Africa polio outbreak feared

World health officials warned yesterday that West Africa and Central Africa were on the verge of the worst polio outbreak in years, stemming from the refusal of a single state in northern Nigeria to vaccinate children against the disease.

The officials announced a 22-country synchronized vaccination campaign for this fall that would span from Senegal in the west, Mauritania in the north, and parts of the Democratic Republic of Congo in the south in hopes of averting the crisis and staying on track for the goal of eradicating the disease by year's end.

But several indicators for controlling the virus were not positive.

On Monday, officials from the US Centers for Disease Control and Prevention confirmed that a polio case in the western Sudan region of Darfur was genetically linked to Kano state in northern Nigeria, which has not immunized children for polio since August 2003 because of fears over the safety of the vaccine.

Conflict between Arab militias and residents of Darfur has led to a refugee crisis, with many fleeing into neighboring Chad.

Officials in Kano said last month they will resume vaccinations, but they still have not announced a starting date.

Soon the "high season" for polio transmission starts in the Northern Hemisphere, a time when the virus is more easily transmittable in wet, hot conditions. West and central Africa has five times as many cases as it had at this point in 2003. Nigeria alone has recorded 197 children paralyzed from polio this year.

Cases from northern Nigeria have spread to 10 African countries that had been polio-free, according to the World Health Organization. Sudan, for instance, had not recorded a case for three years.

"The stakes are real high right now," said Bruce Aylward, head of WHO's polio eradication campaign. "Without some action, we could see literally thousands of cases, and that would be tragic for the kids who are going to be paralyzed."

The polio eradication partners -- WHO, UNICEF, CDC, and Rotary International -- are asking donors for $100 million in additional funding because of the extent of the polio outbreak in Africa. Officials said they needed $25 million by the end of summer in order to start the 22-country immunization campaign.

"These campaigns could avert a public health tragedy," said Carol Bellamy, executive director of UNICEF.

Bellamy also warned that more effort will be needed in local communities to persuade people that immunization would protect children.

"Many families still need reassurance, in the wake of rumors spreading out of northern Nigeria, about the safety of the polio vaccine," Bellamy said.

The polio virus is now transmitted in just six countries -- Nigeria, Niger, India, Pakistan, Afghanistan and Egypt -- and 90 percent of the cases are in Africa. The number of known cases in the world as of yesterday is 333, down from several hundred thousand cases in 1988, when the eradication campaign began.

So far, the eradication effort has spent $3 billion, including $600 million in donations from Rotary chapters.

But all that effort is in jeopardy.

"Our original plan was to immunize 10 countries this spring," Aylward said by telephone from Geneva. "The 22-country plan was plan B, something we hoped would not be needed. The disease is breaking past the 10 countries surrounding Nigeria. We now have to deal with Sudan to the east, Congo to the south, Liberia, Sierra Leone, Guinea to the west -- tremendous challenges.

"Just this past week, we've had the largest number of cases from Nigeria -- 50 cases in one week," Aylward added. "That's a walloping number. Now it's going to be very difficult."

John Donnelly can be reached at donnelly@globe.com.