On the move. poliovirus from Pakistan, where the disease is still endemic, was found in wastewater in Egypt, which has been polio-free since 04. Here is a girl in Pakistan receives polio vaccine drops.
Global Initiative for polio eradication
Health officials in Egypt and around the world are scrambling to prevent a polio outbreak after poliovirus from Pakistan has been found in samples of wastewater collected at two sites in Cairo in December.
Genetic analysis just completed has linked the virus to Egyptian one that was last seen in Pakistan in September 2012. How he arrived in Cairo remains unclear, but genetic evidence suggests that the virus made the long journey in the course of the past 3 months. Egypt has been polio-free since 04.
So far, no cases of polio have been found in Cairo, and there is no evidence that the virus itself has established and begun to circulate widely. But there is a real risk, said Bruce Aylward, who heads the global initiative to eradicate poliomyelitis (GPEI) of the World Health Organization (WHO) in Geneva, Switzerland.
"The last thing anyone wants is for Eqypt to reinfected," says Aylward. That is why the countries and international organizations who advise the deal positive samples as a fulfilling epidemic, "We are very, very aggressive," Aylward said.
The importation of the virus in Egypt is another setback for the global program, which was finally made significant progress over the past two years, with only three cornered polio in endemic countries. Pakistan, Afghanistan and Nigeria (India is now past 2 years without a single case of polio.) of the three, Pakistan has done particularly well in knocking out the virus, but the program has recently been disrupted by the targeted killing of nine polio workers in December and early January. These killings, widely convicted, have fueled fears that the virus will regain strength in Pakistan, then reinfect polio-free countries. "This is a positive proof of import long distance from Pakistan, and it may be more," says Aylward .
This is only the second time poliovirus from Pakistan has infected other countries neighboring Afghanistan; the first was China, where the virus Pakistan triggered an epidemic in 2011. The new import puts more pressure on Pakistan to eradicate the virus within its borders.
The wild poliovirus was detected in the untreated wastewater collected on 2 and 6 December in routine sampling in areas under Al Salam and Al Haggana in Cairo. Once they were considered positive, samples were shipped to the US Centers for Disease Control and Prevention (CDC) in Atlanta for genetic sequencing. The analysis, completed Jan. 18, showed that viruses of the two sites are closely related to each other, and both could be attributed to a virus for the last time in September in environmental samples in Sukkur in northern Sindh province in Pakistan.
The presence of the virus in untreated sewage mean a person or several people, perhaps a family conducted from Pakistan and are now excrete in their feces. No cases of polio have been found so far; in general, polio causes paralysis in about one in 100 people it infects. The two samples are from the same tributary wastewater, said Sona Bari, a WHO spokesman.
Alerted Friday night (18 January), WHO, CDC, and other partners of the global initiative immediately sent teams to help the Egyptian Ministry of Health and Population to investigate and to plan a response. The intensified environmental monitoring and are actively looking for all cases of paralysis that may have been missed. Planning is underway for an emergency campaign to immunize children in both areas of Cairo, as soon as possible, to be followed by one in the Cairo metropolitan area in mid-February, then national campaigns.
Egypt had two other poliovirus importations known since 04, but neither caused disease. A key variable in determining how widely the virus spreads is the level of population immunity. The poliovirus can not take off if immunity is high and few children are sensitive, as is generally the case in Egypt. But experts are worried, Bari said, because Egypt has reduced its national immunization campaigns against polio for two to once a year during the turmoil of the revolution. And even in the best case, Aylward said, there are still children who do not receive immunization against polio, mostly in poor populations living in slums with poor sanitation.
The events come in the WHO Executive Board meets week in Geneva to discuss, among other things, progress and threats to the effort to long-term polio eradication, originally scheduled for completion in 00. "first and foremost on everyone's mind is Pakistan," said Alyward. a question that he expects to be on the table is travel restrictions. the independent monitoring Board overseeing the GPEI recommended in a November 2012 report that, under the International health Regulations, the three endemic countries introduce measures to ensure that no one can leave the country without proof of vaccination against polio.
already, Shahnaz Wazir Ali, focal point of the Pakistani Prime Minister to eradicate polio, advised all the provincial and federal governments to establish permanent booths at international airports to vaccinate all children under 5 years against polio before leaving the country.
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