Indonesian polio epidemic poses 'real risk' to Asia
By Shaoni Bhattacharya The ongoing and expanding polio epidemic in Indonesia poses a “real risk” of spreading the deadly disease to the rest of Asia, according to polio eradication experts. If polio does spread to nearby countries such as China, Laos, Malaysia and the Philippines, it would be “way, way harder to control” than its recent onslaught through Africa and into the Middle East, says Bruce Aylward, co-ordinator of the World Health Organization’s Global Eradication Initiative. Nevertheless, if “very, very aggressive” action is taken in Indonesia, polio could still be quelled and eradicated by the end of 2005 as planned, he says. However, endemic polio in Nigeria may mean the goal of consigning polio to the history books by year end may be unfeasible. “In terms of slippage of the date – with that much disease in Nigeria it’s going to be extremely difficult to hit the end of the year,” says Aylward. “We are planning through to 2006 for that group of countries.” But nevertheless, he adds: “Overall, the prospect for eradicating polio has never, ever been as good.” This is because, despite setbacks, significant progress has been made in stemming the recent outbreaks in Africa and tackling endemic polio in India, Pakistan and Afghanistan in 2005. New and powerful versions of the oral polio vaccine may be pivotal in dealing with this, he says. Indonesia has 220 cases of transmitted polio virus, according to an update on Friday from the WHO’s regional office for south-east Asia. The disease had been eradicated in Indonesia in 1995, but reappeared in April 2005. “Genetic data indicates that the initial case was due to a virus imported from Sudan or Saudi Arabia,” says Brenton Burkholder in New Delhi, India, and adviser for immunisation and vaccine development at the regional office. The deadly virus has re-infected several countries since the polio immunisation campaign was suspended by Muslim elders in three regions in northern Nigeria in October 2003 – local rumours suggested the vaccine was laced with reproductive hormones and HIV in a plot to depopulate Africa. The disease then spread from Nigeria into neighbouring countries where polio had also been eradicated. It is endemic in Nigeria – with 325 cases in 2005 so far. In Yemen there have been 415 cases in 2005. The disease has also been imported or re-established in Burkino Faso, Sudan, Ethiopia, Angola, Mali and Chad, amongst others. “Indonesia is the only place we have an expanding epidemic,” Aylward told New Scientist. Although Yemen has more cases of polio, its outbreak is much less worrying. “Yemen has really passed the peak of its epidemic and cases [month by month] have plummeted,” he explains. But in Indonesia, although the number of cases is actually declining, the virus is continuing to spread into new regions, which is a major worry. “The concern is that Indonesia could become like Sudan,” says Aylward. He explains that when polio reached Sudan from Nigeria in the past, it radiated outwards to Saudi Arabia, Yemen, Ethiopia and Eritrea and others. An outbreak spreading from Indonesia would be much harder to control than the transmission from Sudan into the Horn of Africa and Yemen, as these routes were often through sparsely populated desert or back into already infected areas. “But there are 200 million people in Indonesia moving all over and trading all over,” he notes. If the virus does escape Indonesia to neighbouring countries, its containment will vary depending on the polio vaccination coverage those countries already have. China for example, might be able to quash an outbreak within a couple of months. Laos, where coverage is low, for example, would pose more problems. Burkholder told New Scientist: “Some countries such as Thailand have opted to conduct some supplemental immunisation campaigns in susceptible areas. Others are at least preparing plans to ensure that they can respond adequately if an importation does occur.” To curb the epidemic, Indonesia is to vaccinate 24 million children over three days starting on 30 August. Two “mop-up” campaigns have already been held. The second one suffered a drop in coverage due to negative media publicity, but Aylward is optimistic that a drive to raise awareness of polio will improve take-up in the next round. He believes the prospects for controlling the Indonesian outbreak are extremely good, but cautions: “The key is – is it out already?