Tuesday, March 3, 2015

Really? Hundreds of parents jailed in Pakistan for not giving children polio vaccine--a vaccine stopped in the US in 2000 after causing 144 paralytic polio cases, due to reversion to virulence and prolonged fecal excretion of live virus/ Guardian and CDC

Pakistan jails 471 parents who refused to give polio vaccine to children--The Guardian

Parents in north-west of country were imprisoned under government orders on charges of endangering public security

Polio vaccine in Peshawar, Pakistan
A health worker gives a polio vaccine to a child in Peshawar, Pakistan. Photograph: Mohammad Sajjad/AP

Endemic polio was eliminated in the US by 1980.  Nearly all US cases since then have been due to the live vaccine (vaccine-associated paralytic polio or VAPP) according to CDC.  Between 1980 and 1999 "the remaining 144 (95%) cases were vaccine-associated paralytic polio (VAPP) caused by live oral polio vaccine." *

From the Guardian:
Hundreds of parents in north-west Pakistan have been arrested and jailed after refusing to give their children polio vaccinations, according to officials.
Feroz Shah, a spokesman for the district administration in Peshawar, said 471 people had been imprisoned in the city and surrounding villages under government orders on charges of endangering public security.
Parents targeted by police were not arrested if they agreed to vaccinate their children, said Shakirullah Khan, a senior police officer in Peshawar.
Authorities have previously made scattered arrests for polio refusals, but such a widespread crackdown is rare.
 “This is the first time such drastic action was taken,” Shah said. “This shows the determination of the government to eradicate polio.”
Pakistan is one of three countries, along with Afghanistan and Nigeria, where polio is endemic, and the country last year accounted for the vast majority of reported cases.
The disease has been common since the Taliban banned vaccinations and attacked medical workers. Some Pakistanis are suspicious about vaccinations, fearing they will sterilise their children. 
In January, officials targeted around 35 million children in a nationwide campaign, while smaller vaccination drives are held more frequently. Officials have also implemented new security strategies to help protect vaccinators.
*  "In order to eliminate VAPP from the United States, ACIP recommended in 2000 that IPV be used exclusively in the United States. The last case of VAPP acquired in the United States was reported in 1999. In 2005, an unvaccinated U.S. resident was infected with polio vaccine virus in Costa Rica and subsequently developed VAPP. A second case of VAPP from vaccine-derived poliovirus was reported in 2009. Also in 2005, several asymptomatic infections with a vaccine-derived poliovirus were detected in unvaccinated children in Minnesota. The source of the vaccine virus has not been determined, but it appeared to have been circulating among humans for at least 2 years based on genetic changes in the virus."

Meanwhile, it has been suggested that concomitant with India's successful polio eradication program, there was a huge uptick in non-polio flaccid paralysis cases.  Whether this has any relationship to the vaccinations given (some vaccines have increased the disease they were meant to prevent, or caused severe neurological syndromes like polio (Guillain Barre syndrome, for example)) has not been investigated, according to two Indian physician academics.

Comparing measles cases by year in the US/ CDC, WaPo

This graph comes from the Washington Post.  Before 1993 there were many US measles cases, mainly due to waning of vaccine-induced immunity. Then an additional MMR dose was added to the vaccine schedule in the US, and measles immunity improved. There is no endemic measles in the US, helped by the fact there is no animal reservoir.

People who are incubating cases of measles, and are infectious, continue to enter the US from abroad. This caused 23 separate outbreaks in the US in 2014. However, there is very reduced measles transmission within the US, due both to high levels of immunity and careful case-finding by public health workers, who recommend quarantines, vaccinations or use of immune serum when necessary. There have been no deaths from measles in the US since 2003.

Measles cases: Jan. 1 to Feb. 6, 2015. There are 121 cases reported in the District of Columbia and 17 states (Arizona, California, Colorado, Delaware, Illinois, Michigan, Minnesota, Nebraska, Nevada, New Jersey, New York, Oregon, Pennsylvania, South Dakota, Texas, Utah and Washington). (CDC)