polio outbreak was confirmed a week ago. 
 
According to Bari the campaigns fanning out throughout the region aim to vaccinate 22 million children.
 
“This is a sustained six-month effort.  There will be repeated campaigns over this period of time.  It is going to need quite an intense period of activity to raise the immunity in a region that has been ravaged both by conflict in some parts, but also by large population movements.  So, the virus is moving throughout the region,” she said.
 
The WHO reports in the past few days, nearly 19,000 children under age five in Jordan’s Zaatari refugee camp have been vaccinated against polio.  And, it says a nationwide campaign is currently under way to reach 3.5 million people with polio, measles, and rubella.  It says a vaccination campaign has started in western Iraq and soon will begin in the Kurdistan region. Lebanon, Turkey and Egypt also plan campaigns this month. 
 
The polio virus usually infects children in unsanitary conditions through faecal-oral transmission.  It attacks the nerves and can kill or cause paralysis.  There is no cure for polio, but it can be prevented through immunization.
 
Bari says 12 suspected cases of polio are under investigation.  She says preliminary evidence indicates the polio virus circulating in the region is of Pakistani origin. 
 
There have been media reports that Pakistani fighters brought the polio virus into Syria but the WHO spokeswoman said that is unlikely. 
 
“We are never going to know exactly how it arrived in Syria.  What we do know is that we have seen a virus that is very similar in Egypt, in the West Bank and Gaza, and in Israel over the past 12 months.  We also know that adults tend to have a much higher level of immunity already developed.  So, it is unlikely that adults brought this in.  It is probably more likely some other route.  But, we will never really know for sure.  All we can say for certain is that it is of Pakistani origin and that it has been in this region for a little while,” she said.
 
Pakistan, Nigeria and Afghanistan are the last three endemic countries in the world, so it is from there that polio will continue to spread.  Since WHO began its polio eradication campaign in 1988, vaccination has reduced this crippling disease by more than 99 percent globally.
 
Despite this setback, Bari says the World Health Organization remains optimistic the outbreak can be stopped and polio, eventually, will be eradicated.

[Courtesy of VOA]

Uganda: Paediatric Vaccine Crisis

KAMPALA, 20 May 2013  – Ugandan children are going unimmunized as the country grapples with persistent and widespread vaccine shortages, the result of insufficient funds and inefficient procurement and supply systems, officials say.

“We are getting reports and calls from all the districts about the stock-outs of all types of anti-immunization vaccines. They don’t have anti-TB [tuberculosis] vaccines, anti-tetanus, polio [vaccines]. The ministry is faced with inadequate funding for most of our programmes,” Asuman Lukwago, permanent secretary in the Ministry of Health, told IRIN.

“The current major problem on the vaccines is the distribution issue. We are working around the clock to have the problem solved and sorted out immediately.”

Most of the health centres across the country are facing critical shortages of vaccines to protect against tuberculosis, polio, tetanus, diphtheria, rotavirus and pneumonia, putting children at risk of largely preventable diseases.

Health officials now fear these frequent shortages could prevent mothers from bringing their children in for immunizations.

“You can’t [ask] mothers to move to health facilities three to four times and they don’t find vaccines. This practice discourages some of them to go back to the hospitals,” said Huda Oleru Abason, chairperson of the Parliamentary Forum on Immunization.

Procurement woes

In 2011, the government of Uganda shifted the procurement of vaccines and drugs from the Uganda National Expanded Programme on Immunization (UNEPI), under the Ministry of Health, to the National Medical Stores (NMS), an autonomous government corporation. The move was intended to inject efficiency into the country’s drug procurement system, but the drug shortages have continued.

Yet officials at NMS are blaming the shortages on late requisitions for vaccines by UNEPI. The procurement of drugs is the responsibility of NMS.

