Meeting with the District Health Management Team at Tarkwa.
Samuel Amo-Tachie1
doi: http://dx.doi.org/10.5195/ijms.2022.1490
Volume 10, Number 4: 429-431
Received 04 04 2022; Rev-request 05 05 2022; Rev-request 12 05 2022; Rev-recd 12 05 2022; Rev-recd 13 07 2022; Accepted 15 07 2022
ABSTRACT
Poliomyelitis is one of the diseases such as measles and dracunculiasis that can be eradicated, because it meets the criteria for eradicable diseases: being infectious, having humans as major host, effective vaccines or treatment available for disease control, and the availability of political and financial support for the eradication efforts. Ghana, along with the rest of the world, has already come far in the fight against polio, by reducing its incidence drastically (to zero as of now). The disease can only be prevented but not reversed, once infection results in paralysis and leaves victims permanently maimed, almost invariably reducing their quality of life. The recent outbreak (caused by a circulating vaccine-derived virus of the type 2 strain) was a call to pay more attention to the disease in order to realize the global aim of its elimination. All the attention needed by the disease is center around vaccination, which indeed was the tool to combat the outbreak that ensued in Ghana.
Keywords: Poliomyelitis; Vaccine; Poliovirus (Source: MeSH-NLM).
As final year medical students, we were fortunate to visit less privileged districts in the country, to observe the health management systems there. I happened to be in one such district (Tarkwa in the Western Region of Ghana) with a colleague during which time some cases of polio were recorded. Being exposed to such cases of public health importance involving children caused me heartbreak, disappointment and frustration. Even though we were not privy to the details of the affected children, it felt like a major battle was lost whenever we met with the District Health Management Team (Figure 1).
Figure 1.Meeting with the District Health Management Team at Tarkwa.
Poliomyelitis is a highly contagious, disabling, and potentially life-threatening disease of the nervous system.1 It has several manifestations, most common of which is paralysis, when it affects the spinal cord is involved. Affecting mainly children under 5, it usually results in irreversible paralysis. The associated paralysis and limb deformities have made it a deplorable morbidity. Researches necessitated by this epidemic in developed countries led to the development of the polio vaccines, which have dramatically decreased its incidence.2 This disease has neared eradication, as active transmission persists in just a couple of countries—Afghanistan and Pakistan.3 Ghana follows the Global Polio Eradication Initiative (GPEI) and had been polio-free for about a decade, until August 2019, when a case involving a 2-year old girl was confirmed in the North-East Region.4 About 30 more cases were then confirmed and investigations revealed that it was a circulating vaccine-derived poliovirus (cVDPV). Three of these 30 national cases were registered in the region that I visited.
Poliomyelitis meets the criteria for eradicable diseases: being infectious, having humans as major hosts, effective vaccines or treatment available for their control, and the availability of political and financial support for eradication efforts.5–6 The disease can only be prevented but not reversed, once infection results in paralysis and leaves victims permanently injured, almost invariably reducing their quality of life. Given that most cases occur in low socioeconomic settings (as the one I visited),7 these affected children are unable to achieve their full potentials because they do not have access to rehabilitation facilities.
Unchecked outbreaks could abate decades of expenditure channeled into its eradication—a major reason for furor in the public health world. Again, immunity to one strain of the virus does not confer immunity to another.8 This is what gave room for the emergence of the cVDPV (in Ghana) as we shifted from the use of the trivalent oral polio vaccine (OPV) to the bivalent one, which excluded the type 2 strain. There is history that should neither be relived nor forgotten—when up to 75,000 children were paralyzed from this infection all across the continent by 1996.7
The GPEI guidelines stipulate minimum response standards following notification of a new poliovirus, or the spread of poliovirus to a new geographic area or population. These include: detailed investigation and risk assessment, enhanced surveillance to increase sensitivity and confidence that any ongoing person-to-person spread of poliovirus is quickly detected, and vaccination response.9 These steps are effective and comprehensive; following them has saved many countries including Ghana. During my stay at Tarkwa, a mop-up vaccination exercise was being conducted to help curb the outbreak (this was a nationwide program), for which my colleague and I attended orientation programs organized for vaccination volunteers (Figure 2).
Figure 2.At the Orientation for Vaccination Volunteers.
The poliovirus is an enterovirus surrounded by a protein coat and no lipid envelope (making it resistant to harsh gastrointestinal conditions) with 3 strains: types 1, 2 and 3; with type 1 accounting for most cases. It is termed wild-type when acquired naturally and vaccine-derived when related to vaccinations. Administration of the OPV allows polioviruses to replicate for a while in the gut of the recipients and shed in stool, which is normal. Following eradication of the type 2 strain (and its removal from successive vaccines in 2016),10 the subsequent generation of children benefited from the herd immunity generated by the previous generation (who had received trivalent OPV) against type 2. However, with time, the efficacy of this herd immunity was lost, while some of those who had received the trivalent oral vaccine still shed the type 2 strain in their stool. Furthermore, some of the children had not received any polio vaccination. Children who were immunologically naive to this strain were exposed via the fecal-oral route, resulting in some developing severe polio, which could also be spread (resulting in the cVDPV). Successful spread of the cVDPV was facilitated by its mutability13 and insanitary practices, such as improper hand washing. Environmental sanitation officers performed laboratory testing on the sewage contents of some of the affected communities and found traces of the type 2 strain, indicating active shed in feces. This explained the mechanism of the outbreak, which was followed by mass immunization with OPV for Type 2. Following this exercise, there have been no new recorded cases, proving the effectiveness of vaccination.
