Pakistan’s failings to fight polio spark global emergency response


Pakistan's failure to stem the spread of polio triggered global emergency health measures on Monday, with the World Health Organisation (WHO) recommending all residents must show proof of vaccination before they can leave the country.

The emergency measures also apply to Syria and Cameroon, which along with Pakistan are seen as posing the greatest risk of exporting the crippling virus and undermining a U.N. plan to eradicate it by 2018.

Pakistan is in the spotlight as the only country with endemic polio that saw cases rise last year. Its caseload rose to 93 from 58 in 2012, accounting for more than a fifth of the 417 cases globally in 2013.

The virus has recently spread to AfghanistanIraqIsrael and Syria, and has been found in sewage in the West Bank, Gaza Strip and greater Cairo, said WHO assistant director general Bruce Aylward. It also appeared in China two years ago.

“In the majority of these reinfected areas, the viruses circulating actually trace back to Pakistan within the last 12-18 months,” Aylward told reporters on a conference call.

Pakistan has called an emergency meeting of senior provincial and federal health officials for Wednesday to finalise how to implement the new requirements.

“The best option would be vaccinating the passengers at the airport departure where polio vaccination cards would be issued to the passengers. Human resource and vaccines would have to be worked out for the purpose,” State Minister for Health Services Saira Afzal Tarar said in a televised broadcast.

“It would be most practical as people often have to fly in emergencies.”

2018 TARGET

Aylward said Pakistan had done “tremendous” work to restore security in Peshawar after deadly attacks on health workers had impeded the fight against polio. The race to meet a target to eradicate polio by 2018 was still feasible, he said.

“In terms of the 2014 working target to try and stop transmission, from the data presented, clearly Pakistan would be the only country that would be considered 'off track' in terms of its ability to meet that deadline,” he added.

WHO chief Margaret Chan declared the resurgence of the disease to be a public health emergency of international concern, the first such designation since a 2009 flu pandemic.

The travel restrictions should stay in place until there is a whole year with no new exports of the disease, or six months if the countries can show they have carried out high quality eradication activities in infected and high risk areas.

The WHO's emergency committee, an independent group of experts that drew up the recommendations, will meet in three months to assess the countries' actions, or sooner if needed.

The steps published on Monday were the minimum actions that could be taken without unnecessarily disrupting travel or trade, but much stronger measures could have been recommended, Aylward said. Those include full vaccination programmes, restrictions on more countries and recommendations on countries of arrival.

The WHO says 10 million people are walking today thanks to efforts to wipe out the disease, which mainly affects children under five years old. It says economic models show eradicating polio would save at least $40-50 billion over the next 20 years.

Polio passes easily from person to person and can spread rapidly among children, especially in the kind of unsanitary conditions endured by displaced people in war-torn regions, refugee camps and areas where health care is limited.

The virus invades the nervous system and can cause irreversible paralysis within hours. The WHO has repeatedly warned that as long as any single child remains infected with polio, children everywhere are at risk.

There is no cure for the disease but it can be prevented by immunization. The polio vaccine, administered multiple times, can protect a child for life. 

Polio virus strain in Syria confirmed as being from Pakistan, WHO says


Polio that has crippled at least 13 children in Syria has been confirmed as being caused by a strain of the virus that originated in Pakistan and is spreading across the Middle East, the World Health Organisation said.

Genetic sequencing shows the strain found in Syrian children in Deir al-Zor, where an outbreak was detected last month, is linked to the strain of Pakistani origin found in sewage in Egypt, Israel and Palestinian territories in the past year.

“Genetic sequencing indicates that the isolated viruses are most closely linked to virus detected in environmental samples in Egypt in December 2012 (which in turn had been linked to wild poliovirus circulating in Pakistan),” the United Nations agency said in a statement on Monday.

Closely-related strains of the wild poliovirus of Pakistani origin have also been detected in sewage samples in Israel, the West Bank and Gaza Strip since February 2013, it said.

Polio virus has been confirmed in 13 of 22 children who became paralysed in the northern Syrian province of Deir al-Zor. Investigations continue into the other 9 cases. It is Syria's first polio outbreak since 1999.

No children in Egypt, Israel or the Palestinian territories have been hit by polio thanks to high immunisation rates and a strong response to the alert, WHO spokeswoman Sona Bari said.

Polio virus is endemic in Pakistan, Afghanistan and Nigeria despite a 25-year-old campaign to eradicate the disease, which can paralyse a child in hours.

IMMUNISATION RATES

Islamist fighters from countries including Pakistan are among groups battling to oust President Bashar al-Assad, leading to speculation that they brought the virus into the country.

The WHO says it is unlikely that adults, who generally have higher immunity, carried the virus into Syria and that its mode of transmission will probably never be known.

Syria's immunisation rates have plummeted from more than 90 percent before the conflict to around 68 percent. Polio mainly affects children under five and cannot be cured, only prevented.

“All the children (paralysed) are under two years old, so they were all born after immunisation services fell apart,” Bari told Reuters. “No doubt the outbreak will be large.”

Children living in unsanitary conditions are especially vulnerable to the virus, which spreads via faecal-oral transmission and contaminated food and water.

More than 20 million children, including 1.6 million in Syria, are to be vaccinated in Syria and neighbouring countries over the next six months, U.N. agencies said last week.

Reporting by Stephanie Nebehay; editing by Andrew Roche

Polio virus spreads to northern Israel


A strain of the polio virus was found in wastewater near Hadera, meaning the virus has spread to the north of Israel.

The discovery comes two weeks into a national vaccination project to inoculate Israeli children aged 9 and under with a weakened form of the live virus. The vaccination project, scheduled to last three months, has been expanded from southern Israel to central and northern Israel.

As of Wednesday, 182,000 children have been vaccinated with the live virus. The children already have been inoculated against polio in their regular childhood vaccinations.

The campaign is in response to the discovery in May of the polio virus in wastewater in Israel’s South that reportedly had been there since February. The virus was found about a month ago in wastewater in central Israel.

The purpose of the extra vaccine is to pass the weakened virus to adults with whom the children come into contact who may not previously have been vaccinated.

It is believed the virus was brought to Israel from Egypt; polio was discovered in sewage in Egypt in December. The same virus also is prevalent in Pakistan.