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The diagnosis of a young boy and girl paralysed with polio has
sparked an emergency mass vaccination campaign in Nigeria.
Having celebrated its first full year free of the disease in
2015, the country looked set to be polio free by 2017, along
with the rest of Africa.

Health officials are now busy planning their next steps to
alleviate the effects of what Michel Zaffran, director of polio
eradication for the World Health Organization (WHO), said in a
conference call was a “reminder to all of us to reinforce the
fact that we cannot be complacent”. A first round of
vaccinations for children in affected areas will begin as early
as next week.

Clearly any resurgence of polio is bad news, but this particular
outbreak is especially troubling. Here’s why:

Nigeria was nearly polio free
The country was on the cusp of eradicating polio completely,
which would have made the entire continent polio free. In order
to be certified by the WHO as polio free, countries cannot
register a case of wild polio for three years in the presence of
high quality surveillance. These diagnoses have set the clock
back three years.

“These two cases have been detected after two years of thinking
that Nigeria was free of polio, so this is a true
disappointment,” Zaffran said. “In 2012, the country was
representing half of the cases of polio in the world, and a huge
amount of progress had been made to the point where we thought
we had interrupted transmission of the wild polio virus.”

The two children with polio live in an area threatened by Boko
Haram
A boy aged around 15 months and a two-year-old girl were
diagnosed with polio in early summer of this year, and both live
in the heavily-forested region of Borno – a state in north-
eastern Nigeria that is regularly raided by militant group Boko
Haram.

This means that there are serious logistical issues with
accessing some areas in order to vaccinate local children. To
get around this, Zaffran explained that the teams will keep an
eye on areas they are unable to access, and if there is an
opening a “hit-and-run strategy” will be used.

“This is when we sent the vaccination teams in a very quick
manner to access the children,” he explained. “It is very tricky
in some areas but in the past we have been able to use it.”

The teams will also do their best to spread the message about
the vaccinations as much as they can, in the hope that people in
areas that are not easily accessible because of security reasons
will hear about the campaign and reach out to them – but it
won’t be simple.

Medical teams also need to access the countries of the Lake Chad
basin
Children across the border in Chad also need to be vaccinated,
as well as in Cameroon, Niger and the Central African Republic.
“We want to absolutely avoid that the virus circulates and is
transmitted internationally, thus causing an outbreak in all of
this area and potentially affecting other countries,” said
Zaffran. However, like in Borno, access to immunization is not
easy in these areas and the security situation is not optimal.

Four vaccinations are needed to properly protect someone from
polio
Most of the children in the affected areas will not have kept a
written record of how many doses of the vaccination they have
received in the past. It relies on a family member to remember
how many times the child was involved in a vaccination campaign
or whether they were taken to the health centre – but it will
not always be clear.

This is an endemic virus – and was not brought in from elsewhere
Having investigated the polio caught by the children, WHO
officials say it is clear that they have type one of the virus –
type two was last seen in India in 1999 and was declared
eradicated last September, and type three has not been seen
since 2011.

Type one is endemic in Pakistan and Afghanistan – and now it
looks like it’s back in Nigeria. However, testing has shown that
it is a Nigeria-specific virus that has circulated out of
Nigeria in the past. It hasn’t been transported from Pakistan or
Afghanistan, meaning that Nigeria was never totally polio free.

Despite this disappointing news, Zaffran remains optimistic.
“Although this is a setback and a disappointment, we still
believe that polio eradication is absolutely feasible,” he said.


http://time.com/4450308/nigeria-polio-africa-who-vaccines/
 

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