political efforts to eliminate another disease with vaccines

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W.H.O. Advises Full Polio Immunization for Travelers to Nigeria

By LAWRENCE K. ALTMAN

Published: July 1, 2004




he World Health Organization yesterday advised all travelers to Nigeria to be fully immunized against polio.

The move is seen as an attempt to step up international pressure on the West African nation, where officials of one state, Kano, have refused to offer polio immunizations for nearly a year despite the wide spread of the virus.

Nigeria, with 259 polio cases, now accounts for 77 percent of all polio cases in the world, and health officials are awaiting findings from tests on an additional 85 paralyzed children. The polio virus has also spread from Nigeria, particularly from Kano, in the northern part of the country, to 10 polio-free countries elsewhere on the continent.

Officials at W.H.O., a United Nations agency based in Geneva, said they were alarmed about the rise in cases because it occurred at the beginning of the rainy season, when transmission of polio virus is highest. Last week W.H.O. warned that West and Central Africa were on the brink of the largest polio epidemic in recent years.

The spread of the virus comes at a time when W.H.O. and its partners had come tantalizingly close to making polio the second disease, after smallpox, to be eradicated from the world through immunizations.

"Today, Kano state in northern Nigeria is the only endemic area in the world where polio immunization is not taking place," said Dr. David L. Heymann, who directs the health agency's polio eradication program.

"Because of this extreme danger in northern Nigeria now for international travelers, we are advising that" they be fully immunized against polio, Dr. Heymann said in a telephone news conference.

Americans who have received the full course of three doses of injected or oral polio vaccine should get a booster shot before traveling to Nigeria, said Dr. Stephen L. Cochi of the Centers for Disease Control and Prevention in Atlanta. Americans who have not received the full series should complete the immunizations before traveling to Nigeria, Dr. Cochi said in a telephone interview.

Health officials recommend an interval of at least four weeks between doses of the polio vaccine, and a person who received one or two doses years ago can still complete the immunization now, Dr. Cochi said.

Kano officials stopped polio immunizations last August when political and religious leaders there claimed that the polio vaccine could make girls infertile. W.H.O. officials say that repeated independent testing of the vaccine have refuted such claims. Dr. Heymann said that Kano's governor, Ibrahim Shekarau, told him that he was satisfied the vaccine was safe.

Since May, Mr. Shekarau has repeatedly pledged to resume vaccinations. W.H.O. and the United Nations Children's Fund, Unicef, have sent additional workers and have taken other "extraordinary measures" to help Nigeria, Dr. Heymann said. Last Saturday, Kano officials began training immunization workers. But in a number of telephone conversations with W.H.O. officials before and since then, Mr. Shekarau has refused to set a date for resumption of polio immunizations.

The vague nature of Mr. Shekarau's pledge may reflect his lack of wider support in the Kano community, Dr. Heymann said. Powerful local committees in Kano have not fully agreed with Mr. Shekarau and supporters of the polio vaccine have not countered rumors in the region about its dangers.

W.H.O. rarely issues travel advisories. The polio advisory is intended for personal protection, unlike the advisory W.H.O. issued last year to stop the spread of the respiratory disease SARS, Dr. Heymann said.