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By Susannah A. Nesmith, Associated Press Writer
CONSTANZA,
Dominican Republic (AP) - Sandy Torres sits in a wheelchair
in the front of his sixth grade class, learning anatomy,
though his own body is forever damaged by a disease that
has scientists scrambling for answers.
Sandy,
13, came down with polio in September, nine years after
scientists believed it had been eliminated from the Western
Hemisphere. His mother said he was never vaccinated because
she didn't know he needed to be.
"It's
not easy watching your child, who ran and played like all
the other children, and now he can't walk," Sylvia
Altagracia Nunez said.
Sandy
is one of six confirmed cases in the Dominican Republic.
There is a seventh in Haiti, which shares the island of
Hispaniola, and 15 suspected cases are being investigated
by local health workers, the U.S. Centers for Disease Control
and Prevention and the Pan American Health Organization
based in Washington, D.C.
The
outbreak indicated that the health care systems failed to
follow through on a basic vaccination program, and it also
raised larger concerns about the worldwide effort to eradicate
polio.
For
the victims, the questions are simpler - and harder to face.
Will
3-year-old Erika Pimentel, who now drags herself across
the floor with her hands, ever be able to run around the
neighborhood, tiring her mother out like she used to? How
will 6-year-old Alejandrina Arismendy, now unable to stand
on her own, make it down the steep hill outside her home
to school?
Polio
is a highly infectious disease that usually strikes children
under 5. It damages the spinal cord and brain, causing paralysis
and sometimes death. It is transmitted by ingesting food
or water contaminated by fecal matter of an infected person.
So far,
investigators have determined that the outbreak occurred
because thousands of children were not vaccinated, making
both countries a prime breeding ground for a vaccine-derived
mutation, like the one that infected Sandy.
In Constanza,
a remote mountain town where the first cases appeared, officials
estimate only 20 percent of children had received all three
doses of the vaccine, said Socorro Gross, Pan American's
representative here.
"All
of the people involved either weren't vaccinated, or were
only vaccinated once," Gross said. And the government
wasn't pushing the vaccine or even making it available to
all clinics.
"I
had the vaccine here in a refrigerator but it was old, I
couldn't use it," said Dr. Antonio Santos, director
of Constanza's public hospital.
In an
immunization drive in recent weeks, about 25,000 children
- more than 95 percent - in Constanza and the surrounding
region have been vaccinated, Gross said. A nationwide vaccination
campaign was scheduled the weekend of Dec. 15-17. Haiti
plans a vaccination blitz in January.
The
outbreak raises larger questions about the campaign to eliminate
polio: whether vaccinations can ever be stopped, and the
type of vaccine being used in most countries. The World
Health Organization hopes by 2002 to eliminate wild polio
from the few countries in Africa and Asia where it still
exists.
But
after that, polio would still exist in the children who
received the oral vaccine, a relatively safe version of
the live virus. If the vaccinations stopped, those children
might pass the disease on to unvaccinated children. And
if the vaccine version of the disease circulated long enough
in the population, it could mutate back into the deadly
version, as apparently happened here.
The
only other such case occurred in Egypt in the 1980s, infecting
more than 30 people.
"This
is a real problem because it highlights the point that we
cannot predict what polio virus will do," said Dr.
Vincent Racaniello, a professor of microbiology at Columbia
University. Racaniello long has argued that the effort to
eradicate polio cannot end when the wild virus has been
eliminated.
He is
among those who believe health workers will have to switch
from the oral vaccine, called Sabin, to the older, costlier
Salk vaccine that has to be injected but uses a killed strain
of the virus that cannot mutate.
Pan
American officials are resistant to the idea, saying Salk
is not only too costly but too difficult to use in developing
countries because it has to be administered by a professional.
In addition,
the immunity from the oral Sabin vaccine is contagious,
spreading from child to child and giving what experts call
"herd immunity." As long as a high enough percentage
of children are vaccinated directly, the few who are not
can get the vaccine from the rest.
"Nearly
four decades of experience with oral polio vaccine has shown
that it is very safe and effective in preventing poliomyelitis,"
said Ciro de Quadros, Pan American's director of the vaccination
program.
But
the United States changed the protocol for polio vaccinations
in 1997 to include the Salk vaccine, in order to prevent
mutations. The Hispaniola outbreak does not threaten countries
like the United States, where almost all children are vaccinated
and are therefore immune to the wild disease and the mutation.
For
Sandy Torres the real question is simple.
"I
ask God when I will be able to walk again, and if I can
continue playing baseball."
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