Responses for week 1

Karissa Rodriguez
May 8, 2023 at 2:32 PM
Polio is a deadly virus that has wreaked havoc on people, causing paralysis and countless deaths. Efforts to eradicate Polio were initiated by the World Health Assembly (WHA) in 1988 by implementing the Global Polio Eradication Initiative (GPEI) (Rachlin et al., 2022). The GPEI has clear goals to improve the promptitude of case detection, facilitate emergency response systems, and improve international coordination to foster rapid outbreak response mobilization (Rachlin et al., 2022). Since this initiative was enacted, wild poliovirus (WPV) types two and three, have been declared eradicated. The use of worldwide immunization programs has contributed to halting the transmission of WPV (Rachlin et al., 2022). Unfortunately, two endemic countries are still considered to have cases of WPV, which are Afghanistan and Pakistan. In order to prevent a reoccurrence of a Polio outbreak due to these affected counties, one epidemiological approach is to utilize environmental surveillance (ES). ES uses methodical collection and testing to gather sewage samples to look for poliovirus (Rachlin et al., 2022). Once these samples are identified, increased vaccination efforts for children are executed through programs such as the GPEI.
The epidemiology triad is an infectious disease model that addresses the connection between the causation of a disease-causing agent involving a susceptible host, which can be human or animal, the conditions in which they live, and how their interaction occurs such as the course of transmission whether the spread is direct or indirect by vectors (Jia et al., 2020). The epidemiological triangle can be used to eradicate polio virus in relevance to the prevalence of this disease process at this point by continuing to monitor and identify endemic countries and then incorporate efforts to isolate those cases. World organizations, doctors, and epidemiologists must work together to isolate the host from spreading the agent and perform testing on environmental factors, such as conducting ecological surveillance. Vaccination administration to children to prevent the spread is also a crucial factor in keeping this disease from resurfacing.
Re-emergence of poliovirus is linked to a lack of vaccinations and also vaccine-derived polio. When vaccinations are given via the oral route, vaccine-derived polio occurs due to the weakened virus being excreted by the body through feces (Ming wt al., 2020). In regions where living quarters are unsanitary, this could cause an increase in spread. Solutions to this problem include advocating for the inactivated polio vaccine (IPV) to prevent vaccine-derived polio (Ming wt al., 2020). Another solution is to set up programs to build sanitary living quarters in more impoverished regions to prevent the spread and decrease the risk of transmitting pathogenic organisms. Education should be provided regarding vaccinations, signs and symptoms of poliovirus, and promoting sanitary living conditions. Many of these interventions would require cross-border cooperation.
References
Jia, P., Dong, W., Yang, S., Zhan, Z., Tu, L., Lai, S. (2020). Spatial lifecourse epidemiology and infectious disease research. Trends Parasitol. 2020 Mar;36(3):235-238. doi: 10.1016/j.pt.2019.12.012. Epub 2020 Feb 7. PMID: 32044243; PMCID: PMC7172117.
Ming, L.C., Hussain, Z., Yeoh, S.F., Koh, D., Lee, K.S. (2020). Circulating vaccine-derived poliovirus: a menace to the end game of polio eradication. Global Health. 2020 Jul 16;16(1):63. doi: 10.1186/s12992-020-00594-z. PMID: 32677974; PMCID: PMC7364572.
Rachlin, A., Patel, J,C., Burns, C.C, Jorba, J., Tallis, G., O’Leary, A., Wassilak, Sertefeuille, J,F. (2022). Progress toward polio eradication – worldwide January 2020-April 2022. MMWR Morb Mortal Wkly Rep. 2022 May 13;71(19):650-655. doi: 10.15585/mmwr.mm7119a2. PMID: 35552352; PMCID: PMC9098249.
Kyla Baucom
May 9, 2023 at 12:05 PM
Poliomyelitis is a disease of viral origin with varying severity ranging from self-limiting illness to acute flaccid paralysis (Wolbert & Higginbotham, 2022). Despite its widespread impact on children from the 1900s to the 1950s, polio has been nearly eradicated worldwide (Wolbert & Higginbotham, 2022). This is primarily attributed to heightened vaccination efforts and increased focus from the World Health Assembly in 1988 (Wolbert & Higginbotham, 2022). Vaccination considers polio from an epidemiological approach; an estimated 99% reduction in new cases has been achieved since 1988, secondary to increased vaccination efforts (Wolbert & Higginbotham, 2022). However, this approach excludes the remaining 1% of caregivers who hesitate to vaccinate their children due to social norms (“The Communities,” n.d.). Therefore, community engagement can effectively build trust and provide information to influence social norms (“The Communities,” n.d.). Once a patient is admitted with polio, supportive care is utilized, given that there are no approved antiviral agents for its treatment (Wolbert & Higginbotham, 2022). Therefore, prevention on the epidemiological level is the most beneficial for improved outcomes.
