Health Ministry to give oral polio vaccine to 150,000 children

Health Ministry reaches decision to treat children in the South after consulting with visiting foreign experts.

By JUDY SIEGEL-ITZKOVICH
Roni Gamzu looks up at Health Ministry meeting (photo credit: Judy Siegel-Itzkovich)
Roni Gamzu looks up at Health Ministry meeting
(photo credit: Judy Siegel-Itzkovich)
In an unusual cautionary step, the Health Ministry has decided, after consulting with foreign experts, to give an advanced type of oral polio vaccine (OPV) to 150,000 children in the South.
The ministry will spend “several million shekels” to order up to a million doses of the “live attenuated” vaccine – in drop form – for vaccinating children and even adults elsewhere in the country, if needed.
In a last-minute press conference in a Knesset committee room on Wednesday, Health Minister Yael German, ministry director-general Prof. Ronni Gamzu, public health chief Prof. Itamar Grotto and medical branch head Prof.Arnon Afek told health reporters about their decision.
They stressed that there was “no reason to panic,” as not a single person had actually come down with the clinical form of poliomyelitis that causes paralysis.
The live virus has only been detected in routine samples of sewage taken since February in the Negev, specifically in the Beduin town of Rahat, they said.
The decision came at the end of a three-day visit from four senior experts – three from the World Health Organization and one from the US Centers for Disease Control – who came here to observe what the ministry was doing to prevent the possible spread of the virus.
Only about four or five countries in the world – most of them with low vaccination rates – routinely text stool samples (Israel does so regularly at 16 sewage-treatment centers around the country). Polio, which has been nearly eradicated around the world, occasionally turns up in various places. According to the WHO, from an estimated 350,000 actual cases of the disease in 125 endemic countries in 1988, the number dropped to only 223 reported cases in those countries last year.
Gamzu noted that Israel is at the crossroads of Europe, Asia and Africa and is located not far from Third World countries, but nevertheless has a 95-percent rate of injected, killed, “inactivated” polio vaccine (IPV) coverage in the population. It also has computerized records that one can search within minutes to find every individual child in the country who has not received his or her regular vaccinations, he said.
At present, babies and young children receive several doses of IPV (Salk vaccine) in well-baby (tipat halav) clinics on a standard basis. Until eight years ago, children also received doses of the Sabin OPV, but this was discontinued when the disease was considered eradicated.
As such, Israeli children under the age of eight have never received OPV.
Some 25 years ago, a woman came down with actual polio paralysis, as did 14 other people, all of whom became disabled. As a result, the ministry decided to give oral Sabin vaccine to everyone under the age of 40, and the outbreak stopped. Since no one has actually shown clinical symptoms, the current situation is less worrisome than the previous one and is not considered an “outbreak,” Gamzu noted.
IPV is highly effective in preventing the polio virus from spreading to the individual’s neurological system and causing paralysis. OPV, first licensed as Sabin vaccine in 1962, is shed in the stool and produces antibodies that prevent the wild virus from spreading through society due to poor hygiene.
Grotto noted that the best way to prevent the virus from spreading was to wash one’s hands with soap and water after using the bathroom and diapering babies, and before eating.
Gamzu said the ministry realized a month ago that there were vestiges of the wild virus in the sewage from Rahat and half a dozen other places in the South, as far north as Ashdod. However, the samples themselves were taken as early as February, so it is still not clear whether the wild virus is still spreading or has been contained, he said.
“We had to be careful, as viruses do not respect borders,” he stated.
The strain of polio virus found in the sewage has been identified as coming from Asia, he said.
Afek added that it wasn’t clear how this had reached a resident (or several residents) in the Beduin town.
Children who have already received their full complement of IPV can still spread the virus through their stool to others whose parents did not take them to get their shots, even though the vaccinated children themselves will not become sick.
There are several scenarios, the director- general said. “We will continue to collect data from sewage-processing plants around the country – twice as many as we have been doing. We also want to test individual stools from children in day-care centers, health fund clinics and hospitals – and maybe even from adults to see if the problem is regional or broader or, it is hoped, will just disappear,” the director-general said.
He added that the ministry would be on the lookout for clinical symptoms of polio – besides paralysis, which has not been reported at all – and try to find the individuals responsible for the first cases in Rahat.
“We are prepared to vaccinate with OPV the whole population in the relevant age groups in the South or even in the whole country,” Gamzu said.
The new, improved type of OPV vaccine, manufactured by eight companies abroad since 2010, is “very safe and only rarely causes side effects,” Gamzu said. The ministry will prepare an information campaign to explain why it is important for parents to take their children for OPV, even though they have already received their IPV doses, he continued, since IPV doesn’t prevent transmission to others.
In the unlikely scenario that individuals actually develop the clinical disease, the ministry will go into higher gear.
“Even though we are in a good situation, it could be – a very small chance – that a person could get sick with polio,” Grotto said.
German will report to the cabinet on Sunday on the measures that have been taken.
She noted at the press conference that no drinking water had been affected, as the pipes supplying such water are strictly separated from sewage lines.
One of the foreign experts, who comes from Germany, told the Health Ministry that the delegation was highly impressed with the handling of the sewage scare and the computerization of all well-baby center vaccinations.
“You do it better than we do in Germany,” the WHO official said.