Post-marketing surveillance study to assess the safety and tolerability of an Inactivated Poliomyelitis Vaccine in Indian children.

OBJECTIVE: To evaluate the incidence of adverse events following administration of an Inactivated poliomyelitis vaccine (IPV) manufactured by Serum Institute of India Pvt. Ltd., Pune, India. METHODS: A single 0.5 ml dose of the IPV was administered intramuscularly to children attending private clinics or out-patient department of hospitals for routine immunization across different cities in India. They were observed over a period of 30 d for local or systemic adverse events and rare case of anaphylaxis, if any. RESULTS: A total of 2210 children were enrolled of which 2120 children received the vaccine within primary immunization series and 90 children received booster dose. The common adverse events reported were pain, erythema, swelling and fever. No serious adverse event was reported during the study period. CONCLUSIONS: Poliomyelitis vaccine (Inactivated) manufactured by Serum Institute of India Pvt. Ltd., Pune can be safely administered to children following the Expanded Programme on Immunization or World Health Organization recommended immunization schedule.

Survey of young patients with polio and a foreign background at a Swedish post-polio outpatient clinic.

Nowadays, polio survivors aged under 60 years are non-native Swedes which pose new aspects and challenges to a post-polio outpatient clinic. To analyze the medical data, walking aids, occupational, and family situation in non-native polio survivors aged less than 60 years at a Swedish post-polio outpatient clinic. Retrospective data analysis. Data were retrieved from medical records at the post-polio outpatient clinic. Actual age, age at acute polio infection, walking capacity, pain, concomitant diseases, working and family situation, and ethnical origin were analyzed. Data are presented in numbers and percentage. 153 patients were included. Mean age was 45 (17-60) years, and mean age at acute polio infection was 2 (0-12) years. Paresis of the lower extremities was the most common disability. 10 % were wheelchair dependent. Pain occurred in 70 % with a mean intensity of 55 measured with the visual analog scale. Hypertension was the most common concomitant disease. Half of the polio survivors were working at least part time, and roughly half were singles. Data were comparable with data earlier published in Swedish native polio survivors. Non-native polio survivors aged under 60 years showed similarities in age at acute polio infection, paresis, prevalence, and intensity of pain when compared with native Swedish polio survivors. They were, however, younger, and were less often working and married/cohabitants than native Swedish polio survivors. The results of this study underline the importance of social and vocational rehabilitation tailoring rehabilitation suitable for polio survivors with a foreign background.

Socioeconomic status and vaccine coverage during wild-type poliovirus emergence in Israel.

In August 2013, a nationwide vaccination campaign with bivalent oral polio vaccine (bOPV) was initiated after isolation of wild-type poliovirus type 1 (WPV-1) in routine sewage surveillance in Israel. The campaign started in the Southern district and later extended to the entire country. This study examined the association between socioeconomic status (SES), and compliance with bOPV vaccine during the campaign. Nationwide data relating to SES by geographical cluster were correlated with vaccine coverage rates in the same areas. All analyses were conducted separately for Jews and Arabs. Coverage with the bOPV vaccination campaign in the Arab population (92·4%) was higher than in the Jewish population (59·2%). This difference was consistently present in all SES clusters. In the Jewish population there was an inverse correlation between SES and vaccination coverage rates (R = -0·93, P < 0·001). Lower vaccination coverage with supplemental vaccine activities in higher SES groups is a challenge that needs to be addressed in future public health events and emergencies in order to achieve satisfactory protection rates for the public.

The Global Context of Vaccine Refusal: Insights from a Systematic Comparative Ethnography of the Global Polio Eradication Initiative.

Many of medical anthropology's most pressing research questions require an understanding how infections, money, and ideas move around the globe. The Global Polio Eradication Initiative (GPEI) is a $9 billion project that has delivered 20 billion doses of oral polio vaccine in campaigns across the world. With its array of global activities, it cannot be comprehensively explored by the traditional anthropological method of research at one field site. This article describes an ethnographic study of the GPEI, a collaborative effort between researchers at eight sites in seven countries. We developed a methodology grounded in nuanced understandings of local context but structured to allow analysis of global trends. Here, we examine polio vaccine acceptance and refusal to understand how global phenomena-in this case, policy decisions by donors and global health organizations to support vaccination campaigns rather than building health systems-shape local behavior.

[Poliomyelitis--Challenges for the Last Mile of the Eradication Programme]. / Poliomyelitis--Herausforderungen in der Endphase des globalen Eradikationsprogramms.

