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News Category: Vaccination campaigns
In December:
No case of WPV1 was confirmed
43.5 million children were vaccinated during the December NID.
0.9 million children were vaccinated at 73 Permanent Transit Points
Pakistan polio snapshot – December 2021
In November:
35 million children were vaccinated during the MR Campaign in November 2021.
1 million children were vaccinated at 73 Permanent Transit Points
Pakistan polio snapshot – November2021
In October:
3.53 million children were vaccinated during October 2021 in KP outbreak response.
Pakistan polio snapshot – October 2021
On 31 May, Tajikistan started a supplement immunization campaign against poliomyelitis to vaccinate all children under the age of six with two doses of oral polio vaccine. ).
Poliomyelitis (polio) returned to Tajikistan in the past year, with the first case of an outbreak of circulating vaccine-derived poliovirus type 2 (cVDPV2) detected in a child who developed acute flaccid paralysis (AFP) on 22 November 2020 in the province of Khatlon.
In response to the outbreak, 3 rounds of supplementation immunization with novel oral polio vaccine type 2 (nOPV2) were conducted, all of which reached a reported 99% of the target group of children under the age of 6.
Both environmental surveillance and active AFP case searches in hospitals and health facilities are continuing throughout the country to ensure that any potential further circulation will be detected.
The latest AFP case with confirmed cVDPV2 had onset of paralysis on 26 June 2021. The latest positive environmental sample was collected on 27 August, before completion of the third round of immunization in early September.
"Tajikistan has responded with full commitment and with the dedicated support of Global Polio Eradication Initiative partners to stop this outbreak," said Dr Victor Olsavszky, WHO Representative and Head of the WHO Country Office in Tajikistan.
"We are cautiously optimistic that the extensive surveillance and immunization campaigns of the past 11 months have closed the door on further spread of this virus. This is vital for the health of children in Tajikistan and beyond."
Extent of the outbreak in Tajikistan
As of 1 October 2021, 31 children have been found to have polio (paralysis) caused by cVDPV2, and the virus has also been isolated from 26 children without paralysis. Twenty environmental samples have tested positive for presence of the virus. All detected polioviruses are linked to a virus strain currently circulating in Pakistan.
The geographic spread of cVDPV2 (based on detection among children and in the environment) has been limited to Dushanbe city and 14 districts in the centre and south of the country.
The oral polio vaccine (OPV) that has brought the wild poliovirus to the brink of eradication has many benefits: the live attenuated (weakened) vaccine virus provides better immunity in the gut, which is where polio replicates.
However, in communities with low immunization coverage, as the virus is spread from one unvaccinated child to another over a long period of time (often 12–18 months), it can mutate into a form that can cause paralysis, just like the wild poliovirus. This mutated poliovirus can then spread in communities, leading to cVDPV2 outbreaks.
The number of cVDPV2 outbreaks globally has increased sharply since early 2019. In 2020, cVDPV2 cases emerged in Afghanistan and were reported in areas close to Tajikistan, Turkmenistan and Uzbekistan.
nOPV2 is a new tool that Global Polio Eradication Initiative partners are deploying to better address cVDPV2. nOPV2 is safe and provides comparable protection against poliovirus, while being more genetically stable and therefore less likely to revert into a form that can cause paralysis in under-immunized communities. This means that nOPV2 could help stop cVDPV2 outbreaks.
WHO recommends that all countries, in particular those in which there is frequent travel to and contact with polio-affected countries and areas, strengthen surveillance for AFP and maintain high routine immunization coverage. All travellers to polio-affected areas should be fully vaccinated against polio.
In September:
No new Wild Poliovirus (WPV1) case and no new cVDPV2 cases were confirmed.
809 981 children were vaccinated against polio
Afghanistan polio snapshot – September 2021
41.5 million children were vaccinated during NIDs.
Pakistan polio snapshot – September 2021
In August:
23.4 million children were vaccinated during sNIDs.
1 million children were vaccinated at 121 Permanent Transit Points
Pakistan polio snapshot – August 2021
In July:
1,2 million children were vaccinated at 121 Permanent Transit Points
Pakistan polio snapshot – July 2021
In May:
900,000 children were vaccinated at 121 Permanent Transit Points
Pakistan polio snapshot – May 2021
No new Wild Poliovirus (WPV1)cases and 5 new cVDPV2 cases were confirmed.
712,739 children were vaccinated against polio
Afghanistan polio snapshot – May 2021
In April:
Afghanistan polio snapshot – April 2021
Children wait to be vaccinated as part of national polio vaccination campaign in Mogadishu. © Siyaad Mohamed /Ildoog/ WHO SOMALIA
Dr Hamid Jafari, Director of Polio Eradication for WHO's Eastern Mediterranean Region, declared Somalia's outbreak of circulating vaccine-derived poliovirus type 3 (cVDPV3) closed a full 28 months after this strain of polio was last detected in Somalia.
Seven children were paralysed by the type 3 strain in the 2018 outbreak, and sewage samples regularly monitored for poliovirus tested positive for cVDPV3 a dozen times, beginning March 2018. There is no doubt that the virus circulated widely around southern and central Somalia. Despite extensive disease surveillance measures, no cVDPV3 has been identified since 7 September 2018, when the last child developed paralysis.
Closing a polio outbreak is a formal process steered by a detailed checklist of surveillance indicators that must be met in order to show that the virus is not just hiding in a far-flung pocket but has truly disappeared. Sewage runoff is tested for virus, and health workers and community members actively search for paralysis in children, and then investigate any paralysis they do find to rule out polio. Accessing hard-to-reach communities is a challenge in Somalia, but a vital aspect of this work.
The 2018 cVDPV3 outbreak was part of a 2-strain polio outbreak in Somalia at that time, along with circulating vaccine-derived poliovirus type 2. Both strains emerge and paralyse children in under-immunized populations – places where not enough children have consistently had access to polio vaccines. The cVDPV2 outbreak continues to paralyse children, and environmental samples – sewage water – consistently show that virus moving through Somali communities. For the polio programme, the presence of cVDPV2 samples and the absence of cVDPV3 samples is bittersweet: it demonstrates the sensitivity of our testing, so we can be confident cVDPV3 is no longer a threat to Somali children – but it makes clear that the threat of paralytic polio still looms.
Across the Region, cVDPV2 cases are on the rise – as across much of WHO's African Region. Wild poliovirus still stalks children across Afghanistan and Pakistan, and the movement of people across borders underscores the risk of importation across and beyond the Region.
The end of Somalia's cVDPV3 outbreak shows what can be achieved with high-quality vaccination campaigns, on-the-ground leadership and sensitive surveillance measures.
Volunteers Abdul Basit and Misbahuddin trek up a hill in Aab-e-barik village, Argo district, Badakhshan province. ©Shaim Shahin/WHO Afghanistan
On a wintery November day, vaccinators across Afghanistan wrapped up warm, checked that they had facemasks and hand sanitizer, and headed out into the cold morning. Their mission? To reach 9.9 million children with polio vaccines, before snowfall blocked their way.
From valleys to muddy lanes, we look at some of the environments where vaccinators work, as well as some of the key challenges that have made 2020 one of the toughest years for polio eradicators.
Panjshir province
For some vaccinators, the first snows had already arrived. At the top of the Panjshir valley, Ziaullah and Nawid Ahmad started their day at 7am.
Arsalan Khan helps Khadija, four years old, to climb down a wall in Doshakh village, Rukha district of Panjshir province. ©Ahmadullah Amarkhil/WHO Afghanistan
"We walked six hours to Sar-e Tangi and back to take polio drops to the last houses in the valley", said Ziaullah. The mountainous roads in this area are impassable by car, so vaccinators walk many kilometers to the most remote villages. Sar-e Tangi means 'top narrow edge', and the view during the long winter is of snowy peaks.
A few kilometers from Sar-e Tangi, father Arsalan Khan was proud to have protected his own and other children in the extended family with polio drops. He said, "I ensure all the children in the family are vaccinated during each round the drops were offered and of course I will keep vaccinating them each time the vaccinators visit our village".
Khan continued, "The vaccinators walk long distances across the mountain slopes to our villages, sometimes during harsh weather conditions, to bring polio drops to our doors."
"Thanks to the people and countries that support the vaccination campaigns and make it possible for the drops to reach our doorsteps."
Volunteers Ziaullah and Nawid Ahmad give polio drops to Sanaullah and Khadija in Doshakh village, Rukha district, Panjshir province. ©Ahmadullah Amarkhil/WHO Afghanistan
Badakhshan province
In Badakhstan, Mr. Azizullah had COVID-19 safety measures on his mind. Like all vaccinators working for the polio programme, he had been trained on how to safely deliver polio drops during the pandemic. The temperature was below zero, with the first snow on the ground, as Mr. Azizullah walked through the rugged terrain from home to home, ensuring to wear his mask and regularly sanitize his hands.
