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2024 Gaza Strip polio epidemic

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2024 Gaza Strip polio outbreak
DiseasePolio
Virus strainCirculating vaccine–derived poliovirus type 2 (cVDPV2)
SourceWastewater
LocationKhan Yunis and Deir al-Balah, Gaza Strip
First reportedCentral Gaza Strip
Date16 July 2024 – present
Confirmed cases1[1]
Active cases1[2]
Suspected cases‡3[3]
‡Suspected cases have not been confirmed by laboratory tests as being due to this strain, although some other strains may have been ruled out.

The 2024 Gaza Strip polio outbreak is an ongoing outbreak of circulating vaccine-derived poliovirus type 2 (cVDPV2) in the Gaza Strip, first discovered on 16 July 2024 and officially declared an epidemic by the Gaza health ministry on 29 July.[4][5] The Gaza health ministry stated that the epidemic presented a significant risk to Gaza's citizens and to bordering countries, and called the outbreak "a setback to the global polio eradication program".[6] The World Health Organization reported that it was "very likely" that polio cases infected citizens of Gaza and were spreading among its population, although detecting cases would be very challenging due to the virus being asymptomatic in most cases and due to Israeli medical blockades preventing confirmation of cases.[5] The epidemic marked the first occurrence of poliovirus in the Gaza Strip since the virus was completely eradicated from the region 25 years prior.[7]

On 16 August, tests in Jordan confirmed the first polio infection in Gaza, located in the central Gaza strip.[8]

So far the United Nations has confirmed one case of paralysis in a 10-month-old baby.[9]

On 29 August 2024, Israel made a "preliminary commitment" to comply to pauses in the fighting to facilitate a vaccination campaign.[10] 14 days later the World Health Organization reported that polio vaccination for children of the Gaza strip was achieved.[11]

Background

Main article: Gaza humanitarian crisis (2023–present)

The Gaza Strip is experiencing a humanitarian crisis as a result of the Israel–Hamas war.[12][13] The crisis includes both an impending famine and the destruction of its healthcare system. At the start of the war, Israel tightened its blockade on the Gaza Strip, which has resulted in significant shortages of fuel, food, medication, water, and essential medical supplies.[12][14] This siege resulted in a 90% drop in electricity availability, impacting hospital power supplies, sewage plants, and shutting down the desalination plants that provide drinking water.[15] Widespread disease outbreaks have spread across Gaza as a result.[13]

Public health experts warned of the outbreak and spread of disease in Gaza. According to Oxfam and the United Nations, Gaza's lack of clean water and sanitation would trigger a rise in cholera and other harmful and potentially-deadly infectious diseases.[16] Oxfam stated Gaza's sewage pumping stations and wastewater treatment facilities had ceased operations, so the buildup of solid waste and unburied bodies were likely vectors of disease.[16] Due to the lack of clean drinking water, Gaza residents were drinking water contaminated with sewage, seawater, and farm water, another major source of disease.[16] WHO egional emergency director Richard Brennan stated, "The conditions are ripe for the spread of a number of diarrhoeal and skin diseases".[16]

Raw sewage overflowed in the streets, causing a significant health and environmental disaster.[17] Flooding in Gaza spread sewage water, raising fears of the spread of disease.[18][19] On 19 January, Yahya Al-Sarraj, the mayor of Gaza City, stated more than 50,000 tons of trash had accumulated in the city, further leading to the spread of disease.[20] Parents reported children falling sick after being exposed to raw sewage.[21] In May 2024, the UN stated, "Mosquitoes, flies and rats are spreading, and so are diseases."[22] Oxfam reported the threat of disease outbreaks due to an accumulation of "human waste and rivers of sewage in the streets".[23]

History

The Gaza Strip had successfully eradicated polio and there had been no cases for over 20 years, however there was some evidence of asymptomatic transmission in the occupied Palestinian territories found during a small outbreak in Israel.[citation needed]

