Tag Archives: pandemic

Measles outbreaks continue to grow in US, Europe

Baby with measles
Stephanie Soucheray | News Reporter | CIDRAP News
May 06, 2019

The US count grew by 60, to 764 cases, the most in 25 years, while Europe has recorded 13 deaths.

But 40,000+ cases of AFP in India must mean polio is thriving, right? No.

Have you heard the one about the global conspiracy that polio is rampant in India because thousands of cases of acute flaccid paralysis (AFP) occur there each year? Follow me over here dear readers, we have another lie to debunk, driven by that small but loud cabal of confused pro-disease activists I call hardcore anti-vaxxers.

Bustling New Delhi India
Source: Adam Cohn, Flickr

In my last post, “No, they didn’t rename polio“, I tried to make it clear that India and the region it sits within were declared free of polio transmission years ago (see that evolve in the tables below). Part of that declaration was the development of a helluva lot of polio surveillance.

India and other countries free of wild or vaccine-derived poliovirus-induced disease keep watch to make sure it doesn’t appear. Which makes sense right? An easily transmitted infection somewhere can become an outbreak anywhere in an interconnected world.

But along with the conspiracy theory that renaming is behind the hidden poliovirus scourge we (absolutely do not) face, is the use of India’s large number of AFP cases to reinforce the myth. Let’s look at India and its AFP cases.

Yes, India has a lot of AFP cases

First things first. India is the second most populated country on earth. At writing, India hosts around 1,300,000,000 lives.[1] In the six years of 2013 to 2018 inclusive, that massive population has reported between 36,107 and over 54,000 cases of AFP each year.[2] Sounds vast, right? Compare that to the United States. Wait. No. You can’t because the US doesn’t seem to conduct AFP surveillance, or don’t provide those data to the World Health Organization (WHO).[14] Let’s compare it to other countries then.

Australia has reported 53-62 cases during that same timespan. Australia currently has a population of 25,000,000.

Is there some simpler way we can look at these figures, accounting for population size difference and growth? Yes. The WHO tabulate non-polio AFP cases per 100,000 people under the age of 15 years (children).

In a country that no longer has polio, it is expected that 1 case per 100,000 children would still be found. Fewer than that may mean surveillance isn’t capturing AFP. Australia reached this indicator between 2009 and 2014 although there were some gaps to close.[9-13] But how does the world stack up?

Crowded New Delhi street.
Photo by Fancycrave on Unsplash

AFP rates around the world

There are still a lot of AFP cases the world over (Table below). In the South-East Asia Region (SEAR), India contributed the majority of cases with 27,322. Its rate per 100,000 children was 8.7. That’s not the highest rate though. Afghanistan saw 16.2 AFP cases per 100,000 children, Pakistan reported 14.4 and Nigeria listed 12.35 per 100,000 children. Afghanistan and Pakistan have had wild poliovirus cases in 2019 and Nigeria had vaccine-derived poliovirus cases.

The highest non-polio AFP rates occur in the South-East Asia (SEAR), Africa (AFR) and Eastern Mediterranean (EMR) regions. India is the largest contributor of NPAFP cases in the SEAR.
Source: WHO Weekly Epidemiological Record No. 47, 2018, 93, 633-648.[14]

How many of India’s cases are due to polio?

According to the World Health Organizations, precisely no AFP cases are caused by poliovirus infection.[3]

This information was missed by authors of a recent publication who astonishing pointed to the polio vaccine as the source of India’s AFP caseload.[17] And yet….no AFP cases were due to poliovirus. 😒

If it isn’t laboratory confirmed, it isn’t polio. And samples are collected and they are tested for poliovirus. Ensuring this is happening is cleverly also part of the surveillance system.

This isn’t a conspiracy, this is a highly successful global collaboration with lots of hard work to ensure the world we share is getting closer to 100% polio eradication. And we’re almost there.

A total of 59,436 AFP cases were investigated in India in 2012, another 53,421 in 2013 and 53,383 in 2014. Not a single AFP case has tested positive for polio in 2012, 2013 and 2014. All AFP cases during the last 3 years have been due to non-polio causes.

