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Just a year ago, poliovirus seemed on its last legs in Pakistan, one of its final strongholds. Polio cases were steadily falling, from 306 in 2014 to 54 in 2015, 20 in 2016, and, by last count, eight in 2017. Blood tests showed that, overall, immunity to the virus had never been higher, even among children aged 6 to 11 months, thanks to years of tireless vaccination campaigns. Surely, there were not enough susceptible kids to sustain transmission, and the virus would burn itself out within a year.
Unsettling new findings, however, show it is far from gone. In the most extensive effort in any country to scour the environment for traces of the virus, polio workers are finding it widely across Pakistan, in places they thought it had disappeared. They are wondering "just what the hell is going on" and how worried they should be, says epidemiologist Chris Maher of the World Health Organization (WHO) in Geneva, Switzerland, who runs polio operations in the eastern Mediterranean region. Does this mean the virus is more entrenched than anyone realized and is poised to resurge? Or is this how a virus behaves in its final days—persisting in the environment but not causing disease until it fades out?
[...] Along with Afghanistan and Nigeria, Pakistan is one of just three endemic countries—places where indigenous wild poliovirus has never been vanquished.
[...] Since the eradication effort began in 1988, the gold standard for detecting poliovirus has been surveillance for acute flaccid paralysis (AFP)—finding and testing every child with a sudden weakness or floppiness in the arms or legs. The yearly case count has been the benchmark for success: After 12 months without a polio case, WHO has historically removed a country from the endemic list.
Polio workers collect sewage samples, usually from open drainage ditches, and test them for virus. If the test is positive, that means someone in the catchment area is infected and actively excreting it. Pakistan now has 53 sampling sites, more than any other country. And at a time when cases are the lowest on record, 16% of samples from across the country are testing positive.
[...] One possible explanation for the disconnect is that AFP surveillance is missing cases. Maher doubts that the number is significant, but others suspect that too many children among the mobile populations, including the marginalized Pashtun minority, still aren't being vaccinated despite ramped up efforts to reach them. "I don't think polio is entrenched across Pakistan, but this last reservoir of 'people on the move' is sustaining the virus," says Steve Cochi, a polio expert at the U.S. Centers for Disease Control and Prevention in Atlanta.
[...] The program is not taking any chances. The response to each positive environmental test is now as aggressive as to a case of paralysis. And the program is hammering the virus with repeated vaccination campaigns throughout the "low season," between December and May, when cold weather makes it tougher for the virus to survive. Whether the strategy works will become clear later this year when the weather turns warm. But one thing is certain: The absence of cases is no longer enough to declare victory over polio. Going forward, a country will not be considered polio-free until 12 months have passed without a case—or a positive environmental sample.
(Score: -1, Spam) by Anonymous Coward on Friday January 12 2018, @12:39PM
‘What the hell is going on?’ You should be more concerned with what's going on in your bare, rancid asshole, which my fetid cock has deeply penetrated. Ah! I just breached your anal cervix. If I squirt my diseased cum in here and my cockpoles rape your fecal egg, you'll be pregnant in no time! Give birth to a feces baby, you sow!
(Score: 3, Interesting) by JoeMerchant on Friday January 12 2018, @01:02PM (8 children)
If the surveillance program is only watching open drainage ditches and other common sewage collection channels (53 points in a country of ~200 million, one sample site per 3.7 million people?!) how do they have any confidence at all of their coverage? Is the Pakistani infrastructure such that everybody's sewage ends up channeled together and in open ditches on such a scale?
🌻🌻 [google.com]
(Score: 5, Informative) by Zinho on Friday January 12 2018, @05:31PM (7 children)
Good question, the answer to which is fairly well answered by news articles [tribune.com.pk] detailing what Aid agencies are concerned about in the region.
* For the most part, only rich people have toilets in their home at all, let alone connections to public sewers
* For the most part, there are no public sewer systems, so the rich people with toilets are building self-contained septic systems
* Many poor people in the region prefer public defecation for cultural reasons as well as financial - some believe it's better for their health
* Poor hygiene culture is regional, not just country-specific; India has similar problems. [bbc.com]
If the government isn't building sewers, and rich people are either not getting sick or getting adequate medical care, then it makes sense for the disease eradication efforts to focus on the poor. In this case, open ditches are exactly the place to look for signs of infection.
