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Morbosità e
Mortalità dopo la vaccinazione polio in Assam - CALCUTTA
Almeno 10 bambini sono
morti nello stato dell'India Nord-Orientale di Assam per effetti
collaterali, dopo la somministrazione del vaccino durante una campagna di
immunizzazione della polio, indetta dal Governo.
Più di 500 bambini si ammalarono e furono ammessi in ospedali governativi
e privati.
Gruppi di parenti circondarono gli uffici dell'amministrazione locale per
protestare, in Assam, una città al sud di Silchar
La domenica, in Assam e nella restante Nazione, a migliaia di bambini fu
somministrato il vaccino "Polio", ma entro un giorno dalla
massiccia campagna di immunizzazione della "Polio", arrivarono
rapporti a larga scala, degli effetti collaterali, nella città di Assam e
nel Silchar.
I funzionari dicono che in un villaggio, Labok 9 bambini sono morti e 1
nel Malugram, località del Silchar.
Organizzazioni non governative, che assistono il Governo in questa
campagna, dicono che probabilmente in alcune aree sono stati inviati
vaccini antiquati, ma i funzionari non volevano speculare, su larga scala,
sulle cause degli effetti collaterali.
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Incidenza di reazioni
anafilattiche e di gravi reazioni avverse sistemiche dopo
vaccinazioni
Ricercatori della Kitaso
University, in Giappone, hanno determinato l’incidenza delle
reazioni avverse associate alle vaccinazioni.
Sono stati esaminati i casi riportati nel Programma di
Post-Marketing Surveillance del Kitaso Institute, suddivisi
in due categorie: reazioni allergiche e gravi reazioni
sistemiche.
Il numero di pazienti con allergia alla gelatina che hanno
presentato reazioni allergiche
dopo immunizzazione con vaccini DPT (
difterite,
pertosse,
tetano ) si è ridotto
drasticamente dopo il 1999 quando la gelatina è stata
rimossa da tutti questi vaccini.
L’incidenza di reazione anafilattica è stata stimata essere
0.63 per milione per il vaccino contro il virus
dell’encefalite giapponese ( JEV ), 0.95 per il vaccino
DPT e 0.68 per il vaccino
antinfluenzale.
L’analisi di 67.2 milioni pratiche di immunizzazione ha
evidenziato 6 casi di encefalite o di encefalopatia, 7 casi
di encefalomielite disseminata acuta, 10 casi con sindrome
di Guillain-Barre e 12 casi con porpora trombocitopenica
idiopatica.
Il genoma del virus wild-type del
morbillo è stato individuato in un paziente con
encefalite ed in 2 di 4 aspirati di midollo osseo nei
soggetti con porpora trombocitopenica idiopatica.
Infezioni da enterovirus o da virus wild-type di morbillo
sono state individuate in diversi pazienti con reazioni
avverse ascrivibili alla vaccinazione.
L’incidenza totale stimata di grave malattia neurologica
dopo vaccinazione è stata di 0.1-0.2 per milione di pratiche
di immunizzazione. ( Xagena_2006 )
Nakayama T, Onoda K, Vaccine 2006; Epub ahead of print
INDIA –
Poliomielite da vaccino
post-vaccination 20001220.2234 - Poliomyelitis,
suspected
Mon 12 Nov 2001 23:22:27 –0600 - Henry V. Huang - BBC News Online, Mon 12
Nov 2001 [edited]
http://news.bbc.co.uk
Morbidity and Mortality after Polio vaccination in Assam
CALCUTTA: At least 10 children have died in India's
northeastern state of Assam of side effects after being administered a
vaccine during an polio immunisation campaign run by the state government.
More than 500 children have been admitted to government and private
hospitals after falling sick.
Angry groups of parents have surrounded offices of the
local administration in protest in Assam's southern city of Silchar.
On
Sunday, thousands of children were administered a Polio
vaccine throughout Assam and the rest of the country. But within a day
of the massive polio immunisation campaign, reports have come in of
large-scale side effects in and around the city of Silchar in southern Assam.
Officials say 9 children have died in one village -- Labok -- while one died
in Malugram locality of Silchar.
