Polio is Back in the Horn of Africa

In April, the World Health Organization (WHO) reported the new presence of wild polio virus type 1 (WPV1) in the Banadir region of Somalia. The initial victim was a thirty-two month old girl. By the end of May, there were four polio cases in Somalia. The WHO has also announced a confirmed case of polio at Kenya’s Dadaab refugee camp, the world’s largest, housing 424,000 people from central Africa and the horn, close to the border of Somalia. This is Kenya’s first polio outbreak in two years.

Somalia had been re-infected with wild polio virus from Nigeria in 2005, resulting in 228 documented cases. That outbreak was eradicated in 2007.

The governments of Somalia and Kenya and the relevant UN agencies are moving quickly to respond. WHO and the UN High Commissioner for Refugees (UNHCR) have launched a campaign to vaccinate 288,000 children under the age of fifteen in the Dadaab refugee camp. The Kenya government and WHO have launched a polio vaccination campaign in the country’s North East Province. A WHO spokeswoman also announced a campaign to vaccinate 400,000 children in Somalia.

Polio can spread quickly, particularly in the crowded conditions of refugee camps or in territories ravaged by war. The WHO spokeswoman observes, “polio is a virus that spreads silently. One case presents between 200 and 1,000 people infected. It’s the tip of an iceberg.” Accordingly, The U.S. Center for Disease Control is advising polio vaccination for all travelers to Ethiopia, Djibouti, Somalia, Kenya, South Sudan, Sudan, Uganda, the Central African Republic, Chad, Niger, Nigeria, Mali, Benin, Cameroon, and Tanzania.

Polio was never entirely eradicated in Nigeria, but it has revived from a low level after the Islamist rebellion in the north ended the polio vaccination campaign. Similarly, in Somalia poor security has precluded a polio vaccination campaign in the south-central part of the country since 2009.

Testing for the origin of this new polio outbreak is still underway, but preliminary evidence indicates Nigeria. Nigeria, Afghanistan, and Pakistan are the only countries in the world where polio remains endemic.

This most recent polio episode highlights the importance of thorough and ongoing vaccination campaigns. But, in Somalia and Nigeria fighting has resulted in the curtailment of planned vaccination campaigns. In Kenya, the overcrowding characteristic of refugee camps is a direct result of the fighting in Somalia.

As in so many other areas, governance and security are proving to be essential to the elimination of a disease.