The first case of wild poliomyelitis on the African continent in more than five years should serve as a warning to countries with low vaccination coverage against the disease, such as Brazil. The assessment is from the president of the Brazilian Society of Immunizations (SBIm), Juarez Cunha, who calls for more campaigns that reinforce confidence in immunizers and remind families to comply with the children’s vaccination schedule.
“The message that remains is an alert for the risk we are running as a result of low vaccination coverage”, says Cunha. “The numbers expose this vulnerability. Of every ten children, three are not vaccinated. It is a risk of an entirely avoidable situation.”
The circulation of wild polio in the world was limited by the success of vaccination against the disease, which today is only endemic in Pakistan and Afghanistan. According to the World Health Organization (WHO), only five cases were reported worldwide in 2021.
On the 17th, however, health authorities in Malawi notified the first wild case of polio in Africa in more than five years and declared an outbreak of poliovirus type 1. For the WHO Regional Director for Africa, Matshidiso Moeti, “as long as poliomyelitis exists anywhere in the world, all countries remain at risk of importing the virus.”
Poliomyelitis was declared eradicated from Brazil in 1994, also due to the success of the vaccination campaign. Despite this, since 2015, the country has not been able to reach the target of 95% of the target audience vaccinated, a level necessary for the population to be considered protected.
vaccines
In Brazil, two different vaccines are used to immunize against polio, also known as infantile paralysis: the inactivated and the attenuated. The inactivated vaccine should be given to babies at 2, 4 and 6 months of age. The attenuated vaccine, which is administered in drops orally, is indicated at 15 months and 4 years of age.
According to the National Immunization Program Information System (SI-PNI), polio vaccine coverage was 67.66% in 2021, but only 52.49% of children reached the expected dose for 4 years of age. In the Northeast and North regions, the situation is even worse, with percentages of 42% and 44% for complete immunization, respectively.
Juarez Cunha recalls that low vaccination coverage has already been responsible for the return of measles circulation, which was declared eradicated in the Americas in 2016 and returned to infect people in Brazil in 2018. poliomyelitis remains asymptomatic, which makes detected symptomatic cases even more worrisome.
“Eighty percent of people who become infected with polio do not have any symptoms. So, if a case has been identified that led to polio disease, it means that Malawi is probably circulating the virus. Where there is a case, it is already very worrying”, said the president of SBIm.
The case registered in Malawi was related to the strain of the virus that circulates in the province of Sindh, Pakistan, and, according to the WHO, does not change the certification of Africa as a wild poliomyelitis-free region, granted in 2020. Due to its low vaccination coverage, the african continent, however, still coexists with cases of poliovirus derived from the vaccine, since the attenuated vaccine contains the live and weakened virus.
In rare cases, the attenuated virus is able to replicate in the human intestine, mutate and spread, even with reduced capacity, through feces, if the surrounding population is not immunized, a risk that increases if it circulates in a region with sanitation and housing problems. The more the virus can circulate, the greater the chances of mutating more and regaining the ability to cause paralysis.
Juarez Cunha explained that, in Brazil, the risk of the poliovirus derived from the vaccine is lower, because children only receive the attenuated vaccine as a booster after they have already been immunized with three doses of the inactivated vaccine, which is more effective and safer because it contains the virus. “dead”. Even so, he warns that the risk exists and should be minimized with high vaccination coverage.
“The least favored populations are those with the lowest vaccination coverage. It is a vulnerability on top of another vulnerability, because it is precisely where we have the least possibility of control, hygiene and access to the sewage network”, said the doctor.
The president of SBIm stated that, with such risks, it is necessary to invest in communication to inform about vaccine schedules and reinforce the population’s confidence in vaccines. “Unfortunately, we do not have any communication from the Ministry of Health regarding routine vaccines. We need to strengthen the PNI and the communication of the Ministry of Health”, he says. “Although people don’t know about polio, because they were vaccinated, the disease still exists and is at risk of returning. We have to pass this message and the message of confidence in vaccination, which has not been passed on by governments, institutions and even health professionals, especially for the covid-19 vaccine, but this ends up impacting all vaccines.”
Brazil without cases since 1990
wanted by Brazil Agencythe Ministry of Health responded that Brazil has not detected cases of the disease since 1990 and received in 1994 from the Pan American Health Organization (PAHO) the certification of an area free of circulation of wild poliovirus in its territory, together with the other countries of the Americas.
“The ministry carries out communication actions throughout the year, not just during vaccination campaigns, to reinforce information on the safety and effectiveness of vaccines as a public health measure”, says the ministry, which also highlighted that the Polio vaccine coverage was 76.05% in 2020 and 67.66% in 2021.
“As for the first booster, vaccine coverage is 68.32% in 2020 and 58.07% in 2021. All these data are still preliminary and, therefore, are subject to change”, added the Ministry of Health.
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