Pakistan: Polio Spreads From Syria to Iraq, Causing Worries

Syria’s polio outbreak has now officially spread to Iraq, the first neighbor of the war-ravaged country to be hit by the crippling virus despite an ambitious Middle East inoculation effort, and global health officials warned Monday that dozens of vulnerable Iraqi children could potentially be infected.

The transmission of polio, a highly contagious disease that primarily afflicts children younger than 5 and can lead to partial and sometimes fatal paralysis, reflects one of the most insidious effects of the three-year-old Syria conflict, which has sent millions of refugees across the country’s borders and severely undermined its public health system.

For Iraq, the outbreak is the first time in 14 years that polio has appeared; the disease was absent even during the 2003-2011 war that began with the American-led invasion to topple Saddam Hussein.

A rescue worker carried an injured baby at the scene of a reported air strike attack in Aleppo last month.Report Cites ‘Devastating Toll’ on Health of Syria’s ChildrenMARCH 9, 2014 An Afghan health worker administered polio vaccines to children on the outskirts of Jalalabad last month.Rare Afghan Polio Case Tied to PakistanFEB. 11, 2014

World Health Organization officials said the first Iraqi polio case, that of a 6-month-old boy in Baghdad, was confirmed on March 30 by Iraq’s Ministry of Health and had the same genetic fingerprint as the virus that paralyzed 27 children in eastern Syria in October — both having originated in Pakistan, one of the few countries in the world where polio has not been eradicated. The Polio Global Eradication Initiative, a partnership that includes the W.H.O., reported two new Syria cases last week — in Aleppo and Hama, far from the original outbreak area.

Christopher Maher, the eastern Mediterranean manager of the W.H.O.’s Polio Eradication and Emergency Support unit, said that Iraqi officials had been immunizing children protectively since the Syria outbreak began, and that in light of the first confirmed case in their home country they were now expediting another scheduled round of vaccinations.

“At the moment, they’re madly preparing their response plan,” Mr. Maher said in a telephone interview. It takes multiple rounds of vaccine, taken orally, to immunize a child.

Iraq has an estimated five million children under the age of 5. While estimates vary on the number of infections for every confirmed case, and not all children develop symptoms, Mr. Maher said, “in all likelihood it would be dozens — you’ve got to assume there’s some extension of the transmission.”

The W.H.O. and Unicef said in a joint statement on Sunday that Iraq’s expedited polio response was part of a broader vaccination effort in the region, with the goal of reaching more than 20 million children this week. Lebanon and Turkey will participate later this month, and Jordan and the Palestinian territories will be part of future vaccination rounds, said Juliette S. Touma, a spokeswoman for Unicef’s regional office in Amman, Jordan.

“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,” Maria Calivis, the Unicef regional director for the Middle East and North Africa, said in the statement. “It is now even more imperative to boost routine immunizations to reach every child multiple times and do whatever we can to vaccinate children we could not reach in previous rounds.”

The statement acknowledged that the effort had “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.”

Some rights advocates and public health experts have criticized the W.H.O. and other United Nations agencies for adopting an accommodating policy toward President Bashar al-Assad of Syria, who they contend has deliberately withheld inoculations against polio and other contagious diseases to insurgent-controlled areas.

Dr. Annie Sparrow, a pediatrician and deputy director of human rights at the Icahn School of Medicine at Mount Sinai in New York, said in a study published in February that the polio outbreak in Syria was far more widespread than just the cases reported by the W.H.O. The health organization has disputed her findings. Dr. Sparrow said in a telephone interview on Monday that the most recent polio news from Iraq and Syria was both expected and alarming. “It should signal an absolute failure of the global eradication effort,” she said. Mr. Assad’s forces, she said, “have been bombing the heck out of the people of Aleppo instead of vaccinating them, which is what they should be doing.”

While Mr. Maher said the spread to Iraq was not in itself surprising, health officials were uncertain about its precise path to Baghdad, where the victim had no obvious contact with possible carriers from Syria, most of them refugees concentrated near Iraq’s border with Syria.

“It’s great if you have clear-cut chain of transmission so you can easily see how this would happen — maybe a refugee child,” he said. “But where you would expect to see the virus would have been in the northwest, and not down in Baghdad.” At the same time, he said, the confirmed case reflected the ability of the polio virus to find vulnerable victims, touching a child who had been part of “a pocket of under-immunized children in the community.”

Ms. Touma said the inoculation effort in Syria had made progress but was still failing to regularly reach an estimated 323,000 Syrian children at the highest risk of contracting polio, in areas of fighting or restricted access.

“The trick with polio is that we can’t give up, we have to do multiple inoculations continuously and as wide as possible,” she said.