Polio cases double in Nigeria, doctors fighting 2 different outbreaks
Polio cases double in Nigeria, doctors fighting 2 different outbreaks
The Associated Press
Published: April 21, 2008
LONDON: Polio cases in Nigeria have nearly doubled this year as officials struggle to fight various natural strains of the virus and those unleashed by the vaccine itself.
Outbreaks linked to the vaccine, as opposed to the "wild," or naturally occurring, polio virus, are usually stamped out within months.
But in Nigeria, the outbreak caused by the vaccine has been ongoing since 2005. Low immunization rates, a weak health system and vaccine rumors have fueled a worrying spike in the numbers of paralyzed children.
Some experts worry the sudden jump in polio cases could complicate eradication efforts. Last year at this time, Nigeria had 54 reported cases caused by wild polio virus.
This year, there have been 106 recorded cases so far, according to new figures released by the World Health Organization and its partners last week.
"This is a huge step backwards," said Oyewale Tomori, a polio expert at Redeemer's University in Nigeria. He said the last time the country had every type of polio was in 1999 and described the current situation as "hugely traumatic."
Since acknowledging last year that some Nigerian children were paralyzed by a mutated virus from the oral polio vaccine, health officials have had to use three different vaccines to control the viruses.
The vaccine-sparked outbreak has struck more than 100 children so far, including eight this year. For every paralyzed child, there are about 1,000 others infected and spreading the highly infectious and sometimes fatal disease.
Such outbreaks only happen when immunization rates are low.
The oral polio vaccine contains a weakened virus. In rare instances, as the virus passes through children who have not been immunized, it changes into a form dangerous enough to ignite new outbreaks.
An injectable polio vaccine is used in the West that does not cause outbreaks, but it is more expensive and must be given by a doctor or nurse.
"There are just way too many kids in Nigeria who haven't been vaccinated and that's allowing the virus to spread," said Dr. Bruce Aylward, director of WHO's polio department.
Ending the country's parallel polio outbreaks simply requires more vaccine. Nearly all of the children paralyzed by polio are in northern Nigeria, where a yearlong boycott of the vaccine in 2003 triggered an explosion of the disease, which was exported to more than two dozen countries worldwide.
Hard-line Nigerian Islamic clerics called for the boycott, claiming that an immunization campaign was part of a U.S.-led plot to render Nigerian Muslims infertile or infect them with AIDS.
While Nigerian authorities formally reversed the vaccine boycott, the health system remains weak and there are lingering fears that the vaccine is a Western plot to sterilize Muslims.
Up to 30 percent of children in the north have never had a single dose of polio vaccine, according to WHO.
When doctors attempt to eradicate a disease, more than 90 percent of a population must be immunized, and about four doses of polio vaccine are needed in Nigeria for children to be protected.
"Our main problem is operational," Aylward said. "Most kids just lie beyond the reach of the Health Ministry."
Aylward said that vaccine-sparked outbreaks are much easier to contain than those caused by wild viruses. Similar outbreaks have happened elsewhere, including China, Indonesia and Madagascar. In Egypt, a vaccine-caused outbreak lasted about a decade.
In a report to be submitted to the World Health Assembly in May, WHO's ruling body, the agency states that the annual risk of a vaccine-caused outbreak ranges from 60 to 95 percent as long as the world continues to use the oral vaccine.
Some experts wonder if the world's reliance on the oral vaccine may ultimately produce more problems as the globe edges toward eradication of polio.
"It is a worry because we've seen these outbreaks happen in a number of countries," said Olen Kew, a polio virologist at the U.S. Centers for Disease Control and Prevention. "But we are aware of the risks and trying to deal with the difficulties."
Countries with little or no polio may also take a medical gamble by deciding to spend their money elsewhere.
"As countries slip back on their polio vaccination, they become ripe for outbreaks," said Dr. Neal Halsey, a polio and vaccine safety expert at the Johns Hopkins Bloomberg School of Public Health.
Halsey and others think using the injectable vaccine, in addition to the oral vaccine, might solve the problem. WHO has acknowledged that countries must stop using the oral vaccine as soon as possible because of its risks (the vaccine also causes about 250 to 500 cases of polio a year), but says more research is needed.
In the meantime, officials say that the large numbers of unvaccinated children in Nigeria make the entire world vulnerable to polio. While much progress has been made in the other three countries where polio is endemic — Afghanistan, Pakistan, and India — the surge in cases in Nigeria could undo all of that.
"The outbreak in Nigeria is a shared global problem," Aylward said. "Until it is stopped in Nigeria, we are all at risk."
Nigeria to immunise 4.6 million children against polio
KANO, Nigeria (AFP) — Nigerian health workers Saturday began house-to-house immunization of 4.6 million children under the age of five in the northern state of Kano in a new drive to eradicate the disease.
"Health personnel from all over the country are in Kano for the four-day polio immunization campaign during which we intend to immunise 4.6 million children against polio virus," Abdurrahman Yakubu, Kano state coordinator of the National Programme of Immunization (NPI), told AFP.
For four days 26,000 health workers will go door-to-door in the 484 wards of the state administering oral polio drops to those under five years old, he said.
"We have decided to employ a staggering strategy of pulling personnel and logistics in one polio-endemic area at a time as a means of effectively fighting the polio virus," senior health official Ado Abdullahi told AFP.
Kano has been the epicentre of the transmission of the crippling polio virus to other parts of the world since 2003 when the authorities suspended polio immunization for 13 months.
The suspension followed claims by radical Muslim clerics and some medical doctors that the vaccine was laced with substances that could render girls infertile as part of a US-led Western plot to depopulate Africa .
Although the state resumed its polio campaign after clinical trials in and outside Nigeria proved the vaccine safe, Kano had already infected other countries in the region that were considered polio-free and the crippling disease spread to other parts of the world.
The World Health Organisation has recently listed Nigeria, India, Pakistan and Afghanistan as the only polio-endemic countries in the world.
"A Type 1 polio outbreak is right now raging in northern Nigeria. Of every 10 children paralysed by the Type 1 polio virus this year, eight are in Nigeria," Margaret Chan, WHO director-general told a Rotary conference in California last month.
Out of 405 polio cases currently recorded in Nigeria, Kano accounts for 138 cases, which represents 34 percent of all the cases, according to WHO.
Eugenol is also the primary aromatic constituent of clove oil. Clove is a significant agricultural export of Nigeria. Herb farming yields high-value crops under sustainable agriculture methods (reducing soil erosion, a significant environmental problem in Northern Nigeria).
Dosing with an extract of either basil or clove oil before/during/after polio vaccine drops may significantly reduce the potential for PV mutation and CNS infection in susceptible Nigerian children and can be accomplished for pennies per dose.
Eugenol could serve as a substitute polio viral control agent in villages that refuse to allow children to be vaccinated. Basil and clove can be grown locally and are easy to dry and store; alcohol extracts (the sole use of alcohol as medicine is allowed in the Qu'ran) are simple to prepare. Both clove and basil can be used in traditional food preparation as well.
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