An outbreak of polio that has paralyzed 13 children in war-torn Syria is linked to a strain of the virus from Pakistan, the World Health Organization said Monday.
The vaccination of children in Syria has been disrupted by the 31-month conflict between President Bashar al-Assad’s forces and rebels fighting to topple his regime.
“Thirteen cases of wild poliovirus type 1 (WPV1) have been confirmed in the Syrian Arab Republic,” the WHO said in a statement.
“Genetic sequencing indicates that the isolated viruses are most closely linked to (a) virus detected in environmental samples in Egypt in December 2012” related to wild poliovirus detected in Pakistan, it added.
“Closely related wild poliovirus strains have also been detected in environmental samples in Israel, (the) West Bank and Gaza Strip since February 2013.”
The United Nations said last week that emergency plans were being made to vaccinate more than 20 million children in the Middle East after polio resurfaced in Syria.
The announcement from the World Health Organization (WHO) and the UN Children’s Fund (UNICEF) called the effort “the largest-ever consolidated immunization response in the Middle East.” It targets children in Syria, Egypt, Iraq, Jordan, Lebanon, Turkey, and the Palestinian territories.
Syria’s polio outbreak is the first there since 1999 and has left 10 children paralyzed. Emergency polio immunization efforts in and around Syria have already reached 650,000 children, including 116,000 in the “highly contested” northeastern province of Deir-ez-Zor, where the outbreak was confirmed last week, the WHO statement said.
It said the campaign aims to reach 1.6 million children in Syria with vaccines against polio, measles, mumps, and rubella. Syria’s polio immunization rate has dropped from 90% before the civil war to 68% today.
In Jordan, more than 18,800 children under age 5 in the Za’atari refugee camp have received polio vaccine in the past few days, and a nationwide campaign aims to reach 3.5 million people with polio, measles, and rubella vaccines, the WHO said. A vaccination drive has also been launched in western Iraq, and another will start soon in the country’s Kurdistan region.
In addition, Lebanon plans to launch a nationwide immunization campaign later this week, and efforts in Turkey and Egypt are expected to start by mid-November, the agency said.
The vaccination in Lebanon is to go house to house and tent by tent. It is a joint effort between the Lebanese government, WHO, UNICEF and a local NGO. The campaign will be vaccinating all nationalities below the age group of 5 living in the country. So, it is not only for the Syrian refugees. According to a report of UNICEF, Lebanon did not have any cases of polio since 2001.
Doctors said they fear that refugees escaping the fighting will bring the disease with them, and that countries with low immunization rates such as Austria, Bosnia and Ukraine are the most at risk.
The UN is trying to convince the Syrian government and rebel forces to instate a “vaccination ceasefire” to allow children to be inoculated. Estimates show that about half a million children have not had the vaccination.
But according to the Lancet, a health journal, vaccinations may not be enough.
Only one in every 200 unvaccinated people infected with polio will show signs, meaning the disease could spread in Europe for up to a year before cases with symptoms appear; at which point, it will be too late for any preventative measures.
The paper calls for routine searching for the virus in European sewage systems, as this method uncovered evidence of polio in Israel.
“Polio is making a comeback,” said Martin Eichner, a professor at the University of Tuebingen who co-authored the letter to The Lancet. Eichner and a German colleague warned that the vaccine used in the United States and Europe offers only partial protection against infection and called for heightened screening of sewage systems near refugee settlements in Turkey and Jordan. Syrian war refugees, moreover, have begun arriving in Western Europe, including Sweden and Germany.
Syria isn’t the only area where poliomyelitis, as the disease is formally known, is rearing its head. It has resurfaced in the Horn of Africa as well as in sewage samples in Israel and Egypt. So far this year, 322 cases have been reported globally, up from last year’s record low of 223. The gain snapped five years of consecutive decline, according to data from the World Health Organization….
Cases of polio, which paralyzed generations around the globe and crippled Franklin D. Roosevelt, have dropped 99 percent since 1988, largely thanks to a global vaccination campaign backed by Bill and Melinda Gates.
More than $10 billion has been invested to eradicate the disease, according to the Global Polio Eradication Initiative, a partnership between the WHO, Rotary International, the U.S. Centers for Disease Control and Prevention and the United Nations Children’s Fund. The Bill & Melinda Gates Foundation has donated or pledged almost $2 billion.
Those efforts have helped stop transmission in all but three countries: Nigeria, Afghanistan, and Pakistan. While cases from those nations are lower this year than in 2012, the virus is re-emerging elsewhere….
Genetic analysis suggests the virus responsible for the cases in Syria is the same as the one found in Israel and Egypt. It came from Pakistan, showing how eradicating the virus at its source is key to stamping out sporadic outbreaks globally, said Hamid Jafari, director of the Global Polio Eradication Initiative.
“What conflict does is that it produces that environment, whereby when poliovirus lands it has plenty of opportunity to thrive, circulate and paralyze children,” Jafari said Thursday….
The virus was also found in sewage and feces samples in Israel, which represents a threat for Europe, the European Centre for Disease Prevention and Control said in September. No actual polio cases have been reported in Israel.
Two vaccines are used to protect children: an oral inoculation that contains the live virus, and a inactivated shot that delivers a disarmed version of the pathogen.
Most Western European countries and the U.S. switched to the disarmed injection more than a decade ago because the oral vaccine was linked to some polio infections. While it prevents paralysis, the shot doesn’t fully protect against infection of the virus. That may enable it to circulate undetected in the region, Eichner and his colleague Stefan Brockmann of the Regional Public Health Office in Reutlingen, Germany wrote in The Lancet.
Eichner said eradication is still possible. “We were so close to getting it done that I still think it is achievable,” he said.
Last month, the World Health Organization (WHO) confirmed 10 cases of polio in the Syrian Arab Republic. Infection is said to have been caused by wild poliovirus type 1 (WPV1), which has not been detected in Syria since 1999….
The majority of European countries now use the inactivated polio vaccine (IPV), as opposed to the oral polio vaccine (OPV), which was discontinued in most areas as it was found to cause some cases of acute flacid paralysis (AFP) – the main symptom of polio.
“Only some of the European Union member states still allow its use and none has a stockpile of oral polio vaccines,” the experts say.
Although the IPV has proved effective in the prevention of polio disease, it only provides partial infection protection, and there is very low vaccination coverage in some regions.
The experts note that infection can only be prevented in Europe if IPV coverage is very high, and if the European population has low crowding and high hygiene levels.
In European regions where vaccination coverage is low, such as Bosnia and Herzegovina, Ukraine and Austria, the experts say the fact that these regions have been polio-free for decades will not provide a “herd immunity” sufficient enough to stop sustained transmission of the WPV1 infection.
Additionally, they note that because only 1 in every 200 WPV1 infections cause identifiable symptoms of polio, such as AFP, it may be almost a year before one case appears and the disease is detected. By this point, they say hundreds of people could be infected.
While the European Centre for Disease Prevention and Control recommends that only Syrian refugees should be vaccinated, Eichner and Brockmann warn that this is insufficient and “more comprehensive measures should be taken into consideration.”…
As the United Nations launched a huge vaccination campaign against polio in the Middle East after an outbreak in Syria, some doctors have questioned its potential effectiveness….
“Polio is very infectious and if we [put together] crowding, poor hygiene, displacement and lack of vaccination, we have the perfect formula for spreading the epidemic out of control,” Zaher Sahloul, president of the Syrian-American Medical Association….
“Given that most kids who get it are asymptomatic or get mild symptoms only, I think the situation reflects that it will be extremely hard to control now,” she said….
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