Vaccine spreads polio in Pakistan.

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Substandard vaccine giving rise to polio cases

 

 

 

 

 

 

 

By By Amer Malik 9/25/2008

 

 

LAHORE

THE unusual upsurge in polio cases in Punjab is believed to be caused by lower than targeted coverage of children coupled with compromise on the quality of vaccines used during anti-polio campaigns in the province.Medical experts said that there was unusual rise in the number of polio cases in Punjab as the ongoing anti-polio campaign was hit by the low coverage, which was variable between 50 and 70 pc in different districts of the province. “The low coverage of immunisation against polio resulted either due to failure in door-to-door campaign or disturbance in cold chain system, which is vital to preserve the efficacy of the vaccines,†said Prof Dr Tahir Masood, dean of Children’s Hospital, Lahore.Out of total 55 polio cases across the country, at least 12 polio cases have been detected so far in Punjab this year in the districts of Lahore, Faisalabad, Rawalpindi, Okara, Hafizabad, Jhang, Sheikhupura, Nankana Sahib and

Gujranwala.As many as 18 cases were detected in the NWFP, 16 in Sindh, six in Balochistan and three in Islamabad.Total of 55 polio cases included 44 cases of P-I strain and 11 cases of P-III strain of the polio virus.Dr Tahir Masood said the polio cases had risen dramatically as Pakistan was still in the process of polio eradication. So the rise in polio cases is not totally unexpected, he said. He said that there were certain reasons including low coverage of immunisation against polio among children below five years of age. He said polio virus had three strains i.e. P-I, P-II and P-III. He said P-II strain had already been wiped out and P-III was on the verge of eradication. However, he said there was real threat of spread of P-I strain of polio virus, which was more dangerous in nature as disability caused by such type of strain was likely to persist throughout one’s whole life.He said it was extremely important to

maintain cold chain as polio vaccine was quite susceptible to light and heat. Thus, he said, it must be ensured that polio vaccines were properly preserved in the EPI stores or ice-boxes carried door-to-door by the vaccinators.He said polio virus was transmissible among other children through fecal-oral route, which contaminated the environment and contracted by the other children. He said people must adopt prevention measures including completion of vaccine course and maintaining environmental hygiene by avoiding contaminated water and adulterated food in order to save their children from the virus. “Although, adults can also be affected by the polio virus but they are less likely to contract polio due to their stronger immunity against the disease,†he added.When asked about any compromise on the quality of vaccines, he said the Global Alliance for Vaccines Initiative (GAVI) was providing and monitoring the supply of vaccines in

the country.In order to effectively control the spread of polio virus, he said that there was dire need to make the Expanded Programme on Immunisation (EPI) effective at all tertiary care, DHQ/THQ hospitals, BHUs and RHCs across the province. “We must have to regularly immunise each and every child below five years of age through the EPI coverage or the National Immunisation Days (NIDs) to achieve over 80 per cent coverage in order to effectively control the spread of disease among children in the province,†he added.Children’s Hospital Medical Director Dr Ahsan Waheed Rathore identified another factor of import of polio virus to Punjab from neighbouring Afghanistan as well as most affected provinces of Sindh and NWFP. However, he emphasised to fully immunise all children including 500,000 newborns against polio every year. Sources in EPI Cell of the Directorate General of Health Services, Punjab, said the quality of vaccines was

compromised after a top-level administrative shake-up in the National Programme of Polio Eradication, as the new administration brought shift in its policy with stopped procurement of vaccines through UNICEF (duly registered with the World Health Organisation) and instead started procuring cheap vaccines against P-III strain of the polio virus from India. “The WHO and UNICEF have also conveyed their reservations against the quality of the vaccines procured from India through local companies,†a senior official at DGHS, Punjab, said on the condition of anonymity.However, he said that vaccine against P-I strain of polio, imported from France with quality assurance under the supervision of UNICEF and WHO, was being administered to the children in Punjab. He feared that the quality of vaccine against P-I strain might also be compromised as soon as the stocks were exhausted, adding that it would be disastrous if the quality of P-I vaccine was

compromised because a child affected with P-I virus had the capacity to affect 312 children around.He said the WHO, in its performance audit report of the national polio eradication campaign, had observed, “During 2008, there has been a resurgence of cases of wild polio virus largely due to the significant change in the national staff, deterioration of security situation in NWFP/FATA and extensive movement of the population from these areas, unsatisfactory performance of campaigns in some of the known areas of transmission and persistently low coverage with routine immunisation.â€

“There is an unpleasant whiff of arrogance in the whole (vaccine-autism) debate,†Horton says. “Can the public not be trusted with a controversial hypothesis? The view that the public cannot interpret uncertainty indicates an old-fashioned paternalism at work. The public is entitled to know as much as possible.â€

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