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Philippines Declares New Polio Outbreak After 19 Years (apnews.com) 73

twocows writes: Philippine health officials declared a polio outbreak in the country on Thursday, nearly two decades after the World Health Organization declared it to be free of the highly contagious and potentially deadly disease. Health Secretary Francisco Duque III said at a news conference that authorities have confirmed at least one case of polio in a 3-year-old girl in southern Lanao del Sur province and detected the polio virus in sewage in Manila and in waterways in the southern Davao region. Those findings are enough to declare an outbreak of the crippling disease in a previously polio-free country like the Philippines, he said. The World Health Organization and the United Nations Children's Fund expressed deep concern over polio's reemergence in the country and said they would support the government in immunizing children, who are the most susceptible, and strengthening surveillance. "As long as one single child remains infected, children across the country and even beyond are at risk of contracting polio," UNICEF Philippines representative Oyun Dendevnorov said. WHO and UNICEF said in a joint statement the polio outbreak in the Philippines is concerning because it is caused by vaccine-derived poliovirus type 2.
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Philippines Declares New Polio Outbreak After 19 Years

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  • satisfied (Score:5, Insightful)

    by guygo ( 894298 ) on Thursday September 19, 2019 @12:58PM (#59213240)
    Seems like the anti-vax movement won't be satisfied until the iron lung wards are back making childhood miserable for millions.
    • Re: (Score:3, Informative)

      by Thelasko ( 1196535 )
      Polio vaccines aren't typically compulsory. They are traditionally administered to individuals most likely to come in contact with the disease. I doubt the anti-vax movement had a role in this, as most people aren't even offered the vaccine.
      • I think I was confused with adult polio vaccines. All children typically receive polio vaccines.
        • I think I was confused with adult polio vaccines. All children typically receive polio vaccines.

          That stopped 30 years ago when the WTO assumed polio is eradicated.

          • by jrumney ( 197329 )

            It didn't stop. Polio [cdc.gov] is one of the basic infant vaccines.

          • The US has only stopped administering the oral polio vaccine. They still administer the intravenous polio vaccine to children. The virus is still out there in the wild and while it's nice to think that the sanitation system in countries where polio is eradicated are good enough it's still possible for the virus to be reintroduced as long as wild cases of the virus are out there.

            • I checked, in Germany it is recommended but no longer mandatory.

              We actually had 3 registered cases between 1990 - 1992.

      • They certainly were when I got mine, and even if they weren't, only the worst kind of imbeciles failed to get one as soon as it was available.

      • by mysidia ( 191772 )

        At least in the 1980s, 90s, and 2000s: Proof of immunization was required to enroll in Elementary and High School.

      • Re:satisfied (Score:5, Informative)

        by Jason1729 ( 561790 ) on Thursday September 19, 2019 @02:55PM (#59213724)
        There's far too few places where vaccines are compulsory. I'm not sure if you actually mean required or as part of the normal vaccine schedule. Here (Ontario) kids receive Polio vaccine starting at 2 months as part of the normal vaccine schedule, but unfortunately none of the vaccines are compulsory here.

        I just googled, and according to the CDC, the US vaccine schedule for Polio is the same as we use in Ontario. 2, 4, 6 and 18 months and 4 and 6 years. What makes you believe most people aren't offered Polio vaccine? They also recommend an accelerated schedule for children who are expected to travel places where it's prevalent before they're 6 years old.

        Polio is a horrible debilitating disease. The doctor that created the vaccine made it available free and royalty free from day one because they wanted the fastest possible distribution without legal issues slowing it down. It is not a disease to play games with.
      • Polio vaccines aren't typically compulsory. They are traditionally administered to individuals most likely to come in contact with the disease. I doubt the anti-vax movement had a role in this, as most people aren't even offered the vaccine.

        Perhaps in your country, but when I was a child, I had to have the vaccine to go to school.

        I believe fully that Anti-vaxxers should be required to spend their days with children thhat contract polio. I b elieve that when a child contracts Diptheria, Pertussis or polio, theier children should camp out with the sick children. I believe they should have ot pay the hospital bills of these children.

        Then again, dead children never contract autism. So they have that going for them.

      • We used to call it the Polio bus, but it was really an Truck converted for NHS use. it would turn up at the beginning of each new school year and the new intake were all called up one class at a time and given a sugar cube impregnated with the vaccine. I also remember some older people wearing caliper from the epidemic.

        My home city recently marked the anniversary of the vaccine.

        https://www.hulldailymail.co.u... [hulldailymail.co.uk]

    • Antivax? (Score:4, Insightful)

      by WoodstockJeff ( 568111 ) on Thursday September 19, 2019 @01:21PM (#59213348) Homepage

      Considering that the reported cases last year (2018) were all in areas where the influence of Facebook and other internet hangouts was next to nil, it is probably the fact that there are still places in the world with bad sanitation... In fact, the vaccine in common use today was responsible for 3 times as many infections as the virus in the wild, even though (when properly administered) it is 99% effective.