Mr. Abdul Basit and Misbahuddin, volunteers in nearby Aab Barik village said, "It is cold and walking through muddy lanes is not easy, but we have to do our job. There was one case of polio in Badakhshan so that means there is probably virus circulation and we have to stop that".
Aynaz, three years old is vaccinated in Herat City, Herat Province. ©Ramin Afshar/WHO Afghanistan
Herat Province
Mr. Abdullah, a university lecturer observing vaccination activities in Herat, said, "I believe a vaccinator's job is more important than mine. I really appreciate their work and appreciate the international community for making the polio immunization operations possible in Afghanistan with their financial support."
"I believe that all these efforts will be fruitful, hopefully soon, and we will get rid of the virus in our country".
The November campaign was particularly aimed at boosting the immunity of unvaccinated children, and children who have not received their full vaccine doses. Many children have missed out on polio vaccines and other routine immunizations due to a pause in vaccination activities in the first few months of the COVID-19 pandemic. Health workers are now racing against time to protect the youngest children from the poliovirus.
Ms. Sitara, mother of Yasameen, who was wrapped up warm against the elements, said, "I am very happy to be able to immunize my daughter and protect her against polio".
Yasameen, two months old, and her mother Sitara. Yasmeen lost her father recently and her mother does domestic work to support the family. ©Ramin Afshar/WHO Afghanistan
Jalalabad Province
In the east region of Afghanistan, 8,530 volunteers, 160 district coordinators and 786 cluster supervisors were hard at work, aiming to reach as many children as possible during the campaign.
Dr. Akram Hussain, Polio Eradication Initiative Team Lead for WHO in the region explained, "We were not able to do house to house campaigns in some parts of the region. As a result many children were missed during the October vaccination campaigns".
Despite the best efforts of vaccinators, in October, 3.4 million children nationwide missed vaccines due to factors including insecurity, the COVID-19 pandemic and vaccine mistrust. The year 2020 has seen a significant rise in polio cases and detection of the virus in the environment, and the disease is present in almost all provinces.
The programme is aiming to reach more children and tackle virus spread next year. Activities include targeted campaigns in high risk districts, collaborating with the religious scholars from the Islamic Advisory Group to encourage vaccine uptake and communicating more effectively with communities.
Twin brothers, Habib-u Rahman and Hamid-u Rahman, and their niece, show their inked fingers after being vaccinated against polio in Botawar village, Rukha district of Panjshir province. ©Ahmadullah Amarkhil/WHO Afghanistan
The incredible contributions of the polio programme to COVID-19 response are testimony to the agility and adaptability of Afghanistan's programme in the most difficult circumstances. Many hope that lessons learnt from this experience can be applied to achieving the eradication goal.
Ending polio requires everyone – including polio personnel, communities, parents, governments and stakeholders – to commit to overcoming challenges. As the weather turns colder and snow continues to fall, many are looking ahead to what 2021 holds for polio eradication in Afghanistan.
Polio outbreak response in Chad, 2018 ©WHO/D Levison
N'Djamena – One of the largest polio immunization campaigns in the African Region this year has just concluded in Chad, where over 3.3 million children in 91 districts were vaccinated. This pushes the total number of children vaccinated against polio to over forty million across 16 countries in the Region, since campaigns resumed following a necessary pause in immunizations due to the COVID-19 pandemic.
While Africa was declared free of the wild poliovirus in August 2020, another form of polio continues to affect children: circulating vaccine-derived poliovirus, or cVDPV. This type of polio is rare and can only occur in areas where not enough children are immunized. The only way to stop spread of cVDPV is through immunization.
The current type 2 cVDPV outbreak in Chad was detected in February 2020—yet immunizations were halted due to COVID-19 and the virus spread to 36 districts across the country, paralyzing more than 80 children and even leading to cases in neighbouring Sudan and the Central African Republic.
"Viruses do not respect national borders," said Dr Ndoutabé Modjirom, head of the polio Rapid Response Team at the World Health Organization (WHO) African Region. "Given Chad's central geographic location and its mobile populations, it was important to carry out a large-scale campaign that targeted key populations and high-risk areas throughout the country."
The vaccination campaign was carried out in two phases, the first taking place between 13-15 November and the second from 27-29 November.
While mass polio vaccination campaigns were stopped across Africa due to COVID-19 restrictions, they resumed in July 2020. The response in the region overall, and in Chad in particular, demonstrates the commitment by Global Polio Eradication Initiative partners and countries across Africa to stop polio, even amidst the difficult operating context of COVID-19.
"The number of children reached since polio campaigns have resumed is extremely encouraging," said Dr Matshidiso Moeti, WHO Regional Director for Africa. "This large-scale campaign in Chad during COVID-19 is a reflection of the Region's commitment and ability to face multiple difficult health challenges and protect the health of all children."
Although campaigns were on hold for several months, work did not stop. Chad's team of national and international polio experts together with the AFRO Rapid Response Team tracked the virus, conducted a comprehensive risk assessment, and planned an outbreak response to take place as soon as it was safe to do so, taking into account timelines in outbreak response standards of practice. Consultations were also held with the national COVID-19 task force to ensure that best practices in infection prevention and control would be followed. The commitment and efforts of the Ministry of Health and other key national and regional health leaders and partners, including UNICEF, were instrumental in conducting the campaign.
"With increased immunizations and the continued commitment of health leaders and partners, we are confident that we will soon see the end of this outbreak and the end of all forms of polio in Africa," said Dr Jean Bosco Ndihokubwayo, WHO representative for Chad.
About polio eradication
The Global Polio Eradication Initiative is spearheaded by WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC), UNICEF, the Bill & Melinda Gates Foundation and Gavi, the Vaccine Alliance.
On 6 November, WHO and UNICEF jointly issued an urgent call to action to avert major measles and polio epidemics as COVID-19 continues to disrupt immunization services worldwide, leaving millions of vulnerable children at heightened risk of preventable childhood diseases. Learn more about the call to action.
© UNICEF Somalia/2020/Taxta
Fahima Ahmed Hassan is a 25-year-old community mobilizer who goes the extra mile to ensure parents of children under the age of five are informed of Somalia's polio vaccination campaigns and are ready for their children to be vaccinated.
Fahima and the other mobilisers are from the local community and they lay the groundwork for vaccinators ahead of campaigns. They work tirelessly to reach every house, speaking to families to help them understand, trust, and accept the vaccine.
On a mid-October morning, children and their families are waiting anxiously. They have been informed, by Fahima and through loudspeaker announcements, that a team of vaccinators will be visiting their community.
Amid the COVID-19 pandemic, some people are concerned and worried about taking their children for vaccinations. They fear they might contract the virus or expose their children to it. Together with her team, Fahima takes every precaution to keep herself and the community she serves protected.
She explains that it is critical to show the community that vaccination can go ahead while maintaining physical distancing, wearing protective masks and using hand sanitizer.
Somalia's vaccine advocates
Some people do not need to be convinced about the benefits of immunization. Asha Osman Yarow is one of them. She is patiently waiting for her son to be vaccinated.
"I decided to vaccinate my children because their health is important to me," Asha says, holding her young son. "Vaccines protect children against diseases, like polio, measles and others."
"Praise be to Allah that these services come to us," chimes in Sahro Mohamed Haile. "I encourage all mothers to take care of their children, vaccinate them and keep records of their vaccination status. Me, I'm here today with my grandson," she adds with a smile.
Others in the community are more reluctant to accept vaccines. "At first, I refused to vaccinate my children. I heard people say that the vaccines were no good and that they were made by non-Muslims. I was scared," explains 30-year-old Wardo. "After speaking to the community mobilizers, I realized that the vaccines are good for my children's health – and I changed my mind."
"I understand where they are coming from, and I do my best to give them information and convince them that vaccinations are beneficial," says Fahima. "Illiteracy, lack of education and myths make people reject the vaccines."
Together with the other community mobilizers, Fahima engages elders, religious leaders and community influencers as well as urging parents until the very last minute to come forward.
"I've vaccinated all of my children and I was one of the first people in my community to support vaccines," says Isha Hassan Saney, a fellow community mobilizer. She believes showing a good example helps to convince others in the community to vaccinate their children.
"I am motivated to serve the community, especially the mothers and children, because they need to be taken care of," Fahima says. "There is no better reward than seeing them healthy."
COVID-19 shows why vaccines are so important
Despite COVID-19, and the enhanced risk of infecting her husband and her extended family members when she comes home, Fahima continues to show up for work and doesn't let fear take over.
The COVID-19 pandemic has revealed what is at stake when communities do not have the protective shield of immunization against an infectious disease. When vaccines are available, they are the most effective tool to prevent dangerous disease outbreaks.
Staying informed about their benefits and understanding the risks of not getting vaccinated has never been so important. Fahima and the other community mobilizers play an instrumental role in this.
During the recent polio immunization campaign, 8 951 vaccinators went door to door and 3 390 community mobilizers, including Fahima and her team, sensitized communities. The two-part campaign, organized by the Federal Ministry of Health, UNICEF and WHO, reached more than a million children under the age of five in south and central regions of Somalia.
