Grim reemergence

And now, a polio outbreak. Health Secretary Francisco Duque III declared the outbreak Thursday last week after confirming a second case of polio in a 5-year-old boy from Laguna, following that of a 3-year-old girl from Lanao del Sur province.

The polio virus has also been detected in samples taken from sewage in Tondo, Manila, and the waterways in Davao
during a regular environmental surveillance. Duque explained that “a single confirmed polio case of vaccine-derived poliovirus (VDPV) Type 2 or two positive environmental samples that are genetically linked isolated in two different locations is considered an epidemic in a polio-free country.”

That’s right—the Philippines had successfully eradicated polio in 2000, with the last case recorded in 1993. Its grim reemergence this year is thus significant and worrying. Low vaccination coverage, substandard sanitation practices and poor early surveillance of polio symptoms have contributed to its reappearance, the Department of Health (DOH) said.

Polio, or poliomyelitis is a highly contagious disease caused by the polio virus invading the nervous system. It is transmitted mainly through the oral-fecal route. Polio’s symptoms include fever, fatigue, headache, vomiting, stiff neck and the sudden onset of floppy arms or legs. The illness spreads rapidly and can cause paralysis and even death. Children under 5 years are the most vulnerable to this infectious disease, which has no cure and can only be prevented with multiple doses of polio vaccines given at proper intervals.

At least 95 percent of children under 5 need to be vaccinated to stop the spread of polio in the Philippines, according to the World Health Organization (WHO) and the United Nations Children’s Fund (Unicef). Duque said the average national polio vaccination stands at about 66 to 68 percent.

DOH data also showed that in 2018, 12 out of the 17 regions in the country were identified as high-risk
areas for polio reemergence, and that the number of cities and provinces at high risk of polio grew to 99 this year from just 52 last year.

As part of its rapid response to the polio outbreak, the DOH said it is rolling out a series of synchronized oral polio vaccinations for children under 5 in areas at risk starting October 2019. Aside from door-to-door initiatives, the DOH said it would deploy resources in health centers nationwide, and will strengthen its environmental surveillance throughout the country to detect the virus. The vaccination schedule involves 3 doses of oral polio vaccines (OPV) and one dose of inactivated polio vaccine.

Because poor sanitation helps spread the disease, it is critical for health workers not just to administer the polio vaccine, but also to emphasize to parents and caregivers why exercising proper hygiene—such as thoroughly washing their hands after toilet use, or using a proper toilet instead of open defecation—can help stop the virus from spreading. Parents and caregivers, too, must adhere to the proper vaccine schedules. It’s been reported that the polio-infected boy was given OPV on a delayed schedule, allowing the polio virus in the vaccine to mutate.

On Friday, Duque signed an agreement with 10 Rotary clubs that have pledged to raise funds, mount various advocacy campaigns as well as commit volunteers to ensure that the country would reach the ideal 95-percent vaccination coverage. The DOH chief said a total of P1.1 billion has been set aside for the supplemental OPV drive.

Although limited, with lawmakers having slashed the DOH’s budget by some P10 billion despite the multiple public health crises the agency has to deal with, the DOH’s budget must also be used to plug the gaps that have hobbled the government’s vaccination program in remote areas, including manpower and logistical issues. A lack of health workers plagues the program at ground level, the DOH’s Disease Prevention and Control Bureau officer in charge Anthony Calibo said in a Senate hearing on Tuesday. Calibo also mentioned the need to revisit the monitoring system for the cold chain, the process that ensures that vaccines are delivered at the needed temperatures to maintain quality, especially in areas where electricity remains a luxury.

The WHO and Unicef, meanwhile, are reminding families to exercise basic sanitation: to wash their hands regularly with soap and water, use a toilet, consume food that is fully cooked, and drink safe water. If in doubt, boil the water, the two agencies said. When it comes to preventing polio, nothing is too costly, bothersome or simple to try out.