Q: What is vaccine-derived polio?
A: Oral polio vaccine (OPV) contains an attenuated (weakened) vaccine-virus, activating an immune response in the body. When a child is immunized with OPV, the weakened vaccine-virus replicates in the intestine for a limited period, thereby developing immunity by building up antibodies. During this time, the vaccine-virus is also excreted. In areas of inadequate sanitation, this excreted vaccine-virus can spread in the immediate community (and this can offer protection to other children through ‘passive’ immunization), before eventually dying out.
On rare occasions, if a population is seriously under-immunized, an excreted vaccine-virus can continue to circulate for an extended period of time. The longer it is allowed to survive, the more genetic changes it undergoes. In very rare instances, the vaccine-virus can genetically change into a form that can paralyse – this is what is known as a circulating vaccine-derived poliovirus (cVDPV).
It takes a long time for a cVDPV to occur. Generally, the strain will have been allowed to circulate in an un- or under-immunized population for a period of at least 12 months. Circulating VDPVs occur when routine or supplementary immunization activities (SIAs) are poorly conducted and a population is left susceptible to poliovirus, whether from vaccine-derived or wild poliovirus. Hence, the problem is not with the vaccine itself, but low vaccination coverage. If a population is fully immunized, they will be protected against both vaccine-derived and wild polioviruses.
Since 2000, more than 10 billion doses of OPV have been administered to nearly 3 billion children worldwide. As a result, more than 13 million cases of polio have been prevented, and the disease has been reduced by more than 99%. During that time, 24 cVDPV outbreaks occurred in 21 countries, resulting in fewer than 760 VDPV cases.
Until 2015, over 90% of cVDPV cases were due to the type 2 component in OPV. With the transmission of wild poliovirus type 2 already successfully interrupted since 1999, in April 2016 a switch was implemented from trivalent OPV to bivalent OPV in routine immunization programmes. The removal of the type 2 component of OPV is associated with significant public health benefits, including a reduction of the risk of cases of cVDPV2.
The small risk of cVDPVs pales in significance to the tremendous public health benefits associated with OPV. Every year, hundreds of thousands of cases due to wild polio virus are prevented. Well over 10 million cases have been averted since large-scale administration of OPV began 20 years ago.
Circulating VDPVs in the past have been rapidly stopped with 2–3 rounds of high-quality immunization campaigns. The solution is the same for all polio outbreaks: immunize every child several times with the oral vaccine to stop polio transmission, regardless of the origin of the virus.
In June 2018, the Government of Papua New Guinea notified the World Health Organization (WHO) of an outbreak of circulating vaccine-derived poliovirus.
The Government of Papua New Guinea is working with partners, including WHO and UNICEF, to take appropriate outbreak response measures including contact tracing, testing and vaccination.
Polio is very unlikely to spread in Australia because of high rates of vaccine coverage, good sanitation, and the quality and ability of the health system to respond to cases.
Recommendations for Vaccination
- Australian residents planning to visit PNG for less than 4 weeks should be up to date with their polio vaccination. For adults, this is a 3 dose primary course, with a booster within the last 10 years. For children, a 3 dose primary course with a booster at 4 years old is currently recommended. These recommended vaccines may be given before arrival in PNG.
- Australian residents travelling to PNG intending to stay for longer than 4 weeks should have a documented polio booster within 4 weeks to 12 months prior to the date of departure from PNG. The booster may be given before arrival in PNG, as long as it is given within 4 weeks to 12 months prior to leaving PNG.
- Individuals who are already residing in PNG for 4 weeks or longer should have a documented polio booster within 4 weeks to 12 months prior to departure from PNG (refer to WHO’s International Travel and Health website). The booster may have been given before arrival in PNG, as long as it has been given within 4 weeks to 12 months prior to leaving PNG. Individuals leaving PNG in less than 4 weeks should still receive a polio booster as this will still have benefit.
Consistent with WHO recommendations, polio-affected countries may require proof of vaccination when leaving the country.
