Syria - Credit Wikipedia
# 7993
The discovery last week of a cluster of Acute Flaccid Paralysis (AFP) in Syria (see WHO: Reports Of Suspected Polio In Syria) has set alarm bells ringing both inside, and outside of that civil war torn country. While there are other, non-polio causes of AFP, preliminary testing has indicated that at least 2 of the 22 cases were positive for wild poliovirus.
Final testing is awaited, but the assumption is that they are dealing with `hot’ AFP cases, and an appropriate response is being planned.
While 22 cases may not seem like a lot, the reality is that only about 1%-2% of those infected develop paralysis. This from the New York Health Dept. Poliomyelitis FAQ
Up to 95 percent of people infected with polio have no symptoms. However, infected persons without symptoms can still spread the virus and cause others to develop polio. About four to five percent of infected people have minor symptoms such as fever, muscle weakness, headache, nausea and vomiting. One to two percent of infected persons develop severe muscle pain and stiffness in the neck and back. Less than one percent of polio cases result in paralysis.
Meaning that 22 AFP cases are simply the tip of the viral iceberg, and could represent more than 2,000 additional infections.
Although Polio is believed to be endemic now in only 3 countries (Afghanistan, Nigeria and Pakistan), already this year we’ve seen reports of polio virus detection in the Middle East (see WHO: WPV1 (Polio) Risks In Israel Remain Moderate to High) and in Africa (see WHO: Polio Outbreak In Horn Of Africa). An wider outbreak in Syria would greatly complicate global eradication efforts.
The World Health Organization has warned that a `failure to eradicate polio from these last remaining strongholds could result in as many as 200 000 new cases every year, within 10 years, all over the world’.
The ECDC released a 5-page Rapid Risk Assessment of the situation, and the threat it may pose to EU countries, this morning. First the link to the report, followed by some excerpts:
Suspected outbreak of poliomyelitis in Syria: Risk of importation and spread of poliovirus in the EU
24 Oct 2013
Available as PDF in the following languages
This document is free of charge.
Abstract
Following the announcement by WHO of a cluster of cases of acute flaccid paralysis in Syria, ECDC conducted a risk assessment and concludes that this does pose a risk that polio might be imported to the EU. The Risk Assessment includes number of recommendations for EU Member States.
EXCERPTS
Main conclusions and recommendations
This cluster of cases of acute flaccid paralysis among Syrian citizens increases the risk for the importation of
wild polio virus to the EU/EEA and further re-establishment and transmission in the Member States.
Recommendations:
- Countries hosting Syrian citizens in designated areas (camps) should assess the level of transmission of wild poliovirus among them. Such assessments can be carried out through enhanced clinical surveillance, environmental surveillance, and systematic collection of stool samples from symptomatic and asymptomatic persons.
- EU Member States receiving refugees and asylum seekers from Syria should assess their vaccination status on arrival and provide polio vaccination and other vaccinations as needed.
- Regional and international efforts to assess the risk and provide vaccination and other public health services in Syria and to Syrian refugees hosted by neighbouring countries should be supported.
- This situation stresses the need for Member States to consider implementing the recommendations made in the ECDC risk assessment of wild-type poliovirus transmission in Israel [2] (see Annex).
- Countries should review their national preparedness plans, and ensure that items such as framework and responsibilities for outbreak response, enhanced activities and reporting timelines vaccine of choice for outbreak response, and are appropriately addressed.
ECDC threat assessment for the EU
The probability is very high that the cluster of cases of AFP in Deir Al Zour province in Syria is caused by wild-type poliovirus, and this risk assessment is based on the assumption that wild poliovirus will be confirmed. Confirmation of the polio outbreak in Deir Al Zour province would signal widespread transmission of poliovirus in Syria and possibly in the areas bordering Syria.
The likelihood of poliovirus spreading from Syria to neighbouring countries hosting Syrian refugees is high.
Large numbers of people are leaving Syria and it is expected that the number of asylum seekers, refugees and undocumented migrants entering the EU will probably continue to increase as the conflict evolves. If poliovirus is indeed circulating in Syria, it should be assumed that a proportion of Syrian refugees are also carrying the virus.
The risk will be highest among children born in Syria since 2011 because of the interruptions to vaccination
services. Further, refugees from Syria are more likely to mix with under-vaccinated populations living in poor
sanitary conditions.
