Topic: Health & MedicinePublic Health

Last updated: April 18, 2019

Term Paper
Polio Outbreak in Syria
Global Health and Human Services System
MADS 6642
Prof. Carlos Leon
Fairleigh Dickinson University
Sumeetpal Singh Khaira
Student No.1780946
April 06, 2018

In the early 20th century, polio was one of the most feared disease in industrialized countries which was paralysing every year hundreds of thousands of children. However, in 1950s and 1960s, polio was effectively controlled and eradicated from these countries soon after the introduction of effective vaccines. In developing countries polio took time to be recognised as a major problem. Surveys during the 1970s revealed the prevalence of disease in developing countries. As a result, routine immunization was introduced worldwide as part of national immunization programmes to control the disease in these developing countries.

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In 1988, the time when Global Polio Eradication Initiative began, then worldwide poliovirus paralysed almost more than 1000 children every day. Since then, more than 2.5 billion children have been immunized against polio to eradicate the development. Now, there are 3 countries that have never stopped polio transmission and incidence of polio cases has decreased by 99% globally. The Global Polio Eradication Initiative launched the most comprehensive and ambitious plan to completely eradicate polio in 2013. It was a strategic plan that clearly outlined measures to be taken for eliminating polio and for maintaining a polio-free world.

Polio is a disease which mainly affects children under 5 years of age. Though there is no cure for the disease, however it can be prevented by giving polio vaccine multiple times.
Polio, or poliomyelitis, is a crippling and potentially deadly infectious disease. It is caused by the poliovirus. The virus spreads from person to person and can invade an infected person’s brain and spinal cord, causing paralysis (can’t move parts of the body). People most at risk are those who never had polio vaccine, those who never received all the recommended vaccine doses, and those traveling to areas that could put them at risk for getting polio. Polio has been eliminated from most of the world, but the disease still exists in a few countries in Asia and Africa. Even if you were previously vaccinated, you may need a one-time booster shot before you travel anywhere that could put you at risk for getting polio. A booster is an additional dose of vaccine to ensure the original vaccine series remains effective.

Recent Reports-
As of March 28, 2018, one new case of wild poliovirus type 1 (WPV1) has been confirmed, occurring in Kandahar province. One new WPV1 positive environmental sample has been reported in Kabul province. Pakistan: Two new WPV1 positive environmental samples have been reported, one in Sindh province, and one in Khyber Pakhtunkhwa province. Somalia: Confirmation of one new cVDPV2 positive environmental sample in Banadir province.
Wild poliovirus type 1 and Circulating vaccine-derived poliovirus cases

Case breakdown by country

NA indicates the onset of paralysis prior to 2017 (in most recent cases).

As of April 03, 2018, One new case of wild poliovirus type 1 (WPV1) has been confirmed this week, occurring in Kunar province. Pakistan: One new case of wild poliovirus type 1 (WPV1) has been confirmed this week, occurring in Balochistan province.
Wild poliovirus type 1 and Circulating vaccine-derived poliovirus cases

Case breakdown by country

Global Caseload
Wild poliovirus cases have decreased by over 99% since 1988, from an estimated 350 000 cases in more than 125 endemic countries then, to 22 reported cases in 2017. Of the 3 strains of wild poliovirus (type 1, type 2, and type 3), wild poliovirus type 2 was eradicated in 1999 and no case of wild poliovirus type 3 has been found since the last reported case in Nigeria in November 2012.

Polio outbreak in Syria-
Most cases of vaccine-derived polio had been derived in Mayadeen District of Syria. Vaccine-derived polio can occur in places with low vaccination rates and poor sanitation where oral polio vaccine is used. Oral polio vaccine contained live, weekend version of virus. This weekend virus circulated for an extended period and changed into a form that caused paralysis.

Incidence in Syria-
The first outbreak of Syria since 1999, caused by wild strain. Ten cases of polio were confirmed in Syria among children as of October 29, 2013, out of 22-suspected cases that were identified on October 17 in the eastern city of Deir Ezzor after children exhibited symptoms of acute flaccid paralysis. Most of the victims were younger than 2 years old and were either unimmunized or under-immunized. The incidence of the disease has dropped by more than 99% since 1988.

As of June 13, 2017, three children contracted polio in the Deir Ezzor eastern region of Syria. As per the confirmation of World Health Organization on June 08, 2017, a poliovirus strain designated as vaccine-derived poliovirus type 2 found in a healthy Syrian child. It was caused by oral polio vaccine, which uses an attenuated form of the poliovirus. The two other children diagnosed with acute flaccid paralysis who experienced the onset of paralysis on March 5 and May 6.