Read this story on the UNICEF Somalia site.
Captain Nestor and Nurse Jeff support each other during polio vaccination campaigns in Barangay Bianoan, in Aurora in the Philippines. A barangay is the smallest administrative district in the Philippines, often home to a tightknit community. By combining their skills to raise vaccine confidence, publicize the campaign and share vehicles to reach every child with immunizations, Nestor and Jeff are playing a vital role to close the polio outbreak.
Meet more of the #HeroesEndingPolio in the Philippines, from nurses and laboratory workers, to Rotarians and polio campaign monitors.
Ismail Taxta/Ildoog/WHO Somalia
From 30 August to 3 September, Somalia conducted an integrated measles and polio campaign in the Banadir region – the first immunization campaign held since the COVID-19 pandemic reached Somalia. Over the last seven months, health workers have been fully engaged in fighting the pandemic. This campaign, conducted whilst observing safety measures to prevent spread of COVID-19, was a chance to get back on track to protect children who have missed out on vital immunizations.
The campaign was conducted by Somalia's Federal Ministry of Health, with technical support from WHO and UNICEF, and financial support from the Global Polio Eradication Initiative and Gavi, the Vaccine Alliance. The campaign had initially been scheduled to take place in 2019 as part of a nationwide effort, but was postponed due to technical challenges.
Ahead of the campaign, vaccines were procured and stored in optimum cool conditions. Microplans and maps were updated to help vaccinators reach all children at health facilities and fixed outreach sites. Building population immunity to polio and measles is extremely important in Somalia: Since the start of the year, 744 children in Banadir have contracted measles, accounting for half of the cases nationwide. Two forms of polioviruses, in circulation in Somalia since the end of 2017, have caused paralysis in 19 children across the country.
As part of the planning, 602 teams of health workers were given protective face masks and gloves, and were trained rigorously to keep themselves and their families safe from COVID-19. Every morning, they were checked to see if they had COVID-19 symptoms. Precautionary measures taken during the campaign included washing hands regularly, wearing face masks and ensuring physical distancing.
On the first day of the campaign, health teams set up fixed outreach vaccination sites and health facilities in different locations in Banadir. The aim was to reach as many children as possible: those living in urban and rural locations, those with nomadic lifestyles, and those living in camps for internally displaced persons.
All children under five who visited facilities during the campaign received deworming tablets and vitamin A, in addition to measles and polio vaccines. The inclusion of other health interventions in polio campaigns is a safe and effective way to help parents give their children the best possible protection against childhood diseases. This is particularly crucial in the Somali context, where children have limited access to health facilities, and population immunity is chronically low.
Two hundred and twenty-four district field assistants supervised more than 3000 vaccinators to ensure vaccinations were administered correctly and COVID-19 safety measures were observed. The campaign was also monitored by staff from the Ministry of Health, UNICEF and WHO.
Women and men played an important role in the campaign as social mobilizers, sharing messages on the benefits of vaccinations and COVID-19 prevention measures. Additionally, community volunteers helped to manage crowds of caregivers who visited health facilities and vaccination sites, ensuring that physical distancing was observed.
At the end of the day, all waste products from the campaign, including syringes, sharps and empty vials, were disposed of safely. By delivering multiple health interventions at once, cost savings can be achieved, and environmental impact is reduced when compared to delivering interventions separately.
Vaccination teams provided caregivers with vaccination cards for children, so that monitors could keep track of children who did not receive measles and polio vaccines.
Around 408 000 children aged between six months and five years (92% of those targeted by the campaign) received vaccinations against measles and 459 000 children aged under five (93% of the target) were vaccinated against polio. Ninety-two percent of children also received vitamin A and deworming tablets. This campaign proved that delivering health interventions amid COVID-19 in Somalia is achievable – and paved the way for subsequent campaigns to fill immunity gaps.
Community Health Workers deliver polio vaccine in Pehlwan Goth in Karachi. ©PEI/2020
Welcome to Pehlwan Goth, Pakistan. A low-income neighbourhood on the edge of Karachi city, it is home to many families from Khyber Pakhtunkhwa province who have moved here for work.
An open sewage drain lined with litter runs the length of the settlement. Cattle are often seen grazing near the heaps of garbage. It is a high-risk area for polio, and virus is regularly detected in the environment.
Samreen, a 25-year-old Polio Area Supervisor, leads a team of four community health workers in the area.
"I started working with the Polio Eradication Programme four years ago and I am happy to say that we have made a lot of progress here. This is my neighbourhood; this is where I grew up and this helps me immensely. People here listen to me, especially the women, and I know most of the children by name," says Samreen.
Converting refusals
There are around 32,000 children under five years of age in Pehlwan Goth. In April 2019, parents of around 3,000 children refused the polio vaccine. Through the hard work of supervisors like Samreen however, now over 80% of these children have received vaccines.
"I am in charge of an area that has 210 households with 196 children. In 2019, families of more than 50 children refused vaccines. That's almost one fourth of all the children in my area," said Samreen.
Samreen delivers polio drops to children whose parents initially rejected vaccination. ©PEI/2020
"Building trust takes time, and we continued engaging with community members, visiting families, listening to their concerns, and explaining the benefits of vaccination. Today, we have only eight refusal cases out of the previous 50. I will try my level best to bring this number down to zero during the polio campaign next month."
"But for me, it is not just about just converting refusals during every campaign, I want all families to understand the benefits of vaccines in the long run and ensure the immunization of their children against polio and other diseases."
Her rapport with families is apparent during house visits. A family with three children, who had refused vaccination in previous months, agreed that their children could this time receive the life-saving polio drops.
Confronting misconception
Building trust with the community has not been an easy task. Samreen is supported by a social mobilizer as well as a local religious support person. The team members work together to address misconceptions and raise awareness of good health practices among caregivers in Pehlwan Goth.
Samreen and Maulana Mohammad Hanif vaccinate the children of local resident Tayyab Khan. ©PEI/2020
"We speak the same language and our homes are in the same area where we work. It is easier to communicate with people when you are part of the same community," said Maulana Mohammad Hanif, the religious support person in Samreen's team.
Sometimes, however, it can take only one negative social media video or news item to reignite refusals and overturn all their efforts.
"The process takes time. The work is tough but I am grateful to Allah for this job, which allows me to feed my family, and contribute to a noble cause, which will save future generations of Pakistanis," added Maulana Mohammad Hanif.
It's clear that Samreen and her team will do whatever it takes to deliver a polio-free future to all 196 children in their care. Pakistan and Afghanistan are the final two polio endemic countries in the world and there are still many challenges that remain.
It is the local efforts of teams like Samreen's that will make all the difference – by listening to communities, building trust and ensuring rapport, they are playing a crucial role to bring their country closer to ending polio.
In July
722,500 children were vaccinated during the SNID campaign.
Pakistan polio snapshot - July 2020
Dr. Ana Elena Chevez with her medical school cohort in El Salvador. During her career, Dr. Ana has made an immense contribution to polio eradication and broader public health. Credit: Provided by Dr. Ana Elena Chevez
Little Ana first learned about the importance of vaccines from her father, a pediatrician. Growing up during El Salvador's 12-year civil war meant that electricity cuts were a common occurrence. Whenever the electricity went out, Ana's father would rush the vaccines he kept in his clinic to the nearby hospital, where generators kept the cold chain refrigerators working. Seeing her father's dedication to his work, Ana knew she would also become a doctor.
Fast-forward to 2020. Dr. Ana Elena Chevez has dedicated over twenty years of her life to protecting children from vaccine preventable diseases. She has worked in four countries across two regions, and currently serves as a Regional Immunization Advisor for polio at the Pan American Health Organization (PAHO), the Regional Office for the Americas of the World Health Organization, supporting the 52 countries and territories of the Americas to maintain polio-free status.
Throughout her career, she has never stopped dreaming high – advice given to her by family, mentors and colleagues.
Dr. Ana's first job in public health was as a national immunization manager in El Salvador. Her mentor was PAHO/WHO immunization advisor Dr. Salvador Garcia. "Dr. Garcia taught me everything I needed to know about running an immunization programme. I knew that I could call him at any time, and I would get the answer that I needed," she said.
The last mile of polio eradication in Nigeria
As polio cases surged in the African region in 2007, Dr. Ana was selected to go to Nigeria to support outbreak response. In a twist of fate, a three-month assignment turned into four years as Nigeria's Supplementary Immunization Activity (SIA) coordinator.
It was in Nigeria that Dr. Ana refined her skills as a polio eradicator, as well as finding a 'home away from home'. Credit: Dr. Ana Elena Chevez
This experience was pivotal for Dr. Ana's career – it solidified her passion for polio eradication and introduced her to new colleagues and a new
country, which would soon become Dr. Ana's second family and her home-away-from-home.
