Eliminating Polio in Latin America and the Caribbean Region

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Poliomyelitis (polio) has been in existence for long. Intestinal poliovirus is responsible for polio cases. This virus gets into the human body through the nose or mouth and increases in number in the lymph nodes. The common symptom of polio is paralysis. Paralysis affects less than a per cent of polio victims and occurs when the poliovirus affects the central nervous system, and subsequently destroys the nerve cells that control the movement of muscles, particular legs’ muscles. This condition is results into acute flaccid paralysis. Poliovirus also causes quadriplegia which affects the trunk and muscles of the abdomen and thorax. It may also affect the motor neurons of the brain stem (bulbar polio). Bulbar polio affects the muscles resulting into swallowing, breathing and speaking difficulties. Bulbar polio is the most serious form of polio paralysis. Poliovirus is very contagious and can spread through contaminated feces. The virus mode of transmission shows no signs in its carriers. Poliovirus can live for two months outside the human body in drinking water, clothing, swimming pools, and even clothing. Non-paralyzing symptoms such as fatigue, headache, fever, stiff neck, or vomiting cannot give conclusive indication of polio attack. Statistics show that we are almost eradicating polio from the globe (Silver and Wilson, 2007).

The success of fighting polio using EPI in Latin America inspired experts who proposed the eradication of the common and wild poliovirus in Caribbean and Latin America by the year 1990, through planned regional efforts. Experts believed that polio elimination campaign could be used to strengthen the whole EPI, establish the missing surveillance system, and improve the health infrastructure in order to monitor the results of intervention measures on polio and other childhood diseases. It is vital to note that Latin America and the Caribbean eliminated smallpox more than a decade earlier. This encouraged health experts to push for resolutions in 1985 on polio eradication (Silver and Wilson, 2007).

Starting conditions that facilitated the achievement of polio elimination

Latin America and the Caribbean put all the pieces of financial, political and managerial resources to fight polio. The eradication efforts focused on a functional surveillance system, which could detect even low level of infection. This aimed at initiating immediate investigations necessary for the project success. Extreme vigilance program set out to create a uniform reference points for polio through the region. According to the doctors, any suspected cases of acute paralytic incidences were most likely to be polio. The doctors responded to every suspected case within 48 hours. On the other hand, a probable incidence (case acute flaccid paralysis) required testing of two stool specimens. In any case, the laboratory results were positive, doctor would call the case as confirmed. Extreme vigilance encouraged community involvement to aid in identification of polio cases. The system offered a reward of $100 to the community for reporting any case of polio (Silver, J. and Wilson, D., 2007).

The surveillance system for polio elimination had a higher level of dissemination with several health workers in the field. The system had a computerized system to track polio indicators by 1989. There were also reporting networks of more than 22,000 health stations. Local clinics had to report weekly on the presence or absence of polio (Killewo, 2010).

Latin America and the Caribbean polio immunization strategy focused on achieving and promoting a higher number of immunizations, instance identification of emerging incidences, and strict control of new outbreaks. Latin America countries and the Caribbean region consisted of two groups i.e. polio-free and polio-endemic. Polio-free countries were to maintain their status while polio-endemic countries were to improve on immunization campaigns as in the case of Brazil (Jacobsen, 2007).

Latin America and the Caribbean adopted Operation Mop-Up to supplement the national polio eradication days. This was the final step to eliminating polio completely. The operation aimed at countries with low coverage, poor sanitation, overcrowded areas, reported polio cases, poor health facilities and areas with heavy prevailing migration.

Societies and groups that benefited most from polio eradication

While most countries are still struggling to eliminate polio, Latin America and Caribbean region have been free of polio for almost two decades. The impact of eliminating polio has seen tangible health and welfare benefits to the residents and governments of Latin America and Caribbean region. The program has left vital health infrastructure, trained nurses, established laboratories centers, and strong surveillance system to monitor polio occurrences in the region (Killewo, 2010).

The success of polio eradication in Latin America and Caribbean region occurred due to strong political commitment, regional coordination and interagency efforts. These efforts must address a complacency, which poses threats to total eradication of polio. Therefore, maintaining and expanding polio eradication must look into constant provision of the above factors. The success of polio eradication in Latin America and Caribbean region served as a model to other countries around the world in their efforts to eradicate polio (Levine, 2007).

