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ProMED-mail | POLIOMYELITIS UPDATE (12): SYRIA (DEIR AL ZOUR, AR RAQQAH), SUSPECTED CASES

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Published Date: 2017-06-21 22:00:52
Subject: PRO/EDR> Poliomyelitis update (12): Syria (DY, RA), susp. cases
Archive Number: 20170621.5122019
POLIOMYELITIS UPDATE (12): SYRIA (DEIR AL ZOUR, AR RAQQAH), SUSPECTED CASES
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[1]
Date: 20 Jun 2017
Source: NY Times [edited]
https://www.nytimes.com/2017/06/20/world/middleeast/syria-polio-children-paralyzed.html?hpw&rref=world&action=click&pgtype=Homepage&module=well-region®ion=bottom-well&WT.nav=bottom-well


At least 17 children in eastern Syria have been paralyzed from a recently confirmed outbreak of polio, the World Health Organization said Tuesday [20 Jun 2017], punctuating the health risks to a population ravaged by more than 6 years of war.

It is the 2nd outbreak of the crippling disease to hit Syria since the war began, and largely reflected the inability of health workers to immunize all children caught in conflict zones where access is difficult and sanitation is poor.

The polio virus, once thought to verge on eradication, is one of the most contagious diseases in inadequately protected areas. One confirmed case of paralysis is considered an outbreak, as doctors assume it means up to 200 other people may have been exposed to the virus.

Tarik Jasarevic, a spokesman for the World Health Organization in Geneva, said there was an urgent need to vaccinate more than 400 000 children under the age of 5 in the Deir al-Zour area, where the outbreak was 1st confirmed in an announcement made by the organization on 8 Jun 2017. He described the outbreak as "very serious."

16 of the paralyzed children were from Mayadin, south of Deir al-Zour, and one was from farther north in Raqqa, the Syrian redoubt of the Islamic State extremist group. The entire region has been upended by fighting.

All of the children developed the paralysis between [3 Mar 2017 and 23 May 2017], Mr. Jasarevic said.

Unlike Syria's 1st polio outbreak in 2013, caused by a wild strain that paralyzed 36 children before it was brought under control, the new outbreak is derived from the polio vaccine itself, Mr. Jasarevic said.

The vaccine, a weakened form of the polio virus that triggers the immune system's response, is secreted in the waste of vaccinated children, and over time can mutate into an infectious strain that may afflict the unvaccinated. The risks are especially high in areas where not all children have received the vaccine and where the mutated virus can spread from contaminated sewage or water.

"These vaccine-derived outbreaks really are a marker of poor vaccination and poor sanitation in the community," said Dr. Homer Venters, director of programs at Physicians for Human Rights, an international aid group based in New York that supports humanitarian work in war zones, including Syria and Yemen.

Along with a recent measles outbreak near Damascus, the Syrian capital, and a cholera scourge raging in war-torn Yemen, Dr. Venters said, the new polio outbreak "is another indication that public health systems have been decimated by these conflicts."

As of late March and April [2017], Mr. Jasarevic said, there had been some vaccinations in parts of the Deir al-Zour area, "but security remained an issue, and that's why many children were not vaccinated."

He also said it was unclear whether the afflicted child in Raqqa meant that the virus was circulating there or whether the child had traveled to Raqqa and then developed the case.

[Byline: Rick Gladstone]

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Communicated by:
ProMED-mail
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[2]
Date: 20 Jun 2017
Source: Reuters [edited]
http://www.reuters.com/article/us-mideast-crisis-syria-polio-idUSKBN19B1V8


15 new cases of polio have been confirmed in Syria, including a child who may have caught the disease in Raqqa, the World Health Organization said on Tuesday [20 Jun 2017].

Aid workers are unable to vaccinate the population in and around Raqqa, a city held by Islamic State militants and a target of U.S.-led airstrikes.

The WHO reported 2 polio cases in an area of Syria partly held by the Islamic State earlier this month [June 2017, see prior ProMED posts below for details], the 1st reemergence of the virus in Syria since 2014 and a blow for hopes of eradicating the disease globally.

WHO spokesman Tarik Jasarevic told a U.N. briefing on Tuesday [20 Jun 2017] that 14 more cases had been found in the same area, the Mayadin district of Deir al-Zour province, and another had come from Raqqa, a city where Islamic State fighters are trying to resist a U.S.-backed assault.

"We are very worried, because, obviously, if there is already one case of polio of a kid that is paralyzed, it's already an outbreak. We know, for example, that for one kid that is paralyzed, there are almost 200 asymptomatic, so it means that virus is circulating, so it is very serious," Jasarevic said.

