On March 9, the United States issues a travel advisory against global polio and listed 32 countries, including some European countries. The International travel often comes with vaccine reminder and health checks to stay safe. The Centers for Disease Control and Prevention (CDC) issued a Level 2 travel advisory for certain international destinations with circulating poliovirus. The CDC has asked travelers to ensure they are up to date on their polio vaccines.

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The Destination list for global polio travel Advisory notice includes:

• Afghanistan
• Algeria
• Angola
• Benin
• Burkina Faso
• Cameroon
• Central African Republic
• Chad
• Côte d'Ivoire
• Democratic Republic of the Congo
• Djibouti
• Ethiopia
• Gaza
• Germany
• Guinea
• Israel
• Laos
• Namibia
• Niger
• Nigeria
• Pakistan
• Papua New Guinea
• Poland
• Senegal
• Somalia
• South Sudan
• Sudan
• Tanzania
• United Kingdom
• Yemen

The CDC issued a 'Level 2' advisory, which means to 'practice enhanced precautions'.

The advisory suggests that children and adults should be up to date on their routine polio vaccines. Travelers are also asked to get an inactivated polio vaccine booster if they are going to the destination that has circulating poliovirus, or have completed their routine polio vaccine series; and have not already received one adult booster dose.

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If Polio Has Been Eliminated In The US, Then Why Do Travelers Need Advisory?

Dr Leana Wen, CNN wellness expert, who is an emergency physician and adjunct associate professor at the George Washington University said that while the US eliminated continuous transmission of polio in 1979, eradication within the country does not eliminate the risk when people travel to places where the virus is still circulating.

Speaking to CNN, Wen said that the risk for any individual traveler is usually low if they are fully vaccinated, however, from a population health perspective, it is important to take the precautionary steps. "Even a single imported case could lead to local spread in communities where vaccination coverage is low."

Types Of Notices Issued By CDC

The CDC issues four different types of notices based on the gravity of the disease spread.

Level 1 : Practice Usual Precautions

Practice usual precautions for this destination, as described in the Travel Health Notice and/or on the destination page.

Level 2: Practice Enhanced Precautions

Practice enhanced precautions for this destination. The Travel Health Notice describes additional precautions or defines a specific population at risk.

Level 3: Reconsider Nonessential Travel

Reconsider nonessential travel to this destination. The outbreak or event poses risk to travelers because limited precautions are available.

Level 4: Avoid All Travel

Avoid travel to this destination unless traveling for humanitarian aid or emergency response; there is an extreme health risk for travelers and no available precautions.

What Is Polio?

The World Health Organization (WHO) notes that it is a highly infectious disease caused by a virus that invades the nervous system and can cause total paralysis in matter of hours. The virus is transmitted by person to person spread mainly through the fecal-oral route, or less frequently, by a common vehicle, which could be either from contaminated food or water. The virus also multiplies in the intestine.

The National Institute of Health (NIH), US, notes that the virus responsible for causing Polio belongs to the Picornaviridae family.

As per the WHO, the common Polio symptoms are:

• Fever
• Fatigue
• Headache
• Vomiting
• Stiffness of the neck a
• Pain in the limbs

How Does Polio Spread?

Polio is mainly transmitted through the fecal-oral route, meaning it spreads when a person consumes food or water contaminated with the virus. It can also spread through close contact with an infected individual. The poliovirus lives in the throat and intestines of those infected, and poor sanitation, unsafe water, and inadequate hygiene greatly increase the risk of transmission, especially in communities with limited access to clean facilities.

In severe cases, polio can lead to acute flaccid paralysis, which may affect the diaphragm and throat muscles, making it difficult to breathe or swallow. Since there is no cure for polio, prevention remains the only line of defense. Raising awareness about polio vaccination is therefore essential to protect individuals, especially children, from this potentially life-threatening disease.

The ongoing conflict in the Middle East, which has stretched to more than 10 days, is disrupting health services and fueling the risk of several infectious diseases as well as environmental hazards, the World Health Organization (WHO) has said.

