African Strain of Polio Virus Hits Indonesia
By DONALD G. McNEIL Jr.
Published: May 3, 2005
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A case of polio has been detected in Indonesia, World Health Organization
officials said yesterday, indicating that an outbreak spreading from
northern Nigeria since 2003 has crossed an ocean and reached the world's
fourth most populous country.
The virus, found in a village on the island of Java, is most closely related
to a strain that was found in Saudi Arabia in December, the officials said.
The most likely explanations of how it got there are that it either was
brought back by an Indonesian working in Saudi Arabia or by a pilgrim who
went to Mecca in January.
Indonesia's last case was in 1995, and it is now the 16th country to be
reinfected by a strain of the virus that broke out in northern Nigeria when
vaccinations stopped there, then crossed Africa and the Red Sea.
Officials recommended that Indonesia immediately vaccinate five million
children on the western end of Java, including the capital, Jakarta, to
contain the virus. The country began planning such a drive last week, they
Indonesia has more Muslims than any other nation, and polio is now found
almost exclusively in Muslim countries or regions.
Resistance to polio vaccine has been high from northern Nigeria to the
Pakistan frontier because of persistent rumors that it is a Western plot to
render Muslim girls infertile or to spread AIDS. Paradoxically, after
several states in Muslim northern Nigeria halted vaccinations in 2003, it
was purchases of Indonesian vaccine that persuaded wary imams and
politicians to drop their opposition, because it is a Muslim country.
With each new case, the W.H.O.'s goal of eradicating polio by the end of
this year slips farther away. With its emergency response fund virtually
depleted, the organization is pleading with donors for help with containing
new outbreaks in Ethiopia, Yemen and other very poor countries.
At the disease's low point, in early 2003, it was endemic in only six
countries: Nigeria, Niger, Egypt, Pakistan, Afghanistan and India.
The current case was found in a village in Sukabumi Province in West Java in
an 18-month-old boy who became paralyzed in mid-March, said Dr. Bruce
Aylward, coordinator of the polio eradication drive for the health
Genetic typing of the virus, completed in India, shows that the original
source of the strain was northern Nigeria, said Dr. David L. Heymann, the
W.H.O. director general's representative for polio eradication.
Comparison with databases at the Centers for Disease Control and Prevention
in Atlanta shows that it is about 99.2 percent similar to a strain
circulating in Saudi Arabia and 99.1 percent similar to a strain in Sudan,
suggesting that it came through Saudi Arabia, "but they're so close that
it's a hard call," Dr. Aylward said.
Dr. Christopher P. Maher, chief of technical support in the health
organization's polio division, visited Sukabumi last week and found that no
relatives of the child had gone to areas where polio was endemic, but other
families in the village had members who had gone recently to Saudi Arabia as
workers or pilgrims.
There are other cases of paralysis in the village that "are very hot - they
clinically look like polio," Dr. Aylward said.
It is unclear how many cases exist, but their presence suggests widespread
circulation of the virus, since only one case in 200 produces paralysis.
Confirmation takes time; each requires two stool samples taken at least 24
hours apart and then shipped to a laboratory and cultured for days or weeks
But vaccination should start as soon as possible, the officials said.
Reaching five million children "doesn't sound like 'targeted' vaccination,"
Dr. Aylward conceded, "but in a country of 250 million, it is."
Only 75 percent to 80 percent of Indonesia's children get routine polio
vaccinations, he said, and some areas have better coverage than others.
Indonesia is a large chain of islands, and parts of it, including northern
Sumatra, are in rebellion against Jakarta's rule. When polio gets into
war-torn areas, as it has in Sudan and Ivory Coast, it can become much
harder to eliminate.
Until recently, Indonesia also lacked a polio emergency plan that provides
for vaccinating at least half a million children within four weeks of
finding a case, going house to house. Still, Dr. Aylward said, "I'd rather
take the virus on in Indonesia than in a Sudan or a Yemen or the Horn of
Africa, where you've got less than 50 percent baseline coverage."
Many countries stopped vaccinating or cut back substantially when they
eliminated polio in the 1990's. "We're paying a penalty for that now," Dr.
During the 11 months it took until northern Nigeria resumed vaccinations,
the disease spread across Africa from Guinea on the Atlantic to Sudan on the
Red Sea. One case was found as far south as Botswana. Some outbreaks have
been contained quickly, but those in Sudan and Ivory Coast, and a new one in
Yemen, all appear to be spreading faster than vaccinators can head them off.
The infection routes followed African highways that skirt the southern edge
of the Sahara, and ferry routes on the Red Sea.
The disease was found in Jidda and Mecca in Saudi Arabia late last year, and
polio eradication officials said in February that they feared that the
annual Muslim pilgrimage could spread it around the world.
In 1988, when polio was endemic in 125 countries, the annual world assembly
of health ministers in Geneva declared a goal of eradicating it by 2000.
That target was missed, but a $3 billion campaign had it contained in six
countries by early 2003.