30th December 1999
Polio Eradication: Kenya Polio Drive Ignored.

In Africa News Online (http://www.africanews.org/) Dagi Kimani, Special Correspondent for The East African, reports from Nairobi:

Kenya's Central province recorded the least coverage in the recent polio immunisation campaigns. Health experts have blamed poor mobilisation strategies and partisan politics for the continued poor coverage in the province.

According to figures to be released by the Kenya Expanded Programme on Immunisation (Kepi) this week, the province recorded the lowest coverage among Kenya's eight provinces during the second round of immunisation, which ended in late November with just 52.4 per cent of the targeted children below five years having been covered.

In contrast, other provinces registered significantly higher coverage, with Western reporting a coverage of 103 per cent, Nairobi 100.9 per cent, Nyanza 90.3 per cent and Rift Valley 88.6 per cent. Even the relatively less endowed and more expansive Coast, Eastern, and North Eastern provinces registered 83.6, 72.9 and 73.6 per cent respectively.

In total, according to the figures, more than 4.4 million of the targeted 5.1 million children were immunised against polio during the first and second rounds, representing 84 per cent of the national target. At the same time, 3.2 million children were given vitamin A supplements.

During the first round of immunisation, Central similarly recorded the lowest polio coverage in the country, with only 57 per cent of the targeted children immunised. Nairobi, in comparison, recorded a coverage of 107.4 per cent while Western recorded 99 per cent.

Analysts blame the continued poor performance of Central Province on the failure by Kepi to innovatively market the benefits of vaccination to parents in the populous region, including a failure to counter claims that the vaccines destined for the province are laced with HIV and contraceptives by the Kenya government.

Health experts say that Kepi may also not have done enough to explain to parents why they need to take their below-five children for polio immunisation year after year, and not just once as in other vaccination campaigns.

At a broader level, health experts say that the outcome of this year's Kepi polio immunisation effort reflects the impact of growing politicisation, both at the grassroots and national levels, of public health issues in Kenya.

In addition to immunisation, other important health care initiatives whose performance has been influenced by either religious or political pressures in the country include a programme to popularise condoms to help curb HIV transmission.

The complete text of the news report can be found at http://www.africanews.org/
east/kenya/stories/19991230/19991230_feat15.html

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20th December 1999
Polio Eradication: Global Campaign Seeks to End Polio.

World Health Effort Is Largest Ever.

David Brown, Staff Writer at the Washington Post (http://washingtonpost.com/) reports:

Polio, the world's great crippler of children, will survive into the next century. But if all goes well, it will also be the new millennium's first great casualty.

Over the next 12 months, an international effort will attempt to drive polio into the most exclusive category of human disease--those eradicated from Earth. The list has one item: smallpox.

The campaign against this disease, launched in 1988 and coordinated by the World Health Organization, is the largest public health endeavor ever undertaken.

Over the last decade, the campaign has temporarily stopped wars so that whole populations of children could be immunized simultaneously. Logistical feats, such as the vaccination of 134 million Indian children on one day in 1998, have no match in history. Counting part-time volunteers, about 10 million people worked in the campaign this year.

Because polio cases must be sought out and distinguished from other forms of paralysis, the campaign has required establishment of disease surveillance systems in some of the poorest and most chaotic nations on Earth. In all, the effort will cost about $2 billion. In inflation-adjusted dollars, this is about one-third more than the cost of the campaign to eradicate smallpox, which lasted from 1967 to 1977. More than half the money will be spent during the "accelerated phase" now beginning, and in the three years of intensive surveillance that will follow the last case.

Although the Americas have been free of the disease since 1991, no child here -- or anywhere else -- can safely forgo polio vaccination as long as the virus exists anywhere on Earth.

So far this year, 1,240 confirmed cases of polio have been found worldwide, although the actual number may be two or three times that. In 1988, there were 350,000. Although disappearing fast, the disease still exists in 23 countries and is suspected to be circulating in six others, where conditions have hampered a thorough search.