Citing national health authorities, the WHO reported casualties:

• Iran - over 1,300 died, 9,000 injured
• Lebanon - 570 people died and more than 1,400 injured
• Israel - 15 died and 2,142 injured.

These include:

• Iran

- 8 deaths among health workers

• Lebanon

- 16 deaths and 29 injuries to health care workers.

"The conflict is affecting the very services meant to save lives," the WHO said.

"These attacks not only cost lives but deprive communities of care when they need it most. Health workers, patients, and health facilities must always be protected under international humanitarian law,” it added.

Notably, the conflict is also collapsing health system with the shutdown of critical medical services:

• Lebanon - 49 primary health care centers and 5 hospitals shut down.
• Occupied Palestinian territory - ambulances and mobile clinics access delayed.
• Gaza - medical evacuations suspended since 28 February
• WHO’s global logistics hub in Dubai - disruption in movement of medical supplies

Francesca Quinto, Desk Manager at Doctors Without Borders, in an update social media platform X informed the threat to healthcare facilities in Lebanon.

"Our teams are witnessing the suffering up close: hospitals under pressure, communities repeatedly displaced and humanitarian needs rising sharply. Civilians and healthcare facilities must be protected and access to care and safety must be guaranteed," Quinto said.

The global health body also flagged wider public health risks due to the crisis, driving up disease risks among people displaced and living in shelter camps with limited access to safe water, sanitation, and hygiene.

As per current estimates, more than 100,000 people in Iran have relocated to other areas of the country due to insecurity, and up to 700,000 people have been internally displaced in Lebanon.

"These conditions increase the risk of respiratory infections, diarrheal diseases, and other communicable illnesses, especially for the most vulnerable populations, such as women and children," the WHO said.

Black Rain And Environmental Hazard

In addition, the Middle East crisis is also increasing concerns over environmental hazards. The petroleum fires and smoke from damaged infrastructure in Iran are potentially causing breathing problems, eye and skin irritation, and contaminated water and food sources.

Recently, Iran saw black rainfall after overnight Israeli strikes on several fuel depots caused fires to burn for hours.

Iran's Red Crescent Society had warned the residents of Tehran and the surrounding region that the rainfall after the strikes could be "highly dangerous and acidic", and could cause "chemical burns of the skin and serious damage to the lungs".

Call For De-escalation

The WHO called on all countries to de-escalate the conflict and "to protect civilians and health care, ensure unimpeded and sustained humanitarian access".

The WHO Director General, Tedros Adhanom Ghebreyesus, shared concerns about the rising global military expenditure and the rising world hunger rates.

"Global military expenditure just hit $2.7 trillion - in a single year. According to the UN estimates, ending world hunger by 2030 would require $93 billion annually. That means we spend almost 30 times more every year on killing each other than on making sure everyone eats. Numbers don't lie. Our priorities do," he said, in a post on social media platform X.

About 30 to 83.7 million adults in the United States have Obstructive Sleep Apnea (OSA), notes American Lung Association. Roughly 80 per cent of these cases remain undiagnosed. However, now, a simple daily pill, an old drug, could just be the solution.

Scientists in Sweden and other places too, have been studying the anti-seizure medicine sultiame as a treatment for OSA. In their latest Phase II trial, the scientists found that people on sultiame experienced an improvement in their apsea symptoms, and their sleep quality too improved as compared to those taking placebo.

The results points towards the potential of sultiame becoming an effective option for people with sleep apnea, especially those who cannot tolerate continuous positive airway pressure (CPACP) machines. The findings are published in The Lancet, and the researchers noted: "These findings offer perspective for a pharmaceutical approach to treatment of patients with obstructive sleep apnea."

Sleep Apnea Pill: What Is This Condition?

OSA is the most common form of sleep apnea, and it happens when airway muscles physically block a person's breathing during sleep. This could pause the body to wake up enough to start breathing again, only for the cycle to restart throughout the night, anywhere from five to 100 times an hour. This also causes low oxygen levels and disturb people's sleep and, over time, can raise the risk of other long-term health problems, which could include heart diseases and even dementia.

What CPAP machines do is they use air pressure to keep the airways open during sleep. While machines are an effective way, some people have trouble using them long term, which is why some companies use less cumbersome interventions, including medicines.

