Risk of Polio Spread in Europe After Ukraine Cases

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Sept. 8, 2015 – While the UN has set 2018 as its target for the global eradication of polio the confirmation last week of cases in Ukraine – which left two children aged four years and ten months paralyzed for life – is worrying proof that if vaccination rates slip then the virus will reemerge.

Ukraine had only a 50 percent polio vaccination coverage rate in 2014 but that had reportedly slipped to 14 percent this year due to low or no availability of vaccine doses and strong anti-vaccine sentiment.

The Global Polio Eradication’s International Monitoring Board (IMB) issued a warning less than a year ago that “the risk in Ukraine is of deep concern.”

The Oct. 2014 warning added that, “The last thing the global polio eradication program now needs is the re-emergence of polio in a place distant from its two epicentres and threatening to reverse the certified polio-free status of a whole region (in this case Europe).”

Polio incidence has been reduced by 99.9 percent since 1988 when there was an estimated 350,000 cases to just 37 cases in 2015 as of Sept. 2.

The two Ukraine cases occurred in the southwest of the country which shares borders with Hungary, Poland, Romania and Slovakia. To contain the spread, the World Health Organization says two million children in Ukraine under the age of five must begin to get vaccinated within two weeks of the confirmed cases.

Children typically get four doses of the polio vaccine, at ages two months, four months, 6-18 months and a booster does at 4-6 years.

The children in Ukraine were infected with a vaccine-derived type of polio. Such cases are rare – there have only been only 500 cases of paralysis from circulating vaccine-derived polio virus type 1 (cVDPV1) from 2001-2011 while the oral polio vaccine has prevented some 3.5 million cases of paralysis – but the most important risk factor for emergence and spread of cVDPV1 is immunity gaps resulting from low immunization coverage.

The European Center for Disease Control (ECDC) in a bulletin last week said, “It is likely that the cVDPV1 strain has been circulating for many months in Ukraine and that the virus could be found in other parts of the country.”

“Based on experiences from other similar events in the past, we can assume that the risk of more children presenting with paralytic poliomyelitis in Ukraine is high and that it will remain high until large-scale supplementary immunisations have been implemented, in accordance with WHO recommendations for the control of polio outbreaks,” the bulletin added.

It said there is risk of the virus being imported into EU countries from border areas but the risk of it resulting in paralysis is low given widespread vaccine coverage. However, the ECDC warned that there are pockets of under-immunized or unimmunized people in the European region, and said Bosnia and Herzegovina, Romania and Ukraine are at high risk for further polio spread.

– Denis Fitzgerald @denisfitz

Preliminary Evidence Suggests Polio in Syria Came from Pakistan

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Nov 10, 2013 – Foreign fighters appear to be the source of the outbreak of polio in Syria that risks infecting hundreds of thousands of children in the region.

Initial tests indicate that the poliovirus detected in Syria is of Pakistani origin, according to UNICEF and the World Health Organization.

Pakistan is one of only three countries – along with Afghanistan and Nigeria – where the virus remains endemic. The BBC reported in July that the Pakistan Taliban had set up a base inside Syria to join the fight against the Assad regime.

Syria had been polio free for fourteen years prior to the outbreak and the virus had not been detected in neighboring countries in the past decade but so far this year has been found in sewage samples in Egypt, Israel, the West Bank and Gaza.

Polio affects the nervous system and can cause paralysis within hours. It usually affects children under five and is typically spread through contact with contaminated feces.

Children usually require four doses of the polio vaccine before school-age to provide lifelong protection against the virus.

As a result of the conflict, immunization rates have plummeted from 92 percent before the conflict to 67 percent as of 2012, according to UNICEF.

WHO and UNICEF aim to vaccinate 20 million children in Syria and neighboring countries in the coming months to prevent an epidemic.

– Denis Fitzgerald
On Twitter: @denisfitz

photo/UN Photo

Syria: The War on Development

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Oct. 31, 2013 – Syria’s economy has lost more than $103 billion since March 2011 while 2.3 million jobs have been lost and almost half the country’s school-age children are no longer in formal education.

The country’s conflict, which started after government forces used lethal force on peaceful protesters, has claimed the lives of more than 100,000 people while an estimated 400,000 more people have been maimed or injured. That’s 2 percent of the population that have been killed, injured or maimed.

These are among the dire statistics in a joint report issued by UNDP and UNRWA this week on the devastating impact of the conflict on Syria’s socio-economic development.

Some 3,000 schools are out of service as a result of damage or destruction while others are housing internally displaced people.

The effect on medical services is particularly acute with the ratio of doctors to serve the population falling from one for every 660 people to one for every 4,400 people.

The World Health Organization earlier this week reported that cases of polio have been confirmed, the first such outbreak since 1999 and that vaccination rates have plummeted from 91 percent in 2010 to 68 percent in 2012.

Some 8 million Syrians have fallen into poverty since the crisis began with more than half of those living in extreme poverty.

“As the formal economy has imploded there has been a growth in informality, rent-seeking 
activities, criminal enterprise and economies of violence that will plague post-conflict economic regulation, reform, equity and development,” the UNDP-UNRWA report says.

The full report is here

– Denis Fitzgerald
On Twitter @denisfitz

Photo/Wikimedia