Middle East

Dr. Faten has spent almost 25 years fighting the poliovirus. ©Faten Kamel

Dr Faten Kamel is on a flying visit to the WHO Eastern Mediterranean Regional Hub, stopping for meetings and to deliver a lecture on the relationship between polio and patients with primary immunodeficiencies. Then she’s off again – to Pakistan to take part in a polio programme management review.

Dr. Faten has travelled to every country in the Eastern Mediterranean Region, and many more besides. Alongside working as a Senior Global Expert for the programme, she is a wife, a mother, grandmother, and an informal mentor to women in public health.

Growing up in Alexandria, Egypt, Dr. Faten was exposed to the life-altering effects of polio on the people around her and was inspired by the work of her father, a surgeon and a Rotarian.

“My father was my role model, he had great passion for helping others and was also a Rotary Club president in 1989. His project for that year was on polio eradication.”

“Polio was prevalent in Egypt in those days. A number of people around me were affected. I was touched by their suffering in a place which was not highly equipped for people with special needs at that time.”

Checking the immunization status of children in Upper Egypt. ©Faten Kamel

Making rapid gains against polio

After graduating from her Medical Degree and Doctorate in Public Health, and lecturing for several years at Alexandria University, Dr. Faten moved into a role for WHO. She found her niche working in the immunization team. “Immunization is the most cost effective public health tool – it can prevent severe and deadly diseases with just two drops or a simple injection – I strongly believe in preventive medicine,” she explains.

“I became the Eastern Mediterranean Regional Medical Officer for polio eradication in 1998. At that time many countries were still endemic.”

The 1990s and early 2000s were years of rapid gains against the virus. However to fully eradicate polio, it was becoming clear that the programme would have to be more ingenious than any disease elimination or eradication project that had come before.

Dr. Faten took a leading role. She explains, “Strategies for immunization and disease surveillance were established, and these methods evolved over time. We pushed the boundaries to make the programme more effective – shifting to house to house vaccination, detailed microplanning and mapping, retrieval of missed children and independent monitoring.”

“We started as a small team – covering different aspects of work and supporting all the countries. My team started the regular analysis and publishing of data in “Poliofax”, we supported the shift to case based and active surveillance and gradually added different supplementary activities including environmental surveillance.”

“I was blessed to have the support of my parents, my husband and my son. As a married woman I think it is very important to have the support of your family. I also had wonderful supervisors who believed in my capabilities and gave me opportunities. I am similarly impressed with many of the young women in the programme today.”

Determined to monitor immunization activities in hard to reach areas in Pakistan. ©Faten Kamel

Overcoming outbreaks

Sometimes the biggest challenges for Dr. Faten and her team came out of the blue, such as when the programme faced huge polio outbreaks in areas that had become free of the virus.

“We didn’t expect polio to cause large outbreaks, but we were faced with them. To overcome the situation we started to work together as partners on effective response strategies within and across regions. The virus does not stop at borders and we had to coordinate multi-country activities.”

“In the polio eradication programme we cannot be satisfied with 80% or 90% coverage – we need to reach each and every child no matter where they are, even in the hard to reach and insecure places. So there was always a lot of innovation and adaptive strategies, we were thinking how can we bridge this, and reach these children.”

“That’s how we came up with access analysis and negotiation, days of tranquility, using windows of opportunities and short interval campaigns, community involvement and collaboration with NGOs, intensifying work at exit points, thinking out of the box all the time.”

Visiting homes in a tribal area of Pakistan close to the border with Afghanistan. All children in this photo lived in the same household, underlining the importance of going door to door to ensure that every child is reached. ©Faten Kamel

Tracking polio down unexpected paths

Dr. Faten was determined to possess firsthand information on polio cases, no matter where they occurred. Sometimes, this led her down unexpected paths – such as when she travelled 21 hours through the Sudanese bush to track down a polio case in a remote village.