World Health Organization. Acute Flaccid Paralysis (AFP) surveillance: the surveillance strategy for poliomyelitis eradication [3]

Despite a lot of testing. India had its last polio case in January 2011 and was considered polio-free from February 2012 and the South-East Asia region followed.[6-8]

Despite all this, some will wrongly say “but these successes are all due to sanitation, not vaccination.” Improved hygiene and sanitation does reduce the spread of many gastrointestinal viruses. No argument.

Ironically the fact that India still has tens of thousands of NPAFP cases each year – and not a single polio case among them – highlights that the polio vaccine is what made the real difference. Vaccines work. And polio is almost eradicated because of their effectiveness.

It’s also worth noting that we, in our shiny white tiled, mirrored, LED-lit, laminated-bench bedecked bathrooms in our PVC sewer-piped houses in our rich neighbourhoods, also come down with gastro viruses every year.

We do have community outbreaks. If these outbreaks were due to poliovirus, we’d still be getting polio were it not for the bloody vaccine!

In the United States, there is a virus which seems to be heading in the direction of becoming a “new polio”.[15] It isn’t the first.[16] It is an enterovirus called D68. EV-D68 is linked to a syndrome that is a more technically diagnosed and defined subset of AFP called acute flaccid myelitis or AFM.

AFM comes in waves every two years and every wave sees its numbers rise. More cases may just be due to better surveillance (see above) or they may be something new. But it’s happening. Not in India, in the US. And do you know what prevents the illnesses EV-D68 causes? A vaccine. And that’s all that will.

SHared bathing in the sacred water can be a daily ritual .
Photo by Fancycrave on Unsplash

What are the non-polio causes of AFP then?

For a start – not poliovirus. Have I said that already? Because of this, let’s call these cases by a more obvious name – non-polio AFP or NPAFP.

In my last post, I listed a bunch of non-viral things linked with AFP. Polio is just one of many causes.[3]

Staying in my lane, let’s talk about viruses. There are around 100 cousins of poliovirus nicknamed “non-poliovirus enteroviruses (NPEVs). NPEVs are found in India among people that develop NPAFP.

The enteroviruses belong to a huge viral super-group called the family Picornaviridae. Among the picornaviruses are other viral groups containing members seemingly capable of causing problems for our nervous system. Cardioviruses are one example.[18] Cosaviruses another.[19] And there are the parechoviruses as well.[20]

In one 2019 study, 34 distinct NPEVs were identified from among 20% of stool samples collected mostly from children under the age of five years, with AFP in India.[4] NPEVs were more often circulating where the population density was highest. Some of these viruses were distinct from those found elsewhere in the world.

The implication is that – for some reason – India has a problem with these viruses. One reason could be that transmission is being encouraged in some way. Let’s keep in mind a few things:

  • Outbreaks happen because of humans, not viruses
  • Enteroviruses are mostly spread by faecal-oral infection (droplets and contamination of hands and surfaces)
  • Sanitation and hygiene-related issues are important factors to consider in transmission fo viruses in densely populated regions.[5,19]

To wrap up

India has a lot of NPAFP cases but no polio cases and no sign of poliovirus.

Inadequate sanitation, insufficient hygiene, human habits and population density have likely created an ideal storm for virus transmission. Among these viruses are some capable of causing NPAFP. This is on top of the many non-viral causes.

The pro-disease cult will try and convince us otherwise, but polio is not on the rampage and being covered up. Lies are the only thing rampaging here.

