Polio Epidemic Could Follow Syrian Refugees to Europe

Health workers scramble to vaccinate Syrian refugees, but the virus may have already traveled with some to neighboring countries and Europe.

An Afghan health worker administers the polio vaccine to a child during a vaccination campaign at a refugee camp in Laghman province on June 9, 2013. Polio, once a worldwide scourge, is endemic in just three countries now — Afghanistan, Nigeria and Pakistan.
National Journal
Marina Koren
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Marina Koren
Nov. 7, 2013, 1:30 p.m.

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.

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