On an unrelated note, mods be crazy today. Two redundant mods on the first two relevant article responses? How can the first non-spam post be redundant??? I'm glad we can do the post-and-moderate thing here, doing what I can to fix it.
"Space Exploration is not endless circles in low earth orbit." -Buzz Aldrin
(Score: 2) by JoeMerchant on Friday January 12 2018, @05:41PM (2 children)
So, while we're on the subject of Polio - it is much more problematic in the rich countries where everyone has toilets - and now are choosing to forego vaccines again...
🌻🌻 [google.com]
(Score: 0) by Anonymous Coward on Friday January 12 2018, @08:34PM (1 child)
But but heavy metals! Can make people sick! WE JUST DON'T KNOW!!!
(Score: 2) by JoeMerchant on Friday January 12 2018, @09:44PM
No, no, actually we do know: Mad as a Hatter, Newton's madness - mercury will f-you up if you get too much in your system.
Still, polio vaccine is one of the great achievements of modern medicine - the 249th follow on, me too, I want my slice of that sweet vaccine profit pie lame excuse of a trumped up argument against a disease that's not all that out of hand? Personally, I think the vaccine show jumped the shark shortly after tetanus.
🌻🌻 [google.com]
(Score: 2, Informative) by pdfernhout on Saturday January 13 2018, @03:02AM (3 children)
Related: https://www.nationalgeographic.com/magazine/2017/08/toilet-defecate-outdoors-stunting-sanitation/ [nationalgeographic.com]
"Nearly a Billion People Still Defecate Outdoors. Here’s Why. The problem isn’t just a lack of toilets—it’s a lack of toilets that people want to use. The result: millions of deaths and disease-stunted lives."
I remember one story about the Gates Foundation plowing money into vaccination against specific diseases when some local people were begging desperately for funding to deal with the sewage problem. The local pleas were being ignored because it was not what the money was earmarked for -- even though fixing the sewage problem would help prevent all sorts of diseases.
The biggest challenge of the 21st century: the irony of technologies of abundance used by scarcity-minded people.
(Score: 1) by khallow on Saturday January 13 2018, @04:09AM (2 children)
Apparently, it is exclusively the Gates Foundation's responsibility to listen to people and fix the sewage problem. They don't have infinite resources to fix everything, so it shouldn't be surprising that they don't fix everything. There are numerous other parties slacking on this job, including several levels of government. Further, the Gates Foundation probably was funding one or more of those other glaring oversights with the immunizations.
(Score: 0) by Anonymous Coward on Saturday January 13 2018, @04:26PM (1 child)
It's the Gates Foundation's responsibility to research the situation and make the most effective use of the money. But vaccinations are high-tech, toilets low-tech and therefore not as sexy. If it was a government program doing this, you'd be apoplectic about how this was going down. So why give the Gates Foundation a pass?
(Score: 1) by khallow on Monday January 15 2018, @02:57AM
No, it's not their responsibility. And what makes you think they made the wrong choice? Building sewers, toilets, and such is in reach of these communities. These are local problems easily solved at the local level. Immunizing large swaths of humanity is not.
And yet, vaccines aren't high-tech or sexy. That is an absurd thing to say. That's why the Gates Foundation ended up funding these things in the first place. Because a lot of others weren't.
(Score: 2, Interesting) by Anonymous Coward on Friday January 12 2018, @01:45PM (1 child)
The virus has changed to not cause symptoms
The population has developed an immunity
They are under reporting the symptoms
They are eliminating the folks with symptoms
They are underestimating the number of folks represented in a sewer sample
(Score: 3, Interesting) by Zinho on Friday January 12 2018, @05:34PM
From the article, it looks like a little of number 3, and a little of number 5. Disadvantaged transients both add to the number represented in each sample and have a high likelihood of developing symptoms without reporting. Hard people to help, but worth the effort to reach them.