“I’ll never forget when a wild poliovirus type 3 (WPV3) case appeared in a very faraway place in Sudan after years without WPV3. I said, “I have to see it myself”. This mission was one of my most challenging fieldtrips.”

“We faced many difficulties, it was the rainy season, the car slipped on its side on our way and we arrived after midnight.”

“I thought the virus must have been hiding in this place for years. But I found the disease surveillance to be very good. Then by investigating, we found there was a wedding, and relatives were coming from another province, so I could nearly point my finger to where the virus came from. The virus was detected in that area and we managed to curtail its spread.

Addressing the media to declare the end of the Middle East polio outbreak on World Polio Day, 24 October 2015 in Lebanon. ©Faten Kamel

A career spent getting ahead of the virus

In 2016, Dr. Faten set up the Rapid Response Unit in Pakistan – a dedicated ‘A team’ that can jump into an at-risk area to mitigate virus spread. Today, she is working with medical professionals to ensure that individuals with primary immunodeficiencies get tested for poliovirus, as some of them are at risk of prolonged virus shedding.

What keeps her awake at night?

“I care about where we are not reaching. Polio eradication is beyond health – it needs all the sectors to come together especially in a big country. In the last strongholds of the virus we have population movement across the border, some areas that are difficult to reach, and there are some misconceptions.”

“If someone comes and says this area is inaccessible, this is not an answer for me. I ask: What should we do to reach? I like to make use of the ideas and experience that come from local people. The virus strongholds are in certain areas, so let us work closely with the people in these areas, empower them, and allow them to change the situation.”

Dr Faten is proud to be part of the polio eradication programme and looks forward to the day when polio eradication is achieved, so she can spend more time with her family in Australia.

“As a grandmother, I am especially determined to finish the job. I want my grandkids to grow up in a world free of polio. This will be my contribution to their futures.”

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More than 27 million children across the Middle East have been reached with polio vaccines since the outbreak in 2013. WHO

Despite continuing conflict, declining immunization rates in conflict-affected areas and mass population displacement, no new polio cases have been reported in the Middle East for over 18 months, and experts believe the extensive multi-country outbreak response has been effective in stopping the outbreak.

The outbreak, which was detected when a case of polio was confirmed in northern Syria, paralysed 36 children in Syria and 2 in Iraq between October 2013 and April 2014, prompting fears of a major epidemic. In what has become the largest ever immunization response in the history of the Middle East, more than 70 mass immunization campaigns were implemented in 8 countries, aimed at reaching 27 million children with vaccine multiple times, and more than 200 million doses of vaccine were given.

“The response in the Middle East is one of the most well-coordinated and intensely focused outbreak response efforts we’ve seen in the history of eradication programmes,” said Chris Maher, Manager Polio Eradication and Emergency, WHO. “We congratulate governments, health partners and communities around the Region for the role they’ve played in preventing a major epidemic.”

The swift and collaborative intervention and effective partnerships between the governments of countries dealing with the outbreak, World Health Organization (WHO), UNICEF, other global Polio Eradication Initiative partners, international organizations and nongovernmental organizations has been given credit for the successes of the response and the lessons learned have been shared globally.

“In such a complex environment, teams were working round the clock to reach missed children and engage in social mobilization with communities and raise awareness about the vaccination” says SM Moazzem Hossain, regional Chief of Child Survival for UNICEF.

Representatives from governments and the Global Polio Eradication Initiative met in Beirut this week to review the outbreak response and discuss next steps to maintain the gains made. Experts strongly encouraged governments to continue working with partners to strengthen the basic delivery of routine immunization and focus on further strengthening surveillance so that the virus will be detected should it reappear.

Despite the positive news for the Region, the risks and factors that led to the outbreak remain and complacency at this time could be disastrous. In the Region, up to 700 000 children under the age of 5 are not reached on a regular basis by polio vaccine.

