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posted by martyb on Friday January 12 2018, @12:00PM   Printer-friendly
from the the-end-is-near...-we-hope! dept.

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.

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  • (Score: 3, Informative) by FlyingSock on Friday January 12 2018, @04:04PM (1 child)

    by FlyingSock (4339) on Friday January 12 2018, @04:04PM (#621415)

    just because a publication has 'science' in its name does not mean it is a scientific publication, ie. publishing scientific papers.

    Sorry, but this response only shows you are entirely out of loop:

    Science, also widely referred to as Science Magazine,[1] is the peer-reviewed academic journal of the American Association for the Advancement of Science[2][3] (AAAS) and one of the world's top academic journals. [] []

    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).

    How is it clear that the data is coming from this site?

    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.

    Can you point to exactly where you found the data?

    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] []
    [2] []
    [3] []
    [4] []
    [5] []

    If it feels as if I am making fun of you, it is because I am. Sorry.

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  • (Score: 0) by Anonymous Coward on Friday January 12 2018, @04:38PM

    by Anonymous Coward on Friday January 12 2018, @04:38PM (#621434)

    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:

    Year   p-AFP       Total AFP
    2014    306         5369
    2015    54           5814
    2016    20           7797

    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.