by Matthew Bowdish, MD
The World Health Organization (WHO) reports that approximately 180 Nigerian children have become paralyzed by polio as a result of widespread vaccination efforts in Africa’s most populous country. The outbreak is from the use of an oral polio vaccine (OPV) that contains a live-attenuated form of the poliovirus.
OPV was initially developed by Albert Sabin in the 1950s. A live-attenuated poliovirus vaccine is ingested and stimulates the lymphatic tissue in the gut to resist future infections since the gastrointestinal tract is the major transmission route for natural poliovirus.
The oral vaccine is also preferred in developing nations due to its cheap production costs, easier administration (i.e. no needles/syringes required) and better efficacy than the injected killed virus vaccine used in the developed world.
However, the use of live-attenuated poliovirus vaccine has its downsides. Live virus is processed in the gut and then passed out via defecation into the environment. If the virus mutates and if public sanitation is unavailable, then infective virus can be spread to other non-vaccinated children. This seems to be the case in Nigeria.
Vaccine-derived poliovirus (VDPV) infection can occur in countries using OPVs and public health officials need to weigh the risks of this iatrogenic infection with the overall disease burden. So while 42 million people have been vaccinated against polio in Nigeria, around 180 children have been paralyzed over the last two years.
This episode may also have implications for Nigeria’s large Muslim minority, which has been reluctant to take part in vaccination efforts due to concerns about adverse effects, the unfounded fear of vaccines contaminated with HIV and due to Muslim distrust of the international organizations involved in promoting the vaccine program.
I also wonder whether anti-vaccination advocates in the developed world will use the Nigerian program as fodder for their own opposition to other vaccines such as MMR, which they claim to be the cause autism and other disorders.
Matthew Bowdish is an allergy and clinical immunology specialist.
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Nigerian fears over the agendas of global health campaigns are not completely unfounded — take, for example, Pfizer’s experimental trial of the meningitis drug, Trovan, which in 1996 was administered without consent to children in northern NIgeria in the midst of an epidemic, dozens of who died or were disabled.
Polio vaccination projects take place in communities that often have limited or no access to clinics, drug dispensaries, or clean water. Infant and child mortality rates are among the highest in Africa. Vaccine refusal [regrettably] became one of the ways through which northerners and their leaders could express their discontent over these larger inequalities, and attain global attention.
Basic questions such as, “why is their one type of vaccine for the developed world and one for the developing world?” and “Why are American agencies far more concerned with HIV and polio in Nigeria than with other disorders?” invite understandable suspicions.
I have no doubt that these findings could exacerbate polio eradication goals, but I think the more important question is whether they will do anything to challenge the political will to address these basic infrastructure issues? Or will the debate — as usual — end up in a quagmire of Muslim/Christian accusations?
http://www.tuskegee.edu/Global/Story.asp?s=1207598
I think the mistrust is worldwide and not related only to religion. It is also related to the race, socioeconomic state,….
I remember this study done for follow up of syphilis over decades in America. Finally, a group was not treated intentionally, and given just placebo. This is mistrust due to race.
In Nigeria, I have no full data to know if it is related to religion or no. but taking the same principle, who could believe untruthful health care researchers again?
As an African doctor, I can tell you some people do not trust health care givers esp. foreigners. Lack of ethics is one reason. Whatever it is well known vaccine or new one. Tell me where you are doing your first trials.
As I understand it, we switched to IPV when it became clear that the only polio we saw in the USA was vaccine-induced by the live, attenuated virus.
I don’t know where Africa stands with polio. Is there any polio from wild virus anymore? Maybe they need IPV too.
Is there any information on a possible adverse effect of the seasonal and/or H1N1 vaccine on persons who had polio in childhood (ages 3 and 10) and in their 60s now? The polio treatment in early 50s was B-vitamin shots and combination of traditional and folk medicine.
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