Syria crisis 'may resurrect polio'
Refugees fleeing war-torn Syria could resurrect the spectre of polio in Europe, experts have warned.
Europe was declared polio-free by the World Health Organisation (WHO) in 2002, but is now threatened by a new outbreak of the disease reported in Syria, it is claimed.
Two German infection experts writing in The Lancet medical journal highlight the fact that the polio vaccine currently used throughout Europe is not 100% effective.
In parts of Europe where vaccine coverage is low, including Bosnia and Herzegovina, Ukraine, and Austria, immunisation levels may not be high enough to prevent sustained transmission of the polio virus, they stress.
With large numbers of people now fleeing Syria and seeking refuge in neighbouring countries and Europe, polio could reappear in areas that have been free of the disease for decades.
"Vaccinating only Syrian refugees - as has been recommended by the European Centre for Disease Prevention and Control - must be judged as insufficient; more comprehensive measures should be taken into consideration," said Professor Martin Eichner, from the University of Tubingen, and Dr Stefan Brockmann, from the Department of Infection Control in Reutlingen.
The polio vaccine used in most European countries today is the inactivated polio vaccine (IPC), which is injected. It usually forms part of a combined diphtheria, tetanus, whooping cough and polio jab.
While good at preventing paralysis, IPC provides only partial protection from infection, Prof Eichner and Dr Brockmann point out.
Once children were routinely vaccinated with an oral polio vaccine (OPV), taken in the form of mouth drops, which uses a live virus and is more effective. But this was discontinued in the UK and many other countries because in rare cases it can trigger paralysis.
Since only one in 200 polio infections cause symptoms, the virus could be circulating for nearly a year before a single case of paralysis occurs, according to the experts. By this time, hundreds of individuals may be carrying the virus.
Prof Eichner and Dr Brockmann wrote: "Hundreds of thousands of people are fleeing Syria and seek refuge in neighbouring countries and Europe. Because only one in 200 unvaccinated individuals infection with WPV1 (wild-type polio virus 1) will develop acute flaccid paralysis, infected individuals can spread the virus unrecognised.
"Oral polio vaccination provides high protection against acquisition and spreading of the infection, but this vaccine was discontinued in Europe because of rare cases of vaccination-related acute flaccid paralysis.
"Only some of the European Union member states still allow its use and none has a stockpile of oral polio vaccines. Routine screening of sewage for polio virus has not been done in most European countries, but this intensified surveillance measure should be considered for settlements with large numbers of Syrian refugees."
The WHO has confirmed an outbreak of at least 10 cases of polio in Syria, where vaccination coverage has dramatically decreased because of the civil war.
Dr Benjamin Neuman, a virologist at the University of Reading, said: " Where war goes, pestilence, famine and death often follow. Each new baby who is born is at risk of polio until vaccinated, and conflict inevitably disrupts local vaccination efforts.
"Poliovirus has been nearly eradicated for almost a decade now. Most of the last pockets of poliovirus in Somalia, Pakistan, Afghanistan and now Syria have been centres of conflict. It is likely that poliovirus will continue to linger, following conflict around the globe until it is eradicated once and for all.
"The Syrian outbreak puts Europe at risk because of the way we give vaccines. In parts of the world where it is still possible to catch a wild strain of poliovirus, children are usually vaccinated with a live but genetically weakened poliovirus which gives excellent protection but has a tiny risk of changing back to the more dangerous form.
"However, in parts of the world where polio has been eradicated, like the UK, children are usually given a killed vaccine. It doesn't protect quite as well but it cannot mutate, so it protects reasonably well while preventing polio from being accidentally reintroduced to a country.
"Vaccination is never perfect, so despite being vaccinated, a small percentage of children in the UK would be at risk of contracting polio if they were exposed to the virus. Until the virus is completely extinct, it is essential that we continue to vaccinate our children."