FEATURES NEWS THE RISING NEPAL (DAILY)

National Immunisation Day
Threatened By Use Of Live Polio Viruses

By Balaram Chaulagain

AS A part of the global effort to wipe-out the polio from Earth by the year 2005. Nepal launched the 1st round of five-year anti polio drive today 9th Dec. 2000. The four National Immunisation Days (NIDs) conducted in the last years were completely successful. The generosity of WHO, UNICEF, CDC Altanta, Rotary International, USAID and other line agencies in providing financial and technical support for the last years of NIDs is highly appreciated. All set has been prepared for this year, too. The disease is will endemic in Africa and Asia. The SAARC region is believed to be a fertile ground for paralylic polio including other vaccine preventable diseases. Till date, it has been concluded that to eliminate polio oral polio vaccine (OPV) is prepared from attenuated, harmless and toxin free live viruses. But due to the confusion over the nature of the live polio viruses, hopes of eradicating polio from the globe within stipulated time frame are being compromised. According to a news the use of live polio viruses as immunising agent in the long run may harm instead of doing well. That news is quite controversial, but no such reaction has been put forth by any international, health authorities like WHO and UNICEF.

Contagious

Polio is a highly contagious disease which is transmitted from one person is another. It cripples children below five years of age for long and can even kill them. Once the disease attacks, there is no any kind of specific treatment for which 2 to 3 drops of polio is the only way to escape it’s threat. Poor sanitation and rural slums are believed to be main causes behind the spread of the virus. Unplanned sewage system is a favourable breeding place for polio viruses. Primarily, polio virus affects the alimentary canal, and may be transmitted upto the central nervous system through the spinal cord resulting in paralysis or causing life long deformities of the body or probably death. In the prevaccination era, polio was found in all parts of the world. The extensive use of polio vaccines since 1954 has virtually eliminated the disease in the developed countries where public health system was strong and well. For immunising purpose two types of vaccines are used throughout the world, they are inactivated ( salk) injectable polio vaccine (IPV) and live attenuated oral (sabin) polio vaccine (OPV). Because of administrative convenience, rather than efficacy OPV has been widely used. The WHO programme on immunisation (IPI) and the National Immunisation Programme in our country recommended 3 dose of OPV 4 to 6 weeks apart. Pegging on its vow to revive the planet from its rampant situation of a crippling disease of children under five years of age in 1988 World Health Organisation (WHO) adopted a goal of polio eradication by the year 2000. Nepal is an active member country of WHO hence as a part of the global effort to banish the scourge from the surface of the earth by 2000, a national immunisation against polio began in Nepal four years ago. Similarly, 5th round of nation-wide anti-polio is just round the corner. To materialise the goal all set is ready. But as soon as the date of 5th year’s first round of intensive national immunisation day is approaching nearer doubt over it is looming large in the international health arena in general and Nepalese health care system in particular. According to another news report (Oct 27) from AFP source intitled "polio eradication goals threatened by use of live virus: Research" has put fourth question mark on immunisation against polio by attenuated live OPV. Till date, most of the countries are using OPV for immunising purpose either in routine immunisation period or in the time of mass vaccination.

Globally, it has been concluded that OPV after administration induces local as well as systemic immunity against the disease. OPV is a component of five, weakened and toxinless viruses prepared by highly advanced modern technology. When children are fed such vaccine viruses, they get immunity themselves, and besides, the vaccine viruses are excreted through their stool and may be disseminated in nature to kill or replace other wild disease causing polio viruses. As such, the importance of OPV is not only to develop immunity to a single child but also to cultivate vaccine viruses to overcome the disease causing wild polio viruses present in nature. But these logics are now being compromised by the use of live polio viruses that is enabling the polio viruses to return to the environment through stool excreted by the child who receive it. The news reports says 29 cases of polio viruses were detected from the samples taken from a sewage and river in Japan. These are all tested samples were taken from children who received OPV as an integral part of mass vaccination launched by their school. The search further clears that prior to take samples the stool excreted by the children were passed through their system and intered the sewage network. Besides most of the excreted samples were found highly virulent and active viruses after replicating in the gut of the children. But the report still fails to give more details about the pathogenicists of the viruses. As far as logic goes we must agree with the report, it is so because that the live but attenuated virus may be active if it gets suitable temperature and media to grow. In such a situation if anyone comes into direct contact with raw sewage, what would happen then? It is a matter of serious concern to all. Let alone the matter of the other hygienically advanced country, in the context of Nepal where there is absence of basic sanitation, what will be the result of the free flow of sewage, to the rivers located inside the Kathmandu valley alone? So long as we continue the process of immunisation with OPV the risk of polio virus to return to the society through infected faecal matter will still exist. Such type of conflict seen in the field of polio eradication through OPV are threatening the progress gained so far. In such a sceptical situation international health authorities like WHO, UNICEF and such other line agencies should not lag behind to clarify the doubt seen in this sector.

Curiosity

Lastly, it goes without saying that as the fixed date of immunisation days are approaching curiosity is increasing among the general public residing across the globe who are eager to know the facts published in news stories. In this regard international health agencies are also seen like mute spectators without showing any reaction regarding such confusion over OPV so far. In our context, the government is also turning a deaf ear. Such conflicting notion should be clarified as soon as possible otherwise it would take wrong attitude among the general mass. Since there is very little chance that individuals come into direct contact with waste matter from the child’s faeces who receives OPV, however, access to the sewage system and river is easy for many individuals. As such, the chances to be infected with oro-faecal route is likely more than expected.

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