Every day, hundreds of Syrians flee their country, seeking shelter in neighboring countries. Some are traveling farther, to Europe, bringing what few belongings they have. What the refugees don't know — what their host countries don't either — is that some of their possessions may be dangerous.
Late last month, the World Health Organization confirmed in Syria 10 cases of polio, a crippling disease largely eradicated in the developed world. As the stream of Syrians pouring into other parts of the world continues, experts say, the risk of an outbreak in polio-free countries climbs.
Government health officials are scrambling to vaccinate young children in refugee camps, where close quarters and poor hygiene create breeding crowds for any communicable disease, including polio. Although Syria's last polio case surfaced in 1999 thanks to a rigorous national public-health campaign, the country's vaccination rates have dropped to 60 percent during the ongoing civil war.
In a memo published Thursday in the the medical journal The Lancet, two German public-health experts warn that Syria's outbreak may threaten Europe. "Vaccinating only Syrian refugees — as has been recommended by the European Centre for Disease Prevention and Control — must be judged as insufficient," they write. "More comprehensive measures should be taken into consideration."
"The likelihood of poliovirus spreading from Syria to neighbouring countries hosting Syrian refugees is high," an Oct. 23 report from the European Centre for Disease Prevention and Control read. The organization advised Middle Eastern countries hosting Syrian refugees to "assess the level of transmission" of the disease and European nations to "assess [refugees'] vaccination status on arrival and provide polio vaccination" as needed.
Today, according to WHO, polio is endemic in only three countries: Afghanistan, Nigeria, and Pakistan. Most European countries, free of the disease for decades, use inactivated polio vaccine, or IPV, administered through an injection, rather than oral polio vaccination, taken by mouth, which was discontinued because it caused, in rare cases, acute flaccid paralysis, the main symptom of polio.
According to the Lancet letter, IPV is very effective in preventing the disease, but does not provide complete protection from infection. Transmission of the disease can only be stymied, the experts write, if IPV coverage remains widespread and routine. In polio-free countries, that's not always the case. Countries like Austria, Ukraine, and Bosnia and Herzegovina, where vaccination rates are low, are most at risk, the experts say.
Because only one in 200 people infected with the virus exhibit symptoms of the disease, many carriers don't know they're infected, nor that they're putting others at risk. The virus can circulate through a population for up to a year before a single case of the acute paraylsis appears, the memo explains. By then, hundreds of people could already unknowingly infected.
Only some countries within the European Union still offer the oral vaccination, Lancet reports, and none have a stockpile of it for emergency use for a possible outbreak.