PS - I gave you an "underrated" mod to back out the nonsense "redundant" you had before.
"Space Exploration is not endless circles in low earth orbit." -Buzz Aldrin
(Score: 1, Interesting) by Anonymous Coward on Friday January 12 2018, @01:47PM (4 children)
This requires a source so people can see how that data was generated. The quality of "Science" is dropping lower and lower to the point it offends the sensibilities of scholarly people.
Anway, polio is another case where a small percentage of infected people show the symptoms and many other causes apparently result in the exact same symptoms (similar to measles). What I would like to know is whether the cases of non-polio AFP have been increasing proportional to the drop in AFP blamed on polio.
(Score: 3, Informative) by FlyingSock on Friday January 12 2018, @02:11PM (3 children)
While I agree that it would have been nice to have a direct link to the reports, just because a publication has 'science' in its name does not mean it is a scientific publication, ie. publishing scientific papers. In this case it appears the publication is merely reporting on science, hence the less stringent citation rules. This scholarly person is not offended by the missing link, as they know the difference between a newspaper and a scientific journal. So while science (no " necessary) has quite a few problems (procrastination being a big one ;) ) this is not really one of them.
It is clear from the article where the data is from though. So lmgtfy:
http://polioeradication.org/tools-and-library/policy-reports/who-weekly-epidemiological-record/ [polioeradication.org]
The numbers can be found in the respective yearly reports.
(Score: 0, Interesting) by Anonymous Coward on Friday January 12 2018, @02:21PM (2 children)
Sorry, but this response only shows you are entirely out of loop:
https://en.wikipedia.org/wiki/Science_%28journal%29 [wikipedia.org]
How is it clear that the data is coming from this site? Can you point to exactly where you found the data?
(Score: 3, Informative) by FlyingSock on Friday January 12 2018, @04:04PM (1 child)
Eh, fair enough, no need to apologise. Science is of course a well known scientific publication. Given the style of the article I assumed it was from a different publication with a similar name. This does not negate my point however, that this is a news article as opposed to a scientific one. The article we are discussing here is not from the 'research' section of science but from the 'news' section. A good example for the difference between the two is the mars ice cliffs articles in the current issue. One in the news section [1] and one in the research section [2]. The first is written in a similar way as the polio article, the latter as a scientific article (including a reference list, sources and I assume peer reviewed).
All the people cited in the article are from the WHO anti polio campaign, hence the data can be found in the WHO reports on polio. The reports I linked are hosted on WHO's own site, this site [3] was simply the first hit when I googled the WHO's anti polio campaign.
The 54 cases for 2015 and 20 cases for 2016 can be found in table 1 in the respective year sections under the heading "Confirmed WPV cases" in the report "Surveillance systems to track progress towards polio eradication worldwide, 2015–2016" [4].
The 306 cases in 2014 can be found in "Polio surveillance: tracking progress towards eradication, worldwide, 2014–2015" [5] also table 1.
Both [4] and [5] are linked from the site I originally linked [3], where I found them.
But I really would expect a scholarly person to be able to find these reports themselves, as do the editors of science apparently.
[1] https://www.sciencemag.org/news/2018/01/ice-cliffs-spotted-mars [sciencemag.org]
[2] http://science.sciencemag.org/content/359/6372/199.full [sciencemag.org]
[3] http://polioeradication.org/tools-and-library/policy-reports/who-weekly-epidemiological-record/ [polioeradication.org]
[4] http://apps.who.int/iris/bitstream/10665/254988/1/WER9214.pdf [who.int]
[5] http://www.who.int/wer/2016/wer9115.pdf [who.int]
If it feels as if I am making fun of you, it is because I am. Sorry.
(Score: 0) by Anonymous Coward on Friday January 12 2018, @04:38PM
It is funny that you think it is "making fun of [me]" to cite your sources correctly (not link to a page with dozens of pdfs) when responding to a claim that the quality of scholarship is dropping. Also, yes I realized that was their "news" section, plenty of news sites not associated with (and leveraging the prestige of) scientific journals manage to cite their sources. It really isn't hard.
