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13 May 2014

The World Health Organisation has declared a global health emergency over the spread of polio, heralding the unwelcome return of a devastating disease recently pushed to the brink of extinction.

The WHO has taken the rare step of issuing a worldwide alert following evidence that wild poliovirus is spreading internationally during what is traditionally a period of low transmission for the disease, raising concerns infections could become much more rapid and wide ranging when conditions conducive to high transmission kick in during the northern hemisphere summer.

“During the 2014 low transmission season there has already been international spread of wild poliovirus from three of the 10 states that are currently infected,” the WHO said. “If unchecked, this situation could result in failure to eradicate globally on of the world’s most serious vaccine preventable diseases.”

It is only the second time the UN agency has declared an international public health emergency: the first was in 2009 during the global influenza pandemic.

AMA President Dr Steve Hambleton said the disease’s re-emergence was “extremely disappointing” given the decades of effort put into eradicating the disease.

“The only disease we have eliminated is small pox, and we wanted polio to be number two,” Dr Hambleton said.

Polio remains endemic in three countries, Pakistan, Syria and Cameroon, and conditions of conflict and regional instability have helped the disease spread to adjoining nations including, in central Asia, Afghanistan; in the Middle East, Iraq and Israel; and in Central Africa, Equatorial Guinea, Ethiopia, Somalia and Nigeria.

The WHO said that, as at the end of 2013, 60 per cent of all polio cases were as a result of the international spread of the virus, with mounting evidence it was often being carried by adults traversing borders.

“The international spread of polio to date in 2014 constitutes an extraordinary event and a public health risk to other states,” the WHO said. “The current situation stands in stark contrast to the near-cessation of international spread of wild poliovirus from January 2012 through the 2013 low transmission season for this disease.”

After reaching a record low of 223 cases in 2012, the number of polio cases jumped to 417 last year and so far this year 74 cases have been notified, including 59 in Pakistan.

Dr Hambleton said conditions in the Pakistan had led to local outbreaks of the disease, and conflict in surrounding countries had helped its transmission, a view shared by the WHO.

“The consequences of further international spread are particularly acute today given the large number of polio-free but conflict-torn and fragile states which have severely compromised routine immunisation services and are at high risk of re-infection,” the UN agency said.

The polio vaccination program in Pakistan, where the disease has its strongest toehold, has been severely disrupted by violence and misinformation. Almost 30 polio vaccination workers and their police offer guards were assassinated in the country last year. Suspicions about the vaccination program have also been heightened in the wake of revelations the US Central Intelligence Agency used a fake vaccination program as cover to help hunt down Osama bin Laden.

The polio virus, spread through faeces and contaminated water, attacks the central nervous system and can cause paralysis within hours. It is fatal in up to 10 per cent of cases, and there is no cure.

The WHO said a coordinated international response was essential to prevent the spread of the disease. It said unilateral action would likely be ineffective.

Adrian Rollins

Published: 13 May 2014