Non-governmental organisations in Silchar who assist
the government in this campaign say outdated vaccines were possibly supplied
in some areas. But officials were not willing to speculate on the causes of
the large-scale side effects. [Byline: Subir Bhaumik]
Henry V. Huang Dept. of Molecular Microbiology
Washington U. School of Medicine - Box 8230, 660 S. Euclid Avenue - St.
Louis, MO 63110-1093 USA -
huang@borcim.wustl.edu
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SMALLPOX VACCINE, WHO STATEMENT
Date: Tue 22 Oct 2001 - From: Jaime R. Torres, ProMED-ESP - Source: BBC
Mundo [edited];
[translated by
MJ) http://news.bbc.co.uk/hi/spanish/science/newsid_1613000/1613692.stm
WHO Statement on Smallpox Vaccination Policy
The World Health Organization, WHO, stated that it is
reconsidering using the vaccine against smallpox, in light of the possible
use of the virus as a biological weapon. Smallpox is considered to have been
officially eradicated in 1980. For years, there have been no cases reported.
Nonetheless, because of the potential for the use of the virus in terrorist
actions, WHO has decided to include it in the list of 11 diseases that might
be used by extremist groups.
Ian
Simpson, spokesman for the organization, stated
that WHO's recommendation to governments is that they verify their level of
preparedness to handle diseases, including smallpox. The resurgence of fear
related to smallpox was prompted by the cases of anthrax in the US.
However, unlike anthrax, smallpox is a highly
contagious disease among humans. Nonetheless, the vaccine may be effective
in preventing or reducing the severity of the clinical disease, up until 4
days after the person has been infected. Contrary to popular belief, the
immunity conferred by the vaccine is not for life and, in many cases, it is
necessary to administer booster doses every 5 to 10 years in order to
maintain protective levels of neutralizing antibodies.
WHO calculates that there are close to 90 million doses
of the vaccine stored by governments for use in civilian populations.
However, manufacture of the vaccine involves a complex procedure and some
specialists affirm that it is probable that the WHO will maintain its
recommendations against massive vaccination.
For the time being, although there are no indications of a possible
terrorist act with the smallpox virus, the United States has begun to
multiply its vaccine reserves, according to a multi-tiered plan that even
contemplates immunizing the entire population of the country.
Some scientists calculate that a massive vaccination
campaign could take months, even years, and that by the time of its
conclusion, the threat may well have vanished.
ProMED-mail -
promed@promedmail.org
[Smallpox vaccine -- which is made from vaccinia &
not smallpox virus -- saved many more lives than those who died from adverse
reactions. The major problem with restarting mass vaccination in the absence
of disease is that adverse reactions will kill some people -- perhaps many
in this age of AIDS & lowered immunity. Remember the swine flu vaccine
problems ? - Mod.JW]
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SMALLPOX VACCINE, WHO STATEMENT (02)
Date: Fri 26 Oct 2001 - From: Daniel B. Epstein (WDC) -
epsteind@paho.org
Source: Statement WHO/16, Fri 26 Oct 2001 [edited]
http://www.who.int/inf-pr-2001/en/state2001-16.html
Statement to the Press by the Director-general of the WHO, Dr Gro Harlem
Brundtland: World Health Organization Announces Updated Guidance on Smallpox
Vaccination
GENEVA: Following the review of guidance on smallpox vaccination I announced
last week, WHO has consulted with our advisory committee and has updated the
official guidance. The conclusion of the review states that:
"Existing vaccines have proven efficacy but also
have a high incidence of adverse side-effects. The risk of adverse events is
sufficiently high that mass vaccination is not warranted if there is no or
little real risk of exposure. Individual countries that have reason to
believe that their people face an increased risk of smallpox because of
deliberate use of the virus are considering options for increasing their
access to vaccines.
The vaccines would be given to people who are at risk
of exposure to smallpox, including health and civil workers, and would be
used in a search and containment exercise should an outbreak occur.
In
summary, the guidance is that vaccination of entire
populations is not recommended. The reason for not recommending such mass
vaccination is that there is a risk of severe reactions to the vaccine, *including
death*, and the fact that vaccination can prevent smallpox even after
exposure to the virus.