“Placing of orders is not the responsibility of NMS, it’s [the job of] UNEPI,” Dan Kimosho, a spokesperson at the NMS, told IRIN. “So if they don’t put request in time or under-quantified for the supplies, it’s not our problem. Our responsibility is to procure, store and deliver the requested vaccines. We can’t begin delivering vaccines to districts and health [facilities] if the orders have not been placed to us. We have the competency to deliver the requested drugs and vaccines.”

An estimated 48 percent of children under age five in Uganda are either unimmunized or under-immunized, meaning they do not complete their immunization schedules, according to the 2011 Uganda Demographic and Health Survey.

Uganda has recently experienced a decline in immunization levels, in part due to inadequate funding, health staff shortages and  [parents’]poor adherence to vaccination schedules.

In April 2013, the government launched a countrywide rotavirus and pneumococcal vaccination program targeting over 1.7 million children.

In an interview with IRIN, Director General of Health Services Ruth Achieng noted that, “Uganda is not doing very well in [its] immunization programme… We don’t want our children to die from preventable diseases. We need to act now. Otherwise, we shall get an outbreak of polio and tetanus.”

Uganda’s budget support for the Expanded Programme on Immunization, EPI, – which had been hailed for increased vaccination coverage between 2000-2007 – decreased by more than half in recent years, falling from 7.7 percent in the 2006-2007 financial year to 3.6 percent in 2009-2010.

Officials say the government has plans to revitalize the country’s immunization programs.
“We have worked out the revitalization plan, and if implemented well, we shall be able to change the low status of immunization in Uganda. The government has mobilized some funds and, with support from GAVI, everything is revisable. We are going to embark on [an] aggressive campaign to ensure there are no vaccine stock-outs in the country and ensure all the children are immunized,” the Ministry of Health’s Lukwago said.

There is also a legal push to improve immunization. An immunisation bill currently pending in parliament will make it illegal for parents and guardians to fail to have their children immunized. It also seeks to punish health officials who fail to offer immunization services to children.

[Courtesy of IRIN)

Nigeria polio: Immunising the vaccine fears

Usman Al Hassan and his children, including on his lap Abubarkar who contracted polio in 2013, on their home in the outskirts of Nigeria's capital, Abuja

Two-year-old Abubarkar Al Hassan has the unfortunate tag of being Nigeria’s first polio victim of 2013.

“It’s quite upsetting to see that my son cannot play with his friends when they come here,” says his father Usman Al Hassan, who lives on the outskirts of Nigeria’s capital, Abuja.

“He cannot move unless someone carries him. This makes him cry.”

As Mr Al Hassan strokes his son’s legs, some of his daughters sit around and one of his two wives prepares a meal in a tiny kitchen off the courtyard.

“I have 14 children and 13 of them are vaccinated; it is very unfortunate that when the vaccinators came around this area they missed my house and my son was not vaccinated,” he says, looking at his son who is sitting on his lap.

In the long winding alleys of this community, houses are packed close together.

Open gutters like streams run like central veins carrying household waste water from homes.

Passers-by leap over them to avoid the dirty greyish sludge.

Nigeria has been making some strides in the battle against the polio, which can cause lifelong paralysis, but the task has been slow and fraught with challenges.

The West African nation is only one of three countries where polio is endemic – Afghanistan and Pakistan being the other two.

Journalists Arrested

Last year, 122 cases of the virus were reported and the government is hoping to keep the numbers down this year.

“We still continue to miss too many children. In a campaign where you aim to reach 32 million children house-to-house there are number of challenges,” says Melissa Corkum spokesperson for the UN children agency’s polio campaign in Nigeria.

“In Nigeria there are a lot of nomadic populations on the move… there is no fixed address where you can knock on their door during the campaign,” she says.

“This leads to many children being… missed.”

Together with the government of Nigeria, Unicef is running nationwide immunisation campaigns.

Polio cases in Nigeria are mostly found in the mainly Muslim north of the country.

In the past few months there have been violent attacks against health workers believed to be connected with polio vaccination drives.