      In the US, where we have an outbreak of antivax supporters, our better sanitation allowed us to get away with no infections.

      • I had mine on a sugar cube. Not sure how that can be misadministered.

        • "Properly administered" is at least 3 doses of the oral vaccine over a period of time. You can find more about this in many places, but the Wikipedia article on Polio explains it fairly well.

          • Maybe now it is all orally administered. I was stabbed as an infant, along with the other standard shots, then a sugar cube at 4 and another 11 years later. The latter two were at school and we just lined up, ate the cube and went back to class. As did every child in UK. Easy peasy.

        • Instructions unclear.

          Sharp cube corners very unpleasant for anal region at insertion.

    • Re:satisfied (Score:5, Informative)

      by JeffOwl ( 2858633 ) on Thursday September 19, 2019 @01:21PM (#59213350)
      I am pro-vax and have had many more vaccinations than most people due to work and travel requirements. But you should RTFA linked in the summary. It says "WHO and UNICEF said in a joint statement the polio outbreak in the Philippines is concerning because it is caused by vaccine-derived poliovirus type 2. The weakened virus used in vaccines replicates for a short time in children’s intestines and is excreted in their feces. In rare instances, they said, the weakened virus can strengthen in areas with poor sanitation and hygiene. Children who have not been properly immunized can be susceptible. They said the last known case from a wild strain of the virus in the Philippines was in 1993. Wild poliovirus type 2 was declared globally eradicated in 2015."
      • Why weren't they using the attenuated version as used for decades in the West instead of a weakened one? There is no disease vector from the attenuated one, no matter how much you crap out and where.

        • Why weren't they using the attenuated version as used for decades in the West instead of a weakened one?

          "attenuated poliovirus" and "weakened poliovirus" are two phrases referring to the same thing.

          https://www.who.int/features/qa/64/en/

          https://www.who.int/immunization/diseases/poliomyelitis/endgame_objective2/oral_polio_vaccine/VAPPandcVDPVFactSheet-Feb2015.pdf

          http://polioeradication.org/polio-today/polio-prevention/the-virus/vaccine-derived-polio-viruses/

          • The longer it is allowed to survive, the more genetic changes it undergoes. In very rare instances, the vaccine-virus can genetically change into a form that can paralyse – this is what is known as a circulating vaccine-derived poliovirus (cVDPV).

            It takes a long time for a cVDPV to occur. Generally, the strain will have been allowed to circulate in an un- or under-immunized population for a period of at least 12 months.

            Note that although the paralysis is caused by the virus, it isn't actually poliomye

          • by jrumney ( 197329 )

            There are however two forms of vaccine. OPV (oral polio vaccine), and IPV (inactivated polio vaccine). In Western countries, IPV is exclusively used since around 20 years ago. Countries like the Philippines are still using OPV, as it is easier to administer (no injection, just a drop of medicine that can be added to sugar or a drink), but as it is not inactivated, the vaccine itself can become the origin of an outbreak, especially for type-2 polio. WHO [who.int] is trying to eradicate the use of OPV for type-2 poli

      • by skids ( 119237 )

        A fuller explanation is here:
        https://www.who.int/features/q... [who.int]

        Basically achieving "herd immunity" is extra important with polio vaccine as opposed to many other vaccines, and even more so in low-hygiene areas, because the use of a live (but weakened) virus in the vaccine means if it is left slowly circulating person-by-person through a population that was not vaccinated enough, then it can mutate back to something more harmful. This and not all polio vaccines bother to vaccinate against all varieties since

        • by Mal-2 ( 675116 )

          not exposing yourself to human excrement

          ...is recommended also to avoid typhoid, parasites, hepatitis, salmonella, e. coli...

      • That is interesting. My understanding is that in Canada and the US (at least) we use an inactivated polio vaccine rather than a weakened virus vaccine specifically to make it impossible for the vaccine to spread the disease.

        But this story is all the more reason everyone should receive the vaccine.
        • Re:satisfied (Score:4, Interesting)

          by dgatwood ( 11270 ) on Thursday September 19, 2019 @04:22PM (#59214054) Homepage Journal

          The United States also hasn't had any polio cases in a long time, so not being meaningfully protected until the second dose isn't a big deal. When you're in an environment where you might actually plausibly be exposed to it, getting a strong enough immune response in the first dose so that you don't have to have a second dose is at least arguably an advantage.

      • by Cederic ( 9623 )

        I am pro-vax

        Is that a thing now?

        I thought there were two populations, anti-vaxxers and everybody else.

    • by Altus ( 1034 )

      Think of all the manufacturing jobs though!

