Polio: Why is it a Health Emergency in 2014?

Poliomyelitis or polio is a highly infectious viral disease which affects young children (see World Health Organization in-depth definition). Dating back from prehistoric era, evidence such as Egyptian stele had proven its existence. Polio has major epidemic recorded in the 1880’s in Europe. By 1940’s and 1950’s, it killed over half a million people around the globe every year. The polio virus, though not eradicated fully, has been minimised as vaccines have been discovered. After that, the world’s most feared disease has finally been halted.

More than five decades after the polio vaccine was first tested and after three decades of massive campaigning against the virus, the word polio seemed ancient among developing countries, but why is the modern world now still in fear of polio?

Polio: Worldwide Emergency

In May of this year, the World Health Organization declared the polio virus spread as an international public health emergency. This, as feared, will continue to grow in the next few months and put decades of effort to eliminate the disease that cripples many lives, to nothing.

The outbreak has been noted by WHO across 10 countries in the Middle East, Africa and Asia. This emergency has called for an international coordinated response.

“The international spread of polio to date in 2014 constitutes an extraordinary event and a public health risk to other states for which a co-ordinated international response is essential,” WHO assistant director general Bruce Aylward told the press during the announcement.

The counties which currently experience the epidemic are listed below:

  • Wild Polio virus infected the state; poliovirus is spreading beyond its borders.
    1. Syria
    2. Pakistan
    3. Cameroon
  • Wild Polio virus infected the state but not currently exporting
    1. Israel
    2. Iraq
    3. Afghanistan
    4. Nigeria
    5. Ethiopia
    6. Somalia
    7. Equatorial Guinea

polio-mapVisualization by CBC/Radio Canada

The first three countries have been identified to have allowed the virus to spread beyond its borders. WHO recommended that these three governments require its citizens to obtain a certificate proving that they have been injected with the polio vaccine before they get to travel abroad or cross their country’s borders.

Dr. Bruce Aylward, lead of WHO’s program on polio efforts quipped during the press briefing, “Until it is eradicated, polio will continue to spread internationally, find and paralyze susceptible kids”.

polio wsjVisualisation by Wall Street Journal

Syria, Iraq and Somalia are countries that previously were polio free. Given that these countries are now under unrest, the eradication effort of the concerned agencies has turned complicated. The polio virus spread has happened in a season wherein there should be traditionally low polio spread which added more concerns from experts.

Syria, where civil war has ignited, has posed further health threats due to refugees fleeing the country. While Pakistan vaccination teams face more ill fate since militants are accusing them of spying for the US government. As of this moment, dozens have already been killed in the country in the past two years. Pakistan, labelled as the “tap” of the wild polio virus, may ignite worldwide polio transmission once the virus spread is not curtailed.

When the Virus has been Curtailed

Since 1988, more than 2.5 billion children has been immunised worldwide. This immunisation campaign has reduced the polio cases by 99%.

As of 1994, the United States has been polio free, and in 2002 Europe was declared free of the virus. Australia and other Western Pacific Region has been declared polio virus free in year 2000. By March 27, 2014 the South East Asia Region has been declared polio free. India too has finished the feat that marked history since the country has one of the highest polio rates even in modern times.

How a Polio Virus is Spread

How is a Polio virus spread? There are many possible ways that the polio virus is spread. One can catch it if:

  1. A person next to you who has polio virus coughs (spreading the virus through saliva).
  2. A person who has the virus gets saliva in his or her hand and touches someone.
  3. Virus infected stool has been exposed to food sources, fecal-oral contact.
  4. Virus may spread from water source contamination.

(You may further read National Geographic’s interview with Walter A. Orenstein, associate director of the Emory Vaccine Centre at the Emory University School of Medicine in Atlanta, Georgia, and former director of the Centres for Disease Control and Prevention’s national immunization program, in this link for Polio history and possible spread threat.)

The fast spread of the virus has rung the WHO’s alarm, the second time that a health emergency has been sounded. First of which was for the H1N1 influenza pandemic back in 2011. Due to international travel, the WPV has risen, striking young children although adult travellers are mainly contributing to the virus spread.