References

  1. Worldometers | India population
    http://www.worldometers.info/world-population/india-population/
  2. World Health Organization | AFP case count
    https://extranet.who.int/polis/public/CaseCount.aspx
  3. Acute Flaccid Paralysis (AFP) surveillance: the surveillance strategy for poliomyelitis eradication
    http://www.searo.who.int/india/topics/poliomyelitis/acute_flaccid_paralysis_surveillance.pdf?ua=1
  4. Identification and characterization of nonpolio enterovirus associated with nonpolio-acute flaccid paralysis in polio endemic state of Uttar Pradesh, Northern India
    https://www.ncbi.nlm.nih.gov/pubmed/30699113
  5. New strategies for the elimination of polio from India.
    https://www.ncbi.nlm.nih.gov/pubmed/17110580
  6. Progress Toward Interruption of Wild Poliovirus Transmission — Worldwide, January 2011–March 2012
    https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6119a6.htm
  7. World Health Organization in South-East Asia
    http://www.searo.who.int/about/en/
  8. Twenty-eighth meeting of the Eastern Mediterranean Regional Commission for Certification of Poliomyelitis Eradication
    http://applications.emro.who.int/docs/IC_Meet_Rep_2014_EN_15405.pdf?ua=1
  9. Australian National Enterovirus Reference Laboratory annual report, 2009
    http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi3403-pdf-cnt.htm/$FILE/cdi3403e.pdf
  10. Australian National Enterovirus Reference Laboratory annual report, 2010-2011
    http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi3702-pdf-cnt.htm/$FILE/cdi3702b.pdf
  11. Australian National Enterovirus Reference Laboratory annual report, 2012
    http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi3702-pdf-cnt.htm/$FILE/cdi3702a.pdf
  12. Australian National Enterovirus Reference Laboratory annual report, 2013
    http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi3902-pdf-cnt.htm/$FILE/cdi3902e.pdf
  13. Australian National Enterovirus Reference Laboratory annual report, 2014
    http://www.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi4102-pdf-cnt.htm/$FILE/cdi4102e.pdf
  14. WHO Weekly Epidemiological Record No. 47, 2018, 93, 633-648
    https://apps.who.int/iris/bitstream/handle/10665/275983/WER9347.pdf?ua=1
  15. Enterovirus D68 – The New Polio?
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6243117/
  16. Enterovirus 71: emergence of the new poliomyelitis
    https://www.tandfonline.com/doi/pdf/10.1080/10158782.2009.11441350
  17. Oral polio drops linked to paralysis in India | SciDevNet
    https://www.scidev.net/asia-pacific/disease/news/oral-polio-drops-linked-to-paralysis-in-india.html
  18. Cardioviruses Are Genetically Diverse and Cause Common Enteric Infections in South Asian Children
    https://www.ncbi.nlm.nih.gov/pubmed/19193786
  19. A highly prevalent and genetically diversified Picornaviridae genus in South Asian children
    https://www.ncbi.nlm.nih.gov/pubmed/19033469
  20. Genomic Characterization of Novel Human Parechovirus Type
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657611/pdf/08-0341_finalD.pdf

Hits: 302

The post But 40,000+ cases of AFP in India must mean polio is thriving, right? No. appeared first on Virology Down Under.

Influenza immunity

It seems like every year we’re told that the timespan for which influenza (flu) vaccination provides us immunity is a little shorter. In the next few posts, I’ll have a look at some studies that have delved into this issue of influenza immunity following vaccination.

🤧

I wonder if we may be focusing on the wrong aspect of all this. Immunity will probably see many of us safely through an entire flu season unless the multiple circulating flu viruses mutate in such a way as to “escape” the immunity we’ve developed from vaccination. That happens. A universal flu vaccine will fix this failing up.

A study into persistence of flu immunity

A study from 2015 followed people vaccinated for two seasons in a row or given a placebo (saline). They were bled before and then at one, six, 12 and 18 months after receiving the flu vaccine.[1]

If the subjects acquired a confirmed flu infection during the study period they were excluded (this would not have been immunity due to vaccination). Any booster effect from a flu infection that was too mild to register as symptomatic enough, was at least partly accounted for by some pre-testing which created a kind of baseline.

Blood gets collected then sent to the lab to have cells removed for antibody testing
Photo by Hush Naidoo on Unsplash

Blood specimens were tested in the laboratory for antibodies developing to two flu virus surface proteins; hemagglutinin (HA) and neuraminidase (NA). The test is called hemagglutination-inhibition (HAI; see here for more of an overview on the HA version). In this study, it used viruses closely related to those in the vaccine which the subjects received. These were used to see how much antibody each subject produced after vaccination, at each of the time points.

AN ASIDE: The flu strains used were “closely related” as determined by lab testing. They reacted similarly to the vaccine strains when using ferret sera in HAI. What I’d like to see is the exact same strains used, together with human antisera. With other viruses that have a single-stranded genome (rather than multiple strands like an influenza virus), we generally don’t settle for “closely related” being good enough. This approach – used widely in flu’ville – overlooks contributions to human immunity made by viral components other than the surface-exposed HA and NA. This may or may not be important for understanding the strength and longevity of vaccine-induced protection.

