Socioeconomic status and vaccine coverage during wild-type poliovirus emergence in Israel.

In August 2013, a nationwide vaccination campaign with bivalent oral polio vaccine (bOPV) was initiated after isolation of wild-type poliovirus type 1 (WPV-1) in routine sewage surveillance in Israel. The campaign started in the Southern district and later extended to the entire country. This study examined the association between socioeconomic status (SES), and compliance with bOPV vaccine during the campaign. Nationwide data relating to SES by geographical cluster were correlated with vaccine coverage rates in the same areas. All analyses were conducted separately for Jews and Arabs. Coverage with the bOPV vaccination campaign in the Arab population (92·4%) was higher than in the Jewish population (59·2%). This difference was consistently present in all SES clusters. In the Jewish population there was an inverse correlation between SES and vaccination coverage rates (R = -0·93, P < 0·001). Lower vaccination coverage with supplemental vaccine activities in higher SES groups is a challenge that needs to be addressed in future public health events and emergencies in order to achieve satisfactory protection rates for the public.

Survey of young patients with polio and a foreign background at a Swedish post-polio outpatient clinic.

Nowadays, polio survivors aged under 60 years are non-native Swedes which pose new aspects and challenges to a post-polio outpatient clinic. To analyze the medical data, walking aids, occupational, and family situation in non-native polio survivors aged less than 60 years at a Swedish post-polio outpatient clinic. Retrospective data analysis. Data were retrieved from medical records at the post-polio outpatient clinic. Actual age, age at acute polio infection, walking capacity, pain, concomitant diseases, working and family situation, and ethnical origin were analyzed. Data are presented in numbers and percentage. 153 patients were included. Mean age was 45 (17-60) years, and mean age at acute polio infection was 2 (0-12) years. Paresis of the lower extremities was the most common disability. 10 % were wheelchair dependent. Pain occurred in 70 % with a mean intensity of 55 measured with the visual analog scale. Hypertension was the most common concomitant disease. Half of the polio survivors were working at least part time, and roughly half were singles. Data were comparable with data earlier published in Swedish native polio survivors. Non-native polio survivors aged under 60 years showed similarities in age at acute polio infection, paresis, prevalence, and intensity of pain when compared with native Swedish polio survivors. They were, however, younger, and were less often working and married/cohabitants than native Swedish polio survivors. The results of this study underline the importance of social and vocational rehabilitation tailoring rehabilitation suitable for polio survivors with a foreign background.

[Poliomyelitis--Challenges for the Last Mile of the Eradication Programme]. / Poliomyelitis--Herausforderungen in der Endphase des globalen Eradikationsprogramms.

The World Health Organisation initiated the Global Polio Eradication Initiative in the year 1988. With the large-scale application of routine and mass vaccinations in children under the age of 5 years, polio disease has become restricted to only 3 endemic countries (Afghanistan, Pakistan and Nigeria) by today. However, since the beginning of the 21st century, increasing numbers of secondary polio epidemics have been observed which were triggered through migration, political turmoil and weak health systems. In addition, there emerged serious technical (e. g., back-mutations of oral vaccine virus to wild virus) and socio-political (refusal of vaccinations in Muslim populations of Nigeria and Pakistan) problems with the vaccination in the remaining endemic countries. It thus appears questionable if the current eradiation initiative will reach its goal in the foreseeable future.

The Global Context of Vaccine Refusal: Insights from a Systematic Comparative Ethnography of the Global Polio Eradication Initiative.

Many of medical anthropology's most pressing research questions require an understanding how infections, money, and ideas move around the globe. The Global Polio Eradication Initiative (GPEI) is a $9 billion project that has delivered 20 billion doses of oral polio vaccine in campaigns across the world. With its array of global activities, it cannot be comprehensively explored by the traditional anthropological method of research at one field site. This article describes an ethnographic study of the GPEI, a collaborative effort between researchers at eight sites in seven countries. We developed a methodology grounded in nuanced understandings of local context but structured to allow analysis of global trends. Here, we examine polio vaccine acceptance and refusal to understand how global phenomena-in this case, policy decisions by donors and global health organizations to support vaccination campaigns rather than building health systems-shape local behavior.

