Battling polio's reemergence

THE Philippines was already declared "poliovirus free" by the World Health Organization (WHO) since 2000, until the Department of Health (DOH) broke the bad news last September 19.

Health Secretary Francisco Duque III immediately declared an outbreak after one polio case was confirmed on a three-year-old girl from Lanao del Sur, making it the first confirmed case after 19 years. Right now, there are already three confirmed polio cases in the country.

In the same month, another shocker is that a sample of the virus was detected from sewage in Manila and waterways in Davao City during a regular environmental surveillance wherein samples were tested by the DOH - Research Institute for Tropical Medicine.

Davao City Health Office (CHO) head Dr. Josephine Villafuerte, later, confirmed the sample was taken from the Davao River near the Bolton Bridge area, and that the sample manifested a vaccine-derived poliovirus type 2 (VDPV2).

Villafuerte said the study remains a puzzle as to where the virus originated. Nevertheless, its finding is already alarming.

Prior to the result, which took place two weeks before Duque made the announcement, the local health official said DOH already gave them the test result, and necessary steps were already planned way ahead.

To sound the alarm, Villafuerte immediately called the attention of all 14 coastal river barangay heads, including resort owners, and hotel owners with swimming pool amenities to mitigate the situation.

Since polio (or poliomyelitis) is a highly infectious viral disease that affects young children that is transmitted by person-to-person spread mainly through the fecal-oral route or, less frequently, WHO cites contaminated water or food as a common vehicle which multiplies in the intestine, from where it can invade the nervous system and can cause paralysis.

However, children continuously residing and swimming near the Davao River, particularly near the Bolton Bridge where the virus’ sample was detected, have huge chances of acquiring it.

In a clean-up drive initiated along Davao River in Barangay 1-A by the office of Davao City First District Representative Paolo Duterte last October, the team discovered many plastics with feces thrown into the river.

Barangay 1-A Captain Arnel Policarpio said it is unclear if these feces came from residents in the area since their barangay is considered a "catch basin". However, he discovered that in his barangay, 20 houses near the river are without septic tank, their wastes immediately dumped into the river.

The continuous human waste dumping into the river had pushed Councilor Mary Joselle Villafuerte to push for an ordinance for zero open defecation in the river. Her proposed ordinance would also address the lack of toilets in each households settling nearby these areas. Under the proposed ordinance, it would be requiring each household to use toilets with a septic tank and practice proper waste disposal.

Councilor Villafuerte, in her privilege speech, instructed CHO to conduct a massive campaign for Davao residents to build one toilet with a septic tank in every home.

"It is high time we stop dumping human waste into the Davao River and its tributaries. In fact, we should altogether stop dumping human waste directly into the environment," she said.

The councilor revealed it could have contributed to the Davao River reaching an “overwhelming” level coliform at the river’s mouth

This came on the heels of a DENR-Environmental Management Bureau (EMB) report that the river had reached a level of 920,000 most probable per number (MPN) per 100 milliliter of coliform in September this year.

DENR-EMB, in a data September this year, recorded a level of 920,000 most probable per number (MPN) per 100 milliliter of coliform in the river. It is far from the safe level of zero MPN, while the "acceptable level" is 100 MPN.

While reviving the river’s original state would take too long to achieve, the councilor, who is a medical practitioner and the City Council committee on health chair, urged to strengthen the immunization coverage of the city as a best measure to prevent polio from spreading.

The Davao City government, in collaboration with DOH and WHO, conducted the Sabayang Patak Kontra Polio, a three-round synchronized mass immunization conducted in all health centers and house-to-house visits in the city.

DOH-Davao Director Annabele Yumang reiterated the 100-percent coverage against the virus, saying “no child must be left unvaccinated”.

Mayor Sara Duterte-Carpio, herself, during a barangay speaking engagement in Barangay Tapak, Paquibato personally pleaded parents to have their children vaccinated for their protection. Vice Mayor Sebastian Duterte also seconded his sister’s call in a series of social media campaign.

