Kyrgyzstan Polio Threat Complicated by Ethnic Strife

The World Health Organization began a campaign in July to inoculate children in war-torn southern Kyrgyzstan against the type-1 poliovirus that has infected a confirmed 413 people in neighboring Tajikistan.

However, dissimilarly from Tajikistan, where strong public response to the well-coordinated vaccination campaigns has resulted in more than 90% vaccine uptake among targeted groups, the ongoing violence and displacement will make the job in Kyrgyzstan extremely difficult, Dr. Mark Witschi, a medical officer at WHO's office in Bishek, Kyrgyzstan, said in an interview.

An estimated 670,000 Kyrgyz children aged 5 years and younger are estimated to be in urgent need of polio vaccine, and UNICEF has already provided two rounds of vaccine per child. “In the south, there are whole communities in hiding,” according to Dr. Witschi, referring to the ethnic Uzbeks who have borne the brunt of the violence that began in April—around the same time, coincidentally, that polio was detected in Tajikistan.

The United Nations estimated in June 2010 that 400,000 people had become homeless as a result of the southern Kyrgyzstan violence. Many victims have crossed the border into Uzbekistan, seeking refuge, only to be forcibly returned to Kyrgyzstan.

Now, mobile vaccination teams will have to go from house to house to find these families and inoculate their children. “We don't know how [this campaign] will turn out,” Dr. Witschi said, “and we need to do some close monitoring.”

The threat of a polio outbreak in Kyrgyzstan comes not just from Tajikistan, where the most recent case was reported June 6 and which may already have successfully stopped the outbreak. WHO officials suspect that there have been unreported polio cases in Uzbekistan.

“The fact that Uzebekistan is planning a third and fourth round [of vaccinations] tells us indirectly that they have cases, and we know that they have never reported a case,” Dr. Witschi said. “It would be very strange if they would really have had no cases.”

The first round of polio vaccinations in Kyrgyzstan will be completed by the end of July; the second round is scheduled to be implemented in late August. The World Health Organization said on its Web site that storage facilities in Kyrgyzstan are functioning, with vaccines stored properly and the cold chain intact.

Dr. Witschi reported that so far, of 26 recent cases of acute flaccid paralysis reported in Kyrgyzstan, none has tested positive for wild polio-virus.