New African polio cases are from India. (WHO)

[Sonny]

WHO says polio virus detected in four countries was from western Uttar Pradesh, India

http://www.indianexpress.com/printerFriendly/12642.html

DARSHAN DESAI

Posted online: Thursday, September 14, 2006 at 0000 hrs IST

LUCKNOW, SEPTEMBER 13
The news is not just that Uttar Pradesh accounts for as many as 255 polio cases out of the 283 reported across the country this year. The news is that Moradabad and five neighbouring districts in western UP, which account for 70 per cent of India?s cases, have emerged as the exporter of the polio virus, according to the World Health Organisation (WHO).

?In 2006, western UP is the only area in the world with a geographically expanding polio epidemic that is actively exporting polio to previously polio-free countries, like Namibia, Democratic Republic of Congo, Bangladesh and Nepal. The virus originating from here has also been detected in polio-free area like Madhya Pradesh in India,? states the WHO website relating to polio eradication.

What WHO indicates is that the virus strain found in those countries and in Madhya Pradesh has a lineage linked to that found in western Uttar Pradesh. Nine countries? Somalia, Yemen, Indonesia, Bangladesh, Ethiopia, Namibia, Niger, Nepal, and Democratic Republic of Congo ? have reported polio cases because of ?importations? this year, and four say they have got it from India, more precisely western Uttar Pradesh. The cases in Congo and Namibia have been genetically inked to a virus strain originating from Angola, which in turn had got it from western Uttar Pradesh in 2005.

India is among the four countries in the world identified by WHO as polio-endemic. The others are Pakistan, Afghanistan, and Nigeria. And Moradabad and adjoining regions stand out for the high incidence of cases, which took up by 29 from last year?s figure the number of cases reported from Uttar Pradesh.

The reasons for western Uttar Pradesh reporting a high incidence of polio are several, though the most immediate ones are a slack government health machinery, which simply missed covering many children, as well as localized pressures from Muslim clergy spreading the canard among the most poor and illiterate that the polio drop aims to reduce the community?s fertility. Also, lack of sanitation, and contamination of piped water with water from leaking sewers. Polio virus is released from faeces of infected persons.

When contacted, Director General of Health B Nath agreed to all the reasons cited by WHO and UNICEF for the outbreak in Moradabad and neighbouring districts. ?If the number of missed houses is more, if the nutritional status of children is poor, if the sanitary conditions are poor, this was expected to happen,? she said. However, she denied any slackness in the vaccination campaign. ?There would not be more than one per cent slackness,? she said.

Dr Nimal Hettiaratchy, the UNICEF State Representative in UP, says during his visits to the region he found a general tendency of health department staff was to miss children in certain localities.

?This was either on the assumption that the immunisation efforts may be resisted or sheer fudging of figures to show more than the number of children covered,? he says.

A joint team of the WHO and UNICEF found during an evaluation study in April this year that the coverage deteriorated between late 2005 and early 2006, resulting in large number of children not receiving polio vaccine.

In Moradabad, the houses with missed children increased from eight per cent in January 2005 to nearly 12 per cent during rounds conducted in August, September, November, 2005 and January 2006.

Sources in WHO said it was further revealed during a sample check of 3,300 houses in Moradabad district in June 2006 that an additional 6.5 per cent children did not actually receive polio vaccine, though records said the children in the house had been vaccinated.

Random stool checks of children, too, showed 12 per cent testing positive for the vaccine in the first quarter of 2005, but this fell to four per cent for the corresponding period in 2006. This was clearly because fewer children had been vaccinated from late 2005 to early 2006.

Dr Hettiaratchy denies that Muslims as a community resisted polio immunisation and that it was a chief reason for the programme failing in western Uttar Pradesh ? he said the resistance was localised, in a few places.

The real reasons, he said, were pathetic sanitary conditions, contamination of piped water supply from leaking sewers, and so forth.

?Since the polio virus releases from the faeces of the infected person, open defecation and poor sanitation make the spread easier,? he says. Besides, he said lack of nutrition contributes to lowering immunity. Add to this the slackness of government vaccinators, ignorance of the people and misleading local leaders and the picture is complete.

[Sonny]

Fear of vaccinations cause Polio to spread.

Polio vaccination dismissed as devil's work across Africa
MARIA CHENG AND JOHN ALECHENU IN KANO, NIGERIA
The Scotsman Thu 14 Sep 2006

FOR Ramatu Garba, the polio vaccine is more curse than saviour - part of an evil conspiracy hatched in the West to sterilise Nigerian girls.

"Allah used Muslim scientists to expose the western plot of using polio vaccines to reduce our population," said the 28-year-old Muslim food vendor in the northern Nigerian town of Kano.

Each time health teams have tried to vaccinate her daughter, Ms Garba has refused.

