A Rotarian records that a household s children have been vaccinated against polio during Immunization Plus Days in Nigeria. Rotary Images/Joseph Lorenzo

The incidence of polio in Nigeria dropped by more than 50 percent in 2009 to 388 cases as of 22 December, compared with 783 cases for the same period in 2008.

Most dramatic was the decline in the transmission of the type 1 wild poliovirus, to 74 cases from 707. Also, the proportion of unimmunized children in Nigeria’s highest-risk states fell below 10 percent for the first time.

The World Health Organization s  Advisory Committee on Polio Eradication attributes 95 percent of the world’s progress against the disease in 2009 to Nigeria’s success. Rotarians are playing a key role in their country’s gains by

• Immunizing children and helping to overcome resistance from families initially opposed to vaccination
• Airing public service announcements on state radio and sponsoring town criers to urge mothers to bring their children to immunization posts
• Monitoring National Immunization Days and Immunization Plus Days, and handing out soap, school supplies, and other items to children who were vaccinated
• Advocating with government, religious, and traditional leaders to step up support for ending polio
• Conducting a national workshop in September to train local Rotary leaders in polio eradication

“There is a big momentum, much more than ever before, of the federal government, more state governments, and traditional leaders, as well as some local governments, to mobilize all the needed forces,” says Busuyi Onabolu, chair of the Nigeria PolioPlus Committee. The effort aims to ensure “that the required quality of the campaigns is regularly implemented and every child is immunized with the potent OPV [oral polio vaccine] drops.”

Supplementary Immunization Plus Days in November “witnessed a massive support from traditional leaders,” says Onabolu. “There is no doubt that the traditional and religious institutions have added a new and positive dynamic to the polio eradication campaign.”

Dr. Muhammad Ali Pate, executive director of the National Primary Health Care Development Agency, the government entity responsible for polio immunization activities in Nigeria, pointed to “an enormous responsiveness on the part of parents in many states” as key to the success of Immunization Plus Days in October that reached more than 30 million children.

Other allies in Nigeria’s drive to end the disease include Journalists Against Polio and the Forum of Muslim Women of Nigeria, both with networks in the country’s high-risk northern states. Organizations like these are working in partnership with the media and communities to help coordinate the promotion of polio eradication.

A bivalent vaccine, already in use in Afghanistan, has been developed to stop the transmission of the type 1 and type 3 wild polioviruses simultaneously. According to WHO, the vaccine is intended for introduction in India and Nigeria by late January and is expected to be “a critical new tool” in the Global Polio Eradication Initiative. 

WHO report: Nigeria no longer has world s most polio cases

From Best Syndication:

Nigeria no longer enjoys the reputation of being the country with the highest number of polio cases in the world. India , going by a new survey, is currently occupying that position while 95 per cent of world s progress in polio fight recorded between 2008/2009 was attributed to Nigeria s success.

The details emerged from the World Health Organisation (WHO) Advisory Committee on Polio Eradication (ACPE) after its meeting last week in Geneva , Switzerland , The Guardian was told yesterday by the country s representative to the meeting and Executive Director, National Primary Health Care Development Agency (NPHCDA), Dr. Muhammad Ali Pate.

Nigeria , India , Pakistan and Afghanistan are the only four countries in the world where polio is endemic and have never stopped transmission of the wild poliovirus.

By August 7, 2009, Nigeria had reported more polio cases than India . During the year 2009 (till July 31), India had reported 163 polio cases compared to 349 polio cases in Nigeria . In 2008, India reported 559 polio cases while Nigeria reported 789.

Pate said: "You will recall recent WHO Advisory Committee on Polio Eradication (ACPE) meeting in Geneva last week where Nigeria is no longer leading the world in number of polio cases. India has had more cases in 2009 than Nigeria , while last year, we had more than twice India s cases. Ninety-five per cent of world s progress in polio fight between 2008/2009 is attributable to Nigeria s success."

Also, the latest figures from the CountDown to Polio Eradication in Nigeria released after the last round of Supplementary Immunisation Plus Days (SIPDs) 2009 held between November 21 and 24, 2009, indicate that the country has recorded a 50.7 per cent reduction in number ofpolio cases in one year while 27,840,131 children were immunised during the SIPDs.