“Across a number of countries in the Region, insecurity and displacement of communities is making it difficult to reach all children with vaccines,” WHO’s Mr Maher said, “the job of our partnership is far from done, over the coming months we will continue to work together to reach children to be able to sustain the achievements and keep the Region polio free.”

This World Polio Day, we celebrate the gains made and say “thank you” to the countless people have been working tirelessly to stop the polio outbreak in the Middle East.

20150217_MEMtg — A newborn receives the oral polio vaccine in Lebanon during the October campaign as part of phase II of the Middle East outbreak response. © WHO EMRO

On the 26 and 27 January the Middle East Polio Outbreak Response Meeting was held in Beirut to review the response to the outbreak of polio that began in 2013 in Syria, and to plan for the next phase of response.

The World Health Organization and UNICEF congratulated everyone involved in the extraordinary effort since October 2013, from governments and non-governmental organizations (NGOs) through to health workers and volunteers, and most importantly parents. Tremendous efforts, especially from those health workers on the frontline working under extremely difficult conditions, have established the Middle East outbreak response as one of the most effective in recent years globally.

At the Outbreak Response Review Meeting, updates of the current situation and plans were presented from 8 countries within the region, with particular emphasis on the highest priority countries, Syria and Iraq, where cases of polio were reported during the outbreak.

The review concluded that the evidence demonstrated that the Middle East outbreak response has prevented a major multi country epidemic. Best practices from Phase II were shared, including evidence for successful measures taken to reach high risk populations, processes for tailoring interventions to reach missed children, the engagement of private sector physicians, the mobilization of social media, and the role of community leaders in supporting polio eradication activities.

The success of the outbreak response was attributed to several key factors. Firstly, rapid, repeated and targeted vaccination campaigns enabled 27.7 million children to be reached across the sub region, with over 142 million doses of oral polio vaccine provided since the first of 56 vaccination campaigns was rolled out since October 2013. In addition, strong commitment from national and local authorities, NGOs, the United Nations and communities who participated in the process were absolutely crucial in the scale of the response.

Phase I and II of the response have improved levels of immunization against polio across the region and strengthened surveillance. The containment of the virus to just two countries in the region despite conflict and major population movements was commended. The review also showed that during phase II, efforts were made to improve basic immunization services for internally displaced people and refugees, especially in high risk areas, with the support of polio staff.

The review committee was quick to emphasise that major threats remain in the region. The possibility remains that transmission continues undetected, or that the virus could be reimported from remaining reservoirs of the virus, such as Pakistan, the original source of the outbreak in the Middle East. In addition it was stressed that inconsistencies remain in the quality of immunization activities and surveillance across the region and that immunity gaps remain in high risk areas where conflict makes access a significant challenge.

With these challenges in mind, plans were set in place at the meeting for phase III of the response. Syria and Iraq will remain the highest geographic priorities, with additional high focus on high risk populations in Jordan, Lebanon and Turkey. Programmatically, the highest priority will be to access hard-to-reach or displaced populations, minority groups and mobile communities by addressing social barriers to vaccination, as well as those caused by insecurity. A plan will also be put in place so that any re-emergence of polio viruses is rapidly responded to. The work plans will continue to draw on cross-border cooperation to detect and investigate cases, and to reach all groups.

Keeping momentum against polio in the Middle East is crucial in the coming months to ensure that no more children are killed or crippled by this disease ever again.

Amman, 7 April 2014– Polio vaccination campaigns have commenced in Syria, Iraq and Egypt, aiming to reach more than 20 million children over five days.

For Iraq, this will be the first nationwide vaccination campaign since a case of polio was confirmed by the Ministry of Health on 30 March in a six-month-old boy from Rusafa, northern Baghdad.

“The recent detection of a polio case in Iraq after a 14-year absence is a reminder of the risk currently facing children throughout the region,” said Maria Calivis, UNICEF Regional Director for the Middle East and North Africa. “It is now even more imperative to boost routine immunisations to reach every child multiple times and do whatever we can to vaccinate children we could not reach in previous rounds. That’s the only way we will prevent this outbreak from spreading further.”

