Ms. Van Orden’s Group #5

1. Ms. Van Orden’s Group #5 Global Health Presentation Title: The Global Polio Eradication Initiative Presented By: Kya Letsinger, Kevin Ryan, Janice Seale, and Amanda Underwood

2. Some Facts About Polio: • Polio (Poliomyelitis) has plagued humans since ancient times. • A severe form of the disease called paralytic polio causes muscle paralysis, and can lead to death. • At the peak of the 1952 epidemic in the United States there were nearly 57,000 cases of Polio with more than 21,000 cases of paralytic polio. • “On 12 April 1955, Dr. Thomas Francis, Jr., announced the success of the field tests he had supervised of Dr. Jonas Salk's "killed-virus" polio vaccine.” • While Polio (Poliomyelitis) is still killing and disabling people in a few countries around the globe, it appears that this killed-virus polio vaccine may have been the beginning of the end or the disease. Many believe a complete eradication of the disease is within our reach.

3. Additional Facts About Polio: • By 1988, polio had eliminated in places like the US, UK, Australia and much of Europe but remained prevalent in more than 125 countries. That year, the World Health Assembly developed a solution to eradicate polio by the year of 2018. • The WHO (World Health Organization), in conjunction with the Rotary International and the Bill and Melinda Gates Foundation, are working together to spearheading the Global Polio Eradication Initiative.

4. The World Health Agency • Identify the chosen Global Health Agency. The World Health Organization (WHO) heads the Global Polio Eradication Initiative with major funding from the Rotary and the Bill and Melinda Gates Foundation. • The WHO is a global health agency. • The WHO was discussed in 1945 when diplomats met to form the United Nations. • Its was created and its constitution and came into force on April 7, 1948. • It is funded through Member States (which makes up about eight percent of the annual budget), and Voluntary Contributions (which makes up about 92 percent of the annual budget). • Nurses are involved at many levels working for the WHO, the CDC, and in the field all over the world. Nurses are involved in training/educations, treatment, and immunization programs in both paid and unpaid positions.

5. One Focus Of The WHO • Identify the agency's global health focus. The health focus of the WHO is the Global Polio Eradication Initiative. “The Global Polio Eradication Initiative (GPEI) has reduced the global incidence of polio by more than 99% and the number of countries with endemic polio from 125 to 3. More than 10 million people are walking today who otherwise would have been paralyzed.” Images retrieved from http://kickpoliooutofafrica.wordpress.com

6. Populations Vulnerable To Polio • Identify which vulnerable population is affected. • Polio mainly impacts young children under the age of five. • About one in 200 patients infected will be irreversibly paralyzed. Of the patient's paralyzed 5 to 10 percent will die due to immobilized breathing muscles. • In 1998 it was estimated that there were 350,000 new cases of Polio. In 2012 there were 223 cases reported. • In some countries the global effort to eradicated Polio has built effective surveillance and immunization systems that will help tackle other infectious diseases. • Children in all countries remain at risk of contracting Polio as long as one child remains infected.

7. CDC Quotes • Identify which vulnerable population is affected. (Continued) Some quotes from the Centers for Disease Control and Prevention’s (CDC) July 5th, 2013 update on the GPEI: • “GPEI’s Independent Monitoring Board considers Nigeria and Pakistan to be the greatest challenges for eradicating polio.” • “In addition, Angola, Chad, and the Democratic Republic of Congo had eliminated polio in the past but have experienced reestablished transmission of poliovirus that has continued for more than one year, raising concerns that a window of opportunity to eradicate this crippling and sometimes deadly disease may be closing.” • As Dr. Frieden has stated, “If we fail to get over the finish line, we will need to continue expensive control measures for the indefinite future…More importantly, without eradication, a resurgence of polio could paralyze more than 200,000 children worldwide every year within a decade.” Now is the time, we must not fail.

8. Polio Through Time • Provide historical information related to WHY this is such a problem, and WHERE it exists as a problem (i.e. which country/environment). • Polio in the early 20th century. Polio was one of the most feared diseases in industrialized countries, paralyzing thousands of children every year. After the introduction of successful vaccines in the 1950s and 1960s, polio was virtually eliminated in industrialized countries. During the 1970s, routine immunization was introduced worldwide to help control the disease in many developing countries. In 1988, when the Global Polio Eradication Initiative began, polio paralyzed more than 1000 children worldwide every day. • Since the world came together to eradicate polio in 1988, the disease has been almost completely eliminated. Failure to eradicate the disease could allow this illness to resurface in higher numbers that could kill or disable thousands of children over the next decade.

9. Polio Then And Now • Provide historical information related to WHY this is such a problem, and WHERE it exists as a problem (i.e. which country/environment). (Continued) • By 1988, polio had eliminated in places like the US, UK, Australia and much of Europe but remained prevalent in more than 125 countries. That year, the World Health Assembly developed a solution to eradicate polio by the year of 2018. • Polio is endemic in only three countries: Afghanistan, Pakistan, and Nigeria. Last year, India was declared one-year polio free by the World Health Organization. Image retrieved from: http://www.undispatch.com/theres-a-global-polio-emergency-now-what#sthash.iD0OfmBG.dpuf

10. A Combination Of Strategies • Describe what this agency is doing to help solve this problem and help those affected by this problem. A combination of strategies, such as permanent polio teams operating in the key high-risk areas and intense outreach efforts with community leaders is being used to reach between 80,000 and 15,000 hard to reach children in Afghanistan. In Nigeria case numbers had stabilized by the last quarter of the year due to revised micro-plans, better vaccination team selection, improved monitoring and strong oversight at the national and state levels. “The tragic, targeted killings of health workers in late 2012 and early 2013 in Pakistan and Nigeria present a new threat to this progress. However, governments and partners have initiated a number of adjustments to improve safety in specific areas and to ensure the continuity of campaigns.” (Polio Eradication & Endgame Strategic Plan, 2013) • WHO’s initiatives are aimed at achieving the following objectives: • Detecting and inhibiting all polio transmission. • Eliminating the oral polio vaccine and implementing and reinforcing the immunization programs in place. • Quarantine of the poliovirus outbreaks and transmissions to endemic countries and continuing global surveillance.

