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 Randa Hamadeh

Randa Hamadeh

Ministry of Public Health, Lebanon

Title: Polio returns to Middle East, situation analysis, strategies and way forward

Biography

Randa Hamadeh is the Head of the Social Health & the Primary Health Care department, and the Manager of Immunization and Essential Drugs Program at the Lebanese Ministry of Public Health. She contributed to creating a PHC network in Lebanon through which preventive programs and community health initiatives could be initiated, usually involving local municipalities and NGOs. She contributed to the introduction of the PHC facility accreditation program in Lebanon in 2008, and is the Vice Chair of the national accreditation committee. She has actively participated in the foundation of various NGOs. She is the author of many public health papers and booklets. She holds an MPH degree and a Vaccinology Diploma, she is a doctorate candidate in Public Health and is currently a Senior Lecturer in the faculty of Health Sciences at the Antonine University in Lebanon.

Abstract

The Middle East was a polio free area for more than a decade, until wild polio virus from Pakistan found its way through Middle East unrest to paralyze the first Syrian child in Oct 2013. Genetic sequence study suggested virus had been circulating for one year. In October 2013, WHO announced that polio had returned to Syria. Since that time, a total of 36 cases have been confirmed in Syria with the most recent reported case had onset of paralysis on January 2014. On February 2014, Iraq had its first polio case since 2000, in a 6-months old, unvaccinated child. Genetic sequencing indicated the virus is related to virus detected in the Syrian Arab Republic. In Egypt, Palestine, Gaza and West Bank the polio virus has been isolated from sewage systems. The virus was closely linked to one that circulates in Pakistan. Although no polio case have been detected, these samples reminded us that the virus is highly contagious and knows no borders. Following the confirmation of polio outbreak, health ministers from EMRO countries met in Muscat Oman in October 2013. They declared a regional emergency, and a comprehensive multi-country “Strategic Plan for Polio Response in the Middle East” was put in place. This plan focused on conducting mass polio vaccination campaigns, improving AFP surveillance and enhancing routine immunization. The goal of the strategic plan was to interrupt wild poliovirus transmission in Syria and surrounding countries by end of March 2014. Since the beginning of the outbreak, more than 38 Supplementary Immunization Activities have been conducted across the region targeting approximately 25 million children with multiple doses, they were all supported and funded through UNICEF and WHO. Partnership with private sector decreased refusal among families. Private sector has accepted to combine the IPV vaccine with OPV in routine EPI. Cross border vaccination posts were established in the official and non-official border crossing. The strategy was successful in reaching the children escaping from areas of active conflict. Coordination with other UN agencies facilitated the vaccination of thousands children through UNHCR registration centers before they were integrated within communities. The outcomes of the strategies were able to reach 25 million children with multiple OPV doses. Synchronized campaigns prevent the spread of the polio virus out of Syria and Iraq. The last polio case reported from Syria was Jan 2014 and that of Iraq was April 2014. Each country developed a routine EPI plan to cover Syrian refugees in 2015. However, significant risk still remains due to continuous population movement both within Middle East countries and from polio endemic countries to unrest countries of Middle East. Some areas are still inaccessible in Syria and Iraq to vaccination teams so that virus can re-establish circulation. In outbreak countries, National campaigns should continue to reach every child. In neighbor countries, the effort should continue to maintain high immunity level much more through routine EPI and mop up campaigns whenever needed. Sensitivity of the surveillance is one of the important tools to certify polio free area

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