The World Health Organization says it has received reports of the first suspected outbreak in the country in 14 years.
Syrian’s Ministry of Public Health is launching an urgent response, but experts fear the disease will be hard to control amid civil unrest.
Immunisation is almost impossible to carry out in regions under intense shellfire.
As a result, vaccination rates have been waning – from 95% in 2010 to an estimated 45% in 2013.
At least a third of the country’s public hospitals are out of service, and in some areas, up to 70% of the health workforce has fled.
Outbreak risks have also increased due to overcrowding, poor sanitation and deterioration in water supply.
- Caused by a highly-infectious virus
- Mainly affects children under five years
- Can lead to irreversible muscle paralysis
- A course of vaccines against polio can protect a child for life
- Global eradication efforts continue
- The disease remains endemic in only a few countries – Afghanistan, Nigeria and Pakistan
- Mass vaccination is needed to eradicate polio
More than four million Syrians who have relocated to less volatile areas of the country are mostly living in overcrowded, unsanitary conditions.
The WHO says it is already seeing increased cases of measles, typhoid and hepatitis A in Syria.
Dr Jaouad Mahjour, director of the department for communicable diseases at WHO’s regional office for the Eastern Mediterranean, said: “Given the scale of population movement both inside Syria and across borders, together with deteriorating environmental health conditions, outbreaks are inevitable.”
The cluster of suspected polio cases was detected in early October 2013 in Deir al-Zour province.
Initial results from a laboratory in Damascus indicate that at least two of the cases could indeed be polio.
A surveillance alert has been issued for the region to actively search for additional potential cases. Supplementary immunisation activities in neighbouring countries are currently being planned.
WHO’s International Travel and Health recommends that all travellers to and from polio-infected areas be fully vaccinated against polio.
Most people infected with the poliovirus have no signs of illness and are never aware they have been infected. These symptomless people carry the virus in their intestines and can “silently” spread the infection to thousands of others before the first case of polio paralysis emerges.
Polio is spread by eating food or drink contaminated with faeces or, more rarely, directly from person-to-person via saliva.
India is getting close to marking its third year without a new recorded polio case, setting the stage for the country to be officially declared polio-free in January. While much has been done to immunize infants against the disease, millions of people are living with polio, unable to live a normal life.
But one surgeon is working to change that.
“I can stand and walk,” Khatoon said. “I just need a little help, and soon I won’t need that as well. Soon, I will be able to walk on my own.”
It took two months of surgery and rehabilitation at St. Stephen’s Hospital for Khatoon to achieve her life-long dream of being able to walk.
She and other young women in this eight-bed ward credit Dr. Mathew Varghese, an orthopedic surgeon who has devoted his entire career to restoring mobility and dignity to those left crippled by the poliovirus that invades the brain and spinal cord, causing paralysis.
“All these girls have been crawling, except for this one, all the others have been crawling,” Varghese said. “The other muscles are very weak. They have never had the opportunity to stand on their two feet. For the first time in their lives – like this girl is paralyzed at six months — she has never been able to stand on her two feet.”
As India gets closer to officially being declared polio-free, the effect of the massive immunization effort can be seen in the hospital, with Varghese now mostly treating people in their early twenties as opposed to young children some two decades ago.
In 1990, New Delhi alone saw 3,000 new polio cases. Now that number is zero.The trend is reflected here at this polio ward, where at its peak it saw 600 patients annually. Now that number is down to fewer than 200.
Rotary International has been on the frontline of India’s polio eradication efforts and helps fund reconstructive surgeries at St. Stephen’s. Former Rotary President Rajendra Saboo saw the need to give polio patients a second chance at a normal life during a trip to a village in the northern Indian state of Uttar Pradesh.
“Then another child came, also crawling,” said Saboo. “And I said ‘what is happening to these children?’ They seem to have been struck by polio. And the villagers said, ‘no, no, no, just forget them, they are dust.’”
But Rotary and Varghese did not forget them. Patients hear about the ward and travel to New Delhi from across India in hopes of correcting bent legs and feet. No one is turned away.
After weeks in the hospital, 19-year-old Abida Khartoon is getting ready to go home to her village in Uttar Pradesh.
“If I had only met Dr. Varghese earlier, I wouldn’t have had as much hardship in life,” she said. “My hands wouldn’t be so calloused [from using them to get around]. Because of him, I am doing better,” she said tearfully.
But Khartoon is not the only one brought to tears. When asked what this surgeon’s dream is — the answer was simple.
