Divining Without Seeds: The Case for Strengthening Laboratory Medicine in Africa by Iruka N. Okeke

Author:Iruka N. Okeke [Okeke, Iruka N.]
Language: eng
Format: epub
Tags: Africa, General, History
ISBN: 9780801460906
Google: PfytDwAAQBAJ
Publisher: Cornell
Published: 2011-02-15T13:53:07+00:00

Eradication Challenges

In 1988, two years into the guinea worm eradication campaign, a bold step was made to begin the eradication of poliomyelitis, with a target completion date of 2000. In the first half of the twentieth century, amid a marked decline in the incidence of other infectious diseases in North America, thousands of middle-class children and a few adults were killed or crippled by the paralyzing disease—most notably, future president Franklin Delano Roosevelt. This epidemic spurred fund-raising for a concerted research effort to develop a vaccine, with American scientific heroes Albert Sabin, Jonas Salk, and Hilary Koprowski at the front lines.20 These well-supported and largely political efforts resulted in several effective vaccines and the elimination of the disease in the United States by 1979. In 2001, 575 million polio immunizations were administered in ninety-four countries as part of the worldwide eradication effort.

Unlike smallpox and guinea worm disease, patients who can transmit polio can be reliably identified only by laboratory tests. Although a high prevalence of lameness in a population points to endemic poliomyelitis, less than half of seriously ill polio patients are paralyzed, so paralysis is not a sensitive enough diagnostic sign.21 The virus is transmissible during the early stages of the illness, when symptoms often resemble those of other common conditions such as influenza. Recognizing this problem early in the campaign, WHO issued a statement explaining why it was essential to integrate laboratory and clinical approaches. High-burden countries, including many in Africa, would not necessarily need laboratory support to verify each infection, although local isolates should be preserved in order to track infections during the final mopping-up phase. Toward the end of the campaign, when most countries would be polio-free and some would have a few cases, laboratory support would be fundamental. In this strategy, polio eradication could begin even with diagnostic insufficiency in many endemic areas, but diagnostic development in the most troublesome spots would be essential to complete the campaign. A global laboratory network was an integral part of this plan.22 As an editorial observed, “Progress achieved by the network has demonstrated that high-quality virology in support of public health activities can be made accessible to all areas of the world, including war-torn countries and countries without organized government or health infrastructure.”23 With sufficient support and motivation, laboratory diagnostics can be used anywhere, even for a viral disease such as polio. Polio surveillance has increased laboratory capacity for diagnosis and surveillance of other infections in many parts of Africa.

Polio eradication is now at a challenging last stage. Insufficient access and political will are the preeminent roadblocks, but there are biological challenges as well. The poor immune response of Indian children means that their vaccines must be carefully crafted and more frequently administered. The return of an eradicated polio subtype warrants reintroducing a discontinued vaccine in Nigeria. Viruses are periodically exported from the last four endemic nations (India, Nigeria, Afghanistan, and Pakistan) to other countries that have eliminated the disease.24 All of these problems were identified, and are

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