WHO Claims Polio Stopped in Somalia

[Som@li]

By MARIA CHENG – 2 hours ago

 

LONDON (AP) — The World Health Organization claims polio transmission has been stopped in Somalia, leaving only a dozen other countries with the deadly disease.

 

But given the lack of detailed medical data from Somalia, the absence of a centralized government and continued violence across the country, officials admitted the virus could very easily pop up again.

 

"Polio could absolutely return to Somalia," said Dr. Bruce Aylward, director of WHO's polio department. "Based on our surveillance, we're pretty confident, but we could still be surprised."

 

Polio mostly strikes children under five, and is spread when unvaccinated people come into contact with the feces of those with the virus, often through water. It usually attacks the nervous system, causing paralysis, muscular atrophy, deformation and sometimes death.

 

WHO said Somalia has not reported a case in exactly a year. Last year, the country identified eight cases. Aylward said that WHO has a network of about 100 local Somalis across the country who regularly report any suspected polio cases.

 

About 10,000 Somali health workers and volunteers were involved in efforts during the past decade to vaccinate nearly every child under the age of five, Aylward said.

 

Somalia has been ravaged by violence and anarchy since warlords overthrew dictator Mohamed Siad Barre in 1991 and then turned on one another. The current government — formed with U.N. help in 2004 — has struggled to assert any real control.

 

At most, polio paralyzes one out of every 200 children it infects, leading other health officials to suspect that cases might be missed in Somalia.

 

"I would be very surprised if there were any reliable data at all," said Dr. Donald A. Henderson, who led WHO's smallpox eradication effort in the 1970s. "We can be optimistic, but I think we should also be very cautious."

 

Henderson also said that without a strong health system in Somalia, reporting polio cases would be extremely difficult.

 

"If you're the mother of a 10-month-old baby who's suddenly paralyzed, where do you go for this to be reported if there's no health facility?" he asked.

 

Somalia was declared polio-free in 2002 but the disease was detected again in 2005. Aylward said the country had succeeded this time because of strengthened vaccination campaign strategies, and that the polio strategy could be used to combat other health problems in war-torn areas.

 

So far in 2008 there have been 191 cases globally, compared with 61 at the same time last year. But only a fraction of the cases have been type 1 polio, which WHO says is the most dangerous and fastest spreading type.

 

When WHO and partners began their anti-polio campaign in 1988, the worldwide case count was more than 350,000 annually. The disease's incidence has since been slashed by more than 99 percent and remains endemic in four countries: Afghanistan, India, Nigeria and Pakistan.

 

Polio cases were also detected last year in Angola, Cameroon, Chad, Congo, Myanmar, Nepal, Niger and Sudan.

 

The health body has missed goals of eradicating the disease globally by 2000 and 2005, and critics have wondered whether the goal is logistically possible.

 

No new target date for eradication has been set, and the campaign has cost over $4 billion. To continue fighting polio until 2010, WHO estimates that another $525 million is needed.

[Cara.]

What's polio in Somali?

 

"Dabeyl baa qaaday" baan maqli jirey when children became paralyzed or died suddenly. Is it the same thing?

[peasant]

^ Dabyle ...cudur nafeeya ciyaalka

[Som@li]

Polio (also called poliomyelitis) is a contagious, historically devastating disease that was virtually eliminated from the Western hemisphere in the second half of the 20th century. Although polio has plagued humans since ancient times, its most extensive outbreak occurred in the first half of the 1900s before the vaccination, created by Jonas Salk, became widely available in 1955.

 

At the height of the polio epidemic in 1952, nearly 60,000 cases with more than 3,000 deaths were reported in the United States alone. However, with widespread vaccination, wild-type polio, or polio occurring through natural infection, was eliminated from the United States by 1979 and the Western hemisphere by 1991.

 

Signs and Symptoms

Polio is a viral illness that, in about 95% of cases, actually produces no symptoms at all (called asymptomatic polio). In the 4% to 8% of cases in which there are symptoms (called symptomatic polio), the illness appears in three forms:

 

a mild form called abortive polio (most people with this form of polio may not even suspect they have it because their sickness is limited to mild flu-like symptoms such as mild upper respiratory infection, diarrhea, fever, sore throat, and a general feeling of being ill)

a more serious form associated with aseptic meningitis called nonparalytic polio (1% to 5% show neurological symptoms such as sensitivity to light and neck stiffness)

a severe, debilitating form called paralytic polio (this occurs in 0.1% to 2% of cases)

People who have abortive polio or nonparalytic polio usually make a full recovery. However, paralytic polio, as its name implies, causes muscle paralysis - and can even result in death. In paralytic polio, the virus leaves the intestinal tract and enters the bloodstream, attacking the nerves (in abortive or asymptomatic polio, the virus usually doesn't get past the intestinal tract). The virus may affect the nerves governing the muscles in the limbs and the muscles necessary for breathing, causing respiratory difficulty and paralysis of the arms and legs.