Besides lack of funding, equipment and personnel, international health teams fighting disease in the world's poorest countries must also contend with rumours that spread through vulnerable populations and create barriers to urgent health campaigns that have saved millions of lives.

In Kenya, whispers were once rife that polio vaccine is a tool for devil worship. Across Africa, there is widespread belief that vaccines spread HIV.

The rumours in Kano started in 2003, when local politicians claimed polio vaccine contained anti-fertility agents and suspended vaccination for nearly a year. Since then, public-health authorities have been working desperately to convince the government and people like Ms Garba of the vaccine's safety.

Fears about the polio vaccine have been so prevalent in rural Nigeria that villagers have fled their homes when polio vaccination teams arrive.

The total cost of fighting the polio-vaccine scare in Nigeria and in other countries where the sterility rumours spread has cost $200 million and caused the World Health Organisation and its partners to miss their 2005 polio-eradication deadline by at least two years, said Dr David Heymann, WHO's top official in the fight against the disease.

Part of the problem, experts say, is rooted in health workers' own failure to inform people in poor countries about real vaccine-related risks.

In the developed world, it is virtually a legal requirement to inform people of any potential vaccine-associated risks. But in the developing world, standards of informed consent are often abandoned as a logistical stumbling block.

Claire Hajaj, who has worked on polio eradication at UNICEF, said communicating medical risk to illiterate and remote populations was not always possible. "Usually, you have to settle for something that's not quite as perfect," Ms Hajaj said.

"We go repeatedly to families who have no electricity or sanitation," said Michael Galway, head of UNICEF's polio communications in India. "They see their kids dying from things like malaria and diarrhoea. And then we bring the polio vaccine - which is not what they want."

And public-health officials have kept quiet about one obvious adverse effect the polio vaccine can cause: polio itself. For approximately every three million doses of the oral polio vaccine administered, one child is paralysed by the live virus in the vaccine itself.

Some medical ethicists say this failure to educate is wrong - regardless of the difficulties.

"Failing to divulge adverse effects is non-transparent, and it's essentially a lie," said Dr Ross Upshur, a specialist in medical ethics at the University of Toronto. "There's no point in controlling infectious diseases if you've violated communities' dignities and rights in the process."

Whatever the root cause, experts agree on the dangers of rumours in public-health efforts.

In Nigeria, some mothers try to fool health workers into believing their children have been vaccinated by painting their children's fingers with nail polish, an attempt to imitate the ink marks used in vaccine campaigns to record that a child has been immunised.

This article: http://news.scotsman.com/internation...?id=1356802006

Last updated: 14-Sep-06 01:45 BST

[sharon sanders]

Nigerian states again boycott polio-vaccination drive

Unfortunately a boycott against polio vaccination is nothing new ----



The Lancet 2004; 363:709
DOI:10.1016/S0140-6736(04)15665-1
Nigerian states again boycott polio-vaccination drive

Clare Kapp

Muslim officials have rejected assurances that the polio vaccine is safe?leaving Africa on the brink of reinfection


Tens of thousands of volunteers embarked on an emergency campaign on Feb 23 to immunise 63million children against polio in ten African countries. But their efforts were overshadowed by the continuing boycott in northern Nigerian states which are the epicenter of an upsurge in the disease.
Officials in the state of Kano said they are still not satisfied with the plethora of international assurances that the oral doses of vaccine are safe and are not part of a western campaign to spread infertility or HIV among Muslims.


?Fear and misinformation about the polio vaccine have become as deadly as any disease?, said Jonathan Majiyagbe, president of Rotary International, one of the partners in the eradication initiative. ?The polio vaccine is a safe and essential protection for children. We must not allow these unfounded rumours to come between our children and their health?, he pleaded.
Ebrahim Samba, WHO regional director for the African region, warned that the entire continent is on the ?brink of reinfection? and that the global goal of eradicating polio by 2005 is at risk, thus jeopardising 15 years of work and US$3 billion in spending.


Nigeria reported 347 cases of polio last year?about half the world's total?with many of them occurring in the Muslim northern states, which interrupted the immunisation campaigns.


Of particular concern to the global health community is the confirmation of more than 30 cases of polio in neighbouring countries that had previously been declared polio free.


In addition to Nigeria, the vaccination drive will target Niger?where polio is still endemic?Ghana, Togo, Cameroon, Benin, Burkina Faso, Central African Republic, and Chad.


But Kano officials insisted that they wanted to wait for the findings of a committee of Nigerian government and scientific experts and Muslim leaders who spent a week examining tests on vaccines in South Africa, India, and Indonesia.


Tests initiated by the federal government last year ?which proved the vaccines were safe?were dismissed by Kano Islamic groups, who claimed that their own laboratory tests found traces of oestrogen and progesterone in the polio vaccines: proof, they say, that they really are antifertility drugs.


