Polio is back in Nigeria, two children left paralyzed
The global effort in eradicating polio was met by a huge disappointment as Nigeria reported two recent cases of children paralyzed by the disease. The country has previously gone on two years without reporting a case.
Prior to the announcement by the World Health Organization, the polio virus was thought to only be circulating in two countries, Afghanistan and Pakistan.
The recent development is one that has been dreaded by the community of people fighting the polio. “I think of all of those things that have kept people in polio eradication up at night, this is the one that we have been most fearful of,” said Dr. Stephen Cochi, a senior polio program scientist at the Centers for Disease Control and Prevention.
Now the fear is about how many cases there will be and over how large a distance before the outbreak can be brought under control.
“We’re anticipating that there may well be more than two cases,” Cochi admitted. “We have to be prepared for additional cases and perhaps the possibility that there’s a larger geographic extent to this outbreak.”
Both cases were reported in Borno, a northeastern Nigerian state, where the Islamic extremist group Boko Haram is active. The region’s instability meant that as many as half a million children have been out of the reach of polio vaccination efforts for the past two years, Cochi said.
Often in conflict zones the polio program has been able to negotiate so-called days of tranquility, where combatants put down their arms to allow for the vaccination of children. That has not been possible in Borno.
Borno sits in the northeastern corner of Nigeria, bordering Chad, Niger, and Cameroon. The political volatility is not restricted to Nigeria and there has been displacement of people within the region.
“Boko Haram is so demonstrably anti-Western in every way, shape, and form, whether it’s education or health care, that there’s no negotiating days of tranquility with Boko Haram,’’ Cochi said.
Emergency vaccination efforts are already being planned to reach as much of Borno as possible, as well as in three other neighboring Nigerian states.
As many as 1 million children will be targeted for vaccination in the next few days, Cochi said, adding that the response will need to be a regional one and may involve the vaccination of as many as 5 million children.
Analysis of the genetic sequences of viruses recovered from the children shows that they are most closely related to polioviruses that were circulating in Borno in 2011. That means transmission in Nigeria or the surrounding countries never fully stopped, but was not detected by surveillance efforts.
Only a small fraction of polio infections lead to paralysis, which means viruses can circulate without being easily detected. It’s estimated that for every one case of paralytic polio, there are 200 silent infections.
Sona Bari, a spokeswoman for the WHO’s polio program, describes the news as “a blow”. She said that this is the first time that a country has stopped transmission and then found indigenous virus again.
In 2015 Nigeria was dropped from the list of polio-endemic countries, having seemingly stopped transmission of the virus for a year. That milestone meant only two countries — Afghanistan and Pakistan — were endemic polio areas.
To date, this year those two countries have reported only 19 cases, the lowest global tally ever. Optimism has been high that transmission in those remaining countries might be arrested in 2017.
In a statement Thursday, the Gates Foundation said it was deeply concerned by the news, but not discouraged.“The fight to end polio continues, often under some of the world’s most difficult and dangerous circumstances, and we will not give up until every last child is protected.”
The Bill and Melinda Gates Foundation is one of the partners in the Global Polio Eradication Initiative. The others are the WHO, UNICEF, the Centers for Disease Control and Prevention, and the service club Rotary International.
Bill Gates said in an interview that polio has characteristics that make it way harder to eradicate than smallpox. Smallpox is the only human disease that has ever been eradicated.