Dr. Ana was inspired by the constant innovation she saw in Nigeria. "We were always looking for ways to improve quality of the campaigns – improve training, surveillance, cold chain. It was always innovation, innovation, innovation."
Dr. Ana believes that way of thinking really took Nigeria to the next level. "We started seeing fewer cases, more children vaccinated, and a higher level of acceptance among parents and leaders."
As SIA coordinator, Dr. Ana oversaw all polio campaigns in the country. During these years, polio campaigns were happening on an almost monthly basis, alongside campaigns for yellow fever, tetanus elimination, and measles. It was overwhelming. "By the time we returned from the field to analyze one campaign, it was already time to start preparation for the next one. It was tiring for everyone – for us (the WHO staff), the partners, for the national/state/local health authorities, and of course for the vaccinators."
Despite the pressure, Dr. Ana said, "If you were to ask me if I would do it again, I would say yes in a heartbeat. For me, it was being a part of an important moment in history – for the country, for public health, and for the polio programme."
Maintaining momentum in a region certified free of polio for over 25 years
In 2017, Dr. Ana became PAHO/WHO's Regional Advisor in charge of polio. The last case of wild poliovirus in the Americas was in 1991 and the region was certified free of polio in 1994. Although more than 25 years have passed since the Americas received polio free status, until polio is eradicated everywhere, the disease is still a risk.
25 years since the Americas were certified polio-free, Dr. Ana emphasizes that the region remains at risk until polio is eradicated everywhere. Credit: Dr. Ana Elena Chevez
Dr. Ana explains, "Even though new generations of nurses, doctors, and epidemiologists have not seen a case of polio firsthand, they understand the risk remains." There have been 26 meetings of PAHO's Technical Advisory Group (TAG) meeting on vaccine preventable diseases, and polio has been included on the agenda for every meeting.
It has not always been easy to keep this momentum. In recent years, countries in the Americas have had trouble meeting the indicators required to prove sensitive surveillance systems. For the last few years, PAHO has been holding almost yearly regional polio meetings to sensitize countries on the GPEI's requirements for eradication and stress the importance of achieving high immunization coverage rates for polio and high standards of surveillance.
Dr. David Salisbury, chair of the Global Certification Commission for Polio Eradication, said at the regional PAHO polio meeting in 2017 that "there will be no free pass" for countries that are polio-free. All nations must provide documentation of certification standard surveillance to back up their belief that polio is eliminated amongst their population.
For Dr. Ana, these words hit home, "The work done by those that here before me has helped the countries to be aware. It has been my role to keep that momentum alive and help countries meet the required goals established in the Endgame Strategy."
A message for the new generation of women public health leaders
In recent decades, women leaders in public health and immunization made important contributions to a field once dominated by men.
Dr. Ana recalls many of the women leaders that she's worked with and considers that they have gone above and beyond what is expected. "They have raised the bar and have given the message that other women can work in public heath – it doesn't matter your religion or colour – it matters that you care."
Dr. Ana is excited to see more women step into leadership roles. "The new generation is coming. We need them – we need to prepare them. We are close to polio eradication, but we must think about what is next and prepare the new generation to tackle these issues with confidence. I tell my nieces that they can go and contribute to the world and make an impact."
Reflecting on her own motivation, Dr. Ana says, "I always believed that I could make an impact, I just needed the tools, time and opportunity."
"Young women leaders: Keep dreaming high. Keep dreaming that you can influence the health of whole populations. Don't be afraid to set high goals– don't be afraid to think that it is possible to control, eliminate, or even eradicate a disease."
Nabeela, a polio frontline worker in Pakistan, vaccinates a child in Liaqatabad using the 'no touch' method. © UNICEF/Pakistan
Vaccinators in countries including Afghanistan, Angola, Burkina Faso and Pakistan took to the streets this month to fill urgent immunity gaps that have widened in the under-five population during a four month pause to polio campaigns due to COVID-19.
Campaigns resumed in alignment with strict COVID-19 prevention measures, including screening of vaccinators for symptoms of COVID-19, regular handwashing, provision of masks and a 'no touch' vaccination method to ensure that distance is maintained between the frontline worker and child. Only workers from local communities provided house-to-house vaccination to prevent introduction of SARS-CoV2 infection in non-infected areas.
Although necessary to protect both health workers and communities from COVID-19, the temporary pause in house-to-house campaigns, coupled with pandemic-related disruptions to routine immunization and other essential health services, has resulted in expanding transmission of poliovirus in communities worldwide. Modelling by the polio programme suggests a potentially devastating cost to eradication efforts if campaigns do not resume.
A child has their finger marked during the campaign in Angola. ©WHO/AFRO
In Afghanistan, 7858 vaccinators aimed to vaccinate 1 101 740 children in three provinces. Vaccinators were trained on COVID-19 infection control and prevention measures and were equipped to answer parents' questions about the pandemic. Through the campaign, teams distributed 500 000 posters and 380 000 flyers featuring COVID-19 prevention messages.
In Angola, 1 287 717 children under five years of age were reached by over 4000 vaccinators observing COVID-19 infection prevention and control measures. All health workers were trained on infection risk, and 90 000 masks and 23 000 hand sanitizers were distributed by the Ministry of Health.
In Burkina Faso, 174 304 children under five years of age were vaccinated in two high-risk districts by 2000 frontline workers. Vaccinators and health care workers were trained on maintaining physical distancing while conducting the vaccination. 41 250 masks and 200 litres of hand sanitizer were made available through the COVID-19 committee in the country to protect frontline workers and families during the campaign.
In Pakistan, almost 800 000 children under the age of five were reached by vaccinators in districts where there is an outbreak of circulating vaccine-derived poliovirus. Staff were trained on preventive measures to be followed during vaccination, including keeping physical distance inside homes and ensuring safe handling of a child while vaccinating and finger marking them.
Farzana, a polio worker in Karachi's Liaqatabad Town, Pakistan uses hand sanitizer during the campaign. ©UNICEF/Pakistan
"Our early stage analysis suggests that almost 80 million vaccination opportunities have been missed by children in our Region due to COVID-19, based on polio vaccination activities that had to be paused," said Dr Hamid Jafari, Director for Polio Eradication in the Eastern Mediterranean Region. "That's close to 60 million children who would have received important protection by vaccines against paralytic polio."
Over the coming months, more countries plan to hold campaigns to close polio outbreaks and prevent further spread, when the local epidemiological situation permits.
"Our teams have been working across the Region to support the COVID-19 response since the beginning of the pandemic, as well as continuing with their work to eradicate polio," said Dr Hamid Jafari. "We must now ensure that we work with communities to protect vulnerable children with vaccines, whilst ensuring strict safety and hygiene measures to prevent any further spread of COVID-19".
In Afghanistan, 7858 vaccinators aimed to vaccinate 1 101 740 children in three provinces. ©WHO/Afghanistan
Dr Matshidiso Moeti, WHO Regional Director for Africa, commented, "We cannot wait for the COVID-19 pandemic to be contained to resume immunization activities. If we stop immunization for too long, including for polio, vaccine-preventable diseases will have a detrimental effect on children's health across the region."
"The campaigns run by the Polio Eradication Programme demonstrate that mass immunization can be safely conducted under the strict implementation of COVID-19 infection prevention and control guidelines."
How the polio programme is supporting Routine Immunization during COVID-19
Community surveillance teams for COVID-19 and acute flaccid paralysis speak to households about any individuals with symptoms in their area. The Somali polio team is currently steering the COVID-19 response and fighting ongoing polio outbreaks amidst challenging conditions. ©WHO/Somalia
For Somalis, COVID-19 is the most immediate crisis in a seemingly unending cycle of floods, food insecurity, conflict and outbreaks of vaccine-preventable diseases like measles, cholera and polio. Against this backdrop, the World Health Organization's polio programme is working to steer the COVID response and, more broadly, maintain vaccine immunity levels and improve access to healthcare. It's no easy feat.
Dr Mohamed Ali Kamil, the outgoing World Health Organization Polio Team Lead and COVID-19 incident manager for Somalia, is in awe of the commitment shown by health staff. He recently phoned a Polio Logistician diagnosed with COVID-19 who was experiencing symptoms, to insist he stop working remotely from his sickbed. Dr Kamil recalls, "He said, "No Sir, I will continue."
Since the first COVID-19 case was diagnosed in Somalia on 16 March 2020, the polio programme has fought the pandemic from the ground up. Dr Kamil explains, "No other health programme has comparable expertise to serve the Somali population during COVID-19. During their time in the programme, members of the polio team have responded to many different disease outbreaks. This means they were well placed and well trained to respond to COVID-19."
"The polio programme has spent years building staff capacity and systems to implement vaccination campaigns and detect the poliovirus in the community. In some ways, the team are the first and last line of defense."
The response includes education, case identification, contact tracing, case management and data support. As of June, polio staff working as part of rapid response teams (RRTs) had reached 2.6 million people with messages about COVID-19 prevention. District Polio Officers within the RRTs have led the investigation of over 4500 people with suspected COVID-19 across the country. The country has set up three COVID-19 testing facilities and the polio structure established for the collection and shipment of stool samples from AFP cases has been used for the transportation of COVID-19 samples.