The World Health Organisation initiated the Global Polio Eradication Initiative in the year 1988. With the large-scale application of routine and mass vaccinations in children under the age of 5 years, polio disease has become restricted to only 3 endemic countries (Afghanistan, Pakistan and Nigeria) by today. However, since the beginning of the 21st century, increasing numbers of secondary polio epidemics have been observed which were triggered through migration, political turmoil and weak health systems. In addition, there emerged serious technical (e. g., back-mutations of oral vaccine virus to wild virus) and socio-political (refusal of vaccinations in Muslim populations of Nigeria and Pakistan) problems with the vaccination in the remaining endemic countries. It thus appears questionable if the current eradiation initiative will reach its goal in the foreseeable future.

Parental perceptions surrounding polio and self-reported non-participation in polio supplementary immunization activities in Karachi, Pakistan: a mixed methods study.

OBJECTIVE: To assess parent's knowledge and perceptions surrounding polio and polio vaccination, self-reported participation in polio supplementary immunization activities (SIAs) targeting children aged < 5 years, and reasons for non-participation. METHODS: The mixed methods study began with a cross-sectional survey in Karachi, Pakistan. A structured questionnaire was administered to assess parental knowledge of polio and participation in polio SIAs conducted in September and October 2011. Additionally, 30 parents of Pashtun ethnicity (a high-risk group) who refused to vaccinate their children were interviewed in depth to determine why. Descriptive and bivariate analyses by ethnic and socioeconomic group were performed for quantitative data; thematic analysis was conducted for qualitative interviews with Pashtun parents. FINDINGS: Of 1017 parents surveyed, 412 (41%) had never heard of polio; 132 (13%) did not participate in one SIA and 157 (15.4%) did not participate in either SIA. Among non-participants, 34 (21.6%) reported not having been contacted by a vaccinator; 116 (73.9%) reported having refused to participate, and 7 (4.5%) reported that the child was absent from home when the vaccinator visited. Refusals clustered in low-income Pashtun (43/441; 9.8%) and high-income families of any ethnic background (71/153; 46.4%). Low-income Pashtuns were more likely to not have participated in polio SIAs than low-income non-Pashtuns (odds ratio, OR: 7.1; 95% confidence interval, CI: 3.47-14.5). Reasons commonly cited among Pashtuns for refusing vaccination included fear of sterility; lack of faith in the polio vaccine; scepticism about the vaccination programme, and fear that the vaccine might contain religiously forbidden ingredients. CONCLUSION: In Karachi, interruption of polio transmission requires integrated and participatory community interventions targeting high-risk populations.

"Do not eat those apples; they've been on the ground!": polio epidemics and preventive measures, Sweden 1880s-1940s.

This article will address how Swedish scientists, physicians and public health officers tried to combat the polio epidemics in the pre-vaccine era. It shows that once polio was considered as an epidemic disease the preventive measures used were based on the hindrance of other infectious diseases. It also illustrates how epidemiological and laboratory studies to some degree affected the thoughts of how polio should be prevented, and that Swedish ideas and experiences differed from those put forward in the USA.

[Epidemiological and virological studies into the poliomyelitis in Valencia (1959-1969)]. / Estudios epidemiológicos y virológicos sobre la poliomielitis en Valencia (1959-1969).

Studies into the polio virus began in Valencia in 1959 with the work undertaken by the microbiologist Vicente Sanchis-Bayarri Vaillant. After his education at the Rochester University and at the Pasteur Institute, Sanchis-Bayarri Vaillant established a laboratory of cell cultures at the Faculty of Medicine in Valencia, where he developed a new diagnostic technique for the poliomyelitis virus. In addition, epidemiological studies were carried out both prior to and post the 1963 vaccination campaign, which proved that Sabin's oral vaccine was both effective and safe for use.

[The historical meaning of serological surveys as a laboratory technology applied to the immunization campaigns. The case of poliomyelitis in Spain]. / El significado histórico de las encuestas de seroprevalencia como tecnología de laboratorio aplicada a las campañas de inmunización. El caso de la poliomielitis en España.

The aim of the paper is to analyse the introduction, use and diffusion of the serological surveys, a public health technology on the borderline between epidemiology and laboratory, in connection with poliomyelitis in Spain during the Francoism period. Within the framework of the "new history" of medical technologies and innovations, the serological surveys played an important role both in the improvement of knowledge on socio-demographic distribution and the health politics arena.

Deconstructing social resistance to pulse polio campaign in two North Indian districts.

