POST 00942E :THINKING THE UNTHINKABLE

POST 00942E :THINKING THE UNTHINKABLE Follow-up on Posts 00917E, 00923E, 00931E and 00937E 17 June 2006 ____________________________________________________________ B. K. Suvedi (mailto:[email protected]) from Nepal contributes to the discussion with a number of questions. ______________________________________________________________ Dear Technet Members, The recent brain-blowing contributions from experts and attached materials has stimulated me to ask few questions to the experts. These are on the background of our own experience, as follows: Nepal initiated National Immunization Days in 1996 targeting all children under five years of age. The coverage was above 95% and the NIDs continued till 2004. NIDs were stopped after 2004 following TCG recommendations. Nepal remained polio free since November 2000 till 2005. In 2005 we had few "imported" cases in the bordering districts. This year, we have detected a wild poliomyelitis case in a 17 year old male in a hill district far from bordering district. He had never travelled out of his home area but got the infection. It is raising many questions with regard to "eradication" that we did not try to answer in the past. 1. The infection has occurred in an "adult", beyond the targeted "surveillance" age group (under 15 years). 2. The infected person did not receive any polio vaccine because he did not fall in targeted age group during NIDs and more questionably during the (three-dose) routine immunization before 1990. 3. The topography of Nepal and the scarce population therein does not epidemiologically permit the virus to sustain for five years in some or other locality. 4. The poor hygienic/sanitation conditions (with a practice of defecating along the foot-trail or riverside or nearby source of water) has never been considered an important strategy to "contain" the virus. 5. The foot-trails/routes to travel from/to mountains/hills to/from Terai (flatland and to India) are usually along the streams/rivers. Fecal contamination is a greater possibility from an infected person (apparently without symptoms) travelling the route from an infected area and shedding the virus and consequently infecting "immunization-naive" population. 6. The un-targeted ("aged") population in the hills and mountaionous area, who probably have been "naive" to the wild poliovirus for at least few decades, if not centuries, travelling to "endemic" area might be infected and bring back the infection with all possibility to infect many more "naive" persons (correlate with point 4 and 5). 7. Many of the "endemic areas" have poor systems in terms of hygiene and sanitation. So, can only vaccine help in addressing the issue of poliovirus transmission. In such a scenario, targeting under 5 children (with whatever vaccine: mono or tri-valent, large scale or small scale, WHA 117th Session, EB 117 R1) might be a self-deceiving measure if older chidren and "adults" are not targeted. Besides, when are we going to talk about hygiene and sanitation as one of the prime measures in such places? Is not poliomyelitis transmitted by fecal-oral route (basically a hygiene/sanitation question) and can we forget about it? Reagrds to all. Dr. B. K. Suvedi Nepal ______________________________________________________________________________ Visit the TECHNET21 Website at http://www.technet21.org You will find instructions to subscribe, a direct access to archives, links to reference documents and other features. ______________________________________________________________________________ To UNSUBSCRIBE, send a message to : mailto:[email protected] Leave the subject area BLANK In the message body, write unsubscribe TECHNET21E ______________________________________________________________________________ The World Health Organization and UNICEF support TechNet21. The TechNet21 e-Forum is a communication/information tool for generation of ideas on how to improve immunization services. It is moderated by Claude Letarte and is hosted in cooperation with the Centre de internationale en sant, Canada (http://www.ccisd.org) ______________________________________________________________________________