“My dream,” he asked, trying to choke back his own tears. “This ward should be empty. No polio.”
read the fill story:
Following two long hauling decades of global vaccination campaign, the world is at the edge of eradicating polio. Pakistan is one of the only three countries, labouring under a huge burden of polio, Afghanistan and Nigeria being the other two. The national campaign to wipe out polio and various deadly diseases from the roots have feared failure for the past few years and very recently, a devastating blow when the murders of the aid workers made headlines and pushed the agencies to suspend the Polio Crusade. Over 90 percent of the polio cases being reported are from four major transmission zones in Fata, Khyber-Pakhtunkhwa (K-P), Baluchistan, central Punjab and Sindh.
Pakistan declared a national health emergency in January 2011 uncovering an action plan with a singular goal of disrupting transmission of the disease by the year’s end. Unfortunately, the initiative failed. A recent intensification of the disease with emerging violence has been highlighted, which unfortunately continues up to date. The incidence of the highly infectious disease is relatively low in the peaceful areas, Punjab and Sindh and high in KPK, FATA and Baluchistan.
In 2011, Pakistan reported 198 fresh cases, being the highest in the world. Over 188 out of the 198 new infections reported to have emerged from the violence-plagued areas. Similarly, 55 out of 58 cases in 2012 emerged from Baluchistan, FATA and KPK. The ruling under the new leadership could have the government to eradicate polio from Pakistan; a goal we have almost achieved. However, in the light of recent attacks on the health care personnel, which included women, have raised fear and subsequent departure from respective duties, abandoning the vaccination campaigns and various health associated activities.
Many have spoken about the government responsibilities, highlighted the need for education of the masses, remote accessibility, promising security services and making this world an infection-free place to live in. However, Polio and I sat down with the Pakistani dilemma where we discussed weaknesses thereafter coming up with a plan we called the Success Staircase. Polio highlighted the first step towards eradication – Health education, which by definition is a positive impact on individual, which results in a favourable behavioural change, leading to good health. Health education in primary health care aims to foster activities that encourage people to want to be healthy, know how to stay healthy, do what they can to maintain health and seek help when needed.
It remains the duty of all conscientious persons dealing with each other in everyday life. Therefore, it starts form “Us”. – The second step towards enlightenment as mentioned by polio was sensitization. This step is overlooked by the authorities who race towards achieving bigger goals neglecting the basics.
Therefore, the nation can come up with new ideas, polices and agendas once we have successfully eradicated polio. Those who have access to health care services should be given a tutorial supplemented with visuals (as seeing is believing) whereas those who remain unattended and unreachable should be approached through media and community leaders. In health campaigns driven in the country so far, no special efforts have been dedicated to reach to the illiterate population. Do we and our future really require clothing labels, processed food, tea and telecommunication plans to recover our health liabilities?
How about we incorporate polio awareness regimens with the existing advertisements. We can target the product consumed/adopted widely by the masses to spread knowledge. For example, through the mobile facility, we can extend text/pictorial messages and offer free tele-health services. Polio and Publicity go hand in hand.
Back in my childhood days, I memorized a jingle that played in a short advertisement of a family planning service. I sang it like all other poems from the recitation classes. A very good example in today’s time emanates from the practice of hand-washing which is a primary step towards nipping the disease in the bud. The hand-wash product came up with a good theme and a child friendly song, bagging nationwide incentive.
My idea was to contemplate campaigns and advertisements in an entertaining approach to grab mass appeal. Instead of having crippled children look at the sight of ordinary kids performing daily activities coupled with a distressing melody in the backdrop, make the practice of inoculation fun and enamouring. Bright colours, energetic theme and lively environment is definitely heartening. Even the census participation was made encouraging due to the cheerful rattle; it ran over the tube a hundred times in a day resultantly.
Polio asked to re-establish priorities. In addition to door-to-door services, establish and push school-to-school and community–to-community agenda forward. Bangladesh is becoming an emerging economy showing cohesive tendencies to various changes and demands. It achieved a huge reduction in poverty; there has been a growth in trade and education, overcoming most of their challenges.
Therefore, in order for Pakistan to grow into a healthy nation, we need a collective collaboration and sustenance program and adequate funds free of manoeuvre. Continued education and training of the health care personnel is a very important step towards the quality of implementation. The trainees should be motivated and expectant for absolute health care delivery. A very important aspect of this exercise remains bridging the communication gap.
Special attention should be given to areas of barriers such as social and cultural divide, negative attitudes, insufficient emphasis and contradictory messages. The trainees should also be offered attractive quality packages keeping in mind the objectives of occupational health; thereby encouraging performance and dedication. Special training and advancements should be offered to promote remote access and healthcare relief. Considering the recent event in the lawless areas, operations and killings of the charity and aid workers had gripped the localities with fear.
Polio emphasized upon security as a requisite for the protection of the conduct. All health associated movements and activities should have satisfactory safety arrangements due to various events in history that have endangered medicine and medical practice. Polio and I spent hours discussing the merits of pressing a campaign in a low profile manner where authorities could inoculate children in phases, with adequate security arrangements instead of pulling off a nationwide campaign which may not only be strenuous to supervise but also under-productive. Another idea that hit us was to offer general healthcare facilities which obviously encased the polio proposal instead of highlighting special polio camps and workers.
