Pioneer international consultant on the Global Poliomyelitis Eradication Initiative, Dr. Kayode Osagbemi, talks to MOTUNRAYO JOEL on how to guard against a re-emergence of polio in Nigeria
Now that Nigeria has been declared polio-free, are there health implications for Nigerians?
The correct status is that Nigeria has been removed from the list of polio endemic countries globally. This means the transmission has been interrupted in Nigeria. This is because there have been no new cases for just over a year now. To be certified polio-free, the country has to maintain this status for at least two more years. To achieve this, there has to be active surveillance throughout the country. Active surveillance means we have to search for cases of poliomyelitis continuously all over the country from the remotest to the most urban parts of the country. It has to be scientifically proven that there are no new cases in any nook or cranny of Nigeria for three continuous years before we can achieve World Health Organisation certification. The process of active surveillance involves everybody being on the look out for any sudden weakness of any of the limbs (arms and/or legs) with rapid onset occurring in children aged 15 years or below. All cases of such sudden weaknesses that are not due to physical injuries should be reported to the nearest health facility. Health workers throughout the country are being trained and retrained to be able to investigate such cases appropriately as soon as they are reported.
There are other viral infections that may mimic polio infection and these are still endemic in Nigeria. If we maintain adequate vigilance and report all these cases to the nearest health facilities, proper investigation and laboratory test would be carried out to determine if the weaknesses are due to polio virus infections or not. If we see many cases of weakness that are traceable to other causes apart from polio virus, we can then confidently say polio is no longer present in the country. This process has to be ongoing for three years without a single case of wild polio virus before we can attain WHO certification.
The health and social benefits or implications of polio eradication in Nigeria include the fact that we can join the rest of the world in the global feat. The debilitating effect of the disease on the affected persons is considerable. The effects on the family and the society at large will also become minimal if eventually the country is certified polio- free. A lot of resources in terms of money, manpower and materials have been committed into the Global Poliomyelitis Eradication Initiative in the past three decades. These efforts can be geared towards the control and prevention of other communicable and non-communicable diseases in Nigeria when eventually we are certified polio-free. The common sight of crippling effects with the social and psychological consequences would also reduce in Nigeria after the final eradication.
What else needs to be done to prevent re-emergence?
The interruption of transmission was achieved through sustained efforts on routine immunisation, supplemental or booster extra doses of immunisation, continuous active surveillance and active mop up vaccination when cases of paralysis were traced to the wild polio virus. Routine immunisation is the regular doses of the vaccine given to infants or children within one year after birth while supplemental doses are given to children five years and below as booster or extra doses irrespective of their routine immunisation status. Active surveillance is the ongoing vigilance in all parts of the country in order to promptly detect and report all sudden weaknesses to health care workers for appropriate investigations and test. If any weakness is found to be due to wild polio virus infection, another round of immunisation activities would need to be carried out within the locality of the confirmed case in order to mop up in case there may be hidden or yet-to-be manifested cases in the area. These strategies have been implemented globally including Nigeria in the past three decades before we got to where we are currently. These, therefore, have to be sustained vigorously especially the routine immunisation in order to prevent re-emergence of the wild polio virus in Nigeria. This is not the time to fold our arms and think we are there. Any single case hiding in any part of the country can still spell doom if not detected and prompt actions taken. Community and laboratory based researches focussed on poliomyelitis are important in order to maintain the eradication status we have attained so far.
The poliomyelitis partners including community members, government at all levels, WHO, UNICEF, Rotary International and the various foundations should sustain their efforts until final global eradication is achieved. Health workers, religious and traditional leaders as well as the media should continue to mobilise the populace to encourage mothers of children aged one year and below to present their infants for routine immunisation for poliomyelitis and other vaccine preventable diseases.
Explain how the virus is transmitted?
Poliomyelitis is a musculoskeletal disease caused by a virus known as polio virus. It commonly affects the nerves of muscles of limbs that is arms and legs but in some cases may affect nerves of the muscles of respiration. Most of the infections go unnoticed manifesting as mild fever and disappear on their own. It is only a few cases that result in the paralysis of the affected limbs. By the time the paralysis sets in, the serious damage has been done leaving the main option of care to be physiotherapy. The infection is spread from person to person through the faeco-oral route. This implies that the virus infects the guts or digestive system of the affected person. The affected person can shed the virus in his or her stool. If the infected stool contaminates food or drinks such as water, the food or drinks become infectious to other people who may consume such contaminated products.
Constant vaccination is important, how can this be enforced in different parts of the country especially in the northern areas?
The strategies put in place to ensure optimal availability; access and acceptability of vaccination include the creation of sensitisation and awareness among parents of eligible children within the first year of birth. Sensitisation and awareness can be strengthened with the help of the mass media as well as religious and traditional leaders. However, if any child misses any of the doses within the first year of life, such a child is still considered for immunisation with the vaccine but the recommended period is the first year. Other measures include immunisation outreaches and mobile trips carried out by health care workers who move to areas that are considered hard to reach particularly due to geographical and difficult terrains. In many instances, health care workers have gone from house to house in order to administer the oral polio vaccines among eligible children. The government at all levels should also play their roles in ensuring the availability of the vaccines at all times and provide the enabling environment including logistics support to enable health care workers carry out these activities.
Some tribes think that polio vaccination causes disability in children….?
The eradication programme suffered some setback in the past due to rumours in some parts of the country. These rumours have not been proven and the vaccine is considered safe by the relevant international health organisations.
How is the vaccine administered?
There are two type of polio vaccine. The oral polio vaccine, which is administered by mouth and the injectable polio vaccine, is given through the intra muscular route. Both are available in the country and are considered effective and safe. Currently, the oral type is the one in general use nationwide.
Are there disadvantages or side effects to the polio vaccine?
There may mild body temperature changes after vaccination. Serious reactions are very rare and the vaccine is considered very safe to be administered among children.
Apart from vaccination, how can it be prevented?
The most effective prevention and control measure is the strengthening of routine immunisation among the eligible children whereby, appropriate numbers of vaccine doses are given within the first year of life. Health workers should educate mothers and caregivers to make sure the children are brought to the health facilities to complete all the required doses. This is because incomplete vaccination cannot confer effective immunity on the child. Since it is a disease transmitted via the faeco- oral route, food, water and personal hygiene in homes and community levels are also important in the control of polio.
By the time Pakistan and Afghanistan are declared polio-free, would this mean that the world is finally polio free?
Yes. After that, Nigeria can join the rest of the world in the celebration of a world without polio.
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