IPV and OPV

Polio Basics:
 It is impossible for a totally non-immune person to produce antibodies to all three types of polio virus, from one IPV injection. The body only processes one type at one time. After the second injection, the body selects one of the two types that it hasn’t processed before, and deals with that, and after the third injection, it deals with the third type. But there is a caveat to that. The body only does that if there are no interrupting enteroviruses in the body at the time. If there are, the body just ignores the vaccine altogether. Which is why a minimum of four shots is required. And even after five shots, some people show no immunity to one or sometimes more than one type of vaccine virus. 

 
In the past, there was no laboratory analysis. A case was defined on sight by a doctor and the family was put into quarantine for a long period of time. Even if paralysis was transient, and only lasted 3 days with no residual damage, the case was classified as paralytic polio. Once the vaccine came into play, you had to have three criteria for proof. One was a verified sample of a polio virus. This was due to figuring out that there were other viruses like coxsackie viruses, echo viruses, and other, and chemicals which caused identical clinical symptoms to polio viruses. As you may know, people with West Nile Virus, have identical symptoms of paralysis as the early polio people had. Two, you had to have had paralysis for 60 days or more. Anything less and it wasn’t paralytic polio any more.  Third, you also had to have residual neurological damage, after the 60 days
 
 This new criteria skewed the statistics. The new definition eliminated nearly 90% of paralytic polio under the old diagnostic criteria.  Any cases of polio in the vaccinated child could now be swept under the rug by blaming the circulating wild virus, or a coxsackie virus, or an enterovirus 71, etc. If you look up aseptic meningitis in the old literature it was pretty much non existent until it was decided that diagnosing non-paralytic polio in vaccinated people wasn’t ok. Many non-polio viruses were grouped with polio, because they caused the same syndrome. Non-paralytic polio data is no longer collected. It was avoided after 1959. You could have anything but it would not be labeled non-paralytic polio. Some of the biggest outbreaks of non-polio virus paralysis followed in the decades after the OPV vaccine was used internationally. Viral displacement happened when they used the adenovirus vaccine. In the case of the adenovirus vaccines, it was dropped from the civilian population specifically to re-establish the normal circulating adenoviruses because the newer ones were more virulent. 

 

Polio was essentially a disease caused by a combination of things such as poor nutrition (too much sugar), bottle feeding, poor sanitation, and the rest being doctors treatment, injections, overuse of  antibiotics, tonsillectomy, which made an individual 600 times more susceptible to bulbar polio, and the huge increase in use of toxic chemicals. Thalidomide was associated with polio in Germany. (medical article by Dr.V Wyatt)

 

“A 1992 study, published in the Journal of Infectious Diseases, validated earlier findings. Children who received DPT (diphtheria, tetanus, and pertussis) injections were significantly more likely than controls to suffer paralytic poliomyelitis within the next 30 days. According to the authors, “this study confirms that injections are an important cause of provocative poliomyelitis back to previous levels and polio cases returned to “normal.” [26:146; 29]. 

 

Also:

Provocation Polio and DTP in India

The polio vaccine: a critical assessment of its arcane history, efficacy, and long-term health-related consequences

 

 

 Polio in India:

 

The polio vaccine targets three strains of Polio-P1, P2, and P3. There were 66 cases of Polio detected in 2005, 62 were the P1 strain. The government then introduced the monovalent vaccine which targets the P1 strain. Despite the new vaccine, 16 new cases of P1 were detected in 2006.

 

Most of the cases of polio are reported from the high risk endemic areas of UP and Bihar. This is a clear indicator of the fact that in the effectiveness of the vaccine is under question where issues of nutrition and sanitation are not being addressed alongside.  Associate Professor, JNU Ritu Priya, says, “You need a twin approach. Vaccination plus sanitation, nutrition and clean drinking water. Only vaccination will not curb polio.”

 

 The tragedy is that polio will continue in India, as has been evident even after 6 oral polio vaccines are sometimes given, because the interference from other enteroviruses is so large in that environment.

 

 Even the appropriate WHO document clearly states that there is evidence that OPV has not worked in developing countries.

 That Sabin’s oral polio vaccine (OPV) has not been able to eradicate polio in our country, is now well established (inter alia, Economic and Political Weekly, 4-11-06, p. 4538-4540; and 23-12-06, p.5229-5237; Tehelka, 11-11-06, p.8-9; The Hindu, Hyderabad, November 13, 2006, p.11; Down to Earth, 31-12-06, p.24-31; Conclusions Recommendations of a National Consultative Meeting organised by Ind ian Medical Association in New Delhi on May 14, 2006; Editorial in the Indian Journal of Medical Research, (IJMR), January 2007, p. 1-4; and numerous other articles in some of the world’s best known scientific journals, such as Science.)

