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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