Some shortcomings

The study didn’t look at the immune cell response to vaccination, just the antibodies produced. That’s okay, but it only tells part of the immunity story. The amount of antibody produced to flu strains is known to be related to the level of protection from wild flu strain infections.

The study also didn’t focus on those people at greatest risk of severe disease following influenza infection; young children, older adults, and those with certain pre-existing health conditions. They may respond differently to vaccination.

What the study did find

People receiving the placebo did not develop antibodies to the flu viruses contained in the vaccine. No surprise.

Vaccination offers solid protection against influenza
Photo by Samuel Zeller on Unsplash

Those who were vaccinated maintained (likely) protective levels of antibodies for 18 months – with a definite but only relativity small (2-fold) decline in levels over that time.

Subjects who had been vaccinated in the previous season saw a slightly smaller immune response to the more recent vaccination although the rate of antibody decline wasn’t really any different. This has been reported elsewhere and may be related to the very first symptomatic flu infection we had as children.[2,3,4] It’s a problem that we need to solve. Again, hopefully, future flu vaccines will overcome this issue.

A bit of a different story to what we’re used to?

I wonder if we may be overly confusing, or overly simplifying, the story of the Flu vaccine in order to drive uptake. The story of flu vaccination is certainly gaining more twists and turns as time and research uncover more aspects to consider.

Sure, it’s not the kind of vaccine that protects 95% of vaccinees from influenza every time. Absolutely, it’s not one shot that lasts a decade or more. But it is the only protective vaccine we have for the flu, and it does work better than nothing.

Study highlights

The study had a couple of big takeaways.

Most subjects respond to vaccination by developing antibodies.

I think we may talk too much about those who can’t respond or don’t respond. A caveat: because this study wasn’t focusing on the elderly it was unable to highlight that those over 65 years of age tend to have shorter immunity post-vaccination. [5] On the upside, there are now enhanced trivalent vaccines to cover the over 65s.[6,7]

Antibodies wane over time – but not as rapidly as some might suggest to you.

Protection for adults against influenza was still likely to either completely prevent, or at least reduce the severity of, illness due to wild flu virus infection for 18 months.

There is a lot of research around flu vaccination

Influenza is complex and the scientific literature reflects that. But perhaps the messaging isn’t keeping up.

Studies don’t always include all the variables when coming to conclusions around vaccine effectiveness but it is clear that current vaccines offer more benefit (less illness) than risk (most side effects = sore, warm arm and short term headache).

If you fall into a higher risk group though, make sure you talk to your Doctor about when to get your Flu shot and which one to get. A reminder that in Australia those groups include children from 6 months to five years of age, pregnant women, all Aboriginal and Torres Strait Islander people aged six months and older, a person aged 65 years or older and anyone with underlying medical conditions that can increase the risk of influenza complications.[8]

My family is already vaccinated for the 2019 season. I will be soon as well.

References

  1. Persistence of Antibodies to Influenza Hemagglutinin and Neuraminidase Following One or Two Years of Influenza Vaccination
    https://academic.oup.com/jid/article/212/12/1914/2911917
  2. Original Antigenic Sin: How First Exposure Shapes Lifelong Anti–Influenza Virus Immune Responses
    http://www.jimmunol.org/content/202/2/335
  3. New flu strains and old antibodies: How sinful is ‘original antigenic sin’?
    https://www.sciencedaily.com/releases/2016/08/160818145940.htm
  4. From Original Antigenic Sin to the Universal Influenza Virus Vaccine
    https://www.cell.com/trends/immunology/fulltext/S1471-4906(17)30164-3
  5. Do antibody responses to the influenza vaccine persist year-round in the elderly? A systematic review and meta-analysis
    https://www.sciencedirect.com/science/article/pii/S0264410X16310441
  6. High-dose, immune-boosting or four-strain? A guide to flu vaccines for over-65s
    https://theconversation.com/high-dose-immune-boosting-or-four-strain-a-guide-to-flu-vaccines-for-over-65s-112224
  7. Here’s why the 2017 flu season was so bad
    https://theconversation.com/heres-why-the-2017-flu-season-was-so-bad-86605
  8. http://ncirs.org.au/sites/default/files/2019-03/Influenza-fact-sheet_25%20Mar%202019_Final.pdf

Hits: 7

The post Influenza immunity appeared first on Virology Down Under.