Polio Eradication Suffers A Setback As Somali Outbreak Worsens

Jul 20, 2013
Originally published on July 22, 2013 8:02 pm

Somalia hadn't had a case of polio for nearly six years. But in the past few months, the virus has come back. Now the East African country has the worst polio outbreak anywhere in the world.

Twenty new cases of polio were reported this week in Somalia by the Global Polio Eradication Initiative. That brings the total number of cases in the Horn of Africa to 73. The rest of the world combined has tallied only 59 cases so far this year.

Health workers are worried that the virus could gain a foothold in the Horn of Africa and jeopardize the multibillion-dollar effort to wipe out the virus worldwide.

Until this recent outbreak, global efforts to eradicate polio appeared to be making remarkable progress. Last year the number of children paralyzed by polio hit a record low at 223.

This year it was looking like there were going to be even fewer cases. The last significant pockets of the virus appeared to be isolated in Afghanistan, Pakistan and Nigeria.

Then in May, a 2-year-old girl in Mogadishu became the first confirmed case of polio in Somalia in more than six years.

The number of polio cases in Somalia is increasing by the day, says Dr. Nasir Yusuf, who leads UNICEF's immunization efforts in eastern and southern Africa.

Part of the problem, he says, is that the majority of children in Somalia have never been immunized against polio. "We have an outbreak in a population that has been quite vulnerable for quite some time," Yusuf says.

Somalia has the second worst rate of polio vaccination in the world after Equatorial Guinea, according to the World Health Organization.

In response to the current outbreak, there have been five emergency polio immunization campaigns in Somalia since May. The Somali government directs the campaigns, but it doesn't control or have access to vast swaths of the country. Some of the most recent polio cases have occurred in areas that are considered off limits to vaccination teams.

Underscoring the lack of security in the region even for health workers, two health workers with Doctors Without Borders were freed this week after having been held hostage in Somalia for almost two years. The women had been working in the Dadaab refugee camp in Kenya, where eight new polio cases were reported in May.

The current outbreak is forcing governments throughout the region, including parts of the Middle East, to launch supplemental vaccination drives, Yusuf says, because polio is capable of spreading quickly.

"A week after the virus was reported in south central Somalia, one of the viruses got into the Somali refugee camp in the most eastern part of Kenya," he says. "So that tells you how fast this virus made it."

EDITOR'S ADD NOTE, Monday, July 22, 3:30 p.m.

According to the WHO, the first polio case in the outbreak actually occurred April 30, in Kenya. Then the second case was confirmed May 9 in Somalia. Either way, the outbreak spanned a vast geographic area quickly.

The virus reproduces inside the human gut, and many people carry it but show no symptoms. This give the virus the opportunity to travel long distances inside people and then get shed into the environment through feces.

The World Health Organization traced the poliovirus in Somalia to one in West Africa. Nigeria is the only place there where polio is still endemic.

Before these cases in the Horn of Africa, the end of the multibillion-dollar effort appeared to be in sight.

The Somali outbreak is now forcing UNICEF, the WHO and other international agencies to dedicate vast resources to boost polio vaccination coverage throughout East Africa and parts of the Middle East. Those are resources that can't be used to attack the virus in Afghanistan, Pakistan and Nigeria — which appeared, until now, to be the last few places where polio had a foothold.

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A polio outbreak in Somalia is getting worse. The east African nation was declared polio-free in 2007, but the virus has come back. Somalia currently has the worse polio outbreak anywhere in the world.

NPR's global health correspondent Jason Beaubien is following the story and he joins me now. And, Jason, tell us more about this current outbreak. Where is it centered?

JASON BEAUBIEN, BYLINE: It's centered around Mogadishu at the moment. But what's somewhat significant is that eight cases have turned up across the border in Kenya, in a refugee camp. So it's clear that it's not just sitting still there in Mogadishu, and it is being found outside of Mogadishu and in a broader and broader sort of radius by the week. So that's why there's great concern about this. It clearly is spreading and the fear amongst health officials is that it's going to get worse before it gets better.

BLOCK: Well, we've been reporting over the last few months about a multi-billion dollar effort that's under way to try to eradicate polio. How much of a setback is the outbreak we're talking about in Somalia?

BEAUBIEN: This is significant because up until now, it appeared that we were just dealing with Nigeria, Afghanistan, Pakistan, and the numbers were really quite low. Last year, it was just 223 cases in the entire world. And this year in Afghanistan, they're down to just three cases so far this year. So it really looked like things were going extremely well. And so now to have 73 cases pop up in the Horn of Africa is a really big deal, and that's more than you're getting in any of those other countries combined this year.

So it's a significant outbreak and it's a significant setback. And partly it's a setback because this means that those resources that were getting poured into Nigeria, Afghanistan and Pakistan, to try to just wipe out the virus, now they need to get focused in Somalia and in the areas all around Somalia. You need to be boosting immunization in Uganda, throughout Kenya, probably in Yemen, in Ethiopia. So it means that human resources and financial resources are going to get diverted from what looked like the last few cases on Earth, to now this part of east Africa.

BLOCK: And what are health experts telling you about what is being done, or what can be done, to try to fight the new polio outbreak in Somalia?

BEAUBIEN: So since this first turned up in May, they've done five emergency immunization campaigns around Mogadishu and throughout that sort of zone of Somalia. And basically they go in and just to immunize all of the children. Even children who've been immunized before, they do these boosters to give them even some more immunity.

The problem however in Somalia is that it's got the second worst rate of immunization for polio in the world. And you've got a million kids in that general area - sort of spread between the Kenyan border and Mogadishu -who have never been vaccinated for polio. So there is this huge pool of children who potentially could get it. And if they get it, then the virus replicates inside them, they can spread even further.

So there's an effort being run by the Somali government to go out and get these mass immunization campaigns done. The problem, however, is that there are parts of Somalia which the Somali government doesn't control, and they can't get in there and do these vaccinations.

BLOCK: We've also heard, Jason, in other countries about widespread resistance to immunization campaigns; fears about what the vaccines might do and what they might contain. Is that the same situation in Somalia?

BEAUBIEN: It isn't as much of a problem in Somalia as it has been in some of the other countries. However, right at the moment, it's Ramadan and that was a bit of an issue at first because some of the campaigns were stopped because things were not supposed to be passing people's lips during the daylight when they wanted to do a vaccinations. And so, they had to go out into some negotiating with some of the religious leaders and actually managed to get sort of an exception, so that some of these campaigns could happen during Ramadan.

In that sense, things are going better in Somalia than they are in some other parts of the world.

BLOCK: That's NPR's global health correspondent Jason Beaubien, talking with us from Johannesburg. We were talking about the outbreak of polio in Somalia.

Jason, thanks so much.

BEAUBIEN: You're welcome. Transcript provided by NPR, Copyright NPR.