Progress on polio vaccinations, but resistance lingers

Health workers in Nigeria, considered the epicentre of the current wave of polio outbreaks in West Africa, and in neighbouring countries are racing to stop the spread of polio infections.

Incurable, the highly infectious virus causing polio leads to irreversible paralysis in one out of every 200 cases – and up to 10 percent of these persons die when their breathing muscles are frozen – according to World Health Organization (WHO), which considers one case an epidemic.

“We are making progress [vaccinating], notably in [northern Nigeria's] Kano state, but other areas are still patchy,” said Oliver Rosenbauer with WHO’s Polio Eradication Group. “We are improving [the rate of children immunised], but we are not quite there yet.”

Of Nigeria’s 801 reported cases in 2008, more than one-fourth came from Kano state.

Nigeria is one of four endemic countries worldwide where polio infections originate before they are transferred “silently and stealthily across borders,” said Rosenbauer. He said a case diagnosed recently in Indonesia came from Nigeria. “It is not just neighbouring countries that are at risk. This virus travels.”

Spread

As of 7 April, 232 cases have been reported in 2009 worldwide according to WHO.

Nigeria's northern region has reported 123 infections. More than 30 cases have been reported in seven neighbouring countries this year -- Benin, Burkina Faso, Côte d’Ivoire, Ghana, Mali, Niger and Togo, which had been largely polio-free since 2004, with only Niger reporting annual outbreaks before 2008.

But even more African countries are at risk, according to the International Federation of Red Cross and Red Crescent Societies (IFRC), which recently launched a US$2.1-million appeal to vaccinate in Angola, Central African Republic, Democratic Republic of Congo, Ethiopia, Ghana, Kenya, Sudan and Uganda, in addition to the above countries.

Resistance

Four years after Muslim clerics in northern Nigeria issued warnings based on fears that hormones in the vaccine could cause sterility and HIV infection, resistance is no longer the primary reason children miss vaccinations, WHO’s Rosenbauer said. “Only about 10 percent of missed cases are because of resistance."

Rosenbauer told IRIN vaccinators may have poor neighbourhood maps and are unable to locate children, do not find them at home or do not have enough vaccines and ice to keep the doses cool.

I'm not convinced of its safety despite all the noise that it is safe for children

But a 46-year-old father of seven in Kano state, Haruna Maikudi, said he is still not convinced the vaccine is safe. “I still don't allow my children to receive [the] polio vaccine because I'm not convinced of its safety despite all the noise that it is safe for children.” He added that many believe the Kano state government “was arm-twisted into resuming the polio immunisation after it stopped the campaign in 2003.”

Maikudi told IRIN that he and other parents continue to refuse calls to vaccinate. "We are yet to be told what those sex hormones are doing in the [polio] vaccine in the first place. This is why I and many others don't give the vaccine to their children."

The national government declared the vaccine safe in 2004 after independent tests in three countries confirmed its safety, and some northern clerics lifted their opposition.

Umar Bello, a 31-year-old father of three, told IRIN polio is not a priority for him. "Health workers chase us to our homes offering [the] polio vaccine to our children while we are left without inoculation and drugs for more serious and fatal diseases like malaria, measles and meningitis, which we battle with everyday.”

Health workers chase us to our homes offering [the] polio vaccine to our children while we are left without inoculation and drugs for more serious and fatal diseases

He said he recently had difficulty finding anti-malaria medication for his child.

But WHO’s Rosenbauer said radio jingles, posters, door-to-door campaigns and a government commitment to polio vaccinations have helped spread the message about preventing polio.

Twenty percent of the families surveyed in Kano state this time last year reported that their children had been vaccinated against polio, versus 40 percent this year, said Rosenbauer.

“But there is still a ways to go," he added.

Health workers’ goal is to vaccinate 90 percent of all children under five to build up “herd immunity,” or a group’s ability to withstand an epidemic.

As long as one child is infected all children are at risk, according to WHO.

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