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Global health

Eradication of Polio in Latin America and the Caribbean

Shikha Shah

on 13 April 2012

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Transcript of Global health

Eliminating Polio in Latin America and the Caribbean Polio today Thank you for your attention! Sources ABC's of Polio Quick Facts 1970s: Latin America- 15,000 paralysis cases and 1,750 deaths
1985: Pan American Health Organization began a polio eradication campaign in Latin America and the Caribbean
Due to the massive oral polio vaccine immunization program, Polio is on the verge of eradication
Vaccine administration is highly cost effective
1991: Last case of polio was reported in Latin America and the Caribbean.
Globally, polio is on the verge of being eliminated. By:
Shikha Shah
Shumailia Lakhpati
Maha Khan
Sabeena Shaikh Virus: poliomyelitis
Enters through mouth or nose and multiplies in the lymph nodes
Symptom- paralysis
occurs when the virus invades the central nervous system and kills the nerve cells that are resposible for muscle movement.
Bulbar Polio
Most serious form of polio
Virus invades motor neurons of the brain stem
As a result, victim loses ability to swallow, breathe and speak
Victims need respiratory support
Fatality is as high as 40% Transmission Spreads through contaminated feces
Incubation Period: 4-35 days
Transmission is silent- 90% of carriers show no signs at all
Can live up to two months outside the body
For each case of distinctive polio paralysis, there are 2,000- 3,000 contagious carriers Early 1900's: Polio was prominent in industrialized countries
American public rallied behind the drive for a vaccine
1938: President Roosevelt created the National Foundation for Infantile Paralysis, renamed March of Dimes
Quest for vaccine 1952: Jonas Salk "the hero"
Discovered an inactivated polio vaccine (IPV)
1955-1961: more than 300 million doses were adminstered leading to a 90% drop in the incidence of polio. Improvements OPV -Oral polio vaccine- developed by Dr. Albert Sabin
-Made from live attentuated virus
-Different from Salk's vaccine
administered orally
three doses confers lifelong immunity
like IPV it produces antibodies but in contrast, it reduces the multiplication of the virus in the intestines, halting person-person transmision
Potential OPV is easy to administer on a global scale
5 cents per dose
administration is easier becuase needles are not needed
Example: Chiapas, Mexico
polio outbreak -1961
within 4 days, Dr. Sabin's team vaccinated 80% of children
This displayed OPV's potential for use as large scale immunization Threat in Latin America Solution Mid 1900s: Polio began to be erased in North America and Europe
Not recognized as a threat to devloping countries.
However, in 1980's, incidence of paralysis rivaled that of developed countries before widespread vaccination Polio in Latin America EPI 1977: OPV was added to regular immunization as part of the new Expanded programme on Immunization(EPI)
Promoted immunization services for polio, diptheria, tetanus, pertusis (DTP), measles and TB
OPV coverage grew from 38% to 80% by 1984
Between 1975 and 1981, incidence of polio was cut in half Massive Eradication Success of the EPI inspired Dr. Guerra to propose eradication of poliovirus in Latin America and the Caribbean by 1990.
Eradication campaign was seen as:
capable of strengthening EPI
improving health infrastructure
establishing surveillance systems to monitor impact of interventions
1985- resolution passed by PAHO to eliminate polio from Latin America and the Caribbean Plan for Polio ICC- Interagency Coordinating Committee Was established to gain political and financial support
made up of PAHO, UNICEF, USAID, IDB, Rotary International, and the Canadian Public Health Association
Contributed more than $110 million between 1987 and 1991
Promoted cooperation and decreased competition among agencies

ICC =successful model ICC model was duplicated at the country level
Each national ICC developed a 5-year program for immunization
it included identifying the cost and source of funding for each activity
National commitment in the region was very strong
In the first 5 years, 80% of EPI's first year budget and 90% of the second year's budget was provided by national resources
Surveillance System Lack of Surveillance Even one case of polio can threaten an entire community
A well developed surveillance system is extremely important
At the start of the program in 1985, no surviellance system was set up
Setting up a surviellance system Uniform indicators were established:
SUSPECTED CASES: Cases of acute paralytic illness were investigated within 48 hours.
PROBABLE CASES: Cases of acute flaccid paralysis. Two stool specimens were sent out for examination in this case
CONFIRMED CASES: Stool samples were declared positive within 10 weeks or if a patient died within 60 days
Advancements Overall system became computerized by 1989
22,000 health institutions were established and local clinics were expected to report the presence/absence of cases
8 diagnostic labs were created which were equiped to detect virus in stools
Immunization Strategies Strategy Three primary components
Coverage- achieveing and maintaining immunization
Identification of new cases
Control of outbreaks
Each country was grouped into the following categories:
Polio-free: no polio cases in last 3 years
Polio-endemic: atleast one identified case Brazil: an endemic country Increasing immunization coverage in endemic countries was based on Brazil's OPV experience.
begining in 1980: Brazil implemented national vaccine days held twice a year
OPV was given to 20 million children
Goal was to vaccinate as many children as possible to halt transmission of the poliovirus
Powerful example of how poor countries with less developed health infrastructures could bolster coverage and interrupt polio
transmission "Operation Mop-Up" Launched in 1989 to wipe out the disease for good. It targeted communities where:
polio cases were reported
coverage was low
overcrowded, poor sanitation, weak health care infrastructure and/or heavy migration was seen
In the target communitites, house to house vaccinations was conducted
Weakening hold 1991: only 7 cases confirmed. 6 in Columbia, 1 in Peru
Aggressive mop up strategy was launched in Columbia
House to house vaccination reached almost a million households Final Case Noted in Peru, 1991: 2 yr old Luis Fermin Tenorio
Vaccine coverage continued through routine immunization
in 1994: Polio was declared eliminated from Latin America and the Caribbean Impact of Eradication Benefits Eradication of polio increased health and welfare of citizens
Produced trained epidemiologists and health workers with experience that are currently addressing new challenges
The surveillance system is considered to be "most comprehensive surviellance system"
Network of labs created now detect other threats like cholera, measles and tetanus
Planning capcity of the national government has improved
Coverage for all the EPI vaccines was above 70%