Dr Mohamed Ali Kamil, the outgoing World Health Organization Polio Team Lead and COVID-19 incident manager for Somalia, speaks to a polio vaccinator before the onset of the pandemic. ©WHO/Somalia
Throughout, polio personnel have continued their full-time work to end the circulating vaccine-derived poliovirus (cVDPV) outbreaks that have thus far paralyzed sixteen children since 2017.
The team are driven by a humanitarian commitment to the Somali population, who have suffered over 30 years of protracted conflict and insecurity. At least 5.2 million people are in need of humanitarian assistance, and secondary and tertiary healthcare is virtually non-existent outside of a few large cities. Health literacy is low, and populations are highly vulnerable to diseases like polio, measles, cholera and now COVID-19. In November 2019, widespread flooding brought further turmoil and danger to Somali families.
The team's work is made more difficult by the emotional toll wrought by the pandemic. To date at least 143 health workers have been identified with COVID-19 infection. In April, Ibrahim Elmi Mohamed, a District Polio Officer who spent 19 years striving for a polio-free Somalia, died of a COVID-19-related illness. His death, one of many frontline staff around the world due to COVID-19, remind us of the risks they face every time they go to work.
Challenges lie ahead to defeat polio
Dr Kamil is clear that the polio programme will require ongoing funding and the support of authorities, partners and communities in order to maintain polio activities amidst the pandemic.
"To sustain the immunity gains we must implement a number of polio vaccination campaigns each year until the routine immunization programme can reach every Somali child with all polio vaccines. Somalia is extremely fragile and at high risk of becoming endemic for poliovirus if we do not maintain and support the polio infrastructure," he says.
Since the cVDPV outbreaks were first detected in 2017, the programme has streamlined disease surveillance for cases of acute flaccid paralysis and other preventable diseases, including by introducing mobile technology to record details of suspected cases. For the first time, environmental disease surveillance was introduced. Over three years, frontline health workers have implemented more than 15 polio campaigns, including integrated campaigns with the measles programme.
A volunteer vaccinator gives two drops of the polio vaccine to a Somali child in August 2019. Despite efforts, many inaccessible areas remain where the programme cannot deliver vaccines. ©WHO/Ilyas Ahmed
Dr Kamil explains, "We still don't know where the virus is coming from exactly. There are many inaccessible areas, where we cannot deliver vaccines or respond with immunization campaigns. We suspect that the virus is circulating among vulnerable children and communities living in these areas."
Dr Kamil feels strongly that the polio programme has a duty to support other health interventions. He says, "COVID-19 shows what the frontline polio staff can achieve and the strength of surveillance and response systems.''
Despite the challenges, Dr Kamil retains his belief that with ongoing funding and support, the cVDPV outbreaks in Somalia can be brought to a close. He reflects, "COVID-19 is a huge emergency in Somalia. Our staff are working flat out, and we expect to see many more cases, but at the same time we must continue to fight polio. The Somali community and the world deserve to be free of this disease."
"We must reschedule our March polio vaccination campaign which was delayed because of the COVID 19 outbreak. We must do everything possible to keep health workers safe from COVID-19. It's a hard situation, but we must not stop until we overcome both viruses."
Training health workers to fight COVID-19 in Sudan
Polio eradication expertise backs Africa's COVID-19 response
In May
1 case of wild poliovirus were reported
318 children were vaccinated.
Polio vaccination activities continued to stay postponed due to COVID-19 outbreak
Afghanistan polio snapshot - May 2020
Dr Fiona Braka has spent 17 years working to eradicate polio in the African Region. ©WHO Nigeria
Dr Fiona Braka holds one of the highest-stake roles in the African regional polio programme – supporting the Government of Nigeria in their fight to defeat wild poliovirus.
She is the first woman to hold her position in Nigeria, and before that was the first female polio team lead in Ethiopia.
Fighting the last wild virus in Africa
Dr Braka's work involves leading the country team to strengthen routine immunization and maintain high quality disease surveillance systems in Nigeria. She is also heavily involved in the COVID-19 response, lending expertise established over decades of fighting polio.
In 2016, the detection of wild virus in Nigeria after nearly two years without cases was a devastating setback. "When the outbreak broke out, I was in Uganda on a break with my family. I was having lunch with a friend and my phone was ringing, persistently ringing – a Geneva number. When I picked up the phone it never crossed my mind it would be a wild virus," Dr Braka remembers.
"A good proportion of Borno state was inaccessible due to armed conflict. Delivering vaccination services and conducting surveillance in that area had not been easy. With interventions going on to address the conflict by the Nigerian Government, some ground was gained, and people trapped for over three years were able to move out of the liberated areas to internally displaced persons camps. With population movement, a wild polio case was detected in an internally displaced child."
Cutting short her family holiday, Dr Braka raced to Borno to help launch a truly innovative outbreak response with the government and partners. Adapting strategies for polio response to an insecure setting, the programme started settlement-based microplanning guided by local security assessments, innovative surveillance approaches, and the use of GIS and satellite imagery to estimate trapped populations.
The estimated number of children inaccessible to vaccinators has dropped from over 400,000 in September 2016 to less than 30,000 in May 2020 – an enormous achievement for the programme.
Dr Braka is passionate about equal participation and leadership in public health. ©WHO/Nigeria
Balancing motherhood and a career in public health
The challenges were very different when Dr Braka was working on the 2013 Horn of Africa outbreak in Ethiopia's Somali region. Cases of polio were occurring among pastoral communities and the programme had to rethink tactics to ensure the children of nomadic populations could be reached with vaccines. To maintain the cold chain, polio teams travelled on donkeys or on foot through the bushes. Community leaders among the nomads were employed to help vaccination teams reach families on the move.
"I recall the advice of a parent of a nomadic child who had contracted polio. He said, "We follow where the clouds and rain go – unless the polio programme also moves with the clouds and the rains as we do, you will never reach us and our children will never get the vaccine". This became a guiding quote for us," Dr Braka remembers.
This was also a time of personal challenge, as Dr Braka's youngest daughter was less than a year old. On one occasion, Dr Braka brought her baby with her to a vital cross-border collaboration meeting in Somali region between the Somalia, Kenya and Ethiopia teams. She recalls, "I had to stay in the same hotel as the meeting so I could run upstairs during the break to breastfeed. That moment really stands out an example of the tough decisions you must make as a parent."
Dr Braka praises steps taken so far to promote women's professional development in public health and leadership, whilst noting there is more to do.
"The WHO Regional Director for Africa, Dr Matshidiso Moeti, has provided opportunities for capacity building for women. There has been the first training this year for senior women leaders in the African region – I am proud to be part of this."
Part of the Global Polio Eradication Initiative Gender Strategy 2019-23 commits to promoting a gender-responsive organizational culture. By placing gender at the heart of operations, the strategy closely aligns with the policies of major donors to polio eradication including Canada, Germany, Australia and the United Kingdom.
Explaining why she is a strong supporter of gender equality at all levels of public health, Dr Braka finds, "Even occupying leadership roles you have to have gender in mind – you have to be prepared to prove yourself a bit more."
"It remains our responsibility to create a policy environment that gives opportunities for men and women."
Dr Braka delivering polio vaccine to children in Borno State during an outbreak response campaign. ©WHO/Nigeria
A duty to end polio
Dr Braka emphasizes that many people forget how damaging the disease is.
"Whilst we have polio anywhere in the world, we are all at risk of cross-border virus spread. Until polio is eradiated globally, we must be on our toes with robust surveillance systems and infrastructure to deliver vaccines."
Dr Braka has been able to sustain her demanding job in part thanks to the support of her family. She explains, "I have a very supportive spouse…He knows the polio programme as well as I do!"
"My late father was also very supportive of my career. My mother has been more than a mother – a strong pillar of support, mothering her grandchildren when I am not there and providing moral support in the background."
She explains that she can't imagine a next generation suffering from polio when a vaccine is available.
"Vaccines are a powerful tool and the evidence is clear for saving lives. They reduce burden on families, economically, emotionally, and they prevent the suffering of children."
"We have a duty to secure children's future to be healthy citizens."
Stronger role of women at all levels crucial to end polio for good
Resilient women drive polio eradication in Pakistan
Nurse Madelein Semo vaccinates a young baby with inactivated polio vaccine (IPV) at the Ngbaka health centre in Kinshasa, Democratic Republic of the Congo, on April 29, 2015. Gavi's support for IPV represents the insurance policy for the success of the Polio Endgame Strategy. ©GAVI/2015/Phil Moore
On 4 June 2020, the UK Government hosted Gavi's third donor pledging conference, the Global Vaccine Summit, to mobilize at least US$ 7.4 billion to protect the next generation with vaccines, reduce disease inequality and create a healthier, safer and more prosperous world. Responding to this unique call for global solidarity, leaders from donor countries and the private sector made unprecedented commitments of US$ 8.8 billion in order to save up to 8 million lives.
