H5N1

Pakistan: Man protecting polio team in Bajaur shot dead

Via Dawn.com: Levies man protecting polio team in Bajaur shot dead. Excerpt:

PESHAWAR: An anti-polio vaccination team was attacked in northwestern Pakistan’s Bajaur tribal region, killing one Levies official, DawnNews reported. 

Unidentified men opened fire on the team in Bajaur’s Mamond tehsil killing the Levies man deployed for the purpose of security. 

After the shooting, the attackers escaped from the site of the incident. 

Subsequently, security forces cordoned off the area and started a search operation. 

Earlier in April, a gunman shot dead a policeman and injured another in an attack on a police team protecting women polio workers in Mardan’s Mosam Koroono area.

WHO: 66th World Health Assembly begins

WHA66 begins on May 20, and it should be an important event. The link will take you to the documentation page, where you can download scores of documents. Of particular interest: A66/17 and A66/17 Add. 1, which deal with pandemic influenza preparedness, A66/18, on polio eradication, and A66/7, which proposes a 2014-15 budget of US$3.977 billion. 

Afghanistan: Taliban renounces war on anti-polio workers

Via The Telegraph, surprising good news: Taliban renounces war on anti-polio workers. Excerpt:

The Taliban has ended its war on polio vaccination workers and admitted immunisation is the only way to protect children from the disease, its leadership said in a statement issued today.

The announcement comes just weeks after the Afghan government launched a new campaign to immunise more than eight million children between six months and five years old throughout the country. It said it had trained 46,000 volunteers to conduct the campaign which is funded by the American aid agency USAID, the World Health Organisation and Unicef. 

Afghanistan, Pakistan and Nigeria are the three remaining countries in the world where polio remains a serious threat, but efforts to eradicate the disease have been sabotaged by the Taliban and other Islamic militants who have assassinated immunisation volunteers in all three countries. 

Eleven polio workers were killed in Pakistan last year, including five women who were shot dead in Karachi in December last year. Earlier this year a police officer protecting vaccination campaigners was shot by motorcycle gunmen in Khyber Pukhtunkhwa. In Afghanistan, a 16 year old girl involved in an anti-polio vaccination campaign in Kapisa province was shot six times in the stomach outside her home last December and died later in hospital. 

In March this year the Afghan government was forced to abandon its polio vaccination campaign in Nuristan province where, it said, Taliban opposition had made it impossible.

Somalia: Wild poliovirus identified

It's turning into one of those Sunday mornings again: First MERS, and now WHO has posted a new Disease Outbreak News report on the detection of wild poliovirus in Somalia. I can't excerpt the DONs, but click through for the full report. It's a discouraging setback.

Pakistan: New polio cases

Via The News International, a discouraging report: New cases pour cold water on anti-polio strategy.

PESHAWAR: Two new polio cases reported in a single day from Khyber Pakhtunkhwa and Federally Administered Tribal Areas have raised questions about the strategy for countering the refusal cases.   

The first polio case was reported from a chronically refusing family in Mardan district. Official documents of the National Virology Laboratory (NVI), Islamabad revealed that a seven months old male child from Mardan was diagnosed with the crippling poliomyelitis-1 strain of the poliovirus. His father had refused to allow polio teams to vaccinate his child.   

An official of the provincial Health Department, Nauman Khan, said over six polio campaigns were conducted during the last six months in Mardan but the father of the child could not be convinced to get the child vaccinated.   

The official said the country reported around 70,000 refusal cases during the recently concluded polio campaign whereas almost 50 percent of the total countrywide refusals were from Khyber Pakhtunkhwa.   

Health experts believe the biggest opportunity to counter the refusal cases in the country had already been lost as a local organisation the National Research and Development Foundation (NRDF) developed differences with the Pakistan Polio Control Programme.   

Another polio case was reported from Bara in Khyber Agency on Thursday, where an 11 months old child identified as Fawad was diagnosed with the disease.With the two new polio cases, the number of the affected children reached nine during the current year.   

Khyber Pakhtunkhwa is leading in the numbers, with four polio cases so far, followed by Fata having two cases whereas Punjab and Sindh have reported one case each.

Pakistan: Polio virus about to break loose in Khyber Pakhtunkhwa

Via The News International: Polio virus about to break loose in KP. Excerpt:

PESHAWAR: The highly-paid officials of WHO, Unicef and the ‘rich and prosperous’ provincial Expanded Programme on Immunisation (EPI) may face a lot of criticism in the days ahead as “The News” has received credible information that polio virus is about to get out of control in Khyber Pakhtunkhwa and adjoining tribal areas.