Anyway, thanks. It is nice that they have total AFP cases. We see this:
So the actual problem (AFP) actually appears to be getting worse from this data (of course we need population covered to really compare). No one cares about polio except that it causes AFP, and it seems to be a minor cause at that (~1%)...
It'd be a pain in this format but I'd like to see this comparison for all the countries. Does total AFP always rise as polio-caused AFP drops? There should just be a csv with this data somewhere.
(Score: 5, Informative) by inertnet on Friday January 12 2018, @01:58PM (7 children)
When the USA tracked down Bin Laden, they used a fake vaccination program in order to collect blood samples for testing. Since then many people in Pakistan are still distrustful against vaccination programs. A lot of Red Cross volunteers still get killed there because of this distrust, for example Six Red Cross workers killed [theguardian.com].
(Score: 4, Insightful) by Anonymous Coward on Friday January 12 2018, @02:04PM (2 children)
When people already expect the push for vaccines is part of some kind of nefarious conspiracy, it really doesn't help to prove them right...
(Score: 0) by Anonymous Coward on Friday January 12 2018, @09:07PM
Yeah, it was a dumb idea, Bin Laden couldn't have hurt as many people as Polio did no matter how hard he tried.
(Score: 2, Troll) by realDonaldTrump on Friday January 12 2018, @09:11PM
It's bad in many ways. On many sides. Some vaccines are very important. But autism has become an epidemic. It has gotten totally out of control. Pakistan, after getting more than 33 billion dollars in aid over the last 15 years, have given us nothing but lies & deceit, thinking of our leaders as fools. They give safe haven to the terrorists we hunt in Afghanistan, with little help from that shithole country. But President Obama and the Deep State did a terrible thing. They were just as deceitful.
(Score: 3, Insightful) by tangomargarine on Friday January 12 2018, @05:27PM
One of the most horribly, blatantly unethical things our government has done. Just disgusting.
"Is that really true?" "I just spent the last hour telling you to think for yourself! Didn't you hear anything I said?"
(Score: 0) by Anonymous Coward on Friday January 12 2018, @07:52PM (2 children)
We used a real vaccination program. We were delivering real working vaccines. You make us out to be so evil, but we were vaccinating the children of our worst enemy.
(Score: 0) by Anonymous Coward on Friday January 12 2018, @09:35PM (1 child)
Im sure youd get a real vaccine right along with the secret sterilization shot.
(Score: 0) by Anonymous Coward on Friday January 12 2018, @10:29PM
I'm not saying this was a case where sterilization was done, but the US has been known to sterilize the population in the past. Specifically Native Americans and the mentally handicapped, probably others too.
(Score: 1) by Revek on Friday January 12 2018, @02:44PM (5 children)
The virus lives in a bacterium benignly? Therefore it would be present in the environment while the population has been inoculated against it.
This page was generated by a Swarm of Roaming Elephants
(Score: 5, Informative) by Joe on Friday January 12 2018, @03:05PM (1 child)
There is no other animal known to be infected by poliovirus. Absence of evidence isn't necessarily evidence of absence, but scientists have looked really hard and understand a lot about the virus from both an epidemiology and a virology standpoint.
Bacteria do not have the machinery necessary to support entry or replication of the virus, but polio can persist in sewage for months all on its own.
- Joe
(Score: 1) by Revek on Friday January 12 2018, @03:57PM
Shhh. don't tell everyone I'm talking out my ass.
This page was generated by a Swarm of Roaming Elephants
(Score: 1, Interesting) by Anonymous Coward on Friday January 12 2018, @04:00PM (1 child)
Bacteria have ring shaped DNA rather than strands. Any virus that infects people can't infect bacteria.
The consequence of that is that it would be technically in there, but unable to reproduce.
(Score: 2, Informative) by Anonymous Coward on Friday January 12 2018, @08:06PM
There is a virus that infects a bacterium that is an intracellular parasite of spiders. The virus contains venom-related DNA from the black widow.
(Score: 1, Insightful) by Anonymous Coward on Friday January 12 2018, @08:43PM
There are monkeys.