Since 2019, the Global Polio Eradication Initiative (GPEI) has strengthened its collaboration with Gavi, inviting Gavi to become the sixth core partner of the GPEI. While the GPEI will continue its focus on interrupting virus transmission and eradicating polio through immunization campaigns using the oral polio vaccine (OPV), Gavi's support for the inactivated polio vaccine (IPV) at an estimated cost of US$ 800 million during its 2021-25 strategic period represents the insurance policy for the success of the Polio Endgame Strategy.
Thanks to the remarkable mobilization and solidarity of leaders worldwide, Gavi will be able to maintain immunization in developing countries, mitigating the impact of the COVID-19 pandemic. Gavi will also be able to sustain health systems so that countries are ready to rapidly introduce COVID-19 vaccines. And by 2025 Gavi will have immunized more than 1.1 billion children, saving 22 million lives. Ngozi Okonjo-Iweala, Chair of the Gavi Board, highlighted why this is so important, saying, "Vaccinations should be recognized as a global public good. With your support and commitment, we can generate US$ 70 to US$ 80 billion additional economic benefits."
Henrietta Fore, Executive Director of UNICEF, added, "We have effective vaccines against measles, polio and cholera. While circumstances may require us to temporarily pause some immunization efforts, these immunizations must restart as soon as possible, or we risk exchanging one deadly outbreak for another." UN Secretary-General Antonio Guterres urged partners to "find safe ways to continue to deliver vaccinations during COVID-19." GPEI, Gavi, WHO and UNICEF have issued guidance for countries to encourage resuming immunization activities once it is safe to do so, in recognition of the fact that numerous countries are facing COVID-19 and multiple other disease outbreaks.
During the Summit, top Gavi donors reaffirmed their leadership, including Norway, the UK and the USA, as well as the Bill & Melinda Gates Foundation. Prime Minister Boris Johnson pledged £1.65 billion, recommitting the UK as Gavi's leading donor while the Gates Foundation committed US$ 1.6 billion. More than 60 leaders from all regions of the world in the Asia-Pacific, Middle East, Africa, Europe and the Americas pledged support to Gavi, the Vaccine Alliance both for its upcoming strategic period as well as for COVID-19 response.
The COVID-19 pandemic reminds us of the power of vaccines. WHO Director-General Tedros Adhanom noted, "COVID-19 is a devastating reminder that life is fragile, and that in our global village our individual health depends on our collective health. … Now is the moment for the world to come together in solidarity to realise the power of vaccines for everyone." Responding to this challenge, Gavi has launched the Gavi Advance Market Commitment for COVID-19 (Gavi Covax AMC), which aims to raise additional funding in late June under the leadership of the European Union. Bill Gates, noted, "We would have to create Gavi if it did not exist today to solve the COVID-19 crisis."
Michel Zaffran, director of the WHO polio eradication programme, said, "Congratulations to the Gavi family for this exemplary mobilization and demonstration of global solidarity. We are immensely grateful to Gavi and its donors for their precious partnership and generous support for the inactivated polio vaccine (IPV). The COVID-19 pandemic is a terrible tragedy, which brings us together more than ever and requires to think collectively how best to address the needs of the communities."
Rotary, one of the six GPEI partners, echoed statements from other agencies. "Rotary and its members applaud the commitment of the donors and governments who have pledged their support to ensuring that vulnerable communities can receive lifesaving vaccinations," said Michael K. McGovern, Polio Oversight Board and Chair of Rotary's International PolioPlus Committee. "Continued investment from the global community in programmes such as the Global Polio Eradication Initiative is crucial to not only achieving the eradication of polio, but ensuring stronger health systems worldwide. This firm commitment truly embodies the "Plus" in PolioPlus."
While the Global Vaccine Summit secured the IPV requirements for polio eradication efforts through 2025, further financial commitment is needed for the GPEI to restart the immunizations campaigns that have been paused during the COVID-19 pandemic. More intensive and integrated immunization activities are needed to finish the job and to strengthen the capacities of the governments, health workers and networks, so that the investment in polio eradication can serve as a foundation for future pandemic response. While celebrating the success of the Global Vaccine Summit, GPEI calls for reiterated donor support to eradicate polio once and for all.
Donors pledge to strengthen immunization and accelerate fight against COVID-19
Global Polio Eradication Initiative
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Home > microcontroller > What (type of) sensor can detect odor of faeces?
What (type of) sensor can detect odor of faeces?
"The Chemistry of the Smell of Toilets & Human Waste" has a really nice overview of types of gases you want to detected if you're after building a toilet-clean-air detector.
Hydrogen sulfide (H2S) sensors like MQ-136 are available for as little as $20 but what about the other gases? Isn't there a sensor that detects several of those faeces gases?
I would think though that in 15 years time the sensor capabilities/stability/immunity to humidity may have improved. So you could check the Figaro website for sensors detecting the same chemicals as the paper and maybe get better results.
Instead of checking all of these individually, you might be able to just check for general VOC's.
Seeking advice on how to build a box to brute force hashes?
How do I modify an equation with a long numerator and a normal denominator?
RAID 1 fault " Status Ready for Rebuild : Rebuild Percentage Complete 0%"
Which OS should I install?
What is the coordinate system of this maritime natural gas field map?


Triglide helps reduce cholesterol and triglycerides (fatty acids) in the blood. High levels of these types of fat in the blood are associated with an increased risk of atherosclerosis (clogged arteries).
Triglide may also be used for purposes not listed in this medication guide.
You should not take Triglide if you have liver disease, gallbladder disease, severe kidney disease, or if you are breast-feeding a baby.
Triglide can cause the breakdown of muscle tissue, which can lead to kidney failure. Call your doctor right away if you have unexplained muscle pain, tenderness, or weakness especially if you also have fever, unusual tiredness, or dark urine.
Triglide can cause the breakdown of muscle tissue, which can lead to kidney failure. This happens more often in women, in older adults, or people who have kidney disease, diabetes, or poorly controlled hypothyroidism (underactive thyroid).
Triglide is not approved for use by anyone younger than 18 years old.
How should I take Triglide?
You may need frequent medical tests. Even if you have no symptoms, tests can help your doctor determine if Triglide is effective.
Triglide is only part of a complete program of treatment that may also include diet, exercise, weight control, and other medications. Follow your diet, medication, and exercise routines very closely.
What should I avoid while taking Triglide?
Avoid eating foods high in fat or cholesterol, or Triglide will not be as effective.
In rare cases, Triglide can cause a condition that results in the breakdown of skeletal muscle tissue, leading to kidney failure. Call your doctor right away if you have unexplained muscle pain, tenderness, or weakness especially if you also have fever, unusual tiredness, or dark colored urine.
What other drugs will affect Triglide?
Some medicines can make Triglide much less effective when taken at the same time. If you take any of the following medicines, take your this medicine dose 1 hour before or 4 to 6 hours after you take the other medicine.
This list is not complete. Other drugs may affect Triglide, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.


This Valley is for the Birds – I'm a Writer, Yes, I Am!
Birds are big where I live, I mean that literally and figuratively. The biggest economic boom to my town each year is the Crane Festival when people come from all over the world to watch Sandhill Cranes cavort. But there are other great birds here. All kinds of raptors (bald eagles nest here). The Rio Grande threads through the valley and there are hundreds of artesian wells. On a recent walk along the river, we watched a Great Blue Heron take flight in front of us. At the slough, of course, there is every kind of water bird who might like fishing in these climes. Last week I saw my first Killdeer. In my very yard are humingbirds, sparrows, house finches, gold finches and yellow warblers. Of course, I plant things for them. The finches like the seeds of Bachelor Buttons (aka cornflowers) and everything hangs around sunflowers.
Long long ago when the dinosaurs roamed this valley was a huge lake. The lake is now underground and farmers have relied on it for centuries. Because of that ancient lake what would otherwise be a desert is, well, still a desert, but one in which crops grow.
I have a political sign in my yard right now — the first one since 1980 when I worked on John Anderson's campaign. Yes, that's obscure but if you're really interested there's this thing called Google 😉 Yesterday on my walk with Bear, I was near home when I saw a young, tall, handsome Hispanic guy in a concha belt and cowboy hat in the sidewalk in front of me. Bear and I approached. He remained calm and just patted Bear's head, demonstrating some knowledge of how to be with a big dog.
I don't know how you teach a seed, but I got his point. I had to ask the requisite question of the San Luis Valley which is, "Are you from here?" Not from the usual reason but because if he represents the people here, he should know who they are. His family has a ranch in La Jara and he pronounced La Jarrrra correctly.
And now I have his sign in my yard.
At the moment there are white pelicans at the lake. They are beautiful birds, especially in flight.
Now we are waiting for the fall return of the Sandhill Cranes on their commute from Yellowstone to New Mexico. The cranes ARE our seasons. When they begin flying over again in February, we know spring is on the way. When they come south again, we know winter is coming.
