BEIRUT: As the fourth round of Lebanon’s national polio vaccination campaigns comes to a close, NGOs and U.N. agencies say that ongoing “mop-up” vaccinations are needed to prevent an outbreak of the potentially deadly disease in Lebanon.
“Our strategy at this stage is based on three pillars,” said Dr. Ziad Mansour, the World Health Organization’s program director for Lebanon.
“The first pillar is the ‘mop-up’ or targeted area campaigns. [The second] is the introduction of the oral poliovirus in the private sector, within the national campaign, and the third is a scaling up of the social mobilization with microplanning compatible with each area.”
Mansour also stressed that raising awareness was crucial.
The next stage of the campaign includes targeting children whose parents mistakenly believe them to be immunized.
“There is sometimes resistance from the population,” said Salam Abdelmunem, UNICEF Lebanon’s emergency communication specialist.
“Lebanese children are well-covered through the routine vaccinations, but we need them to be on board with the campaigns too. There is this perception that: ‘This is not for us. This is for the refugees.’ ... There is heavy reliance on private health providers and the perception of risk is lower than it actually should be.
He added that part of the problem was the lack of information.
“Parents do not fully understand that the oral polio vaccination drops are incredibly important to ensure that children are immunized. Many of the children will get their ... shots very early on, so their doctors will tell them: ‘These children have had their polio shots and they’re fine.”
“The risk perception among the refugee population is actually better,” he added, “because they’ve heard of the cases in Syria, so they are worried for their children.”
Polio, a highly infectious viral disease, affects children under the age of five, attacking the nervous system and in some cases leading to irreversible paralysis or death. The virus, which can spread from person to person or through contaminated food and water, has no symptoms in 199 out of 200 cases and is incurable once caught, but can be easily prevented by an initial injection followed by regular oral vaccines.
An outbreak of polio in Syria last year and a verified case in Iraq in January have resulted in stringent measures being taken by UNICEF, the WHO and the Public Health Ministry to prevent the spread of the disease to Lebanon.
“We’ve had no polio cases in Lebanon for more than 13 years,” said Randa Hamadeh, who is in charge of the immunization program at the ministry.
One of the main challenges facing the Lebanese government is ensuring that every child in the country -– including the thousands of unregistered refugees – has access to free oral vaccinations. UNICEF has provided the Lebanese state with more than 1.7 million of these, 300,000 of them to private clinics.
“At the border entry points we have official points for General Security and ... we’ve asked them to have a post for vaccinations,” Hamadeh said, “so we have one in Abudayyeh, in Arida, in Baqaiaa, in Masnaa, and we also have one in al-Qaa. ... It is not an official border entry but we know that people are coming and going unofficially from there.
She said that every child who had crossed the border into Lebanon was receiving the vaccine, along with families that registered for UNHCR services.
Once children are vaccinated at the border, their parents are given a pamphlet explaining where to go for follow-up vaccinations.
“With polio you need multiple vaccinations before the age of five to ensure that you’re fully protected,” Abdelmunem explains. “Especially the oral poly vaccine: the more you take it, the better protected you are.”
Should the vaccination campaign fail to prevent the disease from spreading, additional safety measures are in place.
“We have a surveillance system which reports any case of suspicious paralysis,” explains Dr. Salim Adib, an epidemiology professor at the Lebanese University.
“There is an entire protocol that kicks in, which includes taking fecal specimens to check whether this is polio or something else. ... If it is polio then ... there’ll be a revaccination of all children that were in contact with that first case.”
Polio is currently endemic in four countries – Afghanistan, Pakistan, Nigeria and Yemen – but since the outbreak of the disease in Syria the wild polio virus has been traced to Egypt, Gaza and the West Bank, Abdelmunem and Mansour told The Daily Star.
“We know that it is most probably also present in the environment in Lebanon, but I cannot assume that there is any kind of transmission in humans at this stage,” said Mansour.
However, he added that the WHO has not tested for the presence of the disease in Lebanon.
“We’re behaving as if the virus was present in the environment, so we’re taking maximum measures. We don’t want the environmental sampling to give us a false sense of security.”
Hamadeh said the Public Health Ministry has also begun vaccinating against measles and rubella as part of the polio campaign, in response to an increased number of cases.
“Last year we had an epidemic of measles,” she said. “We exceeded more than 300 cases in the country, but it’s not severe. We’re not in the phase of eradication, we’re in the phase of elimination for measles and that’s why an outbreak won’t tell much about the health situation.
“But [for polio] we’re in the phase of eradication in the whole world. ... One case of polio would be an epidemic, but 100 cases of measles won’t be,” she said.