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Communicated by:
ProMED-mail Rapporteur Mary Marshall

[In early May 2017, we posted on suspected cases of polio in Deir al Zour, Syria (see Poliomyelitis update (05): Syria (DY) susp, RFI20170506.5015784). At that time, there were 15 suspected cases reported from the area. Shortly thereafter, a reliable source reported there were 23 identified AFP (acute flaccid paralysis cases, the syndrome that is used to identify suspected cases of polio) cases in that area (see Poliomyelitis update (06): Syria (DY), cVDPV susp 20170512.5032401) and that cVDPV (circulating vaccine derived poliovirus) was suspected to be the etiology of the paralytic polio cases. cVDPV was confirmed in 2 cases plus a 3rd asymptomatic contact of these cases in early June 2017 (see Poliomyelitis update (09): Syria (DY), conf. cVDPV 20170608.5093275), at which time, it was mentioned that there had been 58 AFP cases identified, with 11 having been ruled out as due to polio, but leaving 44 AFP cases still pending laboratory results.

The above reports in today's [21 Jun 2017] update suggest that in total there have been 17 cases (it appears as though the NY Times article includes the 2 cases confirmed earlier this month [June 2017]). Remembering that there were 44 AFP cases still pending laboratory results as of last week, there still remain at least 29 AFP cases pending results, so additional cases confirmed in the coming days/weeks may not be a surprise. Of additional note is the identification of a case in Raqqa. While the location of transmission of the virus involved in this case is not at present known, (locally acquired in Raqqa with local circulation of the cVDPV2 in Raqqa vs. importation from Deir al Zour), the virus has now been introduced into a 2nd province of Syria - Raqqa - which is geographically adjacent to Deir al Zour province and shares a border with Turkey.

This ongoing outbreak of cVDPV2 associated polio in Syria involving geographic areas that are undergoing civil unrest (Deir al Zour and Raqqa are both areas with intense civil unrest, where routine immunization activities are virtually non-existent) is a reminder of the challenges confronting the Global Polio Eradication Initiative. An analogous situation existed (and still exists) in Borno state, Nigeria where there is ongoing civil unrest. Last year (2016), there were 4 WPV1 associated polio cases identified in Borno state of Nigeria, the 1st confirmation of WPV1 cases in the country in 2 years, with a strain of WPV1 that was genetically related to an isolate from Borno state in 2011. A pity how the world has changed. When we began polio eradication efforts in the Americas region back in the 1980s, there were areas with civil unrest, but cease fires were regularly coordinated and implemented to permit vaccination efforts.

For a map of Syria showing provinces, see http://www.emapsworld.com/images/syria-provinces-map.gif. Deir Al Zour is referred to as Dayr az Zawr in this map.

The HealthMap/ProMED map of Syria can be found at http://healthmap.org/promed/p/86. - Mod.MPP]

See Also

Poliomyelitis update (11): Afghanistan, WPV, global update 20170615.5108445
Poliomyelitis update (10): Syria (DY), Congo DR, cVDPV, WHO 20170613.5103235
Poliomyelitis update (09): Syria (DY), conf. cVDPV 20170608.5093275
Poliomyelitis update (08): global (Congo DR cVDPV) 20170526.5064449
Poliomyelitis update (07): Mozambique, Congo DR, VDPV, RFI 20170525.5060299
Poliomyelitis update (06): Syria (DY), cVDPV susp 20170512.5032401
Poliomyelitis update (05): Syria (DY) susp, RFI 20170506.5015784
Poliomyelitis update (04): fractional IPV 20170430.5003843
Poliomyelitis update (03): Pakistan (GB, IS, PB), environmental samples, global 20170316.4905775
Poliomyelitis update (02): Pakistan (GB) WPV1 20170314.4901037
Poliomyelitis (01): Pakistan (GB), global, RFI 20170314.4898724
2016
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Poliomyelitis update (21): IPV shortage, global 20161231.4733243
Poliomyelitis update (01): India, VDPV, wild type-free 20160115.3939297
2014
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Poliomyelitis - update (03): Lebanon ex Syria, susp, global, RFI 20140312.2328674
2013
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Poliomyelitis update (28): Syria, global, WHO 20131128.2078961
Poliomyelitis update (26): Syria, WHO 20131115.2050618
Poliomyelitis update (25): Syria (DZ) conf, WHO 20131030.2027954
Poliomyelitis update (24): Syria susp, Cameroon, global 20131024.2019404
Poliomyelitis update (23): Syria susp., global, RFI 20131020.2010654
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