Category Archives: polio

SMS and eMedicine in the Elimination of NTDs

mhealth, NTDs, poliomobile technology,

 

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This blog was originally posted by By Matthew Alexander on POLYGEIA‘s blog *

Just over a fortnight ago, 27th March saw India declared a Polio-free country; it has been over three years since 18 month-old Rukhsar Khatoon was diagnosed with the last case in South-East Asia. The disease left her with mild paralysis in her right leg.

Only three decades ago, 200,000 children per year were left with disabilities due to polio in India, and in 2009 India was still the site of 741 of the world’s 1,604 cases. Now, following the elimination of polio from India, 80% of the world is polio free. [1] The final push will involve mass vaccination of remaining endemic countries: Afghanistan, Niger and Pakistan, but with one-hundred children recently infected in Syria there is a race to prevent new epidemics before the 2018 eradication target. [2]

The Polio virus will not be the first pathogen to be eradicated by human intervention. The Variola virus (the causative agent of smallpox) has been extinct in the wild since 1977, and more recently in 2011, the Rinderpest virus was declared eradicated by the OIE. [3] The successful Smallpox campaign cost $1billion in today’s currency, with two-thirds of the financial burden on the endemic countries; this is in stark contrast to the polio programme with the Post Graduation Education Institute (PGEI) estimating that the next four years will cost $5.5 billion in addition to the billions already invested since the 1980s. Yet there is still a strong economic case for eradication, with returns of $25 billion in as few as two decades when compared to routine immunisation. [4]

So what does polio elimination have to do with Neglected Tropical Diseases (NTDs)? Like the polio virus, many of the pathogens that cause NTDs are eradicable; they cause debilitating symptoms that hinder economic and social activity; they cause much suffering to the afflicted and their families; in total, 1.7 billion people are at risk of developing these diseases. Of the 17 NTDs listed by the WHO, two are set to be eradicated worldwide and 10 have co-ordinated programmes to eliminate the disease from endemic populations, all within the next 10 years. [5]

In 2004, another disease was eliminated from India to a much smaller fanfare; Yaws begins as a cutaneous infection and spreads to cartilage inflicting disfigurement and disability. The causative pathogen, a bacterium of the Treponema pallidum species, is easily treated with a single oral dose of azithromycin and yet Ghana, Papua New Guinea and the Solomon Islands report over 10,000 cases per year. WHO hopes for its eradication by 2020 through a programme of identification of endemic areas and blanket treatment. [5]

The NTD policy team members of Polygeia are working hard to find areas where we can take novel ideas and apply them effectively to real world situations. My personal interests lie in the use of mobile phones and SMS to improve uptake of available testing, counselling and treatment concordance. Much work has been done in HIV and TB treatment with schemes such as WelTel showing promise. Under this programme, HIV positive patients were required to respond to weekly texts from a nurse and then outcomes were compared to a control group receiving standard care. Those receiving texts were 19% less likely to be non-compliant and 16% less likely to show failure of viral suppression. In other words, for every 11 people treated, one would remain well who may otherwise have developed AIDS. [6]   We hope to develop policies that will take successful concepts in eMedicine to the fight against NTDs.

References:

[1] Basu, M.  India beats the odds, beats polio. CNN, 27th March 2014

[2] Whewell ], T. Polio in Syria: An outbreak that threatens the Middle East. BBC, 26th March 2014

[3] Rinderpest Eradication, Bulletin No. 2011-12, OIE, Feb 2011

[4] Economic Case for Eradicating Polio, PGEI, 2013

[5[ Sustaining the drive to overcome the global impact of neglected tropical diseases, WHO, 2013

[6] Yaws fact sheet No. 316, WHO, 2014

[7] Lester R. T. et al, 2010. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. The Lancet, Vol. 376, Issue 9755

*Polygeia was founded to give students the opportunity to contribute to global health policy. Its core aims are:

  1. Research and disseminate high quality policy papers and follow up on their implementation where possible.
  2. Develop the skills of our researchers through our policy workshops and mentoring programme.
  3. Engage students and others with the global health issues on which we are working.

How a Polio-Free India could Pave the way for an NTD-Free India

Asia, India, polio,

 

Photo by Esther Havens

Photo by Esther Havens

By Dr. Mirta Roses Periago, NTD Special Envoy

Monday marked the three-year anniversary of the last reported polio case in India — a landmark achievement for a country that reported the highest number of polio cases in the world in 2009. A formal declaration of India as polio-free is expected later this year by the World Health Organization (WHO).

According to the Global Polio Eradication Initiative, India was once thought to be the most difficult country in which to achieve polio eradication.  Today, 71 percent of children in India have received the polio vaccine, and India has become one of the world’s largest donors to global polio eradication as reported by Time magazine.

India’s successful polio eradication program illustrates the leadership role that India can take in the global effort to control and eliminate neglected tropical diseases (NTDs).  Similar to polio eradication programs, successful NTD control and elimination programs rely on well-organized and large-scale mass drug administration and surveillance activities. India’s national lymphatic filariasis elimination program reaches more than 300 million people each year, making it the world’s largest NTD program. India has a long history of ending the suffering caused by many communicable diseases, including smallpox, guinea worm and yaws. These remarkable achievements have been possible because of the concerted efforts and commitment of leaders in the Indian government and across civil society.

Despite these successes, India needs to do much more to achieve national and global NTD control and elimination goals.  India accounts for 35 percent of the global burden of all NTDs, and currently less than half of the population living at risk for these diseases is being reached by mass drug administration programs. India must reinforce its commitment to eliminate NTDs like lymphatic filariasis, trachoma, kala azar and leprosy, and ensure that the necessary resources and capacity exist to scale-up and sustain operations until control and elimination goals are met.

Three years polio-free demonstrates that India has the expertise, capacity and resources to be a world leader in ending the burden of NTDs. There will be human and financial resources freed up from this victory ready to be channeled with renewed enthusiasm and determination to the fight against NTDs. India is a striking demonstration that elimination is possible.  By reducing the NTD burden within its borders, India can contribute to a big reduction in the global NTD burden and its example will be an extraordinary push for all the countries still affected.  As we celebrate India’s contribution to the global fight against polio, let’s also encourage continued leadership and success on NTDs to reach the World Health Organization 2020 goals.

India 1 full year polio-free for the first time in history

polio, vaccines

Re-posted from Sabin the World

In 1957, during a time when polio epidemics ravaged countries worldwide and many considered polio to be the world’s most feared disease, Albert B. Sabin began human trials to test his live oral polio vaccine. From 1952 to 1961, the number of polio cases in the United States fell from 58,000 to 161, due in large part to Sabin’s vaccine.

Today marks another major milestone. India, one of only four remaining countries with endemic polio, has gone one full year without a single case of the disabling disease. Just three years ago, India had more cases of polio than any other country. Since then, 2 million volunteer vaccinators have worked throughout India to deliver more than 780 million polio vaccinations a year. The polio eradication effort is part of an effort led by the Indian government, with the help of global partners like WHO, UNICEF and Rotary International, to set up an infrastructure for delivering health services to some of the most underprivileged children in India and in the world.

“I’d like to praise the people in India for all their hard work and for demonstrating that polio really can be eradicated,” says Dr. Ciro de Quadros, Sabin executive vice president and champion of the polio eradication efforts in the Americas. “We should now apply lessons learned from India to fight back polio in more difficult countries like Nigeria and Pakistan. With the kind of commendable efforts shown in India, we can achieve global eradication of polio.”

More information can be found at Impatient Optimists, the Global Polio Eradication Initiative, and The End of Polio.