Syria: 10 Confirmed Cases of Polio

Following reports of a cluster of 22 acute flaccid paralysis (AFP) cases on [17 Oct 2013] in the Syrian Arab Republic, wild poliovirus type 1 (WPV1) has been isolated from 10 of the cases under investigation. Final genetic sequencing results are pending to determine the origin of the isolated viruses. Wild poliovirus had not been detected in the Syrian Arab Republic since 1999.

Most of the cases are very young (below 2 years of age), and were un- or under-immunized. Estimated immunization rates in the Syrian Arab Republic declined from 91 percent in 2010 to 68 percent in 2012.

Even before this laboratory confirmation, health authorities in the Syrian Arab Republic and neighbouring countries had begun the planning and implementation of a comprehensive outbreak response. On [24 Oct 2013], an already-planned large scale supplementary immunization activity (SIA) was launched in the Syrian Arab Republic to vaccinate 1.6 million children against polio, measles, mumps, and rubella, in both government-controlled and contested areas.

Implementation of an SIA in Deir Al Zour [Dayr az Zawr] province commenced promptly when the 1st 'hot cases' were reported. Larger-scale outbreak response across the Syrian Arab Republic and neighbouring countries is anticipated to begin in early November 2013, to last for at least 6 to 8 months depending on the area and based on evolving epidemiology.

Given the current situation in the Syrian Arab Republic, frequent population movements across the region and subnational immunity gaps in key areas, the risk of further international spread of wild poliovirus type 1 across the region is considered to be high. A surveillance alert has been issued for the region to actively search for additional potential cases.

WHO's International Travel and Health recommends that all travellers to and from polio-infected areas be fully vaccinated against polio.

Source http://www.promedmail.org/

Suspected Polio Outbreak in Syrian Province Spreads

At least 22 people are now suspected of having polio in Syria, where health officials are scrambling to respond to the 1st outbreak of the crippling viral disease in 14 years, the World Health Organization (WHO) said on Thursday [24 Oct 2013].

Most of those stricken with acute flaccid paralysis -- a symptom of diseases including polio -- in the eastern province of Deir al-Zor are children under the age of 2, WHO spokesman Oliver Rosenbauer said."There is a cluster of 22 acute flaccid paralysis cases that is being investigated in that area,". "Everybody is treating this as an outbreak and is in outbreak response mode."

The WHO, a UN agency, announced on Saturday that 2 suspected cases of polio had been detected, the 1st appearance of the disease in Syria since 1999.Initial tests came back positive for polio in 2 of the 22 cases and final laboratory results due next week from a WHO reference laboratory in Tunis are "very, very likely" to confirm presence of the virus, Rosenbauer said.

There is no cure for the highly infectious disease; it can only be prevented through immunization, usually 3 doses.

More than 100 000 children under age 5 [years] are deemed at risk of polio in Deir al-Zor province, he said. Most of the countryside is in opposition hands but the city of Deir al-Zor itself is still partially controlled by government forces.

"The main concern right now is to quickly launch an immunization response," Rosenbauer said. Vaccination campaigns are being planned across Syria from November [2013] but logistics in a civil war are still being discussed. With some 4000 Syrian refugees leaving the country daily, immunization campaigns are also planned in neighboring countries, where there may be gaps in coverage, he said.

Most of the 22 victims are believed never to have been vaccinated or to have received only a single dose of the oral polio vaccine, Rosenbauer said.

Polio invades the nervous system and can cause irreversible paralysis within hours. It is endemic in just 3 countries, Nigeria, Pakistan and Afghanistan, but sporadic cases also occur in other countries.Rosenbauer, asked whether the virus may have been imported into Syria by a foreign combatant fighting in the civil war, replied: "The 1st step is virological verification that it is the polio virus.

"The next step is that every isolated virus gets looked at genetically to see where is the parent. Hopefully that will provide some clarity on where it would have come from," he said.

The outbreak is the latest setback to international efforts to eradicate polio -- as well adding another dimension to Syria's worsening humanitarian crisis as the war forces people from their homes and destroys health systems.

Polio cases worldwide decreased from an estimated 350 000 cases when the campaign began in 1988 to 223 reported cases in 2012, according to WHO. So far this year [2013] -- not including the 22 unconfirmed cases in Syria -- there have been 296 cases of wild poliovirus worldwide.

Source proMEDmail