Syria polio outbreak a heartbreaking setback in struggle against virus

Teams of volunteers are being sent to seven Middle Eastern countries to vaccinate people against polio after an outbreak in eastern Syria paralyzed at least 10 young children.

The outbreak is an unsettling setback in efforts to eradicate the disease and a reminder that the toll of war can include more than those killed or hurt directly by conflict. It’s also a warning of just how hard it can be to eradicate any disease — even one like polio that should be, in theory, easy to eliminate.

The children affected live in Deir al-Zour province in eastern Syria. They all appear to be ages 2 and under, and may have gone unvaccinated in the chaotic conditions caused by the conflict there. They have the worst symptom of polio: paralysis.

“Unfortunately, it is not something that you can reverse,” says Gregory Hartl, a spokesman for the World Health Organization in Geneva. “If they are paralyzed they are paralyzed. They will have to live with it for the rest of their lives.”

“This is what is happening to children as a result of this awful conflict,” added Sarah Crowe of UNICEF. “We think of conflict maiming children but it’s this basic neglect that can kill, maim or cripple them.”

Polio is caused by a virus that spreads between people, but it can survive in water and sewage. A series of vaccines can protect a person for life, but babies too young to have been vaccinated and children who haven’t had the full course are vulnerable.

In Syria, that may mean millions. The conflict has caused a giant humanitarian crisis in which 100,000 people have been killed and nearly 7 million driven from their homes. Two million have fled the country.

It’s not yet clear how the virus got back into Syria, which had eliminated polio in 1999. But it didn’t have far to travel. “The virus was already in the region,” Hartl says. It had been reported in sewage systems in Israel, the West Bank and Egypt in recent months.

“Literally, the virus could have walked in in someone or driven in someone or flown in in someone from any of those three locations into Syria,” Hartl said in a telephone interview. And those viruses in the region carry a genetic fingerprint that indicate they originated in Pakistan.

Polio only causes symptoms in about 1 in every 200 infected, so it can spread unnoticed, at first. “That means 199 out of 200 people carry the virus in their gut for some period of time and excrete that virus,’ says Dr. Greg Wallace of the U.S. Centers for Disease Control and Prevention.

“One person infected with polio is all it takes to start the spread of polio to others if they are not protected by vaccination,” he added. “It is just another warning that you cannot stop until you are completely done…Every last child. That’s what it takes to eradicate this disease.”

Vaccination efforts are focusing on more than 2 million children in Syria, as well as in populations in bordering countries — Iraq, Turkey, Lebanon, Jordan, Israel, the Palestinian territories and Egypt.

Undernourished children are especially vulnerable, so UNICEF is feeding children a nutritious paste called Plumpy’nut, and giving some vitamin A supplements, as well as the measles, mumps and rubella vaccine, Crowe says.

Public health experts have been tantalizingly close to eradicating polio for decades. They wiped it out in the United States in 1979 after a campaign lasting more than 20 years. It’s gone in the Western Hemisphere and now only lingers in spots in Pakistan, Afghanistan and Nigeria, although an outbreak going on in Somalia since April had officials worried.

They know it can be done — mass vaccination eradicated smallpox, another virus that only infects people, so there’ s no animal reservoir for it to hide out in.

But every time vaccination teams make progress, outbreaks of conflict can take them back to page one. This has happened in Syria, where vaccination teams are working with the official department of health, as well as nonpartisan groups such as the Syrian Red Crescent, to get across battle lines and to the people who need vaccines.

“What has happened is that in the two years or so since the conflict has started in Syria, vaccination rates for children have plummeted,” Hartl said.

Nearly all Syrian children, 90 percent, were vaccinated against polio before the civil war began in 2011. Now only 60 percent or so of children are vaccinated.

“So now there are at least 30 percent of children who are not getting the vaccine,” Hartl said. “In those cases you are seeing polio and other diseases as well.”

The disease was last reported in Syria in 1999. Last year, authorities counted 223 cases of polio worldwide, down from 650 the year before.

But WHO and other groups have been working to eradicate polio, which only infects humans. Vaccination has reduced polio outbreaks by 99 percent. Officials had once hoped polio could be the second human disease to be completely eradicated by vaccination, as smallpox was in the 1970s.

Wallace said Americans formed long lines, clamoring for the vaccine when it first became available in the 1950s. There was widespread fear of polio, whose disease manifestation, poliomyelitis, can paralyze limbs, or even the whole body, forcing people to spend their lives in iron lung machines that help them breathe.

One of the last victims in the United States, a 61-year-old woman who lived in an iron lung for nearly all her life, died in 2008 during a power outage.

Syria’s outbreak is unlikely to threaten anyone in the U.S. “Our assessment is that the risk at this time is extremely low,’ Wallace said. “But until polio is completely eradicated from the planet, it’s not zero.”

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