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Largest-ever vaccination campaign underway to stop polio in Middle East
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More than 20 million children are expected to be vaccinated against polio in Syria and neighboring countries, as the largest-ever immunization campaign is underway in the Middle East, according to a joint news release from WHO and UNICEF.
The Middle East declared a polio emergency 1 week ago and the following seven countries and territories are currently attempting a consolidated emergency response to the outbreak: Egypt, Iraq, Jordan, Lebanon, the West Bank and Gaza Strip, Syria and Turkey.
Preliminary evidence has indicated that the poliovirus is of Pakistani origin and is similar to the strain detected in Egypt, Israel, the West Bank and Gaza Strip.
Immunization campaigns
The latest numbers indicate that emergency immunization campaigns in and around Syria to prevent transmission of polio and other preventable diseases have reached more than 650,000 children in Syria. This number includes 116,000 children in the northeastern province of Deir Ezzor where the polio outbreak was confirmed last week.
WHO and UNICEF are initiating multiple mass immunization efforts. In Syria, the campaign is targeting 1.6 million children with vaccines against polio, measles, mumps and rubella. Syria’s immunization rates have plummeted from more than 90% before the conflict to currently 68%.
In Jordan, more than 18,800 children younger than 5 years were vaccinated against polio in a campaign in the past few days; all children at Za’atari camp were targeted. A nationwide campaign is currently underway to reach 3.5 million people with polio, measles and rubella vaccines, according to the release.
In Iraq, a vaccination campaign has started in the west of the country, with another campaign planned in the Kurdistan region. Lebanon’s nationwide campaign is set to begin in a few days and Turkey and Egypt by mid-November.
Polio elimination interrupted
During the past 12 months, poliovirus has been detected in sewage samples from Egypt, Israel, the West Bank and Gaza Strip — regions that have not seen polio for nearly a decade.
The outbreak of paralytic polio among children in Syria has catalyzed the current mass response. This is the first in the country since 1999 and has left 10 children paralyzed and poses a risk of paralysis to all children across the region, according to WHO.
“The polio outbreak in Syria is not just a tragedy for children; it is an urgent alarm — and a crucial opportunity to reach all under-immunized children wherever they are,” said Peter Crowley, UNICEF’s chief of polio. “This should serve as a stark reminder to countries and communities that polio anywhere is a threat to children everywhere.”
This unprecedented response to polio virus circulation in the Middle East calls for 6-month sustained effort of intense immunization activity and heightened disease surveillance until the global eradication of polio.
UNICEF has procured 1.35 billion doses of oral polio vaccine and by the end of the year will have procured up to 1.7 billion doses to meet increased demand. Global supply of oral polio vaccine was already under constraint, with vaccine manufacturers producing at full capacity, according to UNICEF.
Perspective
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Walter Orenstein, MD
The polio outbreak in Syria, which had been free of polio since 1999; wild polioviruses circulating in Israel; and a resurgence of polio in the Horn of Africa (ie, Somalia, Kenya, and Ethiopia) remind us that as long as polioviruses circulate anywhere, countries across the globe are at risk of outbreaks. All of the polioviruses now circulating can be traced genetically to viruses circulating in one of three countries that serve as reservoirs of virus that can be exported to other countries. These countries, called endemic countries because they have never stopped ongoing transmission of indigenous viruses, are Nigeria, Pakistan and Afghanistan. Thus, both to protect children and adults in those countries from this crippling illness, as well as protect the rest of the world, it is important to help those countries terminate the last chains of human-to-human transmission of polio.
The vast majority of polio infections are not associated with paralysis. In fact, almost three-quarters of infections are completely asymptomatic. Therefore, rarely can the sources of a given case of polio be determined. Clinicians should consider polio in the differential diagnosis of any person who presents with the onset of acute flaccid paralysis with fever and intact sensation. If clinically compatible, it is critical to alert the local health department and obtain stool specimens for analysis to rule in or rule out the diagnosis.
Further, it is critical to assure all patients are up to date on their polio vaccinations and that persons traveling to areas where polio is circulating should be updated.
See www.cdc.gov/VACCINES/VPD-VAC/polio/default.htm for more details about polio.
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