Monday, September 25, 2006

Polio outbreak: Do bundein zindagi ki?

It seems there's a Polio outbreak in the country. The number of Polio cases reported this year is around 300, whereas it was 66 last year.

I got to know about this outbreak late. Mainly because I have been traveling over the last two-three weeks and have not been following news regularly (thats also the reason there wasn't any new post on the blog for so many days). I first read about it in the leading front-page story of "The Telegraph" yesterday. But after that I noticed one mail from my friend in my mailbox that gave a link to an Indian Express report on the government's explanation of the rise in Polio cases. Coming from the Government spokespersons, it naturally attributes it to kids who give polio drive a miss. It does not stop there, it goes on to target the Muslim community in particular: "Another problem that the government has to deal with is that UP's large Muslim minority are reluctant to get their children immunized because of rumours that polio drops are part of a Western conspiracy to make their children sterile. Nearly 70% of the cases are from minority communities.."

My friend can't hide his anger:

"Those who do these based on pseudo-scientific reasoning are doing unpardonable crime and
irreversible damage to their children
."

"The Telegraph" story is a twist in the tale, and suggests that the Government is desparately trying to hide the ineffectiveness of the Pulse Polio drive.

"India’s health bureaucracy ignored scientific advice about flaws in the polio immunisation programme for nearly 20 years and suppressed research that might have led to faster eradication, doctors have said.." [Polio botch-up blame at Delhi door, http://www.telegraphindia.com/1060924/asp/frontpage/story_6786709.asp]





"The doctors have challenged assertions by health officials that the surge in polio in western Uttar Pradesh this year -- and the resulting setback in eradication efforts -- was only due to poor immunisation there last year.

In scientific papers and interviews to The Telegraph, they said India's failure to eradicate polio also stems from wrong decisions on dosage and choice of vaccine..." the report continues.






"The number of polio cases in India has surged this year to 297 after a steady decline for years and a record low of 66 last year."

"Children who got as many as 10 doses have still got polio in Uttar Pradesh this year."

"John believes policy-makers displayed an unscientific bias towards OPV over the inactivated injectible polio vaccine (IPV) that has been shown through studies as superior in many ways."

"In a paper three years ago in the Proceedings of the Indian National Science Academy, John suggested there might have been an effort to suppress findings about IPV's advantages. His own studies comparing IPV with OPV in Tamil Nadu were approved by the Centre on the condition that he would not publish the results."

"Another pediatrician in a government medical college in New Delhi told The Telegraph that he was discouraged from studying IPV."

[Images from The Telegraph report]

Now we'll try to check the science and "pseudo-science" in the claims and counter-claims. Last month when we talked about not vaccinating Aadil, I had promised to come back with the arguments against the Oral Polio Vaccines, popularly known as "Pulse Polio" (Amitabh Bachchan and Sachin Tendulkar come on the mini screen often to coax us to give our children the two drops of life).

One of the main arguments of the anti-OPV drive in Kerala was that OPV is discontinued in most developed countries. In USA, the Oral Vaccine was banned in 1999 following a case of "Vaccine caused Parallysis". (Read about one such case at http://www.ryar.org/news/07-28-05.html. The campaigns have documented similar cases reported in India/Kerala as well).

A "Science Daily" report admits that OPV runs such a risk, but says that it can be overcome by "proper coverage" (A 2004 outbreak of polio in China traced back to live attenuated oral polio vaccine (OPV), which is widely used in global eradication efforts, highlights the small but significant risk to eradication posed by the use of OPV at suboptimal rates of coverage.., http://www.sciencedaily.com/releases/2006/08/060815160951.htm)
When this became a debate in India, the Government's stand was that if all the children in the country are given the vaccine at the same time (yes-- same time, not the same day), it was safe. Can one get any more unrealistic?

Oral Polio Vaccine is no longer recommended, says one US health brochure (pdf).

And now, check this:

    Despite the figues showing the Polio cases on the decline in the countries that are on the OPV drive now (India, Pakistan, China, some African countries), the figures (the official ones itself) of Non-Polio AFPs (Accute Flaccid Parallysis, cases of polio-like diseases), is showing an exponential rise in all these countries.
    In India, The number of cases of non-Polio AFPs rose from 772 in 1996 to 27,000 in 2004 (the polio figures dropped from 1105 to 136 in the same period).
The activists claim there is a chance that many of these cases are actually that of Polio and are not reported as Polio, because there are parties who benefit from the OPV drive and they are influential enough. I find it a serious concern. But can we ever expect honest research to happen in such areas, and even if research happens, what is the guarantee that the real results reach us? Chances seem grim:-(

7 comments:

Anonymous said...

Thanks for the remarkable analysis shown in your blog. My reply is given below.

---------------------------------------

It does not stop there, it goes on to target the Muslim community in particular: "Another problem that the government has to deal with is that UP's large Muslim minority are reluctant to get their children immunized because of rumours that polio drops are part of a Western conspiracy to make their children sterile. Nearly 70% of the cases are from minority communities.."

