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From
The NY Times:
An explosive outbreak of polio is taking place in the Congo Republic, with 201 cases of paralysis found in two weeks and 104 deaths, the World Health Organization said Nov. 9.
The government in Brazzaville, the nation’s capital, has declared an emergency and announced plans to vaccinate the entire population with oral drops three times with help from the W.H.O., Unicef and the United States Centers for Disease Control and Prevention.
In Pointe Noire, the port city where most of the cases are concentrated, “We’ve got two hospitals with hundreds of paralyzed people and many dead,” Dr. Bruce Aylward, the W.H.O.’s director of global polio eradication, said in an interview from Geneva. “And a couple of things about this outbreak are different and deeply disturbing.”
Polio normally strikes young boys and girls equally, killing no more than 20 percent of those it paralyzes; death ensues when paralysis moves up the spine to the nerves that control the breathing muscles. In Pointe Noire, 85 percent of the cases are in teenagers and adults, most victims are male, and the death rate is much higher.
However, Dr. Aylward said, as his team on its way there learns more, the outbreak could begin to look more typical, albeit still serious. “We’ve only heard about this in the last seven days,” he said. “This is very much under investigation.”
Pointe Noire is unusual in that rebel activity has so cut off its roads that the city is “almost like an island,” he said, with few outside children visiting. Routine polio vaccination in central Africa began only in the 1980s and focuses on children under age 5, so few adults are protected. Also, the weakened live virus in the vaccine spreads in the same way the disease virus does, shed in feces. Because mothers and sisters tend to change babies’ diapers, they may have picked up that accidental form of protection.
Also, the hospitals are probably seeing only serious cases, making the death rate artificially high. “We’re still dealing with the fog of war,” Dr. Aylward said. “We don’t have exact data.”
In 1996, he noted, there was an adult outbreak in long-isolated Albania after a few years in which only children got the modern vaccine.
It will take a few weeks to see whether the intense central African vaccination campaigns of the last few years can fence off this outbreak, Dr. Aylward said. He called the situation in the Congo Republic an unexpected setback in what had otherwise been a great year in fighting polio.
Nigeria, long Africa’s polio hot spot, had a 98 percent drop in cases since 2009, and 14 of the 15 countries with outbreaks of the Nigerian strain snuffed them out.
The Congo Republic outbreak is of an Indian strain that was first found in Angola in 2007 and is creeping north.
Meanwhile, in northern India, another polio epicenter, “it’s the middle of the high season, and we’ve had no cases in five weeks,” Dr. Aylward said. The worldwide polio-eradication campaign has $800 million less than it estimates it needs to finish the job, he said, “and we’ll never have an opportunity like this again.”
