War-torn Syria is facing another humanitarian crisis: the return of a once eradicated virus.
Reports of acute flaccid paralysis – a telltale sign of polio – are popping up throughout the country, according to the World Health Organization. And preliminary results from a lab in Damascus suggest that at least two of the cases are in fact tied to the deadly virus, which was last seen in Syria in 1999.
"With the civil disturbance, vaccination programs are disrupted, so you have a susceptible population in Syria now," said Dr. William Schaffner, an infectious disease expert and chair of prevention at Vanderbilt University Medical Center in Nashville, Tenn. "Then people who carry the virus in their intestinal tracts can transmit it, either person-to-person or through contaminated water systems."
Although polio lives in the gut, the virus sometimes invades the blood stream and attack the nerve of the spinal cord, causing permanent paralysis in one of every 200 people infected. The resulting disease, poliomyelitis, primarily affects children younger, suffocating one in 10 paralyzed patients as their breathing muscles seize.
"The treatment, unfortunately, is entirely symptomatic," said Schaffner, explaining that the virus usually causes paralysis on one side of the body. "You care for the patient until the infection runs its course. We don't have an antiviral treatment for polio."
Although there's no treatment, there is a polio vaccine. The Global Polio Eradication Initiative, a 1988 effort to eliminate the virus through vaccination, led to a 99 percent drop in polio cases worldwide from 350,000 to 223 in 2012, according to WHO.
"There are just three countries where polio continues to be endemic: Nigeria, Pakistan and Afghanistan," said Schaffner. "But these places can still export the virus to surrounding countries."
Syria's susceptibility to viruses because of its stunted vaccination program was highlighted in an open letter published in the September issue of The Lancet.
"In some areas, children born since the conflict started have had no vaccinations, meaning that conditions for an epidemic, which have no respect for national borders, are ripe," a group of doctors wrote, pleading for medical neutrality in the region. "The number of people requiring medical assistance is increasing exponentially, as a direct result of conflict and indirectly because of the deterioration of a once-sophisticated public health system and the lack of adequate curative and preventive care."
Schaffner said the possibility of polio in Syria is tragic, but not unexpected.
"Whenever you have this kind of domestic turmoil and your vaccination programs are interrupted, you have a growing population of children just waiting to have polio reintroduced," he said, adding that the only way to rid a country of polio again is to "start over" with a vaccination program. "And obviously in a time of conflict, that becomes next to impossible."