Official documents seen by this correspondent reveal that two more highly suspected cases of poliomyelitis called the ‘Acute Flaccid Paralysis’ (AFP) were reported from the volatile North Waziristan Agency during the last 48 hours.

Besides, samples of another highly suspected case from Bara in Khyber Agency and Mardan district were sent by the provincial health department for further tests at the polio laboratory in Islamabad. “We have received these samples at the polio virology laboratory in Islamabad,” said an official of the National Institute of Health (NIH).

According to documents of the provincial polio programme, the samples of a 36-month male child who belongs to Khushali village in Mir Ali tehsil of North Waziristan and was reported ill on April 22 have been sent to the NIH for diagnosis.  

The child did not receive any dose of the polio vaccine as the Hafiz Gul Bahadur-led Taliban in North Waziristan banned anti-polio vaccination campaign on June 16 last year while demanding halt to the US drone strikes.

After the ban, around 160,000 kids have been deprived of anti-polio vaccines in North Waziristan.A 10-month old female child Gul Dasta, daughter of Mustafa and granddaughter of Agha Jan belonging to Maizer village near Miranshah was reported ill on April 25. She did not get any dose of the polio vaccine due to ban on immunisation. 

Official sources could only confirm that many more such “highly suspected” cases were in the pipeline and that the polio cases’ tally may cross all previous records reported in Khyber Pakhtunkhwa and the Federally Administered Tribal Areas (Fata).

The most serious development is that the provincial government and the relevant organisations have made no headway in convincing the Taliban leadership to lift the ban on polio immunisation in North Waziristan.

Pakistan: One-year-old girl diagnosed with polio

Via The News International, the worst news of the day (if not the year): One-year-old girl diagnosed with polio. Excerpt:

PESHAWAR: After the ban on polio vaccination by local Taliban last year, a one-year girl became the first polio victim of the paralysing disease in the volatile North Waziristan Agency, official sources said.   

The ill-fated girl diagnosed with polio was identified as Arifa, daughter of one Qadir. She is the resident of Mir Ali tehsil in North Waziristan and couldn’t be administered anti-polio drops as the Taliban in the tribal region had imposed ban on the anti-polio vaccination in July 2012 as a mark of protest over US drone strikes there.   

Officials at the National Institute of Health in Islamabad confirmed the first polio case in the militancy-plagued North Waziristan. They also feared that an outbreak of polio may erupt in the tribal region if campaign was not carried out on an emergency basis.   

Despite serious attempts made by the international donors, Pakistani authorities have failed to help more than 240,000 kids in the two tribal regions of North and South Waziristan and remaining parts of Fata to get anti-polio vaccination during different National Immunization Days (NIDs) campaign conduced throughout the country.   

In both the tribal regions, North and South Waziristan, the regional Taliban groups, headed by Hafiz Gul Bahadur and late Maulvi Nazeer respectively, banned anti-polio immunisation campaign as a mark of protest against US drone attacks, in which they felt innocent people, including children and women, were being killed.

Poliomyelitis in Pakistan: A Muslim solution

Via The Lancet, an interesting argument: Poliomyelitis in Pakistan: time for the Muslim world to step in. One of the authors,Ziad Al-Memish, is deputy health minister of Saudi Arabia and the ministry's spokesperson on nCoV. Excerpt:

During Hajj 2012, the Saudi Ministry of Health banned all Muslim pilgrims from Uganda and the Democratic Republic of Congo, because of reports of Ebola outbreaks, to safeguard pilgrims. Although this decision could have been contested as not Islamic if not sanctioned by religious authorities, and Saudi authorities vilified for denying the divine rights of African Muslims, the ban was peacefully enforced and accepted because of the religious legitimacy afforded by clerics. 

Similarly, Saudi clerics have supported public health rulings deterring certain Muslims from Hajj during the recent influenza A H1N1 pandemic, which was a particular threat for pregnant women, elderly people, and those with comorbidities—a sensitive matter because all Muslims should attend the Hajj while they are able bodied.

Saudi Arabia's experience has benefited from the Mecca-based World Muslim League's ratification of medical recommendations, facilitating their wider adoption in Saudi Arabia and beyond. This unified approach avoids the opposition seen by extremist groups claiming to act in the name of Islam, despite motives clearly anathema to Islam. 