The epidemiological triangle is a model of infectious disease causation that considers the environment, the animal or human host, and the disease agent (Jia et al., 2020). These dynamic components influence disease outbreaks and overall disease impact (Jia et al., 2020). Principles of the epidemiological triangle can be utilized to eradicate polio primarily by considering the environment and host. Polio is spread through the fecal-oral route; therefore, interventions must focus on limiting factors related to its transmission (Wolbert & Higginbotham, 2022). Environments with high population density and poor sanitation must be considered, along with individual factors such as the age and nutritional status of the host (Jia et al., 2020). By addressing these factors in addition to vaccination efforts, polio may continue to remain on a trajectory toward eradication.
Although the inactivated polio vaccine (IPV) is preferred for vaccination, the live-attenuated oral polio vaccine (OPV) is often given in developing countries due to its low cost (Wolbert & Higginbotham, 2022). However, the OPV can cause Vaccine-Associated Paralytic Poliovirus (VAPP) (Wolbert & Higginbotham, 2022). Therefore, the OPV is being modified to remove the type 2 poliovirus strain, as this strain is the most frequent strain of VAPP (Wolbert & Higginbotham, 2022). If an individual develops VAPP, supportive measures, including splints, respiratory care, and surgical management may reduce residual deficits and improve outcomes.
References:
Jia, P., Dong, W., Yang, S., Zhan, Z., Tu, L., & Lai, S. (2020). Spatial lifecourse epidemiology and infectious disease research. Trends in Parasitology, 36(3), 235–238. https://doi.org/10.1016/j.pt.2019.12.012
The Communities. Global Polio Eradication Initiative. (n.d.). https://polioeradication.org/polio-today/polio-prevention/the-communities/
Wolbert, J.G., & Higginbotham, K. (2022). Poliomyelitis. In: StatPearls . Available from: https://www.ncbi.nlm.nih.gov/books/NBK558944/
Michael Jantaworn
May 9, 2023 at 4:23 PM
Dear Professor and Class,
Epidemiological
One epidemiological approach is to permanently stop all poliovirus transmission in endemic countries, particularly Afghanistan and Pakistan. Afghanistan and Pakistan represent a single epidemiological block due to social, cultural, and economic ties and large-scale population migration between borders (M A S, 2022). In these two countries, a million children did not receive the polio vaccine in 2021, and a ten-year model suggests that if these two countries are not addressed, it could lead to a global resurgence in polio transmission (Ittefaq et al., 2021). Thus the GPEI epidemiological approach of stopping all polio transmission in endemic countries involves some of the following strategic pivot points. (A) Systemic advocacy with all in Afghanistan and Pakistan, (b) multidisciplinary research into vaccine hesitancy and community mistrust, and (c) improved timeliness of detection polio. Research shows that misinformation, criticism, shame, and frustration are some of the challenges faced in Pakistan in eradicating polio (Ittefaq et al., 2021).
Clinical
One clinical approach in the GPEI involves national immunization days where all children under five will receive the oral polio vaccine, regardless of the previous immunization (World Health Organization, 2021). This approach ensures that the clinician can distribute the vaccine to individuals regardless of their understanding of the disease. However, the clinical strategy of national immunization days also works well with the epidemiological approach of stopping polio transmission in endemic countries. In the future, national immunization days will be held in endemic countries such as Afghanistan and Pakistan. The notable difference in the epidemiological tactic is that it aims to target the root cause of why communities do not want the vaccine – community mistrust of vaccinations. Meanwhile, the clinical approach does not address this underlying cause but instead aims just to vaccinate, which in turns helps to eradicate the disease.
Triangulation and Solutions
The epidemiological triangle principles of an external host, a susceptive host, and an environment that brings the host and the agent together can be used to eradicate polio. For example, in polio, the agent threatens the susceptible unvaccinated host that shares a similar environment or community. If healthcare providers vaccinate the susceptible host (unvaccinated hosts), we remove the two parts of the triangle, thus breaking epidemiological triangulation. This interruption in the triangle ultimately serves to eradicate polio. Further, vaccine-derived polio (cVDPV) Is when the vaccine-virus can circulate for prolonged periods and reacquire neurovirulence (Quareli, 2023). The solution is to address the low immunization rates, and cVDPV can rapidly be stopped with two-three rounds of high-quality supplementary immunization activities like immunization campaigns (Quareli, 2023). Also, a novel oral polio vaccine type two is in the works, which makes the polio vaccine less likely to mutate and require neurovirulence (Quareli, 2023).
References
M A S. (2022). Emerging challenges to realizing global polio eradication and their solutions. Eastern Mediterranean Health Journal, 28(7), 515–520. https://doi.org/10.26719/emhj.22.045
Ittefaq, M., Baines, A., Abwao, M., Shah, S. F. A., & Ramzan, T. (2021). “Does Pakistan still have polio cases?”: Exploring discussions on polio and polio vaccine in online news comments in Pakistan. Vaccine, 39(3), 480–486. https://doi.org/10.1016/j.vaccine.2020.12.039
Quarleri J. (2023). Poliomyelitis is a current challenge: long-term sequelae and circulating vaccine-derived poliovirus. GeroScience, 45(2), 707–717. https://doi.org/10.1007/s11357-022-00672-7
World Health Organization. (2021).Polio Eradication Strategy 2022–2026: Delivering on a promise. Geneva: World Health Organization; 2021.
The post Responses for week 1 appeared first on My Perfect Tutors.