As of June 20, 2013, 17 children had been paralyzed in the eastern Syria. Out of these 17 children, 16 paralyzed children were from Mayadin, south of Deir al-Zour, and one was from the farther north of Raqqa. It was unclear whether the afflicted child in Raqqa meant that the virus was circulating there or whether the child had travelled to Raqqa and then developed the case. The paralysis was developed between March 3 and May 23.

Polio, also called poliomyelitis, is caused by poliovirus, which only infects humans. It is contagious and spreads from person to person contact. The virus lives in an infected person’s throat and intestine. It enters the body of a person via mouth and spreads through the contact with the feces of an infected person. An infected person may spread the virus to others immediately before and about 1 to 2 weeks after symptoms appear. The virus can live in an infected person’s feces for many weeks, which can contaminate food and water in poor sanitary conditions. Persons who do not show any symptoms are still viable to transmit virus to others.

Most of the people infected with the virus does not show any visible symptoms. About 1 out of 4 infected people exhibit flu-like symptoms such as sore throat, fever, tiredness, nausea, stomach pain, and headache. These symptoms usually last up to 2 to 5 days and then go away. The other more severe symptoms that affects brain and spinal cord, also developed by smaller proportion of people, which includes-
Paresthesia- It is the feeling of pins and needles in the legs.

Meningitis- It is the inflammation of covering of the spinal cord and brain. It occurs in about 1 out of 25 people infected with poliovirus.

Paralysis- It is the inability to move parts of the body, or weakness of arms, legs, or both. It occurs in about 1 out of every 100 people infected with poliovirus. It can even lead to permanent disability and death as it affects the muscles that help to breathe.

Post-polio syndrome- Infected children once fully recovered develop new muscle pain, weakness or paralysis as adults after 15 to 40 years.
Project purpose and scope-
The purpose of this paper is to have understanding about the poliovirus, incidence and prevalence of Polio outbreak in Syria, how it transmits from infected person to others, symptoms of polio, social determinants of poliovirus, measures taken by World Health Organization and other concerned organizations to eradicate the disease.
The scope of writing this paper is to-
analyse the issue of polio outbreak in Syria.

understand the social determinants, government and public health care policies adopted by WHO and other concerned organizations.

evaluate the methods adopted to deal with the disease and the progress made.

estimate the time and potential for its eradication.

stumble blocks for the progress of elimination process.

This paper does not focus on-
Polio affecting other countries of the world.

Approaches taken by other nations to get rid of the disease.

Other neglected tropical diseases in Syria.

Social Determinants of Health on Polio-
early life
social exclusion
social support
poor sanitation
Interventions and its impact-
On October 24, 2013 WHO, health officials launched a program to immunize 1.6 million Syrian children against Polio, Measles, Mumps and Rubella in government as well as rebel-held areas. The response expected to last at least 6 months, which also included the neighboring countries. Public health could be among the first casualities of the war. Despite the challenges imposed by the ongoing civil war ( as immunization rates in the Syrian Arab Republic declined from 91 percent in 2010 to 68 percent in 2012), polio vaccination helped by the fact that Syria had the highest rates of vaccination coverage among its populace prior to the situation.
Syrian authorities conducted polio vaccination campaigns in Deir Ezzor in March and April 2017 using “bivalent oral polio vaccine.” The polio eradication program in Syria received reports of 58 children who diagnosed with AFP in Deir Ezzor. Tests
conducted on the children determined that vaccine-derived polioviruses were not responsible for the onset of the disease in 11 of the cases.
As of Dec 10, 2013, US $500,000 emergency response grant was provided by Rotary International to support efforts to put an end on an outbreak of the crippling disease polio in strife-torn Syria. The funds are the first to World Health Organization in direct support of a Global Polio Eradication Initiative plan aimed at outbreak response throughout the Middle East, as the region geared up for a multi-country response to the threat of polio. As of December 09, 2013, there had been 17 cases of wild poliovirus confirmed in Syria since October, the first reported cases in the country since 1999. The Rotary grant to the World Health Organization supported immediate response activities in late 2013 and January 2014, such as the establishment of emergency response control rooms and initial vaccination rounds to immunize children in Syria and surrounding countries against polio.
WHO’s International Travel and Health recommended that all travellers to polio-affected areas be fully vaccinated against polio. Residents and visitors who remain in endemic areas for more than 4 weeks should receive an additional dose of OPV or inactivated polio vaccine within 4 weeks to up to12 months of travel.
In July and August 2017, health workers and volunteers vaccinated hundreds of thousands of children in targeted campaigns in Syria to protect them from an outbreak of circulating vaccine-derived poliovirus.

