From the front passenger seat of a small utility truck, Mahmoud Al-Sabr hangs out the window, looking for families and any child under five years old to be vaccinated against polio. As the car he travels in dodges rubble and remnants of buildings that once stood tall in Raqqa city, he flicks the ‘on’ switch for his megaphone.
“From today up to January 20, free and safe vaccine, all children must be vaccinated to be protected from the poliovirus that hit Syria for the second time,” he calls, beckoning families with young children who have recently returned to Raqqa city to come outside of their makeshift homes amongst destroyed buildings, to have their children vaccinated.
In 2017, amidst the protracted conflict and humanitarian crisis in Syria, an outbreak of circulating vaccine-derived poliovirus type 2 (cVDPV2) was detected, threatening an already vulnerable population.
Due to ongoing conflict, Raqqa city, which was once host to half of the governorates population, had been unreached by any vaccination activity or health service since April 2016. During the first phase of the outbreak response, more than 350,000 resident, refugee and displaced children were vaccinated against polio in Syria, but “Raqqa city remained inaccessible,” says Mahmoud.
The Miga Local Government Area of Jigawa says it has purchased 25 cartons of sweets to woo children to participate in the ongoing immunisation programme.
The Information Officer of the council, Abdullahi Yakubu, made this known to newsmen in Dutse on Sunday.
Mr Yakubu said that the sweets would help the council to achieve its target of immunising no fewer than 65,429 children against polio in the ongoing round of the immunisation in the area.
He said that the council had received 72,000 doses of Oral Polio Vaccines, OPVs, to cover the targeted number of children.
In the first two months of 2018, there were 110 deaths in Nigeria from suspected Lassa fever. Outbreak response, led by the Nigerian government and WHO, is focused on detecting every case, and tracing the virus wherever it is hiding.
Bolstering this effort are individuals with experience of guarding against a different disease – polio.
Ms Ireye, who has worked with the Global Polio Eradication Initiative for over ten years, is currently helping to coordinate the Lassa fever outbreak response in Edo State, one of the hardest hit by the outbreak.
“My experiences in polio eradication activities allowed me to immediately swing into action. So, when the [Lassa fever] outbreak was confirmed, I realized the need to use my expertise to serve communities at risk,” she says.
Part of her job is to help coordinate surveillance, specifically ensuring that everyone who has come into contact with someone with Lassa fever is found, and tested for the virus.
The World Health Organization (WHO) reported Friday that three vaccine-derived poliovirus type 2 (cVDPV2) strains were isolated from environmental samples collected on 4 and 11 January 2018, in Banadir province (Mogadishu).
These latest isolates are genetically linked to cVDPV2 strains collected from environmental samples in the same province on 22 October and 2 November 2017.
Since detection of the initial isolates in 2017, two large-scale immunization campaigns (SIA) in line with internationally-agreed guidelines have been implemented, in Banadir, Lower Shabelle and Middle Shabelle provinces.
A third SIA is planned for March 2018, and further response based on evolving epidemiology and ongoing risk assessment is being evaluated. Surveillance for AFP is being strengthened.
Medicine and public health lost a luminary 25 years ago this week with the death of Dr. Albert Sabin. During his life, Sabin became a household name, famous the world over for his development of the oral polio vaccine. He was also a role model for many clinicians and researchers because he refused to patent the vaccine.
I recall a conversation with Sabin at a medical conference in Miami in the early 1960s. My wife and I had come down to the hotel restaurant for breakfast. Sabin, sitting alone having his toast and coffee, motioned us over and invited us to join him. He had something he wanted to talk about that he thought I might find interesting, as we were both involved in work on vaccines. What he described went far beyond interesting.
In those days, children in the United States were immunized much the same way they are now: individually, on a schedule determined by a child’s age. But in Cuba, Sabin told me, they’d done it differently. In a country without reliable refrigeration, it didn’t make sense to try to store perishable vaccine in every hospital and clinic. Instead, the health authorities had decided to vaccinate the entire country in one fell swoop — all of the children in a matter of just a few days. Six months later, they came back and did it again.
Today Sierra Leone officially introduced injectable polio vaccine (or IPV) into its routine immunization programme to maximize protection against polio. IPV is now used in many countries around the world to prevent against the debilitating disease, and will now be available free of cost alongside the oral vaccine at clinics and health facilities across Sierra Leone.
The new vaccine’s introduction is led by the Ministry of Health and Sanitation with support from the WHO Global Polio Eradication Initiative, UNICEF, Gavi the Vaccine Alliance and the vaccine manufacturers.
“The only protection we have, the only way we can be sure of keeping our children safe from polio and the only way we can completely eradicate polio is by ensuring that every child, everywhere, gets their vaccines,” said Alexander Chimbaru, Officer in Charge of the World Health Organization Country Office in Sierra Leone. “Alongside the oral vaccine, IPV will provide children in Sierra Leone with the best possible protection against all polio diseases.”
Since the conception of Nigeria as an independent country it has struggled with a number of deadly viruses and diseases. The most prominent and reoccurring have been polio, Lassa fever and yellow fever.
These three have plagued parts of the country for many years and appear sporadically, peaking and dipping throughout the country's history. Under colonial rule vaccinations were kept for the expatriates and British citizens in the country. The indigenous population was mostly ignored and this allowed the viruses to spread unchecked throughout the country. It wasn't until later in the country's history that measures were taken to slow the spread and commence eradication of the disease.
More than 30 years after the last Irish case of polio was recorded, the health service is treating a new wave of patients struggling with the complications of the disease.
Up to three new patients a month are presenting with post-polio syndrome at Beaumont Hospital, most of them drawn from among the “new Irish” communities.
Consultant neurologist Prof Orla Hardiman says about 70 per cent of the new patients at her post-polio clinic were born outside Ireland.
“The polio epidemic finished in the 1950s, and there were a few people in the 1960s who had polio. But we’re seeing a new wave of people now, a lot of Nigerians, Indians, people from Asia who would have had polio in childhood, are here now and they need some support.”
It’s just after 6am on a Friday morning in Petra, one of Jordan’s ancient southern cities. Ala Baydoun ties her shoe laces with an extra secure knot as she prepares for what is no normal run. It’s the first day of her weekend and Ala will run for 100km to Wadi Rum in an Ultra Marathon, an effort that she’s dedicated to polio eradication.
Taking her position at the starting line, she looks calm and collected, despite the high altitude and the 8 km of hilly terrain immediately ahead of her.
After a grueling 14-hour run, through the desert, Ala crosses the finish line in second place and cuts more than 2 hours off her personal best time.
“I was injured and wasn’t sure I would finish the race, but I beat my time from last race! As runners we are so cautious of seconds, so to say that I cut 2 hours off is a big deal.”
It is one thing to be certain (as Nature is) that widespread immunization is a vital tool for public health. But it is much more contentious, given the diversity of humanity’s ethical and cultural norms, to impose vaccinations on a population. That diversity is reflected, for example, by differing choices among countries in Europe: some (mostly the post-Soviet Union states) make vaccinations for many diseases mandatory, whereas the majority do not.
France is now providing a case study of exactly these debates.
A new French law requires that babies born after 1 January be vaccinated in their early years against 11 diseases. Previously, vaccines against only three of these — diptheria, tetanus and polio — were mandatory. The others were recommended, but the decision was left to parents. Now, children must also be vaccinated against Haemophilus influenzae B, hepatitis B, pertussis, pneumococcal disease, meningitis C, measles, mumps and rubella. Those who haven’t had all their immunizations, including booster shots, the government says, will be refused admission to nurseries, schools and camps in France.