The current vaccination rounds are part of a comprehensive response to the announcement, in October 2013, that wild poliovirus of Pakistani origin had found its way to Syria. In recognition of the risk of further international spread, the governments of seven countries across the Middle East, with the assistance of local non-governmental organizations, civil society groups and UN agencies, are endeavouring to reach 22 million children multiple times with polio vaccine. Since October 2013, 25 polio vaccination campaigns were completed across the region, including five rounds in Syria and six in Iraq.

The numbers of children being vaccinated in each round is rising; however, the outbreak response is yet to reach especially vulnerable groups such as children who are on the move fleeing violence from Syria or those living in the midst of active conflict.

“Midway into the implementation of this outbreak response plan, we’re reaching the vast majority of children across the Middle East,” said Chris Maher, WHO Manager for Polio Eradication and Emergency Support. “In the second phase of the outbreak response we must work with local partners to reach the hardest-to-reach – those pockets of children who continue to miss out, especially in Syria’s besieged and conflict areas and in remote areas of Iraq. We won’t stop until we reach them.”

Health teams in Lebanon and Turkey will also join the campaign on 10 and 18 April.

Feria, Polio Vaccinator UNICEF — Feria, Polio Vaccinator
UNICEF

Iraqi Kurdistan, March 20, 2014 – It is early morning in Gawilan refugee camp in the Kurdistan Region of Iraq. Feria, 31 years old, readies herself for the day`s work. She is one of the many refugees who fled violence in Syria to find shelter in neighbouring Iraqi Kurdistan. She left Damascus 18 months ago with her husband and two young sons, aged seven and nine, when the levels of violence became unbearable. Back home in Syria she was a social worker, helping the poorest people of her neighbourhood.

“When I arrived in this camp, the NGOs and the UN agencies took good care of me and of my sons”, she said. “I received food, shelter and support. It was not the comfort which I was used to in Damascus, but it was enough for us to survive the cold winter. Nevertheless, seeing these aid workers helping people like us, I wanted to be one of them.”

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The paralysis of children by polio throws into sharp relief the damage to the country’s health infrastructure and the impact of that on the health of the Syrian people

The ongoing outbreak of polio in Syria is one of the most challenging and visible outbreaks in the history of polio eradication. The paralysis of children by polio throws into sharp relief the damage to the country’s health infrastructure and the impact of that on the health of the Syrian people. When society and order become precarious, health systems break down and people suffer from the effects. Syria has been no exception.

Media reports over the past few months have raised questions about the work of the World Health Organization in Syria, particularly as regards response to the outbreak of polio. The table below is intended to answer some of these questions, recognizing the scale of the crisis and the challenge of what is happening in Syria.

Polio in Syria (The Lancet )
New polio vaccination round begun in Syria

Questions and Answers

World Health Organization & United Nations Agency support to the Syrian crisis & polio outbreak

