Dr Tunji Funsho is the Chairman of Nigeria National PolioPlus Committee. Funsho recently addressed some journalists on the spread of polio, the Oral Polio Vaccine and other health issues. CHIOMA UMEHA (Health Editor) has the details. Excerpts:
How does the polio virus spread?
Polio is an infectious disease caused by a virus. It leads to permanent paralysis (usually in the legs) and can cause death as well. The polio virus is silent. This means that polio can be widespread in a community before it manifests itself as a case of paralysis and can be fatal if it paralyzes the muscles used for breathing. Polio mainly affects children under five years of age.
The polio virus spreads through the faecal-oral route (from excreta to hand and to the mouth). Usually this is a result of poor hand washing or by eating/drinking contaminated food or water. Those infected with the virus can excrete the virus in their stool for several weeks and are likely to infect others with the virus due to poor hygiene and sanitation. Individuals are most contagious (likely to pass on the virus to others) immediately before the onset of symptoms and soon after they appear.
Outline treatment for the disease
There is no treatment for polio because the nerve damage is permanent but the polio vaccine has proven to be very effective in giving children lifelong protection from the virus. Physical therapy and braces can help paralysed children to regain some function, but nerve damage is permanent.
How many doses of OPV does a child need before they are protected from polio infection?
The Oral Polio Vaccine (OPV) needs to be administered several times to be fully effective. Every child under the age of five years needs to receive the vaccine during each round. The number of doses a child needs to receive in order to be fully protected against polio depends entirely on the child’s health and nutritional status, as well as the number of other viruses that the child has been exposed to. No child is safe if there is one child under the age of five years who is under immunized. This is why every child must be immunized during every immunization campaign against polio. Every missed child is a place for the poliovirus to hide and spread even if that child does not get sick with polio. For as long as the polio virus is in Nigeria every child needs to take the vaccine every round.
Is it safe to administer so many doses of OPV to children?
Yes, it is safe and it is very important to administer multiple doses of polio vaccine to children. The vaccine requires multiple administrations to ensure full protection. In the tropical climate where the weather is hot and sanitation system is poor, several doses of polio vaccine are required for a child to be fully protected – sometimes more than ten. This vaccine is safe for all children. Each additional dose further strengthens a child’s immunity level against polio and ensures that the child does not act as a carrier of the virus.
Why do some children with multiple doses of Oral Polio Vaccine still come down with polio?
A child’s ability to convert the Oral Polio Vaccine into immunity depends upon his or her living circumstances. In temperate climates or industrialized countries with excellent sanitation and health systems, it takes at least three doses of the polio vaccine for a child to reach immunity level and ensure safety from the polio virus. In tropical environments or in the developing countries like Nigeria where some children may be malnourished, sanitation systems are inadequate and immunity levels low, it can often take more than ten doses of the vaccine to reach the same level of immunity. Most of the children who still come down with polio are under-immunized, meaning they received fewer than the number of doses thought necessary to protect children in their circumstances from the virus.
Up to four or five out of every 100 children fail to develop required immunity after multiple doses and can still come down with polio. If these children live in communities where vaccination coverage is low, they have a high risk of exposure and infection. As the number of children repeatedly missed during immunization campaigns goes down, the children at risk are those who have not reached their immunity level. The only way to ensure that no child comes down with polio is to ensure that each and every child is immunised every round.
Assess the polio vaccine programme in the country?
Yes. The estimated annual number of polio cases in the country in the mid-1980s was 20,000-30,000. Extensive use of the polio vaccine during campaigns, particularly in the last 10 years, has led to a 99.9 per cent decrease in the number of cases. This shows that the vaccine is very effective.
Why is polio vaccination free?
Polio is cheaper to prevent than to cure. It is cheaper for you to prevent paralysis than to try and cure it. A lot of tax-payers money is used to buy the vaccines we use. All vaccines against diseases such as measles, tuberculosis, hepatitis and polio are free because it is cheaper to give the vaccines than to try and cure the diseases when they happen, this is apart from other health and economic implications. When our children do not take the vaccine, then they fall sick: we absent from work, pay for transport to go to the clinic, pay for card to see the doctor, pay for medicines, and other services; whereas the illness could have been prevented by a drug that is brought free to your house or available in a clinic that is near your house. There is a difference between community and public health work and community health work. Community health work is done at community level, targeting diseases that spread, and vaccines are free at point of delivery. Public health service is obtained in hospitals, but it may not be free.