The goal of stopping transmission of the virus by the end of 2000 will be "tough," said Harry F. Hull, a pediatrician and epidemiologist who is the senior adviser to the program. "Not impossibly tough, but tough."

Among the many obstacles to the final push toward eradication is the supply of oral polio vaccine. About 2.5 billion doses will be used in the campaign next year, about twice as much as has ever been used in a single year. Combined with the 300 million doses or so that will be used for "routine" polio vaccination, that is all there is in the world.

"The manufacturers are running now at maximum capacity. There's probably enough, but it's very tight," said Hans Everts, the campaign's chief of vaccine supply.

Although its most serious effects are on the nervous system, poliovirus is actually an "enterovirus"--a microbe that replicates in the intestinal tract. It is passed in feces for weeks after infection, and also in airborne droplets. Highly contagious, the virus moves explosively through non-immune populations, especially where hygiene is poor. The vast majority of cases occur in children, in whom it has historically been among the leading causes of disability.

Like a few other microbes, polio has the necessary characteristics for "eradicability."

The virus has no reservoir in the natural world. It doesn't live in soil (like the bacterium that causes tetanus) and it doesn't infect animals (like the virus that causes influenza.) Halt transmission in human beings, and polio dies out.

Equally necessary is a safe and effective method of preventing the infection, which came in the form of the Salk injected vaccine, introduced in 1955, and Sabin oral form, two years later. (In the United States, the vaccines drove the number of cases of paralytic polio caused by "wild" virus from about 16,000 per year in the early 1950s to zero by 1980.) Vaccination causes prolonged immunity, so people don't become reinfected. Further, polio has no chronic "carriers"--people who survive infection but continue to transmit the microbe.

Still, polio has one trait that makes eradication unusually difficult: Only one in 200 cases causes weakness or paralysis, the cardinal feature distinguishing it from other intestinal bugs. Most polio infections go undetected. This is unlike smallpox, where nearly every case gave rise to a dramatic rash.

When epidemiologists find a newly paralyzed child, it's imperative they determine whether the cause is polio. (There are numerous non-polio causes of muscle weakness in childhood, with the autoimmune disorder known as Guillain-Barre syndrome the most common.) If it is polio, investigators can be certain many dozens of undetected cases lurk nearby.

Because of this, the eradication campaign has required more than vaccination. It also has required that countries create permanent systems of disease surveillance, which is not easy in poor, rural countries with little medical infrastructure.

Under WHO guidelines, everyone from doctors at urban hospitals to paramedic-like workers at village "health posts" must report new cases of muscle weakness in children. Often, government health workers also actively look for such cases.

Once found, two samples of feces must be collected from the sick child within 14 days and sent to one of about 100 WHO-certified laboratories, where they will be cultured for polio virus. Before a country is certified polio-free, it must show it is identifying at least one case of non-polio paralysis for every 100,000 children under age 15--evidence the system is working and finding no polio.

Without question, however, the backbone of the eradication campaign is vaccination on an unprecedented scale.

Two drops of a liquid containing live, but weakened, virus are squeezed into the mouth. The usual schedule is three doses, given in infancy and early childhood. Once swallowed, the virus multiplies and stimulates immunity. The vaccine-derived virus can be transmitted to others, immunizing them too.

"I like to joke that the only education necessary to administer polio vaccine is the ability to count to two," Hull said in a recent lecture at the Johns Hopkins University School of Hygiene and Public Health. "This has allowed us to use millions of non-medical volunteers."

Oral polio vaccine is part of the WHO-recommended childhood vaccines used worldwide. For most of the decade, however, the eradication campaign has employed a strategy of supplementing routine vaccination with massive events called "national immunization days" (NIDs). Officials choose a day -- usually in the cool, dry season, when polio is in low prevalence -- in which all children under the age of 5 in a country are given polio vaccine, regardless of whether they have been previously vaccinated.