Parental perceptions surrounding polio and self-reported non-participation in polio supplementary immunization activities in Karachi, Pakistan: a mixed methods study.

OBJECTIVE: To assess parent's knowledge and perceptions surrounding polio and polio vaccination, self-reported participation in polio supplementary immunization activities (SIAs) targeting children aged < 5 years, and reasons for non-participation. METHODS: The mixed methods study began with a cross-sectional survey in Karachi, Pakistan. A structured questionnaire was administered to assess parental knowledge of polio and participation in polio SIAs conducted in September and October 2011. Additionally, 30 parents of Pashtun ethnicity (a high-risk group) who refused to vaccinate their children were interviewed in depth to determine why. Descriptive and bivariate analyses by ethnic and socioeconomic group were performed for quantitative data; thematic analysis was conducted for qualitative interviews with Pashtun parents. FINDINGS: Of 1017 parents surveyed, 412 (41%) had never heard of polio; 132 (13%) did not participate in one SIA and 157 (15.4%) did not participate in either SIA. Among non-participants, 34 (21.6%) reported not having been contacted by a vaccinator; 116 (73.9%) reported having refused to participate, and 7 (4.5%) reported that the child was absent from home when the vaccinator visited. Refusals clustered in low-income Pashtun (43/441; 9.8%) and high-income families of any ethnic background (71/153; 46.4%). Low-income Pashtuns were more likely to not have participated in polio SIAs than low-income non-Pashtuns (odds ratio, OR: 7.1; 95% confidence interval, CI: 3.47-14.5). Reasons commonly cited among Pashtuns for refusing vaccination included fear of sterility; lack of faith in the polio vaccine; scepticism about the vaccination programme, and fear that the vaccine might contain religiously forbidden ingredients. CONCLUSION: In Karachi, interruption of polio transmission requires integrated and participatory community interventions targeting high-risk populations.

A polio intervention in East African refugees to NSW.

This paper summarises a public health intervention in Sydney, NSW in late 2006 that resulted from the potential exposure of a number of refugees to polio virus while in transit in Nairobi, Kenya. The intervention involved the attempted follow-up of 113 persons at risk, assessment for symptoms and immunisation where indicated. No symptomatic cases were found. Seventy-five people were immunised with inactivated poliomyelitis vaccine. The intervention highlighted the importance of close collaboration between health services, the Department of Immigration and Citizenship and settlement service agencies, and provided several lessons to consider when assessing newly arrived refugees.

Mexican American women aging with childhood-onset paralytic polio.

In this study the life histories of 11 Latinas of Mexican American descent aging with permanent impairment related to childhood-onset paralytic polio were explored. These women, age 45 to 62 years, were interviewed 3 times each. Field notes, audiotaped interviews, life course charts, and demographic data were used to collect data chronicling childhood to present day. In the results we present a thematic representation of the societal and cultural influences on the life course trajectories of these women.

Race and the politics of polio: Warm Springs, Tuskegee, and the March of Dimes.

The Tuskegee Institute opened a polio center in 1941, funded by the March of Dimes. The center's founding was the result of a new visibility of Black polio survivors and the growing political embarrassment around the policy of the Georgia Warm Springs polio rehabilitation center, which Franklin Roosevelt had founded in the 1920s before he became president and which had maintained a Whites-only policy of admission. This policy, reflecting the ubiquitous norm of race-segregated health facilities of the era, was also sustained by a persuasive scientific argument about polio itself: that Blacks were not susceptible to the disease. After a decade of civil rights activism, this notion of polio as a White disease was challenged, and Black health professionals, emboldened by a new integrationist epidemiology, demanded that in polio, as in American medicine at large, health care should be provided regardless of race, color, or creed.

Reducing resistance against polio drops.

