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Outbreak of poliomyelitis - Syria 2013 (ECDC/CDTR, November 29 2013): No Confirmed Poliovirus isolation in Austria so far

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  • Outbreak of poliomyelitis - Syria 2013 (ECDC/CDTR, November 29 2013): No Confirmed Poliovirus isolation in Austria so far

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

    COMMUNICABLE DISEASE THREATS REPORT, Week 48, 24-30 November 2013


    Outbreak of poliomyelitis - Syria 2013

    Opening date: 22 October 2013 Latest update: 21 November 2013

    Epidemiological summary

    In October 2013, WHO reported a cluster of 22 AFP cases in Deir Al Zour province in Syria, located 250 km from Damascus in the east of the country along the Iraqi border. On 29 October, WHO confirmed that wild poliovirus type 1 (WPV1) had been isolated from ten of the affected cases under investigation.

    On 11 November, WHO confirmed that there are now 13 confirmed cases of wild poliovirus type 1 (WPV1) in Syria. Genetic sequencing indicates that the isolated viruses are most closely linked to the virus detected in environmental samples in Egypt in December 2012 (which in turn has been linked to wild poliovirus circulating in Pakistan). Closely related wild poliovirus strains have also been detected in environmental samples in the occupied Palestinian territory since February 2013.

    WHO Regional Office for the Eastern Mediterranean (EMRO) posted an update on 13 November regarding the outbreak response across the Middle East following confirmation of the polio outbreak in Syria. Seven countries and territories are holding mass polio vaccination campaigns with further extensive campaigns planned for December targeting 22 million children.

    WHO and UNICEF are committed to working with all organisations and agencies providing humanitarian assistance to Syrians affected by the conflict. This includes vaccinating all Syrian children no matter where they are, whether in government or contested areas, or indeed outside Syria.

    WHO anticipates that a larger-scale outbreak response across Syria and neighbouring countries will continue for at least six to eight months depending on the area, and based on the evolving situation. In the meantime a surveillance alert has been issued for the region to actively search for additional potential cases.

    On 26 November, WHO confirmed that there are now 17 confirmed cases of WPV1 with one case reported in rural Damascus and Aleppo.

    On 26 November, according to two Austrian media sources, four enterovirus positive cases are being investigated. At this stage there is no indication that poliovirus will be identified as enterovirus found in stool samples is common.

    If positive, these cases may be related to vaccine derived polioviruses as refugees are likely to have been vaccinated with oral polio vaccine (OPV) prior to transfer to Austria.


    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 in crowded conditions and there are large movements of people.

    These are all conditions that favour the spread of infectious and vaccine-preventable diseases.

    Seventeen confirmed cases of WPV1 have been reported from Syria, from Deir Al Zour province, rural Damascus and Aleppo. This is an indication of widespread transmission of poliovirus in Syria and possibly in the areas bordering Syria. This cluster of cases increases the risk that wild poliovirus might be imported to the EU/EEA and become further re-established with 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 letter to the Lancet on 14 November. ECDC published an epidemiological update on 30 October. ECDC published a rapid risk assessment on 24 October.