Syria Report

Polio outbreak in Syria prompts massive immunization campaign across Middle East

The largest-ever immunization campaign in the Middle East is under way, aiming to vaccinate more than 23 million children under the age of five against polio in Syria and neighbouring countries.

The campaign, launched by the World Health Organization and UNICEF, is a crucial part of the response to an outbreak of the disease in Syria, where 17 cases, caused by wild poliovirus type 1 (WPV1), have so far been confirmed (December 2013), and to the detection of the virus in environmental samples in other parts of the Middle East. Fifteen of these children are in the contested governorate of Deir Ez Zour, one is in Aleppo and another in Douma, near Damascus. Prior to this outbreak, no polio cases had been recorded in Syria since 1999, but vaccination efforts have suffered during the last three years of conflict.

Genetically-related polio viruses, which originated in Pakistan, have also been detected in sewage samples in Egypt in December 2012, and in Israel and the West Bank and Gaza Strip earlier in 2013. In a joint resolution, all countries of the WHO Eastern Mediterranean Region have declared polio eradication to be an emergency and called on Pakistan to urgently access and vaccinate all of its children to stem the international spread of its viruses.

Organizers aim to vaccinate, repeatedly over the next few months, all children under the age of five, whether they are living at home or displaced by conflict. The WHO has said the vaccinations would take place in Egypt, Iraq, Jordan, Lebanon, the West Bank, Gaza Strip and Turkey. Depending on the area, vaccination will be offered at fixed sites at populous locations or by going from house to house. The activities are carried out by national and local health authorities supported by UNICEF, WHO, the Syrian Arab Red Crescent and other partners.

Inside Syria, the campaign aims to reach 2.2 million children, including those who live in contested areas and those who were missed in an earlier campaign. Many children in Syria remain inaccessible, particularly those trapped in sealed off areas or living in areas where conflict is ongoing. A surveillance alert has been issued for the region to actively search for additional potential cases in addition to implementing the recommended supplementary immunization activities with oral polio vaccine.

UOSSM (Union of Syrian Medical Relief Organizations) has asked the WHO and UNICEF to extend their vaccination campaign against polio to areas under opposition control. In one report, Dr Khaled Almilaji reported that in the rebel-controlled areas, “the virus is spreading faster, where millions of people are displaced and living in dire conditions. Families are drinking directly from the rivers, dependent on contaminated water, which can carry the virus. The opposition’s Polio Task Force charge that the Damascusbased program is not reaching all the vulnerable children in rebel areas.”

Despite the gaps in coverage, however, initial information suggests that vaccine is getting to more areas of Syria than has so far been the case for health interventions delivered as part of the larger ongoing humanitarian effort. In parallel with the vaccination effort, work is ongoing to bolster systems for verifying coverage data in upcoming campaigns inside the war-torn country. At one public health centre in Al Hassakeh in eastern Syria, where 23 UNHCR- supported health volunteers are providing awareness sessions on issues relating to polio and other health-related issues, in one month the number of children attending the centre rose from 46 to 1 357. So far, throughout Al Hassakeh province, 87,728 children have been vaccinated, including 7,676 children who were vaccinated by UNHCR-supported volunteers.

“All Syrian children should be protected from disease,” noted Dr Ala Alwan, Regional Director, WHO Eastern Mediterranean Region. “To eradicate polio, we need to eradicate any reason for failing to reach children.”

Over the coming months, UNICEF is planning to deliver 10 million doses of polio vaccine to Syria. The first shipment of two million vaccines arrived in Damascus on 29 November. All countries of the WHO Eastern Mediterranean Region have united in calling for support to negotiate and establish access to those children who are currently unreached with polio vaccination. It is anticipated that the outbreak response will need to continue for at least six to eight months, depending on the area and based on evolving epidemiology. In Syria, these campaigns will be carried out at monthly intervals until April this year.

The total cost to UNICEF and WHO of supporting the seven-country polio response from November through April is US$39 million, based on a strategic plan developed for the Middle East.

 Date of upload: 17th Jan 2014


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