Suspected outbreak of poliomyelitis in Syria: Risk of importation and spread of poliovirus in the EU

Risk assessment

Following the announcement by WHO of a cluster of cases of acute flaccid paralysis in Syria, ECDC conducted a risk assessment and concludes that this does pose a risk that polio might be imported to the EU. The Risk Assessment includes number of recommendations for EU Member States.

Executive summary

The cluster of suspected acute flaccid paralysis (AFP) due to poliovirus in Deir Al Zour, Syria represents another possible source of infection and importation of wild poliovirus to EU and EEA countries and the further transmission and establishment in Member States. EU Member States receiving refugees and asylum seekers from Syria should assess their vaccination status on arrival and provide polio vaccination and other vaccinations as needed.
On 19 October, the World Health Organization (WHO) announced that it was investigating cases of AFP due to wild poliovirus and results from the WHO regional reference laboratory were pending. However, given the results of two cases from the national reference laboratory in Damascus and the ages of the children (five cases under 1 year old, 13 cases 1–2 years old and four cases over 2 years old) it is likely that the cases are caused by wild poliovirus.
Large numbers of people are leaving Syria and it is expected that the number entering the EU will continue to increase as the conflict evolves. In the first three quarters of 2012, 11 573 Syrians applied for asylum within the EU. 
Regional and international efforts to assess the risk and provide vaccination and other public health services in Syria and to Syrian refugees hosted by neighbouring countries should be supported by the EU.
Polio vaccination coverage in Syria has dropped from 95% of all children receiving three doses of oral polio vaccine between 2002 and 2010 to 52% in 2012 according to the WHO. If poliovirus is circulating in Syria, it should be assumed that a proportion of refugees, asylum seekers and undocumented migrants may also be carrying the virus. The risk will be highest among children born in Syria since 2011 because of the disruption to vaccination services.
This situation stresses the need for Member States to consider implementing the recommendations made in the ECDC risk assessment of wild-type poliovirus transmission in Israel. These include:

  • strengthening AFP surveillance, intensifying enterovirus surveillance, and intensifying environmental surveillance if already used.
  • reviewing national preparedness plans, and ensuring that items such as a framework and responsibilities for outbreak response, enhanced activities and reporting timelines, and vaccine of choice for outbreak response are appropriately in place.