In the most recent attack nine female health workers killed in Kano state.

It is possible that these attacks were the result of religious and political leaders who have opposed the vaccine, saying it is a Western plot to sterilise Nigerian Muslims.

Suspicions about vaccination programmes were fuelled in part by the Pfizer scandal in 1996 when the US drugs firm used an experimental drug during a meningitis outbreak in Kano. Eleven children died and dozens became disabled as a result.

In 2003, these fears and conspiracy theories led to the suspension of vaccination campaigns in Kano, leading to a high number of children contracting the disease.

Then earlier this year, a Muslim cleric and two journalists from Kano were arrested for broadcasting a report saying the vaccines were not safe.

Not all religious leaders are of this school of thought and some regret the harm caused by their colleagues.

“The problem was caused by those who were preaching against it,” says Alhaji Attahiru Ahmad, the Emir of Anka in the northern-western state of Zamfara.

‘Attitudes Changing’

He blames the slow response by the government to the statements.

“They allowed them to have a field day before the intervention, and you know it’s difficult to repair damage,” the emir said.

He and other traditional rulers in the area have been trying to counter criticism of the vaccine.

During the last polio campaign in this area, a father refused to have his child immunised.

He was brought to the emir who convinced him to immunise his child.

However the talk of polio remains a very sensitive subject and many in these communities shy away from talking about refusing immunisation.

But the Nigerian government says they are making strides in reducing suspicion among vulnerable communities.

“People are becoming more aware and are realising that in fact the vaccine is safe, it’s efficacious, and that other parts of the world have actually used it to eradicate this disease,” says Dr Ali Pate, Nigeria’s junior minister of health who also heads the presidential campaign against polio.

“This [is a] collective effort. For the first time, you have the entire global community focusing on a single disease, after smallpox, to eradicate.”

Part of the government campaign has involved community mobilisation workers who talk to people about the benefits of the vaccine.

In the case of Abubarkar, his contracting polio has had a positive effect on his neighbours.

“People are aware, now they know that the disease is real,” says Yakubu Yahaya, a social mobilisation officer.

He has in the past had difficulties convincing the people in that community that polio as a disease was a reality.

“They were saying it is either politics or religion or because they want to make their children infertile,” he says.

“So they are really now ready to comply with all the vaccinators.”

For Abubarkar and his father, the lesson learnt has been a harsh one.

“I do not blame the vaccinators for missing my son, what has happened was God’s will,” says Mr Al Hassan.

“At least because of him, others can now take this seriously and immunise their children.”

Those working on the government’s drive against polio, will also be hoping that lessons can be learnt and they can indeed make strides towards eradicating the disease by 2014.

[Courtesy of BBC News]

 

Roots of polio vaccine suspicion

5 April 2013 – For years, polio vaccination has faced strong resistance within conservative Islamic communities in northern Nigeria, largely due to a deep distrust of the West, persistent rumours that the vaccine is harmful, and the house-to-house approach taken by immunization campaigners, which many saw as intrusive. 

Over recent years, polio campaigners have changed their methods to try to win over reluctant community members and religious leaders – to mixed effect. In February of this year, 10 polio vaccinators were killed in the northern city of Kano by anti-western Boko Haram militants, the latest setback to efforts to eradicate the virus from Nigeria. 

The country is one of only three where polio is still endemic. In 2012, Nigeria recorded 122 cases – over half of the global total that year. 

IRIN spoke to residents, imams and health workers in Kano State to discuss the roots of ongoing vaccine suspicion. 

Geo-politics 

Sheikh Nasir Muhammed Nasir, imam of Fagge Juma’at Mosque, the largest in Kano, is an advocate of polio immunization. 

“There is nothing wrong with the polio vaccine. The major reason why people reject it is the deep-seated suspicion they harbour against the West, particularly the United States due to its foreign policies in the Muslim world, especially the war in Iraq and Afghanistan,” he said. 