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QUESTION	ANSWER
Is it true WHO is unable to be impartial and can only operate in government-held territories in Syria?	WHO is completely impartial in aiding communities on all sides of any conflict, in accordance with international humanitarian principles. In Syria, WHO works with over 30 local and international NGOs, UN agencies including UNICEF, civil society groups, the Syrian Arab Red Crescent Society and other humanitarian partners to deliver medicines, vaccines and medical supplies, to coordinate the delivery of health care, to train health workers, and to prevent and control outbreaks of disease. These efforts have assisted millions of people on all sides of this conflict. During 2013, for example, WHO distributed sufficient medicines to meet the needs of 4.6 million people.
Did WHO only announce the polio outbreak in Syria in October 2013, even though the first case occurred in Aleppo in July 2013?	In areas which have long been polio-free, such as Syria, those who detect and report polio (clinicians, lab technicians, etc.) have a “low index of suspicion”, meaning they tend not to assume polio is the cause of paralysis. Unfortunately therefore, a child may go undiagnosed for some time; this was the case for the child in Aleppo, who was reported to have developed acute flaccid paralysis on 14 July 2013. Samples from this case were collected only in September, and sent for testing in October. The case was reported only after a cluster of paralyzed children were detected in Deir Al Zour governorate in October.WHO was first notified of this cluster on 11 October, and preliminary laboratory results on 17 October suggested the presence of poliovirus. WHO issued an international alert on the risk of a polio outbreak on 19 October. The Government of Syria reported virologically-confirmed cases on 29 October.
Did WHO prevent polio samples from being tested in Turkey?	WHO considers results from all WHO-accredited laboratories in assessing the international risk posed by any polio outbreak as well as for additional response requirements. Turkey has a WHO-accredited laboratory (part of WHO’s European regional network, as Turkey belongs to the European Region).The Government of Syria, however, accepts results from the regional laboratory system for the Eastern Mediterranean, as Syria is a part of the WHO Eastern Mediterranean Region, which does not include Turkey. For this reason, WHO continues to work so that the results of samples potentially tested outside of the Eastern Mediterranean but in laboratories recognized by the Government of Syria can be included in national figures.
Were areas under opposition control, such as Deir Al Zour, not included in earlier national vaccination campaigns?	Since 2010, at least two immunization campaigns have been conducted every year across Syria. All national campaigns strive to reach all areas of the country, including those under opposition control. Activities in some areas of a country may be deferred due to a number of reasons, including active fighting or insecurity. Such areas are then tracked, and re-covered as rapidly as possible. For example, in the national campaign of December 2012, Deir Al Zour activities were deferred; the governorate was covered one month later in January 2013, and 67,000 children were vaccinated.Within five days of WHO’s polio alert on 19 October 2013 a vaccination campaign was launched, reaching an estimated 2.2 million children, including a reported 600,000 from Al-Raqqa, Rural Damascus and Deir Al Zour. Three vaccination rounds have now been conducted in Syria. The most recent national round, in January 2014, was carried out in all Governorates.Preliminary results suggest that vaccine coverage was greater than 85% in all but three of Syria’s governorates, and that coverage was greater than 75% in two of those three.
Was WHO insufficiently prepared for the possibility of a poliovirus importation and an outbreak?	Preventing and controlling infectious diseases such as polio has been one of WHO’s main priorities since the outset of the Syria crisis. Recognizing the increasing risk of polio and other vaccine-preventable diseases, WHO, UNICEF and partners helped organize and support at least 2 immunization campaigns every year within Syria since 2010. In the surrounding countries, mass campaigns with the oral polio vaccine (OPV) were conducted in areas of low routine immunization coverage, while refugees arriving at registration points or camps were systematically vaccinated by host governments or the United Nations High Commission for Refugees (UNHCR). Within five days of WHO’s polio alert on 19 October 2013, a vaccination campaign was launched, reaching an estimated 2.2 million Syrian children.WHO has also established an early warning and response system for outbreaks that now has over 450 reporting sites throughout the country, many of which are in opposition areas. During 2013 WHO trained nearly 1,000 health workers on a range of topics related to infectious diseases, including on early warning and on outbreak response.
Does WHO underestimate the number of polio cases?	In order to plan and implement effective outbreak response, there must be a complete and accurate understanding of the extent of wild poliovirus transmission. That is why WHO uses a broad case definition (‘acute flaccid paralysis’) to find all possible cases of polio. Because acute flaccid paralysis can have a number of causes other than poliovirus, only virological testing confirms a case of polio.In assessing the geographic extent and risk of polio, WHO considers viruses reported by the Government of Syria (23 cases as of 30 January) and all other sources (13 cases as of 30 January). Given the challenges of obtaining adequate laboratory samples in conflict settings, WHO also examines clusters of “polio-compatible” cases to help guide national and international outbreak response planning. Recognizing that in settings of conflict and humanitarian emergencies there are gaps in disease surveillance, all vaccination campaigns planned in Syria are nationwide, to ensure that children in areas with undetected transmission are also fully protected.
Does WHO have no plan for Lebanon and other surrounding countries which are overrun by refugees and have overburdened health systems?	Since the start of the Syrian crisis, WHO has worked with all refugee-hosting countries and agencies (especially UNHCR) to ensure vaccination of arriving refugees and to hold supplementary immunization activities – especially since the detection of poliovirus of Pakistani origin in the sewage in Cairo in January 2012. Even before the Syrian cases, WHO and UNICEF were assisting neighbouring countries to plan and implement supplementary immunization activities.The day after confirmation of the polio outbreak, Ministers of Health from across the region declared polio a regional public health emergency on 30 October. A multi-country strategic plan for the outbreak has been developed to reach more than 22 million children multiple times across seven countries. It is the largest ever immunization response across the Middle East, and includes vaccination for refugees registered in camps as well as in host communities and for the host communities themselves. The Middle East emergency outbreak response plan is available online.
Is it true that WHO and the US CDC have not coordinated their disease surveillance support to Syrian populations?	WHO and CDC are two of the spearheading partners of the Global Polio Eradication Initiative and work closely in the Inter-Agency Standing Committee’s Global Health Cluster. Their close collaboration in humanitarian emergencies, disease outbreaks and polio eradication has a long history. In this crisis, CDC has worked outside Syria to support capacity for the Early Warning System for Disease Outbreaks (EWARS), while WHO has worked within the country. Personnel and offices of both agencies are collaborating closely on the response to the Middle East polio outbreak.
Do WHO representatives avoid contradicting governments?	Heads of WHO Country Offices have dual responsibilities to work with Governments to protect health in the country and also to take those actions necessary to protect global health.

