November 13, 2013
WHO Confirms Syria Polio Originated In Pakistan, Threat To Europe
Lawrence LeBlond for redOrbit.com - Your Universe Online
The outbreak of wild poliovirus type 1 (WPV1) in the Syrian Arab Republic has risen from 10 to 13, after laboratory testing has confirmed three new cases of patients who had previously been diagnosed with acute flaccid paralysis (AFP). Initially, health experts found 22 cases of children, mostly under the age of two, with AFP from the Deir al-Zor province. Preliminary analysis led health officials to believe these children could have polio.
The threat remains high for other children to become infected with the dangerous poliovirus, and Syria has maintained that it will initiate a widespread vaccination program to immunize the country’s children from this paralyzing disease. Polio, which had been eradicated from the country in 1999, is believed to have returned on the heels of civil war, with some people in Syria pointing the finger at Pakistani rebels.
While some have been pointing fingers, expert researchers have been busy trying to find the origination of the virus. In a November 11 report, the WHO, under the direction of the United Nations, confirmed that genetic sequencing shows the isolated viruses are most closely related to environmental samples pulled from Egypt in December 2012. Interestingly enough, those samples had, in fact, been linked to the poliovirus circulating in Pakistan.
Additionally, closely-related strains of Pakistani WPV1 have turned up in sewage samples taken from Israel, the West Bank and Gaza Strip since February 2013, according to a report from Reuters.
While some originally suspected Pakistani and other Islamist fighters as being the cause of bringing polio to Syria, the WHO says that it is unlikely that adults, who generally have a higher immunity to the disease, are the ones carrying polio to Syria. It added that the mode of transmission will likely never be known.
Immunization rates in Syria have plummeted from more than 90 percent before the conflict began in March 2011 to around 68 percent today. Polio mainly affects children under the age of five and cannot be cured, but is preventable.
"All the children (paralyzed) are under two years old, so they were all born after immunization services fell apart," WHO spokeswoman Sona Bari told Reuters’ Stephanie Nebehay. "No doubt the outbreak will be large."
The virus typically affects children living in poor, unsanitary conditions and spreads easily through fecal-oral transmission and can contaminate food and water. Syria, with the aid of the UN, plans to vaccinate more than 1.5 million children in the Syrian Arab Republic. The UN also has plans to vaccinate a total of 20 million kids throughout neighboring regions over the next six months.
While the UN is launching an ambitious immunization plan for the Middle East, some infectious disease experts are concerned that Europe could be at risk from the recent outbreak in Syria.
Two German doctors have reported in the journal The Lancet that polio cases from Syria could endanger nearby regions, as well as spread to other parts of the world, namely Europe. They said that because only one in 200 people infected actually develops paralysis, it could take a year or longer before an outbreak is detected. In that time, hundreds of people could be carrying the infection and not even know it.
The big issue right now is vaccinations, explain Professor Martin Eichner, of the University of Tubingen and Stefan Brockmann, of Reutlingen Regional Public Health Office.
The duo said that most European countries use inactivated polio vaccine (IPV) rather than live oral polio vaccine (OPV), because OPV can, albeit rarely, lead to cases of AFP, which is the main symptom of polio.
While IPV is highly effective at preventing polio, it does not offer the same level of protection as the oral vaccine. So with IPV, vaccination coverage needs to be extremely high. The doctors said that countries with low coverage, such as Austria and Ukraine, risk a sustained outbreak should the virus be introduced by refugees fleeing Syria. In the UK, however, vaccination rates are very high and a sustained risk is minimal.
However, in an interview with the BBC, Dr Benjamin Neuman, a virologist at the University of Reading, said, “Vaccination is never perfect, so despite being vaccinated, a small percentage of children in the UK would be at risk of contracting polio if they were exposed to the virus. Until the virus is completely extinct, it is essential that we continue to vaccinate our children."
"The UK is well defended against the possibility of importation of polio from outbreaks such as the present one in Syria. Our population has very high coverage of polio vaccination with more than 95 percent of young children being vaccinated. We have WHO-approved surveillance in place so we can pick up polio if it does start to circulate in the UK," noted UK Department of Health Director of Immunization, Professor David Salisbury.
Prof Eichner said fighting polio is like fighting an invisible enemy, because while most people who become infected do not display symptoms, they can still spread the disease to others. This will make it much more difficult for the WHO to conquer a disease that at one time was believed to be nearly completely eradicated in most of the world.