    • by harvey the nerd ( 582806 ) on Thursday September 19, 2019 @01:38PM (#59213434)
      In the Philippines, illegal squatters live everywhere that doesn't have a building or security guarding it, peeing and pooing without any sanitation directly into the watershed. This includes them living in the creeks, flood plains, and river bottoms in millionaire acres. Poor, bastard city children get left with grandma in the nicer, greener, more provencial areas near the rivers.

      So it is not totally surprising that OPV virus cycles into the streams, "gifting" some squatters a little further downstream, who may or may not be vaccinated themselves.
      • by deviated_prevert ( 1146403 ) on Thursday September 19, 2019 @02:27PM (#59213620) Journal

        In the Philippines, illegal squatters live everywhere that doesn't have a building or security guarding it, peeing and pooing without any sanitation directly into the watershed. This includes them living in the creeks, flood plains, and river bottoms in millionaire acres. Poor, bastard city children get left with grandma in the nicer, greener, more provencial areas near the rivers. So it is not totally surprising that OPV virus cycles into the streams, "gifting" some squatters a little further downstream, who may or may not be vaccinated themselves.

        Blaming people who cannot scratch together enough to find a roof over their head for disease outbreaks is not a wise use of the intellect. Instead blame the corruption and social neglect going on in the halls of power in the Philippines and their largely American overseers.

        But then again social elite nimby assholes have used that meme to good effect for as long as there have been poor at the door. We see it happening in Vancouver BC and everywhere tent cities are popping up. BUT DON'T start with the self-righteous bullshit lest ye yourself be judged. There but for the grace of God go I...Sir

        • Huh. I did not read the parent's comment as placing blame on anyone. It seemed to be describing a bad situation but I did not see any part of it saying the people were in this position due to their own actions.
          • by Uberbah ( 647458 )

            'illegal squatters peeing and pooping everywhere'

            The distain was visible from space.

            • by Cederic ( 9623 )

              It's factual. If that arouses disdain and derision in you then it's clearly how you perceive such people.

              Don't project your own interpretation onto the original author.

              • by Uberbah ( 647458 )

                It's elitist assholery of the sort that inspired the invention of gulags & guillotines. And your projection about projection is duly noted.

        • American overseers? Duterte would be amused to hear that one.

      • illegal squatters live everywhere that doesn't have a building or security guarding it, peeing and pooing without any sanitation directly into the watershed.

        As opposed to all the Jews in New York who had ready access to modern sanitation and live in their own homes yet caused the largest outbreak of measles in this country in recent history? Or the ones who visited that shit hole country of Israel and brought it back with them?
    • They are going to need more tOPV (trivalent oral polio vaccine) to tamp down an bOPV linked epidemic.

      They have trouble covering the whole population with OPV, I have my doubts about logistics for IPV coverage. Anyone still able to make tOPV, or they burned everything?
    • by Phylter ( 816181 )
      In this case it may be a bit of a double edged sword. The strain that's going around is from vaccines but can also be prevented by vaccination. It's a weird world we live in. "WHO and UNICEF said in a joint statement the polio outbreak in the Philippines is concerning because it is caused by vaccine-derived poliovirus type 2. "The weakened virus used in vaccines replicates for a short time in children’s intestines and is excreted in their feces. In rare instances, they said, the weakened virus can s
    • Anti-vaxxers won't be satisfied untill the pro-vaxxers make themselves look completely stupid by blaming every virus-related thing that happens on anti-vaxxers, including the resurgence of a vaccine derived virus strain that we're not currently vaccinating for.
  • Looks like technology is ready for this contingency. [twitter.com]

  • by MAXOMENOS ( 9802 ) <mike&mikesmithfororegon,com> on Thursday September 19, 2019 @01:07PM (#59213268) Homepage

    There's more information on what this is here [cdc.gov] - but from what I'm reading, it looks like new viruses can emerge from vaccines, and those viruses would then need to be vaccinated against. Per CDC, poliovirus 2 emerged from poliovirus 1 vaccines, and then poliovirus 3 emerged from polio 2 vaccines. Apparently everyone thought poliovirus 2 had been eradicated in the wild in 2015, and so new vaccines only vaccinate against poliovirus 1 and poliovirus 3, and provide no immunity to poliovirus 2.

    So yeah, if I understand correctly - and I'm no expert - then this is an emergency. Hopefully someone with an actual PhD in virology and a Slashdot account can correct me if I'm wrong.

    • They don't need new science; they just need to switch back to the older vaccine,

      After wild poliovirus type 2 was declared eradicated in 2015, the world switched from trivalent to bivalent OPV. Trivalent OPV contains all three types of poliovirus, while bivalent OPV only contains poliovirus type 1 and 3. This switch means that OPV no longer protects against WPV2.

