Is polio re-emerging in Venezuela nearly 30 years after eradication?

A child has been diagnosed with a common symptom of polioin Venezuela, where the infectious viral disease has been eradicated since 1989, according to the Pan American Health Organization, a regional apparatus of the World Health Organization. The Western Hemisphere has been certified polio-free since 1994.

In a statement to CNN, the WHO said, “an acute flaccid paralysis case is currently being investigated” in the state of Delta Amacuro, Venezuela. Acute flaccid paralysis is a sudden onset of weakness in or loss of the ability to move any part of the body of a child less than 15 years of age. Until additional laboratory results are received, polio cannot be confirmed, the WHO said.

“Final results are expected over the coming weeks. Acute flaccid paralysis is caused by a number of different causalities, poliovirus being just one of them,” according to the WHO.

This diagnosis of acute flaccid paralysis in a child comes as Venezuela, with an estimated population of 31.3 million, experiences political and economic turmoil, resulting in a humanitarian and health care crisis.

Poliomyelitis, known as polio, is a highly infectious viral disease that invades the brain and spinal cord and causes permanent paralysis in a small proportion of patients, according to the World Health Organization. There is no cure and it can be deadly. The virus, which mainly affects young children, spreads from person to person and can also be transmitted through contaminated food and water.

The Venezuelan child who is diagnosed with acute flaccid paralysisis 2 years and 10 months old and first experienced paralysis on April 29, according to a statement from PAHO. As of May 31, the child continued to experience crippling symptoms. Part of an indigenous community in Venezuela’s northeastern state of Delta Amacuro, the child had not been vaccinated against polio, the statement noted.

Vaccination, which is both safe and effective, can prevent the disease and also stop it from spreading, according to the US Centers for Disease Control and Prevention.

Delta Amacuro is among Venezuela’s poorest states and communication is generally difficult in the area. Most of the population, and especially the Warao indigenous group, travel by boat along the river to reach the closest medical center, which can be hours away.

Because of chronic medicine shortages and the hyperinflation in Venezuela in the past eight months, getting medicines is extremely hard. Most Venezuelans rely on donations from charities and non-governmental organizations, or on the informal market because licensed pharmacies don’t have medicines to sell.

A March 2018 survey of 104 health facilities in Venezuela suggests low vaccination rates and a general lack of health care services, which can lead to increased disease and childhood mortality, is one result of political and economic turmoil. Since being thrust into chaos, Venezuela has seen either a reemergence or a resurgence of other infectious diseases including diphtheria, tuberculosis, measles and malaria.

Dr. Jose Manuel Olivares, a radiologist and a National Assembly congressman who heads the Committee on Social Development, told CNN it is “unacceptable” that polio may bemaking a comeback after Venezuela has controlled the disease for nearly 30 years.

“This and the comeback of diphtheria and measles, is the result of a serious deficiency in the Immunization Plan,” he said.

An ongoing investigation also identified an 8-year-old girl in the same community who is experiencing paralysis in a lower limb, PAHO stated. This girl’s medical history includes being inoculated with at least one dose of trivalent Oral Polio Vaccine, which requires four doses, delivered by mouth, to protect for life.

Dr. Julio Castro, from the Institute of Tropical Medicine at Central University of Venezuela, said it’s “imperative” the Ministry of Health confirms the type of polio if that diagnosis is made.

The child could be infected with a “wild virus,” one that “sprouted on the ground and is completely new,” he explained. “If it was a wild virus, it’s very significant, there is no evidence of wild cases of polio in the Americas for the past 30 years or so.”

Castro emphasized that the newly reported cases of possible polio infection are important “on a continental scale.”

“My feeling is that most of those children are not receiving vaccine, and we are (seeing) a modified-vaccine virus,” said Castro. “And the alarming thing is that there’s propagation, which means that the population there is not ready to tackle this disease, and the virus could spread very quickly.”

The Venezuelan Society for Public Health, a non-governmental doctors association, is reporting information from an unofficial source that at least four children, all members of the indigenous Warao group, are suffering fromparalysis in Delta Amacuro.

The report, which emphasizes that these possible cases of polio have not yet been laboratory-confirmed, describes the residents of Delta Amacuro as a “vulnerable people,” who are undernourished and affected by a high prevalence of malaria and tuberculosis, among other diseases. The same report also notes that this state has the largest coverage gap in the country for all types of immunizations.

Based on information gathered by Caracas Central University, Castro added, “we can say that there are at least four different cases.”

While the National Institute of Hygiene, a government organization, confirmed polio for the nearly 3-year-old child, Castro said, “the Health Ministry did not address the situation or release any information.”

The Venezuelan Ministry of Health did not reply to a request for comment.

Amador Medina, editor of local news outlet TaneTanae.com,spoke to CNN from Tucupita, Delta Amacuro, said the Ministry of Indigenous Affairs has not yet confirmed or denied the cases.

“The Warao community here is reacting with apathy: most of the population is not aware of the seriousness of the case,” said Medina, who is a Warao indigenous. “Culturally, they just consider it just another disease like diphtheria or malaria, just one more case.”

Dr. Lilian Abbo, a spokeswoman for the Infectious Diseases Society of America and an associate professor at the University of Miami Miller School of Medicine, noted that the case reported by PAHO was originally detected in April. “Now why is it taking until June to report it?” she asks. “The national authorities are not reporting on a timely manner.”

“Twenty, thirty years ago Venezuela was one of the leading countries in Latin America and many parts of the world with free immunization programs,” said Abbo, who participated as a volunteer in the country’s immunization program while a student in Caracas. Today, she adds, “many many public hospitals do not have vaccines available. This is completely unacceptable in a country that has one of the largest oil reserves in the world.”

“A few months ago, Venezuela started to see cases of measles and mumps, which are also viruses that are prevented by vaccines,” she said, noting that the number of cases has increased “significantly.”

Recently, she said, the northern states of Brazil reported over 500 cases of measles.

“More than what they have seen in three years together,” said Abbo. “Many of these cases were being brought by Venezuelans who are desperately trying to leave the country for food, for better health, and they’re crossing the border to Brazil… and importing viral infections.”

“Is there a chance to see polio in other parts of the world? Yes,” she said. Unless they contain this (possible) outbreak in a prompt manner and they immunize people quickly and they improve the conditions of malnutrition and sanitation, she said. She called for an international collaboration to enforce public health measures in Venezuela.

While polio has been eradicated on much of the globe, the WHO reports that it continues to circulate in just three countries: Afghanistan, Pakistan and Nigeria.

This story been updated with new information from the World Health Organization