Is there any link between the polio vaccination (programme) and family planning?
No. The oral polio vaccine (OPV) being used in Nigeria is the same being used in rest of the world to stop polio transmission. The vaccine does not cause infertility and has no side effects. The census figures shows that Nigeria’s population has been growing even faster than that of any other country in this region in spite of the fact that the polio eradication programme and other immunizations against childhood diseases has been going on for quite some time. If you ask people who took the vaccine during childhood, they will tell you they are productive. Also, the census figures show that fertility is high in Nigeria compared to other countries.
The polio programme and other immunizations against childhood diseases have been going on for long in the country. If you ask people who took the vaccine while they were children, they will tell you that it does not cause fertility problems.
When will the government stop giving children OPV?
We will stop giving OPV when every child is protected from the threat of becoming paralyzed by polio. This is why we must give many rounds of OPV to ensure all children are reached with enough doses that will protect them throughout their lifetime. Also, once we stop seeing any children that are paralyzed by polio in Nigeria, then we know we have succeeded in finishing polio the way our parents and grandparents finished small pox. Then we shall stop vaccinations against polio the way we have stopped vaccinations against small pox.
Why is the OPV given only to children under the age of five years?
Children under the age of five years are the most likely to get polio; once they are given the vaccine, it protects them from the disease. All vaccines are given to children while they are still under five years old.
That is why the polio programme is door to door to make sure that every child can be reached with the vaccine and no child is missed. If too many children are missed during campaigns, the virus will continue to circulate in these children putting all others at risk. Going house to house is essential to ensure reduction in the number of children who may be missed.
Can polio vaccination substitute routine immunizations for children?
Yes, polio campaigns are supplementary and not a substitute for routine immunization. All children should receive all the doses outlined in the routine immunization schedule which protects against seven diseases, in addition to polio.
Polio is not the most pressing health needs at the moment. Why is it top priority for the government?
People have priorities depending on their situation. For some people, their need may be good drinking water, for others, it may be electricity or good roads. However, if possible, everyone will like to have these three amenities that I have mentioned. Some people have the three amenities; others have two, while some have only one. As with all things in life, we have to assess all our challenges, rank them from the easiest to the most difficult, and then confront the one that we can tackle easily first; gradually as we finish the easy ones, then we take on the most difficult tasks with time. As people understand that polio is preventable, they have started also appreciating that it is a public health issue. Until they understand that polio kills children and paralyzes others, people will still feel it is better to have a road than to protect a child from dying or becoming paralyzed. Both are issues are important but the polio issue is more important than the others because the health and other implications affect everyone. Government is interested to completely eradicate polio because; we are at a stage where it is relatively easy to eradicate the disease; just like we collaborated with other countries to eradicate small pox.
Attention is being given to all diseases but it is particularly important to emphasize polio for the following reasons: Polio is one of only a few communicable diseases which can be completely eradicated because humans are the only host (as was the case with smallpox). It also has a safe and effective vaccine which is not the case with most diseases. The virus does not survive for extended periods of time in the environment, and while it is contagious, its infection period is relatively short. Global evidence suggests that through repeated immunization campaigns with the polio vaccine, polio can be completely eliminated. The fact that polio remains endemic in only three countries of the world, demonstrates the effectiveness of this strategy. In addition, efforts to eradicate polio can and should lay the groundwork to address other important health and social issues in Nigeria. Polio eradication activities are helping to strengthen routine health services.
It kills and causes permanent paralysis in our children. By paralyzing them it reduces their ability to help themselves, it causes them avoidable hardship and reduces their ability to contribute effectively in our communities compared to if they were not paralyzed.
