Europe could have a new outbreak of polio if stronger action is not taken, experts have warned.
Refugees fleeing the crisis in Syria could spread the disease to neighbouring countries and further afield, say two infectious disease specialists writing in The Lancet.
It comes after the World Health Organisation (WHO) confirmed 10 polio cases in war-ravaged Syria, the first outbreak in the country for 14 years.
Professor Martin Eichner and Stefan Brockmann said stronger measures – such as reintroducing oral polio vaccines and screening sewage – should be considered.
They said because only one in 200 people with polio develop paralysis, it can be spread unknowingly. They claim the polio vaccine used in Europe only partly protects from the disease – it is more effective at reducing the chances of developing the worst symptoms.
It said countries with low vaccination coverage were at particular risk, such as Bosnia and Herzegovina, Ukraine and Austria.
The pair, writing in The Lancet, said: “Vaccinating only Syrian refugees – as has been recommended by the European Centre for Disease Prevention and Control – must be judged as insufficient; more comprehensive measures should be taken into consideration.
“Oral polio vaccination provides high protection against acquisition and spreading of the infection, but this vaccine was discontinued in Europe because of rare cases of vaccination-related acute flaccid paralysis. Only some of the European Union member states still allow its use and none has a stockpile of oral polio vaccines.
“Routine screening of sewage for poliovirus has not been done in most European countries, but this intensified surveillance measure should be considered for settlements with large numbers of Syrian refugees.”
Europe was declared polio free in June 2002, according to WHO. The organisation said before the Syria cases were confirmed this week, only Afghanistan, Nigeria and Pakistan still had the disease.
Before Syria’s civil war began in 2011, some 95% of children in the country were vaccinated against the disease, but now an estimated 500,000 children have not been immunised.
WHO says polio is a highly-infectious disease caused by a virus. Symptoms include fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. One in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5% to 10% die when their breathing muscles become immobilised.
Polio cases have decreased by over 99% since 1988, from an estimated 350 000 cases in more than 125 endemic countries then, to 223 reported cases in 2012.