After a series of vaccination campaigns, transmission was stopped, and the last case was reported in January 2014. It is considered that the virus originated in Pakistan which leads to the fact that there would always be a threat to children unless it is fully eradicated without the matter that where unimmunized children live. WHO has provided technical and financial support to halt transmission of polio in Syria. During the recent campaign conducted in March 2015, nearly 3 million children who were under the age of 5 years were vaccinated.

Special Contribution-
A mass vaccination campaigns was held by seven countries and territories in November 2013, with further extensive campaigns planned for December targeting 22 million children. In a joint resolution all countries of the WHO Eastern Mediterranean Region declared polio eradication to be an emergency and called on Pakistan to urgently access and vaccinate all the children to control the international spread of viruses. The countries also called for support in negotiating and establishing access to those children who are currently unreached with polio vaccination. As per the commitment of WHO and UNICEF with all organizations and agencies to work together, they provided humanitarian assistance to affected Syrians by vaccinating all the children of Syria no matter from where they were, either in government or contested areas, or from the outside of Syria. The priority work was to supply and activate the required health infrastructure once again, such as redeploying health workers so as to deliver vaccine in worst-affected areas and moving vaccine across whereby necessary and possible. The government committed to reach all children, information on which areas are not reached will guide corrective actions and planning for the next rounds. All parties worked to find solutions for conflict-affected areas.

Jordanian Ministry of Health together with the WHO, UNICEF, UNHCR and other partners, has embarked on a series of campaigns to ensure all children under 5 years of age living in high-risk areas of Jordan, including in the camps, vaccinated against polio. Before polio campaigns started, people in the camp were educated about polio vaccination through public announcements and flyers. Then teams of health workers traveled throughout the 12 districts of the camp conducting door-to-door visits. Caravans were marked with a colored cross or tick to indicate which families’ children had been immunized. A second team of health workers conducted a follow-up, to ensure that no child is missed. In 2015 during World Immunization Week, the Ministry planned to vaccinate around 200 000 children, including those at the camp of Zaatari. WHO also supported the campaigns of polio vaccination in Jordan by delivering technical assistance and training to the staff of Ministry of Health. The Organization also has provided support in the introduction of new valuable innovations including use of mobile devices to map immunization data and detect communicable diseases such as acute flaccid paralysis.
In the nutshell, it depicts that since 1999, polio outbreak occurred first time in fourteen years in Syria in 2013. The total of 10 children were confirmed with the diagnosis out of suspected 22 cases. Afterwards, virus emerged in 2017 and 3 children were diagnosed possessing the virus. To deal with the situation, World Health Organization launched vaccination campaigns to immunize the children with the aim to eradicate polio. In 2017, Rotary International provided grant of US$200,000 to support immediate response activities of World Health Organization to eradicate polio. People were advised to get vaccinated before travelling. WHO and UNICEF along with other partners provided humanitarian assistance to Syria. Door to door visits were conducted and people were educated regarding polio immunization by conducting camps in 12 districts.

Watkins, Tom. (2013, October 29). WHO: Polio cases confirmed in Syria. Retrieved from: Children get polio from oral polio vaccine. (2017, June 13). Retrieved from:, Rick. (2017, June 20). Polio Paralyzes 17 children in Syria, WHO says. The New York Times. Retrieved from:
Polio in Syria. Centers for Disease Control and Prevention. Retrieved from: Determinants of Health. (2005, July 12). The Polio Network. Retrieved from: responds to polio emergency in Syria. Retrieved from:
What is Polio. Centers for Disease Control and Prevention. Retrieved from: This Week as of 3 April 2018. Polio Global Eradication Initiative. Retrieved from: of Polio. Polio Global Eradication Initiative. Retrieved from:

History of Polio

Poliomyelitis. (2018, March). Universal Health Coverage: Everyone, Everywhere. World Health Organization. Retrieved from: Polio Free US Thanks to Vaccine Efforts. Centers for Disease Control and Prevention. Retrieved from:
WHO update on polio outbreak in Middle East. (2013, November 13). Universal Health Coverage: Everyone, Everywhere. World Health Organization. Retrieved from:
Stopping Polio in Syria. (2017, August 31). Polio Global Eradication Initiative. Retrieved from:
Keeping Syrian children free from polio at home and across the border. (2015, April). Universal Health Coverage: Everyone, Everywhere. Retrieved from:


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