'Explosive' polio outbreak in Somalia

Somalia is suffering an "explosive" outbreak of polio and now has more cases than the rest of the world combined, an official said Friday, days after an international health organization pulled out of the country citing security concerns.

Somalia now has 105 cases, figures released Friday show, and another 10 cases have been confirmed across the border in a Kenyan refugee camp filled with Somalis. Globally, there have been 181 cases of polio this year, including those in Somalia and Kenya.

Vaccine-wielding health workers face a daunting challenge: accessing areas of Somalia controlled by armed groups, where 7 of 10 children aren't fully immunized.

In a sign of how difficult it is for medical providers to operate in Somalia, the aid group Doctors Without Borders announced this week that it was pulling out of the country after 22 years because of attacks on its staff members. MSF, an acronym based on the group's French name Médecins Sans Frontières, was not taking part in the polio-vaccination campaign.

Polio is considered mostly eliminated around the world, with the exception of three countries where it is considered endemic: Afghanistan, Nigeria and Pakistan. India marked a major success in February 2012 when it was removed from the World Health Organization's (WHO) list of countries plagued by the disease.

Vaccination campaigns in Somalia have reached 4 million people since the outbreak began in May, but health groups have limited access to an estimated 600,000 children who live in areas of the country controlled by the armed group al-Shabab.

"It's very worrying because it's an explosive outbreak and of course polio is a disease that is slated for eradication," said Oliver Rosenbauer, a spokesman for the Global Polio Eradication Initiative at the WHO in Geneva. "In fact we're seeing more cases in this area this year than in the three endemic countries worldwide."

In a bit of good news, Rosenbauer told The Associated Press that polio numbers are down in the three endemic countries.

"The only way to get rid of this risk is to eradicate in the endemic countries, and there the news is actually paradoxically very good," he said.

Somalia was removed from the list of endemic polio countries in 2001, but this year's outbreak is the second since then.

It began one month after Bill Gates, founder of Microsoft, helped unveil a six-year plan to eradicate polio at the Global Vaccine Summit in April. That effort will cost $5.5 billion, three-quarters of which has already been pledged, including $1.8 billion from the Bill and Melinda Gates Foundation.

The outbreak in Somalia does not set back the six-year plan, said Rosenbauer, because unpredictable and intermittent outbreaks were accounted for in the timeline.

Somalia shares one significant trait with the three endemic countries: pockets of severe violence where populations can be hostile to health-care workers.

In February, gunmen believed to belong to the armed group Boko Haram shot and killed at least nine women taking part in a polio vaccination drive in northern Nigeria.

Polio, for the moment, has been defeated in two areas of Pakistan. But in one region where the disease persists — the dangerous Waziristan region near the Afghanistan border — local authorities have banned immunization campaigns since mid-2012. Vaccination programs, especially those with international links, have come under suspicion since a Pakistani doctor ran a fake vaccination scheme to help the CIA track down Osama bin Laden.

"So no immunizations are taking place, and sure that's a challenge and that has to be addressed," said Rosenbauer. Still, he noted that in 90 percent of cases when a child isn't immunized in Pakistan, it's because of operational issues, not social resistance.

Afghanistan saw 37 polio cases last year, but only four so far this year. Polio cases are also down in Nigeria year-over-year, but about the same in Pakistan.

When the Global Polio Eradication Initiative was launched in 1988, the disease was endemic in 125 countries and paralyzed roughly 1,000 children every day. Since then, polio cases have decreased by more than 99 percent. Five children have been paralyzed in Somalia's recent outbreak.

At this year's Global Vaccine Summit, Gates talked about the need to vaccinate the hardest-to-reach children in endemic countries.

Eradicating the last cases has proved difficult. WHO knows the Somalia outbreak came from West Africa, but can't say exactly where. In 2011, the virus jumped from Pakistan to China, and the year before that to Tajikistan. There have been more than 50 outbreaks in the last decade.

Poliovirus is very contagious. It lives in an infected person's throat and intestines. It spreads through contact with the feces of an infected person and through droplets from a sneeze or cough.

Al Jazeera and The Associated Press