The push to immunize all children against polio has been hampered by the ongoing crisis in the Syrian Arab Republic. WHO and UNICEF have appealed to all parties to cooperate, including through temporary pauses in hostilities where needed, to allow vaccination campaigns to take place and for all children to be protected.

When Dr Salah Salem Haithami, a medical officer with WHO, heard that polio had reappeared in the Syrian Arab Republic, his first thought was: can I go there to help? He had been working for a dozen years on polio eradication in Sudan, but just days later he was deployed to Damascus.

Haithami’s second thought was for children in Yemen, his own country. “Polio does not have a passport – it can affect any child anywhere in the world,” he says. “My motivation is to help stop the polio outbreak in Syria and, in this way, to prevent children outside of Syria from being paralyzed for life.”

Since he arrived in Damascus in October, Haithami has focussed day and night on the polio vaccination campaign. “I have helped order vaccines and other supplies. I have shared our experience from the Sudan and other countries and got agreement for new tactics like house-to-house visits and finger-marking, so that vaccinators really reach every single child. I have met with people in all sectors of Syrian society to try and gain crucial support for the campaigns,” he explains.

“All children have the right to be protected from the crippling poliovirus, and the provision of healthcare must remain neutral, regardless of the context.”
Dr Ala Alwan, Regional Director WHO Eastern Mediterranean Regional Office

Polio cases in Syria

The first suspected polio cases in Syria were flagged on 17 October 2013. On 29 October the Government of Syria announced that wild poliovirus had been isolated from 10 paralyzed children in Deir Ez Zour, one of the most fiercely contested areas of the country. Even before this laboratory confirmation, health authorities across the region had begun the planning and implementation of a comprehensive outbreak response. That campaign started on 24 October.

As of late November, 17 children had been paralyzed by polio in three separate Governorates of the Syrian Arab Republic, which had previously not recorded polio for over a decade.