"Running an NID is like running an election," said Bruce Aylward, 37, a Canadian physician and long-time WHO field worker, who two years ago was chosen to lead the final stage of the eradication campaign.

In many ways, the logistical obstacles to such events are advantageous, Aylward said, because they require everything from national governments to village councils to buy into the effort. And because NIDs are done in pairs one month apart, at least once a year, the commitment is lasting.

In December 1996 and January 1997, NIDs were held in Bangladesh, Burma, China, India, Nepal, Pakistan and Thailand. In all, 243 million children were vaccinated -- about 38 percent of the world's children under age 5. On Dec. 7, 1997, 127 million children were vaccinated in India. Five weeks later, 134 million were vaccinated.

Cease-fires have been brokered in Sudan, Sierra Leone, Angola and several other countries so NIDs could be held. In his lecture at Johns Hopkins, Hull showed a photograph of the president of Sierra Leone seated on a couch next to his chief adversary in a bloody civil war. The two leaders and an aide to each wore "Kick Polio Out of Africa" T-shirts.

India, which had about half the world's confirmed cases this year, will hold four nationwide NIDs next year, and two more in the eight northern states where polio is most prevalent. India will use about 1 billion doses of vaccine.

NIDs, however, are insufficient to eradicate polio. Nearly everywhere, they have to be supplemented with "mopping-up" campaigns.

The most dramatic example occurred in Cambodia. Nine cases of polio appeared in the Mekong River area in early 1997, despite three years of NIDs in which more than 90 percent of children were reached. An epidemiologist noticed all nine children lived on boats.

He mentioned this to Cambodian officials who, Hull said, were incredulous such a population existed. The epidemiologist hired an airplane and photographed thousands of boats, with families on board, along the waterway and its tributaries. About 1 million Cambodian and Vietnamese children were subsequently vaccinated in campaigns that included boat-to-boat visits. There have been no new cases since March 1997.

Oral polio vaccine is not without risk. It causes paralytic polio in about one in every 1 million children. During NIDs, there is no attempt to explain the risks and benefits of vaccination to every parent.

As in the smallpox eradication campaign, informed consent of a formal nature comes from the national or regional health ministry. Often, however, details such as the existence of vaccine-associated polio are discussed in media coverage preceding mass immunizations, Aylward said. No child is forced to be immunized.

The polio campaign is being funded by many sources, governmental and private. The largest private donor is Rotary International, a service organization of business and professional men and women. that has about 29,000 clubs in 162 countries. It has raised more than $300 million. Recently, the Bill and Melinda Gates Foundation contributed $50 million.

The complete text of the news report can be found at http://washingtonpost.com/
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15th December 1999
Researchers Challenge Theory That Polio Trials Led to AIDS.

Title: Researchers Challenge Theory that Polio Trials Led to AIDS (Cite discovery of original source of the virus) (1260)

Date: 19991215

Text:

Washington -- AIDS researchers report that little scientific evidence supports the recently publicized suggestion that the origin of the human immunodeficiency virus (HIV) that causes AIDS can be linked to an early oral polio vaccine tested on about a million people in central Africa between 1957 and 1960.

The hypothesis, published in a recent book by British journalist Edward Hooper [see NewsBites 30th November 1999], suggests that HIV-1 -- the virus responsible for the global AIDS pandemic -- originated as a result of the inadvertent inoculation of trial participants with an HIV-like virus present in monkey kidney cell cultures used to prepare the polio vaccine.

The suggestion first appeared in a 1992 Rolling Stone magazine article that sought to link AIDS and the polio vaccine trials in Africa.

A spokesman for the U.S. Centers for Disease Control and Prevention in Atlanta, Georgia, said that the weight of scientific evidence "does not support this idea, and there is no more reason to believe this hypothesis than many others which have been considered and rejected on scientific grounds."

