Africa defeats wild poliovirus: vaccine-derived poliomyelitis remains

Wild (natural) poliovirus is officially considered defeated on the African continent. These lands have been declared free from the disease that has killed thousands of children. This disease causes paralysis and a number of other complications. Writes about it with the BBC.

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Despite the huge success, rare cases of poliomyelitis in Africa do occur, but it is a vaccine disease, not a natural one, which almost never leads to paralysis.

Evidence that natural poliovirus is no longer in Africa has been confirmed by the Regional Certification Commission, an independent body created by the World Health Organization (WHO) to combat polio.

The last time a child fell ill with poliomyelitis was four years ago in Nigeria; since then, experts have officially confirmed that the virus is no longer observed in 47 countries of the African continent. In the past, about 75 African children suffered from this disease every year.

Today, this virus can still be found in two countries - Pakistan and Afghanistan.

What is known about polio

The first symptoms accompanying this disease are high fever, lethargy, headache, nausea and vomiting, neck stiffness, and joint pain. Further, the virus hits the nervous system and begins to progress rapidly - after a couple of hours it can lead to paralysis.

Irreversible consequences are noted in one child out of 200 infected. About 5-10% of these patients die because the paralysis blocks the respiratory muscles.

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Unfortunately, there is no effective treatment for those infected with polio, but vaccinating children gives life-long protection against the disease.

Nigeria suffered the most from poliovirus. Just 10 years ago, it had more than half of all polio cases reported worldwide. This country was the last in Africa to overcome the disease.

The vaccination campaign in Nigeria was extremely difficult and required tremendous efforts from both the authorities and doctors. Getting to remote villages was very dangerous and difficult, largely due to the fact that the armed population could kill without asking who had come and why. Many doctors gave their lives for this.

What polio continues to live

Two of the three strains of natural poliovirus have long been defeated by humanity. On Tuesday, August 25, Africa was declared free of the third and last strain. As you know, the disease spread mainly through water.

As of August 2020, over 95% of the African population is vaccinated against polio. This was the main condition for the continent to be recognized as free from the natural form of the virus in question.

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Despite this, vaccine-derived poliomyelitis (also called cVDPV) is still living in Africa. It is a rare form of the disease that results from a mutation of a weak virus that is the main building block of an oral vaccine.

According to WHO, with an extremely low level of immunization of citizens, the weakened vaccine virus excreted from the body can continue to live for a long period.

“In very rare cases, the vaccine virus may genetically change into a form that can cause paralysis,” WHO officials say. It is clarified that the risk of suffering from cVDPV is low.

Since the beginning of 2020, according to WHO, the mutated virus has been identified in 177 people in Nigeria, the Democratic Republic of the Congo, the Central African Republic, and Angola.

In Africa, doctors recorded 2019 cases of cVDPV in 320. In 2018, this figure was 68. According to experts' forecasts, in 2020 the wave of morbidity may still grow, due to the cessation of immunization in many regions. This is triggered by the coronavirus pandemic.

How Africa coped with poliovirus

Despite the fact that mankind does not know how to treat polio, in 1952 Dr. Jonas Salk created a vaccine that gives the body immunity. So, children all over the world have a hope to protect themselves from the disease.

In 1962, Albert Sabin developed an oral polio vaccine that became life-saving for children around the world.

According to official figures, in 1996, polio paralyzed 75 African children. Moreover, the disease was widespread in all countries of the continent. In the same year, Nelson Mandela informed the people about the launch of the campaign "Drive Polio from Africa". Hundreds of thousands of doctors moved from village to village, vaccinating children.

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Many community organizations provided financial assistance, including the Rotary Club, which was instrumental in vaccinating the population against polio in the 1980s.

Beginning in 1996, billions of doses of vaccine have been shipped to Africa. According to experts, this has prevented more than 1,8 million cases of the disease.

Islamists and current rumors

The last communities at risk of contracting polio were in remote regions of Africa that were difficult to reach for immunization campaigners.

The last officially reported case of natural poliovirus infection occurred in 2016 in Borno State (northeastern Nigeria). It is a remote region that serves as a stronghold for the Islamist terrorist group Boko Haram.

It was then a huge disappointment for the entire continent, because Nigeria has achieved great results in the fight against poliovirus and has already lived for several years without new infections.

Armed conflicts with Boko Haram have made a number of regions of Nigeria, in particular Borno State, inaccessible. About two million residents were forced to leave their homes.

Medical staff, 95% of whom were women, risked their lives by boating through war zones to remote settlements along Lake Chad. They also suffered from rumors and mass misinformation.

Due to this situation, in 2003 in Kano State and several other areas in northern Nigeria, immunization had to be suspended. Muslim preachers taught the population that there was a component in the vaccine that made women sterile, that this was a great "American conspiracy against Muslims."

Due to the spread of rumors, experts in Nigeria conducted a series of laboratory tests that proved the absence of any harmful component that causes infertility. After the official announcements, vaccination continued.

In 2013, nine female medical workers were killed in Kano State while vaccinating. Most likely, the blame lies with the Boko Haram militants.

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How survivors fostered immunization

Nigerians paralyzed by polio were able to defeat prejudices and win the trust of local residents.

“Many people refused to get vaccinated, but they saw how difficult it was, literally crawling, for us to get to them to talk,” says Misbahu Lawan Didi, chairman of the Nigerian Association of Polio Survivors. “We asked: “Do you want to protect your children so that they don’t become like us?”

It is not only the victims of the disease that have risen to the fight against polio. The huge social coalition of fighters included tribal leaders, religious leaders, school teachers, parents, many volunteers and doctors. Only together they were able to reach the most remote corners and vaccinate children.

Outside of Nigeria, the last case of poliovirus infection in Africa was in the Somali province of Puntland in 2014.

Will poliovirus make a comeback?

The natural polio virus has not been completely destroyed on the planet. If it gets into a country free from it, it will quickly spread among the unvaccinated population. This is exactly what happened in Angola, which, despite the civil war, defeated polio back in 2001. So, in 2005, a new outbreak was recorded there, most likely of a foreign poliovirus.

The WHO insists that extreme measures are necessary before the complete global eradication of poliovirus, including vaccine origin. If vaccination is stopped and the protection of children is weakened, the terrible disease can return and scatter around the world.

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