- The Washington Times - Sunday, October 15, 2006


International speci-alists are warning about a serious risk of a polio resurgence unless the four remaining endemic nations — Nigeria, India, Afghanistan and Pakistan — intensify efforts to eradicate the debilitating virus.

“The world will face upwards of a quarter-million new cases of polio every single year if we do not finish the job now in these four remaining polio-endemic countries. It will not remain at the levels of disease burden that we’re at now,” said Dr. Stephen Cochi, chairman of the Advisory Committee on Polio Eradication (ACPE).

Dr. Cochi, also acting director of national immunization programs with the Centers for Diseases Control and Prevention (CDC) in Atlanta, said: “It would be a humanitarian catastrophe not to complete polio eradication now that we are so close … to the finish line and now have the best tools to finish the job.”

Specialists lauded the move by Afghan President Hamid Karzai, who has taken direct oversight of polio vaccinations after a sharp increase in cases in the southern part of his country.

“With a more effective monovalent vaccine and accelerated lab processes for identifying polio virus,” the four endemic countries have the best technical means ever to eradicate the disease, Dr. Cochi said.

ACPE, an independent international advisory group under the auspices of the World Health Organization (WHO), reported its concerns at the end of a two-day meeting here last week assessing the worldwide polio burden.

Cases multiply in a year

WHO data show a tenfold increase in infections in endemic states of India and a twofold increase in Nigeria from last year’s levels.

From Jan. 1 to Tuesday, the number of confirmed cases of polio worldwide stood at 1,403, up from 1,349 at the same period last year. The number of confirmed cases in Nigeria this year as of Tuesday was 888, up from 489 in the same period last year. In India there were 360 confirmed cases of polio this year, up from 37 in 2005. In Pakistan, the number of polio cases this year was 24, up from 18 last year, and in Afghanistan, confirmed polio cases by Tuesday were 28, up from four last year.

Other countries that reported new polio cases this year include Bangladesh, 15; Nepal, two; Somalia, 31, up from three last year; Ethiopia, 14, down from 17; Niger, 10, up from four last year; Angola, one case of polio this year, compared with eight in 2005; Namibia, 20; the Democratic Republic of the Congo, seven; Indonesia, two, down from 264; and Yemen, one case of polio this year, down from 472.

“We’ve been very concerned of further international spread of polio. The risk of importation is higher than ever,” said Dr. Peter Ndumbe, director of the center for the study and control of communicable diseases at the University of Yaounde, Cameroon.

The number of polio cases worldwide last year totaled 1,973, down from 350,000 cases annually in 1988.

Political will is key

“Polio eradication hinges on vaccine supply, community acceptance, funding and political will. The first three are in place. The last will make the difference,” said Dr. Robert Scott, chairman of Rotary International’s PolioPlus Committee.

Dr. Cochi said that polio continues in the endemic countries because health authorities are “failing to reach every child.” Indeed, ACPE specialists say that the world was within reach of wiping out the crippling virus a few years ago, largely because of a costly campaign begun in 1988, led by the WHO, UNICEF, the CDC, Rotary International and national governments. The deadline for total eradication was set for the end of last year.

Rotary International is estimated to have contributed more than $600 million to help immunize more than 2 billion children in more than 120 countries, and donor governments in the past decade had earmarked more than $2.6 billion toward polio eradication.

The effort was set back in 2003 when community and Muslim religious leaders in Nigeria’s northern state of Kano started spreading unfounded rumors that the vaccine would sicken or sterilize children. Immunization was interrupted until the latter half of 2004, and an international emergency arose as the disease spread to many countries.

About 25 countries, including Cameroon, have become reinfected with polio since 2003, and nearly 1,500 children were paralyzed for life. Dr. Ndumbe said the cost of emergency-response activities during this period was estimated at $450 million.

“The barriers that we used to face in the northern states are no longer there, and there is now public interest in polio,” he said. “The entire southern and more populous section [of Cameroon] has been polio-free for some time and has been able to maintain that, except for occasional importations from northern Nigeria.”

Not all children reached

Much of the problem now is now in the four endemic countries, the only ones of the 193 WHO member states that never completely stopped the transmission of polio. Specialists say this is because polio eradication efforts in those four countries are not reaching all the children.

In Nigeria for example, the Advisory Committee on Polio Eradication said that as many as half the children in some polio-infected regions “have never been immunized with oral polio vaccine.” In Pakistan and Afghanistan, polio-immunization campaigns cover 75 percent to 90 percent of children.

In India, polio-eradication campaigns reach more than 90 percent of the target population. Although this would be sufficient to interrupt polio transmission in every other part of the world, ACPE says, it is not enough in India’s Uttar Pradesh and Bihar states.

“Due to high population density, poor sanitation, malnutrition, high [intestinal] disease burden and large birth cohorts, polio transmits extremely easily in this environment,” the ACPE said.

Dr. David Heymann, the WHO’s special envoy for polio, said the ACPE recommended that the WHO promote a standing international health regulation requiring vaccination against polio for all people and travel documents that confirm polio vaccination of all international travelers.

Dr. Yousef Al-Mazra of Saudi Arabia’s health ministry said the kingdom requires that all children from endemic countries, such as Nigeria, be immunized six weeks before applying for visas. As a further precaution, he said, all visitors from endemic countries this year receive an oral polio vaccine at the border before making the pilgrimage to Mecca.

Saudi Arabia reported one imported polio case in 2004.

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