Mass immunisation: are HIV+ folks safe?

Immunisation entails receiving a sub-lethal dosage of the germ or microbe which causes disease.

Sometimes the germ or microbe is killed or attenuated (reduced in virulence) or it is part of the vaccine.

The idea is that once the germ or microbe is introduced into a person’s body it will prompt the body to produce antibodies before exposure.

Namibia is among the worst affected countries in the world by Tuberculosis and HIV, with about 22 percent of its approximately 1,9 million people between 15 and 44 years of age known to be living with the virus that causes AIDS.

Multitudes more do not know their HIV status.

The wild polio vaccine will also reach these people when Namibia begins mass immunisation on June 21 and it is their fate that has excited the imagination of observers of varying levels of enlightenment.

Remarks from one of them, a scientist who spoke on condition he was not named, dramatised the prevailing state of anxiety when he told The Southern Times: “In most countries the TB vaccine that is normally given after birth is no longer being given to HIV positive babies as it is feared that it might hasten their deaths by giving them TB instead of shielding them from it. My prayer is that the wild polio vaccine will not have adverse effects on people whose immune system is already battered.”

Approached for comment, Namibia’s Permanent Secretary in the Ministry of Health and Social Services, Dr Kalumbi Shangula, said people with already compromised immune systems including those living with AIDS, would not be rendered worse through immunisation.

“There is a theoretical but no real risk (that HIV+ people will be negatively affected). Our aim is to protect not just individuals against this outbreak, but the entire community,” he said.

He said there were no benefits, either for the nation or the individual, in not immunising some people on grounds that their immune systems are weak, so there would be no sacred cows when the programme begins.

Shangula said there were actually advantages in immunising everyone including those with weak immune systems as that would give them a fighting chance should polio strike.

“If we do not immunise them they may still be exposed to polio and they would be no better off,” he added.

Asked if the World Health Organisation had a clear policy on immunisation of people with weakened immune systems, WHO Namibia representative Dr Custodia Mandlhate avoided the question and refered all others to Shangula, but not before she let slip: “There is

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no contraindication (in other words immunisation is not prohibited) for …HIV/AIDS, TB and Cancer.”

Shangula said preparations for the mass immunisation were at an advanced stage and expressed optimism that the programme would begin in earnest as scheduled.

Namibia this week received sufficient quantities of the monovalent oral polio vaccine and launched a massive awareness campaign ahead of the mass immunisation.

On Wednesday, aero planes from a private company flew over the capital, Windhoek, distributing hundreds of thousands of pamphlets bearing vital information on polio.

Although the pamphlets distributed on Wednesday were all in English, Shangula said plans were underway to translate them into Namibia’s numerous local languages and to use radio to reach the illiterate and visually challenged.

The Global Polio Eradication Initiative says polio normally affects

children under the age of five. However, if the poliovirus transmits amongst a population of adults who have never been immunised, it is possible for adults to be affected.

This appears to be the case in the current outbreak in Namibia, which is why the immunization response will aim to reach every person, and not just children under the age of five years.

Poliomyelitis (polio) is a highly infectious disease caused by the wild poliovirus. It invades the nervous system, and can cause paralysis or even death in a matter of hours.

It enters the body through the mouth, in water or food that has been contaminated with faecal material from an infected person. The virus multiplies in the intestine and is excreted by the infected person in faeces, which can pass on the virus to others.

The effects of polio are:

-One in every 200 persons infected with polio leads to irreversible paralysis (usually in the legs).

-Among those paralyzed, 5%-10% die when their breathing muscles are immobilized by the virus.

There is no cure for polio. It can only be prevented by immunization. A safe and effective vaccine exists – the oral polio vaccine (OPV)

Genetic sequencing has confirmed that Namibia was re-infected from an imported poliovirus that is genetically similar to viruses currently circulating in Angola, which in turn originated from India. As polio is a highly infectious disease, it can spread easily from infected areas to previously polio-free areas. This underlines the risk that polio poses – as long as the disease exists anywhere in the world, children everywhere remain at risk of lifelong polio-paralysis.

Polio anywhere is a threat to children everywhere. It does not respect borders or social class, and travels with ease. If Namibia does not stop polio quickly, the virus may well spread to other countries in the region, wherever routine immunization rates are low.

Three National Immunization Days (NIDs) are planned in Namibia. The first NID will likely be held on 21-23 June to reach every person in Namibia, the second NID will likely be held on 18-20 July to reach every person in Namibia, and the third NID will likely be held on 22-24 August, to reach every child under the age of five years with polio vaccine, plus measles and Vit. A. (Additional information GPEI)

June 2006
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