This attempt could smash its way into successful inoculation of a child at a routine visit and subsequent education of the guardian. Polio called in for an enterprise which could regain trust. The government should re-think the measures previously taken for the medical movement; making nationwide announcements for a child friendly campaign. Local authorities should scheme initiatives entitled to gain confidence of the masses which is the gateway to reliance upon the government.
Pharmaceutical fraud is the biggest threat to the integrity of the global drug supply. With meager training and knowledge, the criminals have made their way in the market generating illegitimate profits. The impact of the convincing fakes has a potential to contribute to world health crisis. The government should run and revise inspection and subsequent quality control programs and announce strict penalties to the offenders.
Our great emphasis has been on the government abilities. Our system should realize the crisis Pakistan is falling into. We as health officials should join forces to formulate a singular agenda instead of feeding our personal motives, with a sole purpose of a Healthy Nation, Healthier Environment, and the Healthiest People.
Since the eradication of smallpox in the late 1970s, no other diseases have followed suit; the goal that has come closest so far is eradication of polio. The development of vaccines in the 1950s led to cases of polio plummeting: whereas hundreds of thousands were affected annually in the middle of last century, in 2012 around 250 people were paralysed by the disease. But the final stages of eradication are proving more difficult than the early phases. The disease remains entrenched in three countries—Afghanistan, Nigeria, and Pakistan—where social, political, and logistical factors prevent effective vaccination campaigns and lead to export of virus to countries that have previously been free of the disease.
As Haris Riaz and Anis Rehman reported in the journal last month, the global polio eradication programme suffered a grave setback in December last year when seven vaccination workers were shot dead by terrorists as they took part in a 3 day campaign to deliver vaccine in Karachi and Peshawar. At the end of January, two more vaccine workers were killed in a landmine explosion in the Kurrum tribal region. These two latest casualties are not thought to have been directly targeted, but unwitting victims of sectarian violence.
Such events are not only tragic losses—people dedicating their time to a global health effort senselessly killed—but also they leave children who would have received vaccine unprotected and allow the virus to continue to circulate. The consequences of which can be extremely far reaching: in January, poliovirus related to strains circulating in Pakistan was detected in sewage samples in Cairo, Egypt, more than 3000 km away (the last case of polio in Egypt was recorded in 2004). No new cases of polio have been recorded in Cairo, but health authorities are surveying the impoverished districts of Al Salam and Al Haggana where the virus was found for recent cases of paralysis, and vaccination campaigns have been initiated.
In the middle of the 20th century, children in developed countries of Europe and North America would return to school at the end of the summer break and look around to see empty chairs of classmates who had not returned because they had been crippled or killed by polio. When the global polio eradication initiative (GPEI) was launched in 1988, the disease was endemic in 125 countries and caused paralysis in around 350 000 people every year. Recent events highlight how a threat that for many is thankfully a distant memory—or for younger generations in some developed countries unknown—remains a real and present danger.
The Bill & Melinda Gates Foundation is one of the major contributors of financial aid to the polio eradication effort, and speaking recently in London at the Richard Dimbleby lecture, Bill Gates reiterated his commitment to wiping out the diseases, highlighting the new eradication target of 2018. On January 23, the GPEI published a draft Polio Eradication and Endgame Strategic Plan (2013—18). The plan has four main objectives and four milestones for eradication. The four objectives are, detection and interruption of wild poliovirus, strengthening of routine immunisation and withdrawal of the oral polio vaccine, containment and certification (enabling some facilities to store poliovirus and outlining the processes for certification of eradication), and legacy planning to ensure that resources put aside for polio eradication are repurposed when the goal is achieved. The milestones for the new strategic plan are for the last case of wild polio by 2014, withdrawal of type 2 oral polio vaccine by 2015—16, worldwide certification of polio eradication by the end of 2018, and cessation of bivalent oral polio vaccination during 2019.
This is not the first deadline for polio eradication. When the GPEI was set up, the planned date for eradication was 2000. As the cases become fewer, the problems become knottier, and hindrances to final eradication become ever more dependent on localised factors and characteristics of the virus’s remaining toeholds. As the saying goes, the devil is in the detail.
The new plan encouragingly contains intricate analyses of recent outbreaks in the three remaining countries, reasons for programmatic declines, and reflection on the lessons learned from success in India, which has not recorded a case in more than 2 years. It is an excellent example of how data, local knowledge, and experience can be synthesised to provide clear goals and realistic targets. 2018 seems soon, but for some children it will not be soon enough. And for the vaccination workers who have lost their lives, eradication of polio within 5 years would be a tribute to their efforts.