Could or should interagency coordinating committees be established for general health program?

The success of eradicating polio depended on the efforts of health interagency through the provision of funds, regional cooperation, support and strong strategy that covered all the bases in fighting polio. The efforts of the interagency (ICC) eradicated polio in Latin America and the Caribbean region (Killewo, 2010).

Latin America got broad support from both local and international partners. EPI supported delivery of immunization campaigns for polio and other early childhood diseases through the use of basic health services. In the year 1984, the use of Dr. Albert Sabin’s oral polio vaccine (OPV) grew to 80 per cent. This marked reduction of polio incidences in Latin America and Caribbean and countries reported low numbers of polio cases of up from 19 to 11 per cent (Silver and Wilson, 2007).

The polio eradication campaign aimed at mobilizing the crucial financial, political and social commitment for the regional effort and organizing the managerial teams to carry out immunization in each country. The financial and political support led to the formation of Interagency Coordinating Committee (ICC) in Latin America and the Caribbean. The committee consisted of local representatives, the United Nations Children’s Fund (UNICEF), Inter-American Development Bank, the US Agency for International Development (USAID), and Canadian Public Health Association. These donors contributed millions of dollars to support eradication of polio from 1987 to 1991 (Silver and Wilson, 2007). Following the success of ICC in eradication of polio in Latin America and Caribbean regions, the national governments should establish the agency to help in fighting other infectious diseases.

In what ways did the polio elimination campaign strengthen the basic health system? How might you see polio eradication weakening the delivery of basic health services?

Countries expanded program on immunization (EPI), and Latin America targeted six diseases, such as diphtheria, tetanus and pertussis (DTP), tuberculosis, polio and measles. This program targeted children below 1 year (Levine, 2007). These targeted moves strengthened the fight of early childhood diseases.

At the same time, the region’s national governments planning efforts and capacity have improved consistently. The governments have national annual plan that serves as a necessary tool in managing health has now expanded to include both the child and the mother health services. Polio campaign also enhanced the goals of EPI, which saw all the six vaccine attain the highest records in many regions (Levine, 2007).

Polio elimination campaign created vital health infrastructure, and its capacity to handle other infectious diseases. The system left many trained epidemiologists and health workers with vast knowledge and experience in disease control, surveillance cold chain management and operational research. This team is now focusing on new emerging infectious diseases challenges. The Latin America and Caribbean region surveillance systems are the most advanced human monitoring systems that have ever existed in the region. The established chain of laboratories in the Western Hemisphere now serves other public diseases, such as cholera, measles and tetanus as detection and controlling centers (Killewo, 2010).

On the other hand, too much attention on polio elimination neglected mothers, men and children over one year. At the same time, there was also growing complacency in the region, which poses threats to total eradication of polio. All in all, polio eradication served to strengthen health sectors rather than weaken them.

How might the polio eradication initiative contribute to the preparedness for and mitigation of avian influenza?

In addition to natural migration of birds, avian influenza threat comes from smuggling of birds either live or raw meat across continents. The spread of the A(H5N1) virus that cause avian influenza must be counteracted with strong political and government legislation. World governments must focus their attention and cooperation on air transport, which facilitate global transmission of the virus (Killewo, 2010).

Just like using surveillance in mitigating polio, avian influenza can also be managed through the use of emergency surveillance system. This will ensure that people remain alert throughout to the problem. There should be active coordination of various countries agencies and ministries to share information, deal with the problem, and respond to the crisis promptly and consistently. There should also be a prolonged approach involving scientists, professionals, security experts and others to provide specific information on the epidemic. Above all, there should be crucial factors for community participation, transparency, interagency cooperation and funds to fight the spread of the epidemic (Jacobsen, 2007).

References

Jacobsen, K. H. (2007). Introduction to Global Health. Sudbury, MA: Jones & Bartlett Publisher.

Killewo, J. (2010). Epidemiology and Demography in Public Health. San Diego, CA: Elsevier Inc.

Levine, R. (2007). Case Studies in Global Health: Millions Saved. Sudbury, MA: Jones & Bartlett Publishers.

Silver, J. and Wilson, D. (2007). Polio Voices: An Oral History from the American Polio Epidemics and Worldwide Eradication Efforts. Westport, CT: Greenwood Publishing Group, Inc.

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