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The store rooms of some hospitals in deep rural South Africa are stacked with calipers and braces made of steel and leather attached to special shoes, once used as aides by children and adults suffering from the devastating effects of polio. A mere six years ago, 104 new cases were diagnosed in our country.

Thanks to effective vaccines and extensive vaccination programmes, South Africa has had no new cases since 2000 and is now free of polio. This scenario may soon change due to the new outbreaks of polio in Nigeria and ten other African countries the past weeks.

When the Ministers of Health from the seven remaining polio-endemic countries announced in January that polio should be relegated to the history books by the first quarter of 2005, they did not take the devastating effect of rumours spread by Nigerian Shari Muslim leaders into account. A boycott, fuelled by rumours that the polio vaccine may lead to infertility, cancer or HIV/Aids, soon led to the non-vaccination of hundreds of Nigerians, and subsequently to the diagnoses of more than 30 new polio cases within 14 weeks in Nigeria, according to the World Health Organisation (WHO).

The boycott resulted in new outbreaks of polio in Nigeria, and it has now spread to Benin, Burkina Faso, Cameroon, Central African Republic, Chad, Ghana, Niger, the Ivory Coast and Togo. These countries were polio-free. On 15 April doctors diagnosed the first case of polio in our neighbouring state Botswana since 1991.

Laboratory tests performed on the polio vaccine in question in London, South Africa, India and Indonesia confirmed that the vaccine is not contaminated with cancer causing agents, hormones or HI-viruses.

It took 16 years and the successful cooperation of over 200 countries en 20 million volunteers to reduce the poliovirus to only a few remaining reservoirs in Afghanistan, Egypt, India, Niger, Nigeria and Pakistan.

Nigeria – with a vaccination rate of only 16 percent among children - has always posed the greatest threat to the eradication of polio. Almost half of the more than 520 polio cases diagnosed globally in the year 2003, were from Nigeria. About 49 percent of the cases were from India and Pakistan and one percent from the other four countries.

The new outbreaks of polio in Africa are a real threat to South African children. In theory, a single infected emigrant or visitor from Nigeria (or any of the other countries with new polio cases) visiting South Africa may transmit the virus to any unvaccinated South African. The virus is easily transmitted through direct contact. Although only about 5 tot 10 percent of those infected actually develop clinical disease, this may lead to the re-emergence of polio in South Africa. This happened in the Netherlands in 1992.

The emergence of new drug resistant organisms – as happened with tuberculosis in London and New York in the early nineties - is reversing therapeutic miracles of the last 50 years. This underscores the importance of disease prevention. The re-emergence of whooping cough since the 1980s in teenagers and adults in developed countries is also cause for concern.

For this reason, no country dares to slacken their vaccination campaigns against preventable diseases. Not against polio, nor against tuberculosis, measles or any other disease that can cause illness or death.

But, some parents are reluctant to let their children be vaccinated. False rumours and concerns about serious side effects of vaccines lead to lower vaccination rates.

As many as 25% of American parents worry that the mandatory vaccines for their children to prevent diseases like measles, mumps and polio may be to blame for other unintended diseases including hepatitis B, diabetes, neurological disorders and an impaired immune system. Controversies surrounding the link between the MMR vaccine (against measles, mumps and German measles) and autism, have fueled some of their reservations.

A recent survey of 1 000 new parents found 80 percent didn't know which shots their children needed. Or when. Or what the shots were for. If diseases such as measles, diphtheria and whooping cough were to resurface unchecked, thousands of children would die. Some 20 percent of America's two-year-olds haven't had one or more of the recommended shots, the US Centers for Disease Control and Prevention (CDC) says. They blame the re-emergence of whooping cough in the USA partly on parents’ reluctance to let their children be vaccinated.

The reasons
Researchers associated the emergence of new diseases and the re-emergence of old diseases with the following factors:

• Population demographics. The change in distribution of populations from rural areas to urban communities and the growth in populations, are usually accompanied by overcrowding, poor hygiene, inadequate sanitation and insufficient water supplies. The movements of armies and refugees have been associated with the introduction of disease and disease vectors. All these conditions mean increased opportunities for person-to-person transmission of disease and the proliferation of rodents and other vectors. Today the high volume and speed of international travel increase the potential for introduction and spread of disease. Diseases may spread from one continent to another within days. Dengue and opportunistic infections have already spread by this means.
• The increase in proportion of people who are immune-suppressed either due to malnutrition, poor living conditions and hygiene or due to increased vulnerability with age. More people are at risk of becoming ill.
• Risky human behaviour, such as unsafe sexual practices and intravenous drug use, has facilitated the spread of HIV and hepatitis C.
• Complacency about vaccine preventable diseases has led to decreasing immunisation rates in some developed countries and subsequently to major outbreaks of these diseases. Examples include recent outbreaks of measles, whooping cough and German measles in Australia, and the constant rise in the incidence of whooping cough in the US the past 24 years.
• The increased utilisation of childcare centers has been associated with outbreaks of childhood illnesses such as gastroenteritis and respiratory infections.
• Ecological changes such as changes in agriculture methods, die building of dams, changes in water eco systems, deforestation, floods, droughts, earthquakes, famine and sudden climate changes have led to outbreaks of Rift valley fever, cholera and many other diseases.
• Technological changes in food processing and the widespread use of antibiotics have lead to antibiotic resistance and the outbreak of E. coli 0111 in some countries.
• The ability of microbes to evolve and change very quickly, to bypass or suppress inflammatory and immune responses, have lead to the development of drug and antibody resistance. The worldwide increase in antimicrobial resistance is associated with the use of antimicrobial agents in humans, in veterinary medicine and in agriculture.

To prevent the emergence of new diseases or the resurgence of old diseases, the individual can do the following:

• Get vaccinated if a safe and effective vaccine is available. Read the article “To vaccinate or not” for exact description of the efficacy and safety of different vaccines;
• Be aware of the risks when you plan to travel to other areas. Talk to pharmacist or Travel Clinic when you plan a trip and get vaccinated if needed;
• or when you send your child to a crèche or childcare centre. Apply good hygiene by washing your hands regularly and drinking clean water and don’t send your child to a childcare centre while he/she or another child at school is still infectious in order to minimise the risk of spreading or contracting an infectious disease;
• Avoid risky human behaviour to decrease your risk to contract diseases such as HIV/Aids, or hepatitis B or C;
• Use antibiotics as prescribed to lower the risk for drug resistance.

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