The spokesman said that the same oral polio vaccine that was used in central Africa was also tested on thousands of individuals in Poland, but there was no evidence of early HIV infection there. He added that since the 1960s, billions of doses of oral polio vaccine have been delivered worldwide and no association with HIV infection has ever been recorded.

Researchers report that most scientists have long believed that the AIDS virus descended into humans from a primate species. But up to now there had been scant data to support the thesis, allowing theories such as the polio-virus vaccine hypothesis to flourish. Last January, however, an international team of scientists identified a subspecies of chimpanzees native to west equatorial Africa as the original source of the AIDS virus. The discovery was hailed as the best case yet for the AIDS virus jumping from chimpanzees into humans.

The findings were announced at the opening of the largest annual AIDS conference held in the United States and published in the February 4 issue of Nature.

The research team, led by Dr. Beatrice Hahn of the University of Alabama in Birmingham, found through careful molecular analysis that a certain strain of chimpanzee virus is closely related to human HIV-1 infections that cause AIDS. This virus strain infects one particular chimp subspecies, called Pan troglodytes troglodytes, found in a region that includes Gabon, Cameroon and Equatorial Guinea.

Significantly, Dr. Hahn and her colleagues also found that the natural habitat of these chimpanzees "coincides precisely" with the regions in Africa that have had human HIV-1 infections for the longest period of time. The scientists conclude that this particular subspecies of chimpanzees is the natural reservoir of HIV-1, and cite conclusive evidence that the virus has spread from the chimpanzees to humans on three distinct occasions.

The researchers believe that HIV-1 was introduced into the human population when hunters became exposed to infected chimpanzee blood. Furthermore, they speculate that humans might still be at risk from cross-species transmission because the so-called bushmeat trade -- the hunting and killing of chimpanzees and other endangered animals for human consumption -- is still common practice in west equatorial Africa.

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which helped fund the research effort, said the findings had "significant potential."

"We now have chimpanzee isolates of simian immunodeficiency virus (SIV) that have been shown to be closely related to HIV-1," he said. "Furthermore, this virus infects a primate species that is 98 percent related to humans. This may allow us...to study infected chimpanzees in the wild to find out why these animals don't get sick, information that may help us better protect humans from developing AIDS."

Dr. John Moore, a lead researcher at the Aaron Diamond AIDS Research Center in New York, said it is widely accepted that humans became infected with HIV-1 through contact with chimpanzees. He said the question is how did it get from chimps to humans?

"Certainly, the view that has the most credibility in the AIDS research community is that it is a natural transmission event," he said. "When animals are captured and butchered for human consumption -- and chimps are used as food in several parts of Africa -- it is not too difficult to imagine that you would cut yourself during the food preparation and virus transmission would occur. No one can prove it happened, but it's certainly the most immediately sensible idea."

Moore said, however, that Hooper's theory that a polio vaccine produced in cultures of kidney cells from various primate species could have been contaminated "by some strange set of circumstances" with a virus that was later identified in humans as HIV-1 "is extremely unlikely."

"It's not 100 percent impossible, but it's highly, highly unlikely," Moore said. "He really has no evidence other than speculation and coincidence to support his case."

Researchers also point out that different subspecies carry different forms of the chimp virus and, if current research is correct, the subspecies of chimp from central Africa whose kidneys might have been used in the polio vaccine trials are the "wrong" ones -- harboring only a distant relative to HIV-1.

The Wistar Institute, the private, non-profit organization that produced the 1950s polio vaccine used in Africa, said it would allow two independent laboratories to test material from the vaccine trials in hopes that this will end the controversy by showing no evidence of the chimpanzee form of the virus that causes AIDS. Wistar said the labs are expected to receive the material by the end of the year.

In 1995, Swedish scientists tested some of the vaccine used in Africa and found no evidence of either the simian or human immunodeficiency virus. However, the Swedes looked at only one of two batches involved in the production of the vaccine, and the new tests will encompass both. Experts report, however, that negative results from the tests will not necessarily resolve the controversy because other batches, either used up or lost since the vaccine trials in Africa, might have been contaminated.

