Confessions of a Quackbuster

This blog deals with healthcare consumer protection, and is therefore about quackery, healthfraud, chiropractic, and other forms of so-Called "Alternative" Medicine (sCAM).

Sunday, June 12, 2005

Fighting polio, one child at a time

Jun. 12, 2005. 01:00 AM

Fighting polio, one child at a time

African volunteers know that a single missed vaccination can be a major setback for goal of eradication by year's end


Felicia Mahawa waded into the towering stalks of millet, inspecting pinkie fingers on the left hands of babies and toddlers for two hours before stumbling across the undyed fingernail of Nmabila Anyorka.

The missing ink was a telltale sign that 2-year-old Nmabila hadn't been vaccinated against polio, a crippling infectious disease that world health authorities hope to wipe out by the end of this year.

For three days, thousands of volunteers and UNICEF staff like Mahawa criss-crossed the West African sub-region, squirting two drops of vaccine into the mouths of a staggering 80 million children under the age 5, dipping their fingers in ink and marking their homes with "Q1" to document the visit.

The effort was part of the last push to eradicate the disease, which can cause debilitating and sometimes deadly paralysis of limbs, lungs and muscles.

Officials hope to declare the world polio-free by the end of the year, despite major setbacks in West Africa and an outbreak that has spread to Saudi Arabia, Yemen and Indonesia, where 25 cases have been reported, including five south of Jakarta this month.

The World Health Organization (WHO) insists the 2005 deadline is still feasible, although a special meeting in September has been called to determine how much damage has been done to the eradication campaign, which has cost about $3.1 billion (U.S.) since it began in 1998.

Nmabila was missed because she was strapped to her mother's back at a farm up in the dry fields of Ghana's northern savannah when volunteer Samuel Amofeyi pedalled by the family's round mud hut last fall with a cooler full of vaccine strapped to his bicycle.

Even one child missed can lead to anywhere from 200 to 1,000 infections, although only a handful will experience the disease's hallmark paralysis.

Disease experts know from recent experience that even one lapse in vaccinations can allow the disease to make a remarkable comeback.

"In the polio sphere, even one case is an epidemic," says Dr. K.O. Antwi-Agyei, the public health officer in charge of immunization for Ghana.

When Nigeria pulled out of the vaccination campaign in 2003 — amid unfounded rumours the vaccine transmitted HIV, the virus that leads to AIDS, and could leave children infertile — the consequences were devastating.

Health officials had managed to reduce the number of cases from 350,000 in 125 countries in 1988 to 800 cases in six countries in Africa and Asia.

But one missed round of immunizations in Nigeria in the summer of 2003 was all the virus needed to re-emerge in 12 African countries, some once considered polio-free.

"It just got out of hand," explains Jane Nyanzi-Magoba, who smoothes the flow of information from the most isolated African villages to the leaders at UNICEF, Rotary International and the World Health Organization, who co-ordinate and finance the eradication efforts.

"That national immunization days had been restricted to a few countries and now we have to go through the exercise of immunizing 80 million children in 23 countries — that's a huge setback."

There are currently 390 confirmed cases in 11 countries, according to the WHO website. An estimated 90 per cent of the cases are concentrated in West Africa.

"Because Nigeria refused to immunize, it puts every African child at risk," says Nyanzi-Magoba.

Passed through contaminated feces, the disease colonizes and replicates in the intestines.

Most people with the infection will experience nothing more than vomiting, sore throat and fever.

But a handful will see the virus pool in the bloodstream, where it targets the spinal cord, inflaming nerves and causing paralysis or weakened muscles.

There is no treatment other than physiotherapy, and paralysis can occur in as little as two hours.

The virus moves surprisingly swiftly on a continent where people are more likely to travel on foot than by air. In Ghana, for example, the disease entered the country via a Nigerian trader at a northern market. The infection quickly moved into Burkina Faso, where it flourished.

International pressure forced Nigeria to resume vaccinations after meetings with traditional leaders and massive public education campaigns that advertised the results of tests proving the safety of the vaccine.

The massive, three-day immunization operation, the largest in the history of West Africa, was followed by two more door-to-door campaigns.

Health officials say they're confident such a colossal push will keep the campaign on the course to eradication.

It will take about three years of intense surveillance with no new infections reported anywhere in the world before the disease can officially be declared gone. Smallpox, the last disease to be eradicated, was wiped out in 1980.

The eradication program has equipped public health workers with a massive logistical framework to combat everything from vitamin deficiency to measles, a major killer in children under 5 in the developing world.

Two decades of fighting against polio has built an infrastructure that uses volunteers to go door to door to reach millions of children in the most remote, war-torn places.

Even when civil strife tore apart Liberia, Sierra Leone, Angola, Sudan, Somalia and Ivory Coast, volunteers managed to get vaccine to children.

Specially brokered ceasefires and "days of tranquility" allowed volunteers to vaccinate children in Afghanistan and the Democratic Republic of Congo during the most intense years of fighting.

In sprawling Sumbrungu village, Ghanaian volunteer Amofeyi makes the case for equipping volunteers with slickers during the rainy season. To reach some parts of his community, he is forced to wade into a river and swim to some of the children.

Another volunteer asks for a pair of rubber boots to wear when rain has turned roadways into deep puddles of muck, plus a hat to shield him from the intense African sun.

(Nyanzi-Magoba says some volunteers have attempted to cool off by downing the water in the ice packs that are supposed to keep the vaccine chilled.)

For their efforts, volunteers are paid the paltry sum of $3.75 and receive a free T-shirt.

"We've got to get the job done; so much has been put into it," says Nyanzi-Magoba.

"We are almost there."