By Azoma Chikwe
Disease eradication is not hinged on time or ego, but on the goal of ending the occurrence of that disease in a country or the globe. Nigeria had successfully eradicated small pox and guinea-worm, while polio is the next on the line. The country has started the countdown to 2019, when the World Health Organisation(WHO) will give her a polio-free status. The polio-free certification which would have come this year, was punctured by cases identified at Internally Displaced Peoples(IDPs) camp in the North-Eastern region of the country in 2016, which extended the country’s window period to 2019.
Today, polio has been eradicated in all but two countries – Pakistan and Afghanistan. If polio is completely eradicated, it will be the fourth disease to be beaten in this way, after smallpox, guinea worm and rinderpest. The World Health Organization (WHO) had hoped to achieve global eradication of polio by 2018.
With the two cases found in North-East of Nigeria, the countries window period was extended from the day those two cases were detected in August 20i6 for another compulsory three years of window period which means Nigeria’s zero polio case status certification will now be in 2019 if no more incidences of polio is recorded.
Asked if the measure was not harsh on Nigeria, Consultant Physician/Cardiologist and Chairman, Polio plus Committee, Rotary International, Dr Tunji Funsho, said the race is not against time, but against polio. “The race is not against time, but against polio.If the WHO certifies Nigeria polio-free , and two months later we find polio in Nigeria, that will not be the idea. We want every child in Nigeria to be polio-free, that is the goal. No matter how long it will take us to eradicate polio in Nigeria, we will be patient. It is not a thing of ego but that Nigeria is actually polio-free.
“The two cases in the North-East, did not discourage us, rather it was a call for action. The government, Rotary and all the partners will concentrate efforts in that region and ensure that every child in Nigeria is free from polio. The vaccines will be available, immunisation taken to the Internally Displaced Persons camps(IDPs) to ensure every child in the region receives immunisation. “
Dr Matshidiso Moeti, Regional Director, World Health Organisation AFRO, commended the Federal Government for its prompt response and declaration of Public Health Emergency in Borno over the polio outbreak. Moeti noted the openness of the government in the overall handling of the process that led to the discovery of the two cases. She commended President Muhammadu Buhari for his directive to the relevant government agency to release money budgeted for vaccines. Moeti said that the government’s posture was a great motivation for WHO and other polio eradication partners to support the country.
She reiterated the commitment of WHO and other partners to work with Nigeria to address the problem of polio resurgence in Nigeria. “With concerted effort, Nigeria will soon attain the zero po;io case status,” she said.
Polio, also known as poliomyelitis and infantile paralysis, is a highly contagious viral infection that can lead to paralysis, breathing problems, or even death. It can be classified as either symptomatic or asymptomatic (with or without symptoms). About 95 percent of all cases are asymptomatic, and between 4-8 percent of cases are symptomatic.
It is caused by the poliovirus, the vast majority of polio infections present no symptoms. Pregnant women are more susceptible to polio, around half of people who have had the disease go on to develop post-polio syndrome.
Humans have observed the effects of polio for hundreds, if not thousands, of years. The relatively recent history of outbreaks in both the United States (U.S.) and Europe has led to an allocation of resources with which to fight the disease.Throughout history, polio epidemics have led to the deaths of many thousands of people around the world. In 1916, for example, over 6,000 people died of polio in the United States(US)..
However, it wasn’t until 1953 that Jonas Salk developed the first polio vaccine, which has led to the widespread prevention of poliomyelitis. Although polio has essentially been eradicated in the U.S. since 1979, and in the Western Hemisphere since 1991, children and adults in Afghanistan and Pakistan are still battling the disease.
Polio, in its most debilitating forms can cause paralysis and death. However, most people with polio don’t display any symptoms or become noticeably sick. When symptoms do appear, they differ depending on the type of polio. Symptomatic polio can be broken down further into a mild form, called non-paralytic or abortive polio, and a severe form called paralytic polio (occurring in around 1 percent of cases).
Many people with non-paralytic polio make a full recovery. Unfortunately, those with paralytic polio generally develop permanent paralysis. Non-paralytic polio, also called abortive poliomyelitis, leads to flu-like symptoms that last for a few days or weeks. These include: fever, sore throat, headache, vomiting, fatigue, back and neck pain, arm and leg stiffness, muscle tenderness and spasms, meningitis – an infection of the membranes surrounding the brain.
Paralytic polio affects only a small percentage of those invaded by the polio virus. In these cases, the virus enters motor neurons where it replicates and destroys the cells. These cells are in the spinal cord, brain stem, or motor cortex, which is an area of the brain important in controlling movements.
Symptoms of paralytic polio often start in a similar way to non-paralytic polio, but later progress to more serious symptoms such as: a loss of muscle reflexes, severe muscle pain and spasms, loose or floppy limbs that are often worse on one side of the body.
Polio is often recognised because of symptoms, such as neck and back stiffness, abnormal reflexes, and trouble with swallowing and breathing. A doctor who suspects polio will perform laboratory tests that check for poliovirus by examining throat secretions, stool samples, or cerebrospinal fluid.