11. Impact on Healthcare Delivery • How has Polio has impacted nursing practice? • The acute care nurse is likely to see survivors of the polio age in hospitals, both for problems related to PPS and for unrelated illnesses such as cardiac problems and complications of diabetes. They may display symptoms of Post Polio syndrome (PPS) such as progressive weakness, fatigue, myalgia, arthralgia, and muscle atrophy (LaRocco, 2011). • The community nurse may need to screen for polio outbreaks. As recent as 2005 the virus was brought into the country and spread to unvaccinated children (Centers for Disease Control and Prevention, 2011)

12. To Help Solve The Problem • Describe what this agency is doing to help solve this problem and help those affected by this problem. (Continued) • The WHO has developed The Polio Eradication and Endgame Strategic Plan 2013-2018 to strive for a polio free world. • WHO has developed the 4 pillars of polio eradication to achieve population immunity in endemic countries. • Routine immunizations- uniform administration of 3 doses of poliovirus vaccine • Supplementary immunizations- boosting immunity and complementing routine immunizations. • Surveillance- finding children with flaccid paralysis, obtaining stool samples, determining wild strains from vaccine related, determining point of origin, and environmental sampling. • “Mop- up “ campaigns- door to door immunization administrations in areas of outbreaks • The biggest challenge to the campaign appears to be in relation to funding. The U.S. has experienced a shortage of 1.3 billion dollars in funding for this initiative. The key element in success is the impact of immunization compliance, which is threatened by a potential lack of cash flow. Another major problem lies in logistics planning to ensure healthcare volunteers and workers reach the underserved populations where immunity is low.

13. Impact on Healthcare Delivery • How has nursing been involved with Polio? • Nursing has played a key role in the immunization initiative. The polio vaccine is given in 3 doses by age 18 months and a booster at 4-6 years (Centers for Disease Control, 2011). • Nurses have had an impact on the distribution of vaccines in the United States. They supported and helped to develop The Omnibus Reconciliation Act of 1993, which provides free vaccines to public health clinics and private providers participating in the Vaccines for Children program (Scudder, 1995).

14. References Centers for Disease Control an Prevention. (March 18, 2011). Polio Disease – Questions and Answers. Retrieved from http://gx6ac7lq4l.search.serialssolutions.com.proxy.lib.odu.edu/?sid=EBSCO:CINAHL+Plus+with+Full+Text&genre =article&title=Nursing&atitle=Postpolio+syndrome%3a+unraveling+the+mystery.&author=LaRocco%2c+Susan+A. &authors=LaRocco%2c+Susan+A.&date=20110201&volume=41&issue=2&spage=26&issn=03604039 Centers for Disease Control and Prevention. (July 5, 2013). Updates on CDC’s Polio Eradication Efforts. Retrieved from http://www.cdc.gov/polio/updates/2013_0705.htm. BBC News Health. (2012). History of polio. Retrieved July 26,3013 from http://www.bbc.co.uk/news/health-17045202 LaRocco, Susan A. (2011). Post-polio syndrome: unraveling the mystery. Nursing 41(2). 26-30. Rinaldo, Charles R.,Jr. (2005). Passive immunization against poliomyelitis: The hammon gamma globulin field trials, 1951-1953. American Journal of Public Health. 95(5), 790-9. Retrieved from http://search.proquest.com/docview/215087737?accountid=31701.

15. References Scudder, L. (1995). The child immunization initiative: politics and health policy in action. Nursing Policy Forum. 1(3), 20-29. The Global Polio Eradication Initiative. (2010). History of polio. Retrieved from http://www.polioeradication.org/ Polioandprevention/Historyofpolio.aspx#sthash.lXwm5XMa.dpuf. The Nemours Foundation. (1995-2013). Kids Health, Infections Polio. Retrieved July 28,2013 from https://secure02.kidshealth.org/parent/infections/bacterial_viral/polio.html The Polio Eradication Initiative. (2010). Polio Eradication This Week. Retrieved July 28, 2013 from http://www.polioeradication.org/ Umansky, L. (2006). Polio: An american Story/The death of a disease: A history of the eradication of Poliomyelitis/Polio and its aftermath: The paralysis of Culture/Living with polio: The epidemic and its survivors. Bulletin of the History of Medicine, 80(4), 792-794. Retrieved from http://search.proquest.com/ docview/236685154?accountid=31701. World Health Organization. (2013). Polio Eradication & Endgame Strategic Plan. Retrieved from http://www.who.int/ mediacentre/factsheets/fs114/en.

16. Honor Code: Honor Code I pledge to support the Honor System of Old Dominion University. I will refrain from any form of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a member of the academic community it is my responsibility to turn in all suspected violations of the Honor Code. I will report to a hearing if summoned. KyaLetsinger Kevin Michael Ryan KyaLetsinger Kevin Michael Ryan Janice Seal Amanda Underwood Janice Seal Amanda Underwood