21 January 2016 – Syria will reach two years without a reported case of polio today despite enormous challenges adversely affecting the delivery of health services, including childhood vaccinations.
Polio resurged in Syria in October 2013 after 14 years of absence, following a sharp drop in immunization coverage and importation of wild poliovirus. Thirty-five cases were reported in 2013 (25 in Deir ez-Zor, 5 in Aleppo, 3 in Idleb, 2 in Al-Hassakeh) and 1 in Hama in January 2014. Transmission was halted after a series of mass vaccination campaigns held across the country reaching more than 2.9 million children under five years of age with repeat doses of oral polio vaccine (OPV).
“I am pleased and impressed that Syria has maintained a zero polio status for the past two years, given its current crisis context,” said Ms Elizabeth Hoff, WHO Representative to Syria. “This is a testament to the dedication and grit of Syrian health workers. Remember, the country is still at high risk of polio, and to keep Syria polio-free we must continue to carry out vaccination campaigns to increase immunity, focussing particularly on children in hard-to-reach areas,” she said. “We must also continue to strengthen disease surveillance systems to monitor for polio. We need to be prepared if the virus resurfaces,” she added.
“This is a major milestone for Syria,” said Hanaa Singer, UNICEF Representative in Syria. “We pay tribute to all health workers and volunteers who made this possible. We must grant them further protection and champion their efforts to reach every child, everywhere across Syria, particularly in hard-to-reach areas. Maintaining these gains remains of paramount importance.”
Stopping transmission of polio in Syria and in the region
Detection of wild poliovirus in Syria in 2013 prompted swift epidemiological response, not only nationally but across the region. In Syria, Egypt, Iran, Iraq, Jordan, Lebanon, occupied Palestinian territory and Turkey, WHO in collaboration with the central and local health authorities, UNICEF and other partners of the Global Polio Eradication Initiative, embarked on a multi-country, multi-phase outbreak response plan involving the implementation of national and sub-national immunization day campaigns to interrupt transmission and contain the outbreak. Thanks to continuous and coordinated efforts, in November 2015 the Middle East Outbreak Response was officially declared closed. In Syria, WHO and UNICEF supported 17 country-wide and localized campaigns.
“WHO has provided key technical and operational support to the 17 polio vaccination rounds held in Syria, including strategic micro-planning, mobilization and training of volunteers, supervision of vaccination teams, and monitoring and evaluation of programme effectiveness,” said Ms Hoff.
“In addition, WHO together with the central and local health authorities of Syria, has expanded the national Early Warning Response and Alert System to 995 sites across the country, which has enhanced national capacity to detect and respond to cases of priority communicable diseases, including polio,” she said.
“Since October 2013, UNICEF has provided a total of 45 million doses of polio vaccines, 1,500 cold boxes and 67 cold rooms to support the polio response efforts in Syria. A countrywide social mobilization campaign has been crucial to raise awareness on polio and the need to vaccinate all children under the age of five multiple times,” Ms Singer said. “UNICEF confirms its commitment to provide further vaccines and cold chain items.”
A major challenge faced by the polio programme in Syria is access. Reaching children in besieged and hard-to-reach areas, particularly those in areas of active conflict such as Ar Raqqa, Idleb and Deir ez-Zor has proved an arduous task for WHO, UNICEF and their partners. Other major hindrances include population movement, shortages of health workers, and disruption to vaccine cold chain systems.
“In spite of these significant challenges, vaccination campaigns in Syria have achieved between 77% and up to 100% coverage of the estimated target, depending on the security situation during each round,” Ms Hoff said. “A great deal of thanks goes to partner agencies, donors and very importantly, to our health workers risking their personal safety to deliver and administer polio vaccine.”
Polio endemic and at-risk countries
Polio is endemic in only two countries – Pakistan and Afghanistan. The outbreak in Syria was due to virus of Pakistani origin. Until polio transmission is stopped globally, countries such as Syria, Iraq and Yemen, are at high risk of importation and transmission.
History of polio vaccination in Syria
Routine immunization against polio in Syria had been mandatory before the crisis with coverage over 95 per cent. This sharply declined to less than 60 per cent in 2014 due to severe disruption to health services.
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