I was amazed at the havoc that a disease like polio could cause, given the timing of this outbreak (which was in the 3rd quarter of 2020 shortly after lockdown restrictions for Covid-19 were eased). This is because during that time period, it seemed that the much feared and relatively novel COVID-19 had been muffled. We had just been allowed return to school but at that moment, paid less attention was paid to the pandemic and there was more focus on the protection of children endangered by the poliovirus epidemic. The atmosphere was lightened as we could actually make a difference in the lives of the affected children amidst the COVID-19 pandemic.
Polio is a global menace that has taken lives and maimed children for life. The worldwide effort that has culminated in its near-elimination could be annulled by even a hint of negligence to the threatening epidemic. Many other African countries that have experienced this cVDPV tragedy, are still threatened by polio. The furor about polio is not just a minor battle, but a potential global crisis. Vaccination is a simple, but concrete means of its complete eradication. Amendments to regular vaccination schemes in the face of such crises as well as implementation of all indicated regulations of the GPEI are all it takes to eliminate polio. We are near the pinnacle of a global achievement and need not rest now to climax our fight.
Polio is a disease that causes paralysis of children especially below age 5. It is uncommon these days because of mass immunisations done by various countries against the poliovirus, which is indeed a global effort to eradicate the disease. An outbreak occured in a number of countries, including Ghana, which was caused indirectly by vaccines. This was because the administration of the vaccines did not cause disease, but the resurgence of an old strain of the virus that existed in older versions of the vaccine caused this outbreak. This old strain was being shed by people, who had received the older vaccines, living in unhygienic conditions which facilitated the spread (as the virus is spread from stool to mouth). This outbreak caused concerns because polio is a devastating disease that is very preventable and even near eradication. This article addressed the depth of seriousness of the situation and the reason as to why this disease should not be neglected but fought to eradication.
The author wishes to commend the Head of Department of the Department of Community Health of the University of Ghana Medical School (Prof Alfred Yawson) for ensuring his safe transportation to the community where he got to have such a life-changing experience.
The Authors have no funding, financial relationships or conflicts of interest to disclose.
Conceptualization: SAT; Data Curation: SAT; Formal Analysis: SAT; Investigation: SAT; Methodology: SAT; Project Administration: SAT; Resources: SAT; Software: SAT; Supervision: SAT; Validation: SAT; Visualization: SAT; Writing – Original Draft Preparation: SAT; Writing – Review & Editing: SAT.
1. Centers for Disease Control and Prevention. What is Polio. Available from: http://www.cdc.gov; updated 2021 Sep 28; cited 2021 Nov 1.
2. World Health Organisation. [Internet]. Poliomyelitis (polio). Available from: http://www.who.int; updated 2020; cited 2022 Jan 1.
3. Centres for Disease Control and Prevention. Global Immunisation: Our Progress Against Polio. Available from: http://www.cdc.gov; updated 2021 Mar 28; cited 2021 Dec 20.
4. Ghana Health Service. Vaccine Derived Polio Virus (VDPV) Outbreak in the Chereponi District, North East Region. Ghana Weekly Epidemiological Report. 2019; 33(4).
5. Roser M, Ochmann S, Behrens H, Ritchie H, Dadonaite B. Eradication of Diseases. Our World in Data. Available from: http://ourworldindata.org/eradication-of-diseases; updated 2014; cited 2022 Jan 20.
6. Dowdle WR. The principles of disease elimination and eradication. WHO Bulletin OMIS. 1998;76 Suppl 2.
7. World Health Organisation Regional Office for Africa. [Internet]. Three African countries halt polio outbreaks. Available from: https//www.afro.who.int/news/three-african-countries-halt-polio-outbreaks; updated 2019; sited 2022 Jan 20.
8. World Health Organisation. Poliomyelitis. Available from: https://www.who.int/teams/health-product-and-standards/standards; updated 2004 Jan 1; cited 2022 Jan 3.
9. Odoom JK, Forrest L, Dunn G, Osei-Kwasi M, Obodai E, Arthur-Quarm J, et al. Interruption of Poliovirus Transmission in Ghana: Molecular Epidemiology of Wild-Type 1 Poliovirus Isolated From 1995-2008. J Infect Dis. 2012; 206(7):1111–20.
10. World Health Organization. Report of the SAGE Polio Working Group Meeting 7-8 September 2015. Geneva: The Organization; 2015.
Samuel Amo-Tachie, 1 First-year House Officer. University of Ghana Medical School/Korle-bu Teaching Hospital, Ghana.
About the Author: Samuel Amo-Tachie is currently a first-year house officer at the Korle-bu Teaching Hospital. He graduated from the University of Ghana Medical School. He speaks English and French and was awarded outstanding treasurer of his student fellowship on completion.
Correspondence: Samuel Amo-Tachie. Address: University of Ghana Medical School/Korle-bu Teaching Hospital, Ghana. Email: sammytach@gmail.com
Editor: Francisco J. Bonilla-Escobar; Student Editors: Natalia Galindo, Ciara Egan, Natalia Galindo; Copyeditor: Nikoleta Tellios; Proofreader: Joseph Tonge; Layout Editor: Anna-Maria Chantaliyska; Process: Peer-reviewed
Cite as Amo-Tachie S. Why the Furor about Polio?. Int J Med Stud. 2022 Oct-Dec;10(4):429-31.
Copyright © 2022 Samuel Amo-Tachie
This work is licensed under a Creative Commons Attribution 4.0 International License.
International Journal of Medical Students, VOLUME 10, NUMBER 4, July 2022