HEALTH-EGYPT: It Looks Like Goodbye to Polio

By Cam McGrath Reprint | | Print |

Cam McGrath

CAIRO, Feb 19 2004 (IPS) - Egyptian health authorities expect to eradicate polio by the end of the year.

"I think we are very close to the end of polio," says head of Egypt’s polio immunisation campaign Dr Ibrahim Barakat.

Polio, or poliomyelitis, is a virus that as recently as 20 years ago disabled 350,000 children every year. A global campaign launched by the World Health Assembly in 1988 to stamp out the infectious disease reduced this number to only a few hundred cases last year.

Egypt is one of six countries where polio is still endemic. Afghanistan, India, Pakistan, Niger and Nigeria are also battling the disease with varied success.

Humans are the only natural host for the polio virus, which makes eradication feasible. Health officials from all six countries announced plans at a meeting of the World Health Organisation (WHO) in Geneva last month to break the person-to-person transmission cycle of polio by the end of this year.

"We think it can be done," Barakat told IPS. "Before this programme started in 1988 there were 5,000 new cases of polio every year in Egypt. Since 1998 there have been less than 50 new cases of polio, and only one case last year."

Despite this apparent absence, many doctors still see cause for worry.

"We can break the cycle of polio, but we will fail if we don’t achieve success in immunising the whole community at the same time," says paediatrician Dr. Mohammed Ahmed Khalil.

He also fears that health authorities may let down their guard too soon. Even if polio is officially eradicated in Egypt by the end of the year, the vaccine used in the current campaign will continue to pose a threat for many years, Khalil says.

Unlike the IPV (inactivated polio vaccine) used in earlier campaigns, the weakened OPV (oral polio vaccine) can revert to its infectious form and spread in the environment.

"The IPV is a solid injection to the stem cell and the immunised person can never get polio in their life," says Khalil. "But when a person is immunised by the OPV the individual continues to secrete the OPV in their stool, which enters the water system."

Khalil maintains that the only way to prevent recurrent outbreaks of polio is to follow up the OPV campaign with a costlier IPV campaign. "This will give us solid immunity and ensure successful eradication."

Egypt’s health ministry and the United Nations Children’s Fund (UNICEF) are now preparing to launch what a health official called "the final drive" to eradicate polio in Egypt. More than 100,000 trained medical teams will be deployed to administer three doses of the OPV to 10 million children.

The first round of vaccinations to begin Feb. 23 will primarily target children living in and around Cairo. Subsequent national immunisation days (NIDs) will target all children under five nationwide.

Egypt has held NIDs annually since 1989. Vaccination teams work out of schools, community centres and health clinics to ensure that every child receives the polio vaccine.

The last three years have seen a shift to a door-to-door strategy that is more extensive, but far more challenging to coordinate in a country of 70 million people.

"Vaccination teams have to go to every apartment and knock on every door to find out if they have received the vaccine," says UNICEF spokesman Simon Ingram. "If nobody is home they have to come back again. The teams put coloured stickers on the doors to indicate the status of the household. It’s an enormous task."

According to WHO records, Egypt’s last confirmed new case of polio was in June 2003. If no new cases are reported, the agency is expected to change Egypt’s polio status to "eradicated" later this year.

As eradication becomes increasingly imminent, surveillance takes on increased importance to quickly identify and contain any outbreaks.

The decline in polio cases presents also an unusual challenge in training doctors to recognise the symptoms and treat the disease.

"Examination of new cases and teaching the disease to medical students is part of my job, (but) I have not seen any new case of polio since five years," says assistant professor of paediatrics at Assiut University, Dr. Salah El-Din Amry. "We now teach students, house officers, and postgraduate candidates…theoretically."

Egyptians are meanwhile excited about the possible end to the scourge. Mother of two Sherine Zakaria has seen significant progress since the polio eradication campaign began in the late 1980s.

"I remember when I went to school, there was always at least one student in every classroom who had polio," she said. "My sons have never seen a child crippled by polio. I hope they never have to."