Not only that the cases of non–polio acute flaccid paralysis (AFP) in those vaccinated with OPV have shown a dramatic rise. It appears that in 2005, in Uttar Pradesh alone, 4,800 had residual paralysis, or died after acquiring non-polio AFP, in comparison to the all-India figure of 4,793 polio cases in 1994; the 2006 data, after six doses of monovalent OPV, are worse. The infructuous expenditure on the OPV programme would probably run into thousands of crores.

The pity of it is that all this was anticipated (Bhargava, The Hindu, December 12, 1999 ), and that we could have easily eradicated polio from our country by now. We did not do so because our successive governments and those who worked for them in responsible positions such as Secretaries and Joint Secretaries in the Ministry of Health, Directors-General of Medical and Health Services and even of the ICMR, were primarily (exclusively?) committed to personal and certain foreign interests and not to the cause of polio eradication 

 

Two types of vaccines:

There have been two types of vaccines available against polio: the injectable Salk vaccine (IPV) and the oral Sabin vaccine (OPV) using an attenuated live virus. Till the early 1980s, OPV was used in the developed countries to maintain the polio-free status that had been largely achieved through the use of IPV beginning the 1950s. By 1988, Jonas Salk had developed an enhanced potency injectable vaccine (M-IPV).

 

Evidence against OPV

Overwhelming evidence was presented at a meeting held in Delhi in March 1988, convened by Sam Pitroda, the then Adviser to the Prime Minister for National Technology Missions, that OPV had not worked in India.(Bhargava, The Hindu, December 12, 1999 ). There was a clear decision to shift to IPV. From the official minutes of this meeting:

Expedite establishment of M-IPV programme. On moral grounds and considering the involvement of the lives of our children, cost shall be no consideration. Indigenous production of IPV before 1991 shall be aimed at.” “Whenever children in large numbers are dying, getting afflicted with polio, the empty and hollow argument of their being used as guinea pigs cannot be accepted.” “As new M-IPV programme ramps up, the OPV will ramp down.” Although IPV has always been more expensive than OPV, this is compensated by the fact that one may need to take only one or at most two doses of IPV whereas, in the case of OPV, the number of doses could be above ten.

It was clear that, for some time, OPV will continue to be with us. In fact, the then Secretary of the Department of Biotechnology (DBT), S. Ramachandran, had been earlier to the Soviet Union and, with their help, a factory (BIBCOL) to produce OPV was set up in Bulandshahr.

In keeping with the decision of the 1988 meeting — the only meeting of experts and concerned people so far convened by the government in regard to polio vaccination programme — another company called Indian Vaccine Corporation Ltd (IVCOL) was set up with a capital outlay of Rs. 90 crores. Both DBT and the Indian Petrochemicals Ltd. of Baroda had equity in it even though the majority shares belonged to Institute Merieux, one of the world’s largest, most reliable and respected vaccine producers that was committed to produce M-IPV which was far more heat-stable than OPV.

 

WHO Involvement

 

The West had decided to replace OPV with M-IPV. Therefore, market had to be found for OPV. WHO advised that developed countries use IPV, while developing countries use OPV. To oblige WHO, two steps were necessary:

(1) BIBCOL produces no OPV of its own

(2) India reverses its decision to gradually shift to IPV.

 

Both steps were taken. BIBCOL did not produce a single dose of OPV, and the Ministry of Health decided soon after the March 1988 meeting, without any further consultations, to shift permanently to OPV. Consequently IVCOL was closed down after incurring substantial expenditure, and some senior officers of the above Ministry received U.N. jobs with tax-free dollar salaries, after retirement. In January 1992, at a conference jointly organized by the International Comparative Virology Organization and the WHO in New Delhi, experts from all over the world indicated the preference of IPV over OPV for any plans of eradication of polio in developing countries.

 

An article by V.K. Bhasin in January 2008 issue of Nature Biotechnology. The article states that in 2006, there were 1,600 cases of OPV–induced polio plus a large number of cases of AFP from which virus was not cultured. So, the problem continues.

 

 One polio problem solved, another created

 P3 virus resurfaces in a major way in Uttar Pradesh, Bihar (3/2008)

The polio type-1 (P1) virus may have been contained, but another, less dangerous p3 virus is wreaking havoc in Bihar and Uttar Pradesh.