According to the group, as at August 2009, over 1.2 million Nigerian children less than one year of age were not fully vaccinated against various childhood diseases.

CountDown to polio eradication is a monthly publication by the Expert Review Committee on polio eradication (ERC) set up by the NPHCDA and its partners like the WHO, United Nation Children Education Fund (UNICEF), World Bank, Rotary International, Bill and Melinda Gates Foundation and others in the polio fight.

The 2009 polio statistics released by CountDown showed that 383 children were paralysed by polio in 198 Local Government Areas (LGAs) from 27 states as at November 6, 2009, compared to 777 cases in 238 LGAs in 25 states over the same period in 2008.

CountDown showed that although there is evidence that many children are being reached with polio vaccinations during campaigns, the growing rate of those not vaccinated with other routine antigens may frustrate the successes so far achieved towards eradicating poliofrom Nigeria .

A breakdown of the 383 polio cases reported in states showed that Kano had the highest number of cases with 102, followed by Bauchi, 43; Katsina, 36; and Borno 20. Kaduna , Sokoto, Kebbi and Jigawa all have 16 cases each; while Yobe , Niger and Zamfara have 15 cases each. Ogun has 14 cases, Nassarawa and Gombe nine each; Benue and Delta have seven each; Kogi and Plateau five each while Bayelsa and Lagos have four each. Kwara, Ebonyi and Oyo all have two each and Federal Capital Territory (FCT), Adamawa, Edo and Abia all have one case each.

Pate told The Guardian: "We have had another very successful round of Immunisation Plus Days (IPDs). The Kano Emir played a major role with his symbolic flag-off and by vaccinating his grandson in the palace on November 23. He expressed total support for the polio fight until our country is free of the virus."

Pate put the total number of children immunised so far at 27,840,131 but warned that the figure could be higher because more data are still being awaited from the states.

A breakdown showed that 768,242 children had been immunised so far in Abia; 758,528 in Ebonyi; 149,611 in Bayelsa; 741,233 in Delta; 740,358 in Ogun; 275,997 in Oyo; 568,348 in Adamawa; 1,422,717 in Bauchi; 519,754 in Borno; 817,233 in Gombe; 1,339,720 in Taraba, and 1,850,275 in Yobe.

Others include 665,021 children immunised in FCT Abuja; 811,649 in Benue; 1,333,794 in Kogi; 664,904 in Kwara; 1,189,760 in Nasarawa; 750,129 in Plateau; 968,865 in Jigawa; 3,054,494 in Kaduna; 4,763,131 in Kano; 1,795,321 in Katsina, and 539,904 children were immunised in Zamfara State.

The Global Immunisation Vision and Strategy targets countries to fewer than 90 per cent coverage at national level and at least 80 per cent coverage in all LGAs or districts. The global accepted indicator to measure percentage coverage is the third dose of DPT (DPT3). DPT is the vaccine for diphtheria (a highly contagious and potentially life-threatening bacterial disease caused by Corynebacterium diphtheria).

Analysis at the state level in August showed that only Akwa-Ibom State and FCT have 80 per cent of all eligible children vaccinated with DPT3 in 80 per cent of their LGAs.

According to CountDown, the North-West zone, which is the most prevalent for polio in Nigeria , had over 350,000 children not fully vaccinated with DPT3 and ranked the lowest among the zones.

Kano State accounted for 120,000 children unimunised. Kano is surrounded by Jigawa, Katsina, Kaduna and Zamfara - all of which have over 60,000 children not fully vaccinated. Bauchi has the highest number of unimunised children in the North-East, like Lagos , with over 60,000 children in Southern Nigeria .

From the SignOn San Diego News By Scott LaFee
Monday, November 16, 2009 at 1:29 a.m.

Within days, the healthy toddler was crippled, paralysis quickly numbing and immobilizing his left leg, hip and parts of his back. Over the next 12 years, Kneeshaw would endure many operations, each attempting to restore at least partial muscle and nerve function. Between surgeries, Kneeshaw would spend hours in physical therapy, going and growing through countless braces, crutches and other supports.

