Displacement, violence likely cause of Iraq’s first polio case in 14 years

DUBAI - Health officials in Iraq are stepping up polio immunization and surveillance following the first confirmed case of the virus in the country in more than a decade.

“It is a huge blow because for 14 years Iraq has been polio free,” Syed Jaffar Hussain, head of mission for the World Health Organization (WHO) in Iraq, told IRIN.

WHO’s Eastern Mediterranean Region poliovirus laboratory in Egypt and the Centres for Disease Control and Prevention (CDC) in the USA both confirmed the outbreak, detected after a six-month-old baby living on the outskirts of Baghdad became paralysed.  

The strain’s genetic sequence matches the one found last September in Syria - wild polio virus type 1 (WPV1) - but it is not yet clear how the virus made it to the Iraqi capital or how the boy became infected. His family has no links with Syria or record of recent travel there.

Polio is a disease caused by a highly-infectious virus that attacks the nervous system, mostly in children under the age of five. According to WHO, one in 200 infections leads to irreversible paralysis; and of those paralysed, 5 to 10 percent die.

Iraq, which was already on high-alert because of the earlier outbreak of polio in Syria, is home to more than 200,000 Syrian refugees, most of whom have sought refuge in the northern Kurdish region of the country. In addition to regular immunization campaigns, the government had in recent months run several additional immunization campaigns as part of a wider regional response to the outbreak in Syria. Now surveillance has been ramped up and a new wave of vaccination campaigns is scheduled to take place in early April.

“Knowing that Iraq itself has a lot of security challenges and large amounts of population movement, internally and from outside, this presents a major public health challenge in the country,” WHO’s Hussain, a medical doctor, said.

“We do have a worry that other children may have been infected and that is why we are going door-to-door in the area where this child lives in order to collect samples to see if the virus has spread,” he added.

Prioritizing surveillance in Anbar Province

Beyond Baghdad, the Iraqi Ministry of Health, WHO and the UN Children’s Fund (UNICEF) are also prioritizing surveillance in Anbar Province, which shares a long border with the Syrian province of Deir-ez-Zor. That is where polio was first detected after a breakdown in immunization campaigns in Syria as a result of the conflict there.

Residents of Anbar are particularly at risk of infection, in part because of its physical proximity to the virus across the border. In addition, recent immunization campaigns in Anbar have been hit by increasingly violent clashes between government forces, Sunni tribal leaders, members of the formerly al-Qaeda-affiliated Islamic State of Iraq and the Levant (ISIL) and other militant groups.  

Officials are probing whether people fleeing Anbar may have brought the virus to Baghdad.

“Anbar is a big challenge for us because the security situation does not allow the vaccinators to go and do their work,” Hussain said.

“From the last vaccination round that just ended on 10 March, the Anbar coverage was 48 percent, while all other provinces were above 98 percent.”

For parts of Anbar’s cities of Fallujah and Ramadi, where UN agencies have very limited access to the population, the UN is working with the Iraqi Red Crescent to ensure immunization drives go ahead, he added.

Of the estimated 400,000 people who have been displaced by the fighting in Anbar, more than 250,000 of them remain within the province. WHO plans to work with international NGOs like Muslim Aid to set up mobile clinics to deliver both basic healthcare and polio immunization to these internally displaced people (IDPs).

“Iraq had been polio free since the year 2000 so to have this case now is a huge set-back,” said medical doctor Marzio Babille, UNICEF representative in Iraq.

“When you have large population movements and system breakdown, implementation of vaccinations can be patchy, and then you have a perfect picture for the re-introduction of the virus.

“That was the case in Syria and now this is the case in Iraq,” he added.

Response plan for Iraqi Kurdistan

Babille and other UN officials will attend an inter-ministerial meeting with the Kurdistan Regional Government (KRG) this week to set in motion a response plan for the semi-autonomous region, which will include a media campaign.

Funding for the response is likely to run into millions of dollars. As much as $6 million could be required between now and July, Babille said, and external financial support will be needed.

“What we want to do is build an immunization firewall protecting Kurdistan from the circulation of the virus,” he explained.

“Not only are there IDPs from Anbar crossing into Kurdistan but there are also large numbers of Syrian refugees there, so we need to ensure a high quality of immunization campaign.”

An official from the Ministry of Health in Baghdad said the government would not comment for “security reasons”.

Polio flourishes in overcrowded areas with high levels of malnutrition and insufficient sanitation. It spreads through person-to-person contact by eating or drinking items contaminated with the faeces of an infected person.

Though incurable, polio is easily preventable and great strides have been made in reducing its prevalence. According to WHO, the number of polio cases worldwide has reduced by more than 99 percent since 1988.

The virus is only now endemic in three countries: Afghanistan, Pakistan and Nigeria. But 13 countries - now including Iraq - have recorded imports of the virus; most are in sub-Saharan Africa.

IRIN