There are two vaccines available to fight polio: inactivated poliovirus (IPV), oral polio vaccine (OPV).IPV consists of a series of injections that start 2 months after birth and continue until the child is 4-6 years old. This version of the vaccine is provided to most children. The vaccine is made from inactive poliovirus. It is very safe and effective and cannot cause polio.
OPV is created from a weakened form of poliovirus; this version is the vaccine of choice in many countries because it is low cost, easy to administer, and gives an excellent level of immunity. However, in very rare cases, OPV has been known to revert to a dangerous form of poliovirus, which is able to cause paralysis.
Polio vaccinations, or boosters, are highly recommended for anyone who is not vaccinated or is unsure whether they are. Because there is no cure for polio once a person develops the virus, treatments are focused on increasing comfort, managing symptoms, and preventing complications. This can include bed rest, antibiotics for additional infections, painkillers, ventilators to help breathing, physiotherapy, moderate exercise, and a proper diet.
Historically, a person who developed lung paralysis due to polio was placed into an iron lung, a device that would push and pull chest muscles to make them work. However, more modern portable ventilators and jacket-type ventilators are now used instead.
The polio virus usually enters the environment in the faeces of someone who is infected. In areas with poor sanitation, the virus easily spreads from faeces into the water supply, or, by touch, into food. In addition, because polio is so contagious, direct contact with a person infected with the virus can cause polio.
Individuals who carry the poliovirus can spread it via their feces for weeks, even if they have shown no symptoms themselves. Once the virus has entered an individual, it infects the cells of the throat and intestine. The virus stays within the intestines, before spreading to other areas of the body. Eventually, the virus moves into the bloodstream where it can spread to the entire body.
As is the case with many other infectious diseases, people who get polio tend to be some of the most vulnerable members of the population. This includes the very young, pregnant women, and those with immune systems that are substantially weakened by other medical conditions.
Anyone who has not been immunised against polio is especially susceptible to contracting the infection. Additional risk factors for polio include traveling to places where polio is endemic or widespread, especially Pakistan and Afghanistan, living with someone infected with polio, having a weak immune system, pregnant women are more susceptible to polio, but it does not appear to affect the unborn child, working in a laboratory where live poliovirus is kept.
Post-polio syndrome describes a cluster of symptoms that affect up to 64 percent of all polio patients. It occurs several years after polio has passed. On average, post-polio syndrome occurs 35 years after the infection. Signs and symptoms include: muscle and joint pain and weakness that slowly progresses, muscle atrophy (shrinking),exhaustion for no reason, swallowing and breathing difficulties,suffering in colder temperatures,sleep-related problems such as apnea (stopping breathing), concentration and memory difficulties, mood swings and depression.Post-polio syndrome is a slow, progressive disease. There is no cure, but it is not infectious or contagious.
“We have another body set up by the government, The Traditional Leaders Council for Polio which is headed by the Sultan of Sokoto. Members of the Presidential Task Force meets with them every quarter but in between those periods of time, if we find some challenges in the field, depending what the cause of the challenges are, if it is some traditional belief, we talk to traditional leadership, if it is religious belief, we look for the religious sect. UNICEF has assisted us to map out all the Islamic religious sects in the north and who their leaders are, all the Christian religious sects and who their leaders are. In every locality, we know who they are. So, if we go somewhere and we meet resistance, we find out from the local people to which group does this person belong and they tell us, we approach their leaders and talk to them, persuade them. So we have gone as far as knowing who these people are and we meet with them on a regular basis.”
On the need for regular immunisation, Dr Funsho said, “One of the major reasons is that a new child is born every day, there is still polio in the world, the world as we know is a global village, polio can come back into your borders. So, every child needs to be immunised until the last case of polio is seen and three years after that last case is seen, the world will be certified free of polio. We know that the virus is no more anywhere. See what happened in Sierra three years ago, they had not seen a case of polio for 17 years but fighters from Pakistan who went to Sierra Leone carrying the polio virus in their stool contaminated their water and we had polio epidemic in Sierra Leone. Because their structure has broken down for routine immunisation most of their children were not immunised. So, we only need just one person to introduce the virus and we have an epidemic. So, every child needs to continue to be immunised, this is the only way to ensure that we are protected until polio is finally eradicated from every nooks and crannies of the world, then we don’t have any risk of importation. After that whether a child is immunised or not, the virus is no more anywhere to give any infection but as long as the virus is still in the environment anywhere, no matter how far, there is still risk for a child who is born and not covered by vaccine to be infected and to contract polio,” he said.
Tackling last cases
However, tackling the last 1 per cent of polio cases has still proved to be difficult. Conflict, political instability, hard-to-reach populations, and poor infrastructure continue to pose challenges to eradicating the disease. Each country offers a unique set of challenges which require local solutions. Thus, in 2013 the Global Polio Eradication Initiative launched its most comprehensive and ambitious plan for completely eradicating polio. It is an all-encompassing strategic plan that clearly outlines measures for eliminating polio in its last strongholds and for maintaining a polio-free world.