[reply]

I will come to this later.

[/reply]

My friend can't hide his anger:

"Those who do these based on pseudo-scientific reasoning are doing unpardonable crime and
irreversible damage to their children."

[reply]

Thanks for quoting me.

[/reply]
"The Telegraph" story is a twist in the tale, and suggests that the Government is desparately trying to hide the ineffectiveness of the Pulse Polio drive.

"India's health bureaucracy ignored scientific advice about flaws in the polio immunisation programme for nearly 20 years and suppressed research that might have led to faster eradication, doctors have said.." [Polio botch-up blame at Delhi door, http://www.telegraphindia.com/1060924/asp/frontpage/story_6786709.asp]

[reply]

This whole article is not driving any point on anti-vaccination. It is only giving doctors comment about the ineffectiveness of its implementation.

Quoting John himself

[quote]

"Policy-makers adopted three doses despite abundant data that a five-dose plan would protect more children," said Dr T. Jacob John, former head of virology at the Christian Medical College in Vellore and a member of the India Expert Advisory Group for Polio Eradication.

[/quote]

[/reply]

Now we'll try to check the science and "pseudo-science" in the claims and counter-claims. Last month when we talked about not vaccinating Aadil , I had promised to come back with the arguments against the Oral Polio Vaccines, popularly known as "Pulse Polio" (Amitabh Bachchan and Sachin Tendulkar come on the mini screen often to coax us to give our children the two drops of life).

[reply]

Would you consider vaccinating him with IPV if it is available or are you against vaccination at all ?

[/reply]

One of the main arguments of the anti-OPV drive in Kerala was that OPV is discontinued in most developed countries. In USA, the Oral Vaccine was banned in 1999 following a case of "Vaccine caused Parallysis". (Read about one such case at http://www.ryar.org/news/07-28-05.html . The campaigns have documented similar cases reported in India/Kerala as well).

[reply]

Sorry this is only a website of Law firm which gave this example only to attract clients

[/reply]
When this became a debate in India, the Government's stand was that if all the children in the country are given the vaccine at the same time (yes-- same time, not the same day), it was safe. Can one get any more unrealistic?


Oral Polio Vaccine is no longer recommended, says one US health brochure (pdf).

[reply]

Please don't read only the headlines.

Oral Polio Vaccine: No longer recommended

There are two kinds of polio vaccine: IPV, which is the shot recommended in the United States today,
and a live, oral polio vaccine (OPV), which is drops that are swallowed.
Until recently OPV was recommended for most children in the United States. OPV helped us rid the
country of polio, and it is still used in many parts of the world.
Both vaccines give immunity to polio, but OPV is better at keeping the disease from spreading to
other people. However, for a few people (about one in 2.4 million), OPV actually causes polio. Since
the risk of getting polio in the United States is now extremely low, experts believe that using oral
polio vaccine is no longer worth the slight risk, except in limited circumstances which your doctor
can describe. The polio shot (IPV) does not cause polio. If you or your child will be getting OPV, ask
for a copy of the OPV supplemental Vaccine Information Statement.

Quoting from your science daily link

[quote]

In 2003, the World Health Organization recommended discontinuing the use of live virus vaccine after the eradication of the disease and containment of poliovirus stocks.

[/quote]

But FYI, India is still not declared polio free. The date is pushed to the end of this decade.

[/reply]

And now, check this:

Despite the figues showing the Polio cases on the decline in the countries that are on the OPV drive now (India, Pakistan, China, some African countries), the figures (the official ones itself) of Non-Polio AFPs (Accute Flaccid Parallysis, cases of polio-like diseases), is showing an exponential rise in all these countries.

In India, The number of cases of non-Polio AFPs rose from 772 in 1996 to 27,000 in 2004 (the polio figures dropped from 1105 to 136 in the same period).


[reply]

Please give reference or link where you have quoted this from

Another one which you had quoted in

http://sudeepsdiary.blogspot.com/2006/08/about-not-vaccinating-aadil.html

Vaccination myths by Alan Philips

Please read the following reply to that.

A pack of lies titled "Dispelling Vaccination Myths" by Alan Phillips is reproduced in several places on the Internet. A real doctor has taken the time to address the sophistry, statistical misrepresentations and outright lies in Phillips' article.

http://www.rainbowpediatrics.net/faq/18.10.html

[/reply]

The activists claim there is a chance that many of these cases are actually that of Polio and are not reported as Polio, because there are parties who benefit from the OPV drive and they are influential enough. I find it a serious concern. But can we ever expect honest research to happen in such areas, and even if research happens, what is the guarantee that the real results reach us? Chances seem grim:-(

[reply]

I agree there could be a section who is benifitting from the OPV drive, but that doesn't argument devalue vaccination per se. Please ask yourself whether you have done an honest research rather than looking and quoting with a confirmational bias.

