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| Polio Among Hajj Pilgrims? |
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| lala |
| 02/11/05 at 12:58:56 |
| New Concern on Polio Among Mecca Pilgrims By DONALD G. McNEIL Jr. Published: February 11, 2005 http://www.nytimes.com/2005/02/11/health/11polio.html?oref=login A case of polio reached Mecca in Saudi Arabia, Islam's holy city, just before two million Muslims made the annual pilgrimage there last month, and World Health Organization officials now say the disease could spread to other countries, carried by returning pilgrims. In crowded nations with spotty vaccination coverage like Bangladesh and Indonesia, "there could be substantial consequences," Dr. Bruce Aylward, coordinator of the health organization's Global Polio Eradication Initiative, said in an interview from Geneva. "This is a crucial point," he added. "We're staring at the whites of the eyes of this thing." A spokesman at the Saudi Embassy in Washington said his country had feared the arrival of polio this year and started vaccinating 800,000 people in September, hoping to head it off before the height of the hajj, or pilgrimage, in late January. Saudi Arabia had been polio-free since 1995, but two cases were found late last year. The first was in Jidda, the port city 40 miles from Mecca where most pilgrims disembark. The patient was a Sudanese girl who became paralyzed on Nov. 6, just after arriving. The second, more worrisome, case was confirmed just yesterday: that of a 5-year-old Nigerian boy who developed paralysis on Dec. 15. What made it troubling, Dr. Aylward said, was that his family had lived for several years in an illegal encampment on the outskirts of Mecca, so he must have caught a strain circulating in Saudi Arabia. Spotting new outbreaks in far-flung countries will still take weeks, experts said. Paralysis affects only about 1 in 200 carriers of the virus, symptoms can take up to 35 days to emerge, pilgrims traveling by bus or boat can take weeks to get home, and epidemiological reporting in poor countries is often slipshod. "You want to be well into March before you breathe a sigh of relief," Dr. Aylward said. The virus lives in the intestine and spreads through fecal-oral contact, so anything from changing a diaper to sharing a food dish or swimming in contaminated water can transmit it. Polio vaccination was not required for pilgrims, and even if it had been required, thousands arrive illegally, and many legal visitors carry forged immunization records, said the Saudi Embassy spokesman, Nail al-Jubeir. "We have to trust the health services of the countries they come from," he said. "We can't give everyone blood tests." Vaccinations were required for meningococcal meningitis and, in some cases, yellow fever. Polio has been spreading from northern Nigeria since 2003, when vaccination campaigns there halted for months after Muslim imams and local politicians spread rumors that the vaccine could make women sterile or transmit AIDS, or was made with pork products. Most cases from that outbreak have been in the largely Muslim Sahel, the band of arid land south of the Sahara stretching from Mali to Ethiopia. The remaining pockets elsewhere are also mostly in Muslim areas - Pakistan, northern India, Afghanistan and Egypt. Each case of paralysis implies that many more virus carriers are nearby. Most victims suffer symptoms no more serious than those of flu, but even people with no symptoms can spread the virus. In 1988, when polio was endemic in 125 countries, the annual assembly of the health ministers of all nations in Geneva declared their intent to eradicate it by 2000. That target was missed, but $3 billion in vaccination campaigns drove the disease back until it existed in only six countries by the end of 2003. It took until last summer for world health officials and senior clerics from other countries to persuade Nigerian Muslims to accept a vaccine made in Indonesia. By that time, paralysis cases were appearing as far west as Mali and as far south as Botswana. "In most of them, we were able to surround it and stop it from transmitting locally," said Dr. David L. Heymann, the W.H.O. director general's representative for polio eradication. The most persistent spread was to the east. Sudan, which had been free of polio for three years, found a case from Chad in May 2004, and by late January it had 112. Some Sudanese officials blamed refugees fleeing fighting in southern Sudan, but Dr. Aylward said that made no sense because cases were exploding in Port Sudan, the jumping-off point for Mecca. Another urgent worry of his, he said, is that the hundreds of truckers from landlocked Ethiopia who use Port Sudan will carry polio back home, where immunization rates have fallen. Mr. Jubeir said the thousands of doctors Saudi Arabia hires in hajj season to screen pilgrims could not detect asymptomatic cases. Also, he said, the border police have caught as many as 52,000 people a month sneaking in, mostly from Africa, through Yemen. "It's a nightmare," he said. During the hajj, vast crowds pressed tightly together circle the Grand Mosque and stone the pillars of Satan. Thousands live in government tent cities, but many camp illegally in the mountains around Mecca with little sanitation. "Before terrorism, our biggest concern was disease," Mr. Jubeir said. |
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