Gotta love the birds…one of nature's clocks.
I definitely agree — I wouldn't have it any other way!
We have American Eagles, Red-tailed Hawks (they are almost as big as the bald eagles), and of course a LOT of blue herons and swans. If you don't think a swan is big, wait until won walks up right next to you and you realize that swan could easily take you down. They are HUGE.
But not a crane in sight. I love our sand cranes. What cool birds,.
And we've been seeing FINALLY some local people running (and winning primaries which for a lot of people in Massachusetts is the same as winning the election because many Democrats run unopposed — but THIS YEAR, they had youthful (YAY!!) competition. We actually voted for the new kid again long time (forever?) Treasurer Bill Galvin. Galvin has done a good enough job, even though he is a lot more conservative than we are — but he's the treasurer and he has done a good job with our money by basically letting everything fall apart while saving the money until none of the roads are drivable and all the bridges have collapsed. So we have a billion dollar plus in the bank, but the infrastructure, but the trains which only run when they feel like it to the roads which are so broken they really need a complete overhaul.
We thought the young guy (Zakim) — who is middle eastern, but I don't from exactly where — with that name he could be Lebanese or Israeli or Syrian –but Galvin won two to one. We just thought we need some younger blood. We got some — our very first black woman rep to the U.S. Senate — and it's the seat that Tip O'Neill and Teddy Kennedy held, so she has the right place to start.
Even though this is the "bluest" state in the country, "blues" range from surprisingly conservative (in the old-fashioned sense of the word) to far left socialist. So maybe Galvin will be a better treasurer, even if no one ever fixes anything. We can always go back to dirt roads and just keep saving money!
Charlie Baker, our guv, is the most left-wing Republican on the map. We always elect liberal Republican governors. It's a thing. Our senate and house are all Democrats, but the governor is always a Republican. After a brief flurry of Conservative speeches, he buckles down and does what they all do — work with the house to try and get something accomplished. Remarkably, what gets done is rarely what everyone is hoping for — like rebuilding the damned bridges before they fall into the rivers.
I miss Tip and I miss Ted Kennedy. I miss the old savvy guys who knew how to reach across the aisle and make functional policy that actually helped people.
This should probably be a post, not a comment, but you flipped a mental switch in my head. You always do that, you know?


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Diplomacy&Commerce
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HUMANITARIAN CAMPAIGN
H.E. AMR ALJOWAILY Ambassador of the Arab Republic of Egypt: We Have Enormous Potential
Jelena Jovičić
Dynamic and optimistic, the new Egyptian ambassador to Serbia kickstarted many cultural and tourist activities in our country. The launch of Hello! Travel: Serbia magazine at Stara Planina gave us a splendid opportunity to talk to him.
After the tumultous events in Egypt in 2011 and later, after so-called Arab Spring, Egypt is now finally stable while the political relations between Serbia and Egypt are developing. How would you assess the relations between Yugoslavia/Serbia and Egypt in the last 50+ years, and especially the last year or two?
— Thank you for the chance to speak for Diplomacy&Commerce, a magazine we have been reading since we came to Belgrade. It is hard to summarise 50+ years but we can actually do that in one word – milestones. This year, we celebrate 110 years of the establishment of diplomatic relations between the Kingdom of Serbia and Egypt. In 1908, Serbian king sent his first ambassador to Africa and the Arab world, and it happened to be Egypt, with the ambassador stationed in Cairo. You see how far our historical ties date. Countries back then were struggling for independence and were formulating its policies. It was the age of independence of nations. So from 1908 onward, the relations continued to grow with the Kingdom of Yugoslavia moving its cabinet and government to Egypt for a couple of months during WWII. Of course, during the period of anticolonial struggle and the formation of Non-aligned Movement, the ties became great, particularly thanks to the friendship between Tito and Nasser. Recently, following all these developments in the Middle East and the Balkans, presidents Vučić and Sissi met in New York at the UN Assembly and agreed to actively improve and enhance bilateral relations. This is one of other milestones
made by two governments to enhance the cooperation, and there is a very solid foundation in history for that. Now, the main aim is to bolster the development of the economic, commercial, cultural and social relations. One of the first things that Serbian citizens think of when they hear the word "Egypt" is tourism and culture. These two things
are basically interconnected since people don't just go to see beaches, but magnificent monuments too. The Egyptian culture is three-layered: Ancient Egypt, Coptic Christian and Arab Muslim Egypt. Now, after the turbulence in the Arab World the tourists previously refraining from going to the Arab countries are flocking there once again. It is a
great moment to restart the tourist cooperation.
— I agree! Tourism is not only a leisure activity but also a cultural interaction. We have seen the qualitative leap in number of tourists from Serbia in Egypt in the last two years. From 2016 to 2017, there was a 144% rise in the number of tourists. During the first half of 2018, our embassy issued 129% more visas. Considering that the majority
of tourists obtain their visas at the airports, we can expect the same trend there too. Also, in the light of viewing culture and tourism as tied activities, 90% of the Serbian tourists go to the Red Sea Governorate, and its capital Hurghada. We would like to urge travel agencies to include cultural sites close to the sea resorts in their tourist
offers too. Also, we would like to motivate Serbian tourists to visit the oldest monastery in the world, St Anthony, close to Hurghada. When I talked with Pope Tawadros II, the head of the Coptic Orthodox Church, he supported the idea. I would also encourage Serbian tourists to see purely cultural sites, such Cairo pyramids (we call Cairo
"the city of thousand minarets") and the Hanging Church which is the oldest church in the world, as well as to head down to Aswan and up to Alexandria, on the Meditarranean coast.
It would be great to promote the Mediterranean coast of Egypt as a resort centre, since Alexandria is splendid. There must be resorts in the close proximity of Alexandria, and the sea must be really wonderful.
— Egypt borders two seas – the Red Sea and the Mediterranean – and each of these has its own tourist season. Tourists, who enjoyed coral reefs, the warm still waters of the Red Sea and its orange sands, can easily move during the summer season to the Mediterranean, enjoying the white sandy beaches, turquoise water and waves there. It
is a very different experience. Alexandria is the second largest city in Egypt, just like Novi Sad in Serbia, and we discussed a cooperation between the two cities recently. Alexandria is a real city and a cultural hub with marvellous univeristies and strong industries. I would also like to mention that there is a major ongoing project, implemented
by the government, that entails constructing a brand new city west of Alexandria, 100km to the west to be more precise, called El-Alamein. This city held huge importance during WWII but now it is being developed as a main resort. 100km more to the west lies Ras El Hekma, where I have a beach house. Its name means "The Cape of Wisdom". I would like to encourage the "sea tourists" to discover the Mediterranean coast of Egypt. We will do everything we can to push this agenda. Also, there are a couple of airports close to the area – Burj Al Arab in Alexandria and Marsa Matruh. The flight from Belgrade to these destinations lasts no more than 2 hours and is much shorter than to Hurghada.
You told me you didn't have green mountains – even the Mount Sinai is ochre and quite rocky. Can we appeal to Egyptian tourists to come here and see what they don't have: forests, rivers, do some skiing? We could be the gateway to Europe for the Egyptians.
— I am glad you've mentioned it, since tourism is a kind of a cultural two-way street. I would like to encourage
Egyptian tourists to come and enjoy this beautiful country, and to go to places like Stara Planina where we are now. One of the areas that can be of particular interest to the Egyptians is spa and wellness tourism. The combination of
spa and mountain activities could be a winning combination and a wonderful point of attraction.
Vojvodina is flat but also green and fiull of spas and big rivers and it can offer something different to mountain tourism.
— One of the main projects that we are hoping to implement is river cruises. Egypt has a very sophisticated and developed fleet of cruising boats – the Luxor-Aswan is quite famous, and the Aswan-Abu Simbel is also great. There is also a longer line – Cairo-Luxor. I saw the beautiful Sava and Danube rivers, and I noticed one striking similarity
between Cairo and Belgrade. Cairo is where the Nile branches into two main deltas, and Belgrade lies on the confluence of the Sava and the Danube. I call them both "river capitals". River cruises have a potential and I will be happy to send the highest delegation from our river cruising industry to Serbia, to see the Sava and Danube in particular.
Serbia has recently abolished visas with a number of countries, including China, Iran and India, all resulting in a dramatic increase of foreign tourists from these countries. How about abolishing visas for Egypt? Any news about the mutual abolition of visas?
— I think that is one of the first steps to be taken, since with a visa-free regime or at least a facilitating visa regime, there will be an influx of Egyptian tourists to Serbia. Serbian Foreign Ministry, Tourism Ministry and Economy Ministry could take a creative approach to that issue. That can also bolster doing business, encourage investments
and visits by business people from both countries. Also, Serbia can also become a hub for meetings and conferences; a meeting place for Egyptian and EU business people.