WHO said it had ?every confidence? that the new findings would convince ?all concerned parties across Nigeria? to back the resumption of the immunisation campaign.


Another northern Islamic state, Kaduna, lifted its ban at the 11th hour. But initial reports indicated that the uptake of immunisation was patchy, with many locals turning away volunteers. The state of Zamfara continued its boycott.


The standoff in Nigeria has left the international public health community frustrated, especially in view of the widespread belief that power politics between the central government in Abuja and the self-styled Supreme Council for Sharia in the Muslim North?and not medical concerns?are to blame.


UNICEF said that even if authorities in Kano relented, it may still take several weeks to lay the groundwork for a new immunisation drive.
?It is a tragedy that children in some states in northern Nigeria are being denied their right to immunisation against polio, a disease for which a safe vaccine is readily available. As long as polio immunisation activities remain suspended in Kano State, children will be unnecessarily infected and paralysed?, said UNICEF.


UNICEF spokeswoman Claire Hajaj said the agency was hoping it would be still be possible to fit in two strong immunisation rounds in Kano during the ongoing low season. But even before the ban, the lack of routine medical services in the impoverished state meant that as few as 16% of the 3million children under age 5years were sufficiently immunised.


Notwithstanding the problems in Kano, UNICEF said it hoped that 40million Nigerian children would be immunised during the campaign, which is scheduled to be followed by another mass campaign in March.

http://www.thelancet.com/journals/lancet/article/PIIS0140673604156651/fulltext

[AlaskaDenise]

Re: New African polio cases are from India. (WHO)

.....They see their kids dying from things like malaria and diarrhoea. And then we bring the polio vaccine - which is not what they want."

Like Bill Gates trying to teach them to use computers, but when the health care workers show up, they all walk out of class......the priorities are obvious.

.

[Theresa42]

Re: New African polio cases are from India. (WHO)

What's Behind India's Outbreak of Polio Paranoia

A small group of Muslim clerics is spreading the myth that the vaccine is part of a conspiracy to sterilize Muslims -- and as a result, helping to spread a disease many thought was conquered

By ARAVIND ADIGA/NEW DELHI
Posted Thursday, Sep. 28, 2006

It's hard to imagine that anyone could object to a campaign to eliminate polio ? a disease that maims, paralyzes, and even kills its victims, who are mostly children. Yet, in one of the more bizarre confrontations between Islamic fundamentalists and the modern world, a tiny group of clerics in India is doing just that ? and giving new life to a deadly disease.

Poliomyelitis, a contagious viral disease that once crippled and killed thousands of children annually, has been eliminated in most of the Western world thanks to a vaccine invented by Jonas Salk in the 1950s, but it still survives in some of the world's poorest countries. India seemed to be on the verge of eliminating polio last year, when it reported just 66 cases of the disease, down from 1600 in 2002. This year, however, things have gone horribly wrong with India's polio elimination campaign; 325 cases have been reported already, and at least 23 of them have been fatal. What's caught people's attention is that 70% of those infected with polio this year are Muslim, even though Muslims account for only 13% of India's population. What's even stranger, and frightening, is the reason: some Muslims believe that the polio drops are part of a conspiracy to sterilize their children, and are refusing to let them be vaccinated.

This year's polio outbreak has been concentrated in India's largest state, Uttar Pradesh, home to over 170 million people. It is here, say health workers, that a few ultraconservative Muslim clerics have spread a myth that the polio vaccine is part of an underhanded campaign to sterilize Muslim children and lower the Muslim birth rate. Dr Hamid Jafari, the regional advisor for the World Health Organization (WHO) on polio eradication, says that the majority of Uttar Pradesh's Muslims have got their children vaccinated, but, "in certain places, fatwas have been issued against the vaccine." In those places, Muslims have stopped state health workers from entering their houses and administering the polio vaccine, which is administered orally, to their children.

Dr. Jafari adds that paranoia is not the only reason for the hostility to the polio drops. Uttar Pradesh is notorious for being one of the worst-administered regions of India, and most of the state has appallingly bad hospitals and health services. Muslims, who are among the poorest of Indians, bear the brunt of this collapse in the state's health infrastructure. Dr Jafari says: "There's a sense of frustration among many Muslims: they tell the health workers, we've never seen anyone coming to take care of us, why are you coming just to give us polio drops?"

The result: India's health officials estimated recently that up to 15% of households with children in the western part of Uttar Pradesh state may have been skipped in recent vaccination drives. In a state with a very high population density and poor sanitation, that figure is large enough to ensure that polio ? which spreads through contaminated water and contact with excrement ? has made a comeback, just when it looked like the net was closing on it in India. Although 90% of India's districts are polio-free, the disease has spread out this year from its epicenter in western Uttar Pradesh to other parts. In March, sewage samples in three slum areas of Bombay, India's financial capital, found polio virus strains in the water. Earlier this week, a nine-year old Bombay girl was found to have got the polio virus, the first case in two years in the city.