AIMS: The present study was carried out to impart correct health education regarding polio eradication programme and to assess the impact of social mobilization of a Muslim community carried out by medical interns. METHODS: One round of a polio immunization campaign was selected randomly. Five highly resistant areas were included in the study. During house to house A-Team activity, teams of health workers visited the houses and resistant families were identified. These families refused to give polio drops to their children. On the second day of A-Team activity, medical interns visited those identified resistant families. They imparted correct health education and tried to convince them to give polio drops. However, after prolonged persuasion, some of the families were not ready to give polio drops. These more resistant families were again visited by more motivated and enthusiastic teams during B-Team activity, started two to three days after the completion of A-Team activity. Data were collected, tabulated and analysed. RESULTS: Total number of resistant families identified during house to house A-Team activity was 1025 in five high risk areas of Aligarh, India. Out of 1025 resistant houses, 510 (49.76%) houses were converted to P houses where polio drops were given to the children. Five hundred and fifteen (50.24%) houses remained resistant even after social mobilization by A-Team members. These most resistant houses were again visited by B-team members. Out of these 515 houses, polio drops were administered in 303 (58.83%). The overall number of converted houses was 813 (79.32%) after A and B-team activities. 20.68% of families remained resistant and their children could not be given polio drops. CONCLUSIONS: In all high risk areas, maximum numbers of resistant houses were converted to P houses. These families were persuaded and convinced by the teams of interns, social workers and influential persons that polio drops did not have any side effects. They were more receptive to the advice given by medical interns compared to other staff members of the Government District Hospital because of quality of health services provided to the community. There is a need to impart correct health education regarding importance of polio drops and routine immunization more vigorously through information, education and communication (IEC) activities.

Post-marketing surveillance study to assess the safety and tolerability of an Inactivated Poliomyelitis Vaccine in Indian children.

OBJECTIVE: To evaluate the incidence of adverse events following administration of an Inactivated poliomyelitis vaccine (IPV) manufactured by Serum Institute of India Pvt. Ltd., Pune, India. METHODS: A single 0.5 ml dose of the IPV was administered intramuscularly to children attending private clinics or out-patient department of hospitals for routine immunization across different cities in India. They were observed over a period of 30 d for local or systemic adverse events and rare case of anaphylaxis, if any. RESULTS: A total of 2210 children were enrolled of which 2120 children received the vaccine within primary immunization series and 90 children received booster dose. The common adverse events reported were pain, erythema, swelling and fever. No serious adverse event was reported during the study period. CONCLUSIONS: Poliomyelitis vaccine (Inactivated) manufactured by Serum Institute of India Pvt. Ltd., Pune can be safely administered to children following the Expanded Programme on Immunization or World Health Organization recommended immunization schedule.

Analysis of historical epidemiological data to guide intervention policy in the face of an infectious disease outbreak: poliomyelitis in Israel in 1988.

During the 1988 outbreak of 15 cases of Type 1 poliomyelitis mainly among previously vaccinated young adults in Israel, there were conflicting views on the need for and timing of mass vaccination. Since there was a possibility that the initially localized outbreak may spread more widely, it was felt that an early decision on vaccination policy should be made. Public health officials were faced with varied interpretations of the existing data on the extent of the immune status of the population; some indicating that as many as 15% of young adults lacked immunity to the Type 1 virus. Two major questions posed were whether or not the outbreak was a purely localized event in a single subdistrict, and whether the seasonality of the disease would limit its spread. Based on historical data, probability analysis of three cases occurring outside the subdistrict at the time of the outbreak suggested more widespread dispersion of the virus. Further analysis indicated very limited seasonality of the disease in this region, suggesting that the onset of colder weather would have little impact on the spread of the virus. Careful analysis of the local epidemiology of the disease is an important tool for guiding urgent decisions on mass intervention policy in outbreak situations.

Reminiscences of poliomyelitis past.

The article by Markel in the new Historical Perspectives of Pediatrics section of the ARCHIVES brings back a flood of memories, as I belong to the generation of pediatricians who actually used tank respirators in treating patients with poliomyelitis. In 1949, the city of Baltimore, Md, closed its contagious disease hospital (Sydenham), which served all of Maryland, and transferred its function to the Baltimore City Hospitals. The reasoning, in addition to a very low occupancy rate at Sydenham, was that the only contagious disease then likely ever to occur in epidemic form was poliomyelitis.

Immunity status to polioviruses among non-European union immigrants in Veneto Region (North-East Italy).