“The US invasion of Iraq and Afghanistan – which caused deaths and destruction – is seen by many Muslims here as a war on their brethren. They wonder how the same countries responsible for this colossal carnage can now turn and save lives elsewhere. To them, it doesn’t make any sense that you offer to save my children from a crippling disease yet are killing my brothers,” said Nasir. 

Mamman Nababa, a father of three in Kano, said: “I can’t understand how the West will spend millions of dollars in providing medication against polio for our children while they systematically killed 500,000 Muslim children in Iraq by imposing an embargo that denied them access to basic medicines. 

“They are doing the same in Iran, where they imposed sanctions that make drugs scarce. It doesn’t make sense to kill my brother’s child by denying him life-saving drugs and then expect me to believe that you want to save my child from polio for free.”

Residents also expressed scepticism of the focus on polio, saying other diseases should be given priority. 

“How could I be so naive as to allow my children to be given polio drops by people who go door-to-door giving the vaccine free while the government has failed to provide medication for the most urgent diseases affecting us, such as malaria and typhoid?” said one Kano resident. 

Infertility 

For years there has been suspicion that the polio vaccine is laced with infertility hormones as part of a US-led plot to reduce the Muslim population. The Kano State government suspended polio immunization between September 2003 and November 2004 following the spread of such rumours by some Muslim clerics. The suspension led to an unprecedented number of infections and transmission of the virus to 17 countries that had been polio-free. 

Kano resident Zulaihatu Mahmud says most people understand polio is caused by a virus, but even so, she and others fear the vaccine could be harmful: “Nobody wants their child to be crippled by polio, and nobody wants her child to be sterile, either.” 

In 2003, to address these concerns, the Kano State government and federal government set up committees of doctors and clerics to test the polio vaccine. Following trials in Nigeria, South Africa and Indonesia, they declared the vaccine safe. 

However, they also confirmed the presence of traces of two sex hormones – oestrogen and progesterone – that are used in contraceptive medicine, which reinforced the sterility rumours in some communities. 

Sadiq Wali, a professor of medicine who was involved in the committee, explained that the vaccine is developed in a culture made of monkey kidney, which contains the two hormones. Since hormones are highly water-soluble, traces are bound to be found in the vaccine, but they are too minute to have a contraceptive impact, he said. The amounts are so infinitesimal that special equipment is needed to detect them. 

Lingering anti-colonial sentiment 

Much of the long standing distrust of Western influence among northern Nigerians is linked to the British colonial occupation and its dealings with the Islamic caliphates that had ruled the north, explained Aminu Ahmed Tudun-Wada, head of the Kano State Polio Victims Trust Association. 

“Almost a century after the introduction of Western education, there are still parents who don’t enrol their children in school because they believe it is a ploy to convert them to Christianity, and the suspicion has its roots in the British conquest. It is the same sentiment playing out with the polio vaccine,” he said. 

Several people in the north referred to the introduction of cigarettes to Nigeria by the British 50 years ago. Kano tobacconist Habu Iro and several residents told IRIN that in the 1950s, when people bought cigarettes, they would find money in the packet. The amount included was gradually reduced as people became addicted. 

“We now know what [the] cigarette does to human health. The white man will never give anything for free. It is the same thing with [the] polio vaccine. They are hiding something,” 73-year-old Kano resident Dije Umar said. 

Changing approaches 

Early polio campaigners’ approaches were also seen as too insistent, combining radio advertisements, community workshops and teams of health workers going door to door, according to a polio expert with an international agency who asked to remain anonymous. 

But because most inoculations take place in health clinics or hospitals, many families did not trust health workers arriving at their doorsteps. 

One polio expert, who wished to remain anonymous, called initial campaigns “aggressive”. “They… sent a wrong signal to parents. We didn’t take account of the social dynamics then,” he said, referring to the need for more efforts to get communities on board. 