The whole world has almost eradicated polio just like small pox; Only Nigeria and two other countries, are left; therefore if we redouble our efforts, we can also eliminate polio and redirect the money and efforts to eradicate other diseases such as Measles which is also important and we also give vaccine against it. You will agree that because of vaccines, Measles cases are reducing in our communities but for us to also completely banish Measles; we have to eradicate polio and then address other disease such as malaria, meningitis, pneumonia, and diarrhoea.
Other important diseases that we are fighting with free drugs include leprosy, river blindness, and guinea worm (which have almost been eradicated). We also provide free bed nets against malaria, free routine immunization vaccines and free drugs for people with HIV/AIDS.
Does a new-born baby need polio vaccination?
Yes, a new-born needs protection against polio because the vaccine should get to the child before the germ that causes the disease gets to the child; the earlier the child gets the vaccine, the better since the polio germ is everywhere in the environment. All children without immunization are at risk, including new-borns.
Sometimes children over five years are vaccinated. Why?
The polio vaccine is for children under five years of age. Some parents are not very sure about the exact age of their child. It is better to vaccinate in case there is doubt that the child may be under five years of age. Vaccinating a child who is more than five years old does not affect the child but if the child is not given the dose for fear that he is more than five years, he may get the disease if he had not been fully immunized and fully protected.
There are controversies surrounding polio vaccination. Some claim that the vaccination has health dangers. Is the vaccine safe?
The polio vaccine is the safest and most effective way to protect children from polio. Given multiple times, the polio vaccine is safe and effective in providing protection against polio, and is the recommended vaccine for the global eradication of polio. The polio vaccine has been administered to more than two billion children across 125 countries around the world as part of the eradication programme.
Since the launch of the polio vaccine programme in 1988, the number of polio cases has been reduced by 99 per cent globally, and has saved at least five million children from total paralysis and permanent disability. Children sick with another illness must still be given the polio vaccine as there is no harmful effect. OPV is safe and it is very important to administer multiple doses of polio vaccine to children.
The vaccine is designed to be administered multiple times to ensure full protection. In the tropics where the weather is hot and sanitation systems are poor, several doses of polio vaccine are required for a child to be fully protected – sometimes more than ten. This vaccine is safe for all children. Each additional dose further strengthens a child’s immunity level against polio.
You can be sure of the vaccine because when you look round, there are respectable people in the society like the Sultan of Sokoto, the Emir of Kano, Aliko Dangote, our religious leaders and others who have vaccinated their children and grand-children with the oral polio vaccine in public. If the vaccine were not safe, they will not give it to their loved ones.
Is the polio vaccine safe for sick children?
Yes. The Oral Polio Vaccine (OPV) is the safest and most effective way to protect children from polio. Even when given many times, the polio vaccine is safe and effective in providing protection against polio, and is the recommended vaccine for the global eradication of polio. Children sick with another illness can still be given the polio vaccine as there is no harmful effect.
Are there any harmful additives in the polio vaccine used in Nigeria? Is the vaccine tested in the country before being used?
No, the polio vaccine used in Nigeria is purchased from facilities that have been carefully evaluated by WHO. All vaccines, including the polio vaccines, which are procured by UN agencies, must meet rigorous quality-control specifications, which govern the exact contents used in the production of the polio vaccine and ensure the purity of the vaccine. This ensures that the polio vaccine cannot contain any harmful additives.
All batches of vaccine are tested for quality before use. The polio vaccine loses potency if exposed to heat for prolonged periods of time. For that reason each vial has a vaccine vial monitor (VVM), a heat sensitive label, which indicates if the vaccine has been exposed to heat. All personnel working in the polio eradication campaign are trained to examine the monitor and discard any vaccine that might be weakened from exposure to heat. All polio vaccines supplied by UNICEF include the vaccine vial monitor since 1997.
Are other Muslim countries using the same polio vaccine?
The Oral Polio Vaccine (OPV) used in Nigeria is exactly the same as that being used in other countries of the world for polio eradication efforts. The Governments of Saudi Arabia, Indonesia, Egypt and Yemen are using the same vaccine that are being used in Nigeria. All of these countries have successfully contained the spread of the virus. For instance, Saudi Arabia has celebrated 10 years with no polio cases.
This story was published in Newswatch Times on August 22, 2013.