(Score: 5, Informative) by Joe on Friday January 12 2018, @02:59PM (6 children)
First:
Poliovirus only causes disease in about 1% of people infected.
Second:
There are two types of polio vaccines: the weakened "live" vaccine and the regular strain that is "killed".
The "live" vaccine is taken orally, which allows for replication of the weakened virus in the intestines and subsequent shedding of the weakened virus into the sewage system and persist for months. The weakened virus strain is able to mutate (reversion) back to the regular strain and cause disease (vaccine associated poliomyelitis) at some small frequency. Because the immune system is exposed to the virus in the intestines, future immune responses are targeted there and prevent any future viral replication - once a patient stops shedding the vaccine strain, they will not be able to spread anymore (heard immunity).
The "killed" vaccine is injected, so the immune system mounts a general response that is not targeted to the intestines. This means that patients will be protected from disease, but any "live" poliovirus that they are exposed to can still replicate in their intestines and be shed into sewage. This means that heard immunity is not as effective and the virus will spread (without disease in an adequately vaccinated population). This is why you can detect poliovirus in the sewage from countries that haven't had a disease case ("polio free") in years.
In conclusion, "epidemiologist Chris Maher" should remember that just because he doesn't know "what the hell is going on" doesn't mean that scientists haven't already known about this for more than twenty years.
http://science.sciencemag.org/content/277/5327/779.long [sciencemag.org]
- Joe
(Score: 4, Funny) by Anonymous Coward on Friday January 12 2018, @03:04PM (5 children)
No. Actually, I don't think so...
(Score: 4, Touché) by Joe on Friday January 12 2018, @03:21PM (4 children)
Reality doesn't care about what either you or I think on the matter.
What I said is backed by evidence, feel free to point me to any better studies you know of that disagree.
https://www.ncbi.nlm.nih.gov/pubmed/22532797 [nih.gov]
- Joe
(Score: 5, Funny) by Anonymous Coward on Friday January 12 2018, @03:33PM (1 child)
That other AC was obviously playing with your spelling mistake ("heard" = past form of "to hear", where you meant "herd"), stating that he or she actually didn't hear that.
(Score: 5, Funny) by Joe on Friday January 12 2018, @03:45PM
Damn, last time this happened I used "aloud" instead of "allowed".
Intestinal replication of the virus is not aloud on account of heard immunity.
(Score: 2) by Grishnakh on Friday January 12 2018, @06:10PM (1 child)
Reality doesn't care about what either you or I think on the matter.
Webster's Dictionary does.
(Score: 0) by Anonymous Coward on Friday January 12 2018, @09:09PM
Yeah, LITERALLY!
(Score: 2, Insightful) by cellocgw on Friday January 12 2018, @10:33PM (2 children)
I suppose it would be just plain mean to suggest that polio is most virulent in populations practicing the most repressive religions.
Physicist, cellist, former OTTer (1190) resume: https://app.box.com/witthoftresume
(Score: 2, Touché) by Anonymous Coward on Saturday January 13 2018, @03:51AM
Any of the larger nuclear powers could end polio in about an hour.
Nuke all of Pakistan, Afghanistan, and northern Nigeria. That's it. We're done. Polio is gone.
(Score: 4, Funny) by BK on Saturday January 13 2018, @05:25AM
One could also point out that countries with polio problems can't seem to manage their own shit...
...but you HAVE heard of me.
(Score: 1, Funny) by Anonymous Coward on Friday January 12 2018, @11:37PM (1 child)
Note the limited geography in which polio resides. It's just in useless shithole countries.
Trump, Putin, and several other people have the ability to eliminate polio in about an hour. Polio can not survive being turned into plasma.
Step 1: request the "football"
Step 2: pull out card with special codes
Step 3: enter special codes
Step 4: specify destination
Step 5: wait a bit...
All gone now! We are saved from polio, and nothing of value is lost.
(Score: 0) by Anonymous Coward on Saturday January 13 2018, @09:28PM
I think you are overestimating Trump's ability. After step one he would be confused by being presented with a briefcase instead of a TV showing a football game.