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SCIENCE SUNDAY: THE VIRUS THAT CAUSES POLIO HAS BEEN FOUND IN GAZA.
HERE’S WHY THAT IS GRIM NEWS  
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Leslie Roberts
July 22, 2024
Science
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_ Fighting and health system’s collapse will complicate emergency
vaccination campaign _

Children sort through trash at a landfill in the Nuseirat refugee
camp in the Gaza Strip. Many displaced Palestinians live in tent camps
nearby water contaminated with sewage and growing piles of garbage.,
Abdel Kareem Hana/AP

 

On top of relentless bombings and artillery strikes, mass
displacement, the collapse of the health system, and starvation
[[link removed]],
the children of Gaza now face an additional health disaster: a high
risk of paralytic polio.

On 16 July, the Ministry of Health of Gaza announced poliovirus had
been detected in six wastewater samples collected in late June at
sites in Khan Younis and Deir al-Balah, two governorates of Gaza, an
indication that the virus is circulating there.

So far, no cases of paralysis caused by the virus have been reported,
but given the chaos in the Gaza Strip, there could well be some that
have gone undetected, says Hamid Jafari of the Global Polio
Eradication Initiative (GPEI), an international partnership
headquartered at the World Health Organization (WHO). Surveillance for
all diseases, including polio, has been severely disrupted by the war,
says Jafari, who directs polio operations in WHO’s Eastern
Mediterranean region. Tens of thousands of children under age 5 are
now at risk of contracting polio, and the possibility of international
spread beyond Gaza cannot be ruled out, says WHO Spokesperson
Christian Lindmeier.

Here’s what to know about the outbreak and the efforts to stop it in
its tracks.

How far has the virus spread?

WHO, UNICEF, the United Nations Relief and Works Agency for Palestine
Refugees (UNRWA), and Gaza’s Ministry of Health are scrambling to
find out. They have launched a risk assessment, including active
surveillance to find any paralytic cases that may have been missed.
(Only a small fraction of children infected with the poliovirus
becomes paralyzed, but the larger the outbreak, the greater the risk
that such cases will occur.)

The detections at multiple sites suggest transmission is ongoing and
may already be widespread, says WHO’s Aidan O’Leary, director of
GPEI. And although all of the isolates are genetically linked,
indicating they arose from the same source, there are enough
nucleotide differences among them to indicate the virus has been
circulating for some time, Jafari says. Genetic sequencing shows they
are also closely related to a strain that was circulating in Egypt in
the second half of 2023, and that it could have been introduced into
Gaza as early as September 2023, according to GPEI.

Why did the virus take off in Gaza now?

The poliovirus is transmitted through the “fecal-oral” route—by
contact with the feces of an infected child or consumption of water or
food contaminated by fecal matter. The conditions in which the 1.9
million displaced Gazans are living—crammed into unhygienic camps
with little access to clean water and sanitation and untreated sewage
flowing openly between tents—create an ideal environment for the
virus to thrive.

Since the war began in October 2023, 70% of water and sanitation
facilities in Gaza have been significantly damaged, and about 340,000
tons of solid waste have accumulated in or near populated areas,
according to an estimate from the U.N. Water, Sanitation and Hygiene
Cluster. In June, Oxfam estimated there is just one toilet for every
4130 people in Al-Mawasi, a supposed “safe zone” west of Khan
Younis that recently came under Israeli attack.

What do we know about the poliovirus circulating in Gaza?

It’s not the wild poliovirus but one spawned by a vaccine. Known as
vaccine-derived poliovirus type 2, the virus is every bit as dangerous
as the wild virus, however. These variant viruses emerge in areas
where vaccination rates are low, allowing the live, weakened virus
used in the oral polio vaccine (OPV) to pass from child to child and
regain its ability to spread and paralyze.

The type 2 component in OPV was withdrawn from routine immunization
globally in 2016, so children in Gaza are not well protected against
this strain, even though polio immunization rates in Gaza were
“optimal” before October 2023, as WHO Director-General Tedros
Adhanom Ghebreyesus posted Friday on the social media platform X
[[link removed]]. (Since then,
routine immunization for all diseases has been badly disrupted.)

What is being done to respond to the outbreak?

The Gaza Ministry of Health has called for “an immediate halt to the
Israeli aggression,” saying the presence of the poliovirus is the
direct result of “the destruction of infrastructure.” The Israeli
government should provide clean water, repair sewer lines, and reduce
overcrowding in the camps for the displaced, the ministry said.

Meanwhile, the ministry and its international partners are searching
for ways to vaccinate many thousands of children amid an unrelenting
war. “Speed and high coverage” with a vaccine specifically
targeted against poliovirus type 2 will be essential to stop the
outbreak, O’Leary says, and the partners are working furiously on
the logistics of getting the vaccine, known as novel OPV2, into the
territory quickly.

Is a vaccination campaign even possible while the war rages on?

Reaching the huge number of children who need to be vaccinated will
not be possible in areas with active conflict. At a minimum, O’Leary
says, children would be vaccinated in camps, shelters, and health
facilities that are fully or partially functioning. UNRWA, which is
not granting interviews, has a strong presence on the ground, he says,
as do some other partners. The Israeli Ministry of Health is
participating in discussions about the outbreak response.

“An immediate ceasefire is desirable for hundreds of reasons we know
well,” Jafari says. In the meantime, “maybe some ceasefire or
‘days of tranquility’ could be possible when immunization is going
on,” he says, perhaps at very specific times and places. But, Jafari
concedes, “Maybe I imagine more than is possible in reality, as I am
thinking of all those children vulnerable to polio paralysis. I know
it will be very, very difficult.”

doi: 10.1126/science.z1ar5mr

_LESLIE ROBERTS is a freelance writer and former news editor at
Science. After an earlier stint as a senior writer at Science, where
she was widely known for her coverage of the Human Genome Project,
Leslie returned as a deputy news editor in 2000, specializing in
public health, infectious diseases, stem cells, and ecology._

_SCIENCE MAGAZINE. 
Support nonprofit science journalism
Help Science publish trustworthy, high-impact stories about research
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New Theoretical Calculation Solves the “Muon g-2” Puzzle
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Ethan Siegel
Big Think/Starts With A Bang
July 23, 2024
A longstanding mismatch between theory and experiment motivated an
exquisite muon measurement. At last, a theoretical solution has
arrived.

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