WWYD? Africa & polio

[wagamama]

We are moving to Addis Ababa, the capital of Ethiopia, in August. We will be there for 2 1/2 years. My 5-year-old DS was vaxed up to one year, but my 3-year-old DD is completely unvaxed. There have been a couple of cases of polio in Ethiopia in recent years (via Sudan). If you were me, would you vax your child for polio? I am really torn.

I know the chance of DD getting a severe case of polio is miniscule, and i don't even know if the polio vaccine really works or not (there is conflicting info). But there is a fear in me. I keep thinking that if she got paralyzed I would never be able to forgive myself.  :(

[Bokonon]

I would have to do a lot of research on it, but would definitely make sure that if I did get the vaccine, that it would be the IPV (inactivated polio vaccine) instead of the OPV that is still used in many less developed countries.

There is some very thorough information here:

http://insidevaccines.com/wordpress/polio/

Best wishes with your move and decision!

[chaoticzenmom]

Polio is one of  (maybe the only) the vaccines that I would get if I were in your shoes.  It's supposed to be one of the safest and it's been used for decades.  Plus, if you do decide that you want the vaccine when you're there, you may not have access to the inactivated version. 

[LisaSedai]

If I were in your shoes I would probably do the IPV but I wouldn't do the OPV.

[Marnica]

Id have to do more research, but I think Id probably pass.

[cappuccinosmom]

My husband is Ethiopian, and polio is one of vaxes that are most important to him that our children get, because he saw the effects of it first hand. 

I think, living in Addis, and I'm assuming living a fairly Westernized lifestyle (meaning access to hygenic living circumstances and not much exposure to possible contagion), you are correct that the chances of her contracting the disease in that context would be miniscule, unless there was an outbreak in the city.  It is occurring fairly rarely now.  If you are leaning towards vaxing, *definitely* get it done here, don't wait until you are there.

Totally OT: But I am jealous!  Dh just came back from 18 months in Ethiopia, and I was wishing there had been a way for us to live there with him. 

[wagamama]

Thank you everyone. I'm considering the IPV, will do more reading. I do think that, living in Addis, the chances of getting it are very small ... we may do some traveling though.

I guess I felt like being completely unvaxed was a kind of "gift" to my daughter from me. A gift of health, so to speak. So I am sad to "ruin" it by having her vaxed.

To add to the confusion, I have read on this forum that some people believe that polio is not really "polio", but a reaction to DDT. Sigh -- how can we know what is true??

Cppuccinosmom, Ethiopia sounds fascinating and I am so excited. I hope you can live there one day!

[wagamama]

Bokonon, thanks for the link. I found this info on the IPV vaccine:

-grown on monkey kidney cells

-supplemented with newborn calf serum

-other ingredients:  0.5% of 2-phenoxyethanol and 0.02% of formaldehyde per dose as preservatives

-Neomycin, streptomycin and polymyxin B are used in vaccine production, and although purification procedures eliminate measurable amounts, less than 5 ng neomycin, 200 ng streptomycin and 25 ng polymyxin B per dose may still be present. The residual calf serum protein is less than 1 ppm in the final vaccine ..,

This doesn't sound good ...

[lexapurple]

There is a big difference between between living in Western civilized country and living in the westernized area of third world country. In first your chance of exposure is very slim, in second you just have a false sense of security. Your chanses of contracting something are still very high because of workers who come from outside of westernized area and are still not following basic rules. We live on campus of international university in civilized Europen country. One of the students who lived here for a while was just recently diagnosed with TB. Most likely he did not contract it here but he has exposed everyone else to it unknowingly. Polio is one of those things that I would be unwilling to risk getting and it is something that I would vax my child for.

[alegna]

I would consider it, BUT if I thought it was a legitimate risk I would get the OPV not the IPV.  I am not at all convinced the IPV works at all and the OPV definitely does- though it does carry a higher risk.

-Angela

[Otto]

Originally Posted by alegna 

I would consider it, BUT if I thought it was a legitimate risk I would get the OPV not the IPV.  I am not at all convinced the IPV works at all and the OPV definitely does- though it does carry a higher risk.

I suppose this also brings up trivalent IPV vs. trivalent OPV vs. monovalent OPV or OPVs, if I remember the players correctly.

[ammiga]

Originally Posted by Marnica 

Id have to do more research, but I think Id probably pass.

I agree. I would never stop worrying about what I had injected into my kid's body and the long term consequences.

[SleeplessMommy]

I have taken my boys to India 4 times. We do vax before travel - and not just because of the risk of the disease.

