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The only way to determine
if polio persists is to have trained observers on the lookout for it. This
is 'surveillance', the intelligence network underpinning the entire eradication
initiative. It pinpoints where wild poliovirus is circulating, as well as
the type of virus and its origin. Once transmission is halted, surveillance
will help verify complete polio eradication.
Surveillance is a straightforward but intensive process. Health officials
in every country monitor their populations for polio outbreaks. The tell-tale
sign is a specific type of crippling called acute flaccid paralysis (AFP).
Any child under 15 who has a 'floppy' limb is investigated, even though
diseases other than polio might have caused it. If AFP is found, faecal
samples, which must be kept cold, are taken from the child and rushed to
an accredited laboratory for testing.
Until this highly sensitive network was established, health officials had
to estimate the world's total number of polio cases. When the Initiative
started in 1988, they calculated that only 1 of 10 polio cases had been
identified. Now, they can not only identify almost all polio cases, but
can also identify the exact strain and origin of the virus.
Even in the absence of wild poliovirus, surveillance has three main goals:
detecting at least 1 case of AFP per 100,000 children under 15 (this accounts
for the statistical probability of other types of paralysis); collecting
adequate stool specimens from at least 80 per cent of AFP cases; and testing
all specimens at a WHO-accredited laboratory. For this, a 147-laboratory
global network is now in place. The US Centers for Disease Control and Prevention
has been instrumental in establishing and monitoring this network.
Mop-ups are focused vaccination campaigns that back up routine immunization
and National Immunization Days. They specifically focus on places that are
high-risk areas or where surveillance detects a rogue virus. For example,
India is 'mopping up' in the remaining areas with relatively high rates
of polio, in addition to carrying out NIDs. If surveillance finds polio
circulating in a particular area, mop-ups targeting at least one million
children are immediately organized. Vaccination teams go to every house,
giving two doses of vaccine to all children under five, regardless of their
immunization status.
When deployed against rogue viruses, mop-up campaigns are comparable to
fighting brushfires: quick deployments designed to contain unexpected outbreaks.
In 1998, in the last recorded case of paralysis in Europe two-year-old
Melik Minas in Turkey -- mop-up teams immediately blanketed the south-east
of the country, where Melik lived. They also covered adjacent regions of
Iran and Iraq. |
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©
Sebastião
Salgado
United
States of America
A scientist views a wild poliovirus strain called a 'virus tree' on a computer
screen, at the Centers for Disease Control and Prevention in Atlanta. Strains
from countries around the world are sent here to be stored and genetically
identified. This includes pinpointing the exact geographical origin of each
strain, a crucial factor in mapping follow-up immunization strategies.
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