Epidemiology

On 16 July 2024, an investigation of sewage sites in the Gaza Strip by the Global Polio Laboratory Network of the World Health Organization (WHO) discovered traces of circulating vaccine-derived poliovirus type 2 in all six test samples among two regions in Khan Yunis and Deir al-Balah.[4][24] Genomic sequencing of the isolated poliovirus traces by the Centers for Disease Control and Prevention (CDC) found that they had close genetic linkage between each other, and were closely related to cVDPV2 that circulated in Egypt throughout the 2nd half of 2023 and was last detected in December 2023. Research into genetic changes present in the samples indicated that the poliovirus could have spread to Gaza as soon as September 2023.[25]

As of 23 July 2024, no tests had yet been conducted for polio cases or symptoms of paralysis in humans.[26] WHO and UNICEF planned to bring fifty human sample kits to the Gaza Strip on 25 July 2024 and investigate them at a lab in Jordan.[24] In late-July, three cases of acute flaccid paralysis were diagnosed in the Gaza Strip with researchers determining that poliovirus was a potential cause, leading them to take samples of the cases and send them to Jordan for analysis.[27]

The WHO reported that Gaza immunization rates were at 99% in 2022, and fell to 89% in 2023 due to decimation of the Gazan health system in addition to "lack of security, access obstruction, constant population displacement, shortages of medical supplies, poor quality of water and weakened sanitation".[4]

Israeli Infectious Disease Institute director at the Beersheba Soroka Medical Hospital Dr. Lior Nesher claimed that attempts to halt the "ecological movement" of the poliovirus would be "almost impossible", emphasizing that the virus "does not respect borders". He reported that the poliovirus could spread from sewage to underground aquifers as a result of flooding during the rainy season. He stated that even though most Israeli soldiers were immunized against the virus, they could still carry it in their clothes, in mud, and in feces produced with bowel movements, which could cause the virus to spread throughout Israel. He also noted a marked increase in vaccine non-compliance in Israel compared to a few years ago, which could allow the virus to spread easier throughout non-immunized citizens and unvaccinated children. According to his statistics, rates of Israeli measles vaccination were below herd immunity percentages of 92–93%, which could indicate a lack of herd immunity towards polio in the Israeli population were the virus to circulate in Israel.[28]

On 29 July, the Gaza Health Ministry officially declared a polio epidemic in the Gaza Strip, stating that the circulating poliovirus throughout large deposits of wastewater posed a significant health threat to Gaza and countries bordering it. The ministry called the epidemic "a setback to the global polio eradication program" and placed blame on the destruction of hospitals and medical infrastructure by Israel.[6] On 30 July, the WHO reported that it was "very likely" that polio had infected and spread among citizens Gaza.[5]

On 16 August, the Palestinian Ministry of Health recorded the first confirmed case of polio in Gaza in the city of Deir al-Balah.[29] The first polio victim was a ten-month old baby who "stopped crawling, stopped moving, stopped standing up, and stopped sitting."[30]

Response

Humanitarian response

Head of WHO's Palestinian team Dr. Ayadil Saparbekov stated that organization workers were conducting risk assessments and distributing information about protection from polio to the Gazan population. He noted that it would be very difficult for citizens to be able to follow the guidelines recommended due to the lack of wastewater and sanitation treatment and the resulting buildup of waste and debris in densely crowded refugee encampments throughout the Gaza Strip.[4]

Efforts to limit the spread of the disease were significantly complicated by difficulties in moving humanitarian aid into Gaza including sanitation equipment and adequate nutrition. In addition, dangerous conditions in the Gaza Strip due to military assaults and airstrikes prevented safe allocation of resources across the territory to isolated regions and populations with the greatest susceptibility.[4]

WHO vaccination drive

On 12 September the World Health Organization reported reaching the target of polio vaccination for children of the Gaza strip.[11] One week later, the United Nations stated that its second round of polio vaccinations would include doses of micronutrients and a nutritional screening.[31] The W.H.O. began its second round of polio vaccinations on 14 October 2024.[32] It was delayed due to intense bombardment in northern Gaza, however, where the campaign had sought to vaccinate more than 100,000 children.[33]