      The trivalent vaccine would protect against this outbreak. So, the real issue is how long it would take to reestablish production---sometimes it takes a while to do that.

      • by jrumney ( 197329 )

        The trivalent vaccine is what is reintroducing type-2 into the wild. The actual WHO recommendation is to use bivalent OPV in high risk areas to quickly immunize infants against the strains still in the wild without the need to qualified medical personnel, then give them trivalent IPV (inactivited polio vaccine) at a later date when a medical professional is available to administer injections. In the West, we just get IPV along with our other vaccines.

    • by r2kordmaa ( 1163933 ) on Thursday September 19, 2019 @01:28PM (#59213384)
      Wrong, all three types are wild types. The thing is the oral polio vaccine, it's using weakened versions of the viruses. It works just fine and is much easier to administer in difficult conditions, but very rarely it can result in new vaccine derived virus strain. In this case the inheritance is that vaccine against type 2 was purposefully derived from wild type 2 and in someone who was vaccinated with it a mutation occurred that produced the vaccine derived strain which is now the problem. Wild strain 2 -> vaccine against 2 -> vaccine derived strain 2. Strains 1 and 3 are not involved in any step and those immunized against wild type 2 are still immune against vaccine derived type 2.
    • by Anonymous Coward
      Yeah, the AP article mentions that in unsanitary conditions, the virus can survive long enough to reproduce even in its weakened state. That appears to be what happened here. It's worth mentioning that not all vaccines contain live virus, though.

      The other comment attached to this post [slashdot.org] mentions that the trivalent vaccine should fix the problem. The question I have is how cost-prohibitive might that be in a more impoverished area like the Philippines?
    • Describe “emerge” as the very first part of your article says there are 3 “wild” types. No part of the article says these were the result of vaccines. It does say

      In rare cases, the OPV virus can accumulate changes over time and become like wild poliovirus (WPV). These new viruses are called vaccine-derived polioviruses (VDPV) and can cause polio disease.

    • by sjames ( 1099 )

      The regular vaccine will cover this as well. The problem is poor sanitation (due to widespread poverty) and not enough of the population being vaccinated. The latter is in part due to backlash over a dengue fever vaccine implicated in 3 deaths recently.

      The best preventative for outbreaks like this is maintaining good socio-economic conditions for EVERYONE. Fail at that, pay the price.

  • They are going to need more OPV (oral polio vaccine) to tamp down an OPV linked epidemic.

    For anyone directly affected by this epidemic, IV vitamin C is a known cure for polio, see Fred R Klenner. The real problems are obtaining a good dosing (a series of IV vitamin C infusions every 8 hours, or a big drip, for 2-3 days) and a regular doctor won't know beans about IV vitamin C either. Since blood sugar is higher today than Klenner's time it will take an even higher IV dose to clear a victim thoroughly,
    • I looked on pubmed and there were some things from the 30s, but the most likely reason that real doctors won't know much about IV vitamin C is that it appears to be a bunch of quackery. Vitamin C is useful for treating scurvy, though.
      • by skids ( 119237 )

        IV vitamin C, as part of a cocktail, is under investigation for potential addition to sepsis protocols. No doubt there's a lot of quackery as well, but there is some serious research ongoing.

        https://www.ncbi.nlm.nih.gov/p... [nih.gov]

        • Interesting! Sepsis is a very different sort of problem than viral infection, as an adjunctive therapy there could be some benefit.
      • IV vitamin C generated Fenton reactions are very active near the copper and iron sites located on most but not all pathogens (e.g. molybdenum as an alternative). High dose IV C works great for a lot of acute phase viral infections and oxidative toxins. IV C is not quackery, rather long standing, venal medical politics that prevent its recognition. Kind of like government censoring maps for black op sites.

        I've worked in a number of tropical countries, mostly from a corporate research lab. The one
        • I'm also in biomedical research; what "copper and iron sites" are you referring to? It'll make it easier for me to look it up, since like I said, it is mostly quakery that comes back more recently than the 30s. It'd be very surprising if a compound most vertebrates make on their own wouldn't be more upregulated if it had a strong broad spectrum anti-pathogenic effect. Being susceptible to scurvy is bad enough. Guinea pigs would be a good model for high dose vitamin C research, they don't make their own
    • Vitamin C does not cure anything.

      It improves immune responses, that is all.

  • If there is no host left, where did it come from?
    Can it infect other species?
    Was the country not actually free, and they simply did not count those species?

  • Wanna bet that antivaxers are going to totally pounce on the part of this story that says that the virus was derived from a vaccine, and point out how that supposedly proves that vaccinations are dangerous?
    • In this case the vaccination *was* dangerous. You sound like you don't want to admit that. I'm pro-vax FTR.
  • Experts Warn World 'Grossly Unprepared' For Future Pandemics

    https://news.slashdot.org/stor... [slashdot.org]

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