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

http://www.sciencemag.org/news/2018/01/what-hell-going-polio-cases-are-vanishing-pakistan-yet-virus-wont-go-away

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: 5, Informative) by Zinho on Friday January 12, @05:31PM (7 children)

    by Zinho (759) on Friday January 12, @05:31PM (#621457)

    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
    Starting Score:    1  point
    Moderation   +3  
       Informative=3, Total=3
    Extra 'Informative' Modifier   0  
    Karma-Bonus Modifier   +1  

    Total Score:   5  
  • (Score: 2) by JoeMerchant on Friday January 12, @05:41PM (2 children)

    by JoeMerchant (3937) on Friday January 12, @05:41PM (#621459)

    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...

    • (Score: 0) by Anonymous Coward on Friday January 12, @08:34PM (1 child)

      by Anonymous Coward on Friday January 12, @08:34PM (#621543)

      But but heavy metals! Can make people sick! WE JUST DON'T KNOW!!!

      • (Score: 2) by JoeMerchant on Friday January 12, @09:44PM

        by JoeMerchant (3937) on Friday January 12, @09:44PM (#621574)

        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.

  • (Score: 2, Informative) by pdfernhout on Saturday January 13, @03:02AM (3 children)

    by pdfernhout (5984) on Saturday January 13, @03:02AM (#621661)

    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.

    • (Score: 1) by khallow on Saturday January 13, @04:09AM (2 children)

      by khallow (3766) Subscriber Badge on Saturday January 13, @04:09AM (#621691) Journal

      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.

      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, @04:26PM (1 child)

        by Anonymous Coward on Saturday January 13, @04:26PM (#621837)

        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, @02:57AM

          by khallow (3766) Subscriber Badge on Monday January 15, @02:57AM (#622384) Journal

          It's the Gates Foundation's responsibility to research the situation and make the most effective use of the money.

          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.

          But vaccinations are high-tech, toilets low-tech and therefore not as sexy.

          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.