By Rami Assaf and Avery Edelman

AMMAN: Health officials are investigating a cluster of suspected polio cases in eastern Syria where vaccination campaigns to prevent the disease have stalled under Islamic State control.

The suspected cases in Syria’s Deir e-Zor province were first announced by Dr. Emad Mostafa, who posted to his personal Facebook page on May 3 that 16 cases of polio were clinically diagnosed in the area, which is largely controlled by the Islamic State (IS).

Mostafa, who later spoke to the Syrian Voice from Turkey, said that he learned of the cases from medical monitors on the ground in Deir e-Zor.

The doctor nonetheless noted that a clinical diagnosis is not sufficient to confirm the presence of polio, a highly contagious disease affecting infants and young children, because “a number of illnesses have similar symptoms.”

One of those symptoms is acute flaccid paralysis (AFP), described as the sudden onset of paralysis or weakness in any part of the body. AFP is the most common indication of polio, but can also manifest from other viruses.

Analysis of stool samples, a process that can take up to two months and requires specialized laboratories, is therefore necessary to confirm polio, according to Mostafa.

Volunteers administer the polio vaccine in northern Syria. Photo courtesy of UNICEF.

The Program for Monitoring Emerging Diseases (ProMED), an internet-based system for reporting disease outbreaks worldwide, confirmed the presence of “a cluster of suspected polio cases” in Deir e-Zor in a report released on May 12.

In the report, ProMED said that samples from the area have been sent to the US Centers for Disease Control and Prevention (CDC) for further testing.

ProMED put the current number of suspected cases at 23 and claimed that they are concentrated in the Mayadeen region of the Deir e-Zor countryside.

The organization also mentioned that Deir e-Zor is “an area of civil strife” and that there is the potential for a strain of the polio virus to be present among the provinces’ “inadequately immunized population.”

Deir e-Zor was among the Syrian provinces affected by a previous outbreak of polio in 2013, the first emergence of the disease in the war-torn country after a 14-year absence. At that time, 25 of the 35 cases reported were in Deir e-Zor, according to the World Health Organization (WHO).

Transmission of polio in Syria was again halted in early 2014 amid a series of massive, nationwide vaccination campaigns conducted by WHO in collaboration with local health authorities and UNICEF.

The latest preventative, nationwide campaign took place in March 2017, with a particular focus on children in hard-to-reach areas of the country, where mobile teams are sent door-to-door.

Nonetheless, according to Dr. Mostafa, nationwide vaccination campaigns have been unable to reach areas of Deir e-Zor under Islamic State control since July 2016.

This is the case, he said, because IS forbids medical teams from operating freely in the area and from visiting individual homes, claiming such visits would violate aspects of Islamic law.

Without door-to-door campaigns, only children who are brought directly to medical centers are given the immunization.

Furthermore, most medical professions have fled Deir e-Zor, which means administration of the heat-sensitive vaccine is often left to volunteers and others who are not specialized in such work.

Dr. Mostafa estimates that the number of children vaccinated against polio in Dier e-Zor is currently no more than 10 percent. The Syrian Voice could not independently verify this claim.

Medical teams targeted hard-to-reach areas of Syria in the latest nationwide vaccination campaign. Photo courtesy of Polio Reporting.

As residents of Deir e-Zor await further information on the suspected cases, Dr. Mohede al-Mohammad, a doctor from the province, warned that posts like the one Dr. Mostafa shared on Facebook can spread panic in areas under Islamic State control, where routes out are blocked and travel is largely prohibited.

Al-Mohammad, who spoke to the Syrian Voice, added that he has personally seen a number of medical cases which appeared similar to polio but later turned out to be cases of AFP derived from other causes.

Dr. Mostafa himself acknowledged that discussions of polio can spark fear, but was adamant about sharing his information regardless, insisting that “obscuring” the situation is what can really cause harm.

“If the cases are confirmed [as polio] it will be a catastrophe,” he added.

Global incidence of polio, once the cause of paralysis in hundreds of thousands of children each year, has decreased 99 percent since the foundation of the Global Polio Eradication Initiative in 1988.

It is still endemic in three countries: Afghanistan, Nigeria and Pakistan.

As long as polio maintains a presence in those countries or others facing weak healthcare systems and poor sanitation, WHO warns that the potential for the disease to spread to unvaccinated children anywhere remains.

Original Arabic article found here.