Widespread use of poliovirus vaccines has lead to a dramatic decline on the incidence of paralytic poliomyelitis in the Western Hemisphere. In Italy, the use of live attenuated vaccine (OPV) has lead to virtual eradication of poliomyelitis. However, wild poliovirus is still endemic in some less developed countries, and there is still a risk of importation of wild-virus poliomyelitis as result of immigration from these areas. Therefore, a serologic study of the immunologic status to poliovirus was carried out in 242 immigrants from less developed countries in the Veneto Region (North-East Italy). The overall prevalence of serum neutralizing antibodies was 98.3 percent for poliovirus type 1, 99.6 percent for type 2, and 95.9 percent for type 3. The modal titres were 1:128 (21.1 percent), 1:512 (26.4 percent), and 1:32 (22.3 percent) for poliovirus type 1, type 2, and type 3, respectively. No subject was simultaneously lacking neutralizing antibodies to all three polioviruses. The mean duration of stay in Italy before testing was 1.53 years (range 1 month to 7 years). These results show a good level of the immunity status, similar to those found in the Veneto general population. Although the risk of paralytic poliomyelitis in our population is very low, seronegative immigrants originating from areas of high endemicity could reintroduce wild poliovirus. It is therefore important to maintain a careful surveillance system on the importation of wild poliovirus and to plan vaccination programs for unprotected immigrants.

Eradication of poliomyelitis in Bulgaria--problem encountered.

The authors analyze the effectiveness of the National Vaccination Programme with regard to poliomyelitis eradication in Bulgaria and the difficulties encountered in the 1980s and at the beginning of the 1990s. An account is presented on the eradication achieved, interrupted by an outbreak of 46 cases in 1991. The critical analysis points out the negative influence of several factors, disrupted by the failure in 1991. Based on these fact conclusions are drawn on a prolongation of the period needed to achieve the Eradication Programme goal. The main reasons for the delay are as follows: the intensive migration process, the existence of small non-immunized groups of population (gipsy population) as well as some shortcomings in the organization of the health services. According to the authors, stricter epidemiologic supervision is imperative for the country as well as coordination of similar approach to the problem in countries of the region.

Deconstructing social resistance to pulse polio campaign in two North Indian districts.

OBJECTIVE: To gain an insight into the phenomenon of social resistance and rumors against pulse polio campaign. DESIGN: Qualitative, community-based investigation, mapping perceptions of various stakeholders through in-depth interviews (IDIs), focus group discussions (FGDs), non-formal interactions and observations. SETTING: Moradabad and JP Nagar districts of Uttar Pradesh. SUBJECTS: IDIs (providers 33, mothers 33, community leaders 10); FGDs (providers 4, mothers 8) and non-formal interactions (156) with community leaders, parents, businessmen, journalists (Hindi and Urdu media), mobilizers, vaccinators and supervisors. RESULTS: A distinct machination of social resistance and rumors against oral polio vaccine during supplementary immunization activities (SIA) was observed in some minority dominated areas. The pattern can be understood through a model that emerged through qualitative evidence. Inspite of all this, most parents in minority areas supported the SIAs. Only a few clusters from extremely marginalized sections continued to evade SIAs, with an endemic pattern. Through social osmosis, these rumors reached majority community as well and some parents were affected. However, in such cases, the resistance was sporadic and transient. CONCLUSION: While the programs focus was on microbiological issues, the obstacles to polio eradication lie in the endemicity of social (and/or cultural) resistance in some pockets, leading to clustering of perpetually unimmunized children - inspite of good coverage of SIAs at macro level. This may sustain low levels of wild poliovirus transmission, and there can be exceptions to the robustness of the pulse approach. A micro level involvement of volunteers from marginalized pockets of minorities might be able to minimize or eliminate this resistance.

[Epidemiological and virological studies into the poliomyelitis in Valencia (1959-1969)]. / Estudios epidemiológicos y virológicos sobre la poliomielitis en Valencia (1959-1969).

Studies into the polio virus began in Valencia in 1959 with the work undertaken by the microbiologist Vicente Sanchis-Bayarri Vaillant. After his education at the Rochester University and at the Pasteur Institute, Sanchis-Bayarri Vaillant established a laboratory of cell cultures at the Faculty of Medicine in Valencia, where he developed a new diagnostic technique for the poliomyelitis virus. In addition, epidemiological studies were carried out both prior to and post the 1963 vaccination campaign, which proved that Sabin's oral vaccine was both effective and safe for use.