— Tourism is the first and essential step in economic relations, and I am glad to say that, in 2018, we organised the first Egyptian Economic Caravan. In the space of just one week, the Egyptian delegation visited Novi Sad, Niš
and Belgrade twice. You can imagine touring three large cities in one week. We met with all chambers of commerce and the Serbian Chamber of Commerce and Industry and saw an enormous potential for cooperation. We can do even more – Ismailiya, for instance, has one of the biggest folklore festivals and we have never had a Serbian ensemble there, so please try to talk the beautiful Serbian folklore groups into participating next September.
Fantastic! This is an open invitation then. Are they any chances for establishing an educational and technological cooperation?
— I am happy to say that we are finalising the agreement between the ministries of telecommunications and technology from both countries which will do exactly that – bring the two ICT communities together. We met with the Mayor of Niš and this town has the very advanced Faculty of Electrical and Mechanical Engineering. We would be glad if we could connect them with one of the leading engineering faculties in Egypt. We are going to establish more connections both on the academic and technological levels, and also on the intergovernmental level through the Memorandum of Understanding.
You have been extremely active culturally during the past period. This cultural offensive is really impressive. What are you future plans? We are eager to find out more about the countries we know only through TV.
— I see Serbia as an incredibly cultural society. My first impression of Belgrade and Serbia is that the general public here has tremendous appreciation for fine arts, no matter which fine art we are talking about – theatre, music, opera. High culture is almost like popular culture here. I am impressed. It is enjoyed by young and the old, and it's not elitist. That's why I thought, well, that Serbians speak mainly Serbian and that Egyptians speak only Arabic. But, in actuality, what we all speak is the language of art: film, theatre, opera, paintings. That is why my main objective during my 7 months' term is to bring the two peoples speaking one language that we all understand. I arrived here on 16th January and in February, we had the first cultural event with Egyptian participation. We have one major art-related activity almost every two weeks. We have limited resources but have done a lot with them. It is incredibly demanding on HR and finances, but the reception is fantastic – we have a great audience every time! The First Cairo
Opera House came to Serbia for the first time ever this year, despite the fact that our bilateral relations span 110 years. After completing the 15-year-long renovation, the first thing that the National Museum in Belgrade did was to hold a course in Egyptology that focuses on young and older students and amateurs. The course took place
at the Museum of African Art in Belgrade. We had many "firsts" this year. Although, we planned on having an "Egyptian cultural month", in the end, it turned out to be a cultural marathon.
ARABIC LANGUAGE AND YOUTH ARE THE FUTURE
Arabic is becoming the language of business. Could Serbian people learn more Arabicđ through free courses?
— They are more than welcome to do so! I am impressed by the cultural affinities of Serbian people. The Department of Arabic studies in Belgrade is extremely professional, promoting the very refined classical Arabic and Egyptian dialect. I am happy to invite some of these young leaders to World Youth Forum (WYF) in Sharm El-Sheikh on November 6th. My meeting with Mayor Vučević in Novi Sad was great, since we discussed the cooperation with the European Youth Capital 2019 and European Cultural Capital 2021. I also invited him to be a speaker in Sharm.
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Enlightened is a TV show about "A self-destructive woman who has a spiritual awakening who becomes determined to live an enlightened life, creating havoc at home and work." – IMDB…
It stars Laura Dern, Luke Wilson and Diane Ladd. I recently had a chance to interview Diane about Enlightenment and its second season premiere, which is tomorrow, Sunday, January 13 on HBO at 9:30 p.m. Diane Ladd, an actress, director, writer, author and producer is a 3x Emmy and 3x Oscar nominee and the winner of twenty seven international awards, including the British Academy Award, the Independent Spirit Award and the Eleanor Duse Award.
You can download an MP3 of the interview by right-clicking the text below that says "Right-click here to download Diane Ladd Interview"…
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January 10, 2023Newscamp, camp bob waldorf, fundraisingby arykoff
LOS ANGELES, CA – (January 9, 2023) – Jewish Big Brothers Big Sisters of Los Angeles is proud to announce the appointment of Sanford "Sandy" Sigal as the organization's new Board President.
Sandy Sigal, JBBBSLA Board President
Sandy brings a wealth of experience and leadership skills to this role, having been an active member of the board for nearly 20 years. As a child, he attended Camp Bob Waldorf, an overnight camp owned and operated by Jewish Big Brothers Big Sisters, which he credits for teaching him the value of mentorship, inclusivity, and a love of camping, horseback riding, teamwork, and leadership. He has demonstrated a strong commitment to the organization's mission of providing mentorship, camp, college, and teen support to youth in need, and is dedicated to helping make a positive impact in the Los Angeles community.
"We are thrilled to have Sandy take on this important role as our new Board President," said Cari Uslan, CEO of Jewish Big Brothers Big Sisters of Los Angeles. "His passion, personal connection, and dedication to our organization will be invaluable as we continue to grow and serve more youth in need."
"It is an incredible honor to be named President of Jewish Big Brothers Big Sisters," added Sandy Sigal. "When I was 7 years old and my mom needed a place for her young son to be nurtured in a positive environment, with positive role models. Jewish Big Brothers Big Sisters found me a home in Camp Bob Waldorf. To be involved with the organization that changed my life over 50 years ago and help lead it today is the honor of a lifetime. This organization has an amazing mix of great and meaningful impact, and an incredible professional team that achieves great return on investment for our community's youth."
Sandy has been involved with the organization for almost 30 years, serving on the Board of the Foundation for Camp Bob Waldorf, co-chairing their dinner and family day committee, and serving on the Board of Jewish Big Brothers Big Sisters for over 15 years, serving most of that time on the Executive Committee. He was also honored as the first recipient of the William Shatner Humanitarian Award for his service on behalf of the Organization. Sandy also serves on the Board of the Jewish Federation of Greater Los Angeles, the Board of Stephen Wise Temple, and was former Chair of the Real Estate Principals Organization (RPO), the real estate group of the Jewish Federation dedicated to giving and mentoring. He is also an active participant in the Community Leadership Institute (CLI) dedicated to mentoring young leaders in professional, personal, and spiritual development.
On the business front, Sandy is a leading member of the Young President's Organization (YPO) having served twice as a Chapter Chair for local chapters, and three times as learning chair, most recently for the Chapter he helped co-found, YPO Pacific Coast Gold. He has received the Ernst and Young Entrepreneur of the Year Award for Los Angeles, as well as other awards for his community and business involvement.
Sandy Sigal is a graduate of UCLA and has been an entrepreneur in the real estate industry for over 40 years. Mr. Sigal founded and currently serves as Chairman, Chief Executive Officer and President of NewMark Merrill Companies, Inc., which has grown to be one of the fastest growing privately held developers and owners of shopping centers in California, Colorado, and Illinois. Since NewMark Merrill's inception in 1997, Mr. Sigal has acquired, developed and/or managed and repositioned over 150 retail shopping centers. He is also Chairman of BrightStreet Ventures, a company he co-founded to provide more opportunities to his merchants and other owners of shopping centers by integrating on-line and social platforms with traditional brick and mortar businesses.
Sandy has four children, and resides in Hidden Hills, California with his wife, Allison.
About Jewish Big Brothers Big Sisters of Los Angeles:
Founded in 1915, JBBBSLA enriches the lives of children through its meaningful programs: Youth Mentoring, Camp Bob Waldorf, College Access + Success, and Teen Talk App. JBBBSLA's mission is to assist youth in achieving their full potential by providing impactful programs that facilitate lasting relationships and support positive youth development. Each year JBBBSLA serves more than 1,200 youth from a variety of backgrounds, races, religions, and socio-economic status. For more information about the organization or to donate, please visit: www.jbbbsla.org.
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The Browning Automatic Rifle (BAR) is a family of United States automatic rifles (or machine rifles) and light machine guns used by the United States and numerous other countries during the 20th century. The primary variant of the BAR series was the M1918, chambered for the .30-06 Springfield rifle cartridge and designed by John Browning in 1917 for the U.S. Expeditionary Corps in Europe as a replacement for the French-made Chauchat and M1909 Benet-Mercie machine guns.
The BAR was designed to be carried by advancing infantrymen, slung over the shoulder or fired from the hip, a concept called "walking fire"—thought to be necessary for the individual soldier during trench warfare. However, in practice, it was most often used as a light machine gun and fired from a bipod (introduced in later models). A variant of the original M1918 BAR, the Colt Monitor Machine Rifle, remains the lightest production automatic gun to fire the .30-06 Springfield cartridge, though the limited capacity of its standard 20-round magazine tended to hamper its utility in that role.
Although the weapon did see some action in World War I, the BAR did not become standard issue in the U.S. Army until 1938, when it was issued to squads as a portable light machine gun. The BAR saw extensive service in both World War II and the Korean War and saw some service early in the Vietnam War. The U.S. Army began phasing out the BAR in the late 1950s and was without a portable light machine gun until the introduction of the M60 machine gun in 1957 and later M249 Squad Automatic Weapon in the mid-1980s.


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