The push to immunize all children against polio has been hampered by the ongoing internal conflict in the Syrian Arab Republic. “We are appealing to all parties to cooperate with temporary pauses in hostilities over the coming 6 months to allow vaccination campaigns to take place and for all children to be reached,” says Dr Ala Alwan, Regional Director, WHO Eastern Mediterranean Regional Office. “All children have the right to be protected from the crippling poliovirus, and the provision of healthcare must remain neutral, regardless of the context.”

Campaigns targeting 22 million children under 5 years

Recognizing the high risk of spread to countries in the region and beyond, in October/November 7 countries and territories held mass polio vaccination campaigns targeting 22 million children under the age of 5 years. In a joint resolution in early November, all countries of the WHO Eastern Mediterranean Region declared the escalating polio situation to be an emergency for the entire Region, calling for support in negotiating and establishing access to those children who are currently unreached with polio vaccination, in both the Middle East and in Pakistan, from where the outbreak virus had originated. It is estimated that campaigns will need to continue for the next 6 to 8 months to ensure all children in Syria and surrounding countries are vaccinated.

WHO is working with UNICEF, other UN agencies, the Syrian Arab Red Crescent and its committed local volunteers, international and national NGOs, and other local and international groups providing humanitarian assistance to Syrians affected by the conflict to ensure that all children are vaccinated, no matter where they live. It is anticipated that outbreak response activities will need to continue for 6 to 8 months, depending on the area and based on the evolving epidemiology.

“This outbreak underscores the importance of ending polio everywhere, particularly in the 3 remaining endemic countries: Afghanistan, Nigeria and Pakistan,” Dr Alwan says. “As long as polio persists in these reservoirs, the world will always be at risk of outbreaks. We must do everything possible to reach all children in those areas.”

11 November 2013 – 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). Closely related wild poliovirus strains have also been detected in environmental samples in Israel, West Bank and Gaza Strip since February 2013. Wild poliovirus had not been detected in the Syrian Arab Republic since 1999.

A comprehensive outbreak response continues to be implemented across the region. On 24 October 2013, an already-planned large-scale supplementary immunization activity was launched in the Syrian Arab Republic to vaccinate 1.6 million children against polio, measles, mumps and rubella, in both government-controlled and contested areas. Implementation of a supplementary immunization campaign in Deir Al Zour province commenced promptly when the first ‘hot’ acute flaccid paralysis (AFP) cases were reported. Larger-scale outbreak response across the Syrian Arab Republic and neighbouring countries will continue for at least 6-8 months depending on the area and based on the evolving situation.

Given the current situation in the Syrian Arab Republic, frequent population movements across the region and the immunization level in key areas, the risk of further international spread of wild poliovirus type 1 across the region is considered to be high. A surveillance alert has been issued for the region to actively search for additional potential cases.

WHO’s International Travel and Health recommends that all travellers to and from polio-infected areas be fully vaccinated against polio.

On 17 October 2013, the World Health Organization (WHO) received reports of a cluster of acute flaccid paralysis (AFP) cases in the Syrian Arab Republic. This cluster of ‘hot’ AFP was detected in early October in Deir Al Zour province and is currently being investigated. Initial results from the national polio laboratory in Damascus indicate that two of the cases could be positive for polio – final results are awaited from the regional reference laboratory of the Eastern Mediterranean Region of WHO. Wild poliovirus was last reported in Syria in 1999.

The Ministry of Health of the Syrian Arab Republic confirms that it is treating this event as a cluster of ‘hot’ AFP cases, pending final laboratory confirmation, and an urgent response is currently being planned across the country. Syria is considered at high-risk for polio and other vaccine-preventable diseases due to the current situation.

A surveillance alert has been issued for the region to actively search for additional potential cases. Supplementary immunization activities in neighbouring countries are currently being planned.

WHO’s International Travel and Health recommends that all travelers to and from polio-infected areas be fully vaccinated against polio.

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The paralysis of children by polio throws into sharp relief the damage to the country’s health infrastructure and the impact of that on the health of the Syrian people

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Questions and Answers

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Polio cases in Syria

Campaigns targeting 22 million children under 5 years

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