Response to a Large Polio Outbreak in a Setting of Conflict — Middle East, 2013–2015

Weekly / March 3, 2017 / 66(8);227–231

Chukwuma Mbaeyi, DDS1; Michael J. Ryan, MD2; Philip Smith, MD2; Abdirahman Mahamud, MD2; Noha Farag, MD, PhD1; Salah Haithami, MD2; Magdi Sharaf, MD2; Jaume C. Jorba, PhD3; Derek Ehrhardt, MPH, MSN1 (View author affiliations)

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Summary

What is already known about this topic?

Afghanistan, Nigeria, and Pakistan are the only three countries that have never interrupted endemic transmission of wild poliovirus (WPV). Continued WPV circulation in these countries poses a risk for polio outbreaks in polio-free regions of the world, especially in countries experiencing conflict and insecurity, with attendant disruption of health care and immunization services.

What is added by this report?

A WPV outbreak occurred in Syria and Iraq during 2013–2014 after importation of a poliovirus strain circulating in Pakistan. The outbreak represented the first occurrence of polio cases in both countries in approximately a decade, and resulted in 38 polio cases, including 36 in Syria and two in Iraq. Development and implementation of an integrated response plan for strengthening acute flaccid paralysis surveillance and synchronized mass vaccination campaigns by eight national governments in the Middle East facilitated interruption of the outbreak within 6 months of its identification.

What are the implications for public health practice?

Countries experiencing active conflict and chronic insecurity are at increased risk for polio outbreaks because of political instability and population displacement hindering delivery of immunization services. Adoption of a concerted approach to planning and implementing response activities, with involvement of more stable neighboring countries, could serve as a useful model for polio outbreak response in areas affected by conflict, as exemplified by the Middle East polio outbreak response.