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Parental fears block polio eradication

19th November 2012

One of the last obstacles to the eradication of polio is fear of the vaccine itself, according to health experts.

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Immunisation is sorely needed in Nigeria, Afghanistan and Pakistan where polio is endemic, but safety concerns and religious sensitivities are hampering uptake of the polio vaccine among parents, according to presentations at a conference in the United States.

While the incidence of polio, caused by three naturally occurring varieties of polioviruses, is declining worldwide, the number of cases has surged in Nigeria on the back of parental fear.

According to experts addressing the annual conference of the American Society of Tropical Medicine and Hygiene (ASTMH) in Atlanta, the battle against polio is not yet won, in spite of a global reduction in polio cases by more than 99% since 1988.

The decline in cases can be traced to the inception of the multi-billion-dollar Global Polio Eradication Initiative (GPEI) across 200 countries, which was launched that year in Geneva.

Poliovirus (type 2) has already been eradicated completely, with no known cases since 1999.

In spite of this, the GPEI's 2010–2012 strategic targets, which had aimed to bring about an end to the transmission of naturally occurring, or wild, polio, by the end of this year, will not now be yet.

According to Stephen Cochi, special adviser to the director of the Center for Global Health at the Centers for Disease Control and Prevention in Atlanta, pockets of disease transmission remain in Afghanistan, Chad, Nigeria and Pakistan, even though "remarkable progress" has been made.

Polio cases have been in particularly steep decline since 2010, Cochi told the conference, falling from 1,352 in 2010 to 650 in 2011, to the current record low of cases of 181 as of 7 November 2012.

The three endemic countries--Afghanistan, Nigeria and Pakistan--recorded more than 97% of the remaining cases.

Meanwhile, Anita Zaidi, director of research at the Aga Khan University's paediatrics department in Karachi, reported recently that there was still a widespread refusal among parents in the capital city to have their children vaccinated.

Writing in the Bulletin of the World Health Organisation, Zaidi and her colleagues said that 74% of missed immunisations appointments were linked to parental refusal, particularly among the richest and poorest communities in the city.

She said some low-income ethnic Pashtuns feared that the vaccination would make their children sterile, while others were sceptical that it would work, or that it contained ingredients not permitted for Muslims to consume.

She said there was a need for targeted approaches to work with Pashtun families in Karachi in order to meet polio eradication goals.

In Nigeria, the number of reported polio cases rose to 101 so far this year, from 42 in 2011, meaning that the disease could reinfect people in neighbouring countries where it had already been eradicated.

Parents feared the vaccine would cause HIV and sterility, according to Adamu Nuhu, head of the disease control division at the National Primary Healthcare Development Agency in Nigeria's capital, Abuja.

Nuhu warned the conference that all the resources committed over the years to polio eradication will have come to nothing unless Nigeria takes action on the issue.

Cochi agreed, saying that Nigeria and Pakistan were the greatest remaining barriers to a polio-free world.



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