The polio outbreak in Sudan and other central and west African countries is snowballing to such an extent it threatens to spread to the Middle East and beyond. If not brought under control, it could undermine efforts to rid the world of polio by the end of 2005.
鈥淭he outbreak in Sudan is extremely concerning,鈥� says Bruce Aylward, co-ordinator of the Global Polio Eradication Initiative. 鈥淚t鈥檚 the only country in the world where we have an escalating epidemic at this time.鈥�
So far 112 cases of polio have been confirmed in Sudan since the first case was reported in May 2004. That was the first case in Sudan for three years and was imported into the troubled Darfur region of Sudan from a large polio outbreak in Nigeria. At the time, experts feared it might herald the start of a wider epidemic in Africa.
Advertisement
The crucial factor, Aylward explains, was what happened in the polio high season, which in the northern hemisphere runs from August to November. And despite a massive synchronised immunisation campaign by the African Union nations in 22 countries, cases of polio are still appearing.
鈥淲hat Sudan demonstrates is this is an epidemic-prone disease that will keep coming back,鈥� Aylward told 快猫短视频.
Clarion call
Another major concern is the forthcoming Hajj in January, when millions of Muslim pilgrims flock to Mecca in Saudi Arabia. This could provide the opportunity for polio to spread widely, if the virus is imported from Sudan.
A child from Port Sudan took the virus into Saudi Arabia on 6 November 2004, prompting the Saudi government to immediately implement an emergency response to heighten its polio surveillance.
But Aylward notes that about half the cases in Sudan are either in the capital 鈥� Khartoum 鈥� or Port Sudan on the Red Sea coast: 鈥淎nd that port is where the Hajj from Africa mass before they go across to Jeddah.鈥� Although the vast majority are adults, who are much less susceptible to polio than children, there is still a risk of infection spreading, he says.
Any spread into the Middle East from Sudan would be worst for polio-free countries where eradication had been a major challenge, such as Yemen. And with the cultural, religious and economic crossroads that the Middle East represents, spread to polio-free nations further afield such as Bangladesh or Indonesia could even be a possibility.
Truck route
Aylward also worries about the possibility of polio spreading to Sudan鈥檚 immediate neighbours. The outbreak is moving along Sudan鈥檚 border with Ethiopia, and hundreds of trucks roll into Port Sudan every day from the heart of Ethiopia and back again, providing a possible transmission.
Aylward says Ethiopia and another neighbour, the Democratic Republic of Congo, are 鈥渟uccess stories鈥�, having been polio-free for over three years. 鈥淏ut these are big, difficult countries with low routine immunisation rates,鈥� he adds. If polio returned, an outbreak like Sudan鈥檚 would be seen, 鈥渂ut on a much bigger scale as their populations are twice as big鈥�.
The African epidemic has affected 13 previously polio-free countries. It stems from an outbreak in northern Nigeria which occurred after the state of Kano suspended polio immunisations in October 2003, alleging the vaccines were contaminated.
That makes Nigeria 鈥� which saw about 800 cases in 2004 compared with 300 in 2003 鈥� a key target if the deadly disease is to be eradicated in 2005, says Aylward. Another key African target is re-establishing vaccinations in C么te d鈥橧voire where internal conflict meant the programme was suspended in November 2004.
If the problems in Sudan, Nigeria and C么te d鈥橧voire can be overcome, Aylward believes polio can still be eradicated by 2006. 鈥淚t鈥檚 very, very exciting and can still be put together.鈥� He met with officials in Sudan in late December 2004 and the government is backing polio immunisation campaigns, one of which started on Monday.