Two Wistar scientists who led the polio research in Africa, former institute director Hilary Koprowski and his former deputy Stanley Plotkin, reject the suggestion that the vaccine could have been the medium of transfer.

Koprowski said chimpanzees were used only to test the vaccine and never to produce it. Instead, researchers made the vaccine with kidney tissues from Asian rhesus macaque monkeys, whose kidney cells do not support SIV or HIV.

"This book has only preconceptions. There are no facts," said Koprowski, now professor of microbiology and immunology at Thomas Jefferson University in Philadelphia.

"The idea is a house of cards built on circumstantial evidence, and whatever doesn't fit has been ignored," said Plotkin, who developed the modern rubella vaccine before leaving Wistar for France's Pasteur Merrieux Connaught. "It's also, frankly, an attack on people's reputations, and I feel it has to be dealt with."

The Wistar Institute faced similar assertions in 1992, when Rolling Stone magazine published an article on the polio-AIDS theory. At the time, the institute formed an outside panel of scientists who concluded that the polio trials has not been responsible for the spread of AIDS.

(The Washington File is a product of the Office of International Information Programs, U.S. Department of State)

Product Name: WASHINGTON FILE
Document Type: ARTICLE
Keywords: AIDS; HIV; POLIO TRIALS; AFRICA; HOOPER 15A CP
Thematic Codes: 15A
Languages: ENGLISH
Originating Team: 99121506.TGI

Original article located via United States Information Agency search facility, http://usinfo.state.gov/products/pdq/pdq.htm, using search argument "polio AND AIDS AND trials".

Notification of the above news item was received via NewsIndex http://www.newsindex.com/

Related NewsBites reports:
30th November 1999 - Is AIDS a Man-Made Plague? New research revives the theory that HIV may have originated in a polio vaccine.

10th December 1999
Polio Eradication: Gateses praised for helping 'poorest of the poor'.

Tom Paulson of the Seattle Post-Intelligencer (http://www.seattle-pi.com/) reports:

Former South African President Nelson Mandela said the world is becoming a better place, in no small part because of people like Bill and Melinda Gates who are sharing their wealth to help the "poorest of the poor."

"People who are pessimists don't know what's going on," Mandela said.

A global health forum featuring Mandela, Gates and others was held yesterday at the University of Washington Medical Center to publicize the need for increased public and private investment aimed at improving the health of people -- especially children -- in developing nations.

Mandela, who shared the Nobel Peace Prize in 1993 with F. W. de Klerk for their efforts to end apartheid, lauded the Bill and Melinda Gates Foundation's dedication of more than $1 billion to the task of improving children's health worldwide.

Mandela's wife, Graca Machel, noted that her home country of Mozambique is close to declaring itself "polio-free" thanks to local community organizing supported by the concerted efforts of many other organizations.

Machel turned to Gates, after noting that his foundation along with a foundation established by Ted Turner recently gave $78 million to the global polio eradication effort, and said he was a genius who "decided to use your gift to share it with millions of others."

Microsoft's chairman, joined by his father Bill Gates Sr. at the forum, acknowledged that for many years he has been focused on giving the gift of technology to the world. Gates said he still thinks computer technology can help even the poorest countries.

But Gates said he's become convinced that the biggest needs are in health care.

Gates Sr., co-chairman of the foundation, said it is an "ugly fact" that millions of children die every year from diseases that are easily preventable. "This is a solvable problem and we have a moral obligation as a global community to see that it is done," he said.

Dr. William Foegge, former head of the Centers for Disease Control and now a senior adviser to the Gates Foundation on matters of global health, said most Americans have forgotten how many of our children used to die from measles or how fearful parents were with the return of the threat of polio in summer.