In early-November 2024, WHO stated it would resume polio vaccinations in northern Gaza but only in Gaza City.[34] The following day, however, an Israeli drone reportedly bombed the polio vaccination site, the Sheikh Radwan Clinic, wounding three children.[35] The World Health Organization later stated six people, including four children, were injured in the strike.[36] UNICEF condemned the strike, stating, "Health workers and other humanitarian staff cannot do their jobs in the midst of ongoing attacks."[37]

Israeli response

The IDF started a voluntary vaccination campaign for its soldiers.[38] It also announced cooperating with humanitarian agencies for vaccine delivery in Gaza, with ~300,000 vaccines delivered since the start of the conflict in October.[4]

Human Rights Watch stated that both Israel's attacks on healthcare and water infrastructure and obstruction of humanitarian aid were worsening the polio epidemic.[39]

See also

References

  1. ^ "Gaza sees first polio case in 25 years as UN calls for mass vaccinations". The Guardian. 2024-08-16. ISSN 0261-3077. Retrieved 2024-08-17.
  2. ^ "Gaza sees first polio case in 25 years as UN calls for mass vaccinations". The Guardian. 2024-08-16. ISSN 0261-3077. Retrieved 2024-08-17.
  3. ^ "WHO warns Gaza at 'high risk' of polio outbreak". Financial Times. Retrieved 23 July 2024.
  4. ^ a b c d e f "Polio in Gaza: WHO 'extremely worried' about possible outbreak". www.bbc.com. Retrieved 23 July 2024.
  5. ^ a b c "Polio cases 'very likely' in Gaza population, WHO says". Reuters. 30 July 2024. Retrieved 30 July 2024.
  6. ^ a b "Gaza Health Ministry Declares Territory 'Polio Epidemic Area'". Barron's. 30 July 2024. Retrieved 30 July 2024.
  7. ^ Al-Taher, Nada (30 July 2024). "Gaza declares polio epidemic 25 years after disease was eradicated in enclave". The National. Retrieved 30 July 2024.
  8. ^ "Gaza sees first polio case in 25 years as UN calls for mass vaccinations". The Guardian. 2024-08-16. ISSN 0261-3077. Retrieved 2024-08-17.
  9. ^ "Baby contracts Gaza's first case of polio in 25 years". www.bbc.com. 24 August 2024. Retrieved 24 August 2024.
  10. ^ "UN says Israel agrees to pauses in Gaza fighting for polio vaccinations". Al Jazeera. 29 Aug 2024. Retrieved 30 August 2024.
  11. ^ a b "WHO 'confident' that polio vaccine drive in Gaza hit target of 90% of kids under 10 | The Times of Israel". The Times of Israel.
  12. ^ a b Ioanes, Ellen (14 October 2023). "Gaza's spiraling humanitarian crisis, explained". Vox. Archived from the original on 14 October 2023. Retrieved 16 October 2023.
  13. ^ a b Marsi, Federica (14 October 2023). "Gaza doctors warn of a humanitarian catastrophe after Israeli attacks". Al Jazeera. Archived from the original on 14 October 2023. Retrieved 25 October 2023.
  14. ^ Gottbrath, Laurin-Whitney. "Gaza "fast becoming hell hole" on "brink of collapse" amid Israel strikes: UN". Axios. Archived from the original on 16 October 2023. Retrieved 16 October 2023.
  15. ^ Mellen, Ruby; Chen, Szu Yu (26 October 2023). "See how Israel's siege has plunged Gaza into darkness and isolation". The Washington Post. Archived from the original on 27 October 2023. Retrieved 27 October 2023.
  16. ^ a b c d Marsi, Federica. "Gaza's next big threat: Cholera, infectious diseases amid Israeli blockade". Al Jazeera. Archived from the original on 21 October 2023. Retrieved 24 October 2023.
