Strong surveillance, immunization needed to eliminating polio

A higher vaccination coverage and strengthened surveillance is a must to ensure the country’s polio-free status, according to health authorities and anti-polio advocates.

Meeting to tackle issues on polio eradication during “The Polio End Game: What’s Next?” forum at the National Institutes of Health in the University of the Philippines Manila last April 24, advocates are pushing for intensified reporting of children with symptoms of acute flaccid paralysis, a manifestation of polio, to health authorities and ensuring the immunization coverage of at least 95 percent of children.

Dr. Aida Salonga, director of the Institute of Child Health and Human Development at NIH-UP Manila, said the country is “on the red” for polio. She said that factors like routine immunization gaps, outbreaks in disaster zones especially in low coverage areas, contact with overseas-based people especially from endemic countries, led to this status.

In a region that is certified polio-free in 2000, the Philippines is still classified as high risk for reemergence of polio. Though the Western Pacific Region is certified as polio-free in 2000, the country, along with Papua New Guinea, was categorized as high risk for poliovirus transmission in 2010, mainly due to declining AFP surveillance and low immunization coverage.

Highly infectious, viral

Polio is a highly infectious viral disease mainly affecting children under 5. It invades the nervous system and causes total paralysis in a matter of hours. One in 200 infections leads to irreversible paralysis, usually in the legs. Among those paralyzed, 5 to 10 percent die when their breathing muscles become immobilized. Polio has no cure but it can only be prevented. Polio vaccine, given multiple times, can protect a child for life.

Since 1988, polio cases have decreased by over 99 percent, from an estimated 350,000 to only 406 in 2013. As of 2014, only three countries-Afghanistan, Nigeria and Pakistan-remain polio-endemic. Of the three strains of wild poliovirus (type 1, type 2 and type 3), type 2 was eradicated in 1999 and cases of type 3 are down to the lowest-ever levels with the last one reported from Pakistan in April 2012.

Failure to eradicate polio for good will definitely offset the gains we have achieved, said Liliane Boualam of the WHO-Western Pacific Region. She said, “As long as a single child remains infected, children in all countries are at risk of contracting polio.”

Recognizing the threat, the World Health Assembly in May 2012 adopted a resolution declaring the completion of polio eradication a “programmatic emergency for global public health” and called for the development of a comprehensive polio eradication and endgame strategy for a polio-free world.

Eradication and endgame plan

Meanwhile, the WHO initiated the 2013-18 Polio Eradication and Endgame Strategic Plan, a $5.5-billion, six-year cooperative plan which calls for mass immunization campaigns in the three remaining endemic countries. The plan also wants the switch to inactivated virus injections to avoid the risk of the vaccine-derived outbreaks that occasionally occur because of live-virus oral vaccines.

Eradication efforts  in the country have relied on these strategies: immunization coverage via oral polio vaccines, national immunization days, supplemental immunization activities and surveillance of AFP cases among children below 15.

However, Health Assistant Secretary Enrique Tayag said, “We cannot sustain success; we are not locally specific with everything; and we are wrongly satisfied with [our] current effort.” He urged for a renewed and intensified effort to enforce better surveillance and immunization.

Aside from pushing for stronger action against polio, the forum was aimed to increase awareness and understanding on the status of the disease eradication in the country and globally and to discuss the current WHO recommendation on the post-polio eradication and immunization strategy. Noli A. Ermitanio