Wednesday, 21 August 2013

There is no treatment for polio, says Dr. Tunji Funsho

Dr Tunji Funsho

Dr. Tunji Funsho is the Chairman of Nigeria National PolioPlus
Committee. He speaks on the spread of polio, the Oral Polio Vaccine
and other health issues

1. Q: What exactly is polio?

A: 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.

2. Q: How does the polio virus spread?

A: 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

3. Q: Can polio be treated?

A: 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.

4. Q: Is the polio vaccine safe for children, including sick ones?

A: 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.

5. Q: Are other Muslim countries using the same polio vaccine?

A: The Oral Polio Vaccine (OPV) used in Nigeria is exactly the same as
that being used in all other countries of the world for polio
eradication efforts. The Governments of Saudi Arabia, Indonesia, Egypt
and Yemen are all using the same vaccine as that 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.

6. Q: How many doses of OPV does a child need before they are
protected from polio infection?

A: The Oral Polio Vaccine (OPV) needs to be administered several times
to be fully effective. Each and 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 underimmunized.  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.

7. Q: Is it safe to administer so many doses of OPV to children?

A: 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.

8. Q: Why do some children with multiple doses of Oral Polio Vaccine
still come down with polio?

A: 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.

As many as 4 or 5 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.

9. Q: Is the polio vaccine in Nigeria effective in preventing polio?

A: Yes. The estimated annual number of polio cases in Nigeria 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%
decrease in the number of cases. This shows that the vaccine is very
effective.



10. Q: Is the vaccine tested in Nigeria before being used?

A: 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.

11. Q: Are there any harmful additives in the polio vaccine used in Nigeria?

A: 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.

12. Q: Why are the polio campaigns held so frequently?

A: One of the main reasons national immunization campaigns are held so
frequently is that this gives more chance for the uptake of the
vaccine in the child’s intestine. If too much time is taken between
campaigns, the wild virus can have a chance to infect non-immunized
children. When children are given the polio vaccine, it provides some
immediate protection by not allowing the virus to reproduce in the
child’s intestine. Since the virus does not survive in the environment
for long period, it cannot be passed on to other children. If the
virus has no place to live, it dies out in that area. That is why all
children under five years of age must receive the polio vaccine during
every campaign. Globally experience has shown that in the end stages
of eradication, if campaigns are held less frequently, the chances of
an outbreak are increased.

13. Q: Is it necessary to vaccinate the children for routine
immunization if they have been vaccinated in every polio campaign?

A: 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 7
diseases, in addition to polio.

14. Q:  The attention being given to polio is so much. Is this same
level of attention being given to other diseases?

A: Attention is being given to all diseases but it is particularly
important to emphasize polio for the following reasons:

a.        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 3 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.

b.        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.

c.        The whole world has almost eradicated polio just like it
banished small pox forever; Only Nigeria and two other countries, are
left; therefore if we redouble our efforts, we can also banish polio
and focus the money and efforts to banish other diseases such as
Measles which is also important and we are also giving vaccine
against; you will agree that because of the vaccines, Measles cases
are reducing in our communities but for us to also completely banish
Measles, we have to finish polio and then face other disease such as
malaria, meningitis, pneumonia, and diarrhoea, squarely.

d.        Other important diseases that we are fighting with free
drugs include leprosy, river blindness, guinea worm (which has almost
been eradicated), free bed nets against malaria, free routine
immunization vaccines and free drugs for people with HIV/AIDS



15. Q: The masses buy even simple drugs like Paracetamol and pay for
hospital cards before seeing a doctor. But polio is free-why?

A: Polio is cheaper to prevent than to cure. It is cheaper for you to
prevent paralysis than to try and cure it. It is mostly money that we
pay as tax that 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 the human
suffering. When our children don’t take the vaccine, then they fall
sick: we have to leave our work, pay for transport to go to the
clinic, pay for card to see the doctor, pay for medicines, and pay for
some operations; 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.

16. Q: Does the polio programme, by any means, have a linkage with
family planning?

A: No. The Oral Polio Vaccine 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 while they were children, they will tell
you they are having children On the contrary, the census figures show
that we in Nigeria are having more children than most other countries.
The polio program and other immunizations against childhood diseases
have been going on for quite some time. If you ask people who took the
vaccine while they were children, they will tell you they are having
children.

17. Q: When will the government stop giving children OPV?

A: 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 forever. 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.



18. Q: Why is the OPV given only to children under the age of five years?

A: 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
5 years old.

19. Q: Why is the polio programme a door to door programme?

A: The polio program goes door to door so that every child can be
reached with the vaccine and that 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.

20. Q: Why are polio vaccines free and given up to people’s houses
when drugs are not free at hospitals?

A: 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.  It has been so since time immemorial. Public health
service is obtained in hospitals and it may not be free.



21. Polio is not the people’s felt needs at the moment. Why is it a
top priority for the government?

A: People have many priorities depending on their unique situation.
For some people, it may be drinking water, for others it may be
electricity or roads. However, if possible, everyone will like to have
all three of these amenities that I have mentioned. Some people have
all three; 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 easier ones, then
we take on the more difficult tasks with time. As people understand
that polio is preventable, they have started also appreciating that it
is a felt need. 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
important but some become more important than others when we gain a
better understanding of how it affects everyone. Government is
interested in finishing polio because, we are at a stage where it is
relatively easy to finish the job; just like we joined our hands with
other countries to finish small pox.

22. Q: Does a new-born baby need polio vaccination even before his/her
naming ceremony?

A: 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 unimmunized
children are at risk, including new-borns.

23. Q: Sometimes children over five years are vaccinated. Why?

A: 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/she is more than five years, he may get the disease if he
had not been fully immunized and fully protected.

24. Q: How can one be sure of the safety of the vaccine?

A: 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 2 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, sparing at least
5 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.

25. Q: Do the Federal Ministry of Health and other agencies at federal
and states levels have a reliable database of all households visited
by the vaccination workers and number of children immunized from the
beginning of recent Polio Eradication campaign to date?

A: Yes, the NPHCDA has a database for immunization nationwide. It is
this same database that provides guidance on the number rounds per
year, number of States, LGAs, Wards, households, number of eligible
children, nature, antigen (type of OPV either TOPV; BOPV; or MOPV) and
also where mop-up or repeat immunization needs to done.

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