Even more disturbing are the global implications of such paranoia. Dr. Jafari says that genetic analysis shows that the strain of polio from Uttar Pradesh, in the past couple of years, has left India, and spread to at least three African countries that had made great strides against polio ? Angola, Namibia, and the Democratic Republic of the Congo. This year, he says, the Uttar Pradesh strain of the polio virus has leapt out of India and reinfected two polio-free neighboring countries: Bangladesh and Nepal. "This shows that the continuation of polio in one country is a threat to all the world," he says.

Some countries are taking the renewed threat of polio very seriously. Last year, Saudi Arabia announced that all travelers from countries with polio, under the age of 15, would have to show valid proofs of vaccination before they got a visa to enter the country. India's health minister, Anbumani Ramadoss, stung by criticism, announced recently that that he will step up his government's efforts to eliminate polio in the country ? and make a special effort to reach out to India's Muslims. "We are going to have a special program to enlighten them," he told the press recently, adding he would be meeting Islamic leaders in Uttar Pradesh to figure out how he could dispel Muslim anxieties about the polio vaccine. Unless he can, many more parents in India, and throughout the world, will start grappling with their own worries about a disease they thought had been conquered.

http://www.time.com/time/health/article/0,8599,1540477,00.html

[ruthbeme]

Re: New African polio cases are from India. (WHO)

<TABLE cellSpacing=0 cellPadding=0 width=629 border=0><TBODY><TR><TD colSpan=3>Indian alarm at new polio cases


</TD></TR><TR><TD vAlign=top width=416><!-- S BO --><!-- S IBYL --><TABLE cellSpacing=0 cellPadding=0 width=416 border=0><TBODY><TR><TD vAlign=bottom>By Geeta Pandey
BBC News, Delhi

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</TD></TR></TBODY></TABLE><!-- E IIMA --><!-- S SF -->Officials in India say they are worried over the growing number of polio cases in the country.
They say 119 new cases have been reported in the past month, taking the total number of infections to 416.
The disease, which attacks children under five years, affects the nervous system and can result in paralysis.
With almost one-third of the total 1,449 cases in the world, India is seen as a big stumbling block in the struggle against polio. <!-- E SF -->
Particularly dismal has been the case of the northern state of Uttar Pradesh where 358 polio cases have been recorded.
Spreading virus
Earlier it was believed that the virus was confined to some pockets of western Uttar Pradesh, but health ministry officials say now it has spread to 41 of the 70 districts in the state.
The neighbouring state of Bihar comes second with 28 infections.
With new cases being reported from the capital, Delhi, and in the western city of Mumbai, experts say the virus has now travelled out of the region and is afflicting children in the whole of northern and western India.
Officials blame it on people moving out of the worst-affected states to other parts of the country.
"It is the migrants who have taken it out of Bihar and Uttar Pradesh. All the cases found in Delhi or Mumbai can be linked to the state as these children had travelled there in the last few months," a spokesman for the health ministry told the BBC.
Experts say the spread of the virus is dependent on three factors - lack of nutrition, environmental causes and poor hygiene and sanitation.
Concerned
They say almost all the cases have been reported from areas where sanitation is an issue and most of the children belong to poor families unable to give them a nutritious diet.
In the developed countries, a child needs three doses for immunisation. But in India, a child may need up to 10 doses, they say.
Officials have confirmed that one child in Delhi has contracted the virus despite being given nine shots of the vaccine.
"We're still in the process of examining how that happened, but she may have had diarrhoea at the time she was given the vaccine. In such a situation, her body will expel the medicine and it will not have the desired affect," says the health ministry spokesman.
Last month, India's health minister held an emergency meeting of officials from the states affected by the disease.
Last year, only 66 cases of polio were recorded in India and officials say the current numbers are giving them sleepless nights.
A huge pulse polio campaign is being launched in November and officials say they hope the virus will be contained soon.
Although polio has no cure, it is easily preventable through vaccine.
Before 1988, when the World Health Organisation (WHO) launched a global anti-polio campaign, there were more than 350,000 cases worldwide.
Today the disease has been eradicated in much of the world but is still found in some countries.
A strain of the disease, which originated in Uttar Pradesh state, has also travelled to the neighbouring countries of Nepal and Bangladesh.
It has also infected people in faraway African countries like Angola, Namibia and Congo.
India's failure to contain the virus has caused serious concern to the World Health Organisation in Geneva. It has written to India's health minister, seeking a meeting with him.
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http://news.bbc.co.uk/2/hi/south_asia/6082970.stm