OBJECTIVE: To gain an insight into the phenomenon of social resistance and rumors against pulse polio campaign. DESIGN: Qualitative, community-based investigation, mapping perceptions of various stakeholders through in-depth interviews (IDIs), focus group discussions (FGDs), non-formal interactions and observations. SETTING: Moradabad and JP Nagar districts of Uttar Pradesh. SUBJECTS: IDIs (providers 33, mothers 33, community leaders 10); FGDs (providers 4, mothers 8) and non-formal interactions (156) with community leaders, parents, businessmen, journalists (Hindi and Urdu media), mobilizers, vaccinators and supervisors. RESULTS: A distinct machination of social resistance and rumors against oral polio vaccine during supplementary immunization activities (SIA) was observed in some minority dominated areas. The pattern can be understood through a model that emerged through qualitative evidence. Inspite of all this, most parents in minority areas supported the SIAs. Only a few clusters from extremely marginalized sections continued to evade SIAs, with an endemic pattern. Through social osmosis, these rumors reached majority community as well and some parents were affected. However, in such cases, the resistance was sporadic and transient. CONCLUSION: While the programs focus was on microbiological issues, the obstacles to polio eradication lie in the endemicity of social (and/or cultural) resistance in some pockets, leading to clustering of perpetually unimmunized children - inspite of good coverage of SIAs at macro level. This may sustain low levels of wild poliovirus transmission, and there can be exceptions to the robustness of the pulse approach. A micro level involvement of volunteers from marginalized pockets of minorities might be able to minimize or eliminate this resistance.

[Vaccination campaigns against poliomyelitis in Spain in 1963]. / Las campañas de vacunación contra la poliomielitis en España en 1963.

Two anti-poliomyelitic vaccination campaigns coexisted in 1963: the Salk vaccine used by the Compulsory Health Insurance and the pilot experience with the oral Sabin vaccine promoted by the Health General Office. This simultaneity of campaigns was due to the interest that both bodies had to control the Preventive Medicine in Spain. The Compulsory Sickness Insurance used the anti-polio vaccine to promote itself socially in a time when the Basic Law on Social Security was being developed. Under these circumstances, the Health General Office allegedly brought forward its vaccine campaign by using a test of an innovative oral trivalent vaccine in the province of León, something which was hidden to the public. The Health General Office's claim of competence in prevention and the need of a massive response to a voluntary vaccine led to a singular advertising campaign with old messages in innovative means of communication.

[Consolidating the medical model of disability: on poliomyelitis and constitution of orthopedic surgery and orthopaedics as a speciality in Spain (1930-1950)]. / Consolidando el modelo médico de discapacidad: sobre la poliomielitis y la constitución de la traumatología y ortopedia como especialidad en España (1930-1950).

At the beginning of the 1930s, various factors made it necessary to transform one of the institutions which was renowned for its work regarding the social reinsertion of the disabled, that is, the Instituto de Reeducación Profesional de Inválidos del Trabajo (Institute for Occupational Retraining of Invalids of Work). The economic crisis of 1929 and the legislative reform aimed at regulating occupational accidents highlighted the failings of this institution to fulfill its objectives. After a time of uncertainty, the centre was renamed the Instituto Nacional de Reeducación de Inválidos (National Institute for Retraining of Invalids). This was done to take advantage of its work in championing the recovery of all people with disabilities.This work aims to study the role played in this process by the poliomyelitis epidemics in Spain at this time. It aims to highlight how this disease justified the need to continue the work of a group of professionals and how it helped to reorient the previous programme to re-educate the "invalids." Thus we shall see the way in which, from 1930 to 1950, a specific medical technology helped to consolidate an "individual model" of disability and how a certain cultural stereotype of those affected developed as a result. Lastly, this work discusses the way in which all this took place in the midst of a process of professional development of orthopaedic surgeons.

Polio chronicles: warm springs and disability politics in the 1930s.