 

Contagiousness

Polio is transmitted primarily through the ingestion of material contaminated with the virus found in stool (poop). Not washing hands after using the bathroom and drinking contaminated water were common culprits in the transmission of the disease.

 

Prevention

In the United States, it's currently recommended that children have four doses of inactivated polio vaccination (IPV) between the ages of 2 months and 6 years.

 

By 1964, the oral polio vaccine (OPV), developed by Albert Sabin, had become the recommended vaccine. OPV allowed large populations to be immunized because it was easy to administer, and it provided "contact" immunization, which means that an unimmunized person who came in contact with a recently immunized child might become immune, too. The problem with OPV was that, in very rare cases, paralytic polio could develop either in immunized children or in those who came in contact with them.

 

Since 1979 (when wild polio was eliminated in the United States), the approximately 10 cases per year of polio seen in this country were traced to OPV.

 

IPV is a vaccine that stimulates the immune system of the body (through production of antibodies) to fight the virus if it comes in contact with it. IPV cannot cause polio.

 

In an effort to eradicate all polio, including those cases associated with the vaccine, the Centers for Disease Control and Prevention (CDC) decided to make IPV the only vaccine given in the United States. Currently, the CDC and American Academy of Pediatrics (AAP) recommend three spaced doses of IPV given before the age of 18 months, and an IPV booster given between the ages of 4 to 6, when children are entering school.

 

If you're planning to travel outside the United States, particularly to Africa and Asia (where polio still exists), be sure that you and your child have received a complete set of polio vaccinations.

 

Duration

Although the acute illness usually lasts less than 2 weeks, damage to the nerves could last a lifetime. In the past, some patients with polio never regained full use of their limbs, which would appear withered. Those who did fully recover might go on to develop post-polio syndrome (PPS) as many as 30 to 40 years after contracting polio. In PPS, the damage done to the nerves during the disease causes an acceleration of the normal, gradual weakness due to aging.

 

Treatment

In the height of the polio epidemic, the standard treatment involved placing a patient with paralysis of the breathing muscles in an "iron lung" - a large machine that actually pushed and pulled the chest muscles to make them work. The damaged limbs were often kept immobilized because of the confinement of the iron lung. In countries where polio is still a concern, ventilators and some iron lungs are still used.

 

Historically, home treatment for paralytic polio and abortive polio with neurological symptoms wasn't sufficient. However, asymptomatic and mild cases of abortive polio with no neurological symptoms were usually treated like the flu, with plenty of fluids and bed rest.

 

The Future of Polio

The World Health Organization (WHO) is working toward eradicating polio throughout the world. Significant strides have already been made. In 1988, 355,000 cases of polio in 125 countries were reported. By the end of 2004, there were just 1,255 cases.

 

Six countries (Afghanistan, Egypt, India, Niger, Nigeria, and Pakistan) still have polio circulating, and the virus could be introduced to other countries. If the polio virus is imported into a country where not enough people have been immunized, there's the risk that it could spread from person to person. That's what has happened in some countries in Africa and Asia. So until it has been eliminated worldwide, it's important to continue vaccinating kids against polio.

 

Reviewed by: Steven Dowshen, MD

Date reviewed: December 2007

Originally reviewed by: Joel Klein, MD

 

Source

[Jacaylbaro]

Ilaahay run ha ka dhigo ,,,

[Endeavour]

Great news and all BUT polio should be the least of our worries at the moment. WHO should consider tackling diseases like Malaria and TB these diseases are epidemic in Somalia.

They could perhaps start basic vaccination programmes in rural Somali communities. That would be more beneficial to our people than the eridication of polio.

[Baluug]

Great news and all BUT polio should be the least of our worries at the moment. WHO should consider tackling diseases like

qabiilism

Fixed it for ya.

[Cara.]

Endeavour, there are no vaccines for TB or malaria.

 

Cadaan, ditto.