Before 2005, polio campaigners partnered only with political and health authorities. They later learned to work closely with community and religious leaders. Most northern states have since formed polio immunization task forces with village and religious leaders as members. 

The results were largely positive, with greater community acceptance and an improved understanding of polio and the vaccine, said an anonymous polio expert, who said uptake of the vaccine had increased since 2005. 

But in February of this year – following the killing of the 10 polio vaccinators in Kano – the approach changed once again. The campaign is now limited to health clinics and hospitals as part of routine immunizations, and it is entirely government-led. 

Many doctors fear this approach will threaten eradication efforts. To eliminate polio, vaccinators must reach at least 90 percent of children, giving each four doses over a 6-12 month period, according to the World Health Organization. 

“The halt in house-to-house immunization is a serious threat to eradication… A large chunk of children will have no access to the vaccine and will be at risk of infection,” Adamu Isa, a paediatric nurse at Nassarawa Specialist Hospital in Kano said.

The National Primary Health Care Development Agency (NPHCDA), which oversees polio immunization in Nigeria, plans to hold a national workshop in Abuja for Muslim clerics and traditional leaders to clear up all misconceptions about the vaccine. 

“It will be frank, honest and no-questions-barred discussions where we will clear any misgiving they have about the polio vaccine with concrete proofs and evidences, because once we secure their support, we secure the confidence of the public in accepting the vaccine,” NPHCDA’s director-general, Ado Mohammed, told IRIN. 

[Courtesy of IRIN News]

Nigeria: Kano Partners Dangote, Bill Gates Foundations On Polio

Kano State Government has signed an agreement with Bill Gates and Dangote Foundations respectively, in a bid to tackle the scourge of polio meningitis in the state.

Speaking at the ceremony Tuesday at the Government House, Kano, Governor Rabiu Musa Kwankwaso, said the state government would continue to work towards improving healthcare and enhance routine immunisation.

Kwankwaso, who was represented by his deputy, Dr. Abdullahi Umar Ganduje, said the problem of resistance among some parents would be address by the state government as well ensure total immunisation of all eligible children in the state.

He said the goal was to wipe out polio virus to avoid its spread to other parts of the country.

On its part, the representative of Bill Gates and Melinda Foundation, Mr. Jeffery Raikes, said it had become imperative for the state government and the Foundation to partner in the fight against polio.

POLIO WORKER SHOT DEAD IN PAKISTAN

Child receiving oral polio vaccine drops in Balochistan, PakistanA local community worker who was part of the polio eradication initiative in Pakistan was shot and killed Friday (July 20), three days after a shooting incident in the same town injured two World Health Organization staff members.

Muhammad Ishaq’s death comes days after the campaign was suspended in parts of Gadap town in Karachi. He had worked as a Union Council Polio Worker, helping plan and implement vaccination drives to protect children from the disease.

In a joint statement, WHO and UNICEF said they were deeply saddened by the incident and called Ishaq — with his dedication and diligence to immunize “all children” in Pakistan against polio — a hero.

These violent incidents risk undermining gains made against the disease, which remains endemic in Pakistan. Elias Durry, head of the WHO polio eradication program in Pakistan, said that the decision to resume operations in the concerned areas will be “guided by the investigation and situation analysis by local and security-related administrations.”

Campaign activities in others parts of Karachi, however, have been “successfully conducted and completed,” Durry said.

CHAD: Polio Outbreak

 

DAKAR, 5 February 2012
Poor-quality emergency immunization campaigns and low routine polio immunization coverage are helping the polio virus to spread in Chad, with 132 cases reported in 2011 – five times the number in 2010. More commitment is needed across the board, especially from local health authorities, to try to get immunizations right, say aid agencies.
The current outbreak in Chad has been ongoing since 2007, classifying Chad as a “re-established transmission zone” according to the World Health Organization (WHO). Polio is endemic in Nigeria, Pakistan, India and Afghanistan – in other words, transmission of the disease in these places has never been broken.