  17. ^ "Sewage Is Flowing into the Streets because Pumps Don't Have Electricity". Calgary Herald. Archived from the original on 18 November 2023. Retrieved 14 November 2023.
  18. ^ "Gaza flooding latest disaster to hit desperate Palestinians". UN News. United Nations. 14 December 2023. Archived from the original on 18 January 2024. Retrieved 7 January 2024.
  19. ^ "Gaza's Jabalia refugee camp overrun with sewage water". Al Jazeera. Archived from the original on 7 January 2024. Retrieved 7 January 2024.
  20. ^ "Gaza City mayor: Fuel depletion poses challenge to providing services". Al Jazeera. Archived from the original on 19 February 2024. Retrieved 20 January 2024.
  21. ^ Yang, Maya; Sedghi, Amy; Abdul, Geneva; Fulton, Adam (21 January 2024). "WHO: three in four Palestinians in Gaza internally displaced". The Guardian. Archived from the original on 19 February 2024. Retrieved 22 January 2024.
  22. ^ "UN sounds alarms on 'sanitation crisis' in war-stricken Gaza". Al Jazeera. Archived from the original on 10 May 2024. Retrieved 10 May 2024.
  23. ^ Shurafa, Wafaa. "Misery deepens in Gaza's Rafah as Israeli troops press operation". ABC News. Associated Press. Archived from the original on 20 May 2024. Retrieved 20 May 2024.
  24. ^ a b "WHO voices 'extreme' concern over possibility of mass outbreak of polio in Gaza". Anadolu Ajansı. Retrieved 23 July 2024.
  25. ^ "WHO Briefing Notes for UNOG Palais Briefing, 23 July 2024 - occupied Palestinian territory | ReliefWeb". reliefweb.int. 2024-07-23. Retrieved 23 July 2024.
  26. ^ "WHO warns Gaza at 'high risk' of polio outbreak". Financial Times. Retrieved 23 July 2024.
  27. ^ "Gaza remains at 'high risk' of polio virus spread, warn UN aid teams | UN News". news.un.org. 2024-08-14. Retrieved 2024-08-17.
  28. ^ Bletter, Diana (23 July 2024). "Disease expert warns polio outbreak in Gaza could spread to Israel". Times of Israel. Retrieved 23 July 2024.
  29. ^ Siddiqui, Usaid (16 August 2024). "Health ministry records first confirmed case of polio in Gaza". Al Jazeera. Archived from the original on 16 August 2024. Retrieved 16 August 2024.
  30. ^ Shurafa, Wafaa. "A 10-month-old Palestinian baby suddenly stopped crawling. Polio had struck Gaza". Associated Press. Retrieved 15 September 2024.
  31. ^ Nichols, Michelle. "UN to add nutrients to second round of Gaza polio vaccinations". Reuters. Retrieved 22 September 2024.
  32. ^ Farge, Emma. "Second phase of polio vaccination campaign begins in Gaza, WHO says". Reuters. Retrieved 16 October 2024.
  33. ^ "Israeli strikes delay polio vaccine campaign in the north". UN News. Retrieved 25 October 2024.
  34. ^ Williams, Matthias. "Delayed Gaza polio vaccinations to resume on Saturday, agencies say". Reuters. Retrieved 2 November 2024.
  35. ^ "3 children injured in Israeli strike on Gaza clinic during polio vaccination". Xinhua. Retrieved 3 November 2024.
  36. ^ "WHO Says Strike On Gaza Vaccination Centre Wounds Four Children". Barron's. Agence France Presse. Retrieved 3 November 2024.
  37. ^ Berger, Miriam. "Polio vaccinations resume in Gaza City amid 'near-impossible conditions'". The Washington Post. Retrieved 3 November 2024.
  38. ^ "Israeli soldiers to receive polio shots after virus detected in Gaza: Reports". POLITICO. 21 July 2024. Retrieved 24 August 2024.
  39. ^ "Gaza: Israeli Aid Obstruction Inflaming Polio Outbreak". Human Rights Watch. Retrieved 10 September 2024.
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