Syria sees first polio outbreak in three years

Polio outbreak in area partly held by Islamic State is a fresh blow to global efforts to wipe out the paralysing disease

Three new cases of polio have been confirmed in an area of Syria partly held by Islamic State (ISIS) in the first reemergence of the virus in Syria since 2014.

The virus was confirmed in two symptomatic adults in the northern governorate of Deir-Ez-Zor and a healthy child, the Global Polio Eradication Initiative (GPEI) said in a statement.

The outbreak was vaccine-derived poliovirus, a rare type which can emerge in under-immunised regions after mutating from strains contained in the oral polio vaccine.

“This only occurs in very rare cases, or where vaccine coverage is very low,” Michel Saffron, director of polio at the World Health Organisation (WHO), said in an interview posted by GPEI.

“We must act very rapidly to protect the children of Syria, who are already suffering from the conflict"The seven-year war in Syria has hindered vaccination drives by cutting off access to vulnerable communities. There were two immunisation campaigns in Deir-Ez-Zor in March and April this year, GPEI said, but only limited coverage was possible due to security concerns.

However, detection of the cases did demonstrate that disease surveillance systems were functional in Syria, it added.

“This means many children are vulnerable to the spread of the virus,” Saffron said. “We must act very rapidly to protect the children of Syria, who are already suffering from the conflict there.”

The outbreak is a fresh blow to global efforts to quash polio, and jeopardises the goal of making it only the second human-hosted virus to be eradicated since smallpox was banished in 1980.

In 2016, a total of 37 cases of polio were reported globally - in Nigeria, Afghanistan and Pakistan; the three countries still endemic for the virus. As recently as 1988, the disease was rife in 125 countries, paralysing 350,000 people a year.

The original wild virus still circulates in Afghanistan, Pakistan and Nigeria, but vaccine-derived polio can reemerge in warzones and in communities with low health coverage. Nigeria, where widespread unrest has hampered immunisation efforts, has seen vaccine-derived polio cases in recent years.

Deir-Ez-Zor in 2013 and 2014 was the epicenter of a wild poliovirus type 1 outbreak, which resulted in 36 cases. The most recent outbreak will be stopped “in the same way as we stop the circulation of wild poliovirus,” said Saffron. “We have to vaccinate, massively and rapidly, the populations at risk. This is how we interrupt the transmission of the virus.”

The conflict in Syria has left more than half of public hospitals and primary health centres closed or only partially functioning, according to the WHO. Almost two-thirds of healthcare workers have fled, and medical facilities that are open lack clean water, electricity and supplies.

Medical journal The Lancet reported that healthcare workers, clinics and hospitals were attacked more than 400 times between November 2015 and December 2016. Many of the attacks were fatal.