The recently concluded first round, dated October 14 to 27, had fruitfully ended with a great immunization coverage of 99.1 percent, or 185,186 children out of the 186,864 qualified children ages zero to 59 months old were vaccinated. The qualified target children were based on the 2019 Philippine Statistics Authority data.

Despite not being able to meet the 100-percent coverage, CHO technical division chief Julinda Acosta said having a 95-percent reach of the immunization already guarantees the protection of the children from possible virus infection.

“The figures proved that the parents had a change of heart in accepting the vaccines, and the vaccination scare had somewhat become more acceptable to them,” Acosta said, adding that the Dengvaxia vaccine scare, religious belief, and some misinformation on how the vaccine works remain to be a hindering factor to some refusal from parents.

DOH, meanwhile, had assured that the OPV distributed in all health centers in the country is safe, since more than 18 million children, as WHO reported, were saved from being crippled brought by the virus, more than 30 years since it was first introduced.

Acosta, however, said full protection won’t be achieved by only a dose of OPV2. She reminded the parents to bring back their child in the remaining rounds of the mass vaccination: second round on November 25 to December 7, 2019, and last round on January 6 to 18 next year.

Prior to the outbreak, only oral polio vaccine type 1 and 3 (OPV1 and OPV3) were given to children ages zero to 59 months old. OPV2 was already phased out in 2016 after WHO declared VDPV2 was already eradicated.

Based on CHO's 2018 polio vaccination immunization data, with an eligible population of 46,663 ages one year old and below, only 76.6 percent was given an oral polio vaccine type 1 and 3 (OPV3), while only 71.7 percent was given an injectable polio vaccine (IPV).

Although more than half of the total percent were already covered in last year’s data, Acosta said the immunization rate in the previous years had been lower as compared to this year.

The OPV1 and OPV3 and IPV vaccination coverage in the city had a low coverage since 2015.

Acosta admitted the Dengavaxia scare became a major turnoff to the parents. During the rising number of measles cases in the city, DOH recorded in 2017, the immunization rate dropped to 60 percent and in 2018 right after the Dengvaxia issue, the figures decreased further to 39 percent.

She said although they had been strategizing different means in convincing parents, with various information dissemination campaign, the refusal brought by several issues had gave the CHO a hard time in achieving a wide immunization coverage.

With this, they want immunization to be mandated, as agreed upon during a local health board meeting.

Councilor Villafuerte, who chairs the committee on health, lobbied for its enactment as an ordinance. Right now, it is passed under first reading.

Although the proposed ordinance has no penalty clause, Acosta said it would only strengthen its advocacy of convincing the parents to have their children immunized.

However, she said it has to be studied properly, especially the suggestion which requires school to have their children vaccinated before being enrolled.

Department of Education (DepEd), during the spike of measles cases in February this year, was met with various criticisms, citing human rights violations if it would be imposed.

Despite having a confirmed sample of the virus in the city's riverbank, Acosta said the health office has not yet confirmed any single polio case in the city.

But it is not a sigh of relief for the city, as they are on the lookout for children below 15 years old with suspected case of acute flaccid paralysis, one of the symptoms of polio.

“We are surveying those children below 15 years old who manifest signs of deformity on their legs or hands, which were not reported to us,” Acosta said.

She said a house-to-house surveillance covers villages within the 10-kilometer radius from the Davao River is currently being conducted. Barangay health workers outside the radius are also conducting their own surveillance to check if the city has unnoticed persons with such case.

While she said there were suspected cases, a validating test is currently ongoing to confirm that they indeed manifest the symptoms of polio.

"Unlike in measles, wherein its symptoms such as rashes can be easily identified, polio is hard to be determined. Personally I have not yet seen an actual case since I practiced my medical profession," Acosta said.

Full immunization might be sought as a best solution of the widespread of the virus, human wastes floating in the riverbanks and other unsanitary practices will just defeat the vaccine’s purpose, as reiterated by experts.

And as Vice Mayor Duterte emphasized, the government cannot allow a single virus to destroy and end a child’s dream because of a single dreadful virus, which until now has no cure.


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