A Discussion of How Social Media Can Be Used To Help Eradicate Polio

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1 A Discussion of How Social Media Can Be Used To Help Eradicate Polio By Priyanka Joshi GRADE AWARDED: PASS Research Paper based on lectures at the Medlink or Workshop Conferences at Nottingham University in December 2013 April 2014

2 ABSTRACT This paper seeks to consider how social media can help to raise awareness of, and prevent the spread of disease. This paper looks particularly at poliomyelitis. INTRODUCTION Poliomyelitis, also known as polio is a highly contagious viral infection that can induce paralytic and non-paralytic symptoms; after-effects include Post-Polio Syndrome and Meningitis. Polio is spread from person to person contact. The virus enters the body through the mouth from contaminated food and drink, including through poor hygiene (hands contaminated from contact with the stools of an infected person) and there is evidence that flies can passively transfer the virus from contact with faeces to exposed food. The principal source of infection is through contaminated water. The virus multiplies in the intestines, and is then transferred on into the environment through the faeces. (fig.1) diagram to show the progression of the poliomyelitis (paralytic polio) infection Polio can strike at any age, but it mainly affects children under five years old. It follows that young children who are not yet toilet-trained are a ready source of transmission, regardless of their environment [i]. Most people infected with the poliovirus have no signs of illness and are never aware they have been infected. These symptomless people carry the virus in their intestines and can silently spread the infection to thousands of others before the first case of polio paralysis emerges. For this reason, WHO considers a single confirmed case of polio paralysis to be evidence of an epidemic particularly in 2

3 countries where very few cases occur. Symptoms Most infected people (90%) have no symptoms or very mild symptoms and usually go unrecognized. In others, initial symptoms include fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. Acute flaccid paralysis (AFP) One in 200 infections leads to irreversible paralysis, usually in the legs. This is caused by the virus entering the blood stream and invading the central nervous system. As it multiplies, the virus destroys the nerve cells that activate muscles. The affected muscles are no longer functional and the limb becomes floppy and lifeless a condition known as acute flaccid paralysis (AFP). All cases of acute flaccid paralysis (AFP) among children under fifteen years of age are reported and tested for poliovirus within 48 hours of onset. Bulbar polio More extensive paralysis, involving the trunk and muscles of the thorax and abdomen, can result in quadriplegia. In the most severe cases (bulbar polio), poliovirus attacks the nerve cells of the brain stem, reducing breathing capacity and causing difficulty in swallowing and speaking. Among those paralysed, 5% to 10% die when their breathing muscles become immobilized. Post-polio syndrome Around 40% of people who survive paralytic polio may develop additional symptoms years after the original illness. These symptoms called postpolio syndrome include new progressive muscle weakness, severe fatigue and pain in the muscles and joints. Risk factors for paralysis No one knows why only a small percentage of infections lead to paralysis. Several key risk factors have been identified as increasing the likelihood of paralysis in a person infected with polio. These include: immune deficiency pregnancy removal of the tonsils (tonsillectomy) intramuscular injections, e.g. medications strenuous exercise injury. ii Severe polio can cause sufferers to have deformed limbs, misshapen spines, and can affect their nervous systems. It is because the disease is so crippling that it is regarded as a high priority for eradication by the likes of the WHO [iii], the Bill & Melinda Gates Foundation [iv], and UNICEF v. 3