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Sleep Apnea Pill: What Was It Used For?

Sultimae or sulthiame was first launched in the 1960s by Bayger AG as an anticonvulsant - which means, it was a drug designed to treat epilepsy and prevent seizures by stabilizing nerve cell membranes and reducing abnormal, excessive electrical activity in the brain.

What the drug does is, it inhibits carbonic anhydrase, an enzyme that plays a role in regulating our breathing. Research also suggested that this could help people with sleep apnea by preventing airway collapse. The US-based Apnimed, in collaboration with the Japenese company Shionogi & Co., Ltd., have been looking to develop sultiame as a sleep apnea treatment.

How Well Has The Sleep Apnea Pill Been Tested?

The phase II of the trial involved 298 patients. Of them were untreated, moderate and people with severe sleep apnea. The people were observed for over a 15-week period, of them, half were randomized to a placebo pill to be taken right before bed, while rest were given varying doses of sultiame.

The results showed that people who took sultiame saw a noticeable decrease in apnea symptoms and also witnessed improvements in their sleep quality and daytime sleepiness. People in the highest dose group saw the most improvement, with apnea symptoms being reduced up to 47 per cent.

“It feels like a breakthrough, and we now look forward to larger and longer studies to determine whether the effect is sustained over time and whether the treatment is safe for broader patient groups,” said study researcher Jan Hedner, a senior professor of pulmonary medicine at the University of Gothenburg.

Recent legal developments have highlighted the importance of advance planning for end-of-life care.

A Living Will is something every adult should consider discussing and creating at some point.

Conversations within families about individual preferences in the event of a terminal illness are an important first step, and these discussions should take place while everyone is still in good health.

Individuals may have very different views about how they wish to be treated if they develop a terminal illness or certain severe, irreversible conditions. For instance, some may not want ventilator support, while others may choose to avoid ICU care.

Some might accept ICU care but prefer not to undergo CPR. Others may prefer not to receive artificial feeding through tubes. Yet others may wish for every possible treatment to be attempted. A few may prefer to spend their final days at home.

Creating A Living Will

It should be noted that a Living Will does not impose any limitation on treatment for common medical conditions such as infections, surgery for curable illnesses, or routine hospital care.

These preferences apply only to situations such as terminal illness—for example, advanced cancer—or irreversible conditions such as a persistent vegetative state.

Creating a Living Will is now relatively straightforward. It must be signed in the presence of two witnesses and attested by a notary or a gazetted officer.

The earlier requirement of countersignature by a Judicial Magistrate has been removed to make the process easier. Templates are also available online that individuals can use as a basis for drafting their own. Before preparing one, it is helpful to discuss the pros and cons of their choices with the family doctor.

It is important to again emphasize that a Living Will is NOT about refusing all treatment, hospitalization, or ICU admission for routine medical care. Rather, it addresses only specific situations.

When such preferences are clearly documented in advance, important decisions about withholding or withdrawing treatment in select circumstances become less contentious.

Doctors and hospitals will no longer be hesitant to withhold unnecessary treatment measures in such situations, as it will already be documented in the patient’s own Living Will. Relatives also will not face the difficult decision of withholding or withdrawing futile medical treatment on behalf of their loved one.

Essentially, the Living Will protects the patient’s wishes when they are no longer able to speak for themselves.

What Happens Without A Living Will

In a terminally ill patient who is unable to communicate, the absence of a Living Will often leads to differences of opinion among family members about what the patient might have wanted.

This uncertainty frequently results in a collective decision to “do everything possible,” just to be on the safe side.

Doctors are reluctant to override the wishes of relatives, even when they believe that further treatment measures are unlikely to be beneficial.

As a result, the patient may receive prolonged medical interventions that neither improve the underlying condition nor enhance quality of life. Once started, these treatments may continue indefinitely until the patient dies naturally.

This may take months, years, or even decades, and also incur huge costs. In the absence of a Living Will, complex legal procedures are required to withdraw these treatments — even if all the relatives are convinced that they should be withdrawn.