Coming to minority card issue here, remember few muslims are not the one who is against vaccination. It just happened in western UP that 70% of cases were from that community. They were under the myth that it makes them infertile. I don't think credulity always piggy back with any religion.This was same reason cited when there was a outbreak in Nigeria last year

http://skeptico.blogs.com/skeptico/2005/05/polio_rises_tha.html

Anti-vaxers are present in every country. In US it is on autism. You can check these more informed blogs

http://skeptico.blogs.com/skeptico/antivaccination_hysteria/index.html

http://scienceblogs.com/insolence/2006/07/still_more_evidence_that_vaccines_dont_c_1.php

We are not very good in thinking statistically (for evolutionary reasons). We prefer anecdotes and cherry pick based on confirmational bias.

Quoting from

http://scienceblogs.com/insolence/2006/09/vaccines_and_relative_risks_1.php

[quote]

One example was perfect: "So can we also assume that you never allow your child to ride in a motor vehicle? That is certainly far from 100% risk free." Indeed, the risk of a child dying in an automobile accident is many orders of magnitude greater than the risk of being injured by vaccination. And, of course, the parent who is driving is completely responsible for subjecting the child to the risk of serious injury and death. I would point out another example, which produces a smaller risk than cars but larger than vaccines: Sports. Consider, about four children per year in the U.S. die as a result of an injury from playing baseball or softball, an average that, as of the mid-1990's, had not changed appreciably since the 1970's. That's right, around 4-5 children a year in the U.S. die of injuries suffered playing baseball or softball. But deaths are only the worst injuries. Among children ages 5-14, around well over 100,000 children per year are taken to the emergency room for injuries suffered playing baseball. These include sprains, contusions, fractures, dental injuries, head injuries and concussions, and internal injuries. In fact, baseball has the highest child fatality rate of any sport. And those are just the injuries severe enough to cause the coach and parents to take the child to the emergency room. In fact, if you look at all sports injuries in children, there are approximately three million sports injuries per year!

[/quote]
[/reply]

sudeep said...

Let me make it clear that my post was not a detailed analysis, it was only meant to be a starting point of a discussion.

I'll only give link to a Times of India editorial here [http://timesofindia.indiatimes.com/articleshow/2018963.cms]:
"Something is seriously wrong with India's polio eradication initiative (PEI). The Indian Medical Association (IMA) has raised doubts over why, after a decade of intensive implementation of polio vaccination, the incidence of acute flaccid paralysis (AFP) is on the increase, particularly in Uttar Pradesh and Bihar.

The global average incidence of AFP is one in 100,000, but in India the incidence has suddenly risen to 12-13 per 100,000 since the implementation of the polio programme.."

I will come back with a more detailed post/comment on this issue when I have some time to spend on it.

tabassum said...

"Would you consider vaccinating him with IPV if it is available or are you against vaccination at all ?"
I'm just trying to answer this question and am not entering the other aspect of the discussion now.
There are different types of preventions.What I go for is the prevention through lifestyle.
Me and Sudeep tries to save the child from many of the diseases throgh the general health conditions we tries to provide him.
Many though we just deprived Adil of the capacity to prevent disease by rejecting the vaccination process.In fact we are being careful in controlling his food items and are taking care of developing his immunity.What we can do for it consists of giving him fresh food and we avoid tinfood and other sugar content things.
This is all about our approach to a problem.we know as little as life and it's functionings as the govt. So let's choose our faults than choosing that faults that some outside force impose on us.Let us take responsibility of our actions and be with the next generation in their health.

sudeep said...

To add to what Sreejitha said, Tony Blair had made a public statement that he isn't vaccinating his kid, and when some press people tried to make a news of it and click the kid's snap, he refused and said it was intrusion into his private life. I believe he is right, it is a matter of choice. Once the kid grows up and becomes able to make her/his own decisions, it is her/his choice. Till then, of those who are taking care of her/him.

sudeep said...

Here's some more, on OPV and also on Vaccinations in general.

1. OPV paralyses 3,00,000+ children in last two decades, a thread on a google group.

2. CVI Agenda: Vaccinate, all people, for all diseases, at any cost, another post on the same group.

sudeep said...

a doctor scraps me on orkut:

"read ur blog.
apt and informative. i know these facts and i myself have been working in this area under WHO each year but tell u, kuchh honewala nahin hai. agar polio eradicate ho gaya tov bahut logon ki roti chali jayegi. unbelivable no? its true. i ve heard many higher officials uttering these very words.

another thing is this minority people. illiteracy is a curse and the rigidity to contain that illiteracy is the worst thing that can happen to growing(!) india. God save the king! (sorry, the kid)!!!
"

bsc said...

Very interesting inded. All comments and the article itself (post). Masha-Allah Sundeep and Anonymous have done a
n extensive report to update many aspects of the problem. Congratulations.
I was trained by a man who had weakness in one leg from polio and he had worked with Albert Sabin for the Polio vaccine (the other name than Salk who got more publicity also. Thanks and I look forward to Sundeep's future explorations.