Cost Analysis The eradication program was extremely cost effective and cheap
Immunizing a child with
three doses of the polio vaccine (along with the DTP
vaccine) is about $14
It was economically justified based on savings of medical costs for treatment and rehab alone
Net benefits in its first 5 yrs were 217.2 million Success and Sustainability Success was largely due to political committment and interagency and regional coordination
However, complacency and polio from endemic countries are a risk to the program
Success For example... In 2000, incomplete immunization led to brief return of polio in Latin America and Caribbean
A child developed a rare strain when the vaccine virus reverted to a more virulent form.
Total of 20 cases and 2 deaths in Haiti and Dominican Republica
Since immunization coverage was inadequate there was rapid spread of polio
Even though the outbreak was contained, this showed the need for sustained financial support, political will and surviellance
Aim for Global Eradicaiton In 1998, an effort was launched to eradicate
polio from the rest of the world.
it was considered the largest public health campaign in history
it was led by the WHO, Rotary International, UNICEF, and the CDC.
More than $3 billion has been collected from different organizations
Strategies for Global Eradication Include the many of the same successful strategies as those in Latin America and Caribbean
for example, national immunization days and “mop-up” campaigns.
In 1988, it was estimated that 2 billion children have been immunized against polio
Today, there are less than 700 cases reported
compared to 350,000 when the initiative began.
-Only 4 endemic countries remain: India, Pakistan, Afghanistan, Nigeria India has been removed from the list of polio-endemic countries.
Originally, 125 infected with polio when the Global Polio Eradication Initiative (GPEI) began; now only three left!
the last six months have seen the lowest number of cases globally to have been recorded during this six-month period in the last ten years. Brazil- Country Profile Facts World bank Status: Upper Middle Income
Population: 205,716,890 (2012)
Maternal Mortality Ratio: 58 deaths/100,000 live births (2008 est.)
Infant Mortality Ratio: 20.5 deaths/1,000 live births (2012 est.)
Life Expectancy at Birth (Years)(Male/Female/Average): 69.24/76.53/72.79 (2010 est.)
Under 5 Mortality Ratio: 19/1000 children (2010 est.)
Literacy Rates: (Age 15+ can read and write)(2004 est):
Total Population: 88.6%
Male: 88.4%
Female: 88.8%
GDP: $2.282 trillion (2011 est.)in U.S. dollars
GPD Growth(annual %):2.7% (2011 est.)
GDP Per Capita: $11,600 (2011 est.)
GNP: 644.13 billion dollars (2005 est.)
-Spends 9% of GDP on healthcare (2009 est.)
-Recognizes health as a basic right of citizenship in the constitution of 1988
- The Unified Health System Sistema Único de Saúde (SUS) is based on universality and equity and provides free universalized healthcare to all Brazilians. It is supplemented by private insurers that cover about 25% of the population.
-Has three main parts:
1. Services at the federal, state, and municipal level that are publically owned and financed.
2. Private sector services that are contracted by the public sector.
3.Private sector services that are paid for by individuals or corporate health insurance.
1 and 2 are covered under the SUS
-Municipalities are responsible for primary and secondary care and the states for tertiary level care.
-There are 7800 hospitals in the country
-Paid for by general taxation
Health Care System Major Public Health Challenges: -Leprosy is a problem with national prevalence rates around 4 per 10,000 inhabitants.
-There is also a shortage of doctors, nurses and hospitals in areas of low population
-Dengue fever: in 2011, 721,546 cases were reported countrywide
-Tuberculosis: in 2006, over 77,000 cases of TB were reported
-Leishmaniasis is endemic in tropical areas
-Over 650 cases of Oropouche fever were reported in 2009
-Typhoid fever and hepatitis A are considered highly endemic.
-By the end of 2009 about 460,000 – 810,000 Brazilians were living with HIV.
http://data.worldbank.org/country/brazil, www.moiti.org/pdf/Brazil%20Health%20Care%20System.pdf, http://www.netglobers.com/south-america/brazil-main-health-risks-for-brazil.html
Video: video-http://www.youtube.com/watch?v=QgDTwTkWHnI
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