“By the time I was 16, I figure I’d spent a quarter of my life in hospitals,” he said.

Rick Kneeshaw of Scripps Ranch suffered from polio as a child (inset, right). Now he is battling post-polio syndrome, a disease that can strike former polio victims decades after they have recovered from the initial disease.

The payoff was partial recovery. He was able to walk without braces or crutches — at least on level surfaces for short distances. “It gave me nighttime mobility at least. I could get out of bed, go to the bathroom. That was something.”

But something changed in 1971. At age 25, Kneeshaw’s joints on his polio-damaged left side began to ache and act up, forcing him to resume wearing a leg brace. He would never again be without it. He took up using crutches again. And in 1984, his right leg — the healthy one — began to progressively weaken. It got to the point where he could only stand for brief periods. He began using a wheelchair.

Kneeshaw knew he had never actually conquered polio, but he thought he had put it behind him. He had moved on, becoming an electrical engineer, marrying, having children. Polio caught up.

In the late 1940s and 1950s, paralytic poliomyelitis was a scourge and nightmare, the most terrifying public health threat in post-World War II America. The causative agent — a virus that inhabits the gastrointestinal tract — had been identified only a few decades earlier. It was extraordinarily infectious, easily transmitted via contaminated food or water. Epidemics were annual occurrences, each seemingly worse than the last. By 1952, polio was killing more Americans than any other communicable disease: More than 300,000 cases and 58,000 deaths in that year alone. Most of the victims were children, their young immune systems unprepared for the viral onslaught.

After infecting a body and incubating for several days in gastrointestinal cells, the poliovirus spreads along key nerve fiber pathways, replicating in and destroying motor neurons in the spinal cord and brain stem. With their nerve connections destroyed, affected muscles atrophy from lack of stimulation, weakening until permanent paralysis sets in. The damage can be limited to a single finger joint or affect almost the entire body. During one of his stays in a hospital ward occupied entirely by teens with polio, Kneeshaw recalls a girlfriend who was completely paralyzed except for her left arm.

To be sure, the majority of infected children escaped relatively unscathed, acquiring lifelong immunity while suffering only temporary, flu-like symptoms or no symptoms at all. But a small percentage were devastated, the disease exacting permanent, crippling damage. In the worst cases, the virus destroyed motor neurons that control breathing. Many of these polio victims, if they survived, spent the rest of their shortened lives inside “iron lungs” — ungainly, tubular tanks that inflated and deflated their paralyzed lungs by alternating air pressure inside the device.

The polio vaccine, developed by Jonas Salk and introduced in 1955, profoundly changed the equation. The Salk vaccine, which used a killed virus to generate immunity, and a subsequent oral vaccine developed by Albert Sabin (using an attenuated live virus), dramatically reduced the incidence of polio in the United States. New cases declined to less than 1,000 in 1962 and just 121 in 1964. The last reported case of “wild polio” in the United States occurred in 1979. The infrequent infections reported since have all been imported cases or the result of a rare immunological response to the vaccine, which remains one of the major inoculations of childhood.

It’s estimated that up to 600,000 Americans today once had polio. Many are like Kneeshaw, “polio survivors” who labored to rebound from the disease. With treatments and hard work, their bodies overcame at least some of the effects of polio. Motor neurons that survived the initial infection sprouted new and additional fibers, extending into damaged areas to restore at least limited muscle function.

Such was the case with Nan Kaufman, who was 6 years old and living in Texas when she came down with polio in 1954. Her parents thought she had a bad case of the flu until Kaufman collapsed on the way to the doctor, suddenly unable to stand or walk. The disease permanently disabled her right side, stunting growth in her arm and leg, though Kaufman learned to compensate and to persevere.

“I was pretty determined to do what I wanted to do, which was be like other children,” she said. “I learned to ride a bike. I ran, even though my right leg was thinner and shorter. I swam competitively, even though my right hand and arm were chronically weak. There was a good deal of denial and magical thinking. People with polio often become overachievers.”