The goal of the Gates Foundation and the Nelson Mandela Foundation, Foegge said, is to stimulate an aggressive effort that someday will allow parents in other countries to forget about these disease that now steal so many lives.

Mandela congratulated the Gates Foundation for recognizing that improving childrens' health is not simply a matter of donating money for vaccines. The Gateses, he said, recognize that improvements in socioeconomics and education are also needed to sustain any improvements in public health.

"I'm grateful to be associated with this foundation," he said.

The complete text of the news report can be found at http://www.seattle-pi.com/local/heal101.shtml

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For Polio eradication and vaccine related resources see our directory Polio Virus, Vaccine and Eradication

8th December 1999
Polio Eradication: Gates, Turner putting up $78 million to fight polio.

Eric Sorensen of the Sun-Sentinel (http://www.sun-sentinel.com/) reports from Seattle:

Bill Gates, the software mogul, and Ted Turner, the media mogul, have teamed to donate $78 million to wipe polio off the face of the Earth.

"The bottom line is polio is close to being eradicated," said Trevor Neilson, a spokesman for the Bill and Melinda Gates Foundation. "There's the feeling that if a few hundred million more dollars can be found, we can say goodbye to polio."

For philanthropy watchers, the gift is a rare union of the two greatest givers of cash in the world. Turner's 1997 gift of $1 billion to the United Nations was the largest until September, when the Gates foundation pledged $1 billion to send 20,000 minority students to college over the next 20 years.

The Gates foundation donated $50 million toward the polio effort, while Turner's United Nations Foundation contributed $28 million. The gifts are part of a drive by the World Health Organization, Rotary International and the United Nations Children's Fund to raise $400 million.

The drive is a final effort of the World Health Assembly's Polio Eradication Initiative, which was launched in 1988 with a goal of eradicating polio by the end of 2000. Since then polio cases have dropped from an estimated 350,000 to about 6,000 in 1998. The initiative is concentrating on Afghanistan, Angola, the Democratic Republic of the Congo, Somalia, Sudan, Bangladesh, Ethiopia, India, Nigeria and Pakistan.

Polio mainly affects children younger than 3, causing a lifelong paralysis of the limbs. There is no cure.

In recent months, the Gates foundation has made multimillion-dollar donations for research on AIDS, cervical cancer, tuberculosis, tetanus, malaria, cystic fibrosis and pregnancy-related deaths in developing countries. The polio donation is unrelated to a $750 million gift last month to help vaccinate children.

The complete text of the news report can be found at http://www.sun-sentinel.com/
news/daily/detail/0,1136,26000000000105077,00.html

Also reported in the Seattle Times, complete text at http://www.seattletimes.com/news/local/html98/gate_19991208.html

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For Polio eradication and vaccine related resources see our directory Polio Virus, Vaccine and Eradication

7th December 1999
Group prefers polio injection.

The Milwaukee Journal Sentinel carries the following Associated Press report from Chicago:

The nation's largest pediatricians' group is recommending that all routine polio vaccines be given through injections rather than orally.

The policy switch by the American Academy of Pediatrics comes six months after the federal Centers for Disease Control and Prevention made the same recommendation.

Authorities believe the newer vaccine is safer because it uses an inactivated form of polio virus, which means it cannot cause polio. The oral version, which uses a weakened form of the live virus, has been safe for millions of kids who have taken it but has caused polio in a handful of youngsters each year.

Recent studies have shown the injectable vaccine to be just as effective in providing immunity to the paralyzing disease.

While the CDC recommends that doctors switch to the injectable vaccine in January, the academy says physicians may use up their supplies of oral vaccine over the next few months by giving it to children who have already started on the four-dose series and are due for their third and fourth doses.

The complete text of the news report can be found at http://www.jsonline.com/alive/family/dec99/polio08120799.asp

See also NewsBites 18th June 1999 "New polio vaccine recommendation in U.S.A."

For Polio eradication and vaccine related resources see our directory Polio Virus, Vaccine and Eradication

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