In Canada, Japan or USA, you have easy access to quality medical care. If your child somehow got polio in North America, you would have immediate access to the best doctors, medical interventions, and a very nice quarantine suite with cable TV and high speed internet access.

If this happens in Ethiopia or other developing country, your concerns will not be limited to the disease progress in your child. You could get to experience calling a taxi in the middle of the night when you don't know the language. Will the taxi driver be willing to pick up your child if there is visible evidence of contagious disease? Once at the hospital, IV needles which are "probably" sterile but you are not 100% sure. (HIV and hepatitis risk). Medical doctors who have less training than in USA. (India has some 4 year medical doctors). Hospital roommates who could have other contagious diseases. Also questionable access to antiviral treatments, questionable quality of medicines, etc. And your child will be a "novelty" which could lead to EXTRA treatment. Bronchilitis in India with my 11mo old DS got us 4 different medicines. How many of those were really needed? We took the ABX + albuterol.

I would do absolutely anything to stay out of a hospital in Ethiopia - including vaxing my kids.

[wagamama]

Thank you everyone ... I am still undecided, but all the comments are helpful.

Can anyone tell me why the OPV is preferable? I have read the opposite here in this forum!

I was in a bookstore yesterday browsing through a book on randomness theory (forgot the title). The author was talking about risk-taking, and he said that when assessing risk, you don't look at the "normal" cases but the "abnormal" ones. In other words, you don't look at the 100,000 kids who didn't get polio, but the 1 who did.

SIGH!

[Otto]

Originally Posted by wagamama 

Can anyone tell me why the OPV is preferable? I have read the opposite here in this forum!

It's not a one-size-fits-all situation. The monovalent OPVs have proved more effective than trivalent OPV for the same number of doses in areas where a single strain can be targeted. IPV can't give you VAPP, but it also doesn't provide much intestinal immunity and so doesn't stop transmission.

[bluebackpacks]

In your situation, I would vaccinate for polio.

[Wild Lupine]

I've been to Ethiopia twice.

I would (did) vax for polio, though I got the IPV because it isn't a live virus.

I vaxed for all the reasons already mentioned about the risk being small rather than miniscule, and not wanting to find medical care there in an emergency if we did get sick. There is good medical care available in Addis, but it might be harder to find and access than here.

But another thing to consider is that Ethiopia is a beautiful country with a long, fascinating history. You might find yourself wanting to travel outside  Addis Ababa and the infrastructure in rural areas is less than in Addis (clean water, etc..).

This also played a part in my decision, though it might not for you: I do beleive there's a public health aspect to vaccines. Many of the people in Ethiopia who are vulnerable to polio (no access to medical care, homeless, nutritionally compromised, or have HIV or other underlying illness) will benefit by other people being immunized. Fewer people who can be carriers means reduced spread and protection for the vulnerable.

[alegna]

Quote:

Originally Posted by wagamama 

Thank you everyone ... I am still undecided, but all the comments are helpful.

Can anyone tell me why the OPV is preferable? I have read the opposite here in this forum!

I was in a bookstore yesterday browsing through a book on randomness theory (forgot the title). The author was talking about risk-taking, and he said that when assessing risk, you don't look at the "normal" cases but the "abnormal" ones. In other words, you don't look at the 100,000 kids who didn't get polio, but the 1 who did.

SIGH!

For *me* I would choose OPV over IPV if I felt a vax was needed because there isn't a lot of data showing real efficacy of the IPV.  The OPV is live and does have data behind it showing efficacy.  They switched to the IPV in the US when they felt comfortable that polio wasn't circulating any more.

Originally Posted by Wild Lupine 

I've been to Ethiopia twice.

I would (did) vax for polio, though I got the IPV because it isn't a live virus.

(snip)

This also played a part in my decision, though it might not for you: I do beleive there's a public health aspect to vaccines. Many of the people in Ethiopia who are vulnerable to polio (no access to medical care, homeless, nutritionally compromised, or have HIV or other underlying illness) will benefit by other people being immunized. Fewer people who can be carriers means reduced spread and protection for the vulnerable.

If vaxing for polio for public health issues it only makes sense to use OPV as the IPV does not prevent carriage and transmission.  You can still catch it and pass it on, you just don't suffer from effects of the disease.  OPV prevents carriage and transmission.

-Angela

[Pookietooth]

I tested positive for TB (although I had a clear chest X-Ray and therefore it's not active), and I've never been to any undeveloped country except for 10 days in Costa Rica. So I would say TB is not really the same as polio.

[wagamama]

Thank you everyone for the thoughtful and informative comments.