Kaufman, who now lives in Point Loma, became a pediatrician. She retired in 2006 after years of escalating pain, weakness and fatigue convinced her that she could no longer do her job effectively or safely. “It’s hard to say when symptoms first emerged. I had spent my life pushing pretty hard, raising four children, working long hours as a doctor. I had always had bad days, but I thought it was just that I was tired. Then I started having trouble with my ankle. I fell a lot. I dropped things. I became afraid I might one day drop a baby.”

Kaufman saw doctor after doctor, but no one could pinpoint the problem. She worried she had amyotrophic lateral sclerosis (ALS) or Lou Gehrig’s disease, a progressive and fatal neurodegenerative disease that destroys voluntary muscle control. A neurologist finally identified the real problem: post-polio syndrome. Like Kneeshaw, an old nemesis had come back.

Very little is known about post-polio syndrome, or PPS. No one knows why the condition seems to emerge 30 to 40 years after the original infection. The working hypothesis is that years of overcompensation takes its toll, that surviving, functional, motor neurons and muscles are overworked and simply begin to wear out and shut down. There is evidence that people who had milder cases of polio, who had more surviving motor neurons, are at greater risk of developing PPS than those who suffered significant, permanent damage.

“People who essentially had no recovery from the original polio are much less likely to have PPS symptoms than those with good recovery,” said Dr. Susan Perlman, a neurologist at the University of California Los Angeles.

It is confoundingly difficult to identify PPS. Symptoms such as fatigue, breathing difficulties and muscle weakness tend to be subtle and gradual. They may be associated with many other conditions, from simple exhaustion to other serious neurodegenerative diseases. The situation is further complicated by likely pre-existing health problems and aging.

“Remember, this condition arises in the context of someone who has probably already suffered some degree of paralysis or disability for most of their lives, so it can be hard to separate new symptoms from old ones,” said Dr. Sam Pfaff, a neurobiologist at the Salk Institute for Biological Studies in La Jolla. “Plus, the syndrome is superimposed upon the aging process.”

It doesn’t help that most doctors have never treated an active case of polio or that there’s no definitive diagnostic test.

“There are no biomarkers,” said Pfaff. “Identifying the condition means doing a careful work-up of the patient, knowing and understanding the patient’s history. Post-polio syndrome is the answer you get after you’ve excluded all other possibilities.”

There is no cure for PPS. Treatment consists of ameliorating symptoms and limiting circumstances and behaviors that can accelerate or exacerbate health problems. “The only thing you can do to prevent the disease from progressing is to pace yourself,” said Kaufman. “Telling yourself to push through it, to just get on with life, only makes it worse.”

Not surprisingly, people like Kaufman and Kneeshaw, who was actually a poster child for anti-polio efforts in the 1950s, are strong advocates for more and better research into PPS. They would like to see new therapies, a cure if possible. But they also recognize a harsh reality: Theirs is an affliction that strikes only a distinct and shrinking population of people, particularly in the United States. Unless polio re-emerges as a major public health threat, post-polio syndrome will inevitably decline and disappear as polio survivors do the same.

“We’re a dying breed,” said Gladys Swensrud, who got polio as a 3-year-old living in Escondido in 1951 and now suffers from muscle weakness and breathing problems that require her to use a respirator at night when sleeping.

Swensrud would like to feel better. She argues, as do others with PPS, that it is shortsighted and foolish to simply (and cruelly) write off post-polio syndrome as a health problem that will solve itself as PPS patients pass away. Pfaff at the Salk Institute agrees:

“Polio is not a big public health problem anymore, but it hasn’t been completely eliminated. There are still occasional outbreaks in other parts of world, particularly Africa and Asia. There are thousands of other polio survivors in the world.”

A better understanding of PPS could improve treatments and ease the burden upon survivors around the world. It might also fill in knowledge gaps about the basic biology and pathology of the human body, providing “information that’s relevant to other neurological diseases and other biological systems.”

And that, said Kneeshaw, sitting in his wheelchair, is always a step in the right direction.