Documentation should be provided on an International Certificate of Vaccination or Prophylaxis (“Yellow Book”). Copies of the International Certificate of Vaccination or Prophylaxis Booklets can be ordered from WHO Press or downloaded from the WHO website.
Polio vaccine boosters can be given as inactivated polio vaccine (IPV) either alone (IPOL) or as part of another vaccine, such as in combination with diphtheria, tetanus and pertussis (eg Boostrix IPV, Adacel Polio).
Polio vaccine boosters can also be given as oral polio vaccine (OPV). OPV is not available in Australia.
Further advice about polio vaccines can be found in the Australian Immunisation Handbook.
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You will be surrounded by challenges, so much to do and so little time
You will carry Immense responsibilities and very little authority,
You will step into people’s lives and make a difference, some will bless you some will curse you, You will see people at their worst and at their best You will never seize to be amazed at people’s capacity for Love, courage and endurance,
You will see life begin and end
You will experience resounding triumphs and devastating failures,
You will cry alot 😥😥
You will laugh alot.
You will know what it is to be human and to be humane.
Being a nurse is everything. You sacrifice alot that can only be appreciated by the almighty GOD himself, you are brave my Sisters so are you my brothers.
Thousands of government nurses and other health personnel who are deployed in the country’s far-flung barangays from Batanes to Jolo stand to lose their jobs due to the Department of Budget and Management’s (DBM) move to cut the budget of the Department of Health (DoH), according to Senate Minority Leader Franklin M. Drilon.
“If we will just follow the proposed budget of the Department of Health, about 15,000 nurses and health professionals will lose their jobs,” Drilon said after grilling officials during the Senate hearing on the proposed P71 billion budget of the DoH.
“This is a vey serious concern. I have not seen in my 20 years in the Senate that a budget is slashed this much and the budget of the DoH at that,” Drilon said.
“This is injustice and I will not allow the budget to be passed unless this injustice is addressed,” Drilon added.
At the hearing, Drilon grilled a representative from the Department of Budget and Management for cutting the budget of the DoH by P36.2 billion from P107.3 billion in 2018 to P71 billion in 2019, particularly for health human resources deployment (HHRD) which was decreased from P9.59 billion in 2018 to P1.17 billion next year.
Dir. Jane Abella, a representative from DBM, argued that the budget was just transferred to Miscellaneous and Personnel Benefit Fund (MPBF) pending a review by the department and the Commission on Civil Service.
“Fifteen thousand nurses and health professionals will be on the streets while we are evaluating. Can you imagine the effect of this on our 15,000 workers and their performance? What kind of planning is this? Drilon asked.
Drilon said that it is not correct to transfer the funds of active government health personnel to MPBF, fearing it will not be released “without Malacanang’s clearance.”
Instead of reducing the number of health personnel, Drilon said that the DBM should regularize the 26,000 health workers, who are on job order status.
“You cannot have an ‘endo’ situation in the DoH, because the services will be affected. Let us regularize them so that we can provide stability to our health system,” Drilon said.
Drilon proposed that an errata be submitted by the DBM “in order to correct this injustice,” saying that it should not be the Senate scrambling to look for funds to restore the budget, which can be vetoed by the President.
Asked where to source the funds, Drilon said: “We have the budget. Even if we don’t have, reduce some other items in the budget in order to provide the budget for the DoH. Remove the fat in the budget in order to provide funds for the DoH.”
Drilon also questioned DBM’s move to reduce the DoH’s budget for health facilities enhancement program to P50 million in 2019 from the current level of P30.26 billion.
“This is something unusual that is why I am alarmed. This is something worrisome,” Drilon said.
The DBM representative pointed to DoH’s underutilization of the budget to justify the budget cuts.
To which Drilon replied: “So that is a punishment. The DoH should show to DBM that it can perform and if it doesn’t perform, we would just let the poor patients suffer?”
Drilon thus asked the DBM to submit an amendment to the budget to provide enough funds for the construction and maintenance of health facilities throughout the country. (via Senate website)
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