During the 1920s and 1930s, disabled polio survivors initiated a campaign which made them active, dissenting subjects in public discourse about disease and disability. Its source was a core of Warm Springs patients who wanted more than a healing refuge. They were well aware of the need to construct a new image of the disabled, and saw the resort's high public profile as a potent weapon in a cultural war to remake popular images of the disabled, whether as pathetic charitable objects or as horrific movie villains. Drawing on their own, disheartening experiences, this group of activists boldly critiqued the medical care offered most disabled patients as well as the training and attitudes of doctors, nurses and physical therapists. Protesting the narrow, medicalized definition of rehabilitation, they provocatively posed the need to "rehabilitate" prejudiced, able-bodied employers and health professionals. And most of all, they consciously designed the polio center at Warm Springs to function not as an inward-looking refuge but as an exemplar of the way polio survivors and other disabled people should be allowed to live, work and love. This story begins and ends in the 1930s. It traces a rise and fall: the rise of an activist community at the rehabilitative center at Warm Springs; and its decline with the creation of the National Foundation for Infantile Paralysis (known popularly as the March of Dimes) in 1937.

And they shall walk: ideal versus reality in polio rehabilitation in the United States.

This essay explores the significance that rehabilitation physicians and polio patients in the United States put on recovering the ability to walk. Polio often paralyzed or severely weakened the legs of those who contracted the disease. Regaining the ability to walk was thus a significant measure of recovery from the disease. However, walking meant more than the physical act itself. Regaining the ability to walk meant, in a symbolic sense, that one was no longer disabled, that one had again become normal. This attitude was shared by rehabilitation specialists and patients alike. This essay examines this attitude and the cultural values it embodied through a study of the efforts of selected polio survivors to learn to walk again and of the rehabilitation literature that held walking as an ideal. It also explores what happened when polio patients were unable to walk again because of the severity of their paralysis.

A polio intervention in East African refugees to NSW.

This paper summarises a public health intervention in Sydney, NSW in late 2006 that resulted from the potential exposure of a number of refugees to polio virus while in transit in Nairobi, Kenya. The intervention involved the attempted follow-up of 113 persons at risk, assessment for symptoms and immunisation where indicated. No symptomatic cases were found. Seventy-five people were immunised with inactivated poliomyelitis vaccine. The intervention highlighted the importance of close collaboration between health services, the Department of Immigration and Citizenship and settlement service agencies, and provided several lessons to consider when assessing newly arrived refugees.

Mexican American women aging with childhood-onset paralytic polio.

In this study the life histories of 11 Latinas of Mexican American descent aging with permanent impairment related to childhood-onset paralytic polio were explored. These women, age 45 to 62 years, were interviewed 3 times each. Field notes, audiotaped interviews, life course charts, and demographic data were used to collect data chronicling childhood to present day. In the results we present a thematic representation of the societal and cultural influences on the life course trajectories of these women.

International Polio Victims Response Committee

It presents the IPVCR’s project with the Congolese Association for Orthopedic Assistance to Young Disabled Persons (they help people with polio and similar diseases with treatment, braces and integration to society). It brings information about the importance of properly made braces, types of braces, reason not to use wheelchairs, muscular conditions that require these braces, disability types, name of involved people, links and information about how to help with the project. It has a lot of photos to illustrate its content.

Reducing resistance against polio drops.

AIMS: The present study was carried out to impart correct health education regarding polio eradication programme and to assess the impact of social mobilization of a Muslim community carried out by medical interns. METHODS: One round of a polio immunization campaign was selected randomly. Five highly resistant areas were included in the study. During house to house A-Team activity, teams of health workers visited the houses and resistant families were identified. These families refused to give polio drops to their children. On the second day of A-Team activity, medical interns visited those identified resistant families. They imparted correct health education and tried to convince them to give polio drops. However, after prolonged persuasion, some of the families were not ready to give polio drops. These more resistant families were again visited by more motivated and enthusiastic teams during B-Team activity, started two to three days after the completion of A-Team activity. Data were collected, tabulated and analysed. RESULTS: Total number of resistant families identified during house to house A-Team activity was 1025 in five high risk areas of Aligarh, India. Out of 1025 resistant houses, 510 (49.76%) houses were converted to P houses where polio drops were given to the children. Five hundred and fifteen (50.24%) houses remained resistant even after social mobilization by A-Team members. These most resistant houses were again visited by B-team members. Out of these 515 houses, polio drops were administered in 303 (58.83%). The overall number of converted houses was 813 (79.32%) after A and B-team activities. 20.68% of families remained resistant and their children could not be given polio drops. CONCLUSIONS: In all high risk areas, maximum numbers of resistant houses were converted to P houses. These families were persuaded and convinced by the teams of interns, social workers and influential persons that polio drops did not have any side effects. They were more receptive to the advice given by medical interns compared to other staff members of the Government District Hospital because of quality of health services provided to the community. There is a need to impart correct health education regarding importance of polio drops and routine immunization more vigorously through information, education and communication (IEC) activities.