While a dysfunctional health system is linked to poor routine immunization coverage, “the primary reason [for the upsurge] is operational,” said Oliver Rosenbauer, spokesperson for the Global Polio Eradication Initiative at WHO in Geneva. “It is not to do with insecurity or lack of infrastructure… The outbreak response has not been sufficient to stop it [the outbreak]… They continue to miss too many children.”

Immunizers have missed children for a variety of reasons: In some cases government and agency staff or volunteers inaccurately mapped out where they lived; or may have ordered too few vaccines or too few ice packs to cover each district, said WHO. Often communities are not well-sensitized in advance so families remain reluctant to bring their children forward, some resist on religious grounds, or they simply may not know that they can immunize a child even if he or she is sick, said WHO and UNICEF’s West Africa communication for development specialist Irina Dincu.

Human error also plays a role, added Dincu, explaining that an ill-trained vaccinator may rest en route, breaking the cold chain, or a team may miss a few houses in a village.

An outbreak of the polio virus would not spread so far if routine polio immunization coverage was better, said Rosenbauer. Polio immunizations are rigorous to administer: vaccinators must go house-to-house, and must give each child four doses over a 6-12 month period, reaching 90 percent of all children to eliminate polio, according to WHO.

Coverage rates are estimated to be 60 percent at most in Chad, partly due to a poor-quality health system: Just 30 percent of health clinics are operational across the country; access to health care is poor; and routine immunization strategies are poorly planned.

To ensure fewer children are missed, immunizers need to make better use of “social data” to find out why and where a campaign is not working, says Dincu. Agencies used to take a purely medicalized approach to polio immunization but this has now changed. “Immunization campaigns are not just a medical intervention. You need to address campaigns from a medical, political and societal angle,” said Rosenbauer.

Social data has been used creatively in India and Nigeria to help vaccinators reach more children, according to UNICEF. In Nigeria’s Kebbi State households were assigned “godmothers” who came regularly pre-immunization day to discuss the disease and why vaccination was important. When poring over the data afterwards to find missed children, the “godmothers” could identify them by place, name and age, making them much easier to re-trace.

These are the kinds of approaches that could be adopted in Chad, say practitioners, where despite its weak health system, polio should not be too challenging to control, says Rosenbauer. “We don’t face the same high-population challenges that we do in Nigeria, or insecurity as is the case of Afghanistan and Sudan. Here it is more a question of political and societal will.”

In his view, polio could be eliminated in six months if the government committed to doing so at all levels. 

International efforts to combat polio are mounting: the Centers for Disease Control (CDC) has established an Africa-based emergency operations centre which will tackle public health crises, including polio.

Meanwhile, the Polio Eradication Initiative – made up of WHO, UNICEF, CDC, the Bill and Melinda Gates Foundation and the Rotary Foundation – has designated polio a “programmatic public health emergency” until eradication is achieved.

The Chadian government appears to be taking polio seriously: President Idriss Déby has emphasized the importance of fighting it, and catalyzed the development of a six-month polio emergency action plan (which will then be renewed for a further six months). This includes targeting high-risk areas and analyzing what is and is not working.

But commitment at the district and sub-district level in some parts of the country is weak, say aid agency staff. National authorities need to hold “sub-national” staff accountable for their performance, said Rosenbauer. “The virus doesn’t respect district boundaries so we need high commitment in every single one,” he told IRIN.

Without local-level government commitment, elimination efforts will fail, says Rosenbauer. The number of cases in Nigeria rose from 21 to 57 between 2010 and 2011 partly due to local authorities focusing on presidential elections; while election-related violence also distracted from efforts to quash 36 cases that broke out in Côte d’Ivoire in 2011.

And until polio is eliminated in Nigeria and in Chad, all West African countries are at high-risk, according to WHO. “There are immunization gaps in many countries – it can strike in the most unexpected places… that is why it is such a dangerous disease.”

[Courtesy IRIN]