[-Lily-]

There was a story about a Somali refugee in Scotland last week whose body resisted TB treatment, he was on the news.

[Cara.]

Lily, did he have multiple-drug-resistant TB? That's been in the news here lately.

[Faynuus]

Maskiinka Allaha caafiyo.

[Som@li]

Originally posted by Cara:

Lily, did he have multiple-drug-resistant TB? That's been in the news here lately.

Actually worse than Multiple-drug resistant TB, he had Extremely Drug Resistant TB (XDR-TB), rabi ha u sahlo.

 

This is the first case reported in Britain since the revised definition of XDR-TB was published by the World Health Oorganisation in 2006. Recent findings from a survey of data from 2000-04 found that XDR-TB had been identified in all regions of the world but was most frequent in the former Soviet Union and Asia.

 

Professor Peter David, the secretary of TB Alert in Britain, said that drugs could contain the disease but not cure it. Treatment takes 12-18 months and is estimated to cost more than

£100,000

per patient.

[Endeavour]

Originally posted by Cara:

Endeavour, there are no vaccines for TB or malaria.

Very interesting you say this. Have you never heard of the BCG vaccine?? I am sure if you born in Somali you would most definetly have had one, you might even bear the scare and not even be aware of it.

 

There has been over the years much controversy regarding BCG and its effectiveness, like every other vaccine it is not 100% effective however it limits or rather reduces the complications of TB in areas where there is high prevalance. BCG vaccine are virtually unknown if you are in western countries unless you are a microbiologist.

 

Since Somali lacks basic vaccination programmes I am sure BCG vaccines are no longer administered and this is a real worry and also the availability of antibiotics since TB requires vigrous treatment with several antibiotics.

 

As regards to my comment about vaccination programmes I was only referring to the need to immunise our people against deadly diseases like tetanus rubella measles and mumps hepatitis( hepatitis of course one of the number one killers in Somali).My question is do such programmes exist in Somali? I don't think so.

[Cara.]

Dabshid, thanks for the link, that's really tragic. On the other hand, I attended a seminar today on promising antitubercular drugs that are being developed to target these new cases of MDR/XDR TB. Hopefully this young man can get access to clinical trials if all else fails.

 

I could've done without the comments by the xenophobic goons on that webpage.

 

Endeavour, the BCG vaccine is almost entirely useless for Africans. There's an interesting paper I read on it sometime ago, I'll see if I can dig it up for you. Basically it doesn't work for adults, it doesn't work for most non-Western children (especially from rural areas), and it removes one of the key public health screening methods for TB exposure: the skin test.

 

I'm not really sure what you're trying to say otherwise. Do you think they are administering the polio vaccine instead of the MMR or hepatitis B vaccine? Usually these vaccines are given to children all at the same time, or as a series. What you're overlooking though, is that it is possible to claim to have "eradicated" polio, but not tetanus or measles, simply because of the nature of the diseases. Even European countries can't claim to have eradicated tetanus!

 

Here's the WHO immunization profile for Somalia. You'll notice that, while estimates of the number of children getting the full series of vaccines is woefully low, the WHO is not focusing on polio at the expense of other vaccine-preventable diseases. There's a measles eradication program, another program that aims to cut vitamin A deficiency in children, etc.

 

As for TB and malaria, it's not a choice between vaccinating against polio versus treating malaria or TB, since those are entirely different sets of challenges. TB treatment regimens essentially require a first world public health infrastructure, not something that's readily available in our nation at the moment.

[raula]

Good news perhaps that polio has been lessened in its intensity but STOPPED....I wish i could believe that. It is extremely hard to eradicate especially in refugee settings.

 

Maskiin-I hope the man makes it alive-Allaha cafiiyo-Amin.

 

CARA-skin test only is a measure of TB exposure of any kind. However, even those who have gotten any vaccination before (since the vaccine is attenuated)-they can test positive for the Skin test which complicates everything. but it is disproved or confirmed by an X-ray to see if the bacteria has spread to the lungs(if indeed that's when its deadly and needs meds to eradicate it). TB is explosive because its contagious and anyone can acquire it especially in communities that are not HERD IMMUNED(as in HERD IMMUNITY).

 

Its been long time since i have heard of the XDR-TB-its has to be extreme.

 

Endevour-true, they need to start doing mass vaccicnation of deadly disease like you have mentioned..this will lessen the intensity of its impact if a community is hit with it.