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Peshawar Is World’s ‘Largest Reservoir’ Of Polio, WHO Says: Every Polio Case In Pakistan Is Genetically Linked To The City

The World Health Organization (WHO) has dubbed Pakistan’s northwestern city of Peshawar the world’s “largest reservoir” of polio and declared that almost every 2013 polio case in Pakistan could be genetically linked to the virus strains in the city of four million.

“With more than 90 percent of the current polio cases in the country genetically linked to Peshawar, the [city] is now the largest reservoir of endemic poliovirus in the world,” the WHO said in a statement. The WHO has called for urgent action to keep vaccinations ongoing in order to put a halt to the spread of the disease, which affects mainly children. Vaccination involves a quick tongue drop, but efforts to eradicate the virus in rural areas is difficult often due to a widespread belief that vaccines can cause infertility or other complications.

The WHO reported that every sample taken from Peshawar’s sewage system tested positive for a very contagious wild polio virus strain. “As much of the population of the area moves through Peshawar, the city acts as an amplifier of the poliovirus,” the WHO said in a statement.

As if the situation wasn’t dire enough, vaccination efforts are difficult to carry out properly as Pakistani militants continue to attack health workers, as the Taliban banned vaccinations in 2012. “The prevailing security situation in Peshawar has seriously affected the quality of polio campaigns in the city and is resulting in inadequate coverage of children against the virus,” the WHO said. Security needs to be improved in certain areas of Pakistan in order for vaccination efforts to continue, and for eradication to succeed.

Polio (poliomyelitis) is an infectious disease that mostly affects children under the age of 5. According to the WHO, one in 200 infections leads to permanent paralysis, which can lead to death.

Though polio cases around the globe have decreased by 99 percent since 1988, there are three countries left where polio remains endemic — Pakistan, Afghanistan, and Nigeria. In the past year, Pakistan was the only nation that experienced a rise in polio cases. Meanwhile, due to the conflict in Syria, polio has resurfaced in poor areas throughout the country where it is nearly impossible to carry out vaccination efforts due to political turmoil. The WHO also linked the outbreak in Syria to the strain from Pakistan.

Polio has been eradicated from most countries for years, and India recently celebrated three years without a reported case.

Peshawar provincial health minister Shaukat Ali Yousafzai told the AFP, "We are committed to eliminating the disease and doing our best despite continuous attacks on polio workers."

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India Still Reporting Cases of Polio-like Acute Flaccid Paralysis
ndia’s Ministry of Health and Family Welfare has reported that it has investigated approximately 18,000 cases of Acute Flaccid Paralysis (AFP) in the country since January 2015 as part of its national polio surveillance program, established in 1997, and that all of the cases have tested negative for poliovirus. Some 50,000 cases of AFP are being detected annually in India.1 2

According to a press release issued by the Ministry:

India is polio-free. The country reported its last case of wild poliovirus in 2011. After three consecutive polio-free years, the South-East Asia Region of WHO, comprising of 11 countries (including India), was certified polio-free on 27 March 2014. Despite this progress, India has maintained a high vigil and ensured that no complacency sets in order to maintain the polio-free status for the last more than 4 years. It has taken appropriate actions to ensure high population immunity against polio as well as for maintaining a sensitive surveillance system for poliovirus detection.1

Following two decades of repeated child vaccination campaigns using OPV in India, the World Health Organization (WHO) in early 2014 pronounced India “free” of wild-type polio. The controversial declaration comes at a time when India has been experiencing a huge increase in reported cases of non-polio AFP (NPAFP).3

In 2004, 12,000 cases of non-polio paralysis were reported but that number had increased by 2012 to 53,563 cases for a national rate of 12 per 100,000 children. Two pediatricians in India compiled data from the polio surveillance program and discovered a link between the increase in OPV use among children during stepped-up polio eradication campaigns and the increasing cases of NPAFP among children.

In a 2012 article published in a medical ethics journal,4 the doctors stated, “Clinically indistinguishable from polio paralysis but twice as deadly, the incidence of NPAFP was directly proportional to doses of oral polio received.” Because polio is among the more than 200 related viruses in the Picornaviridae family of enteroviruses, the doctors suggested that public health officials investigate “the influence of strain shifts of enteropathogens induced by the [polio] vaccine given practically every month.”

Although not nearly as prevalent as in India, NPAFP cases are also occurring in the U.S. In early 2014, neurologists at Stanford and University of California reported five cases of sudden paralysis of one or more limbs in children ages two to 16—all fully vaccinated against polio—and the California Department of Health of Health began investigating 20 more similar cases. Two of the five children tested positive for enterovirus-68 (EV68).5

During the summer of 2014, many more apparently healthy American children in several states, including Colorado, Missouri, Michigan and Massachusetts, were reported to be suddenly stricken with paralysis after developing cold and flu-like symptoms. Several died and, although some of the cases were associated with EV68, others were not.

Like polio, other enteroviruses are transmitted through shedding of virus in respiratory and gastrointestinal body secretions. Most of the time an enterovirus infection is asymptomatic or there are mild flu-like symptoms that do not progress to paralysis or other serious complications.7 Rarely enterovirus infections like EV68 will cause inflammation of the brain (meningitis, encephalitis), paralysis and death.

The exact cause of the cases of NPAFP among children in California, most of whom were born after 1999 and presumably were given shots of inactivated polio vaccine (IAV), has not been determined. Similarly in India, there has been no determination by government health officials about why there has been a recent dramatic increase in paralysis among tens of thousands of children that country.

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Cancer risk associated with simian virus 40 contaminated polio vaccine.

BACKGROUND:

The presence of SV40 in monkey cell cultures used in the preparation of the polio vaccine from 1955 through 1961 is well documented. Investigations have consistently demonstrated the oncogenic behavior of SV40 in animal models. Early epidemiologic studies were inadequate in demonstrating an increase in cancer incidence associated with contaminated vaccine. Recently, investigators have provided persuasive evidence that SV40 is present in human ependymomas, choroid plexus tumors, bone tumors, and mesotheliomas, however, the etiologic role of the virus in tumorigenesis has not been established.
MATERIALS AND METHODS:

Using data from SEER, we analyzed the incidence of brain tumors, bone tumors, and mesotheliomas from 1973-1993 and the possible relationship of these tumors with the administration of the SV40 contaminated vaccine.
RESULTS:

Our analysis indicates increased rates of ependymomas (37%), osteogenic sarcomas (26%), other bone tumors (34%) and mesothelioma (90%) among those in the exposed as compared to the unexposed birth cohort.
CONCLUSIONS:

These data suggest that there may be an increased incidence of certain cancers among the 98 million persons exposed to contaminated polio vaccine in the U.S.; further investigations are clearly justified.

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