4 Unfortunately, there is no cure for polio however there are vaccines that can be taken to prevent it from infecting the body. (fig.2) showing the typical gait of a severely infected polio patient Vaccination In 1955 Dr Jonas Salk developed the first polio (inactive) vaccine. This was administered by injection. Over 4 million vaccines were given in August In 1955 there were 28,985 cases of polio; in 1956, 14,647; in 1957, 5,894. By 1959, 90 other countries used Salk's vaccine. [vi] The Sabin Vaccine is another form of the polio vaccine invented by Albert Sabin in 1961, and released in It is an oral vaccine and requires boosters every three months to fully protect the person from polio. It is not an inactivated virus like the Salk Vaccine but a mixture of active and weakened versions of the virus. The virus produces antibodies in the blood, so that in the event of the real live virus attacking the body, the antibodies already produced protect the nervous system and guard against the symptoms vii. This is the vaccine we use today to prevent the spread of the polio virus. In 1988, at the World Health Assembly, it was agreed that the WHO would start to eradicate polio completely. Since then the vaccine has been in use, and the number of cases of polio has decreased vastly worldwide. As at 2013, only four countries remain endemic (Syria, Pakistan, Nigeria & Afghanistan). Although polio has been eradicated from many regions, some countries refuse to take the vaccines for various reasons (ethical and cultural and possibly political). If everyone does not take the vaccination then polio can still spread over to countries that have become polio free, for example Syria was polio free until November 2013 when another outbreak occurred; it is believed that the disease has spread from Pakistan and may now be in Iraq as well [viii]. 4

5 (fig.3) showing the incidence of polio in 2013 worldwide Key: AFR Africa EUR Europe SEA South East Asia AMR - America EMR - East Mediterranean WPR Western Pacific Region As noted above, around the world there are many organizations and charities that aim to prevent the spread of polio such as the Bill & Melinda Gates Foundation, Unicef and WaterAid ix. These charities and organisations currently use social media to raise awareness. Internet tools such as Google have special non-profit pages for charities so that they can showcase their goals to try and get support, and also post events that are being held to raise money for the cause. [8] Discussion Using internet tools such as Google Trends we can monitor the rate of interest on the topic of polio in terms of the number of Google searches on the disease. It is thought that if a certain disease or illness is searched more often than normal in a specific region then there may be an outbreak, or people may be looking for a name of the disease that they have symptoms of. Google Flu Trends uses aggregated Google search data to estimate current flu activity around the world in near real-time. x Google Flu Trends is one of the more popular trends because the viral infection is very common and easily spread. Google can also forecast flu outbreaks in specific countries by using previous data and the present trending data as a guideline. Index numbers are used to represent how much interest is shown in the topic in 5

6 regions. (fig.4) relative index showing the interest in polio worldwide by reference to Google searches A similar method could be used to predict polio outbreaks in the world by referencing the symptoms or the searches for polio through search engines like Google. This works on the assumption that with increased use of the internet around the world a greater number of searches should in the same way as Google Flu Trends provide an index of the relative number of searches, and where the frequency of searches increases that may point to an outbreak. This would help to track the incidence of new outbreaks, and likely speed up the rate of eradication of polio as the time delay between locating outbreaks and working out where the disease is still endemic may be shortened. A regional breakdown of hits on Google for polio appears at figure 5 below. That shows that the regions that have showed the most interest in Polio on Google are Kenya, Nigeria and Pakistan. As noted above Pakistan and Nigeria are two of the four countries in the world that are still endemic. This shows a correlation and suggests a theory that the greater interest shown in polio in regions reflects on the number of outbreaks. (fig.5) showing a regional breakdown of Google searches on polio in 2013 However there are possible flaws in the Google Flu Trends feature for predicting outbreaks of diseases. For 108 weeks the number of influenza cases in the US was overestimated, this was a huge problem as many medical professionals bought larger supplies of drugs and ended up using about half. One of the causes they think is the autosuggest feature; when typing a phrase autosuggest in Google brings up a suggestion and more than often the wrong suggestion is picked, this is then recorded in the database used for Google Flu Trends [xi]. If this problem 6

7 occurred within the polio trends it could cause panic in the countries that supposedly have the virus and neighbouring countries. So the Google Flu Trends feature is not always reliable and may be misleading. Similarly, in India the eradication of polio was widely reported in 2013 but at the same time (and perhaps because of the national interest) the number of hits on Google was shown as a high despite there being no outbreaks there of the disease. In countries that are still endemic the use of social media can create a more efficient process to vaccinate people at risk. Usually to report a case of a certain disease it must go through several layers of administration: Public Doctors Hospital Health Official However with the use of social media National Government we can cut the layers of administration Health Officials down by sending a simple message straight to the National Health Officials who can then immediately send out the appropriate supplies needed, in the meantime we can also quarantine the person who has polio. This way we can delay the risk of spreading the virus and reduce the number of people who become infected quickly. If a person in a village realises that there has been an outbreak of polio, and they travel to the next village to report it, they could be unknowingly carrying the disease to the next village. To stop this they could send a message or notify a person in the next village through social media about the recent outbreak, this way we are stopping the unnecessary spread of the disease. Through social media we can also campaign for cleaner water supplies for countries that have poor water supplies and that are still endemic. WaterAid works with third-world countries to eliminate any diseases that can live in the water and then be consumed by people. This is one of the main factors of the spread of polio because in third-world countries many people will defecate anywhere, including near a water supply. If people can connect with others to campaign for cleaner water in the endemic countries it will put pressure on the governments and they will eventually do something about it, or a charity can step in to help out. Campaigning through social media can also raise awareness for people to donate money so that charities can purchase the necessary resources. On the other hand many people are against adding chemicals to water to make it cleaner. Adding fluoride ions to water has been ceased in many European countries due to the belief that it can cause serious health problems and also that the level of fluoride added cannot be controlled. Studies are being done on rats to see if fluoride chemicals in water can affect the health of the consumer [5]. 7

8 We can educate people in other countries through social media about polio so that they know which symptoms to look out for and can do something about it quickly. [6][7] Conclusion In conclusion I believe that the use of Social Media can positively help to eradicate poliomyelitis because through social media people can become more educated about the disease, and can look out for any symptoms of the disease. Social media also connects people directly to charities and organisations that know how to tackle an outbreak and lets them know of forth-coming events where they can donate money to buy vaccines for residents of poorer countries whom are unable to purchase the vaccine. We can use internet tools such as Google Trends to track the rate at which people search around the topic of polio and link it to outbreaks of the disease, and also predict future outbreaks which would help to prevent them from happening by inoculating the citizens there with the vaccines. [5] - This website is from an organisation called Fluoride Action Network. They use the website to raise awareness of using fluoride ions in water or any other necessities we consume. However their arguments may be biased as they could be exaggerating on what they say to interest more people and to prevent fluoride use. [6] - This is an organisation that aims to eradicate polio worldwide. However as this is their main goal, their facts and statements will be biased and could be slightly exaggerated. [7] - This website is a social media marketing blog. It is widely popular in the United States, and is almost like an online magazine [8] [i] From the Polio Eradication Initiative website [ii] From the Polio Eradication Initiative website [iii] The World Health Organisation has worked in partnership with other public and private organisations through the Global Polio Eradication Initiative (GPEI), see and 8

9 [iv] See the Gates Foundation website at Do/Global-Development/Polio [v] UNICEF is part of the Global Polio Eradication Initiative [vi] See This website is a blog, unfortunately not a lot is known about who administers it, however the data collected from here is backed up by other data from more reliable sources. [vii] From the world renowned GPEI website, see PV).aspx [viii] See and also reported in the New York Times on 7 th April 2014 at [ix] See WaterAid s website at [x] Google is one of the worlds biggest online search engines. The quote explains what Google Flu Trends is about and how it works. It should be reliable however the credit given to the feature could be slightly exaggerated to improve the interest to its audience xi The Guardian is a reputable newspaper. The data and facts presented in this article would have been checked by others to make sure that they are correct, which shows that it is a reliable source, see (fig.1)- - I used rnpedia.com as a source for the research of the virus. The website is a source for Nurses or people training to go into a medical profession to read upon diseases or viruses, and their common symptoms. I believe that this is a reliable source as it is used by medical trainees and has been created by professionals in the medical field so it the facts would be accurate. (fig.2)- - I used rnpedia.com as a source for the research of the virus. The website is a source for Nurses or people training to go into a medical profession to read upon diseases or viruses, and their common symptoms. I believe that this is a reliable source as it is used by medical trainees and has 9

10 been created by professionals in the medical field so it the facts would be accurate. (fig.3)- WHO - The WHO carries out their own research to produce reliable data and they are reputable individuals. (fig.4) - (fig.5)

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