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Suspected outbreak of poliomyelitis - Syria ?2013 (ECDC/CDTR, October 25 2013, edited)

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  • Suspected outbreak of poliomyelitis - Syria ?2013 (ECDC/CDTR, October 25 2013, edited)

    [Source: European Centre for Disease Prevention and Control (ECDC), full PDF document: (LINK). Extract.]

    COMMUNICABLE DISEASE THREATS REPORT, Week 43, 20-26 October 2013


    Suspected outbreak of poliomyelitis - Syria ?2013

    Opening date: 22 October 2013 Latest update: 24 October 2013

    Epidemiological summary

    On 19 October 2013, WHO announced a cluster of AFP cases in Deir Al Zour province in Syria, located 250 km from Damascus in the east of the country along the Iraqi border.

    The cluster consists of 22 cases and the age distribution was five cases under one year old, 13 cases one-to-two years old and four cases over two years old. The first cases were detected in early October. Initial tests by the national reference laboratory in Damascus indicated wild poliovirus in two cases.

    Samples have been sent to the regional reference laboratory of the Eastern Mediterranean Region of WHO for confirmation.

    According to WHO, the Syrian Ministry of Health has confirmed that they are addressing this event as a cluster of AFP cases, while they wait for final laboratory confirmation.

    A rapid response is being planned across the country. A surveillance alert has been issued for the region to actively search for additional potential cases. Supplementary immunisation activities in neighbouring countries are currently being planned.


    ECDC assessment

    As a result of the ongoing conflict in Syria, public health services are failing, vaccination coverage has dropped dramatically, sanitary conditions have deteriorated, displaced people are living under crowded conditions and there are large movements of people. These are all conditions that favour the spread of infectious and vaccine preventable diseases.

    The probability is very high that the cluster of cases of acute flaccid paralysis in Deir Al Zour province in Syria is caused by wildtype poliovirus.

    Confirmation of a polio outbreak in Deir Al Zour province would signal widespread transmission of poliovirus in Syria and possibly in the areas bordering Syria.

    This cluster of cases, if confirmed, increases the risk for the importation of wild polio virus to the EU/EEA and further re-establishment and transmission in the Member States.

    It is expected that the number of asylum seekers, refugees and illegal migrants entering the EU will continue to be high and possibly increase as the conflict evolves.

    In the ECDC rapid risk assessment it is recommended that:
    • Countries hosting Syrian citizens in designated areas (camps) should assess the level of transmission of wild poliovirus among them. Such assessments can be carried out through enhanced clinical surveillance, environmental surveillance, and systematic collection of stool samples from symptomatic and asymptomatic persons;
    • EU Member States receiving refugees and asylum seekers from Syria should assess their vaccination status on arrival and provide polio vaccination and other vaccinations as needed;
    • Regional and international efforts to assess the risk and provide vaccination and other public health services in Syria and to Syrian refugees hosted by neighbouring countries should be supported;
    • Member States should consider implementing the recommendations made in the ECDC risk assessment of wild-type poliovirus transmission in Israel;
    • Countries should review their national preparedness plans, and ensure that items such as a framework and responsibilities for outbreak response, enhanced activities and reporting timelines, and vaccine of choice for outbreak response are in place.


    ECDC published a rapid risk assessment on 24 October.