Polio Vaccine

After years of dormancy, the polio virus has made its comeback in an epidemic state in the above-mentioned countries. The spread has been threatening bordering countries as well as countries travelled to by people who came from infected areas. WHO’s answer to this is a massive vaccination campaign.

Polio vaccine since it has been discovered has started the dwindling of polio cases worldwide until some continents has been declared polio free in the past and current decade. A feat has been achieved when India, being the second country to have the highest population and harnessing the highest polio cases in the past years, has been declared polio free due to the vaccine efforts of its government.

Pakistan, now considered the tap of the wild polio virus, has been facing another challenge, aside from the epidemic itself. The Taliban has been blocking all Polio vaccinations in Pakistan as of the moment, some even ending in violence as polio vaccine workers were being gunned down. The fake polio vaccine ploy set up by CIA in the past to hunt for Bin Laden now has been keeping a part of the country unimmunised from the crippling virus. The vaccine ban has been put on the North Waziristan, in the tribal belt where 161, 000 children remains to be exposed to the threat of the virus.

NGO World Vision nurse provides polio vaccination given by the World Health Organization to displaced children in the UNAMID base in Khor Abeche, South Darfur.
NGO World Vision nurse provides polio vaccination given by the World Health Organization to displaced children in the UNAMID base in Khor Abeche, South Darfur.

photo via United Nations Flickr

The health workers ban in the area in 2012 (spans until now), nicknamed by New York Times as the “largest reservoir of the disease”, has been a blow to the efforts of the WHO and other agencies.

Some parents though who are well aware of the condition that the  polio virus may bring, has taken some risks to protect children in tribal belt.

Umar Daraz Wazir, a journalist covering the region said “Many people are ready to vaccinate their children but they have no access to hospitals and can’t travel far. Without a door-to-door campaign it is very difficult to stop this virus.”

The country’s health ministry though has held immunisation posts in every international airport of the country as well as in every travel hubs. Young people though in Afghanistan have started a grassroots vaccination campaign to stop polio from spreading further.

There are two main types of vaccine in the present that is mainly used to protect against polio.

  • Inactivated Polio Vaccine (IPV).

Also known as the Salk Vaccine, it has been developed by Dr. Jonas Salk. It consists of inactivated or killed polio virus strains of all the three polio virus types. IP is injected intramuscularly and has always been administered by trained health worker. This one is used in the US since year 2000 and has replaced OPV in Australia in 2005. The IPV produces antibodies in the blood and prevents the spread of virus to the central nervous system and protect against paralysis. IPV is said to be five times more expensive than the oral polio vaccine.

The setback though has been in the IPV’s triggering of the low immunity of the intestine wherein once a person is infected with the WPV, the virus multiplies in the intestine (though not affecting the person) and will be shed in the faeces which will risk the continued circulation of the virus.

  • Oral Polio Vaccine (OPV)

OPV has been called the Sabin vaccine as it was developed by Albert Sabine in 1961. OPV consists of the live and weakened polio virus strains in poliovirus types. The vaccine produces antibodies and helps prevent the virus spread to the nervous system. It also limits the WPV replication in the intestine preventing person to person spread of the virus. It is administered orally and won’t require specific health trainings. The OPV is literally inexpensive compared to IPV. It’s setback though (although the statistics says its approximately 1 in every 2.7 million first dose of the vaccine), is it can cause paralysis triggered by immune deficiency.

Vaccines need to be travelled in cold temperature to retain its effectiveness.

In depth data and information for the vaccines can be found in the Global Polio Eradication Initiative website.

Note: The world is fighting this epidemic now but it doesn’t mean that help will only be extended to these few people. The UNICEF Australia is running a gift support campaign. You can buy a UNICEF inspired gifts today or donate $35 for the vaccine and save 200 children against polio.

OR you can go visit the website UNICEF Australia for more information.

featured image via Gates Foundation Flickr


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