Troubling return

Philippine Daily Inquirer / 05:16 AM September 05, 2019

It’s another health nightmare waiting to happen — unless the nation acts quickly.
On top of the twin epidemics of measles and dengue afflicting thousands of Filipinos, mostly children, at present, the
Department of Health (DOH) has revealed that two samples taken from Manila’s sewage this year tested positive for
vaccine-derived poliovirus (VDPV).

Why is this deeply troubling news? Because the Philippines has been certified polio-free since 2000 by the DOH, with the
last recorded polio case in 1993.
The return of the polio virus thus indicates a breakdown in the public health program that eradicated the disease and helps
keep it at bay. That appears to be the drop in oral polio vaccine (OPV) coverage in recent years, exacerbated by the
widespread vaccine scare generated by the Dengvaxia controversy.

“In 2018, the vaccine coverage for the third dose of OPV was 66 percent. This figure is below the 95-percent target
required to ensure that the whole population is protected against polio,” said Health Secretary Francisco Duque III. With
the vaccine coverage drop, the Philippines is at “high risk for poliovirus transmission… We need to urgently act to stop
its spread in our communities,” added Duque.
Polio (poliomyelitis) is a highly contagious disease caused when the polio virus invades the nervous system. Symptoms
include fever, fatigue, headache, vomiting, stiff neck and sudden onset of floppy arms or legs. Severe cases can lead to
permanent paralysis or death by breathing paralysis. Children under five years are most vulnerable.

This viral disease has no cure and is transmitted people-to-people, through contaminated feces or food. The virus lives in
the throat and multiplies in the intestines. It is spread via the oral-fecal route, or through droplets spread in a sneeze or
cough.
Duque cited poor hygiene and sanitation practices as a factor in the recurrence of polio.

Dr. Eric Tayag, also of DOH, said the country remains vulnerable to a possible return of polio because of its high migrant
population, weak health surveillance system and underimmunized children.

MedicineNet also cites those who are of increased risk for polio: People with immunodeficiency (HIV, cancer patients,
chemotherapy patients), very young individuals, pregnant females, caregivers for polio patients, travelers to areas were
polio is endemic (Pakistan, Afghanistan and Nigeria), and lab personnel who work with live polioviruses.

Although there is no known cure for this debilitating disease, it can easily be prevented through vaccination. Three doses
of the oral polio vaccine among infants is a crucial step to eliminating virus transmission.

But the DOH needs to warn parents as well of what to expect postvaccination, lest they again attribute perceived ill
effects to vaccines in general. The immunized child may experience mild fever, as well as soreness and redness at the
injection sites, as part of the body’s response to vaccination.

The DOH is currently conducting an immunization drive for polio aimed at covering 5.5 million children in the National
Capital Region, Central Luzon and Calabarzon, much like the World Health Organization’s Global Polio Eradication
Initiative in 1988 that caused polio cases worldwide to drop by as much as 99 percent.

“The vaccination is free and will be administered by giving a child two drops of OPV by mouth,” Duque said.
“There will be three rounds. The first round (done in August) in the City of Manila had 197,000 children vaccinated. For
the second round, we have Manila and the whole of NCR (National Capital Region), with 1.2 million children (targeted)
from Oct. 1 to 14. And for the third round, the whole of NCR, Region III and Region IV-A, with 5.5 million children
expected to be reached, from Nov. 18 to 30,” said Assistant Health Secretary Maria Rosario Vergeire.

Aside from vaccination, the government must seriously implement a zero open-defecation program, and ensure that
proper sewage facilities are built and maintained to keep the fecal-borne virus at bay. Given that most of the city’s sewage
end up in Manila Bay, swimming in its waters should also be forbidden, with barangay officials deployed to keep
stubborn swimmers away. Schools can meanwhile launch a hand-washing and general cleanliness campaign to promote
good personal hygiene and sanitation.

The specter of a generation of children crippled by polio is a scene from the past that must not be allowed to return. In
2019 and thereafter, no Filipino household should have to suffer from this ancient affliction.