Up to now the guidance has also stated that only those
with suspected exposure to smallpox or a related virus should be vaccinated.
That has not changed. What has changed is the increasing attention being
given to the extent and quality of existing vaccine stocks, and to the
possible need both to stimulate vaccine production and increase stocks of
vaccine for use in the event of an outbreak. WHO confirms that the best
method of stopping a smallpox outbreak, should it occur, remains the same --
search and containment. That means identifying persons with smallpox,
identifying those people who have been in contact with them, and vaccinating
them.
*People who have been vaccinated in the past are
unlikely to develop the most serious effects of smallpox.*
This advice and background information on smallpox is now being made
available to governments through the WHO web-site:
http://www.who.int
Along with this advice we are providing Frequently
asked Questions and Answers about smallpox and a smallpox Fact Sheet with an
electronic slide set of training materials on smallpox.
Other information that will be provided to Health
Ministers on request includes a list of vaccine manufacturers that have the
potential to produce smallpox vaccine and the names of laboratories that can
diagnose smallpox. WHO has also re-established a team of technical experts
in smallpox who are available to assist countries in the investigation and
response to outbreaks.
Finally, I want to emphasize that should an outbreak of
smallpox be detected in any country, this should be considered an
international emergency. WHO will help countries to pool available resources
so as to contain the disease as rapidly and effectively as possible."
Daniel Epstein - Information Officer
Pan American Health Organization/World Health Organization 525 23rd
St., NW - Washington D.C. 20037 - (by "BBC News Online", Mon 22,
26 Oct e 12 Nov 2001)
Il
vaccino Sabin (quello della Polio) miete vittime In Repubblica Dominicana
e nelle Filippine
Il virus contenuto nel vaccino della polio, liberatosi nell'ambiente a
causa della vaccinazione di massa con il vaccino Sabin, ha fatto solo
nell’anno 2000, 19 vittime nella Repubblica Dominicana, che hanno
riportato la polio paralitica a causa dell'infezione procurata dal virus
“sabin”
Fra
marzo e luglio 2001, altri 3 casi si sono verificati nelle Filippine
vedi
"Mortality and Morbidity Weekly Report", 12 ottobre 2001/50(40);
874-5.
Le
3 persone erano state vaccinate in precedenza per la polio.
E’ emerso quindi chiaramente che la vaccinazione non copre dal
virus del vaccino Sabin.
Vaccinando
con il Sabin (il vaccino orale con virus vivo attenuato in formalina,
prodotto notoriamente cancerogeno) in paesi dove non esiste un sistema
fognario che divida le acque di scarico da quelle domestiche il virus
vaccinico della polio viene reimmesso nell'ambiente attraverso le feci.
Anche
stavolta il virus del vaccino sabin è rimasto latente nell'ambiente per
un periodo sufficientemente lungo di tempo per acquisire modificazioni
genetiche e riacquistare neurovirulenza,
producendo nuovi casi di malattia in soggetti già vaccinati,
Ugualmente
è accaduto anche in Africa per l’Aids……..scatenato dalle
campagne vaccinali del decennio degli anni 70’
Siamo
infatti di fronte ad un ulteriore nuovo e mutato virus (il
Sabin), alla
cui origine vi è esclusivamente la colpa umana della cosiddetta
“scienza medica”, manipolatrice di virus altamente pericolosi; di
fatto trattasi di guerra batteriologica…...
La
celebre rivista medica Lancet già un anno ha invitato ad abbandonare il
Sabin e vaccinare solo con Salk per non peggiorare la situazione.
Invece
il governo filippino ha deciso di iniziare una nuova campagna di
vaccinazione di massa con il Sabin…….le scorte di vaccino delle
multinazionali……hanno “convinto” qualche ministro…..ad ignorare
i fatti ed a smaltire quei vaccini pericolosi che sono stati inoculati, lo
ricordiamo. anche su oltre 450 milioni di europei; il vaccino sabin è
stato contaminato da un altro virus scimmiesco lo SV 40 concausa del
cancro chiamato “mesiotelioma” dagli anni 50’ fino agli anni 80’
!!!
Dall'International
Society for Infectious Diseases.
