Nigeria is fighting
an unusual outbreak of
polio caused by
mutating polio vaccine,
world health authorities
say, but the only remedy
is to keep vaccinating
children there.
Officials of the
World Health
Organization fear
that news of the
outbreak will be a new
setback for eradication
efforts in northern
Nigeria, where
vaccinations were halted
in 2003 for nearly a
year because of rumors
that the vaccine
sterilized Muslim girls
or contained the
AIDS virus. During
that lull, polio spread
to many new countries,
although most have
snuffed out the small
outbreaks that resulted.
Officials deny
suggestions that they
kept the outbreak, which
began last year, a
secret, and say that
they did not realize
until recently that as
many as 70 of Nigeria’s
last 1,300 polio cases
stemmed from a mutant
vaccine virus rather
than “wild type” virus,
which causes most polio.
“It was an oversight
on our part,” Dr. Bruce
Aylward, director of the
polio eradication
campaign for the W.H.O.,
said yesterday. The
agency discussed the
first 16 cases it knew
of at meetings early
this year and posted
information on its Web
site in April, he said,
“but only in places
where lab people would
look.”
Outbreaks of
vaccine-derived polio
are unusual but not
unheard of. Individual
cases have been known
for years. For example,
a former lieutenant
governor of Virginia was
partly paralyzed in
1973, apparently after
changing the diapers of
his son, who had
received oral vaccine.
The first spreading
outbreak of a
vaccine-derived strain,
in which 22 children
were paralyzed, was
detected in 2001 in the
Dominican Republic and
Haiti.
Experts now believe
another took place in
Egypt in the late 1980s
but went unnoticed amid
the much larger numbers
of wild-type infections.
There have been others
in the Philippines,
Madagascar, China and
Indonesia.
All were eventually
eliminated by immunizing
more children, and
experts argue that the
latest outbreak was able
to spread because, until
recently, only 30 to 40
percent of the children
in northern Nigeria were
vaccinated. About 70
percent are vaccinated
there now, Dr. Aylward
said.
In 2000, the United
States switched to
injected vaccine made
from killed virus, which
cannot mutate. But oral
drops with the live,
weakened version of the
virus are still used in
most poor countries,
including those where
the disease has never
been eliminated:
Nigeria, India, Pakistan
and Afghanistan.
This vaccine,
invented by Albert
Sabin, is easier to
give, offers much
stronger protection and
can beneficially
“infect” other family
members or neighbors,
protecting them too.
But in rare cases, it
can mutate into
something resembling
wild polio virus, which
can paralyze or kill.
Dr. Aylward pointed out
that 10 billion doses of
oral vaccine had been
given in the last 10
years, so such mutations
are presumably extremely
unusual.
Polio often
circulates undetected;
in only one of 200
infections will it cause
paralysis, which signals
health officials to look
for the virus in the
area.