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Poor Sanitation In Haiti, Polio
Vax Produce Polio Outbreak
From Patricia Doyle, PhD
It looks like polio is spreading...due to polio oral vaccine.
I also note that one of the patients who was flown to North Carolina may have put the community at risk in North Carolina as the hosital was originally given the diangosis of Guillain Barre Syndrome and not told of possible polio caused by the vaccine with live virus.
In this day and age, it bogglese my mind that we rely on a vaccine that has a live virus and can spread polio...rather than spend the money on common municipal sanitation measures. 
This is a rather long post but it is well worth the read as it does show oral polio vaccine can cause polio outbreaks.
Given the sanitation situation in Haiti, I feel that we could see a major outbreak of polio and many deaths.  Th polio virus will exist in the environment of Haiti for years to come.
Date: Mon 17 Jan 2011
From: James Wilson jim.wilson@gifde.org
ProMED-mail regrets the delay in posting. - Mod.MPP
Subject: Haiti: Suspected VDPV Type I Cases
I realize many of you are waiting anxiously for the diagnostic  results of the suspected VDPV [vaccine derived poliovirus] Type I  cases that presented as reported "ascending paralysis"/Acute Flaccid  Paralysis (AFP).
Here are updates as we understand them:
1. Three adult cases were identified at a medical facility in Port de  Paix last week [week of 10 Jan 2011]. Two were fatal, and one remains  paralyzed and ventilator-dependent at an ICU in Port au Prince.  Several samples were acquired from this patient for diagnostic  testing. The surviving patient was initially diagnosed with  Guillan-Barre Syndrome.
2. An additional pediatric case was identified as having been  medivac'ed to Charlotte, North Carolina, where she remains  ventilator-dependent in an ICU. This case was found to have been ill  originally in October [2010]; she lived in Petionville. It is notable  the medical team involved in this case had diagnosed the child with  Guillan-Barre syndrome. ... Once the question of VDPV was raised,  there was concern about the safety of the Charlotte community, given  the nationwide problem of childhood vaccination compliance.
3. An anonymous HEAS [Haiti Epidemic Advisory System] partner  reported seeing a "16-18 year old from Fermate die of acute flaccid  paralysis but had no idea at that time the government reported such  things. We spent a long time trying to sort out what part of spinal  cord might have given him an ascending flaccid paralysis causing  death from respiratory failure over the course of about 24 hours and  could not come up with a medical, physiological answer except  Guillan-Barre. Polio never entered my brain. He had a fracture in his  lower leg and had a spinal anesthetic which resolved, but he came  back the next day complaining of weakness and trouble breathing."
4. Investigation by officials has uncovered multiple additional  suspect cases for diagnostic testing in both the Port de Paix and  Port au Prince areas.
As reported previously, Hispaniola (starting in Haiti, with spread to  the Dominican Republic) was the site of a large outbreak of  Vaccine-Derived PolioVirus (VDPV) Type I from 1998-2001 that debunked  the previously held belief that oral polio vaccine only caused rare  single-case reversions. Both Port de Paix and Port au Prince were  involved in the outbreak. Several environment samples provided  evidence of environmental contamination. The virus, an unstable  reverted mutant, was found to have recombined with 4 indigenous  enteroviruses. This series of mutations resulted in a novel virus now  capable of aggressive transmission, severe neurological disease, and  fatalities. It is unclear what the actual case fatality rate is when  compared to wild type polio. My personal opinion is it is likely  higher given this was/is an unstable mutant still adapting to both  the environment and the host population.
The good news is rapid emergency vaccination with OPV in 2001 was  thought to have brought the situation under control. However, the  current situation challenges the notion of whether the virus was  truly contained, hence the absolute need for definitive, credible  laboratory evaluation of both environmental and human samples.
We were dismayed to realize the number of people involved in the  initial care and transport of the Port de Paix patient cluster who  did not provide warning of the situation. They were interviewed after  discovery of a You Tube video depicting the transfer of one of the  patients by one of our astute HEAS members on [9 Jan 2011].  Potentially exposed Haitian and non-Haitian personnel included the  staff of the Port de Paix and Port au Prince facilities and 2  transport teams. We are fortunate none of the involved personnel have  reported symptoms. It is key to note that personnel vaccinated  appropriately for polio are immune; however, Haitian personnel and  the surrounding community are an entirely different matter...
Laboratory results are still pending. We hope this will turn out to  be a false alarm, but as the appearance of cholera has shown us,  complacency costs lives.