Saudi Arabia's experience can inform the debate about eradication of poliomyelitis in Pakistan with similar approaches to management of public opinion through officially sanctioned public health and religious messaging, supported by the international religious theocracy and by the Saudi monarch, the apical authority for Islam in Saudi Arabia. 

Although counteraction of the Taliban with a fundamentally Islamic position might seem inflammatory, this approach is rooted in Islamic teachings guaranteeing the sanctity of human life above all religious rites. Enlisting local mosques and community centres to promote polio vaccination as sanctioned by Islam to preserve life could lend Pakistan's polio programme immeasurable authority. 

These measures, if ratified by national and international Muslim organisations, when supported by the world's health agencies and leading public health academics of Muslim heritage, provide the authority needed. 

Pakistan's demoralised public health workers must be supported by a robust international approach that combines both traditional diplomatic and imaginative political responses to draw on the powerful authority of the international Muslim community, including the Organization of the Islamic Conference, the International Fatwa Body in Mecca, and Al Azhar in Egypt. 

Only then can we relegitimise infection control authorities and engender confidence in both public health officials and the vulnerable Pakistani population.

Pakistan: 1.3 million children missed polio drops during last campaign

At the end of a terrible day of H7N9, nCoV, and H5N1, Dawn.com finishes it with the most discouraging news yet: 1.3m children missed polio drops during last campaign. Excerpt:

PESHAWAR: Health experts on Thursday blamed the delicate law and order situation in Khyber Pakhtunkhwa and adjoining tribal areas for poor vaccination and said 1.385 million children missing polio drops in the two regions during the last immunisation campaign for lawlessness. 

Of these children, more than 763,000 were from the province and around 622,000 from Fata, according to Pakistan Paediatric Association, Khyber Pakhtunkhwa member Dr Mohammad Tufail. 

Dr Tufail told reporters at Peshawar Press Club that doctors were concerned about delay in vaccination campaigns in parts of Fata and demanded adequate steps for protection of vaccinators. 

He said around 265,000 children under five missed vaccination in North and South Waziristan agencies during the last polio campaign. 

The PPA member said Expanded Programme on Immunisation had carried out a weeklong vaccination campaign against seven fatal diseases, including tuberculosis, poliomyelitis, diphtheria, pertussis, measles, tetanus, hepatitis B, hemophilia influenza B and pneumococcal. 

“Around 90 per cent missing children will be contacted for vaccination to help them fight fatal diseases,” he said. 

He, however, said during the campaign, only 30 per cent children were given vaccines against diseases and that there was a need for creation of public awareness of vaccination. 

“We are fighting polio and will continue doing so until the crippling virus is eliminated from the country,” he said. 

Dr Tufail said parents were not cooperating with vaccinators and therefore, around 33,360 children missed vaccination in Khyber Pakhtunkhwa and Fata.

Pakistan: Losing the war against polio?

Via The Express Tribune, an April 20 editorial: Losing the war against polio.

In another statistic, which shows just how far behind the rest of the world we have fallen, over 1.4 million children missed polio vaccinations in the country during the first polio drive of the year. 

This number does not include the 260,000 children in North and South Waziristan, who cannot be vaccinated as teams cannot go into the area. Indeed, the security situation is one of the major reasons for the setbacks in the elimination of polio from the country, with Pakistan being one of the three countries where polio is endemic. 

There seems to be no end in sight to the difficulties in administering polio vaccinations. On April 19, a team of polio vaccinators was attacked in Tank, leaving two levies personnel injured. Earlier, four people opened fire at a polio team in Karachi, while on April 17, three people were injured when villagers themselves pelted polio vaccinators with stones in Benazirabad district. 

Clearly, conspiracy theories built around polio drops have taken strong hold in the minds of many, with groups protesting the vaccinations across the country. The people must be educated on the need for polio drops, for the price of ignorance here is too high. The security problems in the tribal areas preventing the vaccinators from carrying out their duties are another matter, where the fight against militancy and polio coincides. 

Whilst most of the gaps in the campaign are due to security concerns, some also have to do with a delay in training of teams, which should be given the utmost priority given the importance of the matter. 

Furthermore, the work of the vaccinators and the security details given to protect them cannot be appreciated enough, for they are putting their lives at risk to ensure the health of our children. 

It must be ensured that the workers have adequate security to enable them to carry out their work. Those who lose out the most in all this are, of course, the children, and it is heartbreaking to see polio cases when we know that they could have been prevented had the child been vaccinated.