POLIOMYELITIS, VACCINE-DERIVED -
PHILIPPINES: 2001
[see also:
Poliomyelitis - Dominican Republic & Haiti 20011005.2415
Polio, circulation of vaccine-derived virus 20010129.0205
2000
-------
Poliomyelitis - Dominican Rep.: control measures 20001218.2212
Poliomyelitis - Dominican Republic & Haiti: ALERT 20001202.2098
Poliomyelitis - Dominican Republic & Haiti: background 20001203.2102
Poliomyelitis - Dominican Republic & Haiti: comment 20001204.2110
Poliomyelitis - Dominican Republic & Haiti: update 20001208.2149
Poliomyelitis - Dominican Republic: visitor advice 20001215.2195]
Date: 12 Oct 2001
From: ProMED-mail: promed@promedmail.org
Source: MMWR 50(40);874-5 [edited]
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5040a3.htm
Public Health Dispatch: Acute Flaccid Paralysis Associated with
Circulating
Vaccine-Derived Poliovirus --- Philippines, 2001
Three cases of acute flaccid paralysis (AFP) associated with circulating
vaccine-derived poliovirus (cVDPV) isolates were reported in the Philippines during March 15--July 26, 2001. The first case-patient,
a child
aged 8 years from northern Mindanao island (500 miles south of Manila) who
had received 3 doses of oral polio vaccine (OPV), had onset of paralysis
on
March 15. A second child, aged 3 years from Laguna province on Luzon
island
(60 miles south of Manila) who had received 3 OPV doses, presented with
signs of meningitis but no paralysis on July 23. A third child, aged 14
months from Cavite province (25 miles from Manila and 45 miles north of
Laguna province) who had received 2 OPV doses, had onset of paralysis on
July 26. No patients had traveled outside of their province of residence
since birth. Characterization of isolates from the 3 patients revealed
type 1 polioviruses derived from Sabin vaccine strain type 1, with a 3%
genetic sequence difference between Sabin 1 vaccine and vaccine-derived
poliovirus (VDPV) isolates. The 3 polioviruses are not identical but
are closely related (99% sequence homology); they also appear to share an
identical recombination site with a nonpolio enterovirus in the noncapsid
region of the genome.
Following cVDPV outbreaks in the Dominican Republic and Haiti (Hispaniola)
during 2000--2001 (1), the global polio laboratory network implemented
additional testing requirements for all polioviruses under investigation,
prospectively and retrospectively. Both an antigenic-based (ELISA) and a
molecular-based test (probe hybridization) are used to determine whether a
poliovirus is wild or derived from vaccine (i.e., intratypic
differentiation [ITD]). Divergent ITD results (one test showing
vaccine-derived and the other wild-type virus) for any poliovirus isolate
now require genomic sequencing of the suspect isolates. Retrospective
testing of 2000 vaccine-related isolates from AFP cases globally has
revealed no additional cVDPVs, although testing results of other isolates
in the laboratory network are pending. The cVDPVs from the Philippines
were
detected after the implementation of new testing requirements for
prospective virus investigations.
In response to these cases, the Department of Health in the Philippines
1) enhanced surveillance by active record review for AFP cases in hospitals
and other health-care facilities in the affected and neighboring provinces,
2) established surveillance to conduct virologic investigations of aseptic
meningitis at major health-care facilities, 3) collected stool samples
from
healthy contacts of case-patients,
4) conducted field investigations of
clustered AFP cases to determine the extent of cVDPV circulation, and
5) assessed polio vaccination coverage in these communities. The
investigations have found no unreported cases, although some AFP cases
remain under investigation. To interrupt cVDPV circulation, a large-scale
mass vaccination campaign with OPV is planned.
Low routine vaccination coverage is one of the most important causes of
VDPV. Because the location of the originating events is unknown, the
contribution of other factors is difficult to assess; however, a
combination of 2 concurrent events within the virus is necessary for
cVDPV emergence: reversion of attenuating mutations to increase
neurovirulence, and a presumed increase in transmission characteristics
that might be related to recombination with a nonpolio enterovirus.
The molecular basis for the second property is not understood.
Wild poliovirus was last reported in the Philippines in 1993 (2), and
national vaccination rounds were last conducted in the Philippines in 1997
followed by subnational immunization days in 1998 and 1999.
Among the
areas
covered were Cebu, Davao, Manila, and parts of Mindanao; however, coverage
did not extend to the 3 provinces now reporting cVDPV cases. Routine
coverage with 3 OPV doses has been approximately 80% nationwide since
the early 1990s; however, coverage gaps are likely, particularly in slum areas.
Travelers to the Philippines should ensure that they are vaccinated
appropriately against polio according to national recommendations (3).
Reported by: National Epidemiology Center, National Center for Disease
Prevention and Control, Research Institute of Tropical Medicine, Dept of
Health; World Health Organization, Manila, Philippines. Regional Reference
Laboratory, Victorian Infectious Diseases Reference Laboratory, Fairfield,
Victoria, Australia. Global Specialized Laboratory, National Institute of
Infectious Diseases, Tokyo, Japan. Vaccines and Biologicals Dept, World
Health Organization, Geneva, Switzerland. Respiratory and Enteric Viruses
Br, Div of Viral and Rickettsial Diseases, National Center for Infectious
Diseases; Vaccine Preventable Disease Eradication Div, National
Immunization Program, CDC.
References
CDC update: outbreak of poliomyelitis---Dominican Republic and Haiti,
2000--2001. MMWR 2001;50:855--6.
CDC. Progress toward poliomyelitis eradication---Western Pacific Region,
January 1, 1996--September 27, 1997. MMWR 1997;46:1113--7.
CDC. Poliomyelitis prevention in the United States: updated
recommendations
of the Advisory Committee on Immunization Practices. MMWR 2000;49(no.
RR-5).
ProMED-mail: promed@promedmail.org
[This is now the third documented episode of poliomyelitis-like illness
(acute flaccid paralysis - AFP) due to circulating vaccine derived
poliovirus (cVDPV) with reversion to neurovirulence. The 2 prior
episodes were on the island of Hispaniola (Dominican Republic and Haiti)
and in Egypt (see referenced ProMED-mail postings above). In addition,
there were reports of circulating vaccine derived poliovirus in Israel
identified in sewage sampling but not associated with clinical illness
(also reported in above ProMED-mail postings).
One wonders if this is a case of "seek and ye shall find" or if
this is an emerging problem associated with the disease. The former seems to be
preliminarily ruled out by the failure of a retrospective study of over
2000 AFP associated poliovirus isolates to identify additional VDPV,
albeit
if it is a low level occurrence, we may miss it by virtue of the rarity of
the event. If the latter is the case, one wonders why now, after
approximately 50 years of use are we seeing this phenomenon. If one
rejects the reference of "approximately 50 years of use" and
chooses to
further refine the date to when increased vaccination activities
associated
with the polio eradication effort began, then the time frame for
widespread
use is approximately 16 years, when polio eradication activities in the
Americas region began.
Of note is that this has occurred in 3 different regions of the world -- the Middle East (Egypt and Israel), the Americas (Hispaniola) and now
in
the Western Pacific (Philippines). In 2 areas (Hispaniola and the
Philippines) circulation of the wild poliovirus had been interrupted (the
last reported case of wild poliovirus associated disease in the Americas
was in 1991 and in the Philippines in 1993).
In the absence of total interruption of wild poliovirus circulation
world-wide there is still a need to keep up intensified vaccination
efforts
as the risk of disease is still present, especially in today's environment
with extensive travel world-wide. The occurrence of cVDPV in association
with clinical disease is very disturbing as it adds another factor into
the
risk benefit equation of vaccination recommendations. As mentioned in an
earlier comment, a cost-efficacy analysis of switching to the inactivated
vaccine (inactivated polio vaccine - IPV) in countries that have
interrupted wild virus circulation probably negates the economic viability
of such a recommendation. In addition, and not an insignificant addition
is that a switch to the IPV would remove the advantage of flooding the
environment with the vaccine virus (the attenuated very low-neurovirulence
virus) to further interrupt transmission of wild poliovirus if introduced
as well as to "vaccinate" individuals who may not have directly
taken the
vaccine themselves. -
Mod.MPP] ..............................mpp/cp/es
Tratto da "VacciNetwork" del 22.11.2001
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