James M. Wilson V, MD
Haiti Epidemic Advisory System (HEAS)
Executive Director
Praecipio International
Washington-Houston-Port au Prince
The above email is the 1st information that ProMED-mail has received  on the apparent outbreak of acute flaccid paralysis in Haiti, and we  are grateful to Dr. Wilson for sending this alert. On searching the  web, this moderator was able to find the earlier alerts related to  the identification of a "cluster" of acute flaccid paralysis cases  posted on a blog known as the Haiti Medical and Public Health  Information Sharing Environment at  http://haiti.mphise.com/ru/re-update-alert-acute-flaccid-paralysis.
The outbreak of VDPV in Hispanola was covered by ProMED and can be  reviewed through reading the prior posts referenced below. At the  time of this outbreak (2000-2001), there was a total of 21 cases of  VDPV-associated paralysis on Hispanola (Haiti 8 and the Dominican  Republic 13), of which 12 cases were reported in 2000 and 9 cases  were reported in 2001. 
Kew et al demonstrated that the viruses responsible for the paralytic  poliomyelitis outbreak in the Dominican Republic and Haiti were  derivatives from an attenuated poliovirus vaccine (OPV) in use during  1998-1999. (See Kew O, et al. Outbreak of Poliomyelitis in Hispaniola  Associated with Circulating Type 1 Vaccine-Derived Poliovirus.  Science 12 Apr 2002: 356-359. Abstract available at  http://www.ncbi.nlm.nih.gov/pubmed/11896235.
Kew mentions that it is common for vaccine viruses to "back mutate" (revert to wild  poliovirus-like neurovirulence), but the concerns arise in areas with  low vaccination coverage and, therefore, low herd immunity, so that  these reverted viruses are in an environment favorable for  circulation and propagation of an outbreak of paralytic disease. (See  prior ProMED postings on other events associated with VDPVs.)
As part of the global polio eradication initiative activities, all  cases of acute flaccid paralysis (AFP) in individuals less than 15  years of age are to be reported and investigated. A benchmark  indicator of adequate surveillance activities is a reported AFP rate  of at least 1 per 100 000 population annually. According to  monitoring data available on the WHO immunization monitoring website,  during the period 1996 through 2010, non-polio AFP rates reported in  Haiti were less than 1 per 100 000 population under age 15 years for  all years during this period, including 2000 and 2001, the 2 years  during which there were cVDPV (circulating vaccine derived  poliovirus) associated paralytic cases, and AFP surveillance was  significantly increased (from rates of 0.0/0.1 up to 0.6 and 0.8 in  2000/2001 respectively) (data available through an interactive page  at:  http://apps.who.int/immunization_monitoring/en/diseases/poliomyelitis/case_count.cfm.
These figures suggest that surveillance for paralytic disease in  Haiti has been suboptimal and may well not rule out the possibility  of having had some "below the radar" circulation of poliovirus,  either wild poliovirus (WPV) or vaccine derived poliovirus (VDPV). In  addition, as seen with the recent experience with cholera in Haiti,  the possibility of introduction of WPV is there, as there has been  significant influx of international workers in the post earthquake  relief activities.
Unfortunately, laboratory confirmation at this point in time may be  challenged as 2 of the identified cases were fatal cases, one had  onset of illness in October 2010, so a negative virus isolation study  will not definitively rule out a viral infection, leaving the one  case presently hospitalized in Haiti on a respirator as the only case  in which there is a reasonable likelihood of successful virus  isolation studies. That being said, the possibility of a several  cases of Guillain-Barre syndrome (GBS) occurring in close temporal  proximity also exists. GBS has been associated with gastrointestinal  and respiratory infections (both viral as well as bacterial), and  following vaccination, all 3 pre-disposing events/conditions have  been coexisting in the present environment in Haiti.
ProMED-mail awaits further information on the results of 
investigations and laboratory studies.
For the interactive HealthMap/ProMED map of Haiti, see 
http://healthmap.org/r/00Yn. - Mod.MPP
Patricia A. Doyle DVM, PhD Bus Admin, Tropical Agricultural Economics Univ of West Indies Please visit my "Emerging Diseases" message board at:http://www.emergingdisease.org/phpbb/index.php Also my new website: http://drpdoyle.tripod.com/ Zhan le Devlesa tai sastimasa Go with God and in Good Health
Benjamin Franklin said, "They that can give up essential liberty to obtain a little temporary safety deserve neither liberty nor safety." 
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