This has put a question mark on the government policy that singularly focused on eradicating P1, neglecting other forms of the polio virus.

In a policy shift, the government is using the monovalent oral polio vaccine 1 (mOPV1), instead of the regular trivalent polio vaccine that immunises children to all polio types.

As a result, no fresh cases of P1 have been reported in the last one year. But the neglect of other polio viruses has led to an unprecedented outbreak of P3. Eighty-two cases of P3 have been reported since January 2008 – 69 in UP, Bihar (12) and Haryana (1) and the virus is replacing P1.

Health ministry officials agreed that P3 cases were on a sharp rise due to the singular focus on P1, but said that since the latter was more virulent it needed to be checked first.

 Though P3 too disables, it can be contained easily as the virus doesn’t spread fast. However, the health authorities have to be on guard and quickly start immunisation rounds for P3 too,” said Dr Raju C Shah of Indian Pediatrics Association (IPA). Shah has been part of the IPA polio immunisation programme.

Of the three polio viruses, P2 has been eradicated from the world, but P1 and P3 are still active. Between the two, P1 is the most dangerous. It not only spreads rapidly, but also can’t be killed easily and persists in the human chain for long. P3 spreads slowly, doesn’t cause severe paralysis and has a low disability rate. Health experts, however, say it can be a cause of worry in the future.

The trivalent polio vaccine immunises children against all three polio types. However, since monovalent oral polio vaccine produces higher immunity as compared to trivalent, MoPV1 was used in high-risk districts and states.

 Outbreak of Polio in the Amish

 None of the Amish children had any clinical evidence of infection and were only proven to be carriers by virtue of virus in the fecal samples. The doctors would never had known they had contact with the virus, if it hadn’t of been for the hospital doing

an actual test on the fecal matter of an Amish baby admitted with an immunodeficiency, and an infection which wouldn’t resolve, which was not polio. The baby did not have any clinical symptoms of polio, so the finding of the virus was an accident. At the time they were not even thinking it was polio. The CDC said that the polio virus had been circulating for 2 years. The baby, the CDC admits on their website, picked it up in the third hospital she was in. The Amish baby picked it up from vaccinated people and her family picked it up from her. The only reason none of them got polio was because the toxicities in their lives, and their genes, meant that they weren’t susceptible.

 

 

Hillman, Hernando and Alomia, and Doull, Hudson,and Hahn have all reported on the rarity of paralytic poliomyelitis among the natives in the Philippines, before World War II, where poliomyelitis was considered to be a disease of white people. During World War II, when the incidence of poliomyelitis among American troops in the Philippines was exceptionally high (88 and 43 per 100,000, respectively, in 1944 and 1945), repeated investigations of the native population in the affected areas revealed either no cases or rare instances of paralytic poliomyelitis among Filipino children.

 …The high incidence of poliomyelitis antibody among such groups as well as the high incidence of paralytic poliomyelitis among American or British adults stationed in these countries has indicated not only that poliomyelitis infection can be widespread where poliomyelitic paralysis is not, but also that the viruses do not lack virulence in the countries with a low incidence of poliomyelitis in the native population.

 

Serological surveys furthermore have brought forth more than suggestive evidence that the incidence of paralytic poliomyelitis is inversely proportional to the extensiveness of viral dissemination. In general, the poorer the population, its standard of living and sanitation, the more extensively is poliomyelitis virus disseminated among them and the lower is the incidence of paralytic poliomyelitis when virulent strains of virus come their way.

 
Polio was considered the white man’s disease. But what they didn’t realize until they adopted certain aspects of the white man’s lifestyle was that the reason they never needed to consider herd immunity is that their diet, their way of farming, the substances they used in cleaning and other areas of life, didn’t harm the gut lining in such a way that the polio virus became dangerous. The developing countries later learned that the Western way of life is such that certain people with a genetic susceptibility will be susceptible to polio in the presence of arsenic and other toxins. This too makes it very hard to eradicate Polio in India.
 
 
 
 
 The OPV can provide herd immunity to break transmission everywhere all at once, but it doesn’t prevent transmission over a period of time, therefore, the vaccine can also be a disease creator if the toxins are high enough and the person’s immune system weak enough. The herd then doesn’t protect them, because OPV can’t stop the spread and neither can the IPV. 

 A 1951 article shows Am J Public Health Nations Health. 1951 Oct; 41(10):1215-30 those developing countries didn’t have paralytic polio at the time when the developing world was starting to have serious epidemics. 

 

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