Polio in Afghanistan

by Abdullah Qazi/1998

Today, the Afghan people, especially women and children, are not only the innocent victims of war, but also victims of deadly diseases such as polio. Polio, also known as poliomyelitis is an acute viral disease. This infectious disease, in its serious form, affects the central nervous system and, by destruction of the motor neurons in the spinal cord, produces paralysis, breathing incapacity, and sometimes death. As a result of polio, paralysis and deformity is a familiar sight in Afghanistan. In fact, polio is the most common cause of disability among children less than 15 years of age. (1)

The mode of transmission for the poliovirus, the virus that causes poliomyelitis, is direct contact through close association. Fecal-oral is a major route of infection when sanitation is poor. Epidemics have been known to result from contamination of water supplies by sewage. When sanitation conditions are good, pharyngeal spread is more common. After ingestion, the poliovirus first multiplies in the pharynx and/ or small intestine. Once the virus spreads to the draining lymph nodes, viremia occurs. This enables the virus to become widely disseminated throughout the body. The virus is carried via the bloodstream to the anterior horn cells of the spinal cord and motor cortex of the brain. (2) It is commonly thought that 95% of all infections are asymptomatic or resemble cold or intestinal disorders. (3)

Currently there are two polio vaccines available. The first one was developed by Jonas Salk, and is given by means of an injection. The other polio vaccine is an oral one developed by Albert Sabin. The oral polio vaccine is cheaper and easier to administer. In some rare cases, the oral form can cause paralytic polio. As a result of this, the United States Centers for Disease Control and Prevention recommends two doses of injectable vaccine followed by two doses of the oral form. (4)

Before the injected Salk vaccine (1955), and the oral Sabin vaccine (1961), were introduced, the disease was greatly feared throughout the world. Many of the older citizens of the world are still haunted by the dark images of paralysis, iron lungs, steel braces, and little hope. Polio is no longer a serious health problem for people living the developed nations, such as the United States, Germany, or France. In fact, many medical students have not seen a case (5). However, about 100,000 cases and 10,000 deaths still occur each year around the world, mostly in Asia and Africa. (6) In 1988, the World Health Organization (WHO) declared a commitment to eradicate polio by the year 2000. (7) It is now 1998, and as a result of various disruptions such as civil war, the situation in Afghanistan remains poor.

The best method of eradicating polio is through the launching of massive immunization campaigns in the developing world. However, war and economic conditions make things difficult. This is especially true for Afghanistan. Afghanistan suffers from poor polio vaccine coverage. The Afghan population has an immunization coverage of less than 40%, this is considered to be one of the lowest in the world (8). Improving the polio vaccine coverage should be a high priority in Afghanistan. Above all, the civil war in Afghanistan has been a major problem in the organization of immunization campaigns. There are also logistical and cultural factors, such as reaching remote populations, and women being forbidden to access vaccination centers. The exact number of polio cases in Afghanistan is unknown, since there is no surveillance system centralizing the data on polio.

Besides the World Health Organization (WHO), the Iranian Red Crescent is also dedicated to combating polio in Afghanistan. In January of 1998, the Iranian experts announced that vaccination campaigns against polio will be initiated in Northern and Central Afghanistan. The Iranian consul in Northern Afghanistan stated that the project will cover two million people. They also voiced their readiness to carry out their campaigns in the southern Taliban held areas. (9)

An article published in November 29, 1997, in the British Medical Journal provides the best and most reliable data on polio in Afghanistan. The individuals who conducted the survey were Dr. Marie-Laurence Lambert, and her colleagues. Dr. Lambert is a research associate in the Epidemiology Unit of the School of Public Health, Catholic University of Louvain in Clos Chapelle-aux champs, Brussels. They assessed locomotor disability, rehabilitation needs, and coverage of oral polio vaccine in Kandahar province. The researchers reveal high levels of polio amongst the population of Kandahar province.

The research involved a multistage random cluster performed in four districts of Kandahar province (population 428,390). They defined a disabled person as someone unable to walk normally without help or unable to move their hands or arms properly for a reason other than age. They also defined polio as recommend by the World Health Organization (WHO) for lameness surveys. The coverage of oral polio vaccine was covered by standard WHO methods for children aged 12-59 months. The data was collected in June 1996. They surveyed 12,065 people, and the global prevalence of locomotor disability was found to be 23 per 1000, but some high risk populations were not included. According to them, war related injuries were the leading cause of disability. Other causes of disability were medical problems and other traumas. More people had been disabled by polio than by landmines. However, they state that the difference was not significant and that the severity of the disabilities was not compared. They also state that health services in Kandahar do not match the needs of the people (10). Despite this, it must be noted that this study covered only a small part of Kandahar province, and the data collected is prevalence data and not incidence data.

More attention needs to be given to polio in Afghanistan. Afghanistan is very important when it comes to the total eradication of polio. There is a strong possibility that Afghanistan will become a major source of continuous wild poliovirus transmission in the world. Viruses originating from Afghanistan have spread to neighboring countries as well as to some western countries such as Greece (1). For Afghanistan, progress can never truly occur until this disease is eradicated or at least put under control. If this debilitating disease is allowed to spread and grow, the Afghan nation as a whole will have a very dark future.

REFERENCES:

1) World Health Organization. Press Release WHO/83. November 24, 1997.

2) McGraw-Hill Encyclopedia of Science and Technology, 1987 ed., vol 14, "Poliomyelitis," by Joseph L. Melnick.

3) Jubelt B, Lipton HL. Enterovirus infection. In: Vinken PJ, Bruyn GW, Klawens HL, McKendall RR, eds. Handbook of clinical neurology, revised series, vol 56: Viral disease. Amsterdam: Elsevier Science Publishers BV, 1989. pp 314-316.

4) CNN report: "CDC changes polio-vaccine guidelines for children." January 23, 1997.

5) Fenner F.J., White D.O. Medical Virology. Academic Press. New York. 1976. pp. 334-341.

6) Biddle, W. A Field Guide to Germs. Henry Holt and co. New York. 1995. pp. 111- 115.

7) World Health Organization (WHO) Global eradication of poliomyelitis by the year 2000. WHO Weekly Epidemiol Rec. 1988; 63: 161-162.

8) IPS-Inter Press Service report: "250 Million Asian Children Vaccinated Against Polio," by Gustavo Capdevila. February 4, 1997.

9) IRNA report: "Iran to campaign against goiter, polio in Afghanistan." January 8, 1998.

10) Lambert, M.L. et al. "Household survey of locomotor disability caused by poliomyelitis and landmines in Afghanistan." British Journal of Medicine, no. 7120, vol. 315. 1997.

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