Polio: Not Going Without A Fight

Bad news. Back in August I wrote a post about how we were on the verge of eradicating the polio virus from the planet. Nigeria had just gone 12 months without a case and the only two countries in the world where there were still cases were Afghanistan and Pakistan. Since then there have been some developments. Nigeria remains free of the wild virus and there have been well over 30 million children vaccinated in Pakistan which will hopefully go a long way to bringing the disease under control there. However, you may have heard in the news that there was an outbreak of polio in Ukraine at the beginning of September, a disappointing occurrence in what is a modern, westernised, if partially war torn country. The picture is actually a little more complicated than the mainstream press has reported, though.

Having read a few news reports I was under the impression that it was wild poliovirus that had infected the two children involved in the outbreak, in actuality it was vaccine derived polio. Allow me to elaborate. The polio vaccine is an attenuated, or weakened, form of the virus. It is not directly capable of causing paralysis. Like the wild version it makes its way to the gut, multiplies and provokes an immune response. During this period virus particles are excreted from the body and can spread to other people, this is actually not a problem as a child that ingests them will benefit from a more mild ‘passive’ immunisation. Problems arise when the virus is allowed to survive in the environment for a prolonged period of time. This gives the virus the opportunity to mutate into a paralysis causing strain again, and if this is combined with being an an area where there is a low uptake of the vaccine then it can lead to a polio outbreak. This is what has happened in Ukraine.

The reporting of the incident feels a little disingenuous as this has also happened in Laos, Guinea, Madagascar and Nigeria so far this year but they didn’t feel the need to report it in those cases. Maybe it’s because it’s closer to home, maybe it’s because it’s not poor brown and black people anymore, maybe it’s because they’re trying to highlight the plight of the people there since Russia effectively invaded Europe almost two years ago now.

Whatever the truth of it, an emergency response is needed to stop the virus gaining a foothold. Vaccination rates have never been especially high in the country and have positively plummeted since 2008 when a child was supposedly killed by the vaccine. The child, in fact, was not killed by the vaccine, but the national press ran with the story and the Government bungled its response and ever since there has been a deep mistrust of vaccinations. 1.8m children are currently at risk due to absent or incomplete vaccination. Regardless of the origin of the outbreak, wild or vaccine-derived virus, the response is the same: multiple rounds of immunisation for every child in the area.

The military situation, a lack of vaccine in the country and general unhelpfulness from the Government has delayed the emergency vaccination program by some weeks making its containment that much more difficult. Let us hope it is not too great a setback on the road to full eradication of poliomyelitis from the planet.

A poliomyelitis virus particle
A poliomyelitis virus particle

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