Polio, the crippling virus driven to the brink of extinction, may return to Europe as regional conflicts undermine a $10 billion eradication campaign.
Polio’s re-appearance in Syria last month after a 14 year absence raises the risk that the virus will hitch a ride on unsuspecting refugees fleeing the country and return to areas, including Europe, that have been polio-free for decades, according to a letter published in the The Lancet medical journal today.
“Polio is making a comeback,” Martin Eichner, a professor at the University of Tuebingen who co-authored the letter to The Lancet, said by phone today. Eichner and a German colleague warned that the vaccine used in the U.S. and Europe offers only partial protection against infection and called for heightened screening of sewage systems near refugee settlements in Turkey and Jordan. Syrian war refugees, moreover, have begun arriving in Western Europe, including Sweden and Germany.
Syria isn’t the only area where poliomyelitis, as the disease is formally known, is rearing its head. It has resurfaced in the Horn of Africa as well as in sewage samples in Israel and Egypt. So far this year, 322 cases have been reported globally, up from last year’s record low of 223. The gain snapped five years of consecutive decline, according to data from the World Health Organization.
The polio virus, which is spread through feces, attacks the nervous system and can cause paralysis within hours, and death in as many as 10 percent of its victims. There is no cure.
Cases of polio, which paralyzed generations around the globe and crippled former U.S. President Franklin D. Roosevelt, have dropped 99 percent since 1988, largely thanks to a global vaccination campaign backed by Bill and Melinda Gates.
More than $10 billion has been invested to eradicate the disease, according to the Global Polio Eradication Initiative, a partnership between the WHO, Rotary International, U.S. Centers for Disease Control and Prevention and the United Nations Children’s Fund. The Bill & Melinda Gates Foundation has donated or pledged almost $2 billion, making it the biggest donor after the U.S. government.
Those efforts have helped stop transmission in all but three countries: Nigeria, Afghanistan, and Pakistan. While cases from those nations are lower this year than in 2012, the virus is re-emerging elsewhere.
The WHO said last week that 10 cases had been confirmed among 22 children who had become paralyzed in Syria’s northeastern Deir Ezzour province, near the border with Iraq. The proportion of children under age five in Syria who’ve received three protective doses of oral polio vaccine plunged to 68 percent from 99 percent before the conflict began, according to data from the Geneva-based agency.
More than 20 million children will be vaccinated in Syria and neighboring countries as the WHO and UNICEF try to contain the outbreak, the two organizations said in a joint statement today.
Genetic analysis suggests the virus responsible for the cases in Syria is the same as the one found in Israel and Egypt, and came from Pakistan, showing how eradicating the virus at its source is key to stamping out sporadic outbreaks globally, said Hamid Jafari, director of the Global Polio Eradication Initiative.
“What conflict does is that it produces that environment, whereby when poliovirus lands it has plenty of opportunity to thrive, circulate and paralyze children,” Jafari said yesterday in a telephone interview.
Twenty-two vaccinators have been murdered in Pakistan since December, and militants in North Waziristan have banned vaccination in the area, he said. A Pakistan court last year sentenced a doctor to 33 years in prison for running a fake vaccination program in Abbottabad, the town where Osama bin Laden hid for as long as five years, in a bid to obtain a DNA sample from those living in the compound where the al-Qaeda leader was shot dead by Navy SEALs in 2011.
Another 180 polio cases have been reported in Somalia this year, and smaller numbers in Kenya, Ethiopia and South Sudan.
The virus was also found in sewage and feces samples in Israel, which represents a threat for Europe, the European Centre for Disease Prevention and Control said in September. No actual polio cases have been reported in Israel.
Two vaccines are used to protect children: an oral inoculation that contains the live virus, and a so-called inactivated shot that delivers a disarmed version of the pathogen.
Most Western European countries and the U.S. switched to the disarmed injection more than a decade ago because the oral vaccine was linked to some polio infections. While it prevents paralysis, the shot doesn’t fully protect against infection of the virus. That may enable it to circulate undetected in the region, Eichner and his colleague Stefan Brockmann of the Regional Public Health Office in Reutlingen, Germany wrote in The Lancet.
Eichner said eradication is still possible. “We were so close to getting it done that I still think it is achievable,” he said. “We will do it, but it will be harder than a couple of years ago.”