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La propagación de la poliomielitis en Israel, EE. UU. y el Reino Unido destaca el riesgo extremadamente raro de la vacuna oral

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Durante años, los funcionarios de salud de todo el mundo han usado miles de millones de gotas de una vacuna oral en una campaña notablemente eficaz destinada a erradicar la poliomielitis en los últimos bastiones que quedan, por lo general, los rincones pobres y políticamente inestables del mundo.

Ahora, en un giro sorprendente en el esfuerzo de décadas para erradicar el virus, las autoridades de Jerusalén, Nueva York y Londres han descubierto evidencia de que la polio se está propagando allí.

¿La fuente original del virus? La propia vacuna oral.

Los científicos saben desde hace mucho tiempo acerca de este fenómeno extremadamente raro. Es por eso que algunos países han cambiado a otras vacunas contra la poliomielitis. Pero estas infecciones incidentales de la fórmula oral se están volviendo más evidentes a medida que el mundo se acerca cada vez más a la erradicación de la enfermedad, y la cantidad de casos de poliomielitis causados ​​por el virus salvaje o que circula naturalmente se desploma.

Desde 2017, ha habido 396 casos de poliomielitis causados ​​por el virus salvaje, frente a más de 2600 relacionados con la vacuna oral, según cifras de la Organización Mundial de la Salud y sus socios.

“Básicamente estamos reemplazando el virus salvaje con el virus de la vacuna, lo que ahora está provocando nuevos brotes”, dijo Scott Barrett, profesor de la Universidad de Columbia que ha estudiado la erradicación de la poliomielitis. “Supongo que países como el Reino Unido y los EE. UU. podrán detener la transmisión con bastante rapidez, pero también pensamos eso sobre la viruela del simio”.

Los últimos incidentes representan la primera vez en varios años que el virus de la poliomielitis relacionado con la vacuna aparece en los países ricos.

A principios de este año, funcionarios en Israel detectaron polio en un niño de 3 años no vacunado que sufrió parálisis. Se descubrió que varios otros niños, casi todos sin vacunar, tenían el virus, pero no presentaban síntomas.

En junio, las autoridades británicas informaron haber encontrado evidencia en las aguas residuales de que el virus se estaba propagando, aunque no se identificaron infecciones en las personas. La semana pasada, el gobierno dijo que a todos los niños de Londres de 1 a 9 años se les ofrecería una vacuna de refuerzo.

En los EE. UU., un adulto joven no vacunado sufrió parálisis en las piernas después de infectarse con polio, revelaron funcionarios de Nueva York el mes pasado. El virus también apareció en las alcantarillas de Nueva York, lo que sugiere que se está propagando. Pero los funcionarios dijeron que no están planeando una campaña de refuerzo porque creen que la alta tasa de vacunación del estado debería ofrecer suficiente protección.

Los análisis genéticos mostraron que los virus en los tres países eran todos «derivados de vacunas», lo que significa que eran versiones mutadas de un virus que se originó en la vacuna oral.

La vacuna oral en cuestión se ha utilizado desde 1988 porque es económica, fácil de administrar (se ponen dos gotas directamente en la boca de los niños) y protege mejor a poblaciones enteras donde se está propagando la poliomielitis. Contiene una forma debilitada del virus vivo.

Pero también puede causar polio en alrededor de dos a cuatro niños por cada 2 millones de dosis. (Se requieren cuatro dosis para estar completamente inmunizado). En casos extremadamente raros, el virus debilitado también puede mutar a una forma más peligrosa y provocar brotes, especialmente en lugares con malas condiciones sanitarias y bajos niveles de vacunación.

Estos brotes generalmente comienzan cuando las personas vacunadas eliminan el virus vivo de la vacuna en sus heces. A partir de ahí, el virus puede propagarse dentro de la comunidad y, con el tiempo, convertirse en una forma que puede paralizar a las personas y comenzar nuevas epidemias.

Muchos países que eliminaron la poliomielitis cambiaron a vacunas inyectables que contenían un virus muerto hace décadas para evitar tales riesgos; los países nórdicos y los Países Bajos nunca usaron la vacuna oral. El objetivo final es hacer que todo el mundo se inyecte una vez que se erradique la poliomielitis salvaje, pero algunos científicos argumentan que el cambio debería ocurrir antes.

«Probablemente nunca hubiéramos podido superar la poliomielitis en el mundo en desarrollo sin la (vacuna oral contra la poliomielitis), pero este es el precio que estamos pagando ahora», dijo el Dr. Paul Offit, director del Centro de Educación sobre Vacunas del Children’s Hospital de Filadelfia. “La única forma en que vamos a eliminar la poliomielitis es eliminando el uso de la vacuna oral”.

Aidan O’Leary, director del departamento de polio de la OMS, describió el descubrimiento de la propagación de la polio en Londres y Nueva York como «una gran sorpresa», y dijo que los funcionarios se han centrado en erradicar la enfermedad en Afganistán y Pakistán, donde los trabajadores de la salud han sido asesinados. para inmunizar a los niños y donde el conflicto ha imposibilitado el acceso a algunas zonas.

Aún así, O’Leary dijo que confía en que Israel, Gran Bretaña y EE. UU. cerrarán rápidamente sus brotes recientemente identificados.

A la vacuna oral se le atribuye la reducción drástica del número de niños paralizados por la poliomielitis. Cuando comenzó el esfuerzo de erradicación mundial en 1988, había alrededor de 350.000 casos de poliomielitis salvaje al año. En lo que va del año, ha habido 19 casos de poliomielitis salvaje, todos en Pakistán, Afganistán y Mozambique.

En 2020, la cantidad de casos de poliomielitis relacionados con la vacuna alcanzó un pico de más de 1100 repartidos en docenas de países. Desde entonces, ha disminuido a alrededor de 200 este año hasta ahora.

El año pasado, la OMS y sus socios también comenzaron a usar una vacuna oral contra la poliomielitis más nueva, que contiene un virus vivo pero debilitado que, según los científicos, tiene menos probabilidades de mutar a una forma peligrosa. Pero los suministros son limitados.

Para detener la poliomielitis en Gran Bretaña, Estados Unidos e Israel, lo que se necesita es más vacunación, dicen los expertos. Eso es algo que las preocupaciones de Barrett de la Universidad de Columbia podrían ser un desafío en la era COVID-19.

“Lo que es diferente ahora es una reducción de la confianza en las autoridades y la polarización política en países como Estados Unidos y el Reino Unido”, dijo Barrett. “La presunción de que podemos aumentar los números de vacunación rápidamente puede ser más desafiante ahora”.

Oyewale Tomori, un virólogo que ayudó a dirigir el esfuerzo de Nigeria para eliminar la poliomielitis, dijo que, en el pasado, él y sus colegas se resistían a describir los brotes como «derivados de la vacuna», por temor a que la gente temiera a la vacuna.

“Todo lo que podemos hacer es explicar cómo funciona la vacuna y esperar que la gente entienda que la inmunización es la mejor protección, pero es complicado”, dijo Tomori. “En retrospectiva, tal vez hubiera sido mejor no usar esta vacuna, pero en ese momento, nadie sabía que resultaría así”.

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