Guatemala is among the 12 countries with the lowest vaccination coverage against the virus

Guatemala is among the countries with the lowest vaccination coverage against polio in the Americas. When the ideal should be 95 percent -recommendation of the World Health Organization-, the figure in the national territory is around 80 percent. It is a risk, and a “very high” one, according to medical criteria, since the door is opened for an outbreak of the disease, one of which no cases have been detected since the 1990s.

This is a problem that has been dragging on since before the covid-19 pandemic, by 2019 the coverage was 79 percent of the complete scheme -three doses-, as reported by the platform of the Pan American Health Organization and Unicef , fed with official data from each country in the region.

The numbers agree with reports from the Ministry of Health. This report indicates that by 2020 coverage reached 89 percent in the first dose, but not all children who started the scheme completed it, the figure dropped 10 percentage points in the third dose, while the two boosters did not reach all, remained between 77 and 76 percent respectively.

If the numbers were low during the first year of the pandemic, the situation was more unfavorable for the child population. Fewer children started the scheme, and the trend of 10 percent not completing it continued. Those who received the reinforcements were less than the previous year.

Despite the fact that health services and vaccination posts have been more active than during the first two years of the pandemic, polio vaccination coverage has not recovered. As of July of this year, the percentage of vaccinated children reached 53, when the average at that date should be 58. Coverage in the rest of the doses ranges between 32 and 41 percent. If the trend continues, it will be difficult to reach that ideal 95 percent at the end of the year.

Although the percentage of vaccination coverage is due to epidemiological criteria in order to reduce the number of children who could become infected and develop the vaccine-preventable disease, the efforts of the portfolio, as indicated, is that the biological is available in all services of Health to prevent the reintroduction of the virus and subsequent community circulation among the child population.

Imminent

“I never thought I would see this disease again in our region,” said Dr. Carissa F. Etienne, who until then had served as PAHO director, said last week. It was 30 years ago that polio was eradicated in the Americas, however, last July an unvaccinated man was diagnosed with the disease. The case occurred in New York, United States, where the poliovirus was detected in wastewater, and this raised the alarm of a possible polio outbreak, which if not contained could affect more countries.

The greatest risk is in territories with low vaccination coverage. There are 12 countries that are most exposed and Guatemala is one of them. The weak coverage in the region brings up again a disease that was already forgotten in the region, and that at the time condemned thousands of children to pain and disability.

“Polio is not a treatable disease, prevention is the only option, and this is only possible with the use of vaccines, which provide complete protection against infection for life,” Etienne said.

According to the Ministry of Health, the polio vaccination schedule is made up of two or three doses and boosters, since scientific evidence shows that multiple doses increase and maintain immunity against a disease.

That is why families take their children to the vaccination posts so that they receive the doses within the interval established in the technical guidelines, since these guidelines allow the generation of adequate levels of immunity to protect the population from diseases.

Children should get polio shots at 2, 4, and 6 months of age, and boosters at 18 months and 4 years.

Irrigation: Chaos imported or not

According to pediatric infectologist Alicia Chang, president of the Guatemalan Association of Infectious Diseases (AGEI), the low vaccination coverage against vaccine-preventable diseases had been on the decline since before the pandemic, but the covid-19 health crisis exacerbated the crisis. , and today we are below the ideal levels, as the epidemiologist Mario Melgar, a member of the National Council of Immunization Practices (Conapi), agrees.

This fuels the risk of diseases that were already controlled in the country, such as polio, becoming active.

It goes through the difficult access to vaccination centers and posts, but also due to the shortage of the biological in some clinics. Although there is another point to take into account, vaccines are not given to children who are overage despite the fact that they have not completed the schedule, according to the doctor, and they have advocated that this change.

“Coverage levels are so dangerously low that it is only enough to have one case for there to be a very important outbreak,” says Chang, since there is not only the risk of an imported case entering, but there is another extreme, that a case within the national territory.

“Sick people can come because the incubation period of the disease is a bit long, sometimes they do not have any initial symptoms, but they may be actively excreting the virus through the fecal route. But it is not necessary to import the cases, it is very likely that they are already happening and go under the radar of our epidemiological surveillance,” Chang warns.

While Melgar is of the opinion that imported cases are always a risk, and we will not get rid of them as long as there is polio in the world. “What worries us is that this case could spread to other people in the country and become a local outbreak, and with vaccination rates that are not above 95 percent, there is a danger of polio outbreaks,” he adds. .

Any flaccid paralysis, one of the manifestations of the disease, must be tested for poliomyelitis, the problem is how many of these cases have been tested to establish if they are positive cases for polio? If this does not happen, epidemiological surveillance is not working, and there may be cases that go unnoticed.

polio, and the fact that we’re doing those tests on those patients assures us that we’re actively looking for the disease. I don’t think that’s happening right now.

warning signs

Identifying a case of poliomyelitis is not so simple, since it is a disease that has not been present in the country for 30 years and not all doctors are familiar with the disease.

Chang indicates that initially it manifests itself as a flu, but what is worrying is that it causes paralysis, mainly in the lower limbs. Unlike other types of paralysis, the legs become limp, another complication is that there may be respiratory failure, as well as encephalitis or inflammation in the brain.

Patients can recover with treatment, but require rehabilitation. In extreme cases people die.

It is important for parents to go to the vaccination posts so that their children receive the necessary doses. According to the Ministry of Health, the biological is available. In the National Center for Biologicals there are more than a million doses of OPV (oral vaccine) and more than 700 thousand doses of IPV (injected), which are available for the 29 health areas.