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Failed vaccine campaigns may lead to polio resurgence, experts warn

BMJ 2006; 333 doi: (Published 19 October 2006) Cite this as: BMJ 2006;333:823
  1. John Zaracostas
  1. Geneva

    Experts have said that the failure by the four remaining countries where polio is endemic to wipe out the disease could cause a resurgence of more than 250 000 cases a year. Polio remains endemic in Nigeria, India, Pakistan, and Afghanistan.

    Embedded Image

    Saudi Arabia has issued tight polio immunisation requirements for pilgrims at the Great Mosque, Mecca

    Credit: AMR NABIL/AP

    “It would be a humanitarian catastrophe not to complete polio eradication now that we are so close… to the finish line,” said Robert Scott, chairman of Rotary International's “Polio-Plus” committee.

    “Polio eradication hinges on vaccine supply, community acceptance, funding, and political will. The first three are in place. The last will make the difference,” he said.

    However, to prevent the international spread of polio the experts have also recommended that future World Health Organization travel documents concerning personal protection for travellers stress the importance of immunisation of people going to areas with polio, said David Heymann, WHO's special envoy for polio eradication.

    Countries without polio have been taking measures to protect themselves from importation of the virus. Saudi Arabia has enforced stringent polio immunisation requirements for the upcoming pilgrimage to Mecca.

    From 1 January to 10 October 2006 the number of confirmed polio cases worldwide stood at 1403 (the number for the same period in 2005 was 1349), of which 888 were in Nigeria (up from 489 in the same period last year), 360 in India (37 last year), 24 in Pakistan (18 last year), and 28 in Afghanistan (four last year).

    In 2005 the total number of polio cases was 1973, considerably less than the 350 000 cases a year in the 1980s.

    The global eradication initiative was launched in 1988 and spearheaded by WHO, Unicef, the US Centers for Disease Control and Prevention, Rotary International, and national governments. However, the initiative failed to meet the target date of the end of 2005 for eradicating the virus.

    In late 2003 religious and community leaders in the mostly Muslim state of Kano, in northern Nigeria, spread unfounded rumours that polio immunisation was an attempt to sterilise women, bringing the immunisation campaign there to a halt until the second half of 2004.

    This pause was largely responsible for 25 countries becoming reinfected in Africa, Asia, and the Middle East through importations of the virus.

    Peter Ndumbe, director of the centre for the study and control of communicable diseases at the University of Yaoundé, Cameroon, said that between 2003 and 2006 “almost 1500 children became paralysed for life” in these 25 reinfected countries.

    Moreover, the cost of running emergency response activities was estimated at $450m (£245m; €360m), said Dr Ndumbe. He also cautioned, “We've been very concerned at the further international spread of polio. The risk of importation is higher than ever.”

    Dr Cochi, who is also acting director of the national immunisation programme at the US Centers for Disease Control, said that “the political leaders in the remaining few districts and states where polio continues cannot be allowed to shirk their responsibilities.”

    The quality of the polio campaigns in northern Nigeria is not considered good enough. It is thought that as many as half of children in some infected areas there have never been immunised, the committee notes.

    Also, immunisation campaigns are not reaching all children in Pakistan and Afghanistan (where coverage ranges from 75% to 90%) and in parts of India, such as Uttar Pradesh and Bihar, where polio is endemic.

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