New Tajik polio outbreak prompts swift measures from Moscow

From Radio Free Europe:

The reemergence of an old disease in Tajikistan has led to an outbreak of a "polio war" between Moscow and Dushanbe.

The dispute erupted after news emerged in April that the viral disease, which primarily spreads in areas with poor sanitation and can cause paralysis within hours of contraction, had returned to Tajikistan in a big way.

Two deaths resulting from polio have been confirmed in the Central Asian country, although Russian officials have placed the number as high as 15. Some 104 cases of wild polio virus have been confirmed, and nearly 440 cases of acute flaccid paralysis, the most common sign of polio, have been recorded.

In Russia, where hundreds of thousands of Tajik migrant workers trek for seasonal work, suspected cases have appeared among young children of Tajik migrant laborers in hospitals in Moscow and thousands of kilometers away in Angarsk, Irkutsk Region. These illnesses have led officials to introduce a number of measures to prevent the disease from spreading.

Tajik children less than six years of age, the most likely group to contract the virus, have been barred from entering the country and testing at border points has begun. In another move that threatens to further damage Tajikistan's already battered economy, imports of dried fruit were banned by Moscow.

At the same time, Russian officials, including chief sanitary inspector Gennady Onishchenko, have begun to make alarming statements.

"We should bring our children back from Tajikistan,” Onishchenko said. “We have more than 1,000 Russian children there, the children of [Russian] officers. They will be leaving."

On May 26, Onishchenko said that a Russian girl who recently returned to St. Petersburg from Tajikistan carried the polio virus with her. Onishchenko said the girl herself was healthy but was a carrier of polio, adding that there are "several" other cases of Russian children recently returned from Tajikistan who are also carriers of the virus.

The WHO's Global Polio Eradication Initiative, which updates its list of polio cases on a weekly basis, had not officially registered a confirmed case in Russia as of May 25.

Onishchenko also said if Tajik authorities do not heed the ban on Tajik children under six traveling to Russia, then Russia's sanitary control agency would take "effective measures."

At least three citizens of Tajikistan, termed "carriers" of polio by Russian health officials, have been deported to Tajikistan since May 26.

The World Health Organization declared its European region -- which includes Russia and Tajikistan -- polio-free in 2002. Its reemergence is seen as a blow to the WHO's all-out effort launched in 1988 to eradicate the disease from the globe.

In 2009, there were about 1,600 cases of polio recorded in 23 countries, according to the WHO. In Russia the disease had not been seen in 15 years, and no case had been recorded in Tajikistan since 1997.

Tajik Deputy Health Minister Sayeda Jobirova said the reappearance of the disease in Tajikistan came as a surprise. "Many world regions, including Tajikistan, have been free of this disease for the last 10 years,” Jobirova said. “As research shows, the virus entered our country from outside and it is a so-called ‘wild poliomyelitis.’”

Officials have claimed that the virus, which is not endemic to Tajikistan, came from India.

Nine cases of polio have been recorded this year in Afghanistan, neighboring Tajikistan. In Uzbekistan, according to the WHO, three cases of acute flaccid paralysis had been recorded along the country's border with Tajikistan as of April, although no poliovirus cases had been confirmed.

Tajikistan's outbreak of polio is so far confined to the Dushanbe and Khatlon areas, which border Uzbekistan.

The outbreak has led Tajikistan and Uzbekistan to coordinate in launching mass immunization campaigns, according to UNICEF. The UN body reports that history shows that three rapid, large-scale campaigns "can quickly stop an outbreak of polio in a previously polio-free country." The third round is planned for the first week of June.

Tajik Deputy Health Minister Aazam Mirzoev, who this week advised Russian sanitary inspector Onishchenko against "politicizing the situation," has blamed the outbreak on a failure to follow up on inoculations.

"Certainly, there are children who missed the opportunity to be vaccinated due to migration from Tajikistan, and inside of the country,” Mirzoev said. “Some of them have not been vaccinated year after year. They have a role in the outbreak, because they do not have a shield against the disease."

While Tajikistan has a vaccination program in place for polio, Mirzoev notes that migrant laborers sometimes take their families with them to Kazakhstan or Russia and in so doing miss the regular inoculations. Also, he suggests, people in urban areas can miss regular visits or invitations from medical authorities when they change residences.

Polio is a highly contagious and viral illness that can cause difficulty in breathing, paralysis, and death. Early symptoms include fever, sore throat, vomiting, back stiffness, muscle spasms, general fatigue, and headaches.

It can be spread quickly through person-to-person contact, and also through contaminated food and water, and is most often seen in areas with poor sanitary conditions.

Rukhsor Rahim, a Dushanbe resident whose child is thought to have polio, tells RFE/RL's Tajik Service that officials did not provide adequate information to the public. "There was no information about the nature of the disease and what people should do," Rahim said.

One thing that WHO does not recommend doing is imposing restrictions on the international movement of people. But that is nevertheless one of the measures taken by some of Tajikistan's neighbors.

Russia's ban on Tajik children entering the country is the harshest measure, but Uzbekistan also announced this week that it was barring Tajik citizens living in areas bordering Uzbekistan from entering the country.

